Health inspection·March 31, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm the blood vessels outside of the heart and brain) with a goal initiated 12/26/23 of resident's extremities will be free from pain, pallor (skin paleness), rubor (term for redness, sign of inflammation), coldness, edema (excess fluid in the body's tissues, causing swelling), and skin lesions with interventions initiated 11/20/23 of give medications for improved blood flow or anticoagulants (medications that prevent blood clots from forming) as ordered. Residents Affected - Some A focus revised on 09/10/24 of resident uses psychotropic medications (drugs that affect the mind, emotions, and behavior) Seroquel, Haldol and lithium related to behavior management, disease process (schizophrenia) with a goal initiated 11/14/2023 of resident will be/remain free of psychotropic drug related complications, including movement disorder and discomfort, hypotension, gait disturbance, constipation/impaction or cognitive/behavioral impairment and interventions and the resident will reduce the use of psychotropic medications with interventions dated 11/14/23 of administer psychotropic medications as ordered by physician, monitor for side effects and effectiveness and monitor/document/report PRN any adverse reactions of psychotropic medications: unsteady gait, tardive dyskinesia (a movement disorder), EPS (shuffling gait, rigid muscles, shaking), frequent falls, refusal to eat, difficulty swallowing, dry mouth, depression, suicidal ideations, social isolation, blurred vision, diarrhea, fatigue, insomnia, loss of appetite, weight loss, muscle cramps nausea, vomiting, behavioral symptoms not usual to the person. A focus revised on 12/26/23 of resident was on diuretic therapy (medications that increase urine output by promoting the excretion of sodium, water, and other electrolytes through the kidneys (Lasix medication) related to hypertension with a goal initiated on 12/26/23 of resident will be free of any discomfort or adverse side effects of diuretic therapy with interventions initiated 12/26/23 of administer diuretic medications as ordered physician, monitor for side effects and effectiveness, many other medications may interact with antihypertensives (drugs used to treat high blood pressure) to potentiate their effect, monitor for interactions/adverse consequences, monitor dose, may require modification in order to achieve desired effects while minimizing adverse consequences, especially when multiple antihypertensives are prescribed simultaneously. When discontinuing, gradual tapering may be required to avoid adverse consequences caused by abrupt cessation. A focus dated 03/10/24 of resident used antidepressant medication trazadone related to depression and a goal initiated on 03/10/24 of resident will be free from discomfort or adverse reactions related to antidepressant therapy and interventions dated 03/10/24 of administer antidepressant medications as ordered by physician monitor/document side effects and effectiveness. A focus revised on 12/26/23 of resident had a mood problem with a goal revised on 12/26/23 of resident will have improved mood state happier, calmer appearance, no signs and symptoms of depression, anxiety or sadness and interventions initiated 12/26/23 of administer medications as ordered and monitor/document for side effects and effectiveness and behavioral health consults as needed. A focused revised on 03/10/24 of Resident #1 has episodes of refusal to take medications and is at risk for complication and injury/side effects with a goal revised on 03/10/24 of resident will have minimum/no further episodes of medication refusal and will be free from injury/side effects over the next 90 days and interventions dated 01/01/24 of offer medications at scheduled times and re-offer at a later time if refused. A review of Resident #1's quarterly MDS reflected a brief interview for mental status was not conducted because resident was rarely/never understood. Section N Medications reflected high-risk classes used and indicated resident was taking antipsychotic, antianxiety, antidepressant, and diuretic. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 2 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0755 Review of Resident #1's MAR reflected the following Chart Codes: Level of Harm - Minimal harm or potential for actual harm 3 = hold due to condition 8 = other/see progress notes Residents Affected - Some 11 = sleeping 12 = split out medication Review of Resident #1's orders reflected an order for Atorvastatin Calcium Oral Tablet 20 MG, give 1 tablet by mouth one time a day related to hyperlipidemia (a condition characterized by high levels of lipids (fats) in the blood) start date 10/09/14 D/C 03/27/25 A review of the MAR reflected Resident #1 was not administered Atorvastatin Calcium Oral Tablet 20 MG on 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/19/25 (chart code 11), 02/20/25 (chart code 8), 02/21/25 (chart code 8), 02/22/25 (chart code 11), 02/23/25 (chart code 11) Review of Resident #1's orders reflected an order for Lasix Oral tablet 40 MG (Furosemide (a type of medicine called a diuretic used to treat high blood pressure (hypertension), heart failure and a build up of fluid in the body) give 1 tablet by mouth one time a day related to edema (a condition where excess fluid accumulates in the body's tissues, causing swelling) start date 10/09/24 D/C 03/27/25 A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Lasix Oral tablet 40 MG on 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/19/25 (chart code 11), 02/20/25 (chart code 8), 02/21/25 (chart code 8), 02/22/25 (chart code 11), 02/23/25 (chart code 11) Review of Resident #1's orders reflected an order for Lithium Carbonate (to treat manic-depressive disorder (bipolar disorder)) oral tablet extended release 450 MG give 1 tablet by mouth in the morning related to schizoaffective disorder, bipolar type. A review Resident #1's 02/2024 MAR reflected Resident #1 was not administered Lithium Carbonate oral tablet extended release 450 MG medication on 02/16/25 (chart code 8), 02/17/25 (chart code 3), 02/20/25 (chart code 3), 02/21/25 (chart code 8), 02/23/25 (chart code 11) Review of Resident #1's orders reflected an order for Melatonin Tablet 3 MG give 2 tablets by mouth at bedtime related to insomnia, give 2 tabs to equal 6 MG. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Melatonin Tablet 3 MG give 2 to equal 6 MG on 02/09/2025 (no chart code entered, reflected no medication administered), 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/18/25 (no chart code entered, no medication administered) Review of Resident #1's orders reflected an order for methimazole (used to treat hyperthyroidism, a condition that occurs when the thyroid gland produces too much thyroid hormone) give 1 tablet by mouth one time a day related to thyrotoxicosis (a condition characterized by excessive thyroid hormone (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 3 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0755 levels in the bloodstream) start date 11/08/23 D/C 03/27/25. Level of Harm - Minimal harm or potential for actual harm A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered methimazole 1 tablet by mouth one time a day 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/19/25 (chart code 11), 02/20/25 (chart code 8), 02/21/25 (chart code 8), 02/22/25 (chart code 11) and 02/23/25 (chart code 11). Residents Affected - Some Review of Resident #1's orders reflected an order for Seroquel (an antipsychotic medication that treats several kinds of mental health conditions including schizophrenia and bipolar disorder) oral tablet 100 MG give 2.5 tablets to equal 250 mg start date 10/09/24 D/C date 03/27/25. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Seroquel oral tablet 100 MG give 2.5 tablets to equal 250 mg 02/09/25 (no chart code entered, reflected no medication administered), 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/18/25 (no chart code entered, reflected no medication administered), 02/20/25 (chart code 8), 02/21/25 (chart code 8), and 02/23/25 (chart code 8). Review of Resident #1's orders reflected an order for trazodone (used to treat depression, anxiety, or a combination of depression and anxiety) give 1.5 tablet by mouth in the evening related to major depressive disorder, recurrent start date 12/09/24 D/C 03/27/26. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered trazodone 1.5 tablet on 02/15/25 (chart code 8), 02/16/25 (code 3), 02/17/25 (code 8), 02/20/25 (code 8), 02/21/25 (code 8), 02/22/25 (code 11) and 02/23/25 (code 11). A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Vitamin D-3 oral capsule 24 MCG (1000 UT) give 2 capsules by mouth 1 time a day related to vitamin D deficiency start date 11/08/23 and D/C date 03/27/25. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Vitamin D-3 oral capsule 24 MCG (1000 UT) 2 capsule by mouth 1 time a day on 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/19/25 (chart code 11), 02/20/25 (chart code 8), 02/21/25 (chart code 8), 02/22/25 (chart code 11), 02/23/25 (chart code 11). Review of Resident #1's orders reflected an order for Seroquel oral tabled 50 MG quetiapine fumarate (antipsychotic used to treat schizophrenia, bipolar disorder and depression) give 1 tablet by mouth 2 times a day (8:00 am and 4:00 pm) related to schizoaffective disorder bipolar type start date 01/13/25 D/C 03/27/25. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Seroquel oral tabled 50 MG on 02/15/25 at 4:00 pm (chart code 8), on 02/16/25 at 8:00 am (chart code 8) or 4:00 pm (chart code 3), 02/17/25 at 8:00 am (chart code 8) or 4:00 pm (chart code 3), 02/19/25 at 4:00 pm (chart code 11), 02/20/25 at 8:00 am (chart code 3) or 4:00 pm (chart code 8), 02/21/25 at 8:00 am (chart code 8) or 4:00 pm (chart code 8), 02/22/25 at 4:00 pm (chart code 11), 02/23/25 at 8:00 am (chart code 11) or 4:00 pm (chart code 11). Review of Resident #1's orders reflected an order for buspirone HCI (treats anxiety) tablet 10 MG Buspirone HCI give 1 tablet by mouth 3 times a day (8:00 am, 12:00 pm and 4:00 pm) related to anxiety disorder start date 01/27/25 D/C. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 4 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered buspirone HCI tablet 10 MG 3 times a day on 02/05/25 at 12:00 pm (no chart code entered, reflected no medication administered), 02/10/25 at 12:00 pm (no chart code entered, reflected no medication administered), 02/15/25 at 12:00 pm (chart code 3) or 4:00 pm (chart code 8), 02/16/25 at 8:00 am (chart code 8) or 12:00 pm (chart code 8) or 4:00 pm (chart code 3), 02/17/25 at 8:00 am (chart code 3) or 12:00 pm (chart code 3) or 4:00 pm (chart code 8), 02/18/25 at 12:00 pm (chart code 12:00 pm), 02/19/25 4:00 pm (chart code 11), 02/20/25 8:00 am (chart code 3) or 12:00 pm (chart code 3) or 4:00 pm (chart code 8), 02/21/25 8:00 am (chart code 8) or 12:00 pm (chart code 8) or 4:00 pm (chart code 8), 02/22/25 12:00 pm (chart code 12) or 4:00 pm (chart code 11), and 02/23/25 8:00 am (chart code 11) or 12:00 pm (chart code 11) or 4:00 pm (chart code 11). Review of Resident #1's orders reflected an order for Lorazepam Oral Tablet 1 MG Lorazepam (to treat anxiety and sleeping problems that are related to anxiety) give 1 mg by mouth three times a day (9:00 am, 1:00 pm, and 9:00 pm) related to anxiety disorder start date 02/05/2025 D/C 03/27/2025. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Lorazepam Oral Tablet 1 mg by mouth three times a day on 02/09/25 at 9:00 pm (no chart code entered, reflected no medication administered), 02/10/25 at 1:00 pm (no chart code entered, reflected no medication administered), 02/15/25 at 1:00 pm (chart code 3) or 9:00 pm (chart code 8), 02/16/25 9:00 am (chart code 8), 1:00 pm (chart code 8) or 9:00 pm (chart code 3), 02/17/25 9:00 am (chart code 3) or 1:00 pm (chart code 3), or 9:00 pm (chart code 8), 02/18/25 1:00 pm (chart code 11) or 9:00 pm (no chart code entered, reflected no medication administered), 02/20/25 9:00 am (chart code 3) or 1:00 pm (chart code 3) or 9:00 pm (chart code 8), 02/21/25 9:00 am (code 8) or 1:00 pm (chart code 8) or 9:00 pm (chart code 8), 02/22/25 1:00 pm (chart code 12), 02/23/25 9:00 am (chart code 11) or 1:00 pm (chart code 11) or 9:00 pm (chart code 11). Review of Resident #1's progress note dated 02/15/2025 at 12:45 am reflected Administration Note entered by CMA B HOLD PER NURSE. No information recorded on what medication or treatment, or resident care was being held. Review of Resident #1's progress note dated 02/15/2025 5:12 pm reflected Administration Note entered by CMA B [resident] WAS SLEEPING. NO MEDS GIVING. Review of Resident #1's progress note dated 02/16/2025 9:27 am reflected Administration Note by CMA B [resident] WAS ASLEEP. NURSE WAS NOTIFIED. Review of Resident #1's progress note dated 02/16/2025 5:32 pm reflected Administration Note (no staff listed) [resident] HAS BEEN SLEEPING. NURSE INFORMED. MEDS NOT GIVEN. Review of Resident #1's progress note dated 02/17/2025 8:54 am reflected Administration Note entered by CMA B [resident] WAS SLEEPING. NURSE NOTIFIED. Review of Resident #1's progress note dated 02/17/2025 4:41 pm reflected Administration Note by CMA B [resident] WAS ASLEEP UNABLE TO GIVE MEDS NURSE WAS NOTIFIED. Review of Resident #1's progress note dated 02/20/2025 8:29 am reflected Administration Note by CMA B WAS NOTIFIED TO HOLD MEDS. [resident] IS SLEEPING. Review of Resident #1's progress note dated 02/20/2025 5:52 pm reflected Administration Note by CMA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 5 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0755 B [resident] WAS SLEEPING. MEDS NOT