Health inspection·October 10, 2025

F 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few then walked out of the room. In an interview with RNC and Admin on 10/09/2025 at 11:24AM, the RNC stated she was not aware of any restrictions regarding LVN F's ability to care for Resident #1. He will be removed from any future assignments. The Admin stated neither the RP nor the staff informed her that staff were caring for Resident #1 after she informed them not to. Notify the staff after request to remove from care and then they know they don't assign them to that room. If they are informed by a family member not to care for them, they should directly report that to the administrator. LVN F did not report to me that he was told not to care for them. She stated if an RP or a resident requested not to have a staff member care for them, then they do not allow the staff to come in the room again if their care was refused. She stated when a resident or an RP informs the staff that a person was no longer allowed to care for them, we inform the Staffing Coordinator/ ADON and the staff member of the changes. She stated she would look at the assignment sheet for 10/09/2025. She stated the staffing assignment was made prior to the notification in the video on 10/08/2025. She stated they had no notification before that, that LVN F was not allowed to care for the resident. In a phone interview with LVN F on 10/09/2025 at 11:49AM, he stated he did go back in the room to care for Resident #1 around 1:30PM on 10/08/2025 after being told not to care for him by the RP through the camera. He stated he was in there because an aide put him to bed and did pericare, so I did oral care for him while was there. He stated he did not change assignments after the RP told him not to care for Resident #1. He stated She has said that to everyone to the point and now there aren't enough people to go in and care for him. He stated he talked to the ADON about it. He stated he thought he knew it was the RP based on the voice and the way she was talking. He stated technically, he did not know who it was over the camera. He stated the RP never called the facility directly to request that he not care for Resident #1, so I went in later that day and did the oral care and left. He stated Resident #1 still needs the care. He stated there was possibly someone who could have done it, but he did not go searching. In an interview with TN on 10/09/2025 at 5:00PM, she stated t LVN F had picked up a shift to work from 06:00AM to 10:00AM the morning of 10/09/2025. She stated she was not aware of who was restricted from caring for Resident #1. She stated the Assignment sheet for the day was in a binder on the nurses' station. Record review of staff assignment sheets dated 10/08/2025 reflected LVN F was assigned as the nurse to Resident #1's hall from, 6a-10p. Record review of staff assignment sheets dated 10/09/2025 reflected LVN F was assigned as the nurse to Resident #1's hall from, 6a-10a. Record review of List of staff unable to enter room for Resident #1 dated 10/09/2025 reflected LVN F was on the list with 6 other staff members. In an interview with CMA G in 10/09/2025 at 5:05PM she stated that the list of staff not permitted to care for Resident #1 was not available in the binder or anywhere else to her knowledge prior to 10/09/2025. She stated that she could not have said who was allowed or not allowed to care for Resident #1 prior to that day. In an interview with ADON on 10/10/2025 at 12:44PM she stated that she was in charge of scheduling for the nursing staff. She stated that it was not reported to her on 10/08/2025 that LVN F was no longer allowed to care for Resident #1. She stated she received a list from the Admin and DON outlining who could not care for Resident #1 on 10/09/2025. She stated she provided care to Resident #1 with LVN F on 10/09/2025 and 10/08/2025. She stated if she had been aware she would have reassigned LVN F to a different hall at that time. She stated she was responsible for scheduling of the nursing related staff, unless the DON should intervene. She stated if there was something regarding scheduling updates or concerns with scheduling, she would inform the DON. She stated she knew about all other staff on the list provided by the DON, except for LVN F. She stated the facility should honor the resident's rights and requests for refusals of caregivers by themselves or their RP. She stated it was possibly a violation of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 2 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 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 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete their rights to allow the person to continue to care for them after they have been asked not to. She stated it could degrade the resident or RP's trust in the facility. In an interview with Admin on 10/10/2025 at 4:52PM, she stated if we allow staff to work with residents after the resident or RP requested for them not to be, she stated the resident or the RP may feel their rights are not being respected. She stated that we should honor the requests of the RP as we would a direct request from a resident. In an interview with RNC on 10/10/2025 at 4:52PM, she stated it could distress them or trigger trauma to have someone continue to care for them after they have been told not to care for them. Record review of facility policy for Resident Rights (no date) reflected: RESIDENT RIGHTS.3.In the case of a resident who has not been adjudged incompetent by the state court, the resident has the right to designate a representative, in accordance with State law and any legal surrogate so designated may exercise the resident's rights to the extent provided by state law. The same-sex spouse of a resident must be afforded treatment equal to that afforded to an opposite-sex spouse if the marriage was valid in the jurisdiction in which it was celebrated.a. The resident representative has the right to exercise the resident's rights to the extent those rights are delegated to the resident representative.b. The resident retains the right to exercise those rights not delegated to a resident representative, including the right to revoke a delegation of rights, except as limited by State law.4.The facility must treat the decisions of a resident representative as the decisions of the resident to the extent required by the court or delegated by the resident, in accordance with applicable law.5.The facility shall not extend the resident representative the right to make decisions on behalf of the resident beyond the extent required by the court or delegated by the resident, in accordance with applicable law. Event ID: Facility ID: 676019 If continuation sheet Page 3 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide the care and supervision to prevent accidents for 1 of 7 (Resident #1) residents reviewed for accidents