Health inspection·November 18, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few feeding the resident. In an interview on 11/17/2025 at 1:44 PM, Resident #1 did not reply when asked if it was okay for him that the staff was standing up while assisting him during lunchtime. 2. Record review of Resident #2's Face Sheet, dated 11/17/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with chronic kidney disease. Record review of Resident #2's Comprehensive MDS Assessment, dated 11/13/2025, reflected the resident was cognitively intact with a BIMS score of 14. The Comprehensive MDS Assessment indicated that the resident had an indwelling catheter (a thin, flexible tube inserted in the bladder to allow the urine to flow in the catheter bag). Review of Resident #2's Comprehensive Care Plan, dated 11/14/2025, reflected that the resident had a Foley catheter (device used to help drain urine from bladder) and one of the interventions was to provide a catheter bag. Review of Resident #2's Physician Order, dated 11/08/2025, reflected (Specify type . indwelling urinary catheter (device used to help drain urine from bladder): 16 Fr (French: unit of measurement for catheter sizes) with . cc normal saline balloon using a closed drainage system. Change monthly and as needed. every night shift starting on the 10th and ending on the 11th every month. In an observation and interview on 11/17/2025 at 10:39 AM Resident #2 was in her wheelchair at her doorway. She said she was waiting for somebody to push her wheelchair to the activity area. It was observed that the resident had a catheter hooked beneath her wheelchair. The catheter bag, with urine inside, did not have a privacy bag. The resident stated she had a catheter because she had a kidney problem. She said she was transferred by an aide to her wheelchair but did not notice if her catheter was inside a privacy bag. She said she was about to go out of her room and it would be nice if her urine bag was not exposed. In an interview on 11/17/2025 at 10:42 AM, CNA F stated she was the one who transferred Resident #2 to her wheelchair. She said she was aware that the resident's catheter bag did not have a privacy bag. She said she should have asked for a privacy bag before transferring the resident to be sure that the catheter bag was not exposed. She said it would be embarrassing if the resident would be in the hallway and everybody could see her urine. She said she would look for a privacy bag. In an interview on 11/18/2025 at 8:40 AM, the DON stated the staff should sit down next to the resident when assisting them during mealtimes. She said sitting beside the resident also allowed close observation of the resident's eating habits like if the residents were swallowing the food, if there was a problem in swallowing, if the resident was pocketing the food, if the residents were choking. She said standing up while assisting during meals would give an impression that the staff was in a hurry. The DON also stated that catheter bags should be inside a privacy bag to maintain the resident's dignity. She said the facility was using catheter bags that had flaps on them and the flaps served as the cover. She said if the resident was using a catheter bag that did not have a flap, it should be in a privacy bag to prevent embarrassment but provide privacy and dignity. She said the expectation was for all the staff to ensure that the residents were provided dignity by sitting down while assisting during meals and ensuring that the catheter bag was not exposed. She said she already started an in-service pertaining to providing dignity as soon as CNA H told them about the dignity issue. In an interview on 11/18/2025 at 10:31 AM, ADON A stated a privacy bag should be provided if a resident had a catheter to avoid incidents that could lead to embarrassment. The purpose of the privacy bag was to provide dignity for residents with urinary catheters. ADON A said the staff assisting a resident during mealtime should be sitting alongside the residents to also provide dignity. She said sitting beside the residents would allow better observation of the residents' needs during mealtime. She also said sitting beside the resident encouraged interaction and promoted safety when eating. She said the expectation was for the staff to provide dignity in all aspects of the resident's care. She said the DON already started an in-service about (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 2 of 25 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 11/18/2025 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete dignity. In an interview on 11/18/2025 at 1:20 PM, the Administrator stated a catheter bag without a privacy bag was a dignity issue because the content of the catheter bag could be seen from the hall way. She said the staff assisting a resident to eat should be sitting down and within eye level of the resident also to provide dignity. She said all the staff, even her, were responsible in providing dignity to all residents. He said staff must do their due diligence in ensuring that the residents had a dignified existence while in the facility. The Administrator said she would coordinate with the DON to make sure that the staff were aware of the meaning of providing dignity. Record review of the facility's policy entitled, Resident Rights, Dignity and Privacy Handout undated, reflected Resident Dignity: Treating residents with the utmost respect, recognizing their inherent worth and value as individuals. It involves honoring their autonomy, privacy, and personal preferences, while also ensuring their physical and emotional well-being is maintained. Record review of the facility's policy entitled Catheter Care Policies and Procedures revised 02/2024 reflected Catheter Management . Privacy: Store the catheter bag in a privacy bag to maintain dignity. Event ID: Facility ID: 676040 If continuation sheet Page 3 of 25 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 11/18/2025 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 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for five (Resident #3, Resident #4, Resident #5, Resident #13, and Resident #14) of twenty-one residents reviewed for reasonable accommodation of needs. The facility failed to ensure the call light system in Resident #3, Resident #4, Resident #5, Resident #13 and Resident #14's rooms was in a position that was accessible to the resident on 11/17/2025.This failure could place the residents at risk of being unable to obtain assistance when needed and help in the event of an emergency.Findings included: Resident #3 Record review of Resident #3's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with muscle weakness and lack of coordination. Record review of Resident #3's Comprehensive MDS Assessment, dated 08/28/2025, reflected the resident had a severe impairment (the resident required significant assistance and support in daily life) in cognition with a BIMS score of 03. The Quarterly MDS Assessment indicated that the resident was dependent on staff for transfers and bed mobility. Record review of Resident #3's Comprehensive Care Plan, dated 09/29/2025, reflected the resident was at risk for falls and one of the interventions was to ensure the call light was within reach. Observation and interview on 11/17/2025 at 9:05 AM revealed Resident #3 was in her bed, awake. It was observed that the resident's call light was on top of the resident's side table and was not within reach. When asked about what she used when she needed to call the staff, the resident did not answer. During an interview and observation on 11/17/2025 at 9:10 AM, LVN C stated call lights should always be within reach of the resident so the residents would be able to call the staff if they needed assistance. She went inside Resident #3's room and saw the call light on top of the side table. She took the call light from the side table and placed it where the resident could reach it. She said she would tell the CNA assigned to the hall to make sure that residents' call lights were within reach. She called CNA H and talked to her regarding the call light. She said the call lights were for all the residents and all the staff were responsible in making sure they were within reach. In an interview on 11/18/2025 at 1:03 PM, CNA H stated that the call lights should always be with the residents. She said she must have forgotten to put the call light at the side of the resident when she went to check on Resident #3 during her morning round. Resident #4 Review of Resident #4's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with muscle wasting and atrophy. Review of Resident #4's Comprehensive MDS Assessment, dated 09/08/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment indicated that the resident required assistance for bed mobility and transfer. Review of Resident #4's Comprehensive Care Plan, dated 09/26/2025, reflected the resident was at risk for falls and one of the interventions was to be sure the resident's call light was within reach. Observation and interview on 11/17/2025 at 9:20 AM revealed Resident #4 was in her bed with eyes closed. It was observed that the resident's call light was in the trash can and the cord of the call light was between the frame of the bed and the mattress. The cord was not visible. Observation and interview on 11/17/2025 at 9:41 AM, RN B stated the call lights were used by the resident to call the staff if they needed something or if they needed assistance. She said without the call lights, the residents might fall if they tried to do things by themselves. She said the call lights were for all the residents, whether independent or dependent residents. She went inside Resident's #4's room and saw the call light was not within reach of the resident. She took the call light, cleaned it, and placed it where the resident could reach it. In an interview on 11/17/2025 Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 4 of 25 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 