Health inspection·December 11, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few his room he only left to go to the dining room to eat lunch and dinner then he went back to his room.-On 11/03/2025 at 12:00 p.m., LVN A wrote Late Entry I was made aware by the facility DON that there was an incident between Resident #1 and Resident #2 resident and Resident #2 stated to the front office business manager that Resident #1 touched her right breast and grabbed her cat (vagina). I was also informed that the abuse coordinator, ADON, and RPs had already been notified. The resident was placed on 1:1 monitoring with 15-minute documentation until further notice.-On 11/04/2025 at 5:23 a.m., LVN C wrote Late Entry 1:1 monitoring, 15-minute documentation resident location tracking done for this shift. Resident #1 stayed in room the entire shift, currently in his room watching TV, waiting to be taken to the shower room for shower day. 1:1 monitoring continues with q15 minute documentation.-On 11/04/2025 at 9:49 a.m., LVN A wrote 1:1 monitoring with every 15 minutes documentation started at 11:45 am on 11/03/2025.-On 11/04/2025 at 9:52 a.m., LVN A wrote Late Entry Resident #1 is on 1:1 with every 15 minutes documentation per administration until further notice, The resident was in his room until 7am until C hall came took him to the shower room for his shower he returned from the shower at approx.7:22 am, remained in his room until 8:26 am when he was taken to the dining room for breakfast and was assessed back to his room at approx.8:50 am where he has remained.- On 11/04/2025 at 12:00 p.m., LVN A wrote Late Entry I was made aware by a staff member during investigation process that there was an incident between Resident #1 and another female resident (Resident #3) and she alleged that Resident #1 made her uncomfortable and touched her breast without consent, and that the abuse coordinator was notified along with the DON, ADON facility physician and both residents emergency contacts/RPs were notified.On 11/04/2025 at 6:00 p.m., LVN A wrote Late Entry Resident #1 remained in his room for the majority of the 12-hour shift after breakfast the resident only left out his room for lunch and to the nurses' station at approximately 2:15 p.m. to ask about upcoming eye appointment and went directly back to his room. Resident #1 is still on 1:1 monitoring with 15-minute documentation.-On 11/05/2025 at 5:31 a.m., LVN C wrote Late Entry 1:1 monitoring, 15-minute documentation resident location tracking continued for resident. Resident #1 came and sat in the hallway at 6:30pm and stayed there for about 10 minutes then went back into his room where he watched TV and rested in bed for the rest of this shift. Resident is currently in his room lying in bed, resting with eyes closed. 1:1 monitoring continues with q15 minute documentation.- On 11/05/2025 at 9:41 a.m., LVN D wrote Late Entry Resident #1 continues 1:1 monitoring with Q15 minute documentation. The resident is currently sitting on rollator walker in his room. Resident #1 had his breakfast meal in the dining room; resident also did some exercise on the bike in the Physical Therapy room. The resident has no complaints or pain or discomfort at this time.- On 11/05/2025 at 12:33 p.m., LVN D wrote Resident #1 continues on 1:1 monitoring with Q15 minute documentation. Resident #1 is currently ambulating with use of the rollator walker. Resident #1 ambulated outside with CNA for just a little while. Resident #1 had no complaints or pain or discomfort at this time.- On 11/05/2025 at 6:07 p.m., LVN D wrote Resident #1 continues on 1:1 monitoring with Q15 minute documentation. Resident #1 stayed in his room watching television most of the evening. No complaints voiced per resident. No acute distress noted.- On 11/05/2025 at 6:09 p.m., LVN D wrote Initial dose Zoloft 25mg and Estrace 0.5mg administered per MD orders. Resident #1 shows no sign or symptom of any adverse reactions noted.- On 11/05/2025 at 8:29 p.m., ADON wrote Resident #1 continues on 1:1 tracking every 15 minutes. He has been in his room thus far this shift.- On 11/05/2025 at 8:38 p.m., ADON wrote Received a call from behavioral hospital stating that first thing in the morning they will run his insurance, and the intake team will look at his clinicals and she will get back to us.- On 11/06/2025 at 1:29 p.m., LVN D wrote Resident #1 continues on 1:1 monitoring with Q15 minute documentation. Resident #1 stayed in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676055 If continuation sheet Page 2 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few his room watching television most of the evening. Resident #1 had his lunch meal in the dining room with CNA supervision. No complaints voiced at this time.