Health inspection·June 27, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few explain all procedures using terms gestures the resident can understand. Resident # 1 had episodes of behaviors and was at risk for further increased episodes and injury; Goal-Resident # 1 will decrease behavioral episodes through behavioral monitoring and interventions; Interventions- encourage to attend social activities of preference, give medication as ordered, monitor and chart behaviors as they occur and report progress /declines to MD; observe for early warning signs of behavior-approach in a calm manner, call by name remove from unwanted stimuli.During an interview and observation with Resident # 1 on 6/26/2025 at 11:10 a.m., Resident # 1 stated he wanted to move into an apartment. He stated that he was at the nurse's station talking to staff when the Administrator approached him and yelled in his face. He stated the Administrator pissed him off when she yelled at him. He stated he told the Administrator to stay away from him. Resident # 1 stated two days ago he was drawing and the Administrator came by his door and he stated that upset him because he told the Administrator to stay away from him. Resident # 1 stated he wanted to leave the facility because the Administrator was rude. Resident # 1 had a stroked, therefore, he had limited verbal skill. Resident # 1 was able to verbally express his frustration.During an interview with MA A on 6/26/2025 at 2:10 p.m., MA A stated a couple of days ago (she could not remember the date) she heard a verbal altercation. She stated that the verbal altercation was extremely loud, and she thought it was two residents. She stated that when she arrived at the nurse's station, she observed Resident # 1 and the Administrator in a verbal altercation. She stated that she did not know what Resident # 1 and the Administrator were arguing about. She stated that the Administrator was loud and disrespectful towards Resident # 1. She stated that Resident # 1 was loud as well, and the Administrator should have de-escalated the situation by leaving. She stated that another staff member had to ask the Administrator to leave the area. She stated that Resident # 1 was so upset he was standing up and hitting the desk. She stated that another CNA (name unknown) was at the desk and that CNA (name unknown) was able to de-escalate the situation and calm Resident # 1 down.During an interview with Social Worker A on 6/26/2025 at 2:30 p.m., with Social Worker A , she stated that on 6/16/2025 Resident # 1 was sitting next to the nurses' station in his wheelchair. She stated that Resident # 1 had a hard time speaking and expressing himself as he had a stroke. She stated that if someone listened to Resident # 1 they could understand him. She stated that Resident # 1 was expressing his needs to direct care staff. She stated that Resident # 1 was upset, and he started yelling as he could not express himself with words. She stated that the Administrator came from around the corner, and she got in Resident # 1's face and began yelling at him and pointing her finger in his face. She stated that the Administrator told Resident # 1 to shut up. She stated that Resident # 1 was so upset that he stood up and he began to hit the desk with his hands, and he was crying. She stated that the Administrator continued to speak rudely to Resident # 1. She stated that a direct care staff asked the Administrator to leave the area as the situation needed to be de-escalated and the resident was upset. Other A stated that she was concerned that Resident # 1 was going to fall or could possibly had another stroke. She stated that another direct care staff calmed Resident # 1 down and she took him to his room. She stated that the Administrator's approach and the way she spoke to Resident # 1 was unprofessional.During an interview with CNA A on 6/27/2025 at 12:46 p.m., CNA A stated Resident # 1 had a stroke and he has problems verbally expressing himself. She stated that Resident # 1 can communicate his needs, but it is hard to understand hm. She stated that did not remember the date of the verbal altercation between Resident # 1 and the Administrator. She stated that Resident # 1 was at station 2 and he wanted to go out for the day or go home permanently. She stated that Resident # 1 was speaking to the staff at station 2 about leaving. She stated that Resident # 1 was upset, and he began to yell and talk loudly. She stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 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 676040 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Prairies 106 Del Norte Dr El Campo, TX 77437 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 - Actual harm Residents Affected - Few that the Administrator approached Resident # 1, and she introduced herself to him. She stated that Resident # 1 started cursing at the