Health inspection·September 12, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were not observed due to the video being shown via video call with the monitoring agency sharing their screen. Observation and Interview on 09/12/2023 at 10:50 AM of Resident #1 sleeping in his room with family members in the room. Resident #1 was observed having a black ety The family members stated Resident#1 was not verbal and was not able to move his body other than his arms which caused them to be confused regarding how Resident# fell from the bed. Interview on 09/12/2023 at 11:00AM with CNA B revealed he had worked in the facility for 8 years. He stated he was aware that residents were two people assist if they needed a Hoyer lift to be lifted. CNA B stated Resident #1 was a two person assist and both staff should be present before initiating care. CNA B stated staff should never leave a resident in the middle of care. Interview on 09/12/2023 at 11:26AM with Nurse A revealed she was the nurse on duty when Resident #1 fell. She stated CNA A was calling for her and when she entered the room, she saw Resident #1 on the floor. She stated CNA A was changing the resident alone and went to get more supplies. She stated when CNA A returned Resident #1 was on the floor. She stated she assessed Resident #1, and he had a swollen eye. She stated Resident#1's family member was contacted and did not want him sent out however the hospice nurse did see the resident that day. Interview on 09/12/2023 at 3:00PM with CNA C revealed she had worked in the facility for 1 year. She stated she was aware of residents being two people assist if the resident was heavy or aggressive during care. CNA C stated Resident #1 was a two person assist and staff should not began care until both staff were present. CNA C stated staff should never leave residents while providing care and if the resident was a one person assist and additional supplies were needed then the staff should call for help instead of leaving the resident during care. Interview on 09/12/2023 at 3:26 PM with CNA A via phone revealed he had worked in the facility for 1 month. CNA A stated he had worked in the facility in December 2022 and during that time Resident #1 was not a two person assist. CNA A stated he did not look at Resident #1's care plan to determine that Resident #1 was no longer a one person assist. CNA stated he was providing incontinent care to Resident #1 and realized he needed additional supplies. CNA A stated he left the room briefly to obtain additional supplies and by the time he returned Resident #1 was actively falling out of the bed. CNA A stated other staff or management would have communicated to him that CNA A had a change in condition and was no longer one person assist however that did not occur. CNA a stated he could have checked [NAME] however he assumed the resident was still one person assist. CNA A stated had not returned to work however he was contacted by the DON regarding Resident#1 being a two person assist. Interview on 09/12/2023 at 3:35PM with the DON revealed she had been acting as Interim DON for about 1 month. She stated staff were informed weekly regarding resident change of conditions. She stated staff should have looked at the facility [NAME] (brand name for an informational filing system that is used as a quick reference for nurses) to determine if the resident was one person or two people assist before providing care. The DON stated staff should never begin care and leave a resident during care. The DON stated all staff were informed of resident changes weeks and daily upon beginning their shift. The DON stated if a resident was documented as 2 people assist then caregiver should be present before care is provided. The DON stated she was not sure what the risk would be if staff were not adhering to the resident care plan and providing care as directed. The DON stated all staff were in- serviced 09/12/23 regarding not leaving residents during care, having all supplies prior to beginning care and never leaving a resident unattended on their side. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 2 of 4 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 676039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Parks at Garland Healthcare and Rehab 3737 N Garland Avenue Garland, TX 75044 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 - Minimal harm or potential for actual harm Interview on 09/12/2023at 4:00PM with the Administrator and Regional Director of Operations revealed the expectation was for staff to review resident care on the [NAME] before providing care. The Regional [NAME] President stated after reviewing the video it was determined that the staff member did not provide appropriate care by not providing 2 people during care for Resident #1. The Regional [NAME] President stated CNA A has been suspended pending further investigation and the investigation was still on going. Residents Affected - Few and all staff had been reeducated. Review of the In-services completed on 09/12/23 with all staff regarding not leaving residents during care, having all supplies prior to beginning care and never leaving a resident unattended on their side. Review of the facility AD Hoc QAPI meeting/ four-point plan of correction dated 09/12/2023 revealed opportunity for improvement: education for CAN ton bed mobility and where to find resident transfer or function status needs in [NAME] Review of the facility Action plan revealed systematic changes- will reeducate nurses and CNA on proper review of [NAME]/ MDS for function status and required number of staff for assistance prior to providing care for residents. Changes will be communicated to staff via paper in-service 1:1 for staff member involved with return demonstration for care for resident involved. Review of the facility policy Fall: Clinical protocol, dated March 2018, revealed based on the preceding assessment, the staff an physician will identify pertinent interventions to try to prevent subsequent falls and to address the risk of clinically significant consequences of falling. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 3 of 4 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 676039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Parks at Garland Healthcare and Rehab 3737 N Garland Avenue Garland, TX 75044 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to maintain an effective pest control program so that the facility was free of pests for 1(bathroom room [ROOM NUMBER]) of 6 bathrooms reviewed for pest control Residents Affected - Few The facility failed to ensure Resident bathrooms did not contain live roaches. This failure could place residents at risk of a diminished quality of life due to an unsafe environment. The findings were: Observation on 09/12/2023 10:45 a.m. revealed a live roach on Resident #2 and Resident #3's bathroom ceiling. The bathroom had a dead roach on the floor of the shower. Interview on 09/12/2023 at 10:35 AM with Resident #2 revealed she had lived in the facility off an on for 4 years. She stated she had complained of roaches being in the room and maintenance did spray bug spray however the issue had not been resolved. Resident #2 stated she did file a grievance regarding the roaches however did not remember the exact date. Resident #2 was not sure how long there has been issues with roaches in the room and was not sure when was the last time the room was treated Interview on 09/12/2023 at 10:40AM with Resident #3 revealed she and Resident#2 had complained about roaches in their room. She stated saw roaches near her bed and in the bathroom. Observation of the room revealed no roaches near Resident #3's bed. Resident #3 was not sure how long there had been issues with roaches Interview on 09/12/2023 at 1:30 PM with the Maintenance Director stated he had worked in the facility since November. He stated if a resident had an issue with pest he would be alerted and would contact his pest control company and they would come out the same day. He stated if he was not alerted of any issues, pest control came out every two weeks. He stated he was not alerted of any residents having any issues with pest that had not been resolved. Review of the facility grievance log from August 2023 to September 12,2023 revealed no grievance regarding roaches from Resident #2 Review of the facility's pest control log from 09/01/23- 09/013/23 revealed no pest citing for room [ROOM NUMBER]. Review of the facility pest control activity revealed the facility was in the facility on 09/12/2023 Review of the facility policy Pest control undated revealed, An effective pest control program is maintained so the facility is free of pest and rodents. The facility has a vendor contract with pest control services that agrees to treat the facility at regular and routine intervals for control of pest. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 4 of 4