- On 11/06/2025 at 2:45 p.m., LVN D wrote Received phone call from the behavioral hospital. Report given to CN for Resident #1's transport to facility. Behavioral hospital RN notified this nurse that resident is to bring only 3 outfits (without strings or they would have to be cut out) 1 pair shoes/ slippers and the transportation will be arriving around 3:15 p.m. Explained to Resident #1 regarding the amount of clothing & shoes to pack. Resident verbalized understanding. The resident continues 1:1 monitoring with Q15 minute documentation. The resident remains in his room gathering his items. CNA is currently in the room assisting the resident.- On 11/06/2025 at 3:30 p.m., LVN D wrote Behavioral hospital transportation arrived at facility to transport Resident #1 with 2 attendants present. Resident #1 in his room and continuing gathering of his personal items to Backpack. CN instructed the resident that he will now be transported to another facility. Resident verbalized understanding. CN & CNA walked with Resident #1 along with attendants to the transportation van. Resident #1 was ambulating with use of rollator walker as 1:1 monitoring continued until the resident was assisted into the van and in the care of behavioral hospital transportation staff.- On 11/21/2025 at 1:00 p.m., LVN D wrote Resident #1 returned to facility around 1300 after a stay at behavioral hospital; transported by them as well. Resident #1 ambulating with rollator assistive device accompanied by two behavioral hospital staff. Resident#1 assigned to room with all belongings. Covid test negative. VS WNL. Resident AAOx3. VS assessed and WNL. Resident #1 breathing on room air. No new medications. Freedoms staff declined any behavioral concerns as well as sexual moves or tendencies. Upon return, Resident #1 will be 1-on-1 watch and documented every 15 minutes. Resident continent to bowel and bladder. Lung sounds clear to auscultation all lobes. Skin assessment completed by SN; no wounds/skin concerns noted.Record review of Resident #1's 1:1 monitoring with q 15minute documentation tracking log indicated Resident #1 was monitored from 11/03/2025 at 11:45 a.m. until 11/06/2025 at 3:30 p.m. with no new behaviors indicated on tracking log. Record review of Resident #1's behavioral hospital records dated 11/14/2025 indicated Resident #1 did admit to the behavioral hospital staff he had bonded with, his inappropriate behaviors at the nursing facility.Record review of Resident #1's 1:1 monitoring with q 15minute documentation tracking log indicated Resident #1 was monitored from 11/21/2025 at 1:00 p.m. until 12/10/2025 at 8:00 a.m. with no new behaviors indicated on tracking log.Resident #2 Record review of Resident #2's admission record, dated 12/10/2025, indicated a [AGE] year-old female originally admitted on [DATE]. Her diagnoses included spina bifida (a condition that occurs when the spine and spinal cord don't form properly), anxiety disorder (persistent and excessive worry that interferes with daily activities), depressive episodes, and diabetes mellitus type 2 (a chronic condition that affects the way the body processes blood sugar). Resident #2 discharged on 11/16/2025. Record review Resident #2's admission MDS dated [DATE] indicated she was moderately impaired cognitively with a BIMS score of 09 out of 15 and had inattention and disorganized thinking. She was usually able to make herself understood and usually understood others. Record review of Resident #2's care plan reviewed on 12/10/2025 indicated she had the right to be safe in general initiated on 11/03/2025. The goal was she would remain safe. Interventions included perform safety risk evaluations, and safety measures including strategies to reduce the risk of injuries or incidents. 1. Record review of a Provider Investigation Report dated 11/03/2025 indicated an incident categorized as Abuse occurred on 11/03/2025. The incident involved Resident #1 and Resident #2. Resident #1 inappropriately touched Resident #2 on her breast and genitals. Resident #1 placed on 1:1 tracking/monitoring, call to behavioral hospital for transfer/discharge. Resident #1 denied the allegation. An assessment was conducted by nursing staff on Resident #2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676055 If continuation sheet Page 3 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few indicated she had no identifiable marks noted.Record review of Resident #2's incident report dated 11/03/2025 authored by LVN A indicated alleged abuse, incident location was in Resident #2's room. Resident #2 reported to a staff member she was touched by a male resident (Resident#1). She stated while he was in her room he touched her right breast and grabbed her cat. No injuries observed at the time of reported incident. No predisposing environmental, physiological, and/or situational factors indicated. Record review of Resident #2's Weekly Skin Assessment, dated 10/05/2025, indicated she had redness to her peri area related to incontinence and barrier cream applied. No bruising or discoloration indicated. Record review of Resident #2's Progress Notes indicated the following: -On 10/30/2025 at 7:09 p.m., LVN A wrote while standing outside in