Inspection·November 21, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few social worker and current Administrator reflected social worker spoke with Resident #2's guardian and informed her the facility was planning to transfer Resident #2 to an inpatient psych facility. The facility was currently uncertain about how to ensure Resident #2's safety. Therefore, they were relying on the guardian's assistance to find another facility that could better meet his needs. Record review of Resident #2's guardian's note, dated 08/20/25, reflected Received phone call from [former facility social worker current facility Administrator] to inform me that [Resident #2] would be [sic Resident #2] to a behavioral health hospital she stated that another staff member would call her with further information. [former facility social worker current facility Administrator] did state that once [Resident #2] is admitted to the behavioral health hospital that the [facility name] will not take [Resident #2] back due to his behaviors.Record review of Resident #2's guardian's note, dated 08/20/25, subject phone call from [DON] to Resident #2's guardian reflected, Received a phone call from [Don] to confirm that I had received a phone call from a staff prior to his call about the altercation hat [Resident #2] was involved in. I informed [DON] that I had received a phone call from [former social worker and current Administrator] stating that [Resident #2] was in an alteration and that they were looking to send him to a behavioral health hospital. [DON] confirmed that this information was correct, however, [DON] stated that another resident had hit [Resident #2] with a chair due to [Resident #2] provoking him. I asked [DON] why [Resident #2] was being set to the behavioral health hospital due to he was the victim, I stated I understood that [Resident #2] may have provoked the resident I just didn't understand why they would send [Resident #2] out known [sic] that these are some of [Resident #2's] behaviors and that is why he is on the [secured] unit in their facility. [DON] stated that this is the third time [Resident #2] has provoked a resident trying or taking other resident food or drink. [DON] stated that the last incident there was a chair thrown at [Resident #2] which did not hit [Resident #2] at the time, [DON] could not recall the first incident. I then asked [DON] if he knew where they would be sending [Resident #2], [DON] stated he did not know at the time he was still trying to contact facilities to see where he could be sent. I asked DON to keep me posted as to where they would be sending [Resident #2], [DON] stated as soon as he knows anything he give me a call.Record review Resident #2's Discharge Summary from facility, dated 08/21/25, reflected Resident #2's primary care giver reflected [name] guardian and no signatures in areas of resident signature and responsible party signature. Record review of Resident #2's progress note, dated 08/21/25, by former facility social worker and current facility Administrator reflected the ADON and DON informed Resident #2's guardian that Resident #2 was denied admission to [name of facility]. Although [guardian] does not prefer a specific facility (location) she would prefer one close to her family member in San [NAME] if possible. She was notified via phone conversation. Record review of Resident #2's guardian's note, dated 08/21/25, produced by Resident 2's guardian reflected subject phone call from [facility name] reflected, Received a phone call from [former facility social worker and current facility Administrator], stating that [DON], [ADON] and herself were on speakerphone, [former facility social worker and current facility Administrator] stated that they wanted to inform me that the behavioral health hospital they wanted to send [Resident #2] too denied him so they will start the process of finding him another nursing facility for him to do to due to his safety. I informed is [former facility social worker and current facility Administrator] that prior them moving [Resident #2] if they could let me know so that I could see if [registered guardianship program] is in that area. Record review of Resident #2's social services progress notes, dated 08/26/25, by the previous social worker and current Administrator reflected, [Resident #2's] Guardian's [name] was notified that he will be transferring to [name of facility in [NAME]] on Thursday morning. Record review (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 2 of 20 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 11/21/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of note dated 08/26/25 produced by Resident 2's guardian reflected subject phone call from [facility former social worker and current facility Administrator] reflected, Received a phone call from [facility former social worker and current facility Administrator] at [facility name]. [facility former social worker and current facility Administrator] stated that [name of facility] in [NAME], Texas has accepted [Resident #2] for transfer. [facility former social worker and current facility Administrator] stated that the facility would be at [facility name] on Thursday to pick him up and transfer him to [NAME]. I informed [facility former social worker and current facility Administrator] that I would call my supervisor because I believe that we do not go into [NAME], however, I would call her back after speaking with my supervisor. I called [facility former social worker and current facility Administrator] back and informed her that [registered guardianship program] does not service [NAME] at this time so they would need to find an alternate facility. [facility former social worker and current facility Administrator] states she would let them know that NF need to keep looking for placement for [Resident #2].Record review of note dated 08/27/25 produced by Resident 2's guardian reflected subject phone call with former facility administrator, Received a phone call from [facility former administrator]. [facility former administrator] stated he was following Up with her to make sure that [facility former social worker and current facility Administrator] had spoke to me about [Resident #2] being accepted to [facility name] in [NAME]. I informed [facility former administrator] that [facility former social worker and current facility Administrator] did in fact call me to inform me of [Resident #2's] being accepted at [facility name] I then explained that [facility former social worker and current facility Administrator] I had spoken to her supervisor [name] and I was informed that [registered guardianship program] does not go to [NAME] therefore they would have to find another facility for [Resident #2] to go to where [registered guardianship program] is. [facility former administrator] then stated [Resident #2] will be transported due to his safety I then explained to [facility former administrator] that I understood that [Resident #2] had to be transferred for his safety however they needed to find a different facility where [registered guardianship program] is. [facility former administrator] then state that they would issue an emergency eviction for [Resident #2] at which time I informed [facility former administrator] that he could not just evict [Resident #2] with nowhere to go. [facility former administrator] stated that they have to do what is in the best interest for [Resident #2]. I stated to [facility former administrator] that I understood, I told [facility former administrator] that [registered guardianship program] is not saying that [Resident #2] can't be transferred at all, [registered guardianship program] is stating that [Resident #2] cannot be transferred to [NAME] due to [registered guardianship program] does not cover the [NAME] area. I provided [facility former administrator] a list of areas where [registered guardianship program] does cover.Record review of note dated 08/28/25 produced by Resident 2's guardian reflected subject phone call with [facility name] reflected called to speak with [facility former social worker and current facility Administrator] about a care plan meeting scheduled for Sept. 10th for [Resident #2]. Once [facility former social worker and current facility Administrator] got on the phone and I mentioned the care plan meeting, [facility former social worker and current facility Administrator] stated that [Resident #2] was no longer at the facility. I stated to [facility former social worker and current facility Administrator] that I was talking about [Resident #2] and she stated yes he was transferred out this morning. I asked [facility former social worker and current facility Administrator] if she would . transfer me to the Administrator [name of administrator]. When [former administrator] answered the phone he informed me that he had me on speakerphone and [facility former social worker and current facility Administrator] was also in the office. I stated it was a good thing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 3 of 20 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 