11/18/2025 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some at 9:46 AM, CNA I stated she did not notice Resident #4's call light was not with the resident. She said the call lights were there so the resident could use them to call the staff. She said it did not matter if the residents were using them or not, but the important thing was it was within reach of the residents. Resident #5 Review of Resident #5's Face Sheet, dated 11/17/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with muscle weakness and repeated falls. Review of Resident #5's Quarterly MDS Assessment, dated 08/26/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 04. The Quarterly MDS Assessment indicated that the resident required maximal assistance for toileting, bed mobility, and transfer. Review of Resident #5's Comprehensive Care Plan, dated 09/29/2025, reflected the resident was at risk for falls and one of the interventions was to be sure the resident's call light was within reach. Observation and interview on 11/17/2025 at 9:52 AM revealed Resident #5 was in her bed, awake. It was observed that the resident's call light was inside the resident's drawer. The resident said she could not reach it and she did not know who put it inside the drawer of her side table. In an interview on 11/17/2025 at 11:12 AM, CNA G stated she did not notice that Resident #5's call light was inside her drawer. She said call lights should be with the residents in case they needed the staff. She said she would go the resident's room and would check if the call light was within reach of the resident. Resident #13 Record review of Resident #13s Face Sheet, dated 11/18/2025, reflected the resident was a [AGE] year-old female who admitted on [DATE]. Resident #13 had diagnoses which included Alzheimer's disease (progressive cognitive decline, memory loss, and behavioral changes) and muscle wasting and atrophy. Record review of Resident #13's Quarterly MDS Assessment, dated 10/16/2025, reflected severe cognitive impairment with a BIMS score of 05. Section I (active diagnoses) reflected hemiplegia (paralysis on one side of the body) following a stroke. Section GG (functional abilities) indicated the resident required assistance with self-care and mobility needs. Record review of Resident #13's Comprehensive Care Plan, dated 09/29/2025, reflected the resident was at risk for falls and injuries related to impaired cognition, incontinence, and impaired mobility. One intervention was to ensure the call light was within reach and answer it promptly. During an observation and interview on 11/17/25 at 9:20 AM, Resident #13 was lying in bed awake. Her call light was on the floor between the head of the bed and the nightstand. When asked about her call light, Resident #13 did not reply. CNA J came in the room and stated she was going to change Resident #13. When asked about the call light, CNA J stated it should have been within reach. She stated it was important for Resident #13 to be able to reach the call light in case of an emergency or if the resident needed something. She placed the call light on the bed and secured it where Resident #13 could reach it. During an interview on 11/17/2025 at 9:56 AM, ADON K stated Resident #13's call light should have been placed within reach. She stated it was important to ensure Resident #13's call light was within reach in case she needed assistance. Resident #14 Record review of Resident #14's Face Sheet, dated 11/18/2025, reflected the resident was an [AGE] year-old female who admitted on [DATE]. Resident #14 had diagnoses which included Type 2 diabetes mellitus (the body does not use insulin properly which leads to elevated blood glucose levels), dementia (decline in cognitive abilities that affects a person's ability to perform everyday activities), and rheumatoid arthritis (autoimmune disorder that causes pain and swelling of the joints). Record review of Resident #14's Quarterly MDS Assessment, dated 08/27/2025, reflected a BIMS score of 99 which indicated the resident was unable to complete the assessment. Section C (cognitive patterns) reflected Resident #14 was severely impaired with decision making regarding tasks of daily life. Section GG (functional abilities) reflected Resident #14 required assistance with self-care and mobility needs. Record review of Resident #14's Comprehensive Care Plan, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 5 of 25 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 11/18/2025 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete dated 11/05/2025, reflected the resident was at risk for falls and injuries. One intervention was to ensure the call light was within reach and answer it promptly. During an observation and interview on 11/17/2025 at 10:47 AM, Resident #14 was lying in bed awake. The call light was on the floor at the head of the bed. An attempt to interview Resident #14 revealed she was unable to answer questions appropriately related to her cognitive status. CNA J was in the hall and came to Resident #14's room. She picked up the call light and clipped it to the resident's pillow to ensure she could reach it. CNA J stated it was important for Resident #14's call light to be within reach in case she needed to call for help. In an interview on 11/18/2025 at 8:40 AM, the DON stated call lights were safety measures wherein the residents could call the staff if they needed something or needed to do something that needed assistance. She said residents might try to go to the bathroom by themselves because she had no way to call the staff that might result to a fall and injuries. The DON said all the staff were responsible for the call lights, including her. The DON said the expectation was for the staff to scan the resident's room when they do their rounds and ensure the call lights were within reach of the residents before they leave the room. The DON said an in-service was already initiated but she would monitor the staffs' compliance about call lights. In an interview on 11/18/2025 at 10:31 AM, ADON A stated call lights should be with the residents at all times when the residents where inside the room because the call lights were the only way they could reach out to the staff if they were in distress or just needed water. She said the call light were for all residents, whether independent or dependent. She said an independent resident might be having a heart attack and could not call anybody because the call light was not with the resident. She said she was also responsible in checking if the call lights were with the residents. She said an in-service had been going around and that she would coordinate with the DON to randomly check if the call lights were with the residents. During an interview on 11/18/2025 at 12:27 PM, LVN L stated the residents' call lights should have been within reach. She stated it was important to ensure residents were able to reach staff if they needed assistance. She stated the facility had begun in-services. During an interview on 11/18/2025 at 12:40 PM, ADON K stated call lights should have been on the residents' beds. She stated all the call light cords had a clip to secure to the bed. She stated it was important to ensure the residents' call lights were in their reach in case they needed help. In an interview on 11/18/2025 at 1:20 PM, the Administrator stated the staff should make sure that the call lights were with the residents before they leave the room. She said for some residents, the call lights were their sense of protection that if something happened to them, they would be able to call the staff for help. She said without the call light the residents might feel helpless. She said everybody was responsible in making sure the call lights were with the residents, whether the resident was independent or not. She said she would collaborate with the DON about the issue regarding call lights. Record review of the facility's policy Call Lights, revised December 2023, reflected The facility will provide a call light system that is accessible, functional, and responsive to meet the needs of the residents.Call lights will be placed within reach of the resident's bed or sitting area in the resident's room. Event ID: Facility ID: 676040 If continuation sheet Page 6 of 25 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 11/18/2025 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure the residents' right to personal privacy and confidentiality of his or her personal and medical records for two (Resident #6 and Resident #7) of residents reviewed for privacy and confidentiality. 1. The facility failed to ensure MA D did not leave Resident #6's medical information at the side of the medication cart unattended on 11/17/2025. 2. The facility failed to ensure MA E did not leave Resident #7's medical information on top of the medication cart unattended on 11/17/2025.Findings included: 1. Record review of Resident #6's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with chronic obstructive pulmonary disease (a chronic inflammatory lung disease that causes obstructed airflow from the lungs). Record review of Resident #6's Comprehensive MDS Assessment, dated 09/30/2025, reflected the resident was cognitively intact with a BIMS score of 15. The Comprehensive MDS Assessment indicated the resident had chronic obstructive pulmonary disease. Record review of Resident #6's Comprehensive Care Plan, dated 09/27/2025, reflected the resident had asthma (lung disorder caused by narrowing of the airways) and one of the interventions was to give medications as ordered. Record review of Resident #6's Physician Order, dated 05/06/2025, reflected Montelukast Sodium Oral Tablet 10 MG (Montelukast Sodium) Give 1 tablet by mouth one time a day related to CHRONIC OBSTRUCTIVE PULMONARY DISEASE. Observation on 11/17/2025 at 8:57 AM revealed MA D was passing medications down the hall. It was observed that a blister pack was at the side of the medication cart where the plastic cups and small paper cups were stored. The blister pack was facing the hallway and Resident #6's medical information was visible to passers-by. On the blister pack was Resident #6's name, the name of the medication, the prescription number of the medication, the dose and the frequency of the medication, the physician's order, the diagnosis indicating why the medication was being administered, and the name of the pharmacy. Observation on 11/17/2025 at 9:01 AM revealed MA D went inside a resident's room to administer medications. She left the medication cart outside the resident's room with the blister pack still at the side of the medication cart and Resident #6's information still visible. Observation on 11/17/2025 at 9:12 AM revealed MA D took resident #6's blister pack and put them inside the drawer of the medication cart when asked about the blister packs. In an interview on 11/17/2025 at 12:40 PM, MA D stated she should have secured Resident #6's empty blister pack until she got a chance to re-order it or she should have just flipped it so the back of the blister pack would be the one showing. She said since the blister pack had the resident's medical information, then it could be considered as a HIPAA violation because that information was confidential. 