the hallway of Resident #2's room overheard her say that the sex scene in the movie on TV was making her horny. -On 11/03/2025 at 12:02 p.m., LVN A wrote Late Entry It was brought to my attention that a male resident (Resident #1) made unwanted advancements towards Resident #2 by grabbing her right breast and rubbing her genitals. It was immediately reported to the abuse coordinator, ADON, DON, NP and RP. -On 11/03/2025 at 12:05 p.m., LVN A wrote Late Entry I was made aware by the facility DON that there was an incident between the Resident #2 and another male resident (Resident #1), and she stated to the front office business manager that the male resident touched her right breast and grabbed her cat (vagina). I was also informed that the abuse coordinator, ADON, RP and facility physician had already been notified. -On 11/05/2025 at 8:42 p.m., ADON wrote Resident #2 has been in her room thus far this shift. She has had no complaints and does not exhibit any signs of discomfort.- On 11/07/2025 at 10:07 a.m., LVN G wrote Resident #2 moved to new assigned room with all belongings.Observation and interview on 12/10/2025 at 10:21 a.m. with Resident #1 indicated a well-groomed male sitting at a table alone in the facility dining room with 1:1 monitoring by facility activity staff. He denied any sexual abuse allegations or inappropriate touching of female residents. He said he was sent to a behavioral hospital for an evaluation due to the allegations but continues to deny the allegation during interviews. During an interview on 12/10/2025 at 9:30 a.m., LVN A said she was the CN working when Resident #2 reported to BOM B Resident #1 had touched her inappropriately. LVN A said she was notified of the incident by management staff (Administrator, DON and ADON). LVN A said she assessed Resident #2 and did not identify any injuries. LVN A said Resident #2 did not notify her of any sexual abuse incident and the only sexual in nature incident with Resident #2 was she overheard her say a sex scene in a movie was making her horny. LVN A said Resident #2 seemed impaired cognitively and would seek attention and flirt with male residents and staff. LVN A said Resident #1 was placed on immediate 1:1 monitoring and did not exhibit any s/s of sexual behaviors during her shift. LVN A said she was not aware of Resident #1 having a history of sexual behaviors. LVN A said Resident #1 stayed on 1:1 monitoring until sent out to behavioral hospital for evaluation and upon his return to the facility. LVN A said Resident #1 has recently been placed on 1:1 monitoring while outside of his room and every 15-minute tracking while is his room. LVN A said Resident #1 was waiting for an open bed at an all-male nursing facility. LVN A said she had received training regarding sexual abuse and if it occurred to keep residents safe, the perpetrator should be placed on 1:1 monitoring immediately and administrator, DON, ADON, MD/NP, RP and authorities are notified. During an interview on 12/10/2025 at 10:30 a.m., CNA F said she was one of the CNAs provided 1:1 monitoring with Resident #1 prior and after his behavioral hospital stay. CNA F said during her 1:1 monitoring Resident #1 did not exhibit any sexual behaviors. CNA F said she was not aware of Resident #1 having a history of sexual behaviors. During an interview on 12/10/2025 at 1:50 p.m., BOM B said Resident #2 was in her office visiting with her and towards the end of the conversation she said Resident #1 had touched her inappropriately on the breast and cat (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676055 If continuation sheet Page 4 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few (peri area). She said she immediately reported it to the abuse coordinator and DON. During an interview on 12/10/2025 at 3:15 p.m., LVN E said Resident #1 was placed on 1:1 monitoring after the sexual abuse allegation and did not exhibit any s/s of sexual behaviors during her shifts. LVN E said Resident #1 did not have a history of sexual behaviors. LVN E said Resident #1 stayed on 1:1 monitoring until sent out to behavioral hospital for evaluation and upon his return to the facility. LVN E said Resident #1 has recently been placed on 1:1 monitoring while outside of his room and every 15-minute tracking while is his room. LVN E said Resident #1 was waiting for an open bed at an all-male nursing facility. LVN E said she had received training regarding sexual abuse and if it occurred to keep residents safe, the perpetrator should be placed on 1:1 monitoring immediately and administrator, DON, ADON, MD/NP, RP and authorities are notified.During a phone interview on 12/11/2025 at 8:15 a.m., Resident #2 with noted increased emotional tone said Resident #1 came into her room and touched her breast, twisted her nipples and then grabbed her cat (genital area) with her clothing in place. She said she did not want him to touch her and told him to stop several times, she said he did stop and left the room. She said