Health inspection·May 20, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with the social worker on 5/20/25 at 8:20 AM, she stated that she has not had any reports of disrespectful or degrading behavior by any visitors or staff. She stated the best friend's program is determined during a resident's PASRR evaluation. She stated the program is ran by an outside source. She stated a supervisor will come and do observations of the best friends in the building to monitor interactions. She was unable to recall the last visit made by the supervisor. She stated best friends is a companion program and that all training is done prior to individuals being assigned to a resident. She said any complaints would be reported to the administrator and the program director. During an interview with the administrator on 5/20/25 at 8:35 AM, she stated that she has not witnessed any degrading behaviors by any visitors, or the best friends assigned to the facility. She stated staff has not reported any incidents to her. She said she is the abuse coordinator and that all concerns are reported to her. She stated she has not had any complaints related to the best friend's program. She said she would be responsible for investigating any reports of degrading behaviors that occur in the facility. An interview with the best friend was not obtained. She left the building immediately following the incident. Record review of facility resident rights policy from the Social Services [NAME] 2003, revised 11/28/2016 indicated, The resident has a right to be treated with respect and dignity. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 2 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to provide a safe, clean, comfortable, and homelike environment for 2 of 6 sampled residents (Resident #24 and Resident #44) and one of one dining rooms reviewed for environment. The facility failed to ensure the dining room was without excessive noise levels during meals for Resident #24, Resident #44 and other residents in the dining room. This failure could place residents at risk for diminished quality of life due to the lack of an enjoyable dining experience. Findings included: Record review of Resident #24's face sheet, dated 05/19/2025, indicated an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included Dementia (loss of memory, language, problem-solving, and other thinking abilities that were severe enough to interfere with daily life), Chronic obstructive pulmonary disease also known as COPD (a common lung disease causing restricted airflow and breathing problems), and high blood pressure. Record review of Resident #24's quarterly MDS assessment, dated 05/08/20/25, indicated Resident #24 usually understood and was usually understood by others. The MDS assessment indicated she had a BIMS score of 13 indicating she was cognitively intact. Record review of Resident #44's face sheet, dated 05/1920/25, indicated a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included obesity, lack of coordination, and difficulty walking. Record review of Resident #44's quarterly MDS assessment, dated 04/0120/25, indicated Resident #44 usually understood and was usually understood by others. The MDS assessment indicated she had a BIMS score of 15 indicating she was cognitively intact. During an interview on 05/18/2025 at 10:15 AM, Resident #24 said the staff are too loud in the dining room and it makes the whole experience not enjoyable. Resident #24 said the staff just talk too loudly, especially in the evening. Resident #24 said the noise was so loud that she can't enjoy eating in the only dining room in the facility. During an observation on 05/18/2025 at 12:30, PM, of the lunch meal, the television was on in the dining room and very loud, residents and staff were talking loudly to be able to hear each other. This surveyor had to bend down near Resident #24 ear to be able to hold a conversation with her. Resident #24 stated see what I am talking about, all this noise and the evening meal is worse when no administrative staff are here. During an interview on 05/18/2025 at 10:30 AM, Resident #44 said the noise is the dining room was a problem at the facility. Resident #44 said we have talked about this in our council meetings. Resident 44 said the noise level would get better but would return to a level so loud everyone was shouting. She said the meal gets ruined by the staff being so loud. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 3 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 5/20/2025 at 11:00 AM, the Activity Director said the dining room noise has been a problem off and on. She said the loud noise level could decrease dining enjoyment and distract residents while eating. During an interview on 5/20/2025 at 11:30 AM, the Administrator said that not controlling the noise in the dining room could result in a decreased dining experience. She said the facility would in-service staff and acquire signage to remind staff to turn off the television before dining times and be aware of noise in the surroundings. Record review of resident advisory council minutes dated August 2024 revealed under nutrition services review, meal service concerns: Residents stated that staff are extremely loud in the dining room. Record review of resident advisory council minutes dated December 2024 revealed under nutrition services review, meal service concerns: Residents stated that staff are too noisy in the dining room. Record review of resident advisory council minutes dated April 2025 revealed under concerns: During church services two CNAs came through the dining room talking loudly. Record review of facility resident rights policy from the Social Services [NAME] 2003, revised 11/28/2016 indicated, The resident has a right to be treated with respect and dignity .The resident has the right to a safe environment - The resident has a right to a safe, clean, comfortable, and homelike environment, including but not limited to receiving treatment and supports for daily living safely. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 4 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure drugs and biologicals used in the facility were stored in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys for 1 of 6 residents (Resident #348) reviewed for medication storage. The facility did not ensure a medication named Digestive Enzymes was not stored at the bedside for Resident #348 on 05/18/2025. This failure could place all residents at risk of misuse of medication and decreased quality of life. Findings included: Record review of facility face sheet dated 05/18/2025 indicated Resident # 348 were an [AGE] year-old female admitted to facility on 05/10/2025 with diagnosis of Wedge Compression Fracture of T7-T8 Vertebra, Subsequent encounter with routine healing. Record Review of comprehensive care plan dated 05/10/2025 did not indicate Resident # 348 could keep medication at bed side or safely self-administer medications. The care plan reflects to administer medications as ordered. Record review of admission MDS dated [DATE] indicated Resident # 348 had a BIMS of 13 indicating intact cognition. Record review of consolidated physician orders dated 05/18/2025 indicated Resident #348 did not have an order for Digestive Enzymes. During an observation and interview on 05/18/2025 at 10:40 am Resident # 348 was observed with medication on her nightstand. She stated she self-administer the medication (digestive enzymes) every night for nausea. During an interview on 5/20/2025 at 9:10am with LVN-N she said no resident should have medications at their bedside. She said she did not know of any residents having medications in their rooms. She said a physician's order must be on file for the resident to receive the medication as well as to self-administer medications. She said a resident could take inappropriate amounts of the medication or another resident could wonder in the room and get the medication and take it. She said residents could have an allergic reaction or become ill from taking unprescribed medication. During an interview on 5/20/2025 at 9:40am CNA-M said no resident should have medications at bedside. She said the resident could have a negative reaction to the medication such as elevated B/P or other allergic reactions. During an interview on 5/20/2025 at 9:18am CMA-L She said she's not aware of any resident having medications in their room. She said a resident can make themselves sick by taking unprescribed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 5 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medications. She said all medications must have a physician's order and be given by a nurse or medication aide. During an interview on 5/20/2025 at 9:25am CMA-D said no resident should have medications at bedside. She said the resident could have a negative reaction to the medication such as elevated B/P or other allergic reactions. During an interview 5/19/2025 at 3:05pm with DON She said no resident should have medication of any kind at their bedside. She said the medication must be ordered by a physician's prior to administering and should be administered by a nurse or medication aide. She said another resident could go in the room and take the medication. She said any medication no ordered by the physician could cause an adverse reaction to any resident. During an interview on 5/10/2025 at 3:30pm ADON said no medication at bedside has been reported to her. She said residents are care planned to have medications in their rooms. She said resident could become ill or other residents could wonder in the room and get the medication and make them sick as well. She said all medication needs a physician's order and be administered by a nurse or a med aide. During an interview on 5/19/2025 AT 4:00PM with the administrator she said she was not aware of any residents having medications left in their room. She said no residents in the facility are care planned or have orders to have medications in their room and all medications should be administered by a nurse or medication aide and must have a physician's order. She said residents could cause altercation to their