2. Record review of Resident #7's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with hypothyroidism (a condition wherein the thyroid gland did not produce enough thyroid hormones). Record review of Resident #7's Comprehensive MDS Assessment, dated 10/16/2025, reflected the resident had severe impairment in cognition with a BIMS score of 00. The Comprehensive MDS Assessment indicated the resident had hypothyroidism. Record review of Resident #7's Comprehensive Care Plan, dated 10/07/2025, reflected the resident had hypothyroidism and one of the interventions was to observe for edema (swelling caused by fluid trapped in the tissues of the body). Record review of Resident #7's Physician Order, dated 10/08/2019, reflected Lasix Tablet 40 MG (Furosemide) Give 1 tablet by mouth one time a day for Edema. Observation on 11/17/2025 at 9:23 AM revealed a cart was parked on a hallway going to the memory care unit. On top of the cart was a blister pack and on the blister pack was Resident #7's name, the name of the medication, the prescription number of the medication, the dose, the frequency, the physician's order, the diagnosis Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 7 of 25 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 11/18/2025 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete indicating why the medication was being administered, and the name of the pharmacy. It was observed that nobody was attending the cart and the cart was facing the hallway. During an interview on 11/17/2025 at 9:25 AM, MA E stated she was not with her medication cart because she was administering a resident's medication. She said she should have put the blister pack inside the medications cart before leaving her cart because Resident #7's medical medication was on the blister pack. She said she would be mindful that no information about the resident would be left on top of the cart because it was a HIPAA violation. In an interview on 11/18/2025 at 8:40 AM, the DON stated personal and medical information about a resident should not be exposed for everybody to see because it was confidential. She said the health information of a resident should be protected and could not be shared without the permission of the resident or the resident's responsible party. She said all employees were expected to provide full confidentiality and secure any information for all residents. The DON stated she would start an in-service about privacy and confidentiality of the residents' information. In an interview on 11/18/2025 at 10:31 AM, ADON A stated the staff should make sure that no information about any resident was left on top of the cart before leaving the cart unattended. She said the resident's information was confidential and should not be seen by unauthorized individuals. She said that was a HIPAA violation. She said the expectation was for the staff not to leave any personal or medical information about a resident. She said she would coordinate with the DON to do an in-service about privacy and confidentiality. In an interview on 11/18/2025 at 1:20 PM, the Administrator stated the staff must make sure the residents' information was not exposed and protected because it was a violation of the resident's privacy and confidentiality of the care/treatment they were receiving. She said the expectation was for all the staff to make sure the personal and medical information of a resident was not visible to unauthorized individuals. She said she would collaborate with the DON to do an in-service about privacy and confidentiality. Record review of the facility's policy entitled, Resident Rights, Dignity and Privacy Handout undated, reflected Resident Privacy . confidentiality . 4. Right to Privacy and Confidentiality . Confidential handling of medical, personal, and financial information. Event ID: Facility ID: 676040 If continuation sheet Page 8 of 25 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 11/18/2025 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observations, interviews and record reviews, the facility failed to provide a safe, sanitary, and homelike environment including but not limited to treatment and support for daily living safely when one of one sit-to-stand transfer chair was reviewed for environment.The facility failed to ensure the sit-to-stand transfer chair was thoroughly cleaned and sanitized.This deficient practice could place residents at risk of living in an unclean and unsanitary environment which could lead to a decreased quality of life. Findings included:An observation and interview on 11/17/2025 at 10:18 AM revealed CNA J pushing a sit-to-stand transfer chair in the hallway near nurses' station 1. There was no resident in the chair. There was dirt and dried food particles on the footrest of the chair. The base appeared to be covered in dust that had accumulated causing it to appear several shades darker than the cream upper portion of the chair. CNA J stated she was not sure who was responsible for cleaning it. ADON A was sitting at nurses' station 1 and stated she would put in a maintenance order to have it cleaned. She stated it was important to ensure resident equipment was cleaned. During an interview on 11/17/2025 at 12:16 PM, the DON stated the DOS was responsible for ensuring the sit-to-stand was cleaned. The DON stated there was no set cleaning schedule, but she was going to create one to ensure it was routinely cleaned and sanitized. She stated the sit-to-stand transfer chair was used for different residents and should also be wiped down after each use. During an interview on 11/18/25 at 10:32 AM, ADON A stated she had taken the sit-and-stand and cleaned it herself after it was brought to her attention. She stated it looked like there was a wad of hair and food and dirt particles on the footrest. She stated it became gummy when she sprayed it with cleaner, so she knew it was not only food. She stated dust had accumulated all over the sit-to-stand. ADON A stated she spoke with the DON and there would be a cleaning log created to ensure it was routinely cleaned. During an interview on 11/18/25 at 11:41 AM, the DOS stated he had been in the role since August of this year and was over maintenance, laundry, and housekeeping. He stated the housekeeping staff would be responsible for cleaning the equipment used to transfer residents. He stated it was important to ensure equipment used by residents was routinely cleaned and sanitized. He stated he spoke with the DON, and they were creating a cleaning log to ensure it was routinely cleaned.During an interview on 11/18/2025 at 1:58 PM, the Administrator stated she was currently the interim administrator, and it would soon be a permanent position. She stated there was usually a schedule for nursing or maintenance staff to clean equipment used for residents routinely and in between as needed. She stated she spoke with the DON and DOS, and a schedule was being created to ensure wheelchairs, mechanical lifts, and sit-to-stand transfer chairs were routinely cleaned and sanitized. She stated it was important to prevent cross contamination and the spread of germs between residents. Record review of the facility's policy Infection Control: Cleaning and Disinfecting Resident Care Equipment, revised June 2024, reflected Equipment will be maintained and kept clean or disinfected in accordance with acceptable policies. Manufacturers' recommendations will be followed when cleaning or disinfecting medical equipment. Event ID: Facility ID: 676040 If continuation sheet Page 9 of 25 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 11/18/2025 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide appropriate treatment and services to prevent complications of enteral feeding (delivery of food through feeding tube) for one (Resident #8) of one resident reviewed for feeding tube. The facility failed to ensure LVN C checked Resident #8's gastric residual (volume of liquid and food remaining in the stomach) before administering medications via g-tube on 11/17/2025. This failure could place residents with g-tubes at risk for aspiration.Findings included: Record review of Resident #8's Face Sheet, dated 11/17/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with gastrostomy status (having done a surgical procedure that creates artificial opening into the stomach to provide nutritional support). Record review of Resident #8's Comprehensive MDS Assessment, dated 10/24/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Comprehensive MDS Assessment indicated the resident had a feeding tube. Record review of Resident #8's Quarterly Care Plan, dated 09/28/2025, reflected the resident was at risk for aspiration related to g-tube and one of the interventions was to check gastric residual. Record review of Resident #8's Physician