she told the lady in the front office regarding the incident the next day. She said the incident was not witnessed and only recalls it occurred in the evening when her roommate (Resident #3) was out of the room for a smoke break. She expressed I did not want him touching me like that. Resident #2 denied any sexual penetration into a body orifice. Resident #3Record review of Resident #3's admission record, dated 12/10/2025, indicated a [AGE] year-old female originally admitted on [DATE]. Her diagnoses included stroke affecting her right dominant side, aphasia following her stroke (communication disorder that affects her ability to speak, understand, read and write), anxiety disorder (persistent and excessive worry that interferes with daily activities), depressive episodes, and diabetes mellitus type 2 (a chronic condition that affects the way the body processes blood sugar).Record review of Resident #3's annual MDS dated [DATE] indicated she was rarely or never understood and moderately impaired (decisions poor; curs/supervision required) cognitively for daily decision making. She rarely makes herself understood and usually understands others. Record review of Resident #3's care plan reviewed on 12/10/2025 indicated she had the right to be safe in general initiated on 11/03/2025. The goal was she would remain safe. Interventions included perform safety risk evaluations, and safety measures including strategies to reduce the risk of injuries or incidents.2. Record review of a Provider Investigation Report dated 11/04/2025 indicated an incident categorized as Abuse occurred on 11/04/2025. The incident involved Resident #1 and Resident #3. Resident #1 made Resident #3 feel uncomfortable and touched her breast without consent on an unidentified date. Resident #1 was already on 1:1 tracking/monitoring and waiting for transfer/discharge to behavioral hospital. Resident #1 denied the allegation. An assessment was conducted by nursing staff on Resident #3 indicated she was not hurt and no identifiable marks noted. Record review of Resident #1's incident report dated 11/04/2025 authored by LVN A indicated alleged abuse, incident location was in Resident #3's room. Resident #3 reported to facility staff member Resident #1 makes her uncomfortable and he had touched her breast without consent. Immediate action taken with administration, DON, ADON, and MD/NP notification. No injuries observed at the time of reported incident. No predisposing environmental, physiological, and/or situational factors indicated. Record review of Resident #1's physicians ordered dated 11/04/2025 indicated Resident #1 was started on Estrace 0.5mg daily for sexual behaviors. Record review of Resident #3's incident report dated 11/04/2025 authored by LVN A indicated alleged abuse, incident location was unknown. Resident #3 reported to facility staff member Resident #1 makes her feel uncomfortable and he had touched her breast without consent. Immediate action taken with administration, DON, ADON, and MD/NP notification. No injuries observed at the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676055 If continuation sheet Page 5 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few time of reported incident. No predisposing environmental, physiological, and/or situational factors indicated. Record review of Resident #3's Progress Notes indicated the following:- On 11/04/2025 at 12:00 p.m., LVN A wrote Late Entry I was made aware by a staff member that there was an incident between Resident #3 and a male resident (Resident #1) and she alleged that Resident #1 made her uncomfortable and touched her breast without consent, and that the abuse coordinator was notified along with the DON, ADON facility physician and both residents emergency contacts/RPs were notified. - On 11/05/2025 at 8:44 p.m., ADON wrote Resident #3 has been in her room this shift with exception to go smoke at 7:00 p.m. She does not exhibit any signs of discomfort with staff or her roommate.- On 11/06/2025 at 11:30 a.m., LVN E wrote Resident #3 has had no behaviors during her shift. She does not exhibit any signs of discomfort with staff or her roommate.- On 11/07/2025 at 8:30 a.m., LVN E wrote SN called and spoke with resident's RP and informed her that all residents will be moving around to different rooms as the facility has decided to place all females on one hall and all males on the other hall. RP was understanding of change and approved the move to with all belongings.During an interview on 12/10/2025 at 9:40 a.m., LVN A said she was the CN working when Resident #3 reported to AD H Resident #1 had touched her breast inappropriately. LVN A said AD H notified management staff (Administrator, DON and ADON). LVN A said she assessed Resident #3 and did not identify any injuries. LVN A said Resident #3 did not notify her of any sexual abuse incident and Resident #3 was hard to communicate with due to being unable to speak or write after her stroke. LVN A said Resident #3 did