and hazards. The facility failed to ensure that Resident #1 was repositioned with two-person assist and left in an unsafe position when CNA A walked away from the bedside on 9/15/2025. The noncompliance was identified as Past Noncompliance (PNC). The IJ template was provided to the facility on [DATE] at 1:25PM. The IJ began on 9/12/2025 and ended 9/15/2025. The facility corrected the noncompliance before the survey began on 10/08/2025. This failure placed residents at risk for accidents, falls, fractures, and diminished quality of life.Findings Include: Record Review of Resident #1's Facesheet dated 10/08/2025 revealed a 37 y/o male, admitted to the facility on [DATE]. Diagnoses included unspecified convulsions, schizophrenia, weakness, and personal history of traumatic brain injury (TBI). Record review of Resident #1's admission MDS, dated [DATE], reflected no BIMS score. Section GG -Functional Abilities - admission section reflected Resident #1 was categorized as dependent on staff for all forms of mobility that could be safely assessed at that time. Record review of Resident #1's Care plan, dated 10/08/2025, reflected a Focus area stating, The resident is risk for falls r/t Gait/balance problems, Incontinence, Poor communication/comprehension Date Initiated: 09/12/2025 with Interventions/Tasks stating, Anticipate resident's needs. Date Initiated: 09/12/2025. Additional Focus area stating, The resident has an ADL Self Care Performance Deficit Date Initiated: 09/12/2025, with Interventions/Tasks stating, Bed Mobility: requires staff x2 for assistance Date Initiated: 09/12/2025. Record review of Resident #1's Progress Notes dated 10/08/2025 reflected no falls since his admission on [DATE]. Observation of Resident #1 on 10/08/2025 at 10:00AM revealed he was sitting in the lobby area, watching television with several other residents. He was well groomed. He wore non-skid socks, pants, and a shirt. He was lying, with the head of the chair partially raised, in a geri-chair. He had a fleece blanket over his body. He smiled when spoken to but did not respond. Observation of video on 10/9/25 (no time/date stamp), revealed Resident A lying on the bed wearing only a brief, with only a fitted sheet on the bed and his body fully exposed. There are fall mats on both sides of the bed. The bed was in a raised position. Both of his feet are hanging off the left side of the bed. CNA A was standing on the left side of the bed. She attempted to move his feet into the bed, but they bumped the footboard of the bed and moved back to their position off the bed, due to the rigidity of his muscles. She walked to the right side of the bed at the head of the bed and attempted to use the sheet beneath him to pull him up in the bed. The pulling motion resulted in Resident #1 being in a diagonal position with his head on the top, right edge of the bed and his legs positioned off the bed to the level of his knee on his left leg and his foot on the right leg. She attempted to turn Resident #1 on his left side but the resident became more rigid and resisted the movement toward the right side of the bed. She walked to the left side of the bed and tried to push the residents' legs in the bed, assisting him to bend his knees, and rolled him on his right side, holding his body with one hand, she adjusted his brief with the other hand. She then assisted Resident #1 to lay on his back, and due to his muscle tension, his legs and torso moved to being in a position with both legs off the bed up to his knees on the left side of the bed, and in a diagonal position with his head on the edge of the top, right side of the bed. His brief was unfastened on his right side from the movement. CNA A stated, I can't be doing this all day. CNA A walked away from the bedside toward the door. Observation on 10/10/2025 of Video dated 9/15 at 9:41:15 AM revealed CNA A with Resident #1. Resident #1 is lying in bed on his right side with CNA A on the right side of the bed. The bed was in a raised (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 4 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few position with fall mats on both sides of the bed. The resident was wearing a brief with no sheets covering his body. The video fast forwards to Resident #1 laying in a diagonal position across the bed with his legs hanging off the bed up to his knees and his head at the top, left edge of the bed. At the time stamp 9:41:31 AM it continued at normal playing speed, CNA A, still standing on the right side of the bed, walked away from Resident #1's bedside and was heard saying, I can't be doing this all day as she walked to the door. She left the room at 9:41:35 AM. Resident #1's call light was not in reach. The cord can be seen at the top right of the headboard. CNA A returned to the room at 9:42:37 AM with a female staff member. The video cut off momentarily and returned at time label, 9/15 9:42:44 AM. CNA A was standing in front of the cabinet with the camera. The camera view was slightly lower than the previous view. The head of the bed was no longer visible. CNA A and a second staff member (name tag not visible in the video) put on Resident#1's shirt and shorts. CNA A stated, He's a fall risk. Two staff members reposition Resident #1 into the bed with his head at the top of the bed, body midline, and feet above the footboard. The two staff members are still in the room at the close of the video and the bed was raised. Interview with DON on 10/09/2025 at 9:33AM, she stated she had seen and investigated Resident #1's care related to the video from 09/15/2025. She stated she thought the CNA A may have just yelled out the door or came right back with help. She stated she was not sure if she left or for how long. She stated CNA A should not have stepped away from the bedside for any length of time with the bed in the high position and Resident #1's legs hanging off the bed. She stated that he was at high risk of falling from that position. Interview with the Admin, RNC, and Corporate Admin on 10/9/2025 at 3:03PM, the Admin stated she had seen the video of Resident #1 being repositioned by CNA A. She stated the facility had received the video and self-reported the incident. They stated the incident took place on 09/15/2025 and CNA A was immediately suspended and later let go based on customer service concerns. She stated the facility investigation found while the aide was repositioning Resident #1 and the resident tended to push back or become stiff. She stated when CNA A realized she could not reposition him effectively on her own, she went and got help. She stated she did not know how long the resident was alone in the room at the end of the video. She stated CNA A stated she got help right away and was back within minutes at the longest. The RNC and Admin stated that leaving the resident with the bed raised and his legs hanging off the side of the bed was not a safe position