Health inspection·January 25, 2024

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an observation and interview with RN H on 01/24/24 at 2:50 p.m. at Resident #5's bedside, she stated Resident #5's nails needed to be trimmed. She stated the facility in the past had assigned one staff member to do nail care unless the resident was diabetic, but stated she was not sure who it was. RN J inspected Resident #5's hands revealing some nails on her left were shorter but were dirty with dark gray substance under them. Both thumb nails were over ½ inch in length. She stated with the resident's contractures her nails needed to be kept short and clean to prevent skin breakdown. In an interview with LVN G on 01/24/24 at 03:05 p.m. he stated the CNAs were responsible for trimming residents' nails, unless they were diabetic. He stated Resident #5 was not diabetic, but with her hand contractures it might be difficult for the CNAs to trim her nails. He stated the Medical Records clerk use to trim resident's nails but stated she had not done that since the first of January 2024. In an Interview with the Medical Records clerk on 01/24/24 at 03:10 p.m. she stated nail care was done on the resident's scheduled shower days. She stated she was a floor CNA and recently became the medical records clerk. She stated she used to trim the majority of the residents' nails. She stated she had not done that since the end of December 2023. She stated would highlight a resident list and give it to the nurse on any residents she had trimmed nails. She stated she could see where it got miscommunicated. She stated she had trimmed Resident #5's nails in the past but could not remember when she had trimmed them last. She stated Resident #5's hands were very contracted. Interview with the DON on 01/24/24 at 03:30 p.m. she stated it was the CNAs responsibility to make sure residents nails were trimmed and clean. She stated it was done on the resident's shower days. She stated she would make sure the staff were aware of their responsibility. She stated failing to keep resident's nails trimmed and clean could cause skin scratches, risk of infections, and someone with contractures could cause skin breakdown. Review of facility's policy Bathing, dated January 2023 reflected, Staff will provide bathing services for residents within standard practice guidelines .Perform hand hygiene and perform nail care . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 2 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents with limited range of motion received appropriate treatment and services to increase range of motion and/or prevent further decrease in range of motion for one (Resident #5) of three residents reviewed for range of motion. The facility failed to implement interventions to prevent further decline of Resident #5's contracture to her right and left hands after discharge from occupational therapy on 11/13/23. This failure could place residents at risk for decline in range of motion, decreased mobility, and worsening of contractures. Findings included: Record review of Resident #5's quarterly MDS assessment, dated 01/11/24, reflected a [AGE] year-old female with an admission date of 08/14/14. Resident # 5 was unable to participate in the brief interview for mental status and staff had assessed her to be severely cognitively impaired. The Resident had lower extremity impairment on both sides. Resident #5 was dependent for all ADLs and had no history of refusing care. Resident #5 had not received OT or PT services in the seven days look back period. Resident #5 had not received restorative care, splints, or braces. Active diagnoses included cerebral vascular accident (stroke), hemiplegia (paralysis), heart failure and dementia. Record review of Resident #5's comprehensive care plan reviewed and continued 12/05/23, reflected, .[Resident #5] has limited Range of Motion of all extremities .Interventions included .Assess contracted area/areas with decreased ROM for evidence of skin breakdown: report significant changes to MD .Use devises, appliances, splints, or positioning pillows as indicated. Hand rolls placed to bilateral hands . Record Review of Occupational Therapy Discharge summary dated [DATE] reflected, .Dates of Services: 10/16/23-11/13/23 .Short-Term Goals .Patient will safely wear a hand roll and-or a palmar guard on bilateral hands for up to 4 hours w/minimal signs and symptoms of redness, swelling, discomfort or pain .Previous tolerance 10/28/23 .3 hours Discharge .11/13/23 .5 hours Assessment and Summary of Skilled Services Prognosis to Maintain current level of function- Excellent with consistent staff support . Record review of Resident #5's Electronic Medical Record reflected a nursing restorative plan initiated on 11/16/22 for 6 weeks. No record found indicting restorative continued beyond the initial 6-week period. Record review of Resident #5's Consolidated Physician orders, dated 01/24/23 reflected, .Occupation Therapy services 3-5x/week for 1 week with emphasis on Upper extremity therapeutic exercise. Therapeutic activities, Modalities, and Patient/caregiver education . with a start date of 01/23/24. An observation of Resident #5 on 01/23/24 10:00 a.m. revealed both hands drawn into a fist. Resident #5 was unable to open hands or move fingers. Thumb nails on both hands were approximately 1/2 inches long. Unable to view other nails. No hand splints or hand rolls in place. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 3 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview with CNA J on 01/23/24 at 12:15 p.m. she stated Resident #5 used to have a ball like splint that therapy placed in her hands but stated she had not seen it for several months. She stated the residents' hands were awfully hard to open. In an interview with LVN G on 01/23/24 at 1:30 p.m. he stated therapy had been placing splints in Resident #5's hands. He stated he had never had an order for nursing to place splints in her hands. He stated they had placed washcloths in her hands in the past. He stated he thought she was under therapy services at this time. In an interview with the DOR on 01/23/24 at 02:10 p.m. she stated they had put Resident #5 on physical therapy for her legs and hips around the first of January. She stated the resident was on their contracture management list and they did quarterly screenings on her. She stated the previous date of service for Resident #5 was 10/16/23 through 11/13/23 with Occupational therapy and that was for the contractures to her hands. She stated she was not sure if the resident was put on restorative after she was discharged in November, she stated the OT would probably know. In an interview with OTR D on 01/23/24 at 02:20 p.m. he stated when he discharged Resident #5 from therapy in November 2023, he met with the MDS nurse, and the restoratives aide about the residents ongoing needs and he thought they were adding her to restorative. He