Health inspection·March 2, 2024

F 0600 Level of Harm - Actual harm Residents Affected - Few Record Review of Resident #27's progress notes dated 2/27/2024 revealed, Resident #27's went to podiatry appt accompanied by CNA A from the facility. CNA A stated Resident #27's family member arrived at the appointment after they were already in room with the PD. CNA A went on to say that Resident #27's and her family member greeted each other with a hug and the PD was already attempting to provide care on Resident #27's feet. CNA A stated that Resident #27 was screaming anytime the PD would touch her feet. Resident #27's family member told the PD to continue to provide care even though Resident #27 was screaming and saying no and the PD stated that he could not continue since she was refusing. When the appointment was over, Resident #27 family member stated that she would come and see her tonight on 2/27/2024 at 8:00 p.m. DON notified. Observation and interview on 2/26/2024 at 10:20a.m. with Resident #27, revealed her sitting up in bed wearing briefs and a t-shirt. She was using an oxygen machine. Resident #27 was trying to explain herself but had a hard time communicating. There was a wheelchair next to her bed. Her nails were long. She said she wanted to be changed. She pointed to her briefs and said she was burning in the back. Observation and interview on 2/29/2029 at 11:00a.m. with Resident #27 revealed her sitting up in bed, wearing briefs and a t-shirt. Resident #27 was not able to explain the incident that occurred with her and her family member. Resident #27 was not able to communicate if she felt safe with her family member coming to visit her. Resident #27 was not able to communicate effectively and was not able to explain what happened the night her family member came to visit her. Resident #27 was able to say she was doing fine. Interview on 2/27/2024 at 4:00p.m. with the DON and she said the next day after the incident occurred and when she returned to work, Resident #27 was assessed from head to toe for bruising. She said a head-to-toe assessment was not completed the night of the incident because the nurse was busy consoling Resident #27 and keeping her calm. She said Resident #27's family member is from City A, and she drives back and forth. She said she did not put anything in place regarding the family member and Resident #27, but she said she told the family member not to visit for a while and the family member agreed. She said the family member had not been back to the facility. She said the police was called and a report was made. She said the charge nurse asked the family member to leave and she complied. Interview on 2/28/2024 at 10:30a.m. with the Administrator and the DON, and the Administrator said he had set up a meeting with Resident #27 to see if she felt safe with her family member visiting her or would she like her banned from the facility. He said he did not know the family member was going to show up to her appointment. He said had she come to the building she would not have been allowed inside. The DON said she spoke with the family member on yesterday and told her she was not allowed to visit until she heard from them. She said she will talk to the resident to see what she would like to happen regarding her family member coming to visit her. Interview on 2/28/2024 at 11:55a.m. with the Social Worker and she said the DON notified her that Resident #27's family member was coming to visit her at her podiatrist appointment. She said she went and asked Resident #27 if it was okay for her family member to be there. She said Resident #27 told her the family member grabbed her by the face and not just her arm. She said Resident #27 did not have dementia. She said her BIMS score was a 6. She said she felt she needed to do what was necessary for the Resident #27's safety for the appointment, so she requested a CNA to go to the appointment. She said she informed the DON of the new allegations that was made by Resident #27. She said Resident #27 said it had always happened to her. She said she told the DON that Resident #27 said she did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 2 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0600 Level of Harm - Actual harm Residents Affected - Few not want the family member to come to the visit. She said on 2/28/2024 in the meeting, they could not understand what Resident #27 was saying. She said there was a safety issue, and she should have put supervision in place. She said Resident #27 was her own RP. The Social Worker said she was responsible for writing the care plans. She said she just started working at the facility in January and had not been trained on how to complete the care plans which was why the incident was not documented in the care plan. Follow up- interview on 2/28/2024 at 3:42p.m. with the Social Worker and she said she completed a brief trauma questionnaire a day before the incident because the MDS and the UDAs was showing that it was outstanding, so she did the questionnaire. She said it showed how many days they were behind. She said they were behind because the facility was without a social worker for a month. She said if there was something serious going on such as abuse, she would call APS. She said no assessments were done when the incident occurred because she was not aware of any assessments she was supposed to complete. She said she has not had the proper training to complete the assessments. She said the facility could not afford her to go out to training because they need her at the facility. She