indicate Resident #1 had touched her breast without her consent. LVN A said Resident #1 was already on 1:1 monitoring when the incident was reported and Resident #3 could not identify the date her alleged sexual abuse occurred. LVN A said she was not aware of Resident #1 having a history of sexual behaviors. LVN A said Resident #1 stayed on 1:1 monitoring until he was sent out to behavioral hospital for evaluation and upon his return to the facility. LVN A said Resident #1 had recently been placed on 1:1 monitoring while outside of his room and every 15-minute tracking while is his room. LVN A said Resident #1 was waiting for an open bed at an all-male nursing facility. LVN A said she had received training regarding sexual abuse and if it occurred to keep residents safe, the perpetrator should be placed on 1:1 monitoring immediately and administrator, DON, ADON, MD/NP, RP and authorities are notified.During an interview on 12/10/2025 at 1:30 p.m., AD H said she noticed on 11/04/2025 Resident #3 had stayed in her room and not participated in activities for 2-3 days which was out of character for her. AD H said when she started discussing the isolation, Resident #3 expressed to her she had been touched inappropriately on her breast by Resident #1 without her consent on an unidentified date. AD H said she notified the administrator, DON, ADON of her findings. AD H said Resident #3 was upset and withdrawn during the discussion and feels like the allegation was valid. AD H said Resident #3 had returned to participating in facility activities with no recent isolation or withdrawal episodes identified. During an interview on 12/10/2025 at 2:00 p.m., Resident #3 indicated she had been touched on her left breast on top of her clothes by Resident #1 without her consent on an unidentified date. Resident #3 was asked yes or no questions and able to identify locations by pointing or touching. Resident #3 denied any sexual penetration into a body orifice. Resident #3 expressed she currently feels safe at the facility. During an interview on 12/11/2025 at 10:10 a.m., the DON said she investigated the sexual abuse allegations on Resident #1. She said Resident #1 was immediately placed on 1:1 monitoring after the reported incident. She said Resident #1 stayed on 1:1 monitoring until transferred to behavioral hospital for evaluation. She said the NP assessed Resident #1 and ordered Zoloft and Estrace to decrease sexual behaviors. She said Resident #1 was transferred to behavioral hospital on [DATE]. She said Resident #1 admitted to the behavioral hospital staff the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676055 If continuation sheet Page 6 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few inappropriate touching did happen at the nursing facility, but he continues to deny the allegations to the nursing facility staff. She said during the investigation and contact with Resident #1's family she learned he had been incarcerated and had a history of unwanted verbal sexual behaviors. She said the incarceration offense was unknown and the sexual behaviors were not disclosed to facility by family during the admission process. She said Resident #1 did not have any known sexual behavior at the facility prior to this incident. She said Resident #1 returned to the nursing facility on 11/21/2025 from the behavioral hospital and continues to be on 1:1 monitoring while out of his room and every 15-minute tracking while in his room. She said Resident #1 has not had any sexual behavior since his return from behavioral hospital. She said Resident #1 will be transferred to an all-male facility once a bed becomes available. She said Residents #2 and #3 were assessed and monitored after the incidents. She said Residents #2 and #3 were seen by psych services for any effects related to the incidents. She said Resident #2 was known to be attention seeking and flirtatious with other male residents. She said after the reported incidents she visited with residents for safety checks and interviewed residents regarding them feeling safe at the facility and no other residents identified any concerns. She said she in-serviced staff on abuse, neglect, reporting abuse and specific in-service regarding sexual abuse in the nursing home. She said not keeping the residents free from abuse could place them at risk of abuse, physical harm, mental anguish, and emotional distress.During an interview on 12/11/2025 at 10:30 a.m., the ADM said Resident #1 had been at the facility for 1.5 years and he had not exhibited sexual behaviors prior to this incident. He said the facility could not predict he would have sexual behaviors. He said the facility tries to keep all residents safe and free from abuse and neglect. He said as soon as the incident was reported to him, he notified the state agency and began investigating the incident. He said Resident #1 was placed on 1:1 monitoring prior to his transfer to behavioral hospital and upon his return to the facility. He