to leave him unsupervised for any amount of time. Admin stated that he could slide off the bed. Admin stated that the resident was care planned for assist of 2 with repositioning and transfers. They stated the CNA should not have attempted to reposition him alone. The Admin and Corporate Admin stated that was also part of why they separated ways with that employee. The Admin stated she was concerned with the video's content and which was why she started an investigation of her own. The Admin and Corporate Admin stated they learned from this incident. The Corporate Admin stated staff was in-service on abuse, neglect, and exploitation and resident rights. She stated the CNA involved was interviewed and stated they should have used two people to reposition Resident #1 in bed. Despite the admission from the CNA, the company decided to sever ties with CNA A. She stated that Resident #1 was assessed and found to have no injuries. She stated that safe surveys were completed for all residents who were interviewable, and skin assessments were performed for those that were not able to communicate, with no findings. She stated that staff were also interviewed regarding any other issues, with no new findings. Admin and Corporate Admin stated that the facility is thoroughly investigating all incidents reported to the facility and learning from them to improve all resident care. Interview with DON on 10/09/2025 at 4:35PM, she stated that Resident #1's video of care from 9/15/2025 revealed the resident was not left in a safe position when CNA A walked away from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 5 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few the bedside after attempting to reposition the resident. She stated Resident #1 could fall if left in an unsafe position, especially with the bed raised to the high position. She stated it was not a safe position for a resident to walk away from the bedside or leave the room for any amount of time. She stated Resident #1 should have been transferred with two people. She stated the CNA A should have checked the Kardex (a care synopsis generated from the resident care plans). She stated Resident #1 was a known fall risk and known to require two staff for repositioning and transfers on 9/15/2025. She stated [TT7] residents do not need to have interventions stating a resident should have a lowered bed after care. She stated it was a standard of care to lower the bed when staff leave the room, unless it's the residents preference. She stated the person providing care was the one responsible for ensuring safe positioning of residents after care provided. She stated she was responsible for ensuring residents are following fall precautions. She stated the Charge nurses and ADON are also responsible for ensuring fall precautions are being used consistently. She stated it was part of the champion rounds observations every weekday from all department heads. She stated she was not aware of the situation in the video prior to seeing the video. She stated that as a way to monitor residents for safety and positioning, the administrative staff do Champion rounds to monitor their assigned residents for their body positioning, cleanliness, and staff interactions. She stated that nursing administration regularly watched incontinent care and resident transfers with staff as part of their annual competencies for direct care staff, on hire training, and if there was any concerns. In an interview with RNC on 10/09/2025 at 5:13PM, she stated that there was no documentation submitted with Champion Rounds [TT8] that are completed by administrative staff. She stated that the staff are instructed to review areas related to quality of care. She stated that any findings are brought up in the morning meeting and discussed daily during the weekdays. She stated that the administrative teams discussed any issues potentially reportable to the state, any concerns with morning rounds including behaviors, grievances, falls, skin issues, self-reported investigations, injuries of unknown origin, dietary concerns, activity concerns, transportation related concerns or plans, and/or social services concerns. She stated that the facility also generates and analyzes a real time report that examines some several thousand key words to do an overview of potential occurrences that would need to be addressed. Interview with ADON on 10/10/2025 at 03:57PM, she stated that staff should read the resident Kardex and ask the charge nurse if they are unsure of the level of assistance a resident requires for care. She stated that a resident can be hurt if we do not use the appropriate amount of staff when caring for residents. The PNC IJ was identified on 10/10/2025 at 1:25 PM and the administrator was notified the IJ began on 09/12/25 and ended 09/15/25.The following actions were taken by the facility prior to surveyor entering on 10/08/2025 to abate the IJ: Interview with SW on 10/10/2025 at 4:04PM, she stated that she had assessed Resident #1 after all allegations or complaints regarding his care. She stated that Resident #1 had been his normal self from what the facility has experienced of him. She stated that he smiled occasionally and watched television. She stated that Resident #1 was non-verbal. She stated that she performed a trauma assessment after the incident on 09/15/2025 with Resident #1's RP. She denied any change in demeanor, episodes of tearfulness, or increase in behaviors noted by herself or reported by staff. Observations of residents in the facility on 10/08/2025-10/10/2025 revealed that 3 of 3 had assigned fall interventions in place per their care plan interventions with call light in reach when in their room. Interviews with 3 LVNs, 1 RN, 1 CNA, and 2 CMAs from 10/08/2025 to 10/10/2025 revealed all were knowledgeable of responsibilities related to facility policy for abuse, neglect, and exploitation, including when and who to report to if any are observed. All were knowledgeable of care and precautions related to Resident #1. Record review of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 6 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Employee Disciplinary Report for CNA A with an infraction date of 09/15/2025 reflected an Investigatory Suspension was initiated on 09/15/2025. Employment Status print out for CNA A on 09/15/2025 reflected she was involuntarily terminated from employment on that day. Record review of related In-services on 09/15/2025 reflected a in-services for Abuse and Neglect signed by nursing, dietary, housekeeping, therapy departments, and administrative personnel with 67 signatures and an in-service for Resident Rights signed by nursing, dietary, housekeeping, and therapy departments with 41 signatures and a roster of 75 staff members attached. Record review of Staff Interview and In-service forms dated 09/15/2025, reflected staff a questionnaire regarding any