Health inspection·December 9, 2025

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete nurse from the agency LVN E, who had worked on 09/22/2025 at 10:00p.m. to 6:00 a.m. The DON stated she was called multiple times, but no answer and no return call. The DON stated the Medical Director, police and pharmacy consultant were called. The DON stated the police came and the detectives filed a case. The DON stated she initiated an in-service on the two-step counting system in place. The DON stated that was the first time she had ever had something like that happen and she had no problems after. The Agency Supervisor stated the agency had also tried as well as the police to get ahold of LVN E, but LVN E would not return anyone's calls. The police report was requested by the surveyor on 12/09/2025 at 1:00 pm by email. In an interview on 12/09/2025 at 1:00 p.m. with LVN F revealed the count of the medication was conducted on 09/23/2025 at 6:00 a.m., with the off-going nurse, LVN E. LVN E called out the count sheet and LVN F checked the medication, it was the same number of pills, so LVN F did not look at the count sheet. In an interview on 12/09/2025 at 2:15 p.m. with RN D revealed that on 09/23/2025 at 10:15 p.m. the count with MA B, MA B noticed the counting sheet was written over. RN D stated both her and the MA B checked the count sheet and there were some numbers skipped, according to what medications that had been dosed. RN D noticed the count sheet was also signed at 4:00 am, but Resident #2 was not assigned to the nurse who had signed for the medication on the count sheet. Resident #2 did not have a PRN order for Soma. In an interview on 12/09/2025 at 2:30 p.m. with MA B it was revealed he had counted with LVN F on Monday 09/22/2025 at 10:00 p.m. The medication count was right. MA B came back to work on Tuesday 09/23/2205 at 2:00 pm and counted the medicine with LVN F. LVN F called out the number from the count sheet and the medication matched that number and was correct based on the count. MA B stated when he counted at 10:00 p.m. on 09/23/2025 with RN D, before MA B left, that was when it was noticed by RN D and MA B the count numbers had been scribbled over and new numbers written. RN D and MA B tried to count again, and the number of pills did not match the sheet, it showed the Soma count was not correct. The DON was then notified. In an interview on 12/09/2025 at 3:00 p.m. with the ADON revealed she had worked a shift to fill in 09/21/2025 and she counted with RN D. The Soma pills were counted at 42 pills, and the count was correct at that time. In an interview on 12/09/2025 at 11:10 a.m., Resident #2 revealed she was unable to answer the questions due to her confusion and forgetfulness. Resident #2 kept repeating she was fine. During an interview on 12/09/2025 at 10:00 a.m., the Administrator stated they reported the concerns to the local police department and to the state. The Administrator stated he reported to the Agency Supervisor concerning the missing medication and the inability to contact the nurse. The Administrator stated that the agency had tried to contact LVN F, but she had not returned any of his calls. The Supervisor stated he had removed her from the service. The Administrator stated the staff were in-serviced on the two-step counting process and reporting. In an interview on 12/09/2025 at 10:58 a.m., the Medical Director revealed he had been contacted by the facility concerning the missing Soma but had been assured that the resident had missed no dosing of the medications. The Medical Director stated he was informed by the Administrator he had reported it also to the police and the investigation had begun. The Medical Director stated he had no worries about the other staff that worked there, he had never had any problems related to misappropriation of any other medications. Record Review of Abuse Prevention Policy revised dated October 2022 reflected: Our residents have the fifth to be free freedom abuse, neglect, misappropriation of resident property and exploitation. Event ID: Facility ID: 676039 If continuation sheet Page 2 of 7 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 12/09/2025 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review, the facility failed to incorporate recommendations from a PASRR evaluation report into a resident assessment, care planning, and transition of care for 1 (Resident #1) of 2 residents reviewed for PASRR services. The facility failed to submit a complete and accurate request for NFSS in the LTC online portal within 20 days after the IDT meeting. This failure could place residents who were PASRR positive at risk of not getting the PASARR services for a better quality of life and could lead to a decline in health. Findings included: Record review of Resident #1's quarterly MDS dated [DATE] revealed a [AGE] year-old male, admitted to the facility on [DATE]. He had the following diagnoses: muscle