GIVEN. NURSE WAS NOTIIFED. Level of Harm - Minimal harm or potential for actual harm Review of Resident #1's progress note dated 02/21/2025 8:34 am Administration Note by CMA B [resident] RES WAS SLEEPING. NURSE NOTIIFED. Residents Affected - Some Review of Resident #1's progress note dated 02/21/2025 5:52 pm Administration Note by CMA B MEDS NOT GIVEN. [resident] IS SLEEPING NURSE NOTIFIED. A review of Resident #1's progress notes revealed no additional information documenting why Resident #1 was not administered medication. Interview on 04/03/2025 with CMA B at 12:15 pm reflected if a resident was sleeping, she generally would not wake them. She stated she would go to the next resident then come back later. She stated if the resident did not get up then she would need to go tell her charge nurse. She stated after the nurse checked on the resident, she was supposed to do what the nurse told her. She stated, sometimes they just do not want to get up so the nurse would document the resident refused the meds. Interview on 03/28/25 at with RN C at 12:18 pm revealed she knew that the Psych NP was adjusting Resident #1's medications and the Psych NP should have been informed that Resident #1 had not had her medications. The negative consequences of a resident not receiving medications would be that the resident would not receive the effectiveness of the medications, especially if they missed numerous medication doses. Interview on 03/27/24 with LVN A at 3:44 pm revealed she had worked at the facility since December of 2004 and assisted with Resident #1 and was not aware that Resident #1 was not getting her medications. She revealed if a resident did not get their medications, then they would follow up with the NP who would advise them what to do. The negative effect of someone not getting their medications would be that they might have a chance in condition. Interview on 03/27/25 with the Psych NP at 1:43 p.m. revealed, when was asked if she knew that Resident #1 did not receive her mental health medications for several days, she said she did not know. She said that would be a problem because Resident #1 had interesting and complicated mental health issues and she had been working on adjusting her medications and a change of medication could make her decompensate pretty quickly. Interview on 03/27/25 with the NP at 1:58 pm revealed she did not know that Resident #1 did not receive her medications. If she had known Resident #1 was sleeping through her medication, she might have sent her to the ER because the hospital will process labs faster and the facility might be able to have information to treat the resident faster. If a resident is not receiving medication, it could be a change in for that resident. Interview on 03/31/25 with the DON at 1:50 pm revealed when a resident does not receive ordered medication, an adjustment might need to be made to their medication, but this would depend on how many doses of medication the resident missed. Missed medication may also require labs. If a resident is asleep, and the medication is important, the resident should be woken up for them to take the medication. If they continue to be asleep during medication administration times, an adjustment might need to be made to the resident's medication administration times. If the resident missed medication doses, the resident might have a change in condition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 6 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of facility Nursing Policies and Procedures Subject: Medication Administration and Management Policy dated June 2019 reflected: It is the policy of this facility that the facility will implement a Medication Management Program that incorporates systems with established goals to meet each resident's needs as well as regulatory requirements. Administering the Medication Pass: The authorized licensed or certified/permitted medication aide or by state regulatory guidelines staff member documents that the medication is given in the correct slot of MAR, before going to the next patient/resident. If the patient/resident is unable to take the medication or refuses it, the authorized licensed/certified staff member circles his/her initials on the MAR, and documents the reason refused or not given on the designated area of the MAR (physician is notified as necessary). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 7 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were free of any significant medication errors for 1 resident (Resident #1) of six residents reviewed for pharmacy services. Residents Affected - Some The facility repeatedly failed to administer scheduled time-sensitive medications to Residents #1 from 02/05/25 through 02/24/25. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications and supplements, worsening or exacerbation of chronic medical conditions, and hospitalization. Findings included: Review of Resident #1's 03/27/25 face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including schizoaffective disorder (a mental health condition that combines symptoms of schizophrenia and a mood disorder, such as depression or bipolar), dementia, cognitive communication, presence of cerebrospinal fluid drainage device (a hollow tube surgically placed in the brain to help drain cerebrospinal fluid and redirect it to another location in the body where it can be reabsorbed) and unspecified psychosis (a state where an individual experiences a loss of contact with reality, often involving hallucinations, delusions, and disorganized thinking). Review of Resident #1's admission care plan reflected: A focus revised on 11/14/23 reflected resident had a diagnosis of dementia and was at risk for increased confusion and decline in ADLs as the disease progress and a goal revised on 11/14/23 of Resident #1's needs will be anticipated and met by staff and intervention dated 11/08/23 of administer medications as ordered by MD and reorient resident daily as needed. A focus dated 11/20/23 reflected resident had a behavior problem related to schizophrenia (a serious mental illness that affects how a person thinks, feels, and behaves, often leading to a disconnection from reality, and characterized by symptoms like hallucinations, delusions, and disorganized thinking), resident accused staff of certain behavior like rape, abuse, etc. with a focus revised on 12/26/23 of resident will have no evidence of behavior problems and intervention dated 11/20/23 of administer medications as ordered and monitor/document side effects and effectiveness. A focus revised on 01/26/23 of resident had peripheral vascular disease (a condition that affected the blood vessels outside of the heart and brain) with a goal initiated 12/26/23 of resident's extremities will be free from pain, pallor (skin paleness), rubor (term for redness, sign of inflammation), coldness, edema (excess fluid in the body's tissues, causing swelling), and skin lesions with interventions initiated 11/20/23 of give medications for improved blood flow or anticoagulants (medications that prevent blood clots from forming) as ordered. A focus revised on 09/10/24 of resident uses psychotropic medications (drugs that affect the mind, emotions, and behavior) Seroquel, Haldol and lithium related to behavior management, disease process (schizophrenia) with a goal initiated 11/14/2023 of resident will be/remain free of psychotropic drug related complications, including movement disorder and discomfort, hypotension, gait disturbance, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 8 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some constipation/impaction or cognitive/behavioral impairment and interventions and the resident will reduce the use of psychotropic medications with interventions dated 11/14/23 of administer psychotropic medications as ordered by physician, monitor for side effects and effectiveness and monitor/document/report PRN any adverse reactions of psychotropic medications: unsteady gait, tardive dyskinesia (a movement disorder), EPS (shuffling gait, rigid muscles, shaking), frequent falls, refusal to eat, difficulty swallowing, dry mouth, depression, suicidal ideations, social isolation, blurred vision, diarrhea, fatigue, insomnia, loss of appetite, weight loss, muscle cramps nausea, vomiting, behavioral symptoms not usual to the person. A focus revised on 12/26/23 of resident was on diuretic therapy (medications that increase urine output by promoting the excretion of sodium, water, and other electrolytes through the kidneys (Lasix medication) related to hypertension with a goal initiated on 12/26/23 of resident will be free of any discomfort or adverse side effects of diuretic therapy with interventions initiated 12/26/23 of administer diuretic medications as ordered physician, monitor for side effects and effectiveness, many other medications may interact with antihypertensives (drugs used to treat high blood pressure) to potentiate their effect, monitor for interactions/adverse consequences, monitor dose, may require modification in order to achieve desired effects while minimizing adverse consequences, especially when multiple antihypertensives are