Order, dated 03/23/2025, reflected *Enteral Feeding- Check Residual* -Every Shift and With S/S of intolerance. Document Residual in CCs. every shift A) If Residual is < 200 reinsert contents and continue feeding B) If residual is > 200 Discard Contents, Hold Feeding and Notify MD for further orders. Observation on 11/17/2025 at 2:15 PM revealed LVN C was about to give Resident #8's medication via g-tube. LVN C sanitized her hands and started to prepare and crush the medications. After crushing the medication, she went inside the room and placed the medications on the resident's overbed table. She then incorporated some water into the medications to dissolve them. She also had a plastic glass with water in it. She took a 60 ml piston syringe from the resident's side table and placed it also on the overbed table. She raised the bed, lifted the resident's gown to expose the g-tube site, and disconnected the g-tube from the formula. After disconnecting the g-tube, she pulled the plunger of the syringe, attached the syringe to the g-tube, and flushed the g-tube. After flushing the g-tube, she poured the dissolved medications in it, flushing in between each medication. She did not check the residual before flushing and administering the medication. After pouring the last medication, she flushed the g-tube, detached the syringe, connected the g-tube to the formula, and cleaned the table and the syringe. In an interview on 11/17/2025 at 2:47 PM, LVN C stated she forgot to check the Resident #8's gastric residual before administering her medications. She said the right procedure was to check the residual before administering the medications to check if the stomach was not too full and could accommodate the medications and fluid to be introduced. She said the gastric residual should be checked to prevent aspiration. She said she knew she needed to check the residual, but failed to do so because she was nervous. In an interview on 11/18/2025 at 8:40 AM, the DON stated the gastric residual should be checked before administering medications to prevent aspiration and also to assess if the resident's stomach was emptying properly. She said the expectation was for the staff to follow the right procedure for medication administration via g-tube. She said she would do an in-service about enteral feeding. In an interview on 11/18/2025 at 10:31 AM, ADON A stated the residual should be checked before giving medications to prevent aspiration and also to assess if the rate of the formula ,and the fluid used to flush the medication, should be modified. She said the expectation was for the staff to check for gastric residual every time they administered medications. She said she would coordinate with the DON to do an in-service about enteral feeding. In an interview on 11/18/2025 at 1:20 PM, the Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 10 of 25 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 11/18/2025 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stated the expectation was for the staff to follow the right procedure for administering medications via g-tube. She said she was not a clinician and would let the DON take the lead in educating the staff about the issue. Record review of the facility's policy entitled Enteral Feeding Policies and Procedures revised 09/2023 reflected Policy: The facility will provide adequate care for residents with enteral feeding tubes to prevent complications . Residual Check . Check residual every shift and with signs/symptoms of intolerance. Event ID: Facility ID: 676040 If continuation sheet Page 11 of 25 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 11/18/2025 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure that a resident who needed respiratory care, including tracheostomy care and tracheal suctioning, was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for two (Resident #9 and Resident #10) of ten residents reviewed for respiratory care. 1. The facility failed to ensure Resident #9 's nasal cannula (flexible tube used to deliver oxygen to the nose through two prongs) was stored properly when not in use on 11/17/2025. 2. The facility failed to ensure Resident #10's breathing mask was stored properly when not in use on 11/17/2025. These failures could place residents at risk for respiratory infection and not having their respiratory needs met.Findings included: 1. Record review of Resident #9's face sheet, dated 11/17/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. The resident was diagnosed with respiratory disorder. Record review of Resident #9's Quarterly MDS Assessment, dated 11/13/2025, reflected the resident was cognitively intact with a BIMS score of 13. The Quarterly MDS Assessment indicated the resident was on oxygen therapy. Record review of Resident #9's Comprehensive Care Plan, dated 11/10/2025, reflected the resident required supplemental oxygen and one of the interventions was provide oxygen therapy as ordered. Record review of Resident #9's Physician's Order, dated 10/22/2025, reflected Oxygen @ 2-4 LPM via nasal cannula continuously. Monitor O2 sat. every shift. Observation on 11/17/2025 at 9:02 AM revealed Resident #9 was in his bed with eyes closed. It was observed that an oxygen concentrator was at the bedside with a nasal cannula connected to it. The nasal cannula was inside the trash can and was not bagged. Observation and interview on 11/17/2025 at 1:22 PM revealed Resident #9 only shrugged his shoulders when asked who removed his nasal cannula earlier that day. 2. Record review of Resident #10's face sheet, dated 11/17/2025, reflected an [AGE] year-old male who was admitted to the facility on [DATE]. The resident was diagnosed with pneumonia (inflammation and fluid in the lungs caused by a bacterial, viral, or fungal infection). Record review of Resident #10's Quarterly MDS Assessment, dated 09/16/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment indicated the resident had respiratory disorders. Record review of Resident #10's Comprehensive Care Plan, dated 09/29/2025, reflected the resident had respiratory illness and one of the interventions was to follow orders to treat respiratory illnesses. Record review of Resident #10's Physician's Order, dated 10/17/2025, reflected Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML 1 vial inhale orally four times a day related to PNEUMONIA, UNSPECIFIED ORGANISM for 5 Days AND 1 vial inhale orally every 6 hours as needed for Wheezing related to PNEUMONIA, UNSPECIFIED ORGANISM. Observation and interview on 08/12/2025 at 9:03 AM revealed Resident #10 was in his bed, awake. It was observed the nebulization machine was on top of the resident's side table with a breathing mask connected to it. The breathing mask was not bagged. The resident said he would only use it when he needed it. He said he did not know when was the last time he used it. In an observation and interview with LVN C on 11/17/2025 at 9:10 AM, LVN C stated the nasal cannula should not be in the trash can and the breathing mask should be inside the bag to prevent cross contamination and respiratory infection. She went inside Resident #9's room and saw the nasal cannula that was inside the trash can. She disconnected the nasal cannula and threw it on the trash can. She said she would get a new one for the Resident #9. She then went to Resident #10's room and saw the breathing mask was not bagged. She disconnected and threw it on the trash can. She said she would just get a new one when Resident #10 needed a breathing treatment, because his breathing treatment was as needed. She said she did not notice during her morning round that the nasal cannula and the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 12 of 25 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 11/18/2025 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete breathing mask were not bagged. She said she was responsible for bagging them when the residents were not using them. In an interview on 11/18/2025 at 8:40 AM, the DON stated the staff were responsible in making sure the nasal cannula and the breathing masks were bagged when not in use to prevent cross contamination and respiratory infection. She said it was her responsibility to check if the staff were compliant. She said she would do an in-service about bagging the nasal cannula and the breathing mask when not in use and would randomly monitor the staff if they were bagging them when not in use. In an interview on 11/18/2025 at 10:31 AM, ADON A stated the nasal cannula and the breathing mask should be stored properly to prevent cross contamination and respiratory infections. She said whoever administered the breathing treatment was responsible for cleaning it and storing it in a plastic bag. She said the nasal cannula should not be on the trash can. She said the expectation was for the staff to bag the nasal cannula and the breathing mask to when not in use. She said she would coordinate with the DON to do an in-service about the issue with respiratory care. In an interview on 11/18/2025 at 1:20 PM, the Administrator stated the expectation was for the staff to bag the nasal cannula and the breathing mask when not in use to prevent respiratory issues. She said the nasal cannula should not be in the trash can for the same reason. She said she would coordinate with the DON to make sure the nasal cannula and the breathing masks were clean. Record review of the facility's policy entitled RESPIRATORY TREATMENT, CARE AND SERVICES Nursing Policies and Procedures revised June 2019 reflected Policy: The Facility ensures the safe, appropriate and effective provision of respiratory treatment . 6. Infection control practices including standard and transmission-based precautions are followed during . B. Handling of equipment, including cleaning, storage. Event ID: Facility ID: 676040 If continuation sheet Page 13 of 25 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 11/18/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure the medications for two (Residents #6 and #11) of twelve residents were stored properly in locked compartments or provided a safe and secured storage with limited access. 