knowledge of abuse in the facility, who to report allegations of abuse or neglect to, what would staff do if they heard or witnessed abuse, and asked to name examples of abuse and neglect. There are 31 forms filled out by staff. None of the respondents stated they witnessed any abuse in the facility and all were knowledgeable of their reporting responsibilities and able to name a form of abuse or neglect. Record review of In-service signed by DON and dated 09/17/2025 reflected Resident #1 will be increased to hourly rounding with the following checked as part of the rounds: Call light and personal items (e.g. remote, water) within easy reach, bed in low position with fall mat, positioned with pillows, resident comfortable and repositioned every 2 hours, check for incontinence and assist with cleanup if needed, check if the resident is noted to be in any distress, ensure bed linens are clean, and ensure the room is clean. There are 54 staff signatures listed from all departments, no roster was attached with the in-service. Record review of Resident #1's Hourly Rounding form dated 9/17/2025-10/07/2025 reflected initials from staff members on hourly intervals with notes about the position and activity of the resident and some care performed with the round. Record review of blank Champion Rounds checklist reflected columns for all weekdays with areas for observations related to areas related to Resident Comfort, Resident Equipment, Hazards/Personal Care, and Housekeeping Resident Room. These include categories related to: Call light out of reach, water out of reach, privacy, resident concerns, dirty medical equipment, personal care items at bedside, trash removed, room unkept, etc. Record review of Abuse and Neglect related surveys for Residents dated 09/15/2025 and signed by SW reflected 45 resident interviews. All interviews with residents reflected all residents interviewed felt safe, were content at the facility, knew how to report abuse or neglect and denied any uncomfortable encounters with staff or other residents. Record review of Trauma Informed PRN assessment dated [DATE] at 5:15PM and signed by SW, reflected a trauma assessment was completed with Resident #1's RP. Record review of Resident #1's Progress Notes on 9/15/2025 reflected a weekly skin assessment was completed and signed by TN at 5:27PM. There were no abnormal findings in the assessment. Record review of Resident #1's Event Note signed by DON on 9/15/2025 at 6:06PM reflected an allegation that Resident #1's dignity was not maintained during care, skin assessment was performed with no negative findings, and the MD and RP were notified. Record review of Resident #1's note signed by SW on 09/16/2025 at 5:58PM reflected a follow-up assessment stating that the resident appeared calm and comfortable. Record review of Resident #1's PSYCH NP assessment on 09/19/2025 at 5:32PM reflected, Resident resting on Geri chair at community area appears comfortable with no distress, awake & nonverbal baseline per medical records. Her recommendations included: -Safety: At this time patient is not an acute danger to self or others, however this may change based on treatment compliance and psychosocial stressors. Provide resident trauma informed care.-Manage resident's environment with reinforcement of day/night cycle (blinds open during the day; quite at night), frequent reorientation, staff continuity and overall stimulus reduction. Record review of Resident #1's Care plan printed on 10/8/2025 reflected Focus area addressing Resident #1's history of trauma was initiated on 09/16/2025 with related goals and interventions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 7 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete A Focus area stating, Resident is resistive to care r/t (related to) TBI. Resident legs and arms are very stiff when staff try to turn him he pushes back with his body Date Initiated: 09/15/2025, with related interventions including, If resident resists with ADLs, reassure resident, ensure safety, leave and return 5-10 minutes later and try again. Date Initiated: 09/15/2025 Created by: DON. Record review of Resident #1's MD assessment on 09/19/2025 at 11:26AM, reflected Resident #1's condition was stable. Plan included continuing current medication orders and to continue supportive care. Review of facility policy Fall Policy reflected: Preventing falls requires an interdisciplinary program that focuses on modifying the extrinsic factors, correcting intrinsic factors, and educating the resident and family. A Fall Risk Assessment will be completed on admission and after each fall. The MDS 3.0 will also assist in determining a resident who is a fall risk. Procedure 1. On admission, the nurse will complete a fall risk assessment for each resident. 2. If the resident is unable to assist in completion of the tool, or if medical records are unavailable, the nurse may obtain the assistance of a family member or legal representative that is familiar with the resident's current functional status. 3. Fall Risk Assessment The Fall Risk Assessment Tool will be completed at admission and after each fall occurrence. The assessment should be completed by reviewing the resident's medical history, social history, and current functional status. Information may be obtained by reviewing current medical records, interview with resident/family, or conference with the interdisciplinary team members. The assessment tool should be scored and interventions implemented as indicated. The MDS completed on admission, quarterly and upon significant change will also assess for fall risk 4. Appropriate interventions will be addressed immediately on the interdisciplinary plan of care. Reassessment will occur after each fall. 5. Interventions will be resident centered. See Appendix A for Fall Intervention Methods on the following pages.17. Appropriate education will be provided to all staff members as needed on fall prevention. The noncompliance was identified as Past Noncompliance (PNC). The IJ template was provided to the facility on [DATE] at 1:25PM. The IJ began on 9/12/2025 and ended 9/15/2025. The facility corrected the noncompliance before the survey began on 10/08/2025. Event ID: Facility ID: 676019 If continuation sheet Page 8 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews the facility failed to ensure residents were free from significant medication errors for 1 of 7 (Resident #1) residents reviewed for pharmacy services. The facility failed to ensure that Resident #1 was provided pharmacy services to ensure that he did not have a preventable seizure on 9/14/2025 at 8:10AM. The noncompliance was identified as Past Noncompliance (PNC). The IJ template was provided to the facility on [DATE] at 1:25PM. The IJ began on 9/12/2025 at 11:22PM and ended 9/15/2025. The facility corrected the noncompliance before the survey began on 10/08/2025. This failure placed residents