Health inspection·December 7, 2023

F 0600 Level of Harm - Immediate jeopardy to resident health or safety care and living environment. Explain all procedures and Treatments, Medications, results of labs/tests, Condition, All changes, rules, Options. Review of CNA J's time sheet revealed that CNA J worked on 11/28/23 to 11/29/23 during the 10:00 PM to 6:00 AM shift on the secure unit (300 wing). Further review of CNA J's time sheets showed that CNA J did not work at the facility after 11/29/23. Residents Affected - Few Review of CNA K's time sheet revealed that CNA K worked on 11/28/23 to 11/29/23 during the 10:00 PM to 6:00 AM shift on the secure unit (300 wing). Review of RN M's time sheet revealed that RN M worked on 11/28/23 to 11/29/23 during the 10:00 PM to 6:00 AM on the secure unit (300 wing). Interview and observation on 12/5/23 at 12:05 PM with Resident #16 revealed that the resident did not have any visible bruising on any areas of observable skin. The resident stated he did remember his fall, he stated he was just fine, he felt safe at he the facility and that the staff all treated him nicely. Interview on 12/5/23 at 12:23 PM with CNA L revealed she had worked with Resident # 16 for several months now and that he was generally very happy. She had never had any problems with Resident #16 being combative while administering cares but that she could see him possibly being that way if he was disorientated late at night. Interview on 12/06/23 at 12:42 PM with ADM revealed it had been reported to him that Resident #16 had a fall around 5:00 AM on 11/29/23. The ADM reviewed video of the incident at 12:50 PM on 11/29/23 as was his normal course of investigating falls on the secure unit. He stated after reviewing the video and discerning that CNA J had pushed Resident #16 out of his bed intentionally, he immediately called CNA J to his office. CNA J reported continues to report that Resident #16 rolled out of bed.The ADM and CNA J watched the video together and CNA J then confessed to pushing Resident #16 out of his bed to the floor, CNA J was immediately terminated. He stated that he immediately called the police, then conducted 5 Safe Surveys on the secure unit and ordered the nursing staff to conduct immediate skin assessments of all residents on the secure unit. No negative findings were discovered for either the Safe Surveys or the skin assessments. He stated that he started in-service trainings for all secure unit staff that afternoon and completed in-service training for all staff within 24 hours of discovering the incident. He stated that the facility had had an extra nurse on the secure wing since discovery of the incident. Interview on 12/6/23 at 10:00 AM with SW revealed that she had spoken to Resident #16 right after the incident on 11/29/23 and that Resident #16 had expressed he did not feel it had been a big deal, that he still likes all of the staff and the other residents at the facility. Interview and review of video on 12/06/23 at 12:51 PM with DON revealed that DON identified CNA J on the video (no audio available) at timestamp 11/29/23 4:47 AM starting to administer cares for Resident #16. 5:01 AM rolled Resident #16 onto his left side, while Resident #16 was holding on to the side rail. At timestamp 11/29/23 at 5:02 AM CNA J turned resident to right side to move pad under resident. At time stamp 11/29/23 at 5:03 AM Resident #16 appeared to try to help initially, then the resident turned reaching out towards with an open hand and fist and while kicking towards CNA J. CNA J (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 2 of 12 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 12/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few switched to the other side of bed, Resident #16 then moved himself onto his back, with knees up and perpendicular to his shoulders. Resident #16 was then observed to weakly kick CNA J on her right shoulder with his right foot. CNA J roughly pushed Resident #16's extended right leg away from her with enough force to move the resident from laying on his back to laying on his left side. At timestamp 11/29/23 at 5:04:03 CNA J was observed placing both hands on the residents back and pushed/shoved Resident#16 off the left side of the bed to the floor, where Resident #16 landed on his right side. At timestamp 11/29/23 at 5:04:09 AM, Resident #16 observed laying on his right side on the floor, CNA J was then observed immediately going to the resident room door. At timestamp 11/29/23 at 5:04:43 AM Resident #16 was observed still on the floor of his room, Resident #16 then pulls his bed towards him. DON identified CNA K at timestamp 11/29/23 at 5:05:04 AM. CNA K is observed in the video entering the room by himself. CNA K moved the bed away from the resident. At timestamp 11/29/23 at 5:05:36 AM CNA J re-enters room. DON identified RN M at timestamp 11/29/23 at 5:06:36 AM, RN M was observed entering Resident #16's room. RN M is then observed in the video doing an initial assessment of Resident #16 on the floor and is then observed with CNA K lifting Resident #16 from the floor back to his bed. CNA J was observed at the end of Resident #16's bed. RN M is then observed completing Resident #16's assessment. DON then stated that it was very fortunate Resident #16 sustained no immediate injuries. Interview on 12/6/23 at 1:22 PM with