Health inspection·November 21, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete walked out of the room Resident #1 was heard saying What?. CNA A continued to exit the room. During an interview on 11/11/2025 at 1:59 PM, CNA A said Resident #1 had visual impairment and was hard of hearing. CNA A said there was no problem with her making the comment that Resident #1 only wanted the TV on because the surveyors were in his room because he could not hear her. CNA A said there were no dignity issues associated with the way she treated Resident #1 or with her walking away from him without explaining why she was leaving the room when he questioned her. CNA A said she did not talk bad about any of the residents, and she had never said Resident #1 was crazy.,During an interview on 11/12/2025 at 12:38 PM, the DON said she expected the staff to explain to the residents what they were doing. The DON said she had not received any complaints about CNA A. The DON said she did not want any of the staff to speak negatively about the residents. The DON said CNA A walking away from Resident #1 could make him feel confused about the situation. During an interview on 11/12/2025 at 1:05 PM, the Administrator said he expected the staff to explain to the residents what they were doing and prior to leaving the room ensure the residents' needs were met. The Administrator said everyone was responsible for treating the residents with dignity and respect. The Administrator said speaking about the residents in front of them, even if they were not able to hear, and walking away from them without explaining could make them feel bad. Record review of the facility's undated policy titled, Resident Rights, indicated, A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident. Respect and dignity - The resident has a right to be treated with respect and dignity, including. The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences. Event ID: Facility ID: 676045 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brentwood Terrace Healthcare and Rehabilitation 2885 Stillhouse Road Paris, TX 75460 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate dispensing and administering of all drugs and biologicals to meet the needs of each resident and determined that drug records were in order and that an account of all controlled drugs was maintained and periodically reconciled for 1 of 4 residents (Resident #2) reviewed for pharmacy services. The facility failed to ensure Resident #2's Qulipta (medication used to treat migraines) was administered as ordered on 10/31/2025, 11/01/2025, and 11/02/2025. This failure could place the residents at risk of not having medications available for use and medications errors. Findings included: Record review of Resident #2's face sheet dated 11/12/2025 indicated he was a [AGE] year-old male initially admitted to the facility on [DATE] with diagnoses which included quadriplegia (paralysis of all four limbs, and the trunk of the body) and migraine. Record review of Resident #2's Quarterly MDS assessment dated [DATE], indicated he was usually understood and usually understood others. Record review of Resident #2's MDS assessment indicated he had a BIMS score of 15, which indicated his cognition was intact. The MDS assessment indicated Resident #2 received scheduled and PRN pain medication. Record review of Resident #2's care plan reviewed 10/21/2025 indicated he had a potential for uncontrolled pain related to migraines, immobility, and contractures (a shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff, preventing normal movement). Record review of Resident #2's Order Summary Report dated 11/12/2025 indicated Qulipta 60 mg give 1 tablet via g-tube one time a day for migraines with a start date of 08/22/2024. Record review of Resident #2's October 2025 MAR indicated Qulipta 60 mg give 1 tablet via g-tube one time a day was not administered on 10/31/2025. Record review of Resident #2's November 2025 MAR indicated Qulipta 60 mg give 1 tablet via g-tube one time a day was not administered on 11/01/2025 and 11/02/2025. During an interview on 11/11/2025 at 9:44 AM, Resident #2 said he did not receive his headache medication twice. Resident #2 said the nurses told him they were out of his medication. Resident #2 said it was about 2 weeks ago. During an interview on 11/11/2025 at 4:19 PM, LVN B said at the beginning of November 2025 she had not administered Resident #2's Qulipta. She said she was told by LVN C that the medication had been ordered from the pharmacy but had not been delivered and she was not able to administer it. LVN B said she did not know when it was ordered. LVN B said she did not call the pharmacy because she was still training when this happened. LVN B said she had not notified the doctor that Resident #2's Qulipta had not been administered. LVN B said she was training with LVN C, and LVN C notified the doctor. LVN B said it was important for the residents to receive their medications as ordered by the physician for their health and for their mental and physical well-being. During an interview on 11/11/2025 at 9:21 PM, LVN C said Resident #2's Qulipta ran out at the beginning of November 2025, and he did not receive it. LVN C said she was unsure how many doses he missed, but they were waiting on the pharmacy to deliver the medication. LVN C said when a resident did not have a medication, they should contact the pharmacy and notify the doctor. LVN C said she did not contact the pharmacy to see why his Qulipta was not delivered because she was not the only nurse who had not administered the medication. LVN C said she did not notify the doctor about Resident #2's missed doses of Qulipta. LVN C said not administering Resident #2's Qulipta could result in him having headaches. During an interview on 11/12/2025 at 9:14 AM, the Pharmacist said a refill was ordered for Resident #2's Qulipta on 10/31/2025 and was delivered to the facility on [DATE]. The Pharmacist said the facility had not reached out to get the medication delivered sooner. The Pharmacist said if the facility had contacted them and requested a quicker (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676045 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brentwood Terrace Healthcare and Rehabilitation 2885 Stillhouse Road Paris, TX 75460 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete delivery it could have been done. During an interview on 11/12/2025 at 12:24 PM, the DON said the nurses were supposed to call the pharmacy prior to the residents' medications running out. The DON said if a medication was not administered the physician should be contacted. The DON said she was not aware Resident #2's Qulipta was not administered. The DON said the nurses should have contacted her to notify her of the doses of the missed medication, but they did not. The DON said not administering medications as ordered by the physician could result in a negative outcome. During an interview on 11/12/2025 at 12:50 PM, the Administrator said if a medication was not in the building, he expected the nurses to contact the pharmacy and get the medication delivered immediately. The Administrator said it was the nurse's responsibility to ensure medications were administered as ordered, and his expectations were if they did not, they should notify the ADON and DON. The Administrator said he was not medical; therefore, he was not aware of the risks associated with not administering medications as ordered. During an attempted phone interview on 11/12/2025 at 1:09 PM, LVN D did not answer the phone. Record review of the facility's policy, Medication Administration and General Guideline v3-2025, indicated, Medications are administered as prescribed.Medications are administered in accordance with written orders of the attending physician. Event ID: Facility ID: 676045 If continuation sheet Page 4 of 4