said Resident #1 was pending a transfer to all male facility once a bed becomes available. He said one intervention after the incident was the facility residents (with consent) were moved, and a female hall and male hall was developed. He said facility staff were trained on abuse, neglect and sexual abuse in nursing homes. He said he felt the facility acted quickly and put things in place to prevent continued incidents. He said his expectations were residents were free from abuse and neglect. During an interview on 12/11/2025 at 11:09 a.m., the Psych NP said during her weekly visits to the nursing facility she provided services to Resident #2 and #3 and she did not identify any new concerns following the incidents with Resident #1 in early November 2025. She said both Resident #2 and #3 were being seen prior to incident for depressive episodes but she did not recall any changes or new treatment following the incident. During an interview on 12/11/2025 at 2:41 p.m., the NP said she was aware of Resident #1's allegations of sexual abuse in early November 2025. She said she evaluated Resident #1, initiated 1:1 monitoring, referral to behavioral hospital and started on Estrace 0.5mg daily and Zoloft 25mg daily for sexual behaviors during the transition to behavioral hospital. She said she was not aware of Resident #1 having a history of sexual behaviors and it was not disclosed during admission to nursing facility. She said she had been treating Resident #1 for over a year and she did not recall any sexual behavior reported prior to this incident. Record review of the facility's Abuse, Neglect, Exploitation and Misappropriation Prevention Program dated 04/2021 indicated Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms.Record review of Resident #1's 1:1 monitoring with q 15minute documentation tracking log (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676055 If continuation sheet Page 7 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete indicated Resident #1 was monitored from 11/03/2025 at 11:45 a.m. until 11/06/2025 at 3:30 p.m. with no new behaviors indicated on tracking log. Record review of Resident #1's 1:1 monitoring with q 15minute documentation tracking log indicated Resident #1 was monitored from 11/21/2025 at 1:00 p.m. until 12/10/2025 at 8:00 a.m. with no new behaviors indicated on tracking log.Record review of Resident #1's Medication Administration Record (MAR) indicated he received Estrace .5mg by month daily (sexual behavior management) starting 11/05/2025 until 11/06/2025 and it was resumed upon his return to the facility on [DATE] until current 12/11/2025. Record reviews of resident safety checks completed with 28 residents revealed they felt safe in the facility.Record review of Resident #2 and Resident #3 psychiatry assessment on 11/09/2025 indicated both residents were receiving treatment for depression with no new or changes to the current treatment plans and both had shown improvement in response process. Record review of Resident #2 and #3 Treatment Administration Record (TAR) indicated both residents were being monitored for following behaviors: afraid/panic, agitated, angry, anxiety, biting, compulsive, continual crying, continual pacing, continual yelling, danger to others, danger to self, delusions, depression, withdrawn, extreme fear, fighting, hallucinations, insomnia, jittery, nervousness, kicking, mood changes, paranoia, pinching, pulling lines, restlessness, scratching, spitting, striking out, hitting, suspiciousness, throwing objects, and uncooperative every shift with no documentation of these behaviors identified since incident. Record review of an in-service record dated 11/03/2025, and titled Preventing Resident Abuse, Sexual Abuse in Nursing homes indicated 48 staff signatures indicating they had been in-serviced.During interviews on 12/10/2025 from 8:30 a.m. though 5:30 p.m. and 12/11/2025 from 8:00 a.m. though 1:30 p.m., 5 LVNs (LVN A, LVN D, LVN E, LVN G, LVN J ), 6 CNA's (CNA F, CNA L, CNA M, CNA N, CNA O, and CNA P), 1 Activity Director (AD H), 1 Activity Assistant (AD assistant Q), 2 Housekeeping staff (Housekeeper R and S), 1 Human Resource staff (HR T) and 1 BOM (BOM B) were able to identify the Abuse Coordinator as the administrator. Staff indicated they were to report allegations of abuse and neglect immediately to the Administrator and were able to give examples of physical, verbal, sexual abuse and immediate intervention procedures. They were able to state immediate actions to take when an allegation was made and/or identified, such as immediately removing residents from the situation and staying with the aggressor one-on-one until further instruction from the Abuse Coordinator. They identified actions taken during Resident #1's i Event ID: Facility ID: 676055 If continuation sheet Page 8 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident for 3 of the 4 incidents reviewed for reporting. 