Administrator. She stated that the Administrator told Resident # 1 you will not talk to me like that. She stated that upset Resident # 1 as he was trying to get his words out. She stated that Resident # 1 started crying. She stated that Resident # 1 does have behavior issues and most direct care staff know how to help him calm down. She stated that the Administrator met Resident # 1 for the first time, and she was yelling at him. She stated with Resident # 1 that was not going to work because when he is upset, he will hit things and people. She stated that she and CNA B were able to calm him down as they took him to his room and fixed him coffee. She stated that the Administrator made the situation worse. She stated that the Administrator should approach Resident # 1 differently. She stated that the Administrator approached Resident # 1 yelling at him, and that escalated the situation. She stated that Resident # 1 was sitting in his wheelchair and when he got upset with the Administrator he stood up. She stated that she was concerned because she did not want Resident to fall. She stated that the DON told the Administrator to walkway, and she walked away mumbling. CNA A stated that the Administrators approach towards Resident # 1 was unprofessional.During an interview with CNA B on 6/27/2025 at 1:12 p.m., CNA B stated she did not now the date and time of the incident. She stated that it happened last week. She stated a direct care staff came and got her. She stated that when Resident # 1 is upset she can calm him down. She stated that when she arrived at the nurses' station Resident # 1 was hysterical and cursing. She stated that she observed the Administrator leaned over in Resident # 1's face and she told Resident # 1 that he was not going anywhere. She stated that Resident # 1 wanted to leave the facility. She stated that she doesn't know what was said prior to her arriving at the nurses' station. She stated that the Administrator told Resident # 1 I am the Administrator, and you will not curse at me. She stated that Resident # 1 continued to curse. She stated that she was concerned for Resident # 1 as he was upset, and he recently had a stroke. She stated that she did not want Resident # 1 to fall or have stroke or a heart attack; she stated he was just that mad. The situation was de-escalated as CNA B told the DON to get the Administrator away and the DON walked the Administrator down the hall. She stated that she and CNA A took Resident # 1 to his room. She stated it took a while for him to calm down as he was still cursing. She stated that Resident # 1 was mentally abused by the Administrator. CNA B stated that the DON, CNA A, LVN A and the Social Worker were present.During an interview with LVN A on 6/27/2025 at 2:00 p.m., LVN A stated that Resident # 1 had been talking to the NP about going home and he told the NP he wanted to go home in 2 months. She stated that the NP told Resident # 1 that everything needed to be in place before he discharged home. Resident # 1 had been speaking with the Social Worker about going home. She stated that she thinks the Social Worker was working on Resident # 1's paperwork. She stated that last week (date unknown) Resident # 1 was at the nurses' station and he was inquiring about going home. She stated that she told Resident # 1 that everything must be in place before he can move. She stated that Resident # 1 wants to go to an apartment. LVN A stated that Resident # 1 got upset because he wanted an answer as to when he could move, and she did not have that answer. She stated that the Social Worker would make those arrangements; however, she stated that Social Worker was terminated on 6/25/2025 (two days ago). She stated that Resident # 1 was upset, and he began yelling and cursing. She stated that the new Administrator came from around the corner, and she got in Resident # 1's face and she said, I'm the new Administrator and my name is [Administrator] and you will not curse at me like that. LVN A stated that Resident # 1 was not cursing at the Administrator because she was not around, and he was cursing in general. She stated that the Administrator asked Resident # 1 Where do you think you are going? She stated that made Resident # 1 upset. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 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 676040 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Prairies 106 Del Norte Dr El Campo, TX 77437 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 - Actual harm Residents Affected - Few She stated that she did not understand why the Administrator would say that to Resident # 1 as he was already upset, and he did not know her. She stated that she asked Resident # 1 to calm down. She stated that he did not calm down. She stated that CNA A and CNA B usually can calm him down. She said CNA B told Resident # 1 that she would call his friend for him. She stated that Resident # 1 agreed to go to the room with CNA A and CNA B. She stated that the Administrator should have approached Resident # 1 differently. She stated that if the Administrator would have left Resident # 1 alone and let the staff deal with him he would have calmed down. She stated that both Resident # 1 and the Administrator were yelling. She stated that she wanted Resident # 1 to calm down because she did not want him to have another stroke. She stated that he was also standing, and she did not want him to fall. She stated that the Administrator was yelling back and forward with Resident # 1. She stated that the Administrator's approach was unprofessional.During an interview with the Administrator on 6/27/2025 at 3:05 p.m., the Administrator stated last week (date unknown) Resident # 1 was at the nurse's station. She stated that overheard Resident # 1 screaming. She stated that she was on another hallway. She stated that she went to the nurse's station and Resident # 1 was sitting in his wheelchair. She stated that Resident # 1 was yelling because he wanted to go home. She stated that she approached Resident # 1 and introduced herself to him. She stated that Resident # 1 said I want to get the F out of here. She stated at this point Resident # 1 stood up and came towards her. She stated that attempted to calm Resident # 1 down; however, Resident # 1 continued to scream and curse. She stated that staff (name unknown) went to get the CNA (name unknown) as this CNA was able to calm Resident # 1. The Administrator stated that she did know how the situation was de-escalated as she walked away. The Administrator stated that she did not yell at Resident # 1. The Administrator stated that she did not point her finger at Resident # 1. The Administrator stated that she patted Resident # 1 on his arm when she introduced herself to him.During an interview with ADON A on 6/27/2025 at 3:47 p.m., ADON A stated she was present when the verbal altercation occurred between Resident # 1 and the Administrator. She stated that she thinks the incident happened last Thursday (6/19/2025). She stated she was doing rounds when she heard Resident # 1 being loud. She stated that Resident # 1 is hard to understand because of his stroke and his verbiage is hard to understand and he gets frustrated. She stated that Resident # 1 wanted to leave, and he wanted to go to an apartment where can stay by himself. She stated that the Administrator heard Resident # 1. She stated that Resident # 1 was sitting in his wheelchair when the Administrator walked up to him. She stated that the Administrator patted Resident #1 and he stood up and started cursing at her. She stated that the Administrator was talking with Resident # 1 but she was not speaking to him in an aggressive tone. She stated that the DON told her to go and get CNA B as she can calm Resident # 1 down. She stated that when she left to go get CNA B the Administrator was still standing there talking to Resident # 1. She stated that CNA B was able to calm Resident # 1 down.During an interview the DON on 6/27/2025 at 4:37 p.m., the DON stated she was in her office, and she heard someone with a loud voice. She stated that when she came down the hallway it was Resident # 1 who was loud. She stated that Resident # 1 was voicing that he wanted to leave and go to an apartment. She stated that Resident # 1 was cursing and being very aggressive to staff and pounding on things. She stated that she attempted to calm him down. She stated that the Administrator came from around the hall and the Administrator was speaking to Resident # 1. She stated that the Administrator told Resident # 1 to hold on because it is a process, and the facility needed to make sure Resident # 1 was going somewhere safe. She stated that the Administrator did not say anything wrong to Resident # 1. She stated that Resident # 1 wanted to leave the facility, and he was upset because he could not leave. She stated that Resident # 1 stood up at the nurses' (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 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 676040 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Prairies 106 Del Norte Dr El Campo, TX 77437 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 - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stations as he was upset. She stated that she asked ADON A to go and get CNA B as she can calm Resident # 1 down. She stated that CNA A was able to calm Resident # 1 down.Record review of the facility's policy on Resident Rights, Dignity and Privacy Handout, not dated indicated 1) Right to dignity, respect and freedom a) treated with dignity and respect, b) freedom from abuse , neglect and exploitation, and corporal punishment, c)right to make personal choices about care and daily life. Event ID: Facility ID: 676040 If continuation sheet Page 5 of 5