prescribed simultaneously. When discontinuing, gradual tapering may be required to avoid adverse consequences caused by abrupt cessation. A focus dated 03/10/24 of resident used antidepressant medication trazadone related to depression and a goal initiated on 03/10/24 of resident will be free from discomfort or adverse reactions related to antidepressant therapy and interventions dated 03/10/24 of administer antidepressant medications as ordered by physician monitor/document side effects and effectiveness. A focus revised on 12/26/23 of resident had a mood problem with a goal revised on 12/26/23 of resident will have improved mood state happier, calmer appearance, no signs and symptoms of depression, anxiety or sadness and interventions initiated 12/26/23 of administer medications as ordered and monitor/document for side effects and effectiveness and behavioral health consults as needed. A focused revised on 03/10/24 of Resident #1 has episodes of refusal to take medications and is at risk for complication and injury/side effects with a goal revised on 03/10/24 of resident will have minimum/no further episodes of medication refusal and will be free from injury/side effects over the next 90 days and interventions dated 01/01/24 of offer medications at scheduled times and re-offer at a later time if refused. A review of Resident #1's quarterly MDS reflected a brief interview for mental status was not conducted because resident was rarely/never understood. Section N Medications reflected high-risk classes used and indicated resident was taking antipsychotic, antianxiety, antidepressant, and diuretic. Review of Resident #1's MAR reflected the following Chart Codes: 3 = hold due to condition 8 = other/see progress notes 11 = sleeping 12 = split out medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 9 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #1's orders reflected an order for Lasix Oral tablet 40 MG (Furosemide (a type of medicine called a diuretic used to treat high blood pressure (hypertension), heart failure and a build up of fluid in the body) give 1 tablet by mouth one time a day related to edema (a condition where excess fluid accumulates in the body's tissues, causing swelling) start date 10/09/24 D/C 03/27/25 A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Lasix Oral tablet 40 MG on 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/19/25 (chart code 11), 02/20/25 (chart code 8), 02/21/25 (chart code 8), 02/22/25 (chart code 11), 02/23/25 (chart code 11) Review of Resident #1's orders reflected an order for Lithium Carbonate (to treat manic-depressive disorder (bipolar disorder)) oral tablet extended release 450 MG give 1 tablet by mouth in the morning related to schizoaffective disorder, bipolar type. A review Resident #1's 02/2024 MAR reflected Resident #1 was not administered Lithium Carbonate oral tablet extended release 450 MG medication on 02/16/25 (chart code 8), 02/17/25 (chart code 3), 02/20/25 (chart code 3), 02/21/25 (chart code 8), 02/23/25 (chart code 11) Review of Resident #1's orders reflected an order for Seroquel (an antipsychotic medication that treats several kinds of mental health conditions including schizophrenia and bipolar disorder) oral tablet 100 MG give 2.5 tablets to equal 250 mg start date 10/09/24 D/C date 03/27/25. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Seroquel oral tablet 100 MG give 2.5 tablets to equal 250 mg 02/09/25 (no chart code entered, reflected no medication administered), 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/18/25 (no chart code entered, reflected no medication administered), 02/20/25 (chart code 8), 02/21/25 (chart code 8), and 02/23/25 (chart code 8). Review of Resident #1's orders reflected an order for trazodone (used to treat depression, anxiety, or a combination of depression and anxiety) give 1.5 tablet by mouth in the evening related to major depressive disorder, recurrent start date 12/09/24 D/C 03/27/26. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered trazodone 1.5 tablet on 02/15/25 (chart code 8), 02/16/25 (code 3), 02/17/25 (code 8), 02/20/25 (code 8), 02/21/25 (code 8), 02/22/25 (code 11) and 02/23/25 (code 11). A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Vitamin D-3 oral capsule 24 MCG (1000 UT) 2 capsule by mouth 1 time a day on 02/15/25 (chart code 8), 02/16/25 (chart code 3), 02/17/25 (chart code 8), 02/19/25 (chart code 11), 02/20/25 (chart code 8), 02/21/25 (chart code 8), 02/22/25 (chart code 11), 02/23/25 (chart code 11). Review of Resident #1's orders reflected an order for Seroquel oral tabled 50 MG quetiapine fumarate (antipsychotic used to treat schizophrenia, bipolar disorder and depression) give 1 tablet by mouth 2 times a day (8:00 am and 4:00 pm) related to schizoaffective disorder bipolar type start date 01/13/25 D/C 03/27/25. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Seroquel oral tabled 50 MG on 02/15/25 at 4:00 pm (chart code 8), on 02/16/25 at 8:00 am (chart code 8) or 4:00 pm (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 10 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (chart code 3), 02/17/25 at 8:00 am (chart code 8) or 4:00 pm (chart code 3), 02/19/25 at 4:00 pm (chart code 11), 02/20/25 at 8:00 am (chart code 3) or 4:00 pm (chart code 8), 02/21/25 at 8:00 am (chart code 8) or 4:00 pm (chart code 8), 02/22/25 at 4:00 pm (chart code 11), 02/23/25 at 8:00 am (chart code 11) or 4:00 pm (chart code 11). Review of Resident #1's orders reflected an order for buspirone HCI (treats anxiety) tablet 10 MG Buspirone HCI give 1 tablet by mouth 3 times a day (8:00 am, 12:00 pm and 4:00 pm) related to anxiety disorder start date 01/27/25 D/C. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered buspirone HCI tablet 10 MG 3 times a day on 02/05/25 at 12:00 pm (no chart code entered, reflected no medication administered), 02/10/25 at 12:00 pm (no chart code entered, reflected no medication administered), 02/15/25 at 12:00 pm (chart code 3) or 4:00 pm (chart code 8), 02/16/25 at 8:00 am (chart code 8) or 12:00 pm (chart code 8) or 4:00 pm (chart code 3), 02/17/25 at 8:00 am (chart code 3) or 12:00 pm (chart code 3) or 4:00 pm (chart code 8), 02/18/25 at 12:00 pm (chart code 12:00 pm), 02/19/25 4:00 pm (chart code 11), 02/20/25 8:00 am (chart code 3) or 12:00 pm (chart code 3) or 4:00 pm (chart code 8), 02/21/25 8:00 am (chart code 8) or 12:00 pm (chart code 8) or 4:00 pm (chart code 8), 02/22/25 12:00 pm (chart code 12) or 4:00 pm (chart code 11), and 02/23/25 8:00 am (chart code 11) or 12:00 pm (chart code 11) or 4:00 pm (chart code 11). Review of Resident #1's orders reflected an order for Lorazepam Oral Tablet 1 MG Lorazepam (to treat anxiety and sleeping problems that are related to anxiety) give 1 mg by mouth three times a day (9:00 am, 1:00 pm, and 9:00 pm) related to anxiety disorder start date 02/05/2025 D/C 03/27/2025. A review of Resident #1's 02/2024 MAR reflected Resident #1 was not administered Lorazepam Oral Tablet 1 mg by mouth three times a day on 02/09/25 at 9:00 pm (no chart code entered, reflected no medication administered), 02/10/25 at 1:00 pm (no chart code entered, reflected no medication administered), 02/15/25 at 1:00 pm (chart code 3) or 9:00 pm (chart code 8), 02/16/25 9:00 am (chart code 8), 1:00 pm (chart code 8) or 9:00 pm (chart code 3), 02/17/25 9:00 am (chart code 3) or 1:00 pm (chart code 3), or 9:00 pm (chart code 8), 02/18/25 1:00 pm (chart code 11) or 9:00 pm (no chart code entered, reflected no medication administered), 02/20/25 9:00 am (chart code 3) or 1:00 pm (chart code 3) or 9:00 pm (chart code 8), 02/21/25 9:00 am (code 8) or 1:00 pm (chart code 8) or 9:00 pm (chart code 8), 02/22/25 1:00 pm (chart code 12), 02/23/25 9:00 am (chart code 11) or 1:00 pm (chart code 11) or 9:00 pm (chart code 11). Review of Resident #1's progress note dated 02/15/2025 at 12:45 am reflected Administration Note entered by CMA B HOLD PER NURSE. No information recorded on what medication or treatment, or resident care was being held. Review of Resident #1's progress note dated 02/15/2025 5:12 pm reflected Administration Note entered by CMA B [resident] WAS SLEEPING. NO MEDS GIVING. Review of Resident #1's progress note dated 02/16/2025 9:27 am reflected Administration Note by CMA B [resident] WAS ASLEEP. NURSE WAS NOTIFIED. Review of Resident #1's progress note dated 02/16/2025 5:32 pm reflected Administration Note (no staff listed) [resident] HAS BEEN SLEEPING. NURSE INFORMED. MEDS NOT GIVEN. Review of Resident #1's progress note dated 02/17/2025 8:54 am reflected Administration Note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 11 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0760 entered by CMA B [resident] WAS SLEEPING. NURSE NOTIFIED. Level of Harm - Minimal harm or potential for actual harm Review of Resident #1's progress note dated 02/17/2025 4:41 pm reflected Administration Note by CMA B [resident] WAS ASLEEP UNABLE TO GIVE MEDS NURSE WAS NOTIFIED. Residents Affected - Some Review of Resident #1's progress note dated 02/20/2025 8:29 am reflected Administration Note by CMA B WAS NOTIFIED TO HOLD MEDS. [resident] IS SLEEPING. Review of Resident #1's