prescribed medications by altering the effects of the prescribed medications, causing labs and levels to be off and putting other residents in the facility to be ask risk of unnecessary medication intake. She said another resident could wonder into the room and get the medication, take it and cause harm to themselves. Record Review of Pharmacy Policy & Procedure Manual 2003 titled Bedside storage of medications indicated, 1. A written order for the bedside storage of medication is placed in the resident's medical record. Record Review of Pharmacy Policy & Procedure Manual 2003 titled Bedside storage of medications indicated, 10. All nurses and aides are required to report to the charge nurse on duty any mediations found at the bedside not unauthorized for bedside storage and to give unauthorized medications to the charge nurse for return to the family or responsible party. Families or responsible parties are reminded of this procedure and related policy when necessary. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 6 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the facility's only kitchen reviewed for food safety requirements and kitchen sanitation. 1. The facility failed to ensure the dietary manager, dietary aide and cook effectively wore a hair net to cover all hair. 2. The facility failed to ensure foods stored in the refrigerator and freezer were labeled and dated. 3. The facility failed to ensure foods stored in the pantry were sealed or in a sealed container. These failures could place residents at risk of foodborne illness and food contamination. Findings Include: During an observation on 05/18/2025 at 9:45am and on 05/19/2025 at 11:25, the DM, DA-G, DA-H and [NAME] had hair from under hair covering on the front, sides, and backs of their heads. During an observation on 05/18/2025 between 9:55am-10:25am, the following undated, unlabeled, and unsealed items were identified by Cook-F in the freezer, Refrigerator, and pantry: REFRIGERATOR: *1-bowel tomato soup, no date or label *1-bowel apple sauce, no date or label *1-bowel chicken soup, no date or label FREEZER: *1-gallon bag of chicken, no date or label *1-large bag of French fries, no date or label *3-large pork shoulders, no date or label *1-gallon package of taco meat, no date or label *1-10-inch apple pie, no date or label (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 7 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 PANTRY: Level of Harm - Minimal harm or potential for actual harm *1-4-ounce bag of semi-sweet chocolate chips were open not sealed or in a sealed container. *1-12-ounce box of tea bags were open not sealed or in a sealed container. Residents Affected - Some : During an interview on 5/19/2025 at 3:35pm with DA -E, she said hair nets should be worn to keep hair from getting into food and to be sanitary. She said hair in the resident's food could make them angry or upset and make someone ill due to bacteria exposure. She said labeling and storing should happen as soon as possible when food arrives at the facility. She said if the food is not labeled, someone may not know what the item is and could serve the wrong food to the wrong person. She said the chance of a resident getting ill increases with non-labeled and improperly stored food. During an interview on 5/19/2025 at 3:46pm with DM , she said hair nets are to be worn and cover all hair so no-hair gets into the food. She said hair in the food could be a choking hazard for residents. She said if hair gets into food, it's instantly contaminated. She said chemicals or products on an employee's hair could cause a negative reaction to residents. She said labeling and dating food items should happen as soon as possible when it comes off the delivery truck. She said when food is opened staff should add the open and expiration date and make sure it is sealed properly. During an interview on 5/19/2025 at 4:10pm cook-K said hair nets keep hair out of food. She said hair in the food could cause choking, spread germs and bacteria to the residents. She said labeling and dating, should happen when food first comes into the kitchen. She said dating and labeling protects residents from receiving the wrong foods or out of date foods that could cause them to become ill. During an interview on 5/19/2025 at 11:45am with DA-G, she said hair nets should be worn all the time when in the kitchen. She said all hair should always be covered to keep food from being unsuitable to serve. She said resident could become ill and or upset from having hair in their food. She said foods should be labeled and dated shortly after it's delivered to the facility. She said food items may be out of date and no one will know and use old food if not dated. She said if not labeled some food items cannot be identified and may be served to the wrong resident causing them to be sick. During an interview on 5/19/2025 at 10:30am with DA-H She said hair nets should be always worn when in the kitchen and should cover all the staff's hair. She said hair could get in the food and contaminate the food. She said hair