at risk for seizures, hospitalization and death.Findings Include: Record Review of Resident #1's Facesheet dated 10/08/2025 revealed a 37 y/o male, admitted to the facility on [DATE]. Diagnoses included unspecified convulsions and personal history of traumatic brain injury (TBI). Review of Resident #1's admission MDS, dated [DATE], reflected no BIMS score, indicating the resident was unable to complete the assessment. Resident #1was categorized as severely impaired regarding his cognitive skills for daily decision making and reflected that he was rarely or never understood. Review of Resident #1's Care plan, dated 10/08/25, reflected a Focus area stating, The resident has a seizure disorder Date Initiated: 09/12/25 and Interventions/Tasks that reflected, Give seizure medication as ordered by doctor. Monitor/document side effects and effectiveness of medications. Date Initiated: 09/12/25. Record review of Resident #1's Internal Medicine Discharge summary dated [DATE] and signed by MD C reflected Resident #1 had a seizure at the facility he was at prior to admission. It reflected he was started on Keppra and no further seizure activity was noted after that time.Record review of Resident #1's Medication Administration Record (MAR) printed on 10/08/2025 revealed, and order for Keppra Oral Tablet 500 mg (Levetiracetam) Give 1 tablet by mouth two times a day related to UNSPECIFIED CONVULSIONS. Two of three opportunities to administer Keppra were not administered during the time period starting from the PM dose on 9/12/25 and ending before the AM dose on 9/14/2025 as follows: . *The PM dose on 09/12/2025 is recorded as a 9 by RN A. *The PM dose on 09/13/2025 is recorded as 2 by CMA D. * The order was discontinued on 09/14/2025 at 4:45PM. Further review revealed the legend indicated, 9=Other / See Nurse Notes and 2=Drug Refused. Record review of Resident #1's Progress note dated 09/12/2025 at 11:22PM and signed by RN A reflected the Note Text for the Keppra Oral Tablet 500 mg medication administration stated, unable to arouse resident with verbal and tactile stimuli enough to safely swallow. Record review of Resident #1's Progress note dated 9/13/2025 at 6:16PM signed by CMA D reflected the Note Text for the Keppra Oral Tablet 500 mg medication administration stated, Resident would not open his mouth and kept pressing his lips tightly. Record review of Resident #1's Progress note dated 09/14/2025 at 08:10AM and signed by Weekend Supervisor, reflected, Nsg (nursing) notified by assigned CNA that she had changed the resident's brief; repositioned him. CNA then noted the patient to turn red in the face; mucous appearing drool from the left side of his mouth; BUE extended and stiff; eyes closed; pt (patient) not responsive to verbal or painful stimulation at that time. VS (vital signs) noted to be 116/72 pulse 89 and respirations 27; pulse oximetry on room air was 99%. Pt (patient) noted to have history of Seizure Disorder. Pt (patient) safety maintained at all times. Noted length of active seizure activity was apprx (approximately) 2-2.5 minutes. Pt (patient) then noted to be postictal (the recovery phase after a seizure); eyes remained closed; BUE (bilateral upper extremities) noted to be relaxed; skin color WNL and patient appears relaxed. Staff remained at bedside0819 hrs - Weekend RN notified the DON of event0829 hrs - Weekend RN contacted the [RP] and she requested he be sent to the ED for further evaluation. [RP] stated that she was aware of his last Seizure being on 6/26/2025. 911 was contacted; pt being sent to [ED]. Record review of Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 9 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Resident #1's a Late Entry Event note dated 09/14/2025 at 12:00PM signed by DON, reflected [RP] upset because resident did not get 2 doses of his medication and she was not informed Initial Treatment/New Orders: Keppra Level q (every) 3 months. Resident Statement: NAName of MD/NP notified: [NP] Date/time of notification: 09/14/2025 12:00 PM.Name of RP notified: [RP] Date/time of notification: 09/14/2025 2:00 PM.Interventions: NA Record review of Resident #1's Hospital records dated, 09/14/2025, revealed -LAB RESULTS on 09/14/2025 at 09:22AM reflected a Levetiracetam level of (B) indicating a level of less than 0.2 ug/mL (micrograms per milliliter). Record review of Resident #1's Discharge Instructions from hospital dated 09/14/2025 at 10:48AM reflected Special Instructions stating, The patient's blood work showed an undetectable Keppra level which would imply that he is either not receiving it or no longer is been prescribed it. If the patient has a prescription or orders for Keppra, please ensure that he is being given it this will prevent seizure-like activity. Record review of Resident #1's orders dated 10/8/2025 reflected an active order with a start date of 09/14/2025 at 18:30 for Keppra Oral Solution 100 mg/ml. Give 5 ml by mouth two times a day. Record review of MD assessment of Resident #1 on 9/18/2025 at 11:19AM reflected a note stating, recently had seizure due to low Keppra level.Observation of Resident #1 on 10/08/2025 at 10:00AM revealed he was sitting in the lobby area, watching television with several other residents. He was well groomed. He wore non-skid socks, pants, and a shirt. He was lying, with the head of the chair partially raised, in a geri-chair. He had a fleece blanket over his body. He smiled when spoken to but did not respond. In an interview with MD on 10/08/2025 at 1:55PM he stated he believed Resident #1 was sent out for a seizure with a low Keppra level. He stated he might have missed a dose of the Keppra. He stated he had no other seizures since that day. He stated he thought he may have refused the medication. He stated Resident #1 was nonverbal so he would expect him to use non-verbal movements to indicate a refusal. He stated his expectation was that staff should make multiple attempts with refusals of medication. He stated staff should come back in an hour or two to attempt again. He stated forcing a medication could injure him. He stated that he knew there were time constraints with nursing, but it was well known that their mood could change making them more agreeable to take the medication at a later time. In a phone interview with MD on 10/08/2025 at 3:18PM, he stated that he was not sure of the half life of the medication. He stated that he knew that it did not need a loading dose (large first dose of a medication to achieve the desired drug levels). A phone interview was attempted with CMA D on 10/09/2025 at 8:23AM. Surveyor left a message requesting a call back at that time. In an interview on 10/09/2025 PHARM stated that she would not expect an accumulation of prior doses of medication in his system, even if it was not his first dose of medication. She stated that based on half-life of the drug alone, that she would expect undetectable levels