CNA K revealed he had been working the night of the incident with Resident #16. He stated he had never observed any actions by CNA J that caused him concern. He stated that Resident #16 could sometimes be combative during administering of care, but he was able to redirect Resident #16's behavior. He stated that he had received immediate in-services the next day for Abuse and neglect and Resident Behaviors. Interview on 12/7/23 at 3:38 PM with RN M revealed that CNA J had reported to her that Resident #16 had had a fall while she had been administering cares to Resident #16. RN M reported that after she had gone to resident #16's room and assessed Resident #16 that CNA J described that Resident #16 had been aggressive during administration of cares and that he had fell out of the bed. RN M stated that she had worked with CNA J for several months. She stated that she had never received any complaints about CNA J from residents or other staff and that none of CNA J's actions had ever given her any pause for concern. She stated that she had cared for Resident #16 the next night shift and he had never complained of or exhibited any signs of pain. She stated that the previous shifts nurse had reported that Resident #16 had not complained of or exhibited any signs of pain. Review of the facility's Provider Investigation Report, incident date 11/29/23 and reported to HHSC on 11/29/23, reflected an incident category of abuse. The reports description of the allegation revealed, CNA J reported to the nurse that Resident #16 rolled out of bed during care. As part normal fall investigation routine when DON and ADM review the fall video, it showed memory care unit Resident #16 becoming combative punching and kicking the CNA during care .CNA deliberately pushed hard on residents back and rolled him out the bed. The reports Investigations findings revealed Confirmed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 3 of 12 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 12/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety The reports description of injury revealed no injuries. The reports description of assessment revealed Head to toe assessment. The reports Provider Action Taken Post-Investigation revealed X-ray results were all negative. Resident does not show signs of distress. Abuse in-service and Resident Behavior during Care in-service completed. Employee interviews and statements were completed on 11/29/23. The ADM was informed of the PNC IJ and completed the IJ Template on 12/07/23 at 12:42 PM. Residents Affected - Few Monitoring of the facility's implemented actions that corrected the non-compliance prior to entry included: Review of CNA J's employee file revealed that she had no prior criminal history, and her license was unobstructed. Three references were positive in nature and the CNA had completed all orientation training . Record review of skin assessment sheets dated 11/29/23 for all residents on the secure wing (300 Hall) revealed that there were no unexplained bruising, abrasions or scratches for all residents assessed. Review of the in-service training dated 11/29/23 reflected Abuse and Neglect and Combative Residents/Abuse. Both identified types of abuse, procedures for reporting abuse and interventions for combative residents. Interviews were conducted on 12/07/23 from 1:53 PM to 12/07/23 at 3:38 PM with licensed nursing staff and CNA staff, CNA B, CNA D, CNA N, LVN F, LVN P, and RN M. The nursing staff and CNA's were able to accurately summarize the facility's reporting policy and procedure related to abuse/neglect to include unknown bruising, injuries of unknown origin reporting and documenting and interventions with combative residents. Observations on the secure unit from 12/05/23 at 9:00AM to 12/07/23 at 2:00 PM revealed that the facility had scheduled two nurses on the secure unit at all times/shifts. Review of CNA J's Separation Report dated 11/29/23 revealed CNA J was terminated immediately for Gross Misconduct, and terminated due to resident abuse. The document was signed by both the ADM and DON on 11/29/23. Review of the facility's incident/accident reports and grievance files for the last three months revealed no relevant findings to the incident. The non compliance was identified as PNC. The Immediate Jeopardy (IJ) began on 11/29/23 and ended on 11/29/23. The facility had corrected the noncompliance before the survey began. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 4 of 12 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 12/07/2023 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each Resident, consistent with Resident rights, that include measurable objectives and time frames to meet Residents' mental and psychosocial needs for 2 of 4 (Residents #6 and Resident#235) Residents reviewed for care plans. 1) The facility did not develop and implement a comprehensive person-centered care plan to address Resident # 6 noncompliance with Physician orders of using O2 via Nasal cannula. 