in the food could cause residents to get sick. She said all foods should be dated and labeled as soon as it arrives in the kitchen. She said dating and labeling helps identify food, know when it came into the facility and when it expires. She said if not properly dated and labeled expired or wrong foods could be served to the residents and cause sickness to the residents. During an interview on 5/19/2025 at 4:00pm, with the Administrator she said the kitchen staff should wear a hair net or covering that covers all their hair when in the kitchen. Said hair could easily get in the food causing bacteria/germs to contaminate the food. She said the residents can become ill or have a reaction to hair being in their food. She said all food should be date and labeled when in the kitchen. She said no dates or labels can cause food to be expired and staff would not recognize it and cause to wrong food to be served to the wrong resident. She some residents have allergies (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 8 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to certain foods and if it's not labeled, they could easily get the wrong food and become ill. She said expired foods could also make residents sick. During an interview on 5/19/2025 at 03:50pm, with the DON she said all food must be dated and labeled when entering the kitchen to assure food can be identified and no expired foods are left in the kitchen. She said not labeling correctly can cause a resident to receive the wrong food type and cause an allergic reaction or become ill. She said no date can expose residents to expired foods and cause illness. During an interview on 5/19/2025 at 3:30, with the ADON, she said all food in the kitchen should be dated and always labeled. She said all staff should be using good hand hygiene. She said all kitchen staff's hair should be always covered. She said hair could get in the food and cause contamination. Said all residents are at risk of becoming ill if the staff do not use good hand hygiene, store, and label food appropriately or keep food at appropriate temperatures. Record review of a Dietary Services Policy & Procedure Manual 2012 titled Food Storage and Supplies reads Procedure: 4. Open packages of food are stored in closed containers with covers or in sealed bags and dated as to when opened. Record review of the Food and Drug Code dated 2022 indicated: 3-602 Labeling 3-602.11 Food Labels. (A) FOOD PACKAGED in a FOOD ESTABLISHMENT, shall be labeled as specified in LAW, including 21 CFR 101 - Food labeling, and 9 CFR 317 Labeling, marking devices, and containers. (B) Label information shall include: (1) The common name of the FOOD, or absent a common name, an adequately descriptive identity statement. 3-201.11 Compliance with Food Law. (C) PACKAGED FOOD shall be labeled as specified in LAW, including 21 CFR 101 FOOD Labeling, 9 CFR 317 Labeling, Marking Devices, and Containers, and 9 CFR 381 Subpart N Labeling and Containers, and as specified under § 3-202.18 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 9 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 observations, interviews, and record reviews, 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 for 2 of 13 residents (Resident #41 and Resident #196) and 6 of 9 staff (CNA A, CNA B, CNA O, CNA P, CNA Q, and LVN R) reviewed for infection control. Residents Affected - Some 1.The facility failed to ensure CNA A and CNA B followed enhanced barrier precautions and performed hand hygiene when providing incontinent care to Resident #41 on 5/18/2025. 2.The facility failed to ensure CNA O performed hand hygiene between passing resident trays on 5/18/25. 3.The facility failed to ensure CNA P and CNA Q followed enhanced barrier precautions and performed hand hygiene when providing incontinent care to Resident #196 on 5/19/25. 4.The facility failed to ensure LVN R performed hand hygiene after removing non-sterile gloves and donning sterile gloves for a procedure for Resident #196 on 5/19/25. These failures could place residents at risk for cross contamination and infection. Findings included: 1. Record review of Resident # 41's facility face sheet revealed Resident #41 was a [AGE] year-old male and admitted on [DATE] with diagnosis of multiple sclerosis (disease that affects the central nervous system). Record review of Resident 41's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 9 indicating moderately impaired cognition, relied on staff for all ADL's, was incontinent of bowel and bladder, and required a feeding tube. Record review of Resident #41's comprehensive care plan dated 4/10/2024 revealed Resident #41 was on enhanced barrier precautions (an infection control intervention designed to reduce the transmission of multidrug-resistant organisms (MDROs)) and gloves and gown should be donned if any of the following activities are to occur: linen change, resident hygiene, transfer, dressing, toileting/incontinent care, bed, mobility, wound care, enteral feeding care, catheter care, trach care, bathing, or other high-contact activity. During