if Resident #1 missed the 2/3 opportunities to receive a dose of Keppra on 09/12/2025 and 09/13/2025, when he the Levetiracetam drug levels were drawn on 9/14/2025 at 9:22AM. She stated that there is a correlation between low or undetectable levels of Keppra and seizures. In an email to ADMIN on 10/09/2025 at 9:08AM, surveyor requested a version of the medication administration record for Resident #1 with the times of administration visible. In an interview on 10/09/2025 with NP at 9:10AM, she stated that she was not on call for the weekend of 9/12/2025 through 9/15/2025. She stated that she could see that there was a call from the facility on 9/12/2025 between the hours of 6:00PM to 6:00AM, but stated that she could not read the notes from that call. She stated that she did not see a notification for the on-call provider on 9/13/2025 between 6:00PM to 6:00AM. She stated that she could not recall who told her, but that someone from the facility had told her about the medication refusal for Resident #1 on 9/13/2025 at 12:30PM, and in the afternoon on 9/14/2025 after the seizure activity. She stated that she expected the nurses to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 10 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few notify the provider or the provider on call with medication refusals. She stated that if a resident will not open their mouth, there is not much they can do to give the medication. She stated that, If we don't' give the seizure medication, or if he refuses, the most obvious outcome is that he could have a seizure. She stated that undetectable levels of the medication could cause a seizure. In an interview with DON on 10/09/2025 at 9:56AM, she stated that she was unable to reach CMA D by phone. She stated that she left a message. She stated that she was part of the investigation after Resident #1's seizure. She stated that it made sense that he would have a seizure without any of his seizure medication in his system. She stated that the facility did self-report the incident. She stated that we cannot force a resident to take a medication. She stated, I would expect them to try more than once when residents refuse or when trying to administer a seizure medication. She stated that for the first missed administration on 9/12/2025 the resident was lethargic and the nurse felt it was unsafe to administer the medication. She stated that she knew he refused another dose where he clenched his mouth shut. Surveyor requested the log for the ekit (locked medication dispensing cabinet with emergency medication supply) for the days of the missed doses. In an interview with RN A on 10/09/2025 at 10:28AM, she stated that she worked with Resident #1 on the night of 09/12/2025. She stated that she noticed that the CMA did not give the medication, so she went to the ekit (locked medication dispensing cabinet with emergency medication supply) to remove it and give it to him. She stated that the ekit required an RN to remove the medications and could not be accessed by a CMA. She stated that she could not recall what time it was when she attempted to administer Resident #1's Keppra dose. She stated that she did not attempt to give him the medication later after he was lethargic on the first attempt. She stated that she did not feel safe regarding his ability to swallow the medication. She stated that she should have tried again and that sometimes additional attempts can make a difference for residents' compliance with care and medications. She stated that he could have a seizure if he does not receive his seizure medication. She stated that she did not notify the provider, provider on call, or the RP. She stated that not notifying the physician with seizure medication refusals or missed opportunities to give the medication could result in a seizure for the resident. She stated that not notifying family would result in the family or responsible party not being informed of their loved ones care. She stated that not informing the family or RP may result in a lack of trust in the facility. She stated that not informing the RP of missed medications or refusals could affect the quality of a resident's care. She stated that he had a seizure a few days later. She stated that she was no longer allowed to care for Resident #1 per his RP. In an interview with RNC and Admin on 10/09/2025 at 11:24AM, RNC stated that she expected nurses to notify the RP and the physician with refusals. She stated that the physician should be notified right away with any medication refusals. She stated that the physician and the RP should be notified of a seizure medication refusal at the time of the refusal, regardless of the hour. She stated that the resident could have an adverse reaction if we are not notifying the physician and the RP at the time the medication is missed. In an interview with the DON on 10/09/2025 at 4:35PM, she stated that as part of the investigation and follow up regarding the seizure for Resident #1, the facility did an audit on all residents with seizure medications and found that all other residents were given their medication appropriately. She stated that she in-service the staff about reporting missed medications to the MD or NP immediately. She stated that RNC was working to provide the ekit log. She stated that it was her responsibility to check a report that will analyze the medication administration records to review the documentation for medication refusals and occurrences where a nurse references a nurses note with their administration. She stated that she checks to see the reason for refusal and review the documentation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 11 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few surrounding the occurrence for anything concerning. She stated that she monitors the report on weekdays. She stated that she tries to investigate and address the root cause of repeated refusals or do some lab work if it is a new behavior for the resident. She stated that they also worked with the NP to do a random drug level lab screening for the residents with seizure medications that were appropriate for testing. She stated that she reviewed all the residents in the facility that were on seizure medications, to ensure they had regular lab monitoring orders as appropriate for their seizure medications. In an interview with ADON on 10/10/2025 at 3:57PM, she stated that nurses should attempt to administer a seizure medication more than once before documenting a refusal or missed dose. She stated that they should also find out why the resident refused the medication. She stated it was the nurses responsibility to then let the family and the physician know that the resident did not take their medication. She stated the Care plan should be updated after the refusal. She stated that nurses should notify the MD or NP on call if refusals are taken overnight or on off hours. She