Health inspection·November 20, 2025

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete curtain. Review of facility's policy Resident Rights dignity and respect revised dated 2015, reflected: It is the policy of this facility that all residents be treated with kindness, dignity, and respect.4. residents shall be examined and treated in a manner that maintains the privacy of their bodies. A closed door or drawn curtain shields the residents from passer-by. 5. Privacy of a Resident's body shall be maintained during toileting, bathing and other activities of personal hygiene. 6. Violation of the Residents' Rights to dignity and respect should be promptly reported to the Director of Nursing Services and/or Administrator. Event ID: Facility ID: 675972 If continuation sheet Page 2 of 8 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 675972 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carrollton Health and Rehabilitation Center 1618 Kirby Rd Carrollton, TX 75006 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 the residents' environment remained as free of accident hazards as is possible and ensured each resident received adequate supervision for one (Resident #1) of four residents reviewed for accidents and hazards. The facility failed to ensure Resident #1 was free of injury from accident hazards when CNA D failed to follow policy and procedure and report to the nurse in charge, when CNA D found Resident #1 was on the floor in her room. CNA D picked the resident up from the floor and placed her in wheelchair taking the resident to the dining room for breakfast. The LVN did not assess Resident #1 before she was moved by CNA D. These failures could place residents at risk for harm, pain, and injury.Findings included: Record review of Resident #1's significant change MDS assessment, dated 10/27/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. The resident had diagnoses which included: Hypertension (high blood pressure), non-Alzheimer's dementia (mental confusion), cerebrovascular accident (stroke), and repeated falls. The MDS reflected she had a BIMS score of 01, which indicated severe cognitive impairment. The resident used a wheelchair for mobility, she could wheel up to 150 feet with supervision, and could stand to transfer from wheelchair to bed and bed to wheelchair, but could not walk safely. Resident #1 required the assistance of one staff for activities of daily living. Record review of Resident #1's care plan dated 09/01/2025 indicated she was limited in her ability to transfer due to impaired mobility. She was unable to ambulate but could stand with stand by assist. Interventions included: assist with transferring using stand by assist or a gait belt (a type of device used to wrap around an individual to give assistance to stand safely and transfer), 1-person assist, keep call light within reach, monitor extremities to avoid injury, notify nurse if any injury/fall occurs, provide 1-person assistance for transferring, and when transferring, resident should be face-to-face with caregiver. Further review of Resident #1's care plan dated 09/01/2025 indicated she was at risk for falling r/t impaired mobility, decreased muscle strength. Resident #1 used a w/c for mobility with partial staff assistance. Her falls were related to standing up without assistance and sitting on the floor. Interventions included: transfer to hospital for evaluation, keep bed in lowest position with brakes locked, always keep call light in reach, keep personal items and frequently used items within reach when appropriate. Record review of the incident/accident report for August-November 2025 indicated on 09/21/25 Resident #1 was located on the floor in her room assessed and no injuries noted, 10/31/2025 Resident #1 was located on the floor in the room actual time 6:15 a.m., the resident was not assessed at that time, assessed later by charge nurse when the facility was notified by the Responsible party the resident was on the floor in her room early in the morning and a [CNA] had come in Resident #1's assisted her up and placed her in the wheelchair and wheeled her out of the room, without a nurse assessing her. The Responsible party reported that no one had contacted her about the fall. An observation on 11/20/2025 at 4:45 a.m. revealed Resident #1 was asleep, in a low bed, in her room. Her wheelchair was located in the bathroom. An interview on 11/20/2025 at 4:50 a.m. with CNA C revealed she had taken care of Resident #1 for three months, and she knew her from the past. CNA C stated Resident #1 would get up out of her bed or her wheelchair and sit on the floor. CNA C stated Resident #1 could not get back up on the bed or into the wheelchair without assistance of one person, she would scoot around on the floor. CNA C stated Resident #1 previously had a stability mat, but it had been removed, and she was unstable on it when she tried to stand up. CNA C stated when any resident was found on the floor, they were to be left there, and staff were to get the nurse so the resident could be assessed for injuries. CNA C stated they recently had in-service Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675972 If continuation sheet Page 3 of 8 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 675972 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carrollton Health and Rehabilitation Center 1618 Kirby Rd Carrollton, TX 75006 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on fall and reporting in the past