an observation on 05/18/25 at 3:17 pm Resident #41 had a sign on his door indicating he required EBP and there was PPE outside his room in a cart. During an observation on 5/18/25 at 3:20 pm CNA A and CNA B entered Resident #41's room to provide incontinent care. Both CNAs washed their hands and applied gloves but neither applied a gown per the EBP guidelines. During incontinent care neither CNA performed hand hygiene between glove changes and neither performed hand hygiene before leaving the room. During an interview on 5/18/25 at 3:30 pm CNA A said she had been trained on EBP and hand hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 10 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 - Some She said Resident #41 had a feeding tube and wound and she should have put on a gown as well as gloves for his care but forgot. She said she should have washed or sanitized her hands between glove changes and before leaving the resident's room. She said by not following infection control measures infections could spread. During an interview on 5/18/25 at 3:32 pm CNA B said she had been trained on EBP and hand hygiene. She said Resident #41 had a feeding tube and a wound and she should have put on a gown as well as gloves for his care. She said she got nervous and forgot. She said she should have washed or sanitized her hands between glove changes and before leaving the resident's room. She said by not following infection control measures infections could spread. 2. During an observation on 5/18/25 at 12:50 pm CNA O was observed passing meal trays to residents. She was observed to pass a tray to a resident in their room, exit room, and without sanitizing or washing her hands, served the next room their meal tray. During an interview on 5/18/25 at 12:55 pm CNA O said she did not know she was supposed to sanitize or wash her hands between serving meal trays. She said she guessed it could be because of the risk of cross-contamination. During an interview on 5/20/25 at 10:19 am Administrator said she expected her staff to wash or sanitize their hands between passing resident's trays. She said it could cause cross-contamination. She said the facility would be holding a hand hygiene clinic to educate all staff on hand hygiene to ensure compliance going forward. 3. Record review of a facility face sheet dated 5/19/25 for Resident #196 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of discitis, unspecified, lumbosacral region (inflammation and infection of the space between vertebrae). Resident #196 had not been in facility long enough to have an MDS assessment completed. Record review of a comprehensive care plan dated 5/17/25 for Resident #196 indicated that she required enhanced barrier precautions with the following interventions: .Gloves and gown should be donned if any of the following activities are to occur: linen change, resident hygiene, transfer, dressing, toileting/incontinent care, bed mobility, wound care, enteral feeding care, catheter care, trach care, bathing, or other high-contact activity . and .Perform hand sanitation before entering the room and prior to leaving the room . and .Posting at the residents room entrance indicating the resident is on enhanced barrier precautions . During an observation on 5/19/25 at 9:00 am CNA P and CNA Q were observed to enter Resident #196's room to provide incontinent care. Neither one washed their hands upon entering room nor did they wear appropriate PPE for EBP. After CNA Q provided incontinent care to Resident #196, she did not change gloves before putting a clean brief on resident. During an interview on 5/19/25 at 9:20 am CNA P and CNA Q said they forgot to wash their hands when entering room and CNA Q said she forgot to change gloves before applying a clean brief. Both said they were not aware that Resident #196 required EBP. They both said improper hand hygiene and not changing gloves could cause residents to be at risk for infections. 4.During an observation on 5/19/25 at 12:06 pm LVN R was observed providing a PICC line dressing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 11 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 - Some change on Resident #196. She was observed to apply non-sterile gloves to remove old dressing. After removing old dressing, she removed her non-sterile gloves and applied her sterile gloves without washing or sanitizing hands. During an interview on 5/19/25 at 12:20 pm LVN R said she did not wash or sanitize her hands after removing non-sterile gloves and putting sterile gloves on. She said it could put the resident at risk of cross-contamination. She said she just forgot to wash or sanitize her hands before putting her sterile gloves on. During an interview on 5/20/25 at 9:30 am the ADON said she was also the infection preventionist and was responsible for the oversight of staff following the infection control program. She said all staff were trained on infection control on hire, annually and throughout the year. She said she did observations with the staff for their competency check offs and at random. She said