stated he was splinting both hands and was doing stretching when he saw her in October and November last year. In an Interview with MDS F on 01/23/24 at 02:25 p.m. she stated she provided oversight for the restorative program. She stated Resident #5 had not been on restorative since 2022. She stated Resident #5 was currently on Physical therapy services. She stated she did not recall having a conversation with OTR D about placing the resident on restorative in November 2023. She stated they only had one Restorative aide and could only care 9-10 residents at a time. She stated they could assign application of splints and range of motion to the nursing staff. She stated therapy used to send written restorative plans when they were discharging residents and the resident needed restorative, but they had stopped doing that. She stated now they just discussed it during stand-up meetings. She stated failing to provide ongoing range of motion and splinting could cause a decline in the resident's range of motion and worsening of her contractures. In an Interview with PTA C 01/23/24 at 02:35 a.m. he stated he evaluated Resident #5 and picked her up on physical therapy services. He sated he seen her for decreased mobility to her lower extremities but stated due to the progression of her hand contractures her had started splinting her hands. He stated they had rapidly progressed from her previous round of therapy. He stated he had started her on stretches and splinting to get her back to her previous level. In an interview with the Restorative Aide on 01/23/24 at 2:40 p.m. she stated she had worked in the position of Restorative Aide for about 6 months. She stated Resident #5 had never been assigned to her for restorative services. She stated she recalled having a conversation with therapy and the MDS nurse about putting her on restorative but stated she had never been assigned to her. In a follow up interview with the DOR on 01/23/24 at 02:45 p.m., she stated she and the MDS nurse communicate daily and review upcoming quarterly screenings and residents who will be coming off therapy services. She stated they only had one Restorative aide that worked Monday through Friday. She stated if they had a resident who required ongoing splinting or range of motion, she would request nursing to write the order so it could be continued, and they could monitor the resident's skin. She stated she was not sure what happened with Resident #5, and stated they just dropped the ball. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 4 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated by not having her splinting and stretching continued it could cause a decline and worsening of the residents' contractures. In a follow up interview with OTR D on 01/24/24 at 8:45 a.m. her stated he re-evaluated Resident #5 on 01/23/24 and had placed her on occupational therapy for her hand contractures. He stated he had placed hand rolls in both hands yesterday and she was able to tolerate them for 4 hours. He stated they would be educating the nursing staff on her ongoing needs when he discharged her from therapy. Record review of the Occupation Therapy Evaluation and Plan of treatment dated 01/23/24 reflected, .Clinical Impression: Patient was fitted with bilateral hand rolls and was able to tolerate donning orthosis for 4 hours without signs of redness and discomfort. Bilateral palm protector/palm guard will be ordered, and a restorative nursing program will be implemented with emphasis on proper orthotic fitting and schedule .Skilled OT services are warranted to design and implement Restorative Nursing Program . In an interview with the DON on 01/24/24 at 08:50 a.m. she stated Resident #5 should have been picked up by nursing services for range of motion and splinting when she was discontinued from therapy services in November 2023. She stated therapy just needed to let her know what the ongoing needs were going to be. She stated failing to have interventions in place for residents with limited range of motion could lead to worsening of a resident's contractures and decline in function. Review of the facility's policy titled, Screening, Rehabilitation, dated April 2012, reflected, .Any patient/resident identified by the interdisciplinary team, as requiring a rehabilitation scree will have the screening initiate by a Physical, Occupation Therapist or Assistant, or Speech Language Pathologist withing 48 hours of notification of the request and quarterly A patient /resident is referred for a rehabilitation screen in response to any of the following .Contracture risks or splinting needs .Decline in ROM .A rehab screen is a hands-off' process by which the therapist reviews the medical record, observes the patient/resident, and interviews the patient/resident, caregivers, interdisciplinary team, and/or family to identify the patient's /resident's prior level of function, expectations for return of function and discharge plan .The screening process requires no more than 10 to 15 minutes of the therapist time .The outcome of the screen may be to proceed with a request for a physician's order to evaluate . Review of the facility's policy titled, Quality of Life Rounds Procedures,' dated May 7, 2017, reflected, To identify all therapy/restorative appropriate changes in condition of residents and provide medically necessary services as indicate to ensure the highest practical level of care for each resident .The facility will first ensure that current systems are in place for addressing changes in condition .Any residents identified with decline in ADL . will be referred to Therapy for screening .A team including a MDS, Charge Nurse, CNA, Restorative Aide and Therapy Representative assigned to cover each hall of the nursing facility will be established .The teams will make rounds .complete the quarterly joint mobility screens ( Nursing) and screen resident (Therapy). Changes noted on the mobility screen, declines identified by staff, or triggers noted on Quality Measures will be documented (by charge nurse) and resident will be referred for a therapy eval .Residents identified in the morning meeting to have changes in condition . or other related conditions will be referred to therapy via the Nursing to Therapy communication form .It will be the responsibility of the Restorative Aide9s) to maintain restorative plans and CNASs may perform the maintenance programs The DON or MDS Nurse will be designated as a liaison to the restorative program to insure resident's plans are appropriate . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 5 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0688 Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy titled, Joint Mobility, Splints, and Range of Motion, dated February 2020, reflected, Standard of Practice: The nursing staff will assist the resident with activities of daily living regarding joint mobility, splinting and range of motion using restorative and rehabilitative care techniques . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 6 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents received adequate supervision and assistive devices to prevent accidents for two (Resident #17, Resident #72) of eight Residents reviewed for accidents/hazards/supervision/ devices. The facility failed to properly maintain wheelchairs for Residents #17 and Resident# 72. This failures could affect the resident by placing the residents at risk for discomfort, pain, and injuries. Resident #17 Record review of Resident #17's quarterly MDS assessment dated [DATE] revealed resident was a [AGE] year-old female with an admission date of 03/10/2023. Resident #17 had a BIMS score of 9 indicating moderate cognitive impairment. Resident #17 required 2-person assistance with transfers, and she used a manual wheelchair for mobility. Resident #17 had an active diagnosis of Non-Traumatic Brain Dysfunction (injury to the brain), End-Stage Renal Disease (kidney failure), Muscle weakness, type 2 diabetes mellitus with diabetic nephropathy (Deterioration of kidney function due to high blood sugar). Record review of Resident #17's care plan dated 03/16/2023 revealed Resident #17 had muscular weakness, 03/19/2023 care plan revealed Resident #17 was a fall risk, 12/26/2023 care plan revealed Resident #17 was at risk for skin breakdown. An interview and observation with Resident #17 on 01/23/2024 at 09:56 AM revealed resident was sitting on her wheelchair in her room. Resident complained that the right wheel of her wheelchair was hard to move. Resident stated this was affecting her mobility since it was hard for her to wheel the wheelchair. Resident stated she had reported this issue to a staff member some time back and it was fixed. Resident stated she reported the current problem to a staff (she could not remember the name or title of that staff member) few days ago but nobody came to fix it. It was observed the right arm rest of the wheelchair was touching the right wheel while resident was seated in her wheelchair. Resident #72 Record Review of Resident #72' quarterly MDS assessment dated [DATE] revealed resident was a [AGE] year old male with an admission date of 02/21/2022. Resident #72 had a primary diagnosis of unspecified Dementia, Congestive Heart Failure, diabetes mellitus. Resident has a BIMS score of 9 indicating moderate cognitive impairment. Resident #72 was a one person assist with transfers and bed mobility. Record Review of Resident #72's care plan dated 12/23/23 revealed resident was wheelchair was wheelchair dependent for ambulation. Care Plan dated 12/26/23 revealed resident was a fall risk. An interview and observation of Resident #72 on 12/25/2024 at 02:40 PM revealed Resident #72 was sitting on his wheelchair in his room. Resident #72's stated both arm rests of the wheelchair were torn and exposed. Resident #72 stated the maintenance Director was aware of the issue and he was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 7 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few waiting on parts to arrive to replace the arm rests. Resident #17 stated the maintenance director noticed he issue few weeks ago. The interview with CNA L on 01/24/2024 at 11:27 AM, he stated he was not aware of Resident #17 and Resident #72's wheelchair related problems. CNA L stated every staff member of the facility was expected to report to the charge nurse and enter in the maintenance log located in the nurse's station, when they saw or heard about an issue related to resident's wheelchairs. CNA L stated if a wheelchair was not repaired in a timely manner, it may cause accidents, skin tear to the resident. The interview with CNA M on 01/24/2024 at 11:38 AM, she stated she was not aware of Resident #17 and Resident #72's wheelchair related problems. CNA M stated if she was aware of the problems related to the resident's wheelchair, she would report it to the charge nurse, report it to the maintenance director and in the maintenance log located in the nurses station. The maintenance director checks the maintenance log every day and address any concerns reported to him. CNA M stated a resident can get hurt if a wheelchair was not maintained properly. The interview with ADON E on 01/24/24 11:46, he stated he was not aware the wheelchair issues to Resident #17 and Resident #72. ADON E stated if he learned about a wheelchair issue, he would send a group text via group Me, which could be seen by the maintenance director, DON, Administrator. He would also report it in the maintenance log located in all the nurses' stations. ADON E stated if a wheelchair was not well maintained, it could cause fall risk, affects a resident's free movement and skin tear. The interview with LVN N on 01/24/24 12:21 PM, she stated she was not aware of Resident #17 and Resident #72's issues with their wheelchair. LVN N stated Resident #17 had an issue with her wheelchair around a month ago, her wheelchair arm rest was raised and the issue was resolved. LVN N stated the current wheelchair issues related to Resident #17 and Resident #72 were not reported in the maintenance log. LVN N stated if she knew about the wheelchair issue, she would have reported in the maintenance log, so that the maintenance director would see it when he checked the maintenance log daily. LVN N stated the issues related to resident's wheelchair could cause fall, skin tear, mobility impairment to the residents. The interview with maintenance director on 01/2/2024 at 12:28 PM revealed he was not aware of the current issues with the wheelchairs of Resident #17, he learned about Resident #72's wheelchair arm rest issue few weeks ago when he was doing a routine check and he ordered the parts for it but he could not fix the arm rest since he has not received the parts yet. He stated he had informed the resident the reason for the delay in getting the parts for replacement. Maintenance director stated he checked the maintenance log at the nurses station every day and he did not see any reports about Resident #17's wheelchair issue. He stated a wheelchair which was not maintained could cause fall risk, mobility impairment, skin tear to the resident. Interview with the DON on 01/24/24 at 02:21 PM revealed she was not aware of Resident #17 and Resident #72's wheelchair issues. The DON stated Therapy department and Maintenance department share the responsibility for wheelchairs. The DON stated Maintenance orders parts for the wheelchairs. Therapy department evaluate, repair and order new wheelchairs. The DON stated there was no specific system in place for reporting the issues with wheelchair to therapy. All staff can report to the charge nurse or to therapy if they see or hear a concern about the wheelchair via text message or verbally. The DON stated she was not aware of any maintenance log available at the nurse's station to log wheelchair related issues. The DON