three months. An interview on 11/20/2025 at 5:30 a.m., with Resident #1, using a google translator, revealed the resident stated that she could get up and go to the bathroom by herself and she would not fall. Resident #1 stated she used her wheelchair most of the time. Resident #1 stated she liked living here, and the staff was nice and took care of her. Observation on 11/20/2025 at 5:15 a.m. with CNA C of Resident #1 revealed CNA C assisted Resident #1 to stand. She could bear weight. She was placed in the wheelchair, then taken to the bathroom. Resident #1 was brought into the room and she was dressed and prepared for the breakfast meal. CNA C then transported her to the dining room. Further observations during activities of daily living revealed no bruising or skin tears to resident's body. Interview with CNA D on 11/20/2025 at 8:00 a.m., revealed she came in on 10/31/2025, and as she was making her rounds on her assigned hall, she found Resident #1 scooting around in her room on the floor. CNA D stated she entered the room, assisted the resident up, placed her in the chair, and took her to the dining room for breakfast. CNA D stated she thought it was between 6:00 a.m. and 6:30 a.m. CNA D stated she did not report the incident to the change nurse, and she did not really know why she did not. CNA D was aware she was supposed to report to the nurse anytime a resident was found on the floor, and not to move them. CNA D stated she was written up and counseled by the DON for not reporting, and she was in-serviced on reporting falls; all the staff was. CNA D stated she was glad that the resident was not hurt and she would always remember to tell the nurse. An interview with LVN E on 11/20/2025 at 9:26 a.m., revealed she was never told about Resident #1 being on the floor in her room, by any staff, until the DON informed her. LVN E stated she assessed Resident #1 and found no injuries, filled out all the required papers, documented in the clinical record, started the resident on 72-hour monitoring, and informed the physician and responsible party. LVN E stated Resident #1 was a fall risk and she had multiple incidents where she was found sitting on the floor, but no injuries were noted. Resident #1 continued to be monitored following this incident; exhibiting no injuries. LVN E stated she had been in-serviced concerning reporting falls and assessments, and policy and procedure as to follow-up, in the past three months Interview with the Responsible party of Resident #1 on 11/19/2025 at 10:15 a.m., revealed Resident #1 had been seen (on her camera) at 6:15 a.m. on 10/31/2025 in Resident #1's room on the floor scooting around. The Responsible party stated she saw CNA D come into the room, obtain Resident #1's wheelchair, pick her up and place her in the wheelchair, and wheel her out of the room. The Responsible party stated she never received a phone call from the facility about Resident #1 falling or an assessment of her fall. The Responsible party stated, she then called the DON, reported the incident and how she had never received a call, and the CNA that was involved. The Responsible party stated she could not recall what time she called and spoke with the DON on 10/31/2025 concerning the incident she had viewed on the video. Interview with the DON on 11/20/2025 at 1:11 p.m., revealed the CNAs were expected to follow the policies and procedures for reporting falls. The DON stated if a resident was found on the floor, the CNA was to not move them and report to the nurse in charge immediately. The nurse then was to assess the resident for injury and inform the physician, Responsible party, and the DON. The DON stated if Resident #1 was on the floor CNA D should have left her on the floor and reported to the nurse to the time she had found her. The DON stated when the Responsible party called me and informed me of what she had viewed on the video installed in the room, immediately the nurse was instructed to assess Resident #1, call the Responsible party and the physician. I then wrote up (disciplined) the CNA responsible and scheduled an in-service that day and informed all staff they must attend and could not return to work until they did. The DON stated the risk to the resident when the staff did not follow policy and procedure for reporting incidents and accidents was injury to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675972 If continuation sheet Page 4 of 8 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 675972 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carrollton Health and Rehabilitation Center 1618 Kirby Rd Carrollton, TX 75006 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the resident. Record review of the in-service logs dated 08/2025-10/2025 reflected on 8/10/2025 and on 10/31/2025 an all-staff in-service titled Falls and Fall Management system was conducted. CNA D attended both in-services. Further review reflected the DON followed-up with the staff once a week for two weeks on reporting and following the policy and procedure for falls and reporting. [NAME] review of the employee file for CNA D reflected the only write-up in the CNA D's file was dated 10/31/2025, concerning, resident was on the floor and did not follow the facility policy and procedure. Record review of the facility's policy titled Fall Management System revised December 2023, read in part . Policy: It is the policy of this to provide an environment that remains as free of accident hazards as possible. It is