1. The Administrator or designated representative failed to report the results of an investigation within 5 days to the State Survey Agency for Resident #1's allegation of inappropriately touching Resident #2 reported on 11/3/2025 and Resident #1 allegation of inappropriately touching Resident #3 reported on 11/04/2025. 2. The Administrator or designated representative failed to report the results of an investigation within 5 days to the State Survey Agency for Resident #18's allegation of injury of unknown origin on 11/30/2025. This failure could affect residents if alleged violations are verified, and appropriate corrective actions are not taken.Findings include:Resident #1Record review of Resident #1's admission record, dated 12/10/2025, indicated an [AGE] year-old male originally admitted on [DATE] and readmitted on [DATE]. His diagnoses included mood disorder (mental disorders that primarily affect a person's emotional state), dementia (loss of cognitive functioning), anxiety disorder (persistent and excessive worry that interferes with daily activities) and high risk of heterosexual behaviors added 11/04/2025.Record review of Resident #1's quarterly MDS dated [DATE] indicated he was intact cognitively with a BIMS score of 15 out of 15 and had no behaviors. He was able to make himself understood and understood others.Resident #2Record review of Resident #2's admission record, dated 12/10/2025, indicated a [AGE] year-old female originally admitted on [DATE]. Her diagnoses included spina bifida (a condition that occurs when the spine and spinal cord don't form properly), anxiety disorder (persistent and excessive worry that interferes with daily activities), depressive episodes, and diabetes mellitus type 2 (a chronic condition that affects the way the body processes blood sugar). Resident #2 discharged on 11/16/2025.Record review Resident #2's admission MDS dated [DATE] indicated she was moderately impaired cognitively with a BIMS score of 09 out of 15 and had inattention and disorganized thinking. She was usually able to make herself understood and usually understood others.Resident #3Record review of Resident #3's admission record, dated 12/10/2025, indicated a [AGE] year-old female originally admitted on [DATE]. Her diagnoses included stroke affecting her right dominant side, aphasia following her stroke (communication disorder that affects her ability to speak, understand, read and write), anxiety disorder (persistent and excessive worry that interferes with daily activities), depressive episodes, and diabetes mellitus type 2 (a chronic condition that affects the way the body processes blood sugar).Record review of Resident #3's annual MDS dated [DATE] indicated she was rarely or never understood and moderately impaired (decisions poor; curs/supervision required) cognitively for daily decision making. She rarely makes herself understood and usually understands others.1.Record review of Resident #1's incident report dated 11/03/2025 authored by BOM B indicated alleged abuse, incident location was in Resident #2's room. Resident #2 reported to BOM B she was touched on her right breast and her cat (peri area) by a male resident (Resident#1). Resident #1 stated that he didn't do anything wrong before he was told what we wanted to question him about. He also stated, that he thought they were asking him about the female resident across the hall because she tried to get his attention and she wasn't covered. Immediate action taken with administration, DON, ADON, and MD/NP notification. No injuries observed at the time of reported incident. No predisposing environmental, physiological, and/or situational factors indicated. Record review of Resident #1's incident report dated 11/04/2025 authored by LVN A indicated alleged abuse, incident location was in Resident #3's room. Resident #3 reported (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676055 If continuation sheet Page 9 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to facility staff member Resident #1 makes her uncomfortable and he had touched her breast without consent. Immediate action taken with administration, DON, ADON, and MD/NP notification. No injuries observed at the time of reported incident. No predisposing environmental, physiological, and/or situational factors indicated. Record review completed on 12/10/2025 at 08:32 AM of the TULIP (Texas Unified Licensure Information Portal) reporting system indicated no Provider Investigation Report (Form 3613-A) had been received or uploaded in the system for incidents with allegation of abuse on 11/3/2025 and 11/04/2025. Record review of the Provider Investigation Report (form 3613-A) for the incident with Resident #1's allegation of inappropriately touching Resident #2 on 11/3/2025 was reported on 11/03/2025 indicated it was completed on 11/06/2025. The Provider Investigation Report indicated a thorough investigation of the incident was completed. Record review of the Provider Investigation Report (form 3613-A) for the incident with Resident #1 allegation