11/21/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that [facility former social worker and current facility Administrator] was in the office also so that I would speak with both of them. I told [former administrator] that I was informed that [Resident #2] had been transferred out of the nursing facility this morning. At which time [former administrator] stated that is correct. I asked [former administrator] how was this possible when [registered guardianship program] did not approve the transfer. I stated to [former administrator] that him and myself had a couple of conversations stating that I understood that the nursing facility wanted to transfer [Resident #2] out however the facility that had accepted [Resident #2] was in an area where [registered guardianship program] does not cover. I also stated that I had given [former administrator] several areas where [registered guardianship program] does cover and [Resident #2] could be transferred to. [former administrator] then stated that this this decision had to be made for [Resident #2's] safety, I had mentioned that [former administrator] and I had conversations about [Resident #2's] safety I states that I didn't quite understand how they felt [Resident #2's safety was at risk when it was [Resident #2] who was the one who got assaulted by another resident. I also state that I had been [Resient#2's] care manager for the last year and have never had a report or have never seen [Resident #2] act out toward any other resident. At this time [former administrator] stated there's nothing that can be done [Resident #2] has been transferred. I did recommend to [former administrator] that [Resident #2] would be returned to [facility name], at which time [former administrator] stated absolutely not [Resident #2] cannot come back to this facility. Interview on 09/11/2025 at 5:35 pm with Resident #2's guardian reflected she was informed that on 08/20/25 Resident #2 was in an altercation with another resident, but Resident #2 was not the instigator. She was told another resident threw a chair at Resident #2 because Resident #2 had taken something from the other resident's room. She received a call that Resident #2's behaviors were out of hand. The guardian stated she agreed to the transfer. She said she provided a list of acceptable facilities that were within the jurisdiction of Resident #2's registered guardianship program to both the former administrator and the DON. When she called the facility to check on Resident #2 she was told he had been transferred to another facility. When she found out it was outside of Resident #2's registered guardianship program she told them to go get Resident #2 and return him to the facility and the facility declined. She said Resident #2 was still at the facility with no jurisdiction for his guardian. Interview on 09/19/25 at 4:56 pm with the ADON reflected she knew that Resident #2 who was in the secured unit was involved in another resident-to-resident altercation and the corporate office said he was involved in one too many altercations and he was a danger to himself, and he needed to be discharged . She said she knew he had a guardian. She said there was a phone conference, and the guardian was informed that Resident #2 needed to be transferred, and the guardian did not have a problem with Resident #2 being transferred. The ADON said that after Resident #2 was transferred the guardian said it was a problem because the guardianship agency did not have jurisdiction in that area. She said the guardian did not tell them Resident #2's guardian service did not extend to the facility where he was transferred. She did not know if the Ombudsman was informed of the discharge or if the guardian was given a 30-day discharge notice. She said the Ombudsman should have been informed if a resident was discharged and the responsible party should sign a discharge summary. She said Resident #2 could not advocate for himself and he needed a guardian because he could not make his own decisions. The ADON said several things were not done in accordance with the facility discharge policy. When the ADON was shown that the guardian did not sign the discharge that indicated where Resident #2 was going to be transferred to the ADON said that the guardian needed to have signed the discharge. She said the Administrator and the DON were both responsible for making sure that transfers were done appropriately. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 4 of 20 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 11/21/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few possible negative effects of an inappropriate transfer in this case would be that Resident #2 did not have an RP because the guardianship did not have jurisdiction at the facility where he was transferred. Interview on 09/23/25 at 2:12 pm with the Psych NP who said she felt that Resident #2 was a provocateur (a person who causes trouble, agitates, or instigates conflict) in that he did take things from other resident's rooms, but she did not feel like he was a danger to himself or others. She said she thought Resident 2's legal guardian wanted him to transfer to another facility; she did not know the facility initiated the transfer. She said that Resident #2 could not advocate for himself, he did not have the capacity to do so. She said it was a problem for him to be transferred to a facility where his legal guardian did not have jurisdiction because he could not advocate for himself. She said she did not feel like he had behavioral issues that could not be managed at the facilityInterview on 09/23/25 at 2:35 pm with the Administrator reflected that she had been the Administrator since 09/17/25. The prior administrator left on 09/08/25 when she was the Administrator in Training. She revealed she helped with finding Resident #2 placement at another facility after another resident threw a chair at him. She said Resident #2 had behaviors of taking other residents' belongings and this behavior triggered residents to have aggressive behavior towards him. She said that Resident #2's guardian did not give her a list of facilities where the registered guardianship program had jurisdiction. The Administrator said Resident #2 could not advocate for himself. The Administrator said she did not call the Ombudsman. The Administrator said she did not give a 30-day discharge notice to Resident #2's guardian and she did not do any discharge paperwork. She said she was not sure whose responsibility it was to follow the facility discharge procedures and did not know if they reached out to the psych NP to ask if Resident #2 could stay at the facility. She said the discharge was an emergency discharge and the guardian agreed to him being discharged . She said she did not know if all the things that were required in the facility discharge policy were done. She was told, by the former administrator and the DON, when Resident #2's guardian told them they need to go and pick up Resident #2, we are no longer able to meet his needs. When asked about possible negative effects of sending Resident #2 to a facility where his guardian has no jurisdiction the Administrator said there were no negative effects because they sent him to a facility that would look over his clinicals. She said if they accepted him, they could take care of him. Interview on 09/22/25 at 7:54 pm with the DON reflected Resident #2 had an altercation in the secured unit and the facility decided to transfer him because it was the third time he had been in an altercation with another resident. The DON said this was an immediate discharge and Resident #2's guardian was informed. The DON said the facility did not issue a discharge notice; they told the guardian that they were going to transfer him to another facility. The DON said that Resident #2 could not make his own decisions, he had a low BIMS score. The DON said the guardian said it would be okay to transfer him to another facility ask long as he went to an area near San [NAME]. They then informed the guardian that they could not find a facility for Resident #2 in San [NAME], so they transferred him to [NAME], and the guardian was notified by phone that Resident #2 was sent to a facility in [NAME]. The facility did not obtain the guardian's signature on the discharge paperwork that stated the facility name where Resident #2 would be going to. He thought the guardian was aware that they were sending Resident #2 to the facility in [NAME]. The guardian did not inform the facility that Resident's registered guardianship program did not have jurisdiction to all nursing facilities. The DON said everything was by phone. He said they did not notify the Ombudsman or obtain signatures on the discharge summary. He did not feel like the facility discharge procedure was followed. He was not informed by the guardian that the facility where Resident #2 was transferred to was not in the registered guardianship programs' jurisdiction (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 5 of 20 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 11/21/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete until Resident #2 was sent out. He said the possible negative effect of Resident #2 being transferred to a facility with no guardian was that Resident #2 would have no RP. Record review facility policy Discharge Transfer Policy dated June 2024 reflected the facility was committed to ensuring safe discharge dispositions and would make every effort to facilitate a smooth transition of care. In some cases of difficult or immediate discharges, the facility will follow Centers for Medicare & Medicaid Services and state guidelines to maintain regulatory compliance and protect resident's rights and well-being. Procedures - common discharge/transfer rationales include the transfer, or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility. Behavioral issues that cannot be safely managed in the current setting that endanger other individuals within the facility. The facility will provide the residents with a discharge summary that recaps their stay outlines the discharge plan of care and includes a discharge medication reconciliation listing and instructions. The resident, the resident's representative and the long-term care ombudsman program will receive written notice of discharge at least 30 days before the planned discharge date in a language and manner the resident can understand. The notice will include the reason, effective date, and location of the discharge. A statement that informs the resident of his or her rights to appeal the discharge by requesting a hearing through the Health and Human Services Commission within 90 days. Event ID: Facility ID: 675971 If continuation sheet Page 6 of 20 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 11/21/2025 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to develop and implement a baseline care plan that included the instructions needed to provide effective and person-centered care of the residents that meet professional standards of quality care for one (Resident #3) of five residents reviewed for baseline care plans. The facility failed to create a baseline care plan for how to transfer Resident #3, a paraplegic, within 48hours of his admission. This failure could place residents at risk of not receiving goals and interventions for their individual needs for person centered care and safe transfers. Findings included:Review of Resident #3's face sheet, dated 09/11/25, reflected a 36-year-male who was admitted to the facility on [DATE] with diagnoses including paraplegia (a condition characterized by the loss of voluntary movement and sensation in both lower limbs, typically resulting from an injury to the spinal cord in the thoracic or lumbar regions), displaced fracture of acromial process, right shoulder, initial encounter for closed fracture (a broken bone (acromion) in the right shoulder where the bone fragments moved from their normal position), displaced fracture of body of scapula, right shoulder, initial encounter for closed fracture (a broken shoulder blade (scapula) on the right side, where the broken pieces have shifted out of their normal alignment), and displaced fracture of acromial process, left shoulder, initial encounter for closed fracture (a broken bone at the acromion (the bony point of the shoulder blade) that was no longer in its normal alignment, on the left side, for which the patient was receiving initial medical care, and the skin was unbroken). Review of Resident #3's care plans reflected no care plan for Resident #3's transfers until 08/13/25. Review of Resident #3's Entry MDS dated [DATE] reflected no functional status and no BIMS score. Record review of Resident #3's occupational therapy daily progress note prior to admission, dated 07/23/25, reflected chair/bed to chair transfer detail, patient unable to provide any effort, helper transferred patient to and from bed to chair (or wheelchair) mechanical lift, two helpers required.Record review Resident #3's Admission/readmission Assessment date 08/05/25 primary diagnosis spinal cord injury (occurs when the spinal cord is damaged, disrupting the communication between the brain and the rest of the body. Range of motion - left upper extremity (refers to the left arm, including the shoulder, upper arm, forearm, wrist, and hand), left lower extremity (refers to the left side of the lower body), and right lower extremity impairment (a permanent functional or anatomical loss or derangement of the right leg, foot, or hip).Record review of Resident #1's Baseline Care Plan assessment, dated 08/06/25, signed by DON reflected - select the mobility status below that most accurately described the resident: bed bound, chair/bed-to-chair transfer dependent.Record review of Resident #1's Occupational Therapy Treatment Encounter Notes, dated 08/7/2025, reflected skilled interventions focused on transfer training to increase functional task performance, reduce fall risk, and caregiver burden, transferring from edge of bed to wheelchair with maximum assistance with second person for safety due to compromised strength and paraplegia status.Interview on 09/11/2025 at 2:29 pm with the MDS Coordinator reflected that the initial baseline care plan should be completed within 48 hours of the time a resident was admitted to the facility. Because Resident #3's Baseline Care Plan assessment, signed by the DON, stated Resident #3 was dependent upon admission, his transfer status should have been a mechanical lift in his care plan. She said everyone should have known he was a mechanical lift transfer,and the information would have been passed on by word of mouth to the nurses and aides who were responsible for transferring him. She said that Resident #3's transfer status should have been in his care plan within 24 hours of his admission to the facility. She said it was the responsibility of the DON to know the residents' transfer status and to make sure all staff knew (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 7 of 20 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 11/21/2025 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the residents' transfer status. She said the possible negative effect of a residents' transfer status not being included in the baseline care plan was that the residents could get hurt if they were inappropriately transferred. Interview on 09/11/25 at 3:13 pm with the DOR reflected on 08/07/25 Resident #3 was evaluated by therapy, and his transfer status was maximum assistance with second person for safety. She said this was what should have been in his care plan for how to transfer him after he was evaluated by therapy when he was admitted to the facility. She said the therapy staff did participate in care plans. She said the MDS Coordinator was responsible for care plans, but they all worked together on the IDT team to communicate for the needs of the residents. She said if there was no care plan, staff would not know how to safely transfer a resident, and the resident could get hurt. Interview on 09/17/25 at 1:36 pm with LVN B reflected she was not sure who was responsible for care plans at the facility but when Resident #3 entered the facility, how to transfer him was missing from his care plan and she did not know if it was included in the discharge instructions from the hospital. Interview on 09/17/25 at 2:25 pm with the Administrator reflected when a resident admitted to the facility a baseline care plan was initiated from the discharge plan from where the resident was transferred. She said the baseline care plan should include how a resident was to be transferred. She said the admitting nurse was responsible for the base line care plan. After the facility therapists assessed the resident, how the resident was transferred could change and therapy should update the care plan. She said a care plan was a picture of the residents' overall care and should address resident safety. She said nurses and CNAs should know how a resident was transferred based on the information that was in the plan of care. She said nurses had access to care plans and CNAs had access to a Kardex (a quick reference for care plans). The Administrator reflected that a care plan was a map of the residents' care and directed the facility on how to take care of the residents. She said when a resident entered a facility, the facility had 48 hours to create a baseline care plan. A possible negative effect of not having a baseline care plan was that the residents' needs were not being met. Interview on 09/17/25 at 2:30 pm with the MDS Coordinator reflected the base line care plan should include how a resident was transferred, and it should be created in less than 48 hours because the staff need to know how to move a person. She said how to move a resident was essential. She said if how to transfer a resident was not in the baseline care plan, staff would not know how to get them up or down. She said the admitting nurse prepared the baseline care plan assessment and the DON signed it. She said the information from the baseline care plan assessment should be transferred to the care plan within 48 hours and the nurses had access to the care plan and the aides had access to the