also the policy of this facility to provide each resident with appropriate assessment and interventions to prevent falls and to minimize complications if a fall occurs. procedure: 3.When a resident sustains a fall, a physical assessment will be completed by a licensed nurse.a.The attending physician and Resident Representative shall be notified of the fall and the resident status. Event ID: Facility ID: 675972 If continuation sheet Page 5 of 8 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 675972 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carrollton Health and Rehabilitation Center 1618 Kirby Rd Carrollton, TX 75006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure all drugs and biologicals were stored in accordance with currently accepted professional principles in locked compartments and permit only authorized personnel to have access to the keys for 1 (Resident #2) of 4 reviewed for storage of drugs, in that: The facility failed to ensure Resident #2's calmoseptine ointment (ointment applied to the bottom to treat and prevent redness) was secured. This failure could place residents at risk of medication misuse and diversion.The findings were: Record review of Resident #2's quarterly MDS assessment, dated 06/06/2025, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included: Cerebral Vascular Disease (stroke), aphasia (unable to speak), dysphagia (unable to swallow), and hypertension (high blood pressure). Resident #2's cognition was severely impaired, he was unable to make decisions and required assistance from one staff for activities of daily living. Record review of Resident #2's physician orders dated 11/2025 reflected no orders to self-administer medications. During an observation and interview on 11/20/2025 at 5:00 a.m., a medication cup with a pink substance on the top of the dresser in Resident #2's room wasd unsecured and unattended. RN B stated, Oh that is probably the cream the staff uses on his bottom, when they change him. The RN did not attempt to remove the cream and left the room. An observation on 11/20/2025 at 5:15 a.m. revealed the pink ointment in the medication cup was still on the dresser in Resident #2's room. An interview on 11/20/2025 at 5:15 a.m. with CNA C revealed she did not use the pink ointment in the medication cup on Resident #2 when she changed him. She stated she used incontinent wipes and placed on no cream. CNA C stated she did not know what the ointment was. An interview on 11/20/2025 at 6:15 with CNA D revealed the CNA did not know what the pink stuff was, CNA D stated she had never seen it before. An interview on 11/20/2025 at 12:06 p.m., with LVN E revealed all the treatments for the residents, to include ointments, other medications, and supplies were all in the treatment cart and locked. LVN E stated that the nurses were required to perform the treatments or if the treatment was more than one time a day. LVN E stated the treatment for skin conditions should never be left outside of the locked cart only when being used by the nurse, or if this was an order to leave it in the residents' room. During an interview on 11/20/2025 at 12:17 p.m., the DON stated she expected the nurses to know better than to leave medications in any resident's rooms. The DON stated negative effects could occur to the residents if medications were left in their rooms. During the interview the DON did not confirm what the cream was. The DON stated, anybody can get them and have access to them. The DON stated this could cause harm to another resident or even staff. Record review of the Facility's Policy titled Pharmacy Services revised dated May 2007 reflected: It is the policy of this facility that drugs and treatments shall be administered/carried out upon the order of a person duly licensed and authorized to prescribe such drugs and treatments.2. All drugs and biologicals orders shall be dated. Event ID: Facility ID: 675972 If continuation sheet Page 6 of 8 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 675972 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carrollton Health and Rehabilitation Center 1618 Kirby Rd Carrollton, TX 75006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 2 (CNA A and RN B) staff members and 2 of 2 residents (Residents #3, and #2) reviewed for infection control procedures. CNA A failed to change their soiled gloves and perform hand hygiene during incontinent care on Residents #3. RN B failed to change her soiled gloves and perform hand hygiene during replacement of gastroenterology tube (feeding Tube) supplies for Residents #2. These failures could place residents at risk for cross contamination and infectionsFindings included: Record review of Resident #3's quarterly MDS Assessment, dated 09/01/2025, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included: Hypertension (increased blood pressure), diabetes, (increased blood sugar), and dementia (confusion). Resident #3's cognition was severely impaired, unable to make all decisions for herself, and required one staff member for assistance with activities of daily living. Record Review of Resident #3's plan of care dated 09/05/2025 reflected goals and approaches for incontinent care to be provided by the nursing staff every 2 hours to keep Resident #3 clean and dry and prevention of skin problems. During an observation on 11/20/2025 at 4:30 a.m., CNA A entered the room to perform incontinent care and activities of daily living with Resident #3. CNA A did not use hand gel in the