weakness (decreased strength), drug induced movement disorder (involuntary movements), unspecified lack of coordination (unable to control movement), diabetes (increased sugar), genetic related intellectual disabilities (abnormalities in genes or chromosomes), seizure (nerve disorder), schizophrenia (mental illness), Parkinson (muscle weakness). Resident #1 was severely cognitive impaired and unable to make decisions for himself. Resident #1 required the assistance of two staff for activities of daily living. Record review of Resident #1's care plan dated revision date 10/21/2025 revealed Resident #1 is PASRR positive, will participate in quarterly care plan meetings with PASRR representative/social worker, Coordination of PASRR services and Individual Service Plan developed by PASRR representative/social worker. Resident #1's goals will maintain highest level of practice wellbeing. interventions/task Resident has a customized Wheelchair and rehabilitation services of occupation, speech, and physical therapies. Record review of the Resident #1's PCSP dated 01/28/2025 revealed the IDT meeting was held on 01/28/2025. Attendees included the resident, PASRR habilitation coordinator, the MDS nurse, PASSR Evaluator, and Therapy Representative. The following NFSS were identified and confirmed: Customized Manual Wheelchair, speech, occupational, and physical therapy selected as new. Record review of Resident #1's PCSP dated 04/18/2025 revealed the IDT meeting was held on 04/18/2025. Attendees included the resident, the PASRR habilitation coordinator, the Social Worker, MDS RN, and Resident #1. The following NFSS were identified and confirmed: Customized Manual Wheelchair - 3 indicated on-going. Record review of the Resident #1's PCSP dated 01/28/2025 revealed the IDT meeting was held on 01/28/2025. During an interview on 12/09/2025 at 11:00 a.m. with the DOR revealed they had been treating Resident #1 for habilitation services since 2017. The DOR stated she had worked at the facility for the past 3 years and the resident had been on services since that time. The DOR stated she completed the NFSS forms for the past three years. She stated that the services for habilitation services had never stopped, except when the resident was in the hospital. Resident #1 was receiving habitation services for speech, occupation, and physical therapy services since 01/30/2025 seven times a week three times a day for the next 6 months. Record review of the NFSS with the DOR reflected. speech therapy with portal entries dated: 12/05/2025. change requested completed successfully.TMHP; Approved alert sent. speech therapy with portal entries dated: 02/11/2025:. Change requested completed successfully. TMHP: Approval alert sent. Speech therapy with portal dated: 04/09/2025 . change requested completed successfully. TMHP: Approved alert sent. Record review of the NFSS with the DOR reflected. occupational therapy with portal entries dated: 02/15/2025 change requested for therapy services completed successfully.TMHP: Approved alert sent. speech therapy with portal entries dated 10/08/2025 change requested completed successfully. TMHP: Approval sent. Speech therapy with portal entries dated 03/21/2025 change requested completed successfully. TMHP: Approval sent. Record review of the NFSS with the DOR reflected. physical therapy with portal entries dated: 02/15/2025 change requested for therapy services completed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 3 of 7 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 12/09/2025 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few successfully.TMHP: Approved alert sent. physical therapy with portal entries dated 10/08/2025 change requested completed successfully. TMHP: Approval sent. physical therapy with portal entries dated 03/21/2025 change requested completed successfully. TMHP: Approval sent. During an interview on 12/09/2025 at 11:30 a.m., the MDS nurse stated it would have been in January of 2025 that she attended a PASRR meeting for Resident #1. During the meeting it was mentioned that therapy would need to continue the process for Resident #1 and coordinate with MDS on that process. She stated the DOR was working on a forms for the process to continue services for habitational therapy. Resident #1 had never missed any of the habilitation services, unless he was in the hospital. The MDS nurse verified during the change of ownership she could not access the portal in order to place the needed information, but she had sent all of her paperwork to the case managers for LIDDA/NF and they were aware of the habilitation services that had continued. The MDS nurse stated she had not spoken to anyone concerning her inability to access the portal system during the change of ownership, and that must have been when all that looked like there was a drop in services, but there was not. Record review with the MDS nurse reflected the LIDDA/NF Form was