Health inspection·September 17, 2024

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on 7/31/2024 she had gone through the mail and saw the request and it did not look like a typical medical records request; it had looked like a subpoena. She said she had contacted corporate HR to see how the request should have been handled. She said corporate advised her that the previous owner was responsible for those records. She said Resident #1 was not a resident of the current owner of the building and had discharged from the facility prior to the current owner taking over ownership of the facility on 12/1/2022. She said she had contacted the Previous Owner who then came and picked up the certified mail medical records request on 8/2/2024. She said to her knowledge the facility had not received any other correspondence from the law firm. She said the facility did not send any medical records to the law firm. During an interview on 9/16/2024 at 1:31 p.m., the Paralegal indicated the firm had requested medical records on July 29, 2024, and the facility had signed a certified mail receipt on 7/31/2024. The Paralegal said they had not received any medical records since the request was made. The Paralegal said the firm had received a phone call on 8/02/2024 at 4:02 PM from an Attorney Friend of the previous owner of the facility. The Attorney Friend indicated he was not representing the Previous Owner but was trying to help as a friend. The Attorney Friend indicated the Previous Owner was not ignoring the request for medical records, but it may take longer than the 48 hours requested in the letter. During an interview on 9/16/2024 at 2:19 p.m., the Administrator said when a request was received the request was sent to the corporate level for processing. The Administrator said when there was a delay in sending the medical records there could be a delay of a resolution. During an attempted interview on 9/17/2024 at 2:39 p.m. the Surveyor called and left a voicemail for the Previous Owner. The Surveyor had not received a return call by the time of exit. During an interview on 9/18/2024 at 8:39 a.m. after exit, the Surveyor received a return call from the Previous Owner who said that she had received a notice from the facility of the medical records request. She said on 8/02/2024 she went to the facility and picked up the medical records request. She said she called an Attorney Friend of hers who then reached out to the law firm that was requesting the records and let them know the request had been received. She said she had not contracted the services of the Attorney Friend, but the Attorney Friend was trying to help her and advised her not to send any records to the law firm. She said the Attorney Friend advised her to notify her insurance company and to let them handle the situation. She said she was advised from the insurance company to just wait and see what happens due to the statute of limitations would run out on 11/30/2024. She said she had not sent any of the requested records to the law firm as of 9/18/2024. She said she could send the requested medical records by the end of the day on 9/18/2024 if the law firm still needed them. She said she had never been sued before and was not sure how to handle the situation but said the facility did the right thing by reaching out to her for the medical records. She said she did not contact the law firm to advise them that she was the previous owner and that she had the requested medical records. Record review of an Record Requests policy, undated, revealed: Residents or their authorized legal representatives have the right to access and obtain copies of their records. * Upon the request and two working days' advance notice to the community, the resident or their authorized legal representative per state requirements has the right to purchase photocopies of the records or any portions therein. The community requires a written request for copies as a cost per (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676025 If continuation sheet Page 2 of 3 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 676025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Autumn Leaves Nursing and Rehab Inc 321 Kilgore Drive Henderson, TX 75652 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 0573 state copy fees may apply. Level of Harm - Minimal harm or potential for actual harm 1. The community will notify the company medical records oversight designee, the Administrator and DON of the request, to review the legal right to access and approval prior to the release of any clinical records. Residents Affected - Few 6. If the request is accepted and is for a copy of records, a bill for copying services may be sent. The records will then be provided to the resident . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676025 If continuation sheet Page 3 of 3