said she had a lot of things to catch up on. Interview on 2/28/2024 3:52p.m. with LVN B and she said Resident #27 had been her resident for a while now. She said the family member takes care of things for Resident #27 and visits regularly. She said the family member normally visits late in the evening around 8:00p.m or 9:00p.m. She said the family member always wake up Resident #27 when she came to visit. She said Resident #27 is anxious and confused during those hours. She said she had witnessed in the past, heated exchange of words between Resident #27 and her family member but was not sure what was said. She said she did not tell anyone about it. She said it they just seemed to be arguing but nothing else was happening. She said on the night of the incident, she heard raised voices, and she went to the doorway to see what was going on. She said the family member was shaking her hard. She said her hands were on her shoulders and Resident #27 was trying to push the family member away. She said Resident #27 was yelling and said her family member was trying to kill her. LVN B said she asked the family member to stop, and she told her Resident #27 pushed her. She said she questioned the family member's mental state. She said she is elderly as well. She said she notified LVN C because she is normally the weekend supervisor, but on 2/28/2024 she was covering the halls. She said she asked what to do in this situation because she did not know what to do. She said LVN C told her to text the DON and she did just that. She said the DON said it should have been a phone call. She said she saw Resident #27 wearing hospital gown, and by looking at her when she changed her briefs, there were no marks. She said she did not document that she assessed Resident #27. She said she was not sure if she assessed Resident #27. She said Resident #27 was agitated. She said sat and talked with Resident #27 and calmed her and she went right to sleep. She said she received an in-service annually and that the Administrator is the abuse coordinator. She said he had not gone over anything with her regarding abuse training. She said there was no protocol set in place and if she were to witness abuse at the facility, she was not sure about what to do. She said she is not aware of the process. She said she had been working at the facility for four years. Interview on 2/29/2024 at 10:50a.m. with the Administrator and he said he was made aware of the incident regarding Resident #27 when he came into work the next day. He said the DON told him about the incident by a text she received from a staff member. He said he called in the report on 2/21/2024. He said he will make sure the residents are protected going forward. He said he was more focused on the physical part of the allegations rather than the documentation. He said if the family member were to come back to visit Resident #27, she would not be allowed to enter the facility. He said the protocol for abuse is to report it to the state, remove the threat immediately and design a plan so (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 3 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0600 that it would not happen again. He said he felt like he protected Resident #27, but he did not communicate effectively with staff. Level of Harm - Actual harm Residents Affected - Few Interview on 2/29/2024 at 11:14a.m. with CNA A and she said she arrived at the podiatrist appointment with Resident #27 and the PD came into the room. She said the PD tried to touch Resident #27 feet and she started to scream. She said the family member knocked on the door and the PD allowed her to come inside the room. She said management wanted her to accompany Resident #27, but no one told the PD that the family member was not supposed to be around Resident #27. She said she the PD told her he could not ask the family member to leave the appointment and she said she was not in the position to ask her to leave as well. She said Resident #27 and the family member hugged and kissed each other goodbye. She said she was not told that the family member was supposed to stay away from Resident #27. She said no one explained that to her. She said she was aggravated and did not know why she had to accompany Resident #27. She said she thought someone called the family member about the appointment. She said the Social Worker was worried about Resident #27. She said she was asked to write a statement after the podiatrist appointment with Resident #27. She said she was not sure as to why she did not write a statement when the incident happened. She said the incident happened over a week ago. Interview on 2/29/2024 at 11:56a.m. with CNA B and she said she had been working at the facility for a month. She said she had never been told by a staff member that a particular family member was banned from seeing Resident #27. She said she was not told that a family member could not enter the building. She said she was not aware of the abuse incident that occurred at the facility. She said if she were to witness abuse at the facility, she would inform the Administrator, the DON, and a nurse. She said she had been in-serviced at the facility on abuse and neglect. Interview on 2/29/2024 at 12:05p.m. with CNA C and said she had been working at the facility for a month. She said she heard about the incident, but she was not made aware that a family member was restricted from coming inside the building. She said if she were to ever witness abuse, she would report it to the Administrator, tell the DON and a nurse. She said she had