dated 01/31/2025. The IDT meeting occurred on 01/28/2025 with the Habilitation Service Plan. Further review LIDDA dated 01/28/2025 reflected, . changes made to the Habilitation Service Plan . description of change : IDT Meeting Habilitation Coordination. Speech, physical, and occupational Therapy selected as new. Outcome of the Action Plan:. occupational therapy will improve his ability to participate in activities.Physical therapy will improve ability to transfer and prevent falls,. and speech therapy will allow to increase his cognition and communication skills. During an interview on 12/09/2025 at 12:40 p.m., The Administrator said the MDS nurse took care of all the PASSR needs, he was aware that he had received a specialized wheelchair, but he was unaware of any lapse in service. The Administrator stated he did not have any phone calls or emails related to Resident #1 and a lapse in habilitation services. The Administrator did state that during the change of ownership that the portal would not work for them and he knew that the services from their side could not be placed in the portal. He got his information from the MDS nurse, she filled out all the paperwork, placed the information in the portal, the change of ownership was sometime in March 2025 he thought but he could not recall. The Administrator stated if there were changes following the IDT meeting and with the habilitation coordinator involved then the changes would be placed in the portal then, but he did not submit the form. He stated the facility did not complete the NFSS form in the LTC portal within the 20 days of the changes due to the change of ownership, then that would be a problem. The Administrator stated to his knowledge that no person had been contacted during the change of ownership, for the problems with the portal to see how to correct the problem until the new company had taken over. An observation and attempted interview on 12/09/2025 at 1:00 p.m. with Resident #1 revealed he was in habilitation therapy. He was sitting up in his wheelchair during speech therapy concerning speaking. The resident confirmed he had always been in therapy with no lapse and did not want to answer any further questions and closed his eyes. Record review of the paperwork provided by the Administrator and the MDS nurse dated 12/09/2025 through 01/30/2025 reflected emails: . from the MDS nurse to the IDT coordinator for PASRR meeting concerning habilitation therapies following [Resident #1's] readmit from the hospital. the meeting was scheduled for 01/28/2025. The recommendations at the meeting were followed by the MDS nurse and the DOR to continue the habilitation services. Record review of the NFSS Form Completion dated 01/28/2025 with the MDS nurse revealed The nursing facility provider must complete the NFSS form, including all required information, such as the resident's demographics, the therapist's assessment findings, and the physician's order. For habilitation services for Speech, Occupational, and Physical Therapies, the NFSS form was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 4 of 7 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 12/09/2025 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete completed by a licensed therapist. The Worksheet is to be completed by Therapy and that information is to be imputed into SimpleLTC by MDS will upload the following forms into SimpleLTC -Once this is completed, we submit forms and wait for response from THHS. Once we have approval the completed NFSS form is submitted through the Texas Medicaid and Healthcare Partnership's LTC Online Portal. If any rejection error messages occur during the workflow process, the provider must take action to correct the request and resubmit it. Record review of the facility policy undated Resident Assessment - Coordination with PASRR Program reflected: Policy: The facility coordinates assessments with the preadmission screening and resident review PASRR program under Medicaid to ensure that individuals with a mental disorder, intellectual disability, or a related condition receives care and services in the most integrated setting appropriate to their needs. Policy Explanation and Compliance Guidance: 1. to ensure forms are submitted timely and accurately. The facility only has 20 business days form the date of meeting to submit a completed and accurate form. 7. Recommendations, such as any specialized services, from a PASRR level II determination and/or PASRR evaluation report will be incorporated into the resident's assessment, care planning, and transactions of care. Event ID: Facility ID: 676039 If continuation sheet Page 5 of 7 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 12/09/2025 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure that each resident received food that is palatable, attractive, and at a safe and appetizing temperature for 1 of 1 lunch meals tested for nutritive value, flavor, and