Kardex. Interview on 09/19/25 at 4:56 pm with the ADON reflected a care plan was a daily routine of residents and their care. She said normally the charge nurse who admitted the resident would do the care plan, but the DON would review it and sign off on it as a baseline care plan. The possible negative effects of not following the care plan would be endangering the residents. Interview on 09/22/25 at 3:07 pm with the DON reflected when a resident admitted to the facility the discharge facility sent a referral note including how to transfer the resident. Within approximately 24 hours the facility therapy staff evaluated the resident for how the resident should be safely transferred and that should be entered into the resident's baseline care plan within 48 hours of the resident admission. The DON said when occupational therapy evaluated Resident #3, the care plan should be updated to reflect how occupational therapy recommended transferring the resident. The DON said the care plan should have a focus on resident safety. The DON said it was not specified on the care plan about how to transfer Resident #3 until 09/13/25, when the MDS Coordinator created a 7-day care plan. He said the potential negative effect of having an incorrect baseline care plan, or, no baseline care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 8 of 20 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 11/21/2025 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete plan, was possible injury to the resident. Interview on 09/22/25 at 4:11 pm with AN LVN reflected she admitted Resident #3 into the facility. She said when a resident was admitted , it included how to transfer the resident when they arrived at the facility. She said that Resident #2 was transferred by a mechanical lift, but she had never transferred Resident #2. She said she had access to the care plan, she looked at it and if there were adjustments that needed to be made to the care plan, she could go into the care plan and make adjustments. She said everybody was responsible for care plans, but she did not know who was directly responsible for care plans. She said a possible negative effect of a person not being transferred in accordance with the care plan was injury. Review of facility baseline care policy dated May 2022 reflected that the facility will implement a baseline care plan to ensure continuity of care and communication, prevent adverse events, and inform the resident and or responsible party of the initial care and services. Procedure - a baseline care plan will be developed within 48 hours of admission. At minimum, a baseline care plan will address initial goals based on admission orders, physician orders, dietary orders, therapy services, social services, and PASRR recommendations. Event ID: Facility ID: 675971 If continuation sheet Page 9 of 20 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 11/21/2025 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 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs for one (Resident #3) of six residents reviewed for pharmacy services.The facility failed to administer Resident #3's Lidocaine Pain Relief External 21 times between 08/08/25 and 09/06/25. This failure could place residents at risk of worsening of their condition, increased risk of falls, pain, and injury.Findings included:Review of Resident #3's face sheet, dated 09/11/25, reflected a 36-year-male who was admitted to the facility on [DATE] with diagnoses including paraplegia (a condition characterized by the loss of voluntary movement and sensation in both lower limbs, typically resulting from an injury to the spinal cord in the thoracic or lumbar regions), displaced fracture of acromial process, right shoulder, initial encounter for closed fracture (a broken bone (acromion) in the right shoulder where the bone fragments have moved from their normal position), displaced fracture of body of scapula, right shoulder, initial encounter for closed fracture (a broken shoulder blade (scapula) on the right side, where the broken pieces have shifted out of their normal alignment), and displaced fracture of acromial process, left shoulder, initial encounter for closed fracture (a broken bone at the acromion (the bony point of the shoulder blade) that is no longer in its normal alignment, on the left side, for which the patient is receiving initial medical care, and the skin is unbroken). Review of Resident #3's care plan focus, dated 08/14/25, reflected pain: [Resident #3] complained of increased pain/discomfort and was at risk for further episodes of increased pain/discomfort and injury.Review of Resident #3's Entry MDS, dated [DATE], reflected no functional status and no BIMS score. Record review of Resident #3's orders Lidocaine Pain Relief External start date 08/07/2025 D/C date 08/28/2025 Patch 4% (Lidocaine) apply to left shoulder topically every 24 hours for pain, remove both patches after 12 hours - remove daily at 7pm.Record review of Resident #3's MAR, dated 08/08/25 through 08/10/25, 08/12/25 through 08/15/25, and 08/19/25 through 08/26/25, reflected number 8 which indicated that further information about the medication administration was in the resident's progress notes.Record review of Resident #3's progress notes dated 08/08/25 through 08/10/25, 08/12/25 through 08/15/25, and 08/19/25 through 08/26/25 reflected no notes specific to the administration of Lidocaine Pain Relief External start date 08/07/2025 D/C date 08/28/2025 Patch 4 % (Lidocaine) apply to left shoulder topically every 24 hours for pain remove both patches after 12 hours - remove daily at 7pm.Record review of Resident #3's orders reflected Lidocaine Pain Relief External start date 08/28/25 (no d/c date) (Lidocaine Pain Relief External Patch 4% apply to left shoulder topically in the evening for pain remove both patches after 12 hours - remove daily at 7pm Record review of Resident #3's [DATE]/01/25 through 09/04/25 reflected number 8which indicated that further information about the medication administration was in the resident's progress notes.Review of Resident #3's MAR, dated 09/05/25, reflected a blank, no staff initials and no check mark.Review of Resident #3's MAR, dated 09/06/26, reflected number 8 which indicated that further information about the medication administration was in the resident's progress notes.Record review of Resident #3's progress notes, dated 09/01/25 through 09/04/25 and 09/06/26 reflected no notes specific to the administration of Lidocaine Pain Relief External start date 08/28/2025 Patch 4 % (Lidocaine) Apply to left shoulder topically every 24 hours for pain remove both patches after 12 hours - remove daily at 7pm.Interview on 09/19/25 at 4:56 pm with the ADON reflected a number 8 in a residents' MAR reflected that the resident did not receive the medication. The ADON reflected it usually means that the facility did not have the medication and there should be a progress note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 10 of 20 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 11/21/2025 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 explaining why the resident did not get the medication. She said the process was if the resident did not receive the medication, the person who was to administer the medication informed the nurse, then made a progress note and then inform the NP. She said there should never be a blank space in the MAR because it indicated the medication was not given. She said if Resident #3 did not get his lidocaine pain patch he could have been in pain. She said there was trouble getting the lidocaine patches from the pharmacy and he missed some lidocaine patch administration. She said the nursing staff notified the ADON and the DON if the facility did not have resident medication so it could be obtained. She said it was the responsibility of the medication aide and charge nurse to ensure residents' medication was in the building. She said the lidocaine patches could be purchased at [name of discount store] and they could have gone over there to pick them up. She said the possible negative effect of him not getting the lidocaine patch was pain, but he had several other pain medications he was received. She said Resident #3 was taking tramadol and hydrocodone. She said the NP should have been notified if Resident #3 did not receive his medication. She said residents should receive all the medications ordered for them unless the resident refused medications. She said the potential negative effect of a resident not receiving medications was that they could be in pain, suffer from blood pressure problems, and missing medication administration could cause more serious issues for the residents. Interview on 09/22/25 at 11:47 am with the DOR reflected Resident #3 told her he was not getting his lidocaine patch, and he said the patch helped with the pain. She said she knew staff were going to the pharmacy to get the patches over the counter. She said that he did display some pain medication seeking behavior and did not feel comfortable stating if she thought he was in pain. Interview on 09/22/25 at 1:23 