of inappropriately touched Resident #3 on 11/04/2025 was reported on 11/04/2025 indicated it was completed on 11/07/2025. The Provider Investigation Report indicated a thorough investigation of the incident was completed.2. Record review of Resident #18's admission record, dated 12/10/2025, indicated a [AGE] year-old female originally admitted on [DATE] and readmitted on [DATE]. Her diagnoses included Alzheimer's Disease (progressive disease that destroys memory and other important mental functions), Parkinson's disease (a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves), anxiety disorder (persistent and excessive worry that interferes with daily activities), depressive episodes, disorder of bone density.Record review of Resident #18's annual MDS dated [DATE] indicated she was unable to complete the brief interview for mental status. She had short- and long-term memory problems. She was severely impaired with cognitive skills for daily decision making. She sometimes makes herself understood and usually understands others.Record review of Resident #18's incident report dated 11/30/2025 authored by LVN J indicated injury of unknown origin, incident location was in secure unit reception/lobby area. Resident #18 complaining of stomach pain and transported to local hospital for evaluation. Immediate action taken with administration, DON, ADON, and MD/NP notification. No injuries observed at the time of reported incident. No predisposing environmental, physiological, and/or situational factors indicated. Record review of Resident #18's transfer to hospital summary dated 11/30/2025 indicated the hospital ER CT scan indicated a hip fracture, fecal impaction and distended gallbladder with large gallstones and was being transferred to acute care hospital.Record review completed on 12/10/2025 at 08:32 AM of the TULIP (Texas Unified Licensure Information Portal) reporting system indicated no Provider Investigation Report (Form 3613-A) had been received or uploaded in the system for Resident #18 with allegation of injury of unknown origin on 11/30/2025. Record review of the Provider Investigation Report (form 3613-A) for Resident #18's incident with injury of unknown origin occurred on 11/30/2025 indicated it was completed on 12/03/2025. The Provider Investigation Report indicated a thorough investigation of the incident was completed.During an interview on 12/10/2025 at 11:11 a.m., the ADON said she was the designated representative responsible for completing the Provider Investigation Report (Form 3613-A) and submitting it to the State Agency with 5 working days of the incident. She said the Provider Investigation Report (Form 3613-A) was now in the electronic medical record for completion. She said she completed the Provider Investigation Report (Form 3613-A) in the electronic medical record system for the involved incidents; she just forgot to submit them through the TULIP reporting system. She said I will upload them today into the TULIP reporting system. She said she was responsible for submitting the Provider Investigation Report (Form 3613-A) 5 working days after the incident, initially thought the electronic system would automatically submit the reports once completed but has since learned she must manually upload the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676055 If continuation sheet Page 10 of 11 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 676055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shady Acres Health and Rehabilitation Center 405 Shady Acres Lane Newton, TX 75966 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete report. She said not submitting the Provider Investigation Report (Form 3613-A) timely could delay appropriate corrective actions are to protect residents.During an interview on 12/10/2025 at 11:30 a.m., the Administrator said the ADON was the designated representative responsible for completing the Provider Investigation Reports (Form 3613-A) and submitting it to the State Agency with 5 working days of the incident. He said the Provider Investigation Reports (Form 3613-A) were completed for the incidents involved, which he remembered reviewing them in the electronic medical record. He said the ADON just forgot to upload the information to the TULIP reporting system.Record review of the facility provided policy titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating revised 04/2021, indicated the following: Policy Statement: All reports of resident abuse (including injuries of unknown origin), neglect, exploitation, or theft/misappropriation of resident property are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported. Reporting Results of Investigations: 1. The administrator, or his/her designee, provide the appropriate agencies or individuals listed above with a written report of the findings of the investigation within five (5) working days of the occurrence of the incident. Event ID: Facility ID: 676055 If continuation sheet Page 11 of 11