stated residents are at risk for fall, skin tear, mobility issues if a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 8 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 wheelchair was not repaired or maintained properly. Level of Harm - Minimal harm or potential for actual harm The interview with the Administrator on 01/25/2024 at 10:55 AM revealed all the staff were responsible to immediately report an issue with a resident's wheelchair in the maintenance log located in the nurses' stations. She stated all the staff had access to the maintenance director's phone number and the staff are expected to report any serious concern regarding a resident's wheelchair to the maintenance director immediately. She stated there were extra wheelchairs available at the facility and if a damage was reported, the resident could get a replacement wheelchair. The Administrator stated the Maintenance director was responsible for repairing and maintaining the wheelchairs. She stated a wheelchair which was not maintained properly could cause fall risk, injury, mobility impairment, skin tear to a resident. Residents Affected - Few Record review of the maintenance log located in nurses' station at the 300 hall and 400 hall revealed Resident #17 and Resident #72's wheelchair related issues were not reported. Record review of the facility's Resident General Equipment Cleaning policy with a review date of 02/20/2023 revealed Resident's general equipment will be cleaned on a routine basis in accordance with manufacturer's specifications and guidelines. Facility will check equipment weekly or as needed, General equipment may include wheelchairs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 9 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide behavioral health services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of one (Resident #7) of four residents reviewed for behavioral health services. The Social Worker failed to follow up to ensure Resident #7 received a psychiatric service after a referral was made on 11/02/23. This failure could place residents at risk for not receiving behavioral health services and a decline in Quality of life. Findings Included: Record review of Resident #7 quarterly MDS assessment dated [DATE] reflected an [AGE] year-old female with an admission date of 10/31/23. Resident #7 had a BIMS of 9 which indicated she was moderately cognitively impaired. There were no behaviors, signs of delusions or rejection of care noted on the assessment. Resident #7 had active diagnosis which included Alzheimer's, dementia with unspecified severe psychotic disturbance (suggestive of mental or emotion unsoundness or instability) and depression. Record review of Resident #7's care plan with an onset date of 11/27/23 reflected, .History of Dementia with behaviors .History of being hostile towards roommate at other Long term care facility prior to admitting to this facility .History of Alzheimer's with psychotic disturbance .Behavioral aggression, Anger, Verbally abusive, Socially inappropriate, frustration, poor judgement and history of yanking curtains, cursing at others prior to admitting to the facility .Interventions .Frequent visual checks .Maintain behavior log .Referral to psychiatry/psychology services .remove resident from immediate situation to assure safety . Record Review of Resident #7's Consolidated physician orders dated 01/24/24 reflected resident was taking 75 mg of Seroquel ( antipsychotic) 1 tablet twice a day and Amitriptyline (antidepressant) 50 mg 1 tablet at bedtime. Resident #7 was taking both medications upon admission on [DATE]. Record review of Resident #7's Behavior Monitoring log from 11/01/23 through 01/23/24 reflected the facility was monitoring for hallucinations. No hallucinations were reported on day of monitoring. Record review of the Social Workers progress noted dated 11/02/23 reflected, SW made a psych referral to [psychiatric services] due to diagnosis of Anxiety, Alzheimer's, Dementia with psychotic disturbance .delusions and being hostile toward her roommate at the previous facility she was at. SW received consent from residents [family member] to receive psych services SW will continue to follow up as needed . Record review of Resident #7's electronic medical record did not reflect a psychiatric assessment or progress notes. In an observation on 01/23/24 at 9:25 a.m. revealed Resident #7 in her room eating her breakfast. No complaints at that time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 10 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview with the Social Worker on 01/24/24 at 1:05 p.m. she stated she had made a referral to the facility's psychiatric services. She stated she assumed Resident #7 was receiving psychiatric services. The social worker presented a fax cover sheet to the psychiatric services dated 11/02/23 and it was confirmed as sent. The Social Worker stated she had not followed up with the psychiatric provided and stated she had never followed up after making a referral. She stated she would reach out to them to see when they saw the resident. In an interview with the DON 01/24/24 at 01:23 p.m. she stated Resident #7 was admitted from another facility and was already on Seroquel. She stated the resident had also received services from psychiatric services at her pervious facility and the same psychiatric provider would also be following her here. She stated the Social Worker was responsible for making the referral when the resident admitted to the facility. In a follow up with the Social Worker on 01/24/24 at 01:40 p.m. she stated she contacted the psychiatric provider, and they stated they never received the referral. She stated she had never followed up after making a referral, she just sent them. She stated she was not sure who was responsible for following up when referrals were made. She stated she never spoke with the psychiatric provider and had no idea which resident's they were seeing when they came to the facility. In an interview with the Administrator 01/24/24 at 02:00 p.m. she revealed it was the Social Workers responsibility to follow up on any ancillary service referred. She stated they would put a system in place where referrals made were checked off when the ancillary service came and provided the services. She stated not following up could cause a delay in care and services to the residents. In an interview with the DON 01/24/24 at 02:05 p.m. she stated the Social Worker was responsible for making the referral to the psychiatric provider and following up to ensure the services had been provided. She stated failing to do this causes a delay in the resident receiving necessary services and a possible mental decline and helps determine if the resident is on the proper medications. In an interview with Resident #7's family member on 01/24/23 at 3:54 p.m. she stated the facility had requested her consent for psychiatric services with Resident #7 admitted to the facility. She stated she consented and stated the resident had been on those services at the previous facility. She stated the resident had been treated for depression for several years. She stated she wanted the Resident to have these services if would help with depression and dementia. Record review of the facility's policy titled, Behavior Management- Social Service Referral, dated February 2020, reflected, Standards of Practice: The staff will make social services referrals as deemed appropriate when the resident's behavioral incident and/or accident pattern increases . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 11 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure residents who had not used psychotropic drugs were not given these drugs unless the medication was necessary to treat a condition as diagnosed and documented in the clinical record, and the resident received behavioral interventions unless clinically contraindicated in an effort to discontinue these drugs for 1 (Resident #86) of 5 residents reviewed for unnecessary medications. The facility failed to attempt gradual dose reduction for Resident #86's Divalproex (antipsychotic) and Seroquel (antipsychotic) medications. The facility failed to have specific side effect monitoring for Resident #86s Divalproex and Seroquel medications. These failures could place residents at risk for possible adverse side effects, adverse consequences, and decreased quality of life. Findings included: Review of Resident #86's face sheet dated 01/25/24 reflected Resident #86 was a [AGE] year old female admitted to the facility on [DATE] with diagnoses of Alzheimer's disease, Dysphagia, Cognitive Communication Deficit and Generalized Anxiety Disorder. Review of Resident #86s Significant Change MDS assessment dated [DATE] reflected Resident #86 was readmitted to the facility on [DATE] with diagnoses of Alzheimer's disease, malnutrition, anxiety disorder, depression, bipolar disorder and dementia. Resident #86 had a BIMS of 99 indicating she was severely cognitively impaired. Resident #86 had physical behavioral symptoms directed toward others, verbal behavioral symptoms directed toward others and other behavioral symptoms not directed toward others. Resident #86 received antianxiety, antidepressant and antipsychotic medications. Resident #86 received antipsychotics on a routine basis only and no GDR had been attempted. It reflected GDR had not been documented by a physician as clinically contraindicated. Review of Resident #86's Comprehensive Care Plan last reviewed on 12/13/23 reflected the following: Resident #86 was on Anticonvulsant related to: mood stabilizer and history of behaviors evidenced by Divalproex medication. Interventions included ask physician to review medication for possible dose reduction every three months and observe for possible side effects. Resident #86 psychotropic drug use related to history of dementia with behaviors evidenced by Quetiapine medication and dementia with psychosis. Interventions included monitor behavior every shift and document, observe for possible side effects every shift: muscle rigidity, bladder retention, orthostatic hypotension, sedation, dry mouth, balance problem, unsteady gait, restlessness and physician to review medication for possible dose reduction. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 12 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #86's January physician orders dated 01/25/24 reflected Resident #86 was on the following antipsychotic medications: Dated 12/19/23 to 01/12/24 Divalproex (Depakote) 250 mg tablet, delayed release - 1 tablet by mouth daily for Bipolar disorder at 7:00 AM. Dated 01/12/24 Divalproex 125 mg capsule, delayed release sprinkle 1 capsule by mouth every morning for Alzheimer's disease at 7:00 AM. Dated 11/30/23 to 01/10/24 Divalproex 125 mg capsule, delayed release sprinkle 3 capsules by mouth for persistent mood [affective] disorder at 16:30 Dated 01/20/24 Divalproex 250 mg capsule, delayed release sprinkle 3 capsules by mouth for persistent mood [affective] disorder at 16:30 Dated 08/21/23 Quetiapine (Seroquel) 50 mg tablet - 1 tablet by mouth 3 times per day (7:00, 11:00 and 15:00) for Dementia with other behavioral disturbance Review of Resident #86's October 2023 to January 2024 MAR reflected the following: Dated 08/03/23 to 10/30/23 Resident #86 received Divalproex 125 mg tablet at 7:00 AM Dated 10/30/23 to 11/03/23 Resident #86 received Divalproex 125 mg capsule - 2 capsules at 7:00 AM Dated 01/12/24 Resident #86 received Divalproex 125 mg tablet at 7:00 AM Dated 08/08/23 to 11/03/23 Resident #86 received Divalproex 500 mg capsule - 1 capsule at 5:30 PM Dated 11/30/23 to 01/10/24 Resident #86 received Divalproex 125 mg capsule - 3 capsules at 4:30 PM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 13 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0758 - Level of Harm - Minimal harm or potential for actual harm Dated 01/10/24 Resident #86 received Divalproex 250 mg capsule - 3 capsules at 4:30 PM - Residents Affected - Few Dated 10/30/23 to 11/30/23 Resident #86 received Divalproex 125 mg capsule - 4 capsules at 8:00 PM Dated 08/21/23 Resident #86 received Quetiapine (Seroquel) 50 mg tablet - 1 tablet by mouth 3 times per day at 7:00, 11:00 and 15:00. There was no side effect monitoring for Divalproex and Quetiapine medications. Review of Resident #86's pharmacy recommendation dated 10/19/23 and signed 10/27/23 by physician reflected the combined use of two or more antipsychotic medications has not been demonstrated to be more effective than single agent and has the potential for increased side effects. Please review the duplicate antipsychotic therapy with Quetiapine, Risperidone and Divalproex .Checked All medications are to be continued as they improve the quality of this resident's life. The benefits outweigh the risks. Physician documented arrange with psych consult. Review of December 2023 to January 2024 behavioral monitoring reflected the following behaviors: There were no behaviors of physical aggression and refusing care documented in December 2023. Dates on 01/02/24, 01/14/24 an 01/21/24 revealed Resident #86 had physical aggression. Dates on 12/30/23, 01/11/24, 01/14/24, 01/21/24 revealed Resident #86 had restlessness behaviors. Dates on 12/01/23, 12/03/23 and 12/04/23, 01/14/24, 01/17/24 and 01/21/24 revealed Resident #86 had wandering behavior. Further review of the behavior monitoring revealed it did not specify specific side effects to the medications to monitor for Quetiapine and Divalproex medications. Review of Nurses notes from November 2023 to January 2024 reflected the following: -Dated 01/05/24 by RN H Resident #86 had a witnessed fall in tv room with no injuries and vital signs stable. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 14 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few -Dated 12/14/23 by LVN Q Resident #86 was seen by psychiatry with new order to increase am Depakote to 250 mg Q AM .