Health inspection·December 3, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete began. In an interview with the Food Service Director B on 12/3/2025 at 3:10pm she said the ovens were supposed to be clean on Sundays but the staff who usually clean the oven was sick and left early on Sunday. She said she took care of all the identified issues. She said the staff were in-serviced on cleaning of equipment, food temperature and dish washing. Record review of the policy and procedures titled Food Temperatures date June 2021 read in part.Purpose1. To ensure all food served to residents is safe, palatable, and maintained at proper temperatures to prevent foodborne illness, while supporting resident comfort and dignity. 2. ScopeThis policy applies to all dietary staff, nursing staff assisting with meal service.3. Temperature Standards. Hot Foods It must be held at 135 degrees F or higher. Temperature must be checked at the start of meal service. Every 30 minutes during service.Cooling FoodCool: Cooked turkey, internal temperature to cool down to 70 degrees in two hours of preparation and from 70 to 41 degrees in an additional 4 hours. Reheating Previously Cooked and cooled food must be reheated to 165 degrees F. Record review of the policy and procedures titled Cleaning OvensPolicy: Ovens will be clean and free of buildup of grease or spill.1.Ovens will be cleaned weekly and as spill occurs. Record review of Cleaning Vent Hoods and Filters or Extractor dated Policy: Venting equipment will be clean and free of grease.Procedure: Clean vent hoods monthly to prevent accumulation of dirt and grease.Record review of the policy and procedure for Sanitation and Food handling.Sanitization can occur by means of application of heat or concentration of chemicals for enough time to reduce bacterial count on equipment and utensils. Once utensils and equipment have been cleaned and sanitized, they should be allowed to air dry. The use of towels may re-contaminate sanitized surface. Event ID: Facility ID: 676021 If continuation sheet Page 2 of 5 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 676021 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Clarewood House Extended Care Center 7400 Clarewood Dr Houston, TX 77036 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to maintain clinical records in accordance with acceptable professional standards and practices that are complete, accurately documented, readily accessible and systematically organized for 1 of 1 resident (Resident # 1) reviewed for clinical records. The facility failed to ensure the MDS Coordinator accurately documented and uploaded Resident # 1's care conference reports for 09/10/2025. This failure could place residents at risk for missing progress towards achieving their person-centered plan of care, and delayed care.Findings included: Record review of Resident # 1's face sheet retrieved on 12/02/2025 at 2:56 pm, revealed she was a [AGE] year-old female admitted with the following diagnoses: Hemiplegia(paralysis that affects one side of the body),disorders of bladder ( condition that affects the bladder's ability to store or release urine), chronic obstructive pulmonary disease (lung diseases that causes breathing difficulties ), atherosclerotic heart disease ( fat and cholesterol build up in the arteries), anemia (low blood levels), lack of coordination(clumsy movement ), osteoporosis (causes bones to become weak), major depressive disorder ( mental condition that causes sadness, hopelessness and lose of interest in activities), generalized weakness, abnormalities of gait and mobility, dysphagia (swallow difficulty) , oropharyngeal (cancer of the tonsil),and cognitive communication deficit (difficulty in attention, memory and problem-solving). Record review of Resident # 1's MDS retrieved on 12/02/2025 at 10:20 a.m., dated 09/14/22025, reflected the following: Section A-identifiable information, subsection A0310 was coded 02, which required quarterly review assessment for Resident # 1. Subsection A1110 revealed she did not require an interpreter to communicate with a doctor or health care staff. Section C-cognitive pattern, subsection C0500 revealed she had a BIMS score of 15, which indicated she was cognitively intact. Section GG0120 revealed she uses a wheelchair. Section GG-Functional abilities revealed Resident # 1 requires assistance with ADLs. Record review of Resident # 1's care plan retrieved on 12/02/2025 at 1:07 p.m., revealed the last care conference was on 06/10/2025 and the next care conference was due for 09/10/2025. Record review of Resident # 1's care conference reports retrieved on 12/02/2025 at 12:04 p.m., revealed, the care conference documentations were not done quarterly as indicated in the MDS. The care conference documentation revealed the facility did not have care conference documentation and assessment for 09/10/2025. The documentation was for the following dates: 06/10/2025, and attendees were- ADON, SW, DM and AD. On 03/11/2025, the attendees were- ADON, AD, DM, and SW. During an interview with the MDS Coordinator on 12/02/2025 at 2:12 p.m., he said some of his job description included: attending the care conferences via telephone and taking notes during the care conference meetings. The MDS Coordinator said it was his responsibility to upload the minutes of the care conferences. He said the care conferences were held every three months for each resident. He said if Resident # 1's care conference was held on 06/10/2025, the next one would have been 09/10/2025, and the upcoming care conference would be 12/10/2025. The MDS Coordinator did not give an explanation as to why there was no documentation for Resident # 1's September 2025 care conference report in the EMR. He said from a nurse standpoint, if something is not documented, it means it did not happen. He said, we never missed the care conferences. During an interview with the SW on 12/02/2025 at 3:03 p.m., she said she attends all the care conferences which are held quarterly for all residents. She said, I complete discharged planning as well. The SW said if Resident # 1 had a care conference on 06/10/2025, the next one would have been 09/10/2025, and 12/10/2025 thereafter. She said a care conference meeting could be missed if a resident was hospitalized . The SW said some members who attended the care conferences are the SW, ADON, a member (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676021 If continuation sheet Page 3 of 5 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 676021 