1. The facility failed to ensure there were no nystatin powder (antifungal medication) and barrier ointment inside Resident #6's room on 11/17/2025. 2. The facility failed to ensure a tube of zinc oxide (cream used to treat skin irritations, diaper rash, and other skin conditions) was not left inside Resident #11's room on 11/17/2025. These failures could place the residents at risk of accidental overdose or misuse of medications. Findings included: 1. Record review of Resident #6's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with obesity (excessive accumulation of body fats) and muscle weakness. Record review of Resident #6's Comprehensive MDS Assessment, dated 09/30/2025, reflected the resident was cognitively intact with a BIMS score of 15. The Comprehensive MDS Assessment indicated the resident was incontinent (uncontrolled) for bladder and bowel. Record review of Resident #6's Comprehensive Care Plan, dated 09/27/2025, reflected the resident had urinary and bowel incontinence and one of the interventions was to apply barrier cream after each episode of incontinence. In an observation and interview on 11/17/2025 at 8:46 AM revealed Resident #6 was in his bed, awake. It was observed that that there were three plastic bottles of nystatin powder in a basket at the resident's sink located inside the room. The resident said he used to use it when he would have rashes because of the brief. He said the medications had always been there with his shampoo and IV (intravenous: administering fluids or medications directly into a vein) paraphernalia so for sure the staff saw the medications in his basket. 2. Record review of Resident #11's Face Sheet, dated 11/17/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with muscle weakness. Record review of Resident #11's Quarterly MDS Assessment, dated 09/08/2025, reflected the resident's cognition was intact with a BIMS score of 15. The Quarterly MDS Assessment indicated the resident was always incontinent for bladder and bowel. Record review of Resident #11's Comprehensive Care Plan, dated 09/26/2025, reflected the resident had urinary and bowel incontinence and of the interventions was to apply barrier cream after each episode of incontinence. Observation on 11/17/2025 at 9:01 AM revealed Resident #11 was not inside her room. A tube of barrier ointment was observed on top of the resident's table located at the foot portion of her bed. The container of barrier ointment was visible from the hallway. In an observation and interview on 11/17/2025 at 9:10, LVN C stated there should not be any medications inside the residents' rooms because the residents might misuse them or mistakenly use them as a toothpaste. She went inside Resident #6's room and saw the tube of barrier cream. She said the aides would use it after incontinent care. She said the barrier ointment had zinc oxide in it and was also used to prevent skin issues; making it a form of medication. She took the barrier ointment and said it should be inside the cart. She then went inside Resident #11's room and saw the three bottles of nystatin powder and the tube of barrier cream. She said she was not aware there were medications inside Resident #11's room. She took the medication and said she would ask Resident #11 about it to know if she needed to get an order for the nystatin. In an interview on 11/18/2025 at 8:40 AM, the DON stated the barrier ointment, and the nystatin powder should not be inside the room. She said the barrier ointment could be placed in the drawer where the staff would put the briefs and the wipes used for incontinent care. She said it could also be placed in the carts, as long as the barrier ointment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 14 of 25 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 11/18/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete was not accessible to the residents. She said confused residents might ingest it and suffer adverse reactions especially if somebody who accidentally ingested the medications was allergic to the medications. She said the nystatin powder should not be inside the room, and she was not sure why nobody noticed it. She said the resident might misuse it or other residents might get a hold of it and put them in their mouth or eyes. She said the expectation was the medicated ointment and the nystatin powder be placed inside the carts to secure it, and that the staff would check the residents' room for medications. She said she would do an in-service making sure no medications were accessible to the residents. In an interview on 11/18/2025 at 10:31 AM, ADON A stated zinc oxide and the nystatin powder should not be left or stored inside the residents' rooms because the residents might administer or use them incorrectly that could result in adverse reactions. She said the medicated ointments should be stored in the cart because it had chemicals that could be toxic when consumed. She said she was not sure why nobody saw the nystatin powder inside the basket with the resident's shampoo in it. She said the expectation was for the staff to be observant to see if there were medications inside the residents' room and to be mindful not to leave the medicated ointment inside the residents' rooms. She said she would coordinate with the DON to do an in-service about medication storage. In an interview on 11/18/2025 at 1:20 PM, the Administrator stated the expectation was no medications inside the residents room to prevent accidental consumption that could result to adverse reactions like allergy, stomach upset, and irritations. She said she would coordinate with the DON to educate the staff about the matter. Record review of the facility's policy entitled Medication Administration and Management Nursing Policies and Procedures revised 06/2019 reflected 5. Only authorized medical and licensed nursing staff will administer medications ordered by the physician. Event ID: Facility ID: 676040 If continuation sheet Page 15 of 25 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 11/18/2025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based observation, interview, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for four (Resident #5, Resident #8, Resident #12, and Resident #13) of fifteen residents reviewed for infection control. 1. The facility failed to ensure CNA F and CNA G performed hand hygiene and changed their gloves during Resident #5's incontinent care on 11/17/2025.2. The facility failed to ensure LVN C wore a gown while administering Resident #8's medication via g-tube, who had an order for enhanced barrier protection, on 11/17/2025. 3. The facility failed to ensure CNA I performed hand hygiene during Resident #12's incontinent care on 11/17/2025.4. The facility failed to ensure CNA J changed gloves and washed her hands while providing incontinent care for Resident #13 on 11/17/2025.These failures could place residents at risk of cross-contamination and development of infections.Findings include: Residents Affected - Some 1. Review of Resident #5's Face Sheet, dated 11/17/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with overactive bladder (a bladder control problem which leads to a sudden urge to urinate). Review of Resident #5's Quarterly MDS Assessment, dated 08/26/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 04. The Quarterly MDS Assessment indicated that the resident had urinary and bowel incontinence. Review of Resident #5's Comprehensive Care Plan, dated 09/29/2025, reflected the resident had bowel and bladder incontinence and one of the interventions was to change promptly. Observation on 11/17/2025 at 9:45 AM revealed CNA F and CNA G were about to do Resident #5's incontinent care. Both CNAs put on a pair of gloves, but did not wash their hands before putting on the pairs of gloves. CNA G was observed taking the gloves that she wore from her pocket. CNA F took a brief and placed it on the resident's side. CNA G unfastened the brief and pushed it in the middle of the resident's legs. She then cleaned the resident's perineal area using the front to back technique. After cleaning the perineal area, she assisted the resident to turn towards the wall and cleaned the resident's bottom. After cleaning the resident's bottom, she took the brief from the side of the resident and placed it under the resident. CNA G then rolled back the resident and fixed the brief. She did not change her gloves throughout the process of incontinent care. In an interview on 11/17/2025 at 10:01 AM, CNA F stated their hands should be washed before incontinent care to make sure their hands were clean before touching the gloves that would be used for incontinent care. She said washing hands before any care was done to prevent infection. In an interview on 11/17/2025 at 10:04 AM, CNA G stated she washed her hands after taking care of a resident before going to Resident #5's room. She said she should have washed her hands again before performing the resident incontinent care, because she touched a lot of thing on her way to Resident #5's room. She said she did have some gloves in the pocket of her scrub pants, and she should not be doing that because her pockets might be dirty rendering the gloves used for incontinent care dirty. She said she should have changed her gloves after cleaning the resident's bottom and before touching the new briefs to prevent using dirty gloves. She said using soiled gloves could cause transfer of germs to the new brief. She said her hands should also be sanitized if she changed her gloves. She said she would be mindful the next time she did incontinent care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 16 of 25 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 11/18/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Record review of Resident #8's Face Sheet, dated 11/17/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with