[family member] in agreeance, mar reflects changes. -Dated 12/13/23 by LVN S Resident #86 had unwitnessed with head injury, laceration to right front part of scalp .on call notified, ordered for resident to be seen out for evaluation and stitches and UA with culture to be performed upon return .Resident RP notified, Resident sent via 911, stretcher with EMS. -Dated 12/07/23 by LVN T Resident #86 observed falling by one of the CNA's. Resident seen by this nurse onsite. Resident has mild swelling to right side of forehead with small laceration. Area cleaned and covered with bandage. Resident assisted to room d/t restlessness and multiple attempts to get up on her room .DON, NP and son notified of fall. Resident in no distress at this time. Will continue to monitor for any changes. -Dated 11/30/23 by LVN Q Resident #86 seen by NP with new order for Depakote 125 po in the morning and 375 mg at bedtime, Lorazepam 0.5 mg . -Dated 11/21/23 by LVN S Resident #86 fell in the hallway while walking unassisted. Fall was unwitnessed but CNAs responded fast in help resident up. Nurse performed full body assessment, skin intact .no bruising, abrasions or redness noted. When checking range of motion resident showed (signs) of pain when lifting her right shoulder. ADON notified, .on call notified, left a message for family. Order for stat shoulder x-ray or neuro checks in place. -Dated 11/14/23 by LVN S Resident #86 was walking in the hallway unassisted when she seemed to become weak and fell to ground, resident did hit her head. Witnessed by nurse at the nursing station. Resident normally ambulates with no assistance or devices. On call was notified, resident placed on neuro check. ROM checked. Skin intact, no injuries noted. Supervisor and family notified . Review of Resident #86's Psychiatric assessment dated [DATE] reflected Resident #86 had diagnoses of bipolar disorder, anxiety disorder and dementia. Resident #86 is unable to provide information due to cognitive impairment. Pt is poorly engaged in interview due to cognitive impairment and confusion. Pt has minimal interaction with provider. Patient doesn't appear to have depressive however anxiety noted with anxious mood .per staff: behaviors have improved slightly however pt continues to be restless. Observations on 01/23/24 at 9:43 AM, 9:52 AM and 1:12 PM Resident #86 sleeping in her bed. Observation on 01/24/24 at 8:12 AM revealed Resident #86 was sleeping in her room lying down. Observation on 01/24/24 at 9:12 AM revealed Resident #86 was sleeping in her room lying down. Observation and Interview on 01/24/24 at 9:16 AM revealed MA M was in Resident #86's room feeding Resident #86 with head of bed elevated but Resident #86 had to be prompted and woken up by MA M since Resident #86 was sleepy. MA A stated she had just started feeding Resident #86 since she was sleeping so she waited to assist Resident #86 after she was done in dining room with other residents. She stated Resident #86 would grab and eat other residents' food so she feed her in her room. MA M stated sometimes Resident #86 slept in especially if she had trouble sleeping the night before. Interview on 01/25/24 at 10:25 AM with the DON stated Resident #86 had no gradual dose reduction (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 15 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few for her antipsychotic medications of Depakote and Seroquel. She stated the Consultant Psychiatrist was at the facility today who was currently seeing Resident #86 for psychiatric services. Interview on 01/25/24 at 11:10 AM with Consultant Psychiatrist revealed she first met with Resident #86 on 11/03/23 doing her initial psychiatric assessment. She stated Resident #86 was extremely agitated, kept saying repetitive responses like fine, fine, fine and blurting out. She stated Resident #86 showed no signs of psychosis or depression. She stated Resident #86 was on psychotropic medications for Bipolar mixed episodes. She stated she made no psychotropic medication changes at this time since it was first time meeting with Resident #86 and would look at gradual dose reduction of her psychotropic medications. She stated nursing staff told her the previous psychiatrist medicated Resident #86 due to behavioral issues of aggression and wandering. She stated on her next visit with Resident #86 on 11/13/23 the nursing staff mentioned to her about increased aggression, agitation and combative toward others so she made medication changes. She stated she changed Resident #86's am Depakote dose from 125 mg to 250 mg and kept the Depakote dosage at bedtime the same. She stated the facility did not communicate to her about pharmacy recommendations of gradual dose reduction. She stated she had not reviewed Resident #86's behavioral monitoring and based her decisions about psychotropic medications on staff interviews about Resident #86's behaviors. She stated her plan was to work on decreasing Depakote doses first and then address the Seroquel medication. She stated she was not sure when the last gradual dose reduction was for Seroquel and Depakote medications for Resident #86. She stated staff had not reported to her about Resident #86 becoming more sleepier in the morning. She stated the risk to residents with dementia being on antipsychotics could place residents at risk for falls. She stated both antipsychotics could make Resident #86 more tired and sleepier. She stated she would review and make changes to Resident #86's psychotropic medications today. Interview on 01/25/24 at 11:58 AM with the ADON revealed Resident #86 had been more sleepier the last 2 days and yesterday he noticed she was sleeping more at breakfast. He stated Resident #86 did get up for breakfast and would grab other resident's food on their plates. He stated he was not certain if there were specific side effects for Resident #86. He stated side effects for Seroquel and Depakote were increased drowsiness/sleeping, change in cognition from normal, change in appetite. He stated the nurses should be documenting behaviors for Resident #86 on the behavioral monitoring documentations and any side effects to medications on a nurse progress note. ADON was not aware of Depakote medication side effect could be increased agitation or aggressive behaviors. He stated he did not review the pharmacy recommendations but the DON reviewed them. Interview on 01/25/24 at 12:25 PM with LVN Q revealed he noticed yesterday Resident #86 had been sleeping more than usual. He stated Resident #86 was more active and increased behaviors usually in the evening and night. He stated he would be concerned for Seroquel side effects if resident had increased drowsiness/sleepiness, change in activity level from usual and decrease in appetite. He stated Resident #86 grabbed other residents' food when she was in dining room with other residents during meal time. LVN Q stated Depakote side effects could be increased drowsiness/sleepiness and increase in aggression/agitation behavior. He stated they monitored resident's behaviors on the behavioral monitoring each shift. Interview on 01/25/24 at 2:37 PM with LVN R revealed Resident #86 had increased behaviors of wandering, grabbing and eating other residents' food, screaming and aggressive towards staff. She stated sometimes redirection helped but other times it did not. She stated the side effects to Seroquel and Depakote were drowsiness, lethargic, eating less than usual. She stated she had not noticed any side effects for Resident #86. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 16 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 01/25/24 at 2:32 PM with Pharmacy Consultant revealed he expected the facility to try gradual dose reduction for Seroquel and Depakote medications every 4 months when stable. He stated the risk for residents with dementia on would be falls. He stated the side effects of Seroquel and Depakote would be drowsiness and dizziness. Interview on 01/25/24 at 3:10 PM with DON revealed the charge nurses could review the consents for Seroquel and Depakote if they were not aware of the specific side effects. She stated the facility had not attempted a Seroquel gradual dose reduction for Resident #86 since admit and the note in physician's November note reflected about gradual dose reduction attempt for Depakote not being effective. She stated she referred to the policy on psychotropic drug use and gradual dose reduction. She stated residents with dementia diagnosis with psychotropic medication use placed the resident at risk for increased falls and dehydration. She stated moving forward she would communicate with psych services about gradual dose reduction and psychotropic drug use. She expected the nurse staff to document residents with behaviors on the behavioral monitoring tool. Review of facility's policy Psychotropic Drugs - Use revised 07/27/22 reflected the facility will use psychotropic drug therapy when appropriate to enhance the quality of life, while maximizing functional potential and well-being of the patient/resident. 2. Qualified staff will monitor the patient/resident for potential undesirable side effects that are associated with the use of the psychotropic drugs according to CMS, State specific rules and regulation and Practice Guidelines .For drug therapy: Within the first year in which a resident is admitted on a psychotropic medication or after the facility has initiated a psychotropic medication: GDR attempts in two separate quarters with at least one month between the attempts. The GDR must be attempted annually thereafter unless clinically contradicted. Non-pharmacological approaches must be attempted and documented instead of using psychotropic medications, along with use of psychotropic medications, and while GDR is attempted .Antipsychotic drugs are not used if one or more of the following is/are the ONLY indication: 1. Wandering 2. Poor self-care 3. Restlessness 4. Impaired memory 5. Anxiety 6. Depression 7. Insomnia 8. Unsocialability 9. Indifference to surroundings 10. Fidgeting 11. Nervousness 12. Uncooperativeness, or agitative behaviors which do not represent a danger to the patient/resident or others .Monitor and report side effects to the physician and document in the patient's medical record. 7. Physician and consulting pharmacist will review the progress of the patient/resident and advise the nursing staff of goal, plan to maintain the patient/resident at the lowest possible dose necessary to control symptoms. 8. Monitoring and evaluation of the patient/resident for the potential of antipsychotic medication is an ongoing progress through the Standards of Care Meeting. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 17 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 - Some 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 observation, interview, and record review the facility failed to label drugs and biologicals used in the facility in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 2 (600 hall nurses' medication cart and 400 hall nurses' medication cart) of 4 medication carts reviewed for pharmacy services in that: The facility failed to ensure: 1- The 600 Hall medication cart had 2 insulin pens for Resident #18 without an opened date. 2- The 400 Hall medication cart had 1 insulin pen for Resident #54 without an opened date. These failures could affect residents resulting in diminished effectiveness, and not receiving the therapeutic benefits of the medications. The findings include: 1- Record review of Resident #18's Quarterly MDS, dated [DATE], revealed the resident was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses included type 2 diabetes mellitus, elevated blood pressure, and hyperlipidemia (too many lipids and fats in the blood). She had a BIMS score of 09 indicating her cognition was cognitively moderately impaired. Record review of Resident #18's physician's orders dated January 2024 revealed an order for Humulin 70/30 U-100 insulin 100 unit/ml subcutaneous suspension. Inject 52 units subcutaneously every morning. Humulin R Regular U-100 insulin 100 unit/ml injection solution units per sliding scale. Subcutaneous before meals and at bedtime 0-149=0 units, 150-199=2 units, 200-249=4 units, 250-299=6 units, 300-349=8 units Observation on 01/23/2024 at 3:05 PM revealed the 600-hall nurse's medication cart had a pen of Humulin 70/30 U-100 insulin 100 unit/ml, and a pen of Humulin R Regular U-100 insulin 100 unit/ml for Resident #18, did not have an opened date. Interview on 01/23/2024 at 3:08 PM, LVN A stated the 2 pens of insulin belong to Resident #18 did not have an open date. LVN A stated she used both pen in the morning. She stated she forgot to check if there was an open date on the pens. LVN A stated the purpose for putting an open date was for expiration purposes because the insulin was only good for 28 days. 2- Record review of Resident #54's Comprehensive MDS, dated [DATE], revealed the resident was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses included type 2 diabetes mellitus, elevated blood pressure, and hyperlipidemia (too many lipids and fats in the blood). He had a BIMS score of 10 indicating her cognition was cognitively moderately impaired. Record review of Resident #54's physician's orders dated January 2024 revealed an order for Lantus Solostar U-100 insulin 100 unit/ml (3ml) subcutaneous pen (insulin glargine, human recombinant (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 18 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 analog) 45 units subcutaneous at bedtime. Level of Harm - Minimal harm or potential for actual harm Observation on 01/23/2024 at 3:15 PM revealed the 400-hall nurse's medication cart had a pen of Lantus Solostar U-100 insulin 100 unit/ml (3ml), did not have an opened date. Residents