never witnessed abuse at the facility. Interview on 2/29/2024 at 12:11p.m. with CNA D and she said she started orientation on 2/7/2024 or 2/10/2024. She said she had never been told by the Administrator that a family member was prohibited from coming inside the facility and had to stay away from Resident #27. She said if she witnessed abuse at the facility, she would report it immediately to the Administrator. She said you must make a phone call to the Administrator with 24 hours. She said she was told about abuse and neglect through in-service. She said she never witnessed abuse in the facility. Interview on 2/29/2024 at 12:23p.m. with CNA E and said she had been working at the facility for 3 months. She said she had never witnessed abuse at the facility. She said if she were to witness abuse at the facility, she would report it to the Administrator, the DON or the ADON within 24 hrs. She said she received an in-service today, 2/29/2024 about a resident, but she was not sure what resident they are speaking of. Interview on 2/29/2024 at 3:29p.m. the Family Member and she said Resident #27 was her only family member she had left. She said she is her POA. She said Resident #27 broke her hip and was in and out of the hospital. She said her family member is very friendly, but she would suddenly turn on you. She said there were several times she told her she was leaving and was not coming back to see her although she came back. She said she always come late to visit Resident #27 because she is busy during (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 4 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0600 Level of Harm - Actual harm Residents Affected - Few the day. She said she lives in City A. She said goes back and forth every week to pick up her mail to City B. She said the night of the incident she brought Resident #27 food because she does not eat the food at the facility. She said Resident #27 started telling her she had on nice clothes but accused her of using her money to buy her clothes. She said Resident #27 pushed her away and she grabbed her hands to talk to her. She said she never grabbed Resident #27's shoulders. She said the door was open and LVN A asked her to leave. She said she grabbed her belongings and left. She said the Resident #27 was not screaming. She said LVN A told her she would report the incident. She said she told LVN A to be mindful of how she reported the incident. She said the DON called her on 2/25/2024. She said when the DON first called her on 2/25/2024 she wanted to know what happened between her and Resident #27. She said she had gone to all of Resident #27 appointments. She said she kept tabs on her and paid her insurance. She said she knew she had an appointment with the foot doctor since the appointment was first scheduled. She said she scheduled the appointment. She said she was told by the DON she could not come into the building. She said she did not want Resident #27 to be at a facility where she could not visit her. She said the police called her to find out what the incident was about as well. She said the DON called her and asked for a picture. Record Review of the facility's policy titled Abuse and Neglect - Clinical Protocol, dated 10/01/2020, read in part, . Abuse is defined at §483.5 as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain, or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled using technology. Neglect, means the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. The nurse will assess the individual and document related findings. Assessment data will include injury assessment (bleeding, bruising deformity, swelling etc.); Pain assessment; Current behavior; Patient's age and sex; All current medications, especially anticoagulants, NSAIDs, salicylate; Other platelet inhibitors; Vital signs; Behavior over last 24 hours (bruise could be related to movement disorder or aggressive behavior). The nurse will report findings to the physician. As needed, the physician will assess the resident/patient to verify or clarify such findings, especially if the cause or source of the problem is unclear . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 5 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0610 Respond appropriately to all alleged violations. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to prevent further potential abuse, neglect, exploitation, or mistreatment while the investigation is in progress for 1 of 6 residents (Resident #27) reviewed for abuse and neglect. Residents Affected - Few The facility failed to prevent and correct alleged violation of abuse regarding Resident #27 that was reported on 2/21/2024. It was alleged that abused occurred on 2/20/2024 when a charge nurse witnessed Resident #27's family member shaking her hard by her shoulders and was screaming at her. Resident #27 was heard saying that resident #27 yelled saying her family member was trying to kill her. Resident #27 family member was instructed to leave the facility. The facility did not put in place a care plan or interventions to prevent the abuse from occurring again. After the abuse, the family member went to Resident #27's doctor appointment on 2/27/24 and told the provider to continue providing care even though the resident was screaming and saying no. LVN B had previously witnessed heated exchange of words in the past prior to the abuse incident. The facility failed to thoroughly investigate the abuse allegation and mitigate further harm while they continue to investigate. There were no safety restrictions in place, and