2) The facility did not develop and implement a comprehensive person-centered care plan to address Resident #235 Significant weight loss of 8.64% in 1 month.) This failure could place resident at risk of not having a plan developed to address care needs. Findings include: Resident #6 Record Review of Resident # 6 MDS dated [DATE] revealed that Resident #6 was a [AGE] year-old female admitted to facility on 06/3/2023 with BIMS Score of 13 which means that resident was cognitively intact. Resident # 6 had diagnoses of Cardiovascular condition (conditions affecting the heart or blood vessels) with Heart failure (condition that develops when your heart doesn't pump enough blood for your body's needs), respiratory failure ( a serious condition that makes it difficult to breathe on your own) , hypertension (when the pressure in your blood vessels is too high) , Diabetes mellitus ( metabolic disease, involving inappropriately elevated blood glucose levels). MDS review indicated Resident #6 is on Oxygen therapy. MDS did not indicate rejection of care for oxygen therapy. MDS also indicated that resident #6 required total dependence on staff for all transfers and extensive assistance for dressing, bed mobility and toileting. Record Review of Resident #6 physician order dated 9/15/2023 revealed O2 at 2 L/min via NC to maintain O2 stats > 92% every shift. Record Review of Resident # 6's care plan dated 10/2/2023 revealed: Problem: Resident#6 has oxygen therapy related to respiratory failure and COPD (Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems). Goals: Resident will have no signs and symptoms of poor oxygen absorption through the review date Intervention: Monitor for Signs and symptoms of respiratory distress and report to MD. Oxygen settings: O2 via NC per MD orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 5 of 12 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 12/07/2023 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 0656 Level of Harm - Minimal harm or potential for actual harm Observation and interview on 12/06/23 at 8:30 AM revealed that Resident # 6 had just finished with her breakfast, she was slow to respond to question. Also observed that resident # 6 was not on NC and resident # 6 stated that she had taken off her NC tubing. Resident # 6 revealed that she had taken off NC tubing a while back, she was not able to provide a time frame. She also stated that she took the NC tubing off frequently multiple times a day. Residents Affected - Few Observation and interview on 12/6/023 at 08:48 AM revealed resident #6 stated that she wanted to be back on oxygen and appeared to be little uncomfortable and gasping for breath. Observed O2 NC tubing was fallen on the side of the bed touching the floor. Observation on 12/06/23 at 08:50 AM revealed that Agency LVN H was called for helping resident #6 with Oxygen delivery. Agency LVN H changed the Oxygen tubing, refilled the humidifier bottle with water and reinserted the nasal cannula prongs at Resident #6 face. Interview with CNA E on 12/6/2023 at 09:10 AM revealed that resident #6 often takes off her nasal cannula from the face multiple times a day. She revealed whenever she sees the resident #6 has taken off her nasal cannula, she will try to put it back on her. She revealed this behavior should be care planned and reported that the Floor nurses are aware of resident #6's behavior. She was not sure if ADON and DON were aware of resident # 6's behavior of taking off Nasal cannula by herself. Interview with Agency LVN H on 12/06/23 at 09:20 AM revealed that he was an Agency LVN (he did not work at the facility full time; was hired through a nursing agency to work that shift ) but was familiar with care of Resident #6. He had worked the Hall Resident # 6 was placed couple of times in the past. He revealed that resident # 6 took off her oxygen tubing by herself many times in the past and if any staff saw that she had taken it off, they would help put the NC prongs back on resident#6 face. He also stated that the staff redirected her if she took off her NC tubing. He also noted that Resident's removal of Nasal cannula by herself should be care planned. If care planning was not done, it can lead to decrease in resident's quality of care. He was not sure if the Administration or Nursing was aware about resident's behavior but will report it to ADON on the day of the interview. In an interview with CNA D on 12/06/23 at 09:45 AM revealed that she has worked in the facility for more than a month. She stated that she was familiar with Resident # 6's care. She revealed that resident # 6 takes off her NC tubing and it was usually found on the side of the bed. She also stated that the staff will put on the nasal cannula back if she has taken it off and there were no specific rounding times, but she rounds when they are providing ADL care. She does not look at the Care plans but thinks resident's behavior should be care planned. Observation on 12/7/2023 at 07:55 AM revealed resident #6 was sleeping without Nasal cannula attached to her nose. The tubing was observed at the side of the bed. In an interview with LVN G on 12/07/23 at 03:21 PM revealed that if there was significant changes or behaviors that are not consistent with physician orders, it needs to be care planned. The risk for not care planning was not knowing what the interventions were and can lead to deficient care in resident's care. Care planning helps with understanding what was involved in resident's care and interventions associated with it. Interview with MDS RN on 12/06/23 at 01:18 PM revealed all change in conditions that include significant weight loss or respiratory care including external Oxygen delivery should