that staff not following the infection control program could cause the spread of infections and expected all staff to follow proper EBP, hand hygiene and follow all the appropriate steps for the infection control program. During an interview on 5/20/25 at 9:35 am the Regional Nurse Consultant said that all staff should be following the infection control program daily and had been trained on hire, annually and throughout the year. She said staff that don't follow the infection control guidelines for hand hygiene and EBP could spread infections and expected staff to follow the guidelines the facility had in place. During an interview on 5/20/25 at 9:55 am the Administrator said the infection preventionist and the DON were responsible for the oversight that all staff were following the infection control program. She said they were to make random daily rounds to ensure staff were compliant with following hand hygiene, EBP and any other infection control task. She said she expected the staff to always follow the infection control program to prevent the spread of infections. Record review of a CNA proficiency audit dated 11/19/24 revealed CNA B had been trained on hand washing and infection control measures. Record review of a CNA proficiency audit dated 12/05/24 revealed CNA A had been trained on hand washing and infection control measures. Record review of a CNA proficiency audit dated 10/12/24 revealed CNA O had been trained on hand washing and infection control measures. Record review of a CNA proficiency audit dated 4/21/25 revealed CNA P had been trained on hand washing and infection control measures. Record review of a CNA proficiency audit dated 3/13/25 revealed CNA Q had been trained on hand washing and infection control measures. Record review of a Licensed Nurse Proficiency audit dated 11/19/24 revealed LVN R had been trained on hand washing and infection control measures. Record review of facility policy titled Enhanced Barrier Precautions dated 4/01/2024 indicated, .EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact resident care activities . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 12 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of an undated facility document titled Hand Hygiene revealed, .you may use alcohol-based hand cleaner or soap/water for the following: after removing gloves . Record review of a facility policy titled Perineal Care dated 4/27/2022 revealed, .start 11) don (put on) gloves and all other PPE per standard precautions, 24) doff (take off) gloves and PPE, 25) perform hand hygiene . Event ID: Facility ID: 675960 If continuation sheet Page 13 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record reviews, the facility failed to implement their policy to ensure the residents, or their responsible party, received education of the benefits and risks, or potential side effects of Covid-19 immunizations, receipt of Covid-19 immunizations, or the residents did not receive the Covid-19 immunizations, due to medical contraindication, or refusal, for 5 of 5 residents who were reviewed for immunizations (Resident #24, Resident #25, Resident #44, Resident #49 and Resident #89). The facility failed to document, in Resident #24, Resident #25, Resident #44, Resident #49 and Resident #89 medical records, having had received education, whether by self or with their responsible party, of the benefits and risk, and potential side effects, of the Covid-19 immunization, receipt of the of the Covid-19 immunization, or having had not received the Covid-19 immunization due to medical contraindication or refusal. This failure could place residents at risk of not being informed of complications and potential adverse health outcomes. Findings include: Record review of Resident #24's face sheet, dated 05/19/2025, indicated an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included Dementia (loss of memory, language, problem-solving, and other thinking abilities that were severe enough to interfere with daily life), Chronic obstructive pulmonary disease also known as COPD (a common lung disease causing restricted airflow and breathing problems), and high blood pressure. Record review of Resident #24's quarterly MDS assessment, dated 05/08/2025, indicated Resident #24 usually understood and was usually understood by others. The MDS assessment indicated she had a BIMS score of 13 indicating she was cognitively intact. Review of a document titled, immunization audit report dated 5/20/2025, revealed Resident #24 and/or her representative was offered the Sars-Cov-2 vaccine on 01/0820/24 and refused. The document indicated no other offer of covid vaccination, and no education given. Record review of a facility face sheet dated 05/20/2025 for Resident #25 indicated that she was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses Alzheimer's disease (inability to remember and cognitive decline) and hypertension (high blood pressure). Record review of Resident #25's quarterly MDS assessment, dated 04/24/2025, indicated she had a BIMS score of 7 indicating she had severe cognitive impairment. Review of a document titled, immunization audit report dated 5/20/2025, revealed Resident #25 and/or her representative was not offered the Sars-Cov-2 vaccine on admission and the document indicated no education given. Record review of Resident #44's face sheet, dated 05/19/2025, indicated a [AGE] year-old female who was admitted initially to the facility on [DATE] and re-admitted on [DATE] with diagnoses which (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 14 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 0887 included obesity, lack of coordination, and difficulty walking. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #44's quarterly MDS assessment, dated 04/01/2025, indicated Resident #44 usually understood and was usually understood by others. The MDS assessment indicated she had a BIMS score of 15 indicating she was cognitively intact. Residents Affected - Some Review of a document titled, immunization audit report dated 5/20/2025, revealed Resident #44 had a historical Sars-Cov-2 vaccine on 7/05/2021 and no documentation that resident #44 was offered the Sars-Cov-2 vaccine on admission and readmission. The document indicated no other offer and no education given on covid vaccination since she has lived at the facility. During an interview on 05/20/2025 at 10:22 AM, Resident #44 said she did not remember receiving education on covid vaccines or the facility offering her a covid vaccine. She said she had taken a covid vaccination about three years ago when the vaccine first was developed. Resident # 44 said she might be interested in the covid vaccine if offered. She said she had not received written education on the covid vaccines risks or benefits. Record review of a facility face sheet dated 5/20/2025 for Resident #49 indicated that she was an [AGE] year-old female initially admitted to the facility on [DATE] and re-admitted [DATE] with diagnoses including: urinary tract infection, pain in shoulders, and reduced mobility. Record review of Resident #49's quarterly MDS assessment, dated 04/01/2025, indicated Resident #49 usually understood and was usually understood by others. The MDS assessment indicated she had a BIMS score of 11 indicating she had mild cognitive impairment. Review of a document titled, immunization audit report dated 5/20/2025, revealed Resident #49 and/or her representative was offered the Sars-Cov-2 vaccine on 01/08/2024 with no education given and she refused. The document indicated no other offer, or no education given for covid vaccination. Record review of a facility face sheet dated 5/14/2025 for Resident #89 indicated that she was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: myocardial infarction (heart attack), urinary tract infection, and muscle weakness. Record review of Resident #89's quarterly MDS assessment, dated 02/26/2025, indicated Resident #89 usually understood and was usually understood by others. The MDS assessment indicated she had a BIMS score of 13 indicating she was cognitively intact. Review of a document titled, immunization audit report dated 5/20/2025, revealed Resident #89 and/or her representative was not offered the Sars-Cov-2 vaccine on admission and the document indicated no education given. During an interview on 5/20/2025 at 11:00 AM, the Regional Nurse Consultant said the facility had no consent form for covid vaccination or declination to be used when the resident or representative refused vaccinations. She said it was the policy of the facility to document immunization administration or refusals in the electronic medical record and document education given under the education tab. The Regional Consultant said it was the policy of the facility to offer covid vaccination on admission and as needed. The Regional Nurse Consultant said the DON would be responsible going forward to ensure that residents were educated on immunizations and documentation. She said residents could be at risk of not knowing what they were refusing if they were not provided education on covid (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 15 of 16 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 675960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castle Pines Health and Rehabilitation 2414 W Frank Ave Lufkin, TX 75904 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 0887 vaccines. Level of Harm - Minimal harm or potential for actual harm During an interview on 5/20/2025 at 11:15 am, the Administrator said the DON was responsible for immunizations and going forward residents will be provided education regarding benefits and risks. She said that residents and families could possibly not have the knowledge to make informed decisions concerning covid vaccinations if risks and benefits were not provided. Residents Affected - Some Record Review of Covid Response Plan revised 5/08/2023 indicated . COVID-19 Vaccination: Residents and staff will be provided education regarding Covid-19 vaccines upon hire or admission and as needed afterward. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675960 If continuation sheet Page 16 of 16