pm with the NP reflected she was not aware that the resident was not receiving his lidocaine patches, and this was something that the facility should have told her. She said she could have ordered an alternate medication, maybe a gel, until the patches were available. She said when she saw him, he did not complain about any shoulder pain. She said the negative effect of her not being informed about Resident #3 not getting his lidocaine patches was that she was not informed so she could make decisions for an alternative solution.Interview on 09/22/25 at 5:40 pm with the MA reflected she gave lidocaine patches to Resident #3 when the facility had them. She said she told the agency nurses when she did not have Resident #3's medication but did not remember the names of the nurses. She said she had not seen the DON to tell him when she did not have the patches. She said she did not know how to enter a note in resident progress notes. She said when there was a number 8 in the resident's MAR, it meant the medication was not given to the resident. She said she told the nurse on duty when medication was not given and left it at that. She said it was the responsibility of the MAs and the nurses to make sure that resident medications were in the building. She did not know why he did not have his lidocaine patches. She said she entered a refill for them in the system. She said he was never upset when she was not able to give him the lidocaine patch. She said the negative effect of him not getting his lidocaine patch was that he was not getting the medication that was ordered for him. Interview on 09/22/25 at 5:56 pm with the RN reflected she did not give Resident #3 his Lorazepam on 8/24/25 and she charted in the progress notes medication was not available. The RN said Lorazepam was for anxiety and the negative effect of him not getting the Lorazepam would be that he was anxious. She said she could not give what she did not have, and she said the medication was on order, but the pharmacy was slow. She said she did not tell anyone that Resident #3did not get the Lorazepam, and she should have told the DON and the NP. She said the possible negative effect of not telling the NP was Resident #3 could have had a negative reaction to not having the medication and the NP would not have known what had gone on with him. Interview on 09/22/25 at 7:02 pm with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 11 of 20 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 11/21/2025 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 FORM CMS-2567 (02/99) Previous Versions Obsolete the MA B reflected the number 8 in a residents' MAR meant pending delivery of a medication and the medication was not administered to the resident because the facility did not have it. When Resident #3 first arrived, the pharmacy was not sending his lidocaine patch. She did not know why. She said everyone knew about it, the ADON, DON, and the nurses. She said she informed the nurses, and they would get some into the facility, but they would run out quickly. She said she asked Resident #3 if he only wanted 1 patch to make them last longer and she would only give him one patch. She said sometimes they were purchased from [name of discount store]. She said the DON was responsible for making sure all medications for the residents were in the building. She said the possible negative effect of him not getting his lidocaine patches would be that he was in pain.Interview on 09/22/25 at 7:13 pm with Resident #3 reflected he did not get his lidocaine patch about 20% of the time and he did not receive other medications, he believed, intentionally. He said he felt neglected because he did not get his medication.Interview on 09/22/25 at 7:25 pm with LVN D reflected MAs notified the DON one or two times that Resident #3 did not receive his lidocaine patch. The pharmacy informed her that it was an over-the-counter medication unless there was a consent form signed and then it could be sent out to the facility. She thinks she told this to the people in the morning meeting. She said she did not remember who was at the meeting. She said it was the responsibility of everyone on the team to make sure that all of the medications for residents were in the building. She said the possible negative effects of Resident #3 not receiving his medication was that the resident could have been in pain. Interview on 09/22/25 at 7:54 pm with the DON reflected Resident #3 was not getting his lidocaine patches because there was a problem with availability. The DON said sometimes Resident #3 would get one patch administered instead of two patches administered and this was not good medication administration. He said he saw no information to indicate that the NP was told Resident #3 was not getting the lidocaine patches. He said if there were blanks in the MAR for a medication means the medication was not given or was skipped. The DON said residents should receive all the medications prescribed to them. The DON said that the negative effect of a residents not getting their medication was that the medication did not sustain its sufficiency to maintain the efficiency of the medication or the effects of the medications. He said the negative effect of Resident #3 not getting his lidocaine patch was that he would not get the desired pain management. He said it was the responsibility of the person giving the medications to make sure that residents' medications were in the facility. He said if the medication was not given the medical doctor or NP and the RP should be notified. He said the MAs or the nurse should call the pharmacy to figure out why the medication was not there and tell the DON. He said all steps and phone calls should be documented in the residents' progress notes.Interview on 09/23/25 at 2:35 pm with the Administrator reflected the DON was responsible for making sure that medications were in the building properly administered and the administration of the medications was properly documented. She said the possible negative effects of residents not receiving their medication was that they could experience pain. She said if the doctor ordered the medications, Resident #3 needed to be administered the medications.Record review of facility Nursing Policies and Procedures Medication Management dated June 2019 reflected the facility It is the policy of the 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. The facility's Medical Director will have an active role in the oversight of medication management. Event ID: Facility ID: 675971 If continuation sheet Page 12 of 20 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 11/21/2025 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 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 observations, interviews, and record review, the facility failed to serve foods that were palatable and prepare food by methods that conserve nutritive value, flavor, and appearance for 1 of 1 kitchen observed and five (Resident #1, Resident #3, Resident #4, Resident #5, and Resident #6) of ten residents reviewed.The facility failed to serve warm food to residents.These failures could place residents at risk of decreased food intake, hunger, unwanted weight loss, and diminished quality of life. Findings included:Review of Resident #1's face sheet, dated 09/22/25, reflected a 62-year-male, admitted on [DATE] and readmitted on [DATE] with diagnoses including human immunodeficiency virus [HIV] disease (a virus that attacks the body's immune system), type 2 diabetes mellitus with unspecified complications (a chronic condition in which the body does not use insulin effectively and has not developed any specific complications that can be identified), and bipolar disorder, current episode manic without psychotic features, moderate (periods of manic symptoms, including a prolonged elevated or irritable mood, increased energy, and goal-directed activity, lasting at least a week, without the presence of psychotic features such as delusions or hallucinations. The moderate severity suggests the symptoms are causing significant, but not severe, impairment in daily functioning).Review of Resident #1's care plan reflected focus, dated 09/19/25, Resident #1 was a diabetic and was at risk for fluctuations in blood glucose levels (the amount of sugar (glucose) in the bloodstream), hypo/hyperglycemia (abnormally low or high blood sugar levels) and other complications. Review of Resident #1's Nursing Home Comprehensive MDS, dated [DATE], reflected a BIMS score of 12 indicating moderate cognitive impairment. Review of Resident #3's face sheet, dated 09/11/25, reflected a 36-year-male, admitted on [DATE] with diagnoses including paraplegia (a condition characterized by the loss of voluntary movement and sensation in both lower limbs, typically resulting from an injury to the spinal cord in the thoracic or lumbar regions), displaced fracture of acromial process, right shoulder, initial encounter for closed fracture (a broken bone (acromion) in the right shoulder where the bone fragments have moved from their normal position), displaced fracture of body of