be care planned for resident so that the staff was aware about interventions. She stated that the Nursing administrative (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 6 of 12 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 12/07/2023 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few staff was not aware of resident#6 being non-compliant of O2 orders until today. The risk of not documenting care plans appropriately or not being resident specific may result in decreased quality of care for the resident. Interview with ADON on 12/6/2023 at 01:30 PM revealed she was not aware that resident #6 took off her nasal cannula by herself and hence it was not documented in the care plan. In an interview with Agency LVN I on 12/06/23 at 2:40 PM said he was not familiar with resident's #6 care. He did not get anything in the report about resident#6 takes off her Nasal cannula tubing by herself. He said he saw an order from 12/6 about checking O2 levels every shift. He was not sure if Respiratory care/ resident behavior was care planned. He reported care planning was important because if it was not care planned, staff will not know what to do and can affect quality of care for resident. Resident #235 Record Review of Resident #235 MDS dated [DATE] revealed that Resident #235 was a [AGE] year-old Male admitted to the facility on [DATE] with diagnoses of Medically complex condition including aphasia (loss of ability to understand or express speech, caused by brain damage), gastrostomy status (a surgical procedure used to insert a tube, often referred to as a G-tube, through the abdomen and into the stomach) , Cerebrovascular Accident (an interruption in the flow of blood to cells in the brain) , late onset Alzheimer's disease (a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment) , Esophagitis without bleeding (inflammation in esophagus) and Respiratory failure (a serious condition that makes it difficult to breathe on your own). Resident #235 had BIMS score of unknown which indicated that resident # 235 was cognitively impaired. Resident # 235 admission weight was 111.6 lbs., Height unknown. MDS indicated that resident# 235 required substantial assistance for eating. Record review of resident's weight history included the following: 11/27/2023 103.6 Lbs 11/17/2023 107.0 Lbs 11/10/2023 106.8 Lbs 10/23/2023 113.4 Lbs 10/12/2023 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 7 of 12 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 12/07/2023 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 0656 112.2 Lbs Level of Harm - Minimal harm or potential for actual harm 9/18/2023 111.6 Lbs Residents Affected - Few On 10/23/2023, the resident weighed 113.4 lbs. On 11/27/2023, the resident weighed 103.6 pounds which was -8.64 % Loss. Record review of Resident # 235 care plan dated 10/9/2023 included the following: Problem: Resident # 235 was NPO/enteral feeds (Enteral nutrition, also known as tube feeding, is a way of delivering nutrition directly to your stomach) and has potential nutritional problem r/t BMI too low 17.03. Goal: (1) The resident will maintain adequate nutritional status as evidenced by maintaining weight within (5) % of current weight, no s/sx of malnutrition through review date. Intervention: (1) Monitor/record/report to MD PRN s/sx of malnutrition: Emaciation (Cachexia), muscle wasting, significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. (2) Obtain and monitor lab/diagnostic work as ordered. Report results to MD and follow-up as indicated. (3) RD to evaluate and make diet change recommendations PRN. (4) Speech Therapy to evaluate for potential diet (5) Weigh at same time of day and record monthly Record review of Dietitian's progress note dated 10/27/2023 revealed that Dietitian spoke with speech therapist regarding Resident #235 receiving po diet. Currently. Resident #235 was eating with speech therapist and doing well. Expect to initiate routine meals x3 over the next week: Puree w/nectar thick liquids. Will monitor intake to adjust /reduce bolus tube feeding. Record review of Dietitian's progress note dated 11/17/2023 reflected Resident #235 was noted with Feeding tube replacement. Resident #235 was now eating regular diet now with bolus (small volume of feeding given multiple times a day) tube feeding during the day twice a day was discontinued. Current weight was noted weight loss. Will increase night feeding till weight level was stable. Continue to monitor weight weekly. Monitor feeding rate increases for tolerance. Record Review of Dietitian's progress note dated 12/4/2023 revealed Resident # 235 with unstable weight. Weight = 103.6 lbs.; loss of 3.4 lbs. without noted change of appetite. Skin with wound to Right toe and 2nd toe. Will increase tube feeding time from 12 hour to 15 hour and add house shakes with meals. Monitor feeding tolerance and weight trend. Record Review of Resident #235 physician orders dated 11/8/2023 revealed resident #235 was started on Regular diet, Pureed texture. Record review of resident #235 Physician orders dated 11/17/2023 increase rate of tube feed Jevity 1.5 to 80 ml/hr. feeding from 6PM to 6 AM. Record review of resident #235 Physician orders dated 10/24/2023 increase rate of tube feed Jevity 1.5 feeding to 75 ml/ hr. for 12 hours from 6PM to 6 AM. Record review of resident #235 Physician orders dated 10/20/2023 revealed that resident was on weekly weights. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 8 of 12 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 12/07/2023 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with CNA B on 12/5/2023 at 1:38 PM revealed that Resident #235 did not eat lunch yet since he was too sleepy. She also revealed that resident #235 did not sleep all night. She revealed resident#235 had lost some weight but was not sure if there were any interventions put in place for it. She said that Nursing staff would be more aware. She also revealed she does not take part in care planning process. She revealed that if resident # 235 had lost weight, it needs to care planned so the interventions were known to all staff members. Interview with LVN F on 12/5/2023 at 01:40 PM revealed that ADON does all the care planning. LVN F was aware of resident's weight loss since it was discussed in their meeting yesterday. She also revealed that Dietitian had recently increase the timing of resident's tube feed. She also stated that if it was not documented in care plan then the staff does not know how to do care for the resident. It can also affect the quality of care for the resident. In an interview with Charge RN O on 12/5/2023 at 2:35 PM revealed that resident #235 eats three meals a day, about 80-100% on most meals. He also stated that Dietitian had increased tube feeding hours to 15 hours per day today. RN O reported he was aware that resident was losing weight. He reported that weight loss interventions should be care planned, if not care planned appropriately it can lead to not following the interventions and hence resident's quality of care can be compromised. Interview with Staffing Coordinator/ CNA C on 12/06/2023 at 01:00 PM revealed that he does all the weights in the facility including daily, weekly, and monthly weights. He revealed that resident #235 was on weekly weights since the end of October. He has a list of residents in the facility on weekly weights given to him by ADON. He revealed resident #235 lost weight on 11/27/2023 and he notified ADON about it. He was not sure if any weight loss interventions were added. Interview with MDS RN on 12/06/23 at 01:18 PM revealed that the nursing team was responsible for initial and interim care plans. ADON was responsible for weight loss care plans usually, but they try to do Inter Disciplinary team approach for comprehensive care plans. She also stated that all change in conditions that include significant weight loss should be care planned for resident so that the staff was aware about interventions. She stated that care plans should be resident centered. Interview with ADON on 12/6/2023 at 01:30 PM revealed that She and other ADON along with DON are responsible for care planning acute issues/ Change in conditions etc. She noted that Nursing staff on the floor are expected to inform Charge RN if resident chooses to not follow physician orders or exhibits different behaviors. She stated that she was responsible for monitoring weights in the facility and notify the Dietitian, Physician, and family if resident had a 3 pounds gain or loss. She also reported that Resident # 235 was on weekly weight since October related to weight loss history as a part of weight loss intervention. The risk for not care planning resident's behavior or significant weight changes may lead to not following interventions as stated and can result in quality-of-care issues. She also revealed that care plans should be resident specific since it was resident's planning of care. In a phone interview with Dietitian on 12/06/23 at 01:47 pm revealed that she was aware of resident's weight loss and was present in the facility on 12/4/23. She had increased Resident # 235 tube feedings to 15 hours and added House Shakes daily to provide additional kilocalories after reported weight loss. She also revealed that resident #235 started eating orally sometime in November and weight become a little unstable. She reported that per records, resident # 235 was eating 100% of most meals and increased tube feeding; she anticipated weights to be stable. She reported some of the interventions to mitigate weight loss were: (1) increase tube feeding volume and time (2) Conduct weekly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 9 of 12 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 12/07/2023 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few weights (3) Addition of house shakes (4) Initiation of Oral diet. She does not participate in any care panning activities but notes that interventions should be care planned appropriately so that all staff know what the interventions were put in place and followed appropriately. In an interview with DON on 12/07/23 at 08:53 AM revealed that Nursing Administration team that includes herself, ADON's, MDS RN were responsible for Comprehensive/ acute care plans and all care plans should be resident specific. She reported that not documenting care plans appropriately can lead to resident's care being compromised and can affect quality of care. In an interview with Administrator 12/07/23 at 09:08 AM revealed that MDS RN and DON/ ADON were responsible for Comprehensive and Acute care Planning. He stated that he was aware that there were care plan issues in the facility and they have conducted in-services with the team in the past. He stated that the risk for not documenting care plan appropriately that are resident specific can lead to missing out on proper care of residents. His expectation was that Nursing follows Inter Disciplinary team approach to adequately document care plans that were person specific for all the residents. Record Review of Facility's Care Plans, Comprehensive Person-Centered date March 2022 revealed 11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. 