gastrostomy status. Record review of Resident #8's Comprehensive MDS Assessment, dated 10/24/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Comprehensive MDS Assessment indicated the resident had a feeding tube. Record review of Resident #8's Quarterly Care Plan, dated 09/28/2025, reflected the resident required enhanced barrier protection and one of the interventions was to monitor the resident for signs and symptoms of infection. Record review of Resident #8's Physician Order, dated 04/01/2024, reflected Enhanced Barrier Precautions - PPE: Gloves/Gown during high-contact resident care activities. every shift. Observation on 11/17/2025 at 2:15 PM revealed LVN C was about to administer Resident #8's medication via g-tube. She prepared her medications and went inside the resident's room. She washed her hands and then closed the door. She did not wear a gown before giving the resident's medication via g-tube. It was observed that there was sign outside the door that EBP was required because the resident had a g-tube. In an interview on 11/17/2025 at 2:47 PM, LVN C stated Resident #8 had a g-tube and EBP was required. She said she did not know why she forgot to wear a gown when she administered the resident's medication. She said the gown was needed basically to prevent transmission of microorganisms from one resident to another. She said she would wear a gown the next time she cared for residents with g-tube. 3. Record review of Resident #12's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. The resident was diagnosed with hypertensive encephalopathy (a brain dysfunction due to a rapid increase in blood pressure). Record review of Resident #12's Comprehensive MDS Assessment, dated 10/15/2025, reflected the resident had severe impairment in cognition with a BIMS score of 00. The Comprehensive MDS Assessment indicated the resident was incontinent for bladder and bowel. Record review of Resident #12's Comprehensive Care Plan, dated 10/08/2025, reflected that the resident was incontinent for bladder and bowel, and one of the interventions was to perform routine rounding to include incontinence care and brief changes. An observation on 11/17/2025 at 11:11 AM revealed CNA I was about to do Resident #12's incontinent care. She washed her hands and put on a pair of gloves. She pulled the gloves that she wore from her pocket. She unfastened the brief and pushed it between the resident's legs. She cleaned the perineal area using a front to back technique. She rolled the resident to her side and cleaned the resident's bottom. Before cleaning the resident's bottom, she took off her gloves, pulled a pair form her pocket, and put on the gloves. She did not sanitize her hands. After cleaning the bottom, she took off her gloves, pulled a pair from her pocket, and put I on. She did not sanitize her hands before putting on the new pair of gloves. She took the brief and placed it under the resident. She rolled back the resident and fixed the brief. In an interview on 11/17/2025 at 11:29 AM, CNA I stated she should have sanitized her hands when she changed her gloves to make sure her hands were clean before touching the new pair of gloves. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 17 of 25 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 11/18/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm said she needed to sanitize her hands in between changing of gloves to prevent cross contamination, and eventually infection. She said she did put some gloves in her pockets to have easy access to them. She said she was not sure if her pocket was clean. She said because she would put her keys and cell phone in her pocket, she would not put gloves inside her pocket again, and would just get them from the box to make sure she was using clean gloves. Residents Affected - Some In an interview on 11/18/2025 at 8:40 AM, the DON stated hand hygiene was the most effective way to prevent cross contamination and spread of infection. She said staff should do hand hygiene before and after any care. She said gloves should be changed after cleaning the resident's bottom and before touching the new brief. She said the hands should be sanitized in between changing of gloves. She said staff should not be put gloves inside staff pockets because they put their cell phones and keys in their pockets rendering the pockets not clean. She said the staff would also put their hands in their pocket and nobody would know what they touched before putting their hands in the pockets. She said if a resident had a g-tube, the staff should wear a gown every time the staff had contact with the resident. She said the procedures mentioned should be in place to prevent cross contamination and to prevent the spread of infection. She said every resident that needed EBP had a sign outside to remind the staff that they needed to wear gowns and gloves every time they had contact with the resident. She said she already initiated an in-service about infection control and would closely monitor staffs' adherence to the policy of infection control. In an interview on 11/18/2025 at 10:31 AM, ADON A stated the staff should be mindful that they were not causing any spread of infection in the facility and one way to do that was to do hand hygiene before, during, and after any care. She said the staff should also change their gloves after touching a soiled brief or after cleaning the resident's bottom. She said the staff should sanitize their hands when they were changing their gloves. She said the staff should not put their gloves inside their pockets because they put their car keys, money, snacks, and dirty hands in their pockets. She said another way to prevent the spread of infection was to practice EBP when needed. She said residents with a g-tube required gown to protect the resident and also the staff if the resident had any microorganism that could cling to them. She said she would coordinate with the DON to do an in-service again about infection control. She said the staff would be re-trained and would spot check them. In an interview on 11/18/2025 at 1:20 PM, the Administrator stated the staff should be mindful of what they were doing to ensure that there was no cross contamination or spread of infection. She said after touching something soiled, the staff should change their gloves and sanitize the hands in between changing of gloves. She said she was not a clinician, but she knew that if there was a sign for EBP, then the staff should wear a gown in addition to the gloves. She said the gloves should not be in the pockets. She said the concerns discussed would all contribute to the development and spread of infection. She said she would coordinate with the DON about the issue. 4. Record review of Resident #13's Face Sheet, dated 11/18/2025, reflected the resident was a [AGE] year-old female who admitted on [DATE]. Resident #13 had diagnoses which included Alzheimer's disease (progressive cognitive decline, memory loss, and behavioral changes) and muscle wasting and atrophy. Record review of Resident #13's Quarterly MDS Assessment, dated 10/16/2025, reflected severe cognitive impairment with a BIMS score of 05. Section GG (functional abilities) reflected Resident #13 required assistance with self-care needs. Section H (bowel and bladder) indicated she was frequently incontinent of bowel and bladder. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 18 of 25 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 11/18/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #13's Comprehensive Care Plan, dated 09/29/2025, reflected the resident had bowel and bladder incontinence and was at risk for skin breakdown and infection. One intervention was to provide incontinent care after each incontinent episode and as needed. During an observation and interview on 11/17/2025 at 9:31 AM, CNA J provided incontinence care for Resident #13. CNA J had supplies on the bedside table. She pulled the curtain around the bed to provide privacy. CNA J put on clean gloves and helped the resident roll to her right side. CNA J removed the brief revealing loose stool on the resident's bottom and brief. CNA J dropped the soiled brief into the waste basket. She removed the package of wipes from the bedside table and placed it on the bed near her. CNA J cleaned the resident's bottom and dropped the wipes into the waste basket. CNA J did not remove the gloves. She removed the linens and dropped them into a plastic bag. She secured the fitted sheet on each end on her side of the bed. CNA J moved to the other side of the bed and assisted the resident to roll to her left side. CNA J secured the fitted sheet on each end and placed a clean brief under Resident #13 and the resident rolled to her back. CNA J used her gloved hands to push the end of the bed against the wall and moved to the other side of the bed. CNA J pulled more wipes from the package and cleaned the front of the resident, pulled up the front of the brief, and secured the tabs. She pulled the resident's gown down to cover her, placed the pillow under the resident's head, and covered her with a clean sheet. CNA J did not remove her gloves before carrying the bag of soiled linen and the package of wipes to the shower room in the hall. CNA J came out of the shower room and used hand sanitizer from a pump on the wall to clean her hands. When asked about the package of wipes, she stated she put them in the shower room so could find them quickly when she needed them. CNA J stated she should have changed her gloves and washed her hands or used hand sanitizer while providing incontinent care. She stated she should have removed her gloves and used hand sanitizer or washed her hands before leaving the resident's room. CNA J stated she should not have used the same package of wipes in different residents' rooms. She stated hand hygiene was important for infection control and to prevent spreading germs. During an interview on 11/17/2025 at 9:56 AM, ADON K stated CNA J should have used hand hygiene and changed