staff were unaware there was an issue with the family member or that she was not supposed to be visiting Resident #27. The family member went with Resident #27 to a podiatrist appointment after the abuse incident on 2/27/24. The facility failed to do a thorough investigation as the Social Worker did not do any assessments on Resident #27 after the abuse incident and there were no head-to-toe assessments completed by LVN B or the DON. This failure could place the census of 74 residents at risk of not having allegations of abuse or neglect investigated. These findings included: Record review of Resident #27's face sheet revealed she was a [AGE] year-old woman, admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe), urinary tract infection, muscle wasting and atrophy (decrease in size and wasting of muscle tissue), anxiety disorder, cognitive communication deficit (difficulty with thinking and how someone uses language), lack of coordination, and gastro-esophageal reflux disease (a digestive disease in which stomach acid or bile irritates the food pipe lining). Record review of Resident #27's quarterly MDS assessment dated [DATE] revealed a BIMS score of 6, indicating severely impaired cognition. Further review of Resident #27's MDS revealed she was dependent for toileting hygiene, shower/bath, and personal hygiene. She needed supervision or touching assistance eating, and oral hygiene, and she did not attempt to sit to lying, sit to stand, and chair/bed-to-chair transfer due to medical conditions or safety concerns. Record review of Resident #27's care plan date (unknown) revealed Resident #27 was dependent on staff for meeting emotional, intellectual, physical, and social needs r/t cognitive deficit, and immobility. Interventions dated 1/3/2024: Encourage ongoing family involvement. Invite the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 6 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0610 family to attend special events, activities, and meals. Level of Harm - Actual harm Record Review of Resident #27's progress notes dated 2/27/2024 revealed, Resident #27 went to podiatry appt accompanied by CNA A from the facility. CNA A stated Resident #27's family member arrived at the appointment after they were already in the room with the PD. CNA A went on to say that Resident #27 and her family member greeted each other with a hug and the PD was already attempting to provide care on Resident #27's feet. CNA A stated that Resident #27 was screaming anytime the PD would touch her feet. Resident #27's family member told the PD to continue to provide care even though Resident #27 was screaming and saying no and the PD stated that he could not continue since she was refusing. When the appointment was over, Resident #27's family member stated that she would come and see her tonight on 2/27/2024 at 8:00 p.m. DON notified. Residents Affected - Few Observation and interview on 2/26/2024 at 10:20a.m. with Resident #27, revealed her sitting up in bed wearing briefs and a t-shirt. She was using an oxygen machine. Resident #27 was trying to explain herself but had a hard time communicating. There was a wheelchair next to her bed. Her nails were long. She said she wanted to be changed. She pointed to her brief and said she was burning in the back. Observation and interview on 2/29/2024 at 11:00a.m. with Resident #27 revealed her sitting up in bed, wearing brief, and a t-shirt. Resident #27 was not able to explain the incident that occurred with her and her family member. Resident #27 was not able to communicate if she felt safe with her family member coming to visit her. Resident #27 was not able to communicate effectively and was not able to explain what happened the night her family member came to visit her. Resident #27 was able to say she was doing fine. In an interview on 2/28/2024 3:52p.m. with LVN B, she said Resident #27 had been her resident for a while now. She said the family member took care of things for Resident #27 and visits regularly. She said the family member normally visits late in the evening around 8:00p.m or 9:00p.m. She said the family member always woke up Resident #27 when she came to visit. She said Resident #27 was anxious and confused during those hours. She said she had witnessed in the past, heated exchange of words between Resident #27 and her family member but was not sure what was said. She said she did not tell anyone about it. She said they just seemed to be arguing, but nothing else was happening. She said on the night of the incident, she heard raised voices, and she went to the doorway to see what was going on. She said the family member was shaking her hard. She said her hands were on her shoulders and Resident #27 was trying to push the family member away. She said Resident #27 was yelling and said her family member was trying to kill her. LVN B said she asked the family member to stop, and she told her Resident #27 pushed her. She said she questioned the family member's mental state. She said she was elderly as well. She said she notified LVN C because she was normally the weekend supervisor, but on 2/28/2024 she was covering the halls. She said she asked what to do in this situation because she did not know what to do. She said LVN C told her to text the DON and she did just that. She said the DON said it should have been a phone call. She said she saw Resident #27 wearing a hospital gown, and by looking at her when she changed her brief, there were no marks. She said she did not document that she assessed Resident #27. She said she was not sure if she assessed Resident #27. She said Resident #27 was agitated. She said she sat and talked with Resident #27 and calmed her and she went right to sleep. She said she received an in-service annually and that the Administrator was the abuse coordinator. She said he had not gone over anything with her regarding abuse training. She said there was no protocol set in place and if she were to witness abuse at the facility, she was not sure about what to do. She said she was not aware of the process. She said she had been working at the facility for four years. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 7 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0610 Level of Harm - Actual harm Residents Affected - Few In an interview on 2/27/2024 at 4:00p.m. with the DON, she said the next day after the incident occurred and when she returned to work, Resident #27 was assessed from head to toe for bruising. She said a head-to-toe assessment was not completed the night of the incident because the nurse was busy consoling Resident #27 and keeping her calm. She said Resident #27's family member was from City A, and she drove back and forth. She said she did not put anything in place regarding the family member and Resident #27, but she said she told the family member not to visit for a while and the family member agreed. She said the family member had not been back to the facility. She said the police were called and a report was made. She said the charge nurse asked the family member to leave and she complied. In an interview on 2/28/2024 at 10:30a.m. with the Administrator and the DON, the Administrator said he had set up a meeting with Resident #27 to see if she felt safe with her family member visiting her or would she like her banned from the facility. He said he did not know the family member was going to show up to her appointment. He said had she come to the building she would not have been allowed inside. The DON said she spoke with the family member yesterday and told her she was not allowed to visit until she heard from them. She said she will talk to the resident to see what she would like to happen regarding her family member coming to visit her. In an interview on 2/28/2024 at 11:55a.m. with the Social Worker, she said the DON notified her that Resident #27's family member was coming to visit her at her podiatrist appointment. She said she went and asked Resident #27 if it was okay for her family member to be there. She said Resident #27 told her the family member grabbed her by the face and not just her arm. She said Resident #27 did not have dementia. She said her BIMS score was a 6. She said she felt she needed to do what was necessary for Resident #27's safety for the appointment, so she requested a CNA to go to the appointment. She said she informed the DON of the new allegations that was made by Resident #27. She said Resident #27 said this has always happened to her. She said she told the DON that Resident #27 said she did not want the family member to come to the visit. She said on 2/28/2024 in the meeting, they could not understand what Resident #27 was saying. She said there was a safety issue, and she should have put supervision in place. She said Resident #27 was her own RP. The Social Worker said she was responsible for writing the care plans. She said she just started working at the facility in January and had not been trained on how to complete the care plans which was why the incident was not documented in the care plan. During a follow-up interview on 2/28/2024 at 3:42p.m. with the Social Worker, she said she completed a brief trauma questionnaire a day before the incident because the MDS nurse and the UDA s was showing that it was outstanding, so she did the questionnaire. She said it showed how many days they were behind. She said they were behind because the facility was without a social worker for a month. She said if there was something serious going on such as abuse, she would call APS. She said no assessments were done when the incident occurred because she was not aware of any assessments she was supposed to complete. She said she has not had the proper training to complete the assessments. She said the facility could not afford her to go out to training because they need her at the facility. She said she had a lot of things to catch up on. In an interview on 2/29/2024 at 10:50a.m. with the Administrator, he said he was made aware of the incident regarding Resident #27 when he came into work the next day. He said the DON told him about the incident by a text she received from a staff member. He said he called in the report on 2/21/2024. He said he will make sure the residents were protected going forward. He said he was more focused on the physical part of the allegations rather than the documentation. He said if the family member were to come back to visit Resident #27, she would not be allowed to enter the facility. He said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 8 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0610 Level of Harm - Actual harm Residents Affected - Few the protocol for abuse was to report it to the state, remove the threat immediately, and design a plan so that it would not happen again. He said he felt like he protected Resident #27, but he did not communicate effectively with staff. In an interview on 2/29/2024 at 11:14a.m. with CNA A, she said she arrived at the podiatrist appointment with Resident #27 and the PD came into the room. She said the PD tried to touch Resident #27's feet and she started to scream. She said the family