12. The interdisciplinary team reviews and updates the care plan: a. when there has been a significant change in the resident's condition; b. when the desired outcome is not met; c. when the resident has been readmitted to the facility from a hospital stay; and d. at least quarterly, in conjunction with the required quarterly MDS assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 10 of 12 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 12/07/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for the facility's only kitchen. Residents Affected - Some 1. The facility failed to date food stored in the freezer that should no longer be consumed. 2. The facility failed to discard food stored in the refrigerator that was past use by date and should no longer be consumed. These failures could affect Residents who received their meals from the facility's only kitchen, by placing them at risk for food-borne illness if consumed, and food contamination. Findings included: Observation in facility's kitchen on 12/05/23 at 09:25 AM revealed Whipped topping in freezer was not dated. Observation in facility's kitchen on 12/05/23 at 09:28 AM revealed whole frozen turkey found in the kitchen walk-in freezer in original packaging was not dated. Observation in facility's kitchen on 12/05/23 at 09:31 AM revealed spoiled Lettuce stored in walk-in refrigerator with use-by date of 11/26/2023. In an interview with FSD on 12/05/2023 at 9:47 AM revealed that whipped topping was to be used for tonight's dinner and his aide may have forgotten to date it. He also revealed that the frozen turkey was bought during Thanksgiving week of November 20th and had a dated label on it but may have fallen off. He reported that he has been working with the facility kitchen for the last three years and was aware that all foods should be covered and dated. He revealed that he had not conducted his daily rounds in the kitchen yet and the lettuce that was in the refrigerator beyond use-by date will be thrown out immediately. He revealed that risk of not dating the food was the food can be spoiled. If such spoiled food was served to the resident, it could lead to food borne illness. He also stated he conducted in-service regarding food storage, dating and labeling on a regular basis with the kitchen employees. In an interview with AM Cook/Aide on 12/07/23 at 08:25 AM revealed that she was also responsible for storing food in the refrigerator and freezer. She stated she has been in-serviced that all foods should be covered, dated, and labeled. She also stated that the risk of not dating any food was that food can be spoiled, and it was unknown how long it was stored. She also stated that she would let FSD know about any undated food and throw out the food when in doubt. In a phone interview with Facility Dietitian on 12/07/2023 at 01:47 pm revealed her expectation was all food items in the kitchen should be covered, dated, and labeled appropriately, and all the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 11 of 12 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 12/07/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm kitchen staff adhere to facility policy. She stated that the risk of not dating the food items was not being sure how long the food items have been stored and could be spoiled. Such spoiled foods cannot be served to residents and should be discarded immediately. She revealed she along with FSD provide in-services to the staff when she rounds the facility. Some of the in-services include food storage, labelling and dating, Time and temperature-controlled food safety, and hand hygiene. Residents Affected - Some Record Review of Facility's Food safety and Sanitation undated revealed that .4. b. All time and temperature control for safety (TCS) leftovers are labeled, covered, and dated when stored. They are used within 72 hours (or discarded). Foods with expiration dates are used prior to the use by date on the package. Review of the Food and Drug Administration Food Code, dated 2022, reflected, .3-302.12 Food Storage Containers, Identified with Common Name of Food. Except for containers holding food that can be readily and unmistakably recognized such as dry pasta, working containers holding food or food ingredients that are removed from their original packages for use in the food establishment, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the food 3-305.11 Food Storage.(B) .refrigerated, ready-to eat time/temperature control for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified in (A) of this section and: (1) The day the original container is opened in the food establishment shall be counted as Day 1; and (2) The day or date marked by the food establishment may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on food safety FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 12 of 12