appearance: The facility failed to provide palatable food served at an appetizing temperature to residents, during lunch on 12/09/2025. This failure could affect the residents who ate food from the facility kitchen by placing them at risk of poor food intake and/or dissatisfaction of the meals served.The findings included: During an interview on 12/09/2025 at 9:58 a.m., CNA A stated she had received complaints from residents that the food was cold, but not often and only for residents who ate in their room. The CNA stated that trays were passed when the cart was on the hall. The CNA stated that it could take 10 minutes to pass all trays. During an interview on 12/09/2025 at 10:10 a.m., CNA G stated she had received complaints from residents stating that the food was cold. The CNA G stated that they asked the residents if they would like their tray to be reheated and residents were usually fine once the tray was reheated. The CNA stated that it could take a while to pass trays, just dependent on what was going on, staff could have assisted another resident with care and it was only one person on the hall to pass tray. During an observation on 12/09/2025 at 11:18 a.m., the DM who conducted temperature check of the barbeque, revealed the thermometer read 208 degrees Fahrenheit. For the okra the thermometer read 188 degrees Fahrenheit. For the potato salad the thermometer read 40 degrees Fahrenheit. The state surveyor requested a test tray. Observation of test tray provided to the state surveyor on 12/09/25 at 12:38 p.m., the state surveyor revealed barbeque meat was placed between two buns, the outside edges of the meat was cool to taste but the center was lukewarm; the okra was cold and the potato salad was no longer cold. No facility staff member was present. During an interview on 12/09/2025 12:57 p.m., Resident #2 revealed that the food is often cold. Resident #2 stated the trays often sit on the halls for approximately five minutes before staff pass then out. Resident #2 stated she had received her tray in her room today and the food was not cold, but not it was not hot. During an interview on 12/09/2025 at 3:59 p.m., the DM revealed that residents on halls 100 and 200 had expressed concerns about food being cold. The DM stated that they tried to ensure that the food was cooked and was hot as it could safely be. He stated they covered the plates, utilized plate warmers and had enclosed carts. The DM stated that the dietary staff delivered the cart on time to the hall and announced that the cart was on the hall, but the assigned hall staff did not start passing trays right away. The test tray provided on the last cart was delivered to the hall at 12:22 p.m. but was still on cart at 12:35p.m., that was 13 minutes after that cart had been delivered to the hall and that is unacceptable. The DM stated that he informed the clinical staff when trays would be delivered so they would be ready, but 13 minutes would cause food to be cold. During an interview on 12/09/2025 at 4:15 p.m., the DON revealed that her expectation was for the staff to disperse the trays as soon as they hit the hallway to ensure residents who ate in their room received warm meals. The DON stated that staff were notified by dietary that carts were on the hall and that there were enough staff to pass trays, they just had to find a way to have the carts delivered timely to the residents. The DON stated that she had spoken with the ADM on having staff member sign for cart and put what time cart was accepted and pass completed to be able to hold their staff accountable for getting food out on time. During an interview on 12/09/2025 at 436 p.m., the ADM stated his expectation was that food be served to residents at a safe and appetizing temperature. The ADM stated that the nursing staff was responsible for ensuring food trays were delivered as soon as the dietary staff brought the trays to the hall so that the residents who ate in their rooms received meals at appetizing temperatures. The ADM stated if food was not Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676039 If continuation sheet Page 6 of 7 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 12/09/2025 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete served at an appetizing temperature, it could have caused residents to not want to eat their food which could have led to weight loss. The ADM stated what led to failure was the staff not following facility policies. Record review of facility policy titled Meal Service dated October 2021 revealed: The facility believes that all residents should be treated with dignity and respect at all times. A respectful, positive dining experience is essential to residents' quality of life and helps to identify residents' needs attended to during meal service.Procedure:12. Room service trays will be delivered promptly upon reaching the floor. Event ID: Facility ID: 676039 If continuation sheet Page 7 of 7