scapula, right shoulder, initial encounter for closed fracture (a broken shoulder blade (scapula) on the right side, where the broken pieces have shifted out of their normal alignment), and displaced fracture of acromial process, left shoulder, initial encounter for closed fracture (a broken bone at the acromion (the bony point of the shoulder blade) that is no longer in its normal alignment, on the left side, for which the patient is receiving initial medical care, and the skin is unbroken). Review of Resident #3's care plan, dated 09/01/25, reflected Resident #3 refused meals.Review of Resident #3's Entry MDS, dated [DATE], reflected no functional status and no BIMS score.Review of Resident #4's face sheet, dated 09/11/25, reflected a 63-year-male, admitted on [DATE] and discharged on 08/07/25 with diagnoses including pressure ulcer of sacral region, unstageable (a full-thickness wound located on the bony prominence at the top of the buttocks (sacrum) that cannot be accurately staged due to the presence of thick, non-removable layers of necrotic tissue), paraplegia (a condition characterized by the loss of voluntary movement and sensation in both lower limbs, typically resulting from an injury to the spinal cord in the thoracic or lumbar regions), and unspecified protein-calorie malnutrition (a condition where a person does not consume enough protein and calories to meet their nutritional needs).Review of Resident #4's care plan reflected focus, dated 07/02/25, Resident #4 was a diabetic and was at risk for fluctuations in blood glucose levels, hypo/hyperglycemia, and other complications. Review of Resident #4's discharge MDS, dated [DATE], reflected no BIMS assessment. Review of Resident #4's BIMS assessment, dated 06/30/25, reflected a BIMS score of 13 indicating cognitively intact.Review of Resident #5'sface Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 13 of 20 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 11/21/2025 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some sheet, dated 09/17/25, reflected a 72-year-male who was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including diabetes mellitus (a chronic metabolic disorder characterized by high blood sugar levels that persist over time due to underlying condition with diabetic chronic kidney disease (occurs when a primary disease causes diabetes, which then leads to kidney damage), chronic kidney disease (a condition where the kidneys gradually lose their ability to filter waste products from the blood), and parkinsonism (a general term used to describe a group of neurological disorders that share similar symptoms to Parkinson's disease (a progressive neurological disorder that affects movement, balance, and coordination)Review of Resident #5's care plan reflected focus, dated 04/22/25, Resident #5 was a diabetic and was at risk for fluctuations in blood glucose levels, hypo/hyperglycemia, and other complications. Review of Resident #5's Quarterly MDS, dated [DATE], reflected a BIMS score of 9 indicating moderate cognitive impairment.Review of Resident #6's face sheet, dated 09/17/25, reflected a 71-year-male, admitted on [DATE] with diagnoses including type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (nkhhc) (a serious complication of type 2 diabetes characterized by extremely high blood sugar levels (hyperglycemia) without the presence of ketones (molecules produced by the liver from fat, serving as an alternative energy source when glucose is unavailable, and they are a sign of fat breakdown in the body) in the blood) and heart failure (occurs when the heart muscle doesn't pump blood as well as it should). Review of Resident #6's care plan reflected focus, dated 04/22/25, Resident #6 was a diabetic and was at risk for fluctuations in blood glucose levels, hypo/hyperglycemia and other complications. Review of Resident #6's Quarterly MDS, dated [DATE], reflected a BIMS score of 10 indicating moderate cognitive impairment. Observation on 09/17/25 at 11:57 am reflected lunch meal consisting of diced cooked carrots, mashed sweet potatoes, and ham mixed with beans on uncovered trays passed to residents in the secured unit. Using facility thermometer measured the temperature of lunch meal:Carrots - 118 degrees Fahrenheit Mashed sweet potatoes - 115 degrees FahrenheitHam - 120 degrees FahrenheitBeans - 114 degrees FahrenheitReview of Concern Report from Resident #4, dated 06/03/25, reflected a concern reported to the IDT team that food was served cold on multiple occasions.Record review of resident council meeting, dated 07/02/25, reflected, Kitchen: Foods cold.Record review of resident council meeting, dated 09/02/25, reflected, food is still cold.Interview on 09/11/2025 at 12:25 pm with the RD revealed meals needed to be served at a temperature of 120 degrees Fahrenheit or above for hot food items and this temperature needed to be maintained to the last tray served to a resident. She said today, her dietary staff, told her the meals served to the residents were not hot when the residents received their meals. She said Resident #1 had previously told herthat the meals were not hot when they received them. She said it was the responsibility of the dietary staff and the nursing staff who passed the trays to the residents to make sure the food was both hot and passed in a manner that would keep the food hot. She said the negative effect of the food not being 120 degrees and hot when it was given to the residents was residents were not satisfied with their food and residents look forward to their meals. She said there could also be food safety concerns depending on how long the food was not in the acceptable temperature range. Interview on 09/17/2025 at 11:01 am with Resident #5 reflected he ate in the dining room. He said, hell no, the food was not hot when he gets it. He said it was always cold and he did not want to eat it because it was cold. He said he had told the people who work in the dining room that his food was cold. He said it made him mad and disappointed when his food was cold. Interview on 09/17/2025 at 11:04 am with Resident #6 reflected he ate in the dining room and said 50% of the time his food was not hot when it was served to him. He said residents were always griping about the food being cold when it is served. He said he made him feel (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 14 of 20 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 11/21/2025 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some not good' and disappointed when he was served food that was cold. He could not remember if he has told any of the staff about the food being cold. Interview on 09/17/2025 at 12:11 pm with Resident #1 reflected the food was sometimes warm when he got it and sometimes not. He said if the food was not warm the dining room staff would go get him another plate or a sandwich, but he would rather have a warm plate the first time around, so he did not have to wait for his food. He did not remember the names of the staff members he talked to about the cold food. Interview on 09/17/25 at 12:24 pm with Resident #3 reflected the food was cold in the mornings and there was a resident council meeting about food being cold. He said the cold food made him feel neglected and unimportant. Interview on 09/17/25 at 12:36 pm with CNA A reflected Resident #1 complained a lot about the food being cold when it was served. CNA A said Resident #1 would tell him, food cold man and would not eat the food when it was cold. Interview on 09/17/25 at 1:36 pm with LVN B reflected the residents' food was not warm when they received it. She said some of the dining staff would take the residents' food and warm it up for them but some of the dining staff would not. Interview on 09/17/25 at 2:25 pm with the Administrator reflected the cook was responsible for making sure the food was warm. She said if during resident council meetings and if there were grievances that said the food was cold and it should have been addressed by the dietary manager, and the administrator should have followed up to make sure it was resolved. She said if the food was cold, it did not make residents feel good and she could sympathize with them because she would not want cold food if it was supposed to be hot. She said residents could be upset and have a grievance if their food was not hot or they might not get the proper nutrition because they do not want to eat the food.Interview on 09/17/25 at 5:31 pm with the facility cook reflected she heard residents complain the food was cold when it got to them, but she did not know the names of the residents who complained. She said the food temperature should be 140 degrees Fahrenheit when residents received their food. She said the residents were a little upset about the cold food. She felt there was a lack of communication between the dietary service and the staff who passed out the resident trays. She said it would normally be the responsibility of the dietary manager to make sure residents received their food at the correct temperature, but they currently did not have a dietary manager. She said