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Clarewood House Extended Care Center 7400 Clarewood Dr Houston, TX 77036 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few from the dietary team, the MDS Coordinator who works from home some days and attends the care conferences via telephone. If the resident was on skilled services, the rehabilitation director would be present. The SW said, after the meeting, it is the responsibility of the MDS Coordinator to upload the reports in the EMR. She said if the reports were not uploaded, anyone looking for the reports would have to ask one of the department heads that attended the meeting. During an interview with the AD on 12/02/2025 at 3:18 p.m., she said she did attend care conference meetings but did not say yes or if the facility had a care conference meeting for Resident # 1. The AD said, the care conference meetings are held every Tuesday. She said the care conferences were conducted every three months for each resident. She listed the following as attendees: SW, DON, ADON, DM and herself. She said the MDS Coordinator takes notes, and it was his responsibility to upload the care conference reports into the EMR after the meetings. The AD said if a resident had a care conference meeting in June, the subsequent ones would be in September and December of 2025. She said if an investigator/surveyor needed to know if a care conference was conducted, they would have to look at the residents EMR, because the notes should be in the EMR. The AD said if the notes were not found in the EMR, it meant the care conference was not done. She said the families, and if the residents had a POA, were invited to the meetings too. The AD said, if the residents are on Hospice, a Hospice representative would be invited. She said the residents were welcome to attend the meetings if they could and if the family wants them to attend. During an interview with the DON on 12/02/2025 at 3:36 p.m., she said care conferences were held on Tuesdays at 10 a.m., She said care conferences were conducted on admission and there after quarterly. She said she took minutes during the meeting. The DON said, it is the MDS Coordinator's responsibility to upload the reports into the EMR, and if he were out, I would upload the reports. She said Resident # 1 s September 2025 care conference record could have been missing due to human error. She said a resident would miss a care conference meeting if they were hospitalized . The DON said if Resident # 1 had a care conference in June of 2025 the next one would have been held in September 2025. The DON said if a care conference report was missing in the EMR, the reviewer should look at the previous one and request the report from one of the attendees because they were the same at every care conference. She said, as a nurse, if documentation was missing, it meant the care conference did not take place. She said she could have missed documenting the care conference report for Resident # 1 because she was newly hired and was multitasking. During an interview with the ADON on 12/03/2025 at 3:58 p.m., she said, I attend all meetings. I attended the care conferences with the families, therapy staff, SW, AD, food Director, MDS Coordinator and the DON. The ADON said most often, the time DON and MDS Coordinator would take notes. ADON said it was the responsibility of the DON and the MDS Coordinator to upload the care conference reports in the EMR, but if they are absent, it was ADON's responsibility to upload the meeting reports. ADON could not give an answer to the question why Resident # 1's care conference report for the month of September 2025 was not uploaded into the EMR. She said the facility had never missed a care conference meeting. She said the facility would reschedule if the resident's family was unavailable. She said the care conferences were held every three months. ADON said if not documented, it means it wasn't done. She said, if Resident # 1 had a care conference conducted and documented in June 2025 the next one would have been in September and documented in the EMR. She said during the care conferences, nursing department would discuss the medications, if any fall, and discuss the previous three months skin concerns, and treatment changes. She said sometimes families would voice their concerns, food service would discuss the residents' likes and dislikes. The ADON said if documentation was missing, it would break the trust between the residents, facility and family. She said missed documentation could affect the care of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676021 If continuation sheet Page 4 of 5 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 676021 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Clarewood House Extended Care Center 7400 Clarewood Dr Houston, TX 77036 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident # 1. The ADON said there was no documentation for the month of September 2025 because the DON missed documenting. During an interview with the Administrator on 12/03/2025 at 4 :48 p.m., she stated, care conference was completed quarterly for Resident # 1. She said if there was a care conference for Resident # 1 on 06/10 2025 the next one would be 9/10/2025 and the next would be 12/10/20. The Administrator said it was the responsibility of the MDS Coordinator to upload the conference reports into the EMR. Record review of facility's care planning-interdisciplinary team policy (Care Area Assessments) revised on March 2022, stated: -Residents care plans are developed according to timeframes.-Person-centered care plans are based on resident assessment and developed by an interdisciplinary team.-The IDT includes but is not limited: the physician, RN with responsibility for the resident, a nursing assistant with responsibility for the resident, a member of the food and nutrition services staff, the resident or the resident representative.-Meetings are scheduled at the best time of the day for the residents and family when possible.-If it is determined that the participation of the resident or representative is not practicable for development of the care plan, an explanation is documented in the medical records.-A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychological and functional needs is developed and implemented for each resident.-Each resident's person-centered care plan is consistent with the resident's right to participate in the development and implementation of his or her plan of care. Event ID: Facility ID: 676021 If continuation sheet Page 5 of 5