member knocked on the door and the PD allowed her to come inside the room. She said management wanted her to accompany Resident #27, but no one told the PD that the family member was not supposed to be around Resident #27. She said she the PD told her he could not ask the family member to leave the appointment and she said she was not in the position to ask her to leave as well. She said Resident #27 and the family member hugged and kissed each other goodbye. She said she was not told that the family member was supposed to stay away from Resident #27. She said no one explained that to her. She said she was aggravated and did not know why she had to accompany Resident #27. She said she thought someone called the family member about the appointment. She said the Social Worker was worried about Resident #27. She said she was asked to write a statement after the podiatrist appointment with Resident #27. She said she was not sure as to why she did not write a statement when the incident happened. She said the incident happened over a week ago. In an interview on 2/29/2024 at 11:56a.m. with CNA B, she said she had been working at the facility for a month. She said she had never been told by a staff member that a particular family member was banned from seeing Resident #27. She said she was not told that a family member could not enter the building. She said she was not aware of the abuse incident that occurred at the facility. She said if she were to witness abuse at the facility, she would inform the Administrator, the DON, and a nurse. She said she had been in-serviced at the facility on abuse and neglect. In an interview on 2/29/2024 at 12:05p.m. with CNA C, she said she had been working at the facility for a month. She said she heard about the incident, but she was not made aware that a family member was restricted from coming inside the building. She said if she were to ever witness abuse, she would report it to the Administrator, tell the DON and a nurse. She said she had never witnessed abuse at the facility. In an interview on 2/29/2024 at 12:11p.m. with CNA D, she said she started orientation on 2/7/2024 or 2/10/2024. She said she had never been told by the Administrator that a family member was prohibited from coming inside the facility and had to stay away from Resident #27. She said if she witnessed abuse at the facility, she would report it immediately to the Administrator. She said she must make a phone call to the Administrator within 24 hours. She said she was told about abuse and neglect through an in-service. She said she never witnessed abuse in the facility. In an interview on 2/29/2024 at 12:23p.m. with CNA E, she said she had been working at the facility for 3 months. She said she had never witnessed abuse at the facility. She said if she were to witness abuse at the facility, she would report it to the Administrator, the DON, or the ADON within 24 hrs. She said she received an in-service today, 2/29/2024 about a resident, but she was not sure what resident they were speaking of. In an interview on 2/29/2024 at 3:29p.m. the Family Member said Resident #27 was her only family member she had left. She said she is her POA . She said Resident #27 broke her hip and was in and out of the hospital. She said her family member was very friendly, but she would suddenly turn on you. She said there were several times she told her she was leaving and was not coming back to see her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 9 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0610 Level of Harm - Actual harm Residents Affected - Few although she came back. She said she always came late to visit Resident #27 because she was busy during the day. She said she lives in City A. She said she goes back and forth every week to pick up her mail in City B. She said the night of the incident she brought Resident #27 food because she does not eat the food at the facility. She said Resident #27 started telling her she had on nice clothes but accused her of using her money to buy her clothes. She said Resident #27 pushed her away and she grabbed her hands to talk to her. She said she never grabbed Resident #27's shoulders. She said the door was open and LVN A asked her to leave. She said she grabbed her belongings and left. She said Resident #27 was not screaming. She said LVN A told her she would report the incident. She said she told LVN A to be mindful of how she reported the incident. She said the DON called her on 2/25/2024. She said when the DON first called her on 2/25/2024 she wanted to know what happened between her and Resident #27. She said she had gone to all of Resident #27's appointments. She said she kept tabs on her and paid her insurance. She said she knew she had an appointment with the foot doctor since the appointment was first scheduled. She said she scheduled the appointment. She said she was told by the DON she could not come into the building. She said she did not want Resident #27 to be at a facility where she could not visit her. She said the police called her to find out what the incident was about as well. She said the DON called her and asked for a picture. Record Review of the facility's policy titled Abuse and Neglect - Clinical Protocol, dated 10/01/2020, read in part, . Abuse is defined at §483.5 as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain, or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled using technology. Neglect, means the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. The nurse will assess the individual and document related findings . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 10 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to revise and update the comprehensive care plan for 1 of 5 residents (Resident #27) reviewed for care plans. The facility failed to put in place interventions and update the care plan that would prevent further abuse and make staff aware of the incident for Resident #27. This failure could place other residents at risk of not having their individually needs met and place them at risk of abuse and neglect. Findings included: Record review of Resident #27's face sheet revealed she was a [AGE] year-old woman, admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnosis included chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe), urinary tract infection, muscle wasting and atrophy (decrease in size and wasting of muscle tissue), anxiety disorder, cognitive communication deficit (difficulty with thinking and how someone uses language), lack of coordination, and gastro-esophageal reflux disease (a digestive disease in which stomach acid or bile irritates the food pipe lining). Record review of Resident #27's quarterly MDS assessment dated [DATE] revealed a BIMS score of 6, indicating severely impaired cognition. Further review of Resident #27's MDS revealed she was dependent for toileting hygiene, shower/bath, and personal hygiene. She needed supervision or touching assistance eating, and oral hygiene, and she did not attempt to sit to lying, sit to stand, and chair/bed-to-chair transfer due to medical conditions or safety concerns. Record review of Resident #27's care plan date (unknown) revealed Resident #27 is dependent on staff for meeting emotional, intellectual, physical, and social needs r/t cognitive deficit, and immobility. Interventions dated 1/3/2024: Encourage ongoing family involvement. Invite the resident's family to attend special events, activities, meals. Observation and interview on 2/26/2024 at 10:20a.m. with Resident #27, revealed her sitting up in bed wearing briefs and a t-shirt. She was using an oxygen machine. Resident #27 was trying to explain herself but had a hard time communicating. There was a wheelchair next to her bed. Her nails were long. She said she wanted to be changed. She pointed to her briefs and said she was burning in the back. In an interview on 2/28/2024 at 1:53p.m. with the Administrator, he said he could have informed the Social Worker to update the care plan regarding #27's incident with the family member. He said the DON, and the ADON could have updated it as well. He said the abuse allegations were not care planned. He said the Social Worker had not been able to update the care plan because she had not been properly trained. He said it was important to update the care plan and put in place interventions to protect the resident from future abuse because abuse is the most important thing in a care plan. He said he should have put measures in place. He said moving forward he will audit the care plan and care plans must be updated within 72 hours. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 11 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 2/28/2024 at 2:03p.m. with the DON, she said the alleged abuse that happened between Resident #27 and a family member was not care planned. She said it was an oversight and it was missed. She said she did not have an answer as to why it was missed. She said it was important to have a plan put in place because it was important to make sure staff is aware of the safety of the resident and they know what they need to do to protect the resident. She said if it was not care planned, something could happen to the resident again. In an interview on 2/28/2024 at 11:55a.m. with the Social Worker, she said the DON notified her that Resident #27's family member was coming to visit her at her podiatrist appointment. She said she went and asked Resident #27 if it was okay for her family member to be there. She said Resident #27 told her the family member grabbed her by the face and not just her arm. She said Resident #27 did not have dementia. She said her BIMS score was a 6. She said she felt she needed to do what was necessary for Resident #27's safety for the appointment, so she requested a CNA to go to the appointment. She said she informed the DON of the new allegations that was made by Resident #27. She said Resident #27 said this has always happened to her. She said she told the DON that Resident #27 said she did not want the family member to come to the visit. She said on 2/28/2024 in the meeting, they could not understand what Resident #27 was saying. She said there was a safety issue, and she should have put supervision in place. She said Resident #27 was her own RP. The Social Worker said she was responsible for writing the care plans. She said she just started working at the facility in January and had not been trained on how to complete the care plans which is why the incident was not documented in the care plan. Record review of the facility's policy titled Care Plan revised on (04/2021) read in part . It is the policy of this facility that staff must develop a comprehensive person facility care plan to meet the needs of the resident. Approach / Plan, List care to be provided for the problem listed. The care must be NECESSARY AND APPROPRIATE to accomplish the goal stated, coordinate care to be provided to the resident for the most effective, efficient utilization of resources, individualize care to ensure the care plan is person facility for the unique needs of the resident, communicate vital information to staff providing direct resident care, List infection control measures, and List safety measures. Each discipline should list approaches for the care it will provide. Coordinating care by all disciplines, working toward a common or similar goal, will improve efficiency. Involved Service or Responsible Discipline. The following persons are to be involved in the development of the care plan: Licensed nurses (LVN/RN), Registered Nurse (RN), Nursing assistants (C N A responsible for resident), Restorative nursing assistant (RNA), Dietary supervisor (FSS), Social Service Designee (SSD), Activity Director (AD), Therapists (RPT, ST, OT, RRT), Attending Physician, an any other professional needed . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 12 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0759 Ensure medication error rates are not 5 percent or greater. 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 review, the facility failed to ensure that it was free of medication error rate of 5 percent or greater. Twenty-five opportunities were observed with a total of two errors, resulting in an eight percent medication error rate involving 2 residents (Residents #4 and #66) and 2 of 7 staff (LVN J and LVN L) reviewed for medication errors, in that: Residents Affected - Some -LVN L administered the wrong dose of Prostat AWC (indicated for increased protein needs in low volume related to stages 2 to 4 pressure injuries, multiple pressure injuries, hard-to-heal wounds, unintentional muscle loss, protein-energy malnutrition, low serum proteins, and sarcopenia) to Resident #4. -LVN J administered Morphine Sulfate to Resident #66 using the wrong route. These failures affected 2 residents and placed other residents at risk for not receiving medications as ordered by the physician and not receiving the intended therapeutic benefit of their medications. Findings include: Resident # 4 Record review of clinical record facesheet for Resident #4 revealed that she was an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included Alzheimer's disease, aphasia (loss of ability to understand or express speech, caused by brain damage), pressure ulcer of the right heel, diabetes mellitus, and hypertension. Record review of Resident #4's physician orders dated 09/29/2021 revealed an order for Prostat AWC, give 30mls via PEG Tube two times a day for dietitian recommendation related to Type 2 Diabetes. Observation on 02/29/2024 at 10:00 a.m. revealed LVN L administered Prostat AWC, 25mls (Milliliters) via PEG Tube to Resident # 4 with scheduled daily medications. Interview on 02/29/2024 at 10:15 p.m. LVN L revealed that she did not administer Prostat AWC, 30mls in error. She said that Resident #4 should have been given 30mls of Prostat AWC, but she gave 25mls and failed to administer the remaining 5mls. LVN L said that placed Resident #4 at risk for delayed wound healing and additional skin breakdown by not administering the right dose of medication to Resident #4. LVN L confirmed that the facility had provided training related to administering medications and that she was knowledgeable to the facility policy. Resident #66 Record review of the clinical record facesheet for Resident # 66 revealed that she was an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included Alzheimer's disease, pressure ulcer of the right buttock, anxiety disorder, gastro-esophageal reflux disease, and hypertension. Record review of Resident #66's physician orders dated 01/13/2024 revealed an order for Morphine Sulfate Oral Solution 0.5ml to be given via G-Tube (Gastrostomy Tubes) route every 4 hours for pain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 13 of 14 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 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 0759 and shortness of breath. Level of Harm - Minimal harm or potential for actual harm Observation on 02/29/2024 at 1:03 p.m. revealed LVN J administered Morphine Sulfate to Resident #66 and used the wrong route (oral route). Residents Affected - Some Interview on 02/29/2024 at 1:05 p.m. LVN J revealed the order read that Morphine Sulfate Oral Solution 0.5ml should be given via oral route. LVN J said that she did not realize that the physician ordered the medication to be given via the G-Tube route. LVN J said that she failed to confirm that with the physician order. She said that resident could have serious effects when administering medication via the wrong route. LVN J confirmed that that the facility had provided training related to administering medications and that she was knowledgeable to the facility policy. Interview on 02/29/2024 at 1:15 p.m. the DON said that medications should be checked for the correct dosage and route with each medication pass. The DON said that when medications were administered in error via the wrong route and dose that it can cause serious, sometimes long-term effects to the resident. The DON said that all nurses and CMA staff have been trained and were knowledgeable of the medication administration policy. The DON said that additional training will be provided. Record review of the facility's policy for Medication Administration revised April 2019 read in part: . Medications are administered in accordance with prescriber orders . The individual administering the medication checks the label three times to verify the right resident, right medication, right dosage, right time, and right method (route) of administration before giving the mediation . . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 14 of 14