the residents complained about cold food for the past three months.Interview on 09/19/25 at 10:43 am with the DA reflected Residents #1 and #7 complained that residents did not receive food when it was hot. Residents #1 and #7 would tell the staff if the food was cold. She did not feel it was cold because it was not cold when it left the kitchen. She said it was the responsibility of the aides to make sure that the residents got their food before it got cold because it was the correct temperature when it left the kitchen. She had not told the Administrator, the DON or any nurses that residents complained that the food was cold when they got it. She was pretty sure that the residents told the Administrator and the nursing staff because there were some pretty vocal residents. She said they have not solved the problem, and residents were still getting cold food. She said they cut the kitchen staff down to two aides, and it got pretty hectic in the kitchen. She said it would make her feel very upset if she got cold food. She said she would feel like they did not put any care into the food service. Interview on 09/19/25 at 4:56 pm with the ADON reflected Resident #1 and a former resident, Resident #4, complained that the food was cold. She said it was a group effort between the kitchen and the aides and everyone to make sure that the trays got passed out so that residents' food was hot when they received it. She said residents might not feel happy if their food was cold and she would not be happy if she got served cold food.Review of facility Nutrition Services Policies and Procedures, undated, reflected it is the policy of this facility that food temperatures would be maintained at acceptable levels during food storage, preparation, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 15 of 20 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 11/21/2025 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 0804 Level of Harm - Minimal harm or potential for actual harm holding, serving, delivery, cooling and reheating. Review of facility food Palatability policy, dated 11/31/24, reflected food temperatures were monitored prior to service to ensure palatability and safe point-of-service temperatures. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 16 of 20 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 11/21/2025 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure an effective pest control program was implemented so the facility was free of pests and rodents for 1 of 1 facility reviewed for pest control observed and four (Resident #1, Resident #3, Resident #6, and Resident #7) of seven residents reviewed.The facility failed to keep roaches and rodents out of resident rooms, the facility kitchen, facility common areas, and rest rooms.These failures placed residents at risk of infection, feelings of fear, anxiety, disgust, helplessness, shame, and a diminished quality of life.Findings included:Review of Resident #1's face sheet dated 09/22/25 reflected a 62-year-male who was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including human immunodeficiency virus [HIV] disease (a virus that attacks the body's immune system), type 2 diabetes mellitus with unspecified complications (a chronic condition in which the body does not use insulin effectively and has not developed any specific complications that can be identified), and bipolar disorder, current episode manic without psychotic features, moderate (periods of manic symptoms, including a prolonged elevated or irritable mood, increased energy, and goal-directed activity, lasting at least a week, without the presence of psychotic features such as delusions or hallucinations. The moderate severity suggests the symptoms were causing significant, but not severe, impairment in daily functioning).Review of Resident #1's care plan reflected focus revised 09/19/25 reflected Resident #1 was a diabetic and at risk for fluctuations in blood glucose levels (the amount of sugar (glucose) in the bloodstream), hypo/hyperglycemia (abnormally low or high blood sugar levels) and other complications.Review of Resident #1's Nursing Home Comprehensive MDS, dated [DATE], reflected a BIMS score of 12 indicating moderate cognitive impairment.Review of Resident #3's face sheet, dated 09/11/25, reflected a 36-year-male who was admitted to the facility on [DATE] with diagnoses including paraplegia (a condition characterized by the loss of voluntary movement and sensation in both lower limbs, typically resulting from an injury to the spinal cord in the thoracic or lumbar regions), displaced fracture of acromial process, right shoulder, initial encounter for closed fracture (a broken bone (acromion) in the right shoulder where the bone fragments have moved from their normal position), displaced fracture of body of scapula, right shoulder, initial encounter for closed fracture (a broken shoulder blade (scapula) on the right side, where the broken pieces have shifted out of their normal alignment), and displaced fracture of acromial process, left shoulder, initial encounter for closed fracture (a broken bone at the acromion (the bony point of the shoulder blade) that is no longer in its normal alignment, on the left side, for which the patient is receiving initial medical care, and the skin is unbroken). Review of Resident #3's care plan focus, dated 08/13/25, reflected [mechanical lift] for transfers with staff to use [mechanical lift] x2 aides for transfers.Review of Resident #3's Entry MDS, dated [DATE] reflected no functional status and no BIMS score.Review of Resident #6's face sheet, dated 09/17/25, reflected a 71-year-male who was admitted to the facility on [DATE] with diagnoses including type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (nkhhc) (a serious complication of type 2 diabetes characterized by extremely high blood sugar levels (hyperglycemia) without the presence of ketones (molecules produced by the liver from fat, serving as an alternative energy source when glucose is unavailable, and they are a sign of fat breakdown in the body) in the blood) and heart failure (occurs when the heart muscle does not pump blood as well as it should).Review of Resident #6's care plan reflected focus, dated 04/22/25, was a diabetic and at risk for fluctuations in blood glucose levels, hypo/hyperglycemia and other complications. Review of Resident #6's Quarterly MDS, dated [DATE], reflected a BIMS score of 10 indicating moderate Residents Affected - Many (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 17 of 20 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 11/21/2025 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many cognitive impairment.Review of Resident #7's face sheet, dated 09/17/25, reflected a 51-year-male who was admitted to the facility on [DATE] with diagnoses including type 1 diabetes mellitus (an autoimmune disorder where the body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas) with unspecified diabetic retinopathy with macular edema (medical diagnosis for a person with Type 1 diabetes whose eyesight was affected by a combination of two related eye conditions), major depressive disorder (a common and debilitating mental health condition characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities), and malignant neoplasm of bladder (bladder cancer). Review of Resident #7's care plan reflected focus, dated 04/03/25, was a risk for falls and injuries.Review of Resident #7's Quarterly MDS, dated [DATE], reflected a BIMS score of 15 indicating no cognitive impairment.Observation on 09/17/2025 at 11:11 am of a live roach in the rest room across from Resident #5 and Resident #6s' room.Observation 09/17/25 at 12:34 pm of dresser drawer in Resident #3's room of what appeared to be rodent droppings. Observation 09/19/25 at 10:03 am of a dead smashed roach in the hallway outside of the facility conference room.Observation 09/19/25 at 10:05 am of a dead roach in the facility conference room next to the conference room table.Record review of pest control service invoice, dated 03/04/25, reflected, American Cockroach activity in Beauty Salon.Record review of pest control service invoice, dated 05/31/25, reflected, Dietary staff reported seeing an American roach. Staff reported sightings of roaches.Record review of pest control service invoice, dated 06/12/2025, reflected, Met with maintenance manager. He stated some roaches in the break room.Record review of pest control service invoice, dated 07/09/25, reflected, Kitchen staff said they're seeing roaches around a heating table.Record review of pest control service invoice, dated 07/31/2025, reflected, [name of pest control service] was on site right now for your emergency call-in regarding roaches in offices and break room. Met with [head of maintenance]. He said it is just one office and the break room. Before I (the exterminator) left I (the exterminator) checked in with the administrator. He said he saw an American roach in the hall bathroom next to his office. Ongoing roaches in breakroom, several offices, and bathrooms.Record review of pest control service invoice, dated 