Affected - Some Interview on 01/23/2024 at 3:17 PM, LVN B stated the pen of insulin belong to Resident #54 did not have an open date. LVN B stated he did not give the insulin yet because it was due at bedtime. LVN B stated he did not know when the pen was opened and he stated the nurse who opened the pen supposed to put the open date, because the insulin was good only for 28 days after it was opened. LVN B stated the risk would be giving ineffective insulin to resident. Interview on 01/24/24 at 12:20 PM, the DON stated the insulin flex pens, once opened, needed to be dated because each insulin pen had a 30 or 40 days shelf life and if not thrown out before that time the insulin could lose its effectiveness. The DON stated the Assisted DON and the DON were supposed to do random check of the medication carts for monitoring. Record review of the facility's policy titled Storage of Medication, dated September 2018, revealed in part .12. Insulin products should be stored in the refrigerator until opened. Note the date on the label for insulin vials and pens when first used. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 19 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide food with appetizing temperature for one (01/24/24 breakfast) of one meal reviewed for appetizing temperature. Residents Affected - Some The facility failed to serve eggs and oatmeal that had a palatable texture during the breakfast meal on 01/24/24. This failure could affect residents by placing them at risk of weight loss, altered nutritional status, and a diminished quality of life. Findings included: Review of Resident #7's quarterly MDS assessment dated [DATE] reflected Resident #7 was an [AGE] year old female admitted to the facility on [DATE]. Resident #7 had a BIMS of 9 indicating she was moderately cognitively impaired. Interview on 01/23/24 at 9:25 AM with Resident #7 revealed breakfast was late today and her eggs were cold. She stated hall trays get served last if they chose to eat in their rooms. Review of Resident #10's quarterly MDS dated [DATE] reflected Resident #10 was a [AGE] year-old male admitted to the facility on [DATE]. Resident #10 had a BIMS of 11 indicating he was moderately cognitively impaired. Interview on 01/23/24 at 12:17 PM with Resident #10 revealed his food was cold for his meals and eggs were cold at breakfast for his meals. He stated he ate in his room for meals and ate in his room. Observation on 01/24/24 at 8:10 AM reveal breakfast trays for secure unit were brought to secure unit by Dietary Aide. Observation on 01/24/24 at 8:12 AM revealed Resident #86 was sleeping in her room lying down. Observation on 01/24/24 at 9:12 AM revealed Resident #86 was sleeping in her room lying down. Observation on 01/24/24 at 9:15 AM revealed dining room breakfast trays for secure unit were being put on cart after breakfast in dining room and staff assisted residents out of secure unit after breakfast. Observation and Interview on 01/24/24 at 9:16 AM revealed MA M was in Resident #86's room feeding Resident #86 with head of bed elevated. MA A stated she had just started feeding Resident #86 her eggs and was on vegetarian diet. She had eggs and toast on her breakfast plate. MA A stated Resident #86 was sleeping so she waited to assist her after done in dining room with other residents. She stated Resident #86 would grab and eat other residents' food so she feed her in her room. MA M stated the eggs were barely warm. Observation on 01/24/24 at 9:22 AM revealed facility staff passing out hall breakfast trays to residents on 600 hall and test tray was on cart. Observation at 9:31 AM revealed last hall tray was served to resident room [ROOM NUMBER]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 20 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation on 01/24/24 at 9:33 AM of breakfast test tray revealed plate had cover and oatmeal was covered with plastic lid. Test tray revealed eggs were cold to touch and tasted cold. Test tray revealed oatmeal was covered with plastic lid with no steam and tasted cold. Follow-up interview with Resident #7 on 01/24/24 at 9:46 AM revealed her breakfast was usually cold. She further stated her eggs this morning were cold and would have liked them warmer. She stated she ate her breakfast in her room for meals. Confidential group interview with six of six residents on 01/24/24 at 10:00 AM revealed breakfast was cold. One of the residents in group stated the eggs were cold this morning. Record Review of Resident Council Minutes for the November 2023, December 2023 and January 2024 did not mention about cold food. Interview on 01/24/24 at 9:42 AM with the Dietary Manager revealed he expected breakfast to be served to residents warm. He stated the eggs and oatmeal should not be cold when served. He stated hall trays were the last to be served for meals. He stated secure unit got their meal trays first, then dining room and last were hall trays for the nonsecure unit halls. The Dietary Manager stated he was aware of Resident #10 complaining of cold breakfast food. Review of facility's policy Hot and Cold Food Temperatures dated 08/01/18 reflected The temperatures of the food items will be managed to conserve maximum nutritive value and flavor .All hot food items must be served to the resident at a palatable temperature. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 21 of 22 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 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 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 - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for one of one kitchen reviewed for kitchen sanitation. The facility failed to ensure Dietary Aide O had an effective hair restraint during breakfast meal serving on 01/23/24. This failure could place residents at risk for food-borne illness and food contamination. Findings include: Observations on 01/24/24 from 8:37 AM to 9:01 AM during breakfast meal preparation revealed Dietary Aide O did not have a hair restraint covering the front of her hair about 1 inch on forehead and 1/2 inch in front of both ears while she plated food for resident hall trays. Interview on 01/24/24 at 9:08 AM with Dietary Aide O revealed she was unaware her hair restraint was not covering [NAME] her hair in the front. She stated she had been in-serviced on wearing effective hair restraint when in kitchen. Interview on 01/24/24 at 9:11 AM with the Dietary Manager revealed he expected all dietary staff to wear effective hair restraints to cover all hair. He stated not wearing an effective hair restraint can cause food contamination. Review of facility's in-service dated 10/2/23 on dress code reflected Dietary Aide O was in-serviced along with all dietary staff. Record review of the facility's policy titled Employee Sanitary Practices, undated, reflected All employees shall: 1. Wear restraints . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 22 of 22