gloves for infection control and to prevent spreading infection to other residents. She stated CNA J should not take the same package of wipes into different residents' rooms. During an interview on 11/18/25 at 12:16 PM, the DON stated she spoke with CNA J about changing gloves and using hand hygiene when providing incontinent care. The DON stated she reminded CNA J packages of wipes could not be carried in and out of a resident's room. She stated CNA J should have washed her hands or used hand sanitizer before putting on gloves and after removing gloves. The DON stated it was important to use proper hand hygiene with incontinence care. She stated the risk to residents was the spread of germs and infection. She stated the facility had started in-servicing staff members. During an interview on 11/18/25 at 12:27 PM, LVN L stated CNA J should have changed her gloves and used hand sanitizer or washed her hands when providing incontinence care. She stated CNA J should not have taken the package of wipes in and out of Resident #13's room. She stated it was important to prevent cross contamination and the spread of infection. She stated the facility was already in-servicing staff. Review of the facility's policy Hand Hygiene, revised December 2024, reflected It is the policy of The Facility to prioritize hand hygiene as a fundamental practice in preventing the spread of infections. All staff must perform hand hygiene.When to Utilize Hand Hygiene . Before/after resident contact . After removing gloves or PPE . After contact with bodily fluids, surface, or contaminated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 19 of 25 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 11/18/2025 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 0880 equipment Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy entitled Enhanced Barrier Precautions Policies and Procedures revised March 2024 reflected Policy: Enhanced Barrier Precautions is an infection control intervention designed to reduce the transmission of multidrug-resistant organisms and employs targeted gown and glove use during high-contact resident care activities for targeted residents . EBP are indicated for residents with any of the following . indwelling medical devices . feeding tubes. Residents Affected - Some Policy and procedure for infection control was requested via email to the DON and Administrator on 11/18/2025 at 10:30 AM but was not provided prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 20 of 25 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 11/18/2025 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. 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 ensure that the call light system was adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area from toilet and bathing facilities for fourteen (Resident #4, #12, #15 #16, #17, #18, #19, #20, #21, #22, #23, #24, #25, and #26) of twenty-six residents reviewed for resident call system. 1. The facility failed to ensure the call light system in Resident #4's restroom was functioning on 11/17/2025. 2. The facility failed to ensure the call light system in Resident #15 and Resident #16's restroom was functioning on 11/17/2025. 3. The facility failed to ensure the call light system in Resident #17 and Resident #18's restroom was functioning on 11/17/2025. 4. The facility failed to ensure the call light system in Resident #19 and Resident #20's restroom was functioning on 11/17/2025. 5. The facility failed to ensure the call light system in Resident #12 and Resident #21's restroom was functioning on 11/17/2025. 6. The facility failed to ensure the call light system in Resident #22 and Resident #23's restroom was functioning on 11/17/2025. 7. The facility failed to ensure the call light system in Resident #24 and Resident #25's restroom was functioning on 11/17/2025. 8. The facility failed to ensure the call light system in Resident #26's restroom was functioning on 11/17/2025. This failure could place the residents at the memory care unit at risk of not having a means of directly contacting the staff to obtain assistance for activities of daily living or help in the event of an emergency.Findings included: 1. Resident #4 Review of Resident #4's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with unsteadiness of feet and difficulty in walking. Review of Resident #4's Comprehensive MDS Assessment, dated 09/08/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment indicated that the resident used a walker, required assistance for bed mobility, transfer, hygiene, shower, and dressing. Review of Resident #4's Comprehensive Care Plan, dated 09/26/2025, reflected the resident was at risk for falls and incontinent for bladder and bowel. The interventions were to be sure the resident's call light was within reach and assist the resident to use the toilet regularly. 2. Resident # 15 Review of Resident #15's Face Sheet, dated 11/17/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with cerebrovascular disease (blood supply to the brain was interrupted). Review of Resident #15's Comprehensive MDS Assessment, dated 10/08/2025, reflected the resident had a moderate impairment (resident may need additional support and monitoring) in cognition with a BIMS score of 09. The Quarterly MDS Assessment indicated that the resident used a cane, was independent for eating, bed mobility, transfers, and walking 10 feet. Review of Resident #15's Comprehensive Care Plan, dated 10/24/2025, reflected the resident was at risk for falls, had ADL self-care deficits, and was incontinent for bladder and bladder. The interventions were to be sure the resident's call light was within reach, assist the resident to use the toilet, and provide limited assistance for toileting. Resident #16 Review of Resident #16's Face Sheet, dated 11/17/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with fracture to right patella (knee bone) and frequency of micturition (refers to the need to urinate many times during the day or night). Review of Resident #16's Comprehensive MDS Assessment, dated 10/13/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 03. The Quarterly MDS Assessment indicated that the resident used a walker, needed supervision for toileting and dressing. The resident was independent for bed mobility, and walking for 10 feet. Review of Resident #16's Comprehensive Care Plan, dated 10/20/2025, reflected the Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 21 of 25 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 11/18/2025 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident was at risk for falls, was incontinent, and had ADL self-care deficits. The interventions were to be sure the resident's call light was within reach, encourage independent function, and assist the resident to the toilet. 3. Resident #17 Review of Resident #17's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with hypertensive retinopathy (eye condition caused by high blood pressure) and visual loss. Review of Resident #17's Comprehensive MDS Assessment, dated 09/08/2025, reflected the resident had a moderate impairment in cognition with a BIMS score of 09. The Quarterly MDS Assessment indicated that the resident was not using any adaptive device and was independent for bed mobility, toilet transfer, and could walk for 150 feet. Review of Resident #17's Comprehensive Care Plan, dated 09/26/2025, reflected the resident was at risk for falls and had an ADL self-care deficit. The interventions were to be sure the resident's call light was within reach and to provide assistance for toileting. Resident #18 Review of Resident #18's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with syncope (fainting) and collapse. Review of Resident #18's Comprehensive MDS Assessment, dated 09/01/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 05. The Quarterly MDS Assessment indicated that the resident was using a walker, required supervision for bed mobility, hygiene, dressing, transfer, and was able to walk for 10 feet. Review of Resident #18's Comprehensive Care Plan, dated 09/29/2025, reflected the resident was at risk for falls, had an ADL self-care deficit, and had urinary and bowel incontinence. The interventions were to be sure the resident's call light was within reach, assist to use the toilet regularly, and encourage independent function. 4. Resident #19 Review of Resident #19's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with dizziness and abnormalities of gait and mobility. Review of Resident #19's Comprehensive MDS Assessment, dated 09/19/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 06. The Quarterly MDS Assessment indicated that the resident was using a walker, required supervision for toileting hygiene, dressing, bed mobility and toilet transfer. Review of Resident #19's Comprehensive Care Plan, dated 09/29/2025, reflected the resident was at risk for falls and had a self-care deficit. The interventions were to be sure the resident's call light was within reach and provide supervision for toileting. Resident #20 Review of Resident #20's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with muscle wasting and visual loss. Review of Resident #20's Comprehensive MDS Assessment, dated 10/13/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 06. The Quarterly MDS Assessment indicated that the resident used a walker, required supervision for dressing, and transfer. The resident had the ability to walk at least 150 feet. Review of Resident #20's Comprehensive Care Plan, dated 10/23/2025, reflected the resident was at risk for falls, had ADL self-care deficits, and urinary incontinence. The interventions were to be sure the resident's call light was within reach and to assist the resident to use the toilet. 