08/14/2025, reflected, A staff member said she saw a roach in the employee break room. During inspection I (the exterminator) found a dead American roach under table. Kitchen staff said they saw a roach by the heating table.Record review of pest control service invoice, dated 08/22/25, reflected, resident was claiming to have been bit by something. I (the exterminator) happened to look up at the ceiling above the bed and found what appears to be a type of blister beetle. The ac window unit has gaps around it. I'm sure this is how the beetle entered the room. Therapy asked if I could treat ants. I did find some odorous house ants by the writing board. Maintenance Director assistant asked if I could treat the breakroom for cockroaches.Record review of pest control service invoice, dated 09/12/2025, reflected, [name of pest control service] is on site to address a concern. On arrival, we met with the maintenance director, [name of maintenance director]. He guided us to room [ROOM NUMBER] where droppings were spotted. The majority of droppings appeared to be American cockroach droppings. There is a hole between the baseboard and the floor that [name of maintenance director] will be sealing to aid in control. Rodent bait stations were filled on the exterior of the facility, and a proposal is being sent for additional bait stations to address rodent pressures. Rat droppings reported and foods being eaten. - RoomInterview on 09/11/2025 at 3:14 pm with the MD revealed the facility had not had a bug infestation problem and the pest control services come every month and if pest control service was needed outside of that time, the facility called them, and the service would come. He said no residents told him about a bug problem. He said Resident #3 told him about rat droppings in his room and he looked at them, but he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 18 of 20 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 11/21/2025 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many really was not sure they were rat droppings. He said there were no exposed holes in Resident #3's room that indicated a rodent. Interview on 09/17/2025 at 11:04 am with Resident #6 reflected now there were fewer bugs and the bug problem was getting better, but he saw roaches in the rest room and on the walls of his room. He said he saw roaches run out of the rest room and into the hallway.Interview on 09/17/2025 at 11:27 am with Resident #7 reflected he saw spiders in his room and there were roaches in the bathroom, and the roaches would crawl through the door of his room onto his floor, and it disgusted him, and he believed the place was filthy.Interview on 09/17/2025 at 12:11 pm with Resident #1 reflected he saw a lot of bugs at the facility. He saw bugs in the hallway and in the rooms, mostly roaches, and he said he did not dig it and did not feel good about the bugs. He said the bugs come out at night but he had not complained to anyone about the bugs.Interview on 09/17/2025 at 12:24 pm with Resident #3 reflected the night nurse (he could not recall her name) said she saw a rodent in his room so big she thought it was a possum. He said he saw bugs, roaches, spiders, and mice, which made him feel uncomfortable. He said he heard mice fighting to get to the food in his room and there were rat droppings in his drawer. He said it did not feel sanitary. Interview on 09/17/2025 at 1:36 pm with LVN B reflected she saw tons of roaches at the facility, and she did not pick up night shift because of the roaches with wings. Interview on 09/17/2025 at 2:11 pm with the MD reflected there was a report from a nurse (he did not know the name of the nurse) that she saw a rat in Resident #3's room. He said the nurse reported the rat sighting to the Administrator and the Administrator told him and both he and the Administrator went to Resident #1's room. He said he found a gap on the floorboard where a rodent could have entered, and he plugged the gap. The MD said, after viewing the photo of the dresser drawer in Resident #3's room of what appeared to be rodent droppings, that the photo did depict rat droppings. Interview on 09/17/25 at 4:57 pm with CNA C reflected Resident #3 mentioned there was a mouse in his room and she saw a bag of chips that was nibbled on. She said the Administrator got Resident #3 a bin to put his food in.Interview on 09/17/25 at 6:11 pm with AN LVN reflected she saw a rat, or a mouse run across Resident #3's room and go under the dresser. She said it was big. She said she reported to the oncoming nurse she saw a rodent in Resident #3's room and the oncoming nurse said she would tell the Administrator. She said it concerned her there was a rat in the building because rodents could be detrimental to a resident. She said rodents carry diseases.Interview on 09/19/25 at 4:25 with the Psychiatric NP reflected it was concerning there was a rodent spotted in Resident #3's room. She said a negative effect might be rabies if the resident was bitten because Resident #3 had no sensation from the waist down. She said he was not able to get up and move. She said she was not notified about the rodent situation. She said a review of her progress notes reflected Resident #3 told her the rats were eating his snacks.Interview on 09/19/25 at 4:56 pm with the ADON reflected she saw roaches in the facility every now and then. She said dead pests in the facility would indicate there was a pest problem. The negative effects of having pests in the facility could be infection control and the pests could make the residents feel uncomfortable not knowing if they were going to crawl on them and make the residents feel the facility was not clean. The ADON said she was not aware there was a rodent in Resident #3's room before the nurse witnessed the rodent. She said certain situations could make Resident #3 kind of delusional but a nurse seeing it with their own eyes was the final straw and Resident #3 should have gotten the benefit of the doubt. Because Resident #3 had limited movement, the rodent could have bitten him, and he could have gotten sick. Interview on 09/22/25 at 11:47 pm with the DOR reflected, when asked if she had seen roaches in the facility, she said, oh yea. She said in May, one came out of the secured unit keypad when she was pushing the keypad to get into the secured unit and she saw big water roaches. She said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675971 If continuation sheet Page 19 of 20 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 11/21/2025 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete she told the administrator at the time about it, the MD, and the charge nurse. She said it was a big part of her reason she previously left the facility.Interview on 09/22/25 at 7:54 pm with the DON reflected there were bugs in the facility, and it was a problem because it could create skin abrasions and bites. He said roaches could be an infection control issue because they represented a dirty environment. He said he told the Administrator Resident #3 kept food in his room and mice might eat his food, so the Administrator got a plastic container for his food. The DON said Resident #3 should have been moved as soon as it was confirmed there were rat droppings in his room. He said the negative effect of a rodent in a resident's room was the possibility of being bitten by the rodent and skin infection. A rodent in Resident #3's room was definitely more difficult for him because Resident #3 could not move.Interview on 09/23/25 at 2:35 pm with the Administrator reflected that she could not remember when they brought up the possible rodent situation in Resident #2's room. She said both she and the MD went into Resident #2's room with a flashlight and looked around. She said they did not see anything but there was gap in the floorboard which the MD filled with a foam substance. She said on 09/19/25 the charge nurse called her and said the night agency nurse said she saw a rat running through Resident #2's room. The Administrator thought Resident #2 was delusional because he said it was a possum and Resident #2 had UTIs. The administrator said the MD said Resident #2 made stuff up. They now know there was a rodent in the facility because it was reported by a nurse.Interview on 09/23/25 at 2:35 pm with the Administrator reflected she had not seen live bugs in the facility. She said she did not know if having rodents and bugs in the facility was an infection control issue. She said the facility was supposed to have a homelike environment and people who do not live at nursing facilities have bugs and rodents even though they do not want to. She said the facility tried to keep bugs and rodents out of the facility just like people who do not live in nursing facilities.Record review of facility Policies and Procedures Pest Control dated June 2024 reflected the facility will implement measures to prevent, monitor, and address pest activity in a manner that does not compromise resident safety, infection control, or environmental standards. Event ID: Facility ID: 675971 If continuation sheet Page 20 of 20