hallway or wash his hands before placing on gloves that he got from the box on top of the dirty linen cart. CNA A picked up his incontinent wipes from the top of the dirty linen cart and entered the room. Resident #3 was lying on her back in the bed. CNA A explained to the resident what he was going to do, and the resident agreed. CNA A pulled the pants of Resident #3 down; she had taken off her brief. CNA wiped the pubic area with a disposable wipe, discarded the wipe. CNA A used another wipe on the peri area and discarded it. CNA A assisted with repositioning Resident #3 to her right side; he then used another wipe on the left buttocks and discarded it. CNA A assisted with repositioning Resident #3 to her left side while pulling the clean brief under the resident. CNA A without changing his soiled gloves or washing his hands, he fastened the tabs of the clean brief, placed on the resident's pants, assisting with repositioning her on back, and covered her with a blanket. CNA A placed his gloves in the trashcan, gathered the trash bag, and left the room, without washing his hands or using hand sanitizer. The CNA placed the incontinent wipes back on top of the dirty linen cart, with the box of gloves. An interview on 11/20/2025 at 4:45 a.m. with CNA A revealed the CNA stated, he got nervous when the surveyor entered the room with him and he forgot what to do. CNA B stated he knew he did not change his gloves, and he should not have kept supplies on top of the dirty linen cart. CNA B stated he had been trained in infection control, changing gloves, and handwashing. He stated the DON had worked with him in the past three weeks. The CNA stated that if he did not change his gloves and wash his hands or use sanitizer, he could spread germs to himself and other residents. Record review of Resident #2's quarterly MDS assessment, dated 06/06/2025, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included: Cerebral Vascular Disease (stroke), aphasia (unable to speak), dysphagia (unable to swallow), and hypertension (high blood pressure). Resident #2 was severely cognitive and unable to make decisions and required assistance from one staff for activities of daily living. Record review of Resident #2's plan of care reflected goals and approaches for feeding tube insertion site will be free of any sign's symptoms of infections. Provide local feeding tube care as ordered to prevent any signs and symptoms of infections. Using enhanced barrier precautions (the use of PPE, personal Protective Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675972 If continuation sheet Page 7 of 8 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 675972 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carrollton Health and Rehabilitation Center 1618 Kirby Rd Carrollton, TX 75006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete equipment) Record review of Resident #2's physician orders dated 09/30/2025 reflected, change all enteral feeding tubing and water bags every night shift on Wednesday. An observation on 11/20/2025 at 5:00 a.m., revealed RN B performing the replacement of the gastroenterology tube (feeding tube) supplies for Resident #2. During which time the RN placed on gloves and the PPE, personal protective equipment (gloves, gown and mask) and began to remove the used tubing and the used water bag. The RN placed the used supplies in the trash. RN B opened the door to the bathroom, took the cap off the new water bag, and filled it with water. RN B returned to the bedside of Resident #2, replacing the tubing RN B connected the new tubing to the gastronomy tube and hanging the new water bag and a new bottle of formula. The RN took her gloves off and left the room. The RN never replaced the gloves or sanitized her hands from the dirty supplies used to the new supplies. An interview with the DON, who was the infection control preventionist on 11/20/2025 at 2:39 p.m., revealed the DON stated that all direct care staff must keep their supplies available for usage, but in a clean supply area. The DON stated the staff, when performing incontinent care, should be changing gloves from dirty to clean, and washing their hands or using the available hand sanitizer. The DON stated she had just had an in-service in the past 3 weeks presenting the importance of changing gloves and washing hands during care and incontinent care. The DON stated that some of the CNAs had spent extra time with them, to make sure they understood. The DON stated during the in-service, the staff did not ask any questions and appeared to understand and indicated they knew everything. The DON stated if the staff did not change gloves and clean their hands when they should, they could spread germs to themselves and the residents. Record review of the Facility's Policy titled Infection Control Guidelines for All Nursing Procedures dated December 2024, reflected: Purpose: to provide guidelines for general infection control while caring for residents . for residents when performing high-contact resident care activities: dressing, grooming, transferring, providing hygiene, changing linens, changing briefs ., 4. Employees must wash hands for twenty (20) seconds or longer using antimicrobial or non-antimicrobial soap and water under the following conditions: .a. after direct contact with resident, d. after removing gloves, after handling items potentially contaminated with blood, body fluids, or secretions, Event ID: Facility ID: 675972 If continuation sheet Page 8 of 8