stated that if residents do not receive their seizure medication they can have seizures or seizure like activity. She stated that the facility had liberalized medication times and the evening dose could be administered between 5:00PM-10:00PM unless specified in the order. She stated that staff have until 11:00PM to give the medication. Observation and review of medication administration on 10/08/2025 at 10:06AM with CMA E revealed no medication errors. Observation and review of Medication Storage room for the facility on 10/08/2025 at 11:06AM with LVN F revealed no concerns for noncompliance related to medication storage. Observation of Resident #1 on 10/08/2025, 10/09/2025, and 10/10/2025 revealed no significant findings. No signs of distress or change in mood or abilities from his documented baseline care plan function. Record review of Resident #1's MAR on 10/08/2025 and10/09/2025 revealed that he received all subsequent doses of Keppra after 09/14/2025. The administrator was notified of the PNC IJ on 10/10/25 at 1:25 PM. The IJ began on 09/15/2025 and ended on 09/15/2025.The following actions were taken by the facility prior to surveyor entering on 10/08/2025 to abate the IJ: In an interview with RNC on 10/09/2025 at 5:13PM, she stated that there was no documentation submitted with Champion Rounds that are completed by administrative staff. She stated that the staff are instructed to review areas related to quality of care. She stated that any findings are brought up in the morning meeting and discussed daily during the weekdays. She stated that the administrative teams discussed any issues potentially reportable to the state, any concerns with morning rounds including behaviors, grievances, falls, skin issues, self-reported investigations, injuries of unknown origin, dietary concerns, activity concerns, transportation related concerns or plans, and/or social services concerns. She stated that the facility also generates and analyzes a real time report that examines some several thousand key words to do an overview of potential occurrences that would need to be addressed. Record review of Employee Disciplinary report with a dated of infraction listed as 9/13/2025 reflected RN A was put on investigatory suspension. The form is signed by RN A and DON with a date listed as 9/17/2025. Interviews with 3 LVNs, 1 RN, 1 CNA, and 2 CMAs from 10/08/2025 to 10/10/2025 revealed all were knowledgeable of responsibilities related to facility policy for abuse, neglect, and exploitation, including when and who to report to if any are observed. Interviews with 3 LVNs, 1 RN, and 2 CMAs from 10/08/2025 to 10/10/2025 revealed all were knowledgeable of responsibilities related to refusals of medications, including notifications to provider and RP, responsibility to educate the resident or representative regarding the consequences of missed doses of medications, and making more than one attempt to administer a seizure medication. All were knowledgeable of Resident #1's care and precautions. Record review of facility self-reported intake was submitted to the State of Texas Complaint and Incident Intake via email on 9/14/2025 at 2:30PM. Record review of In-services (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 12 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few dated 9/14/2025, reflected: *Customer Service, Abuse and Neglect Reporting reflected 23 signatures across all departments from a roster of 53 staff, *Reporting Medication Refusals and Missed Medications, Do Not Crush Medication Notice in-service instructed by DON reflected 13 signatures of a roster of 13 medication aides and nurses, *Reporting Missed Medications in-service instructed by DON reflected 9 signatures of a roster of 13 medication aides and nurses, *Reconciling medications upon admissions/Readmissions, and Change in Condition Notification in-service instructed by DON reflected 12 signatures of a roster of 13 medication aides and nurses, and*Properly reconciling medication administration in-service instructed by DON reflected 12 signatures of a roster of 13 medication aides and nurses. Record review of Care plan update dated 9/14/2025 reflected a Focus area stating, The Resident is non-compliant with medication administration will clamp mouth shut tight Date Initiated: 09/14/2025. Record review of NP assessment of Resident #1 was documented with a dated of service listed as 9/15/2025 at 00:00PM. Record review of Trauma Informed PRN assessment dated [DATE] at 5:15PM and signed by SW, reflected a trauma assessment was completed with Resident #1's RP. Record review of Abuse and Neglect related surveys for Residents dated 09/15/2025 and signed by SW reflected 45 resident interviews. All interviews with residents reflected all residents interviewed felt safe, were content at the facility, knew how to report abuse or neglect and denied any uncomfortable encounters with staff or other residents. Record review of SW notes on 9/16/2025 at 5:58PM reflected Resident #1 was assessed and showed no signs of distress. Record review of In-service signed by DON and dated 09/17/2025 reflected Resident #1 will be increased to hourly rounding with the following checked as part of the rounds: Call light and personal items (e.g. remote, water) within easy reach, bed in low position with fall mat, positioned with pillows, resident comfortable and repositioned every 2 hours, check for incontinence and assist with cleanup if needed, check if the resident is noted to be in any distress, ensure bed linens are clean, and ensure the room is clean. There are 54 staff signatures listed from all departments, no roster was attached with the in-service. Record review of Resident #1's Hourly Rounding form dated 9/17/2025-10/07/2025 reflected initials from staff members on hourly intervals with notes about the position and activity of the resident and some care performed with the round. Record review of blank Champion Rounds checklist reflected columns for all weekdays with areas for observations related to areas related to Resident Comfort, Resident Equipment, Hazards/Personal Care, and Housekeeping Resident Room. These include categories related to: Call light out of reach, water out of reach, privacy, resident concerns, dirty medical equipment, personal care items at bedside, trash removed, room unkept, etc. Record review of Resident #1's PSYCH NP assessment on 09/19/2025 at 5:32PM reflected, Resident resting on Geri chair at community area appears comfortable with no distress, awake & nonverbal baseline per medical records. Record review of 15 anonymous staff questionnaire's (no date) regarding any knowledge of abuse or neglect, any knowledge of Resident #1's compliance with care and medications, any knowledge of refusals for other residents, and when and whom to report any abuse revealed there were no reports of abuse in the facility, none reported refusals from Resident #1 or other residents, and all were knowledgeable of the Abuse and Neglect Coordinator and to report abuse immediately. 