progress note dated 02/20/2025 5:52 pm reflected Administration Note by CMA B [resident] WAS SLEEPING. MEDS NOT GIVEN. NURSE WAS NOTIIFED. Review of Resident #1's progress note dated 02/21/2025 8:34 am Administration Note by CMA B [resident] RES WAS SLEEPING. NURSE NOTIIFED. Review of Resident #1's progress note dated 02/21/2025 5:52 pm Administration Note by CMA B MEDS NOT GIVEN. [resident] IS SLEEPING NURSE NOTIFIED. A review of Resident #1's progress notes revealed no additional information documenting why Resident #1 was not administered medication. Interview on 04/03/2025 with CMA B at 12:15 pm reflected if a resident was sleeping, she generally would not wake them. She stated she would go to the next resident then come back later. She stated if the resident did not get up then she would need to go tell her charge nurse. She stated after the nurse checked on the resident, she was supposed to do what the nurse told her. She stated, sometimes they just do not want to get up so the nurse would document the resident refused the meds. Interview on 03/28/25 at with RN C at 12:18 pm revealed she knew that the Psych NP was adjusting Resident #1's medications and the Psych NP should have been informed that Resident #1 had not had her medications. The negative consequences of a resident not receiving medications would be that the resident would not receive the effectiveness of the medications, especially if they missed numerous medication doses. Interview on 03/27/24 with LVN A at 3:44 pm revealed she had worked at the facility since December of 2004 and assisted with Resident #1 and was not aware that Resident #1 was not getting her medications. She revealed if a resident did not get their medications, then they would follow up with the NP who would advise them what to do. The negative effect of someone not getting their medications would be that they might have a chance in condition. Interview on 03/27/25 with the Psych NP at 1:43 p.m. revealed, when was asked if she knew that Resident #1 did not receive her mental health medications for several days, she said she did not know. She said that would be a problem because Resident #1 had interesting and complicated mental health issues and she had been working on adjusting her medications and a change of medication could make her decompensate pretty quickly. Interview on 03/27/25 with the NP at 1:58 pm revealed she did not know that Resident #1 did not receive her medications. If she had known Resident #1 was sleeping through her medication, she might have sent her to the ER because the hospital will process labs faster and the facility might be able to have information to treat the resident faster. If a resident is not receiving medication, it could be a change in for that resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 12 of 13 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 675971 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Oak 507 West Ave Schulenburg, TX 78956 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 03/31/25 with the DON at 1:50 pm revealed when a resident does not receive ordered medication, an adjustment might need to be made to their medication, but this would depend on how many doses of medication the resident missed. Missed medication may also require labs. If a resident is asleep, and the medication is important, the resident should be woken up for them to take the medication. If they continue to be asleep during medication administration times, an adjustment might need to be made to the resident's medication administration times. If the resident missed medication doses, the resident might have a change in condition. Review of facility Nursing Policies and Procedures Subject: Medication Administration and Management Policy dated June 2019 reflected: It is the policy of this facility that the facility will implement a Medication Management Program that incorporates systems with established goals to meet each resident's needs as well as regulatory requirements. Administering the Medication Pass: The authorized licensed or certified/permitted medication aide or by state regulatory guidelines staff member documents that the medication is given in the correct slot of MAR, before going to the next patient/resident. If the patient/resident is unable to take the medication or refuses it, the authorized licensed/certified staff member circles his/her initials on the MAR, and documents the reason refused or not given on the designated area of the MAR (physician is notified as necessary). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 13 of 13