5. Resident #12 Record review of Resident #12's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. The resident was diagnosed with muscle wasting and lack of coordination. Record review of Resident #12's Comprehensive MDS Assessment, dated 10/15/2025, reflected the resident had severe impairment in cognition with a BIMS score of 00. The Comprehensive MDS Assessment indicated the resident was independent for bed mobility and needed assistance for transfer. Record review of Resident #12's Comprehensive Care Plan, dated 10/08/2025, reflected that the resident was at risk for falls, incontinent for bladder and bowel, and had self-care deficits. The interventions were ensure call lights were within reach, assist the resident to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 22 of 25 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 11/18/2025 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some toilet frequently. Resident #21 Review of Resident #21's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with parkinsonism (brain condition that caused slow movements, rigidity, and tremors). Review of Resident #21's Comprehensive MDS Assessment, dated 11/02/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment indicated that the resident was independent for hygiene, dressing, but required assistance for bed mobility and transfer. Review of Resident #21's Comprehensive Care Plan, dated 09/26/2025, reflected the resident was at risk for falls and self-care deficits and one of the interventions was to be sure the resident's call light was within reach. 6. Resident #22 Review of Resident #22's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with muscle wasting and atrophy. Review of Resident #22's Comprehensive MDS Assessment, dated 09/21/2025, reflected the resident had a moderate impairment in cognition with a BIMS score of 09. The Quarterly MDS Assessment indicated that the resident was independent for toileting, dressing, shower, bed mobility and transfer. Review of Resident #22's Comprehensive Care Plan, dated 09/29/2025, reflected the resident was at risk for falls and self-care deficits. The interventions were to be sure the resident's call light was within reach and to remind the resident to use the toilet regularly. Resident #23 Review of Resident #23's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with muscle weakness and muscle wasting. Review of Resident #23's Comprehensive MDS Assessment, dated 08/30/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 05. The Quarterly MDS Assessment indicated that the resident required assistance for toilet hygiene, bed mobility and transfer. Review of Resident #23's Comprehensive Care Plan, dated 09/26/2025, reflected the resident was at risk for falls, incontinent for bladder and bowel, and had a self-care deficit. The interventions were to be sure the resident's call light was within reach and remind the resident to use the toilet regularly. 7. Resident #24 Review of Resident #24's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with pain to thoracic spine (central part of the spine). Review of Resident #24's Comprehensive MDS Assessment, dated 10/13/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 05. The Quarterly MDS Assessment indicated that the resident required assistance for toilet hygiene, dressing, bed mobility and transfer. Review of Resident #24's Comprehensive Care Plan, dated 10/19/2025, reflected the resident was at risk for falls, had urinary and bowel incontinence, ADL self-care deficits. The interventions were to be sure the resident's call light was within reach and remind the resident to use the toilet regularly. Resident #25 Review of Resident #25's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with pain and lack of coordination. Review of Resident #25's Comprehensive MDS Assessment, dated 08/22/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 06. The Quarterly MDS Assessment indicated that the resident required assistance for toileting, dressing, bed mobility and transfer. Review of Resident #25's Comprehensive Care Plan, dated 08/28/2025, reflected the resident was at risk for falls, had urinary and bowel incontinence, and ADL self-care deficits. The interventions were to be sure the resident's call light was within reach and remind the resident to use the toilet regularly. 8. Review of Resident #26's Face Sheet, dated 11/17/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with syncope and repeated falls. Review of Resident #26's Comprehensive MDS Assessment, dated 09/02/2025, reflected the resident had a moderate impairment in cognition with a BIMS score of 10. The Quarterly MDS Assessment indicated that the resident required (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 23 of 25 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 11/18/2025 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some assistance for toileting, hygiene, bed mobility and transfer. Review of Resident #26's Comprehensive Care Plan, dated 09/12/2025, reflected the resident was at risk for falls, had urinary and bowel incontinence, and ADL self-care deficits. The interventions were to be sure the resident's call light was within reach and remind the resident to use the toilet regularly. During an observation in the Memory Care Unit on 11/17/2025 starting at 9:30 AM the call light systems inside Resident #4, #12, #15 #16, #17, #18, #19, #20, #21, #22, #23, #24, #25, and #26's restrooms were not functioning. It was observed that when the call light switches inside the restrooms were activated, there were no lights outside the residents' rooms to signal that somebody triggered the call lights. During interview and observation on 11/17/2025 starting at 9:41 AM, RN B stated the resident's restrooms were supposed to have call lights so the residents could call the staff in case they were done with whatever they were doing inside the restroom. She said she knew the restrooms had call lights but was not sure if the call lights were working. She went inside Residents #21, #19, and #20's restroom and activated the call light. She then went outside the room to check if the call light was working and said the call light was not working because the light outside the resident's room was not flashing. She then went to Residents #22, #23, #24, and #25's restroom and checked the call light and said the call light was also not working. She then went to Residents #15, #16, #17, and #18's restroom and said the call light was also not working. She then went to Residents #4 and #26's restroom and said the call lights were also not working. She said she did not know that the call lights in the memory unit were not working. She said she was responsible in checking if the call lights were working or not. She said the issue was not whether the residents were using it or not, but that the resident did not have a way to call the staff if assistance was needed. She said some of the resident were ambulatory and would go to the restroom by themselves so it would be important that the call lights were working. She said the staff should not assume that the residents in the memory care unit would not know how to use the call lights. She said she would let maintenance know that the call lights in the memory care unit were not functioning. In an interview on 11/17/2025 at 9:45 AM, CNA I stated she was not aware the call lights in the restrooms were not working. She said it would be important that the call lights were working so the residents would be able to call the staff if they were done with bowel movement or if they needed to be changed. She said the staff could also use the call light to call another staff if they needed assistance in case a resident had a fall in the restroom. In an interview on 11/18/2025 at 8:40 AM, the DON stated she was not aware that the call lights inside the restrooms in the memory care unit were not working. She said she did not get a report about the call lights. She said the staff were responsible in checking if the call lights were working or not. She said the head of maintenance should be making their rounds to check the call lights. She said it was important that the call lights were working in case the residents needed help when they were inside the restroom. In an interview on 11/18/2025 at 10:31 AM, ADON A stated call lights should be checked to see if they were working or not. There should be routine checking of the call lights in all the residents' rooms. She said the call lights should all be functioning so that the residents would have something to use to call the staff if they needed help. In an interview on 11/17/2025 at 11:40 AM, the Director of Supplies stated he was also the maintenance manager and that he was just informed that all the call lights in the memory care unit were not functioning. He said he was new in the facility but was still responsible in checking all the call lights in the facility. He said he was not aware that the call lights in the memory care unit were not working because the call lights outside the memory care unit were working. He said he should have checked the call lights personally and not assume that they were working. He said he would include the call lights on his daily walk through to make (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676040 If continuation sheet Page 24 of 25 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 11/18/2025 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete sure they were working. In an interview on 11/18/2025 at 1:20 PM, the Administrator stated somebody should have noticed that the call lights inside the memory care unit were not operating. She said it was important that the call lights were working, not just inside the memory care unit, but in all residents' rooms so that they would have a way to call the staff when needed. Record review of the facility's policy Call Lights Policies and Procedures revised December 2023, reflected The facility will provide a call light system that is accessible, functional, and responsive to meet the needs of the residents . Functionality . Call lights will be in working order . Call lights will be monitored routinely to assess functionality Event ID: Facility ID: 676040 If continuation sheet Page 25 of 25