10 of the forms contain handwritten signatures. 3 forms have handwritten dates of 9/15/2025 and 2 forms are dated 9/14/2025. Record review of Seizure Medication Administration Monitoring form signed by DON with review dates of 9/15/25, 9/16/25, 9/17/25, 9/18/25, 9/19/25, 9/20/25, 9/21/25, 9/22/25, 9/23/25, 9/25/25, 9/26/25, 9/27/25, 9/28/25, 9/29/25, 9/30/25, 10/01/25, 10/02/25, 10/03/25, 10/04/25, 10/05/25, 10/06/25, 10/07/25, 10/08/25, 10/09/25, and 10/10/25; stating that all anticonvulsant medications were given with no corrective action required. Record review of Anticonvulsant Audit form signed by DON (no date) reflected 13 residents with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 13 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few anticonvulsant medications were audited. Three missed medication opportunities were noted for other residents in September 2025, all while residents were out of the building. Lab monitoring was also reviewed in this audit. There was no missed medication opportunities noted for August 2025. Review of Competencies for Aides forms reflected 1 CNA was evaluated by ADON in July 2025, 1 CNA was evaluated by ADON in August 2025, 2 CNAs were evaluated by ADON in September 2025. These competencies include observations of incontinent care, transfers of various types including a mechanical lift, ambulation assistance techniques, feeding a resident, repositioning a resident in bed with 1 or 2 assist of staff, urinary catheter care, various forms of toileting assistance, and post mortem care. Facility policy for Medication Administration and General Guidelines (2025) reflected, PolicyMedications are administered as prescribed, in accordance with State Regulations using good nursing principles and practices and only by persons legally authorized to do so. Personnel authorized to administer medications do so only after they have familiarized themselves with the medication, monograph of all medications is available in LinkRx otherwise authorized personnel should refer to Drug Reference material provided by facility.1. Medications are prepared, administered, and recorded only by licensed nursing, medical, pharmacy, or otherpersonnel authorized by state laws and regulations to administer medications.2. Medications are administered in accordance with written orders of the attending physician. If a dose seemsexcessive considering the resident's age and condition, or a medication order seems to be unrelated to theresident's current diagnosis or condition, the physician is contacted for clarification prior to the administration.of the medication. The interaction with the physician is documented in the nursing notes and elsewhere in themedical record as appropriate.10. Medications are administered within one hour of the scheduled time, unless the physician specifies a specifictime then the med must be given 30 minutes prior to 30 minutes after the specified time (unless facility policydirects otherwise). Before or after meal orders are administered precisely as ordered. Unless otherwisespecified by the physician, routine medications are administered according to the established medicationadministration schedule for the facility.12. If a dose of regularly scheduled medication is withheld, refused, or given at other than the scheduled time (e.g.resident not in facility at scheduled dose time, initial dose of antibiotic), the space provided on the front of theMAR for that dosage administration is initialed and circled. An explanatory note is entered on the reverse side ofthe record provided for PRN documentation. The physician must be notified when a dose of medication has notbeen given. If an electronic medical record is being utilized than the caregiver administering the medication willenter the correct documentation that will then be electronically date/time stamped with their initials. Facility policy for Notifying the Physician of Change in Status (no date) reflected: The nurse should not hesitate to contact the physician at any time when an assessment and their professional judgment deem it necessary for immediate medical attention. 1. The nurse will notify the physician or their delegated nurse practitioner or physician assistant with change in status. The nurse will document signs and symptoms of significant change, time/date of call to physician, and interventions that were implemented in the resident's clinical record. 2. Before the physician is contacted, the nurse will gather and organize resident information. Applicable information will include current medications, vital signs, signs and symptoms initiating call, current laboratory information, and interventions that have currently been implemented. 3. The nurse may collect several non-emergent items and place one telephone call during the shift in order to avoid multiple calls to a physician with non-emergent questions. The nurse is responsible, however, for responding to a change of condition in a timely and effective manner. The nurse will document the time of the call to the physician in the clinical record. 4. If the physician does not return the call within a reasonable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676019 If continuation sheet Page 14 of 15 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 676019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lampstand Nursing and Rehabilitation 2001 E 29th St Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete amount of time, the nurse will attempt to contact the physician a second time. If the situation is an emergency, and the physician does not call back within a reasonable amount of time, the nurse will contact the Medical Director or the nearest ambulance service for assistance. The nurse will document all attempts to contact the physician in the resident's clinical record. 5. The resident's family member or legal guardian should be notified of significant change in resident's status unless the resident has specified otherwise. 6. The nurse will monitor and reassess the resident's status and response to interventions. Physicians should develop a working diagnosis and guide nursing staff in what to monitor, and when to notify the physician if the resident's condition does not improve. 7. The nurse will document all attempts to contact the physician, all attempts to notify the family and/or legal representative, the physician's response, the physician's orders and the resident's status and response to interventions.The noncompliance was identified as Past Noncompliance (PNC). The IJ template was provided to the facility on [DATE] at 1:25PM. The IJ began on 9/12/2025 at 11:22PM and ended 9/15/2025. The facility corrected the noncompliance before the survey began on 10/08/2025. Event ID: Facility ID: 676019 If continuation sheet Page 15 of 15