Health inspection·February 18, 2025

F 0880 facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 02/23/2025. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #3's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 12/13/2024. Residents Affected - Some Record review of Resident #4's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 12/11/2024. Record review of Resident #5's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris present on admission. Record review of Resident #6's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 11/18/2024. Record review of Resident #7's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 11/06/2024. Record review of Resident #8's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 01/30/2025. Record review of Resident #9's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], 41 age years old; Resident tested positive for Candida auris dated 07/31/2024. Record review of Resident #10's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 04/08/2024. Record review of Resident #11's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 12/11/2024. Record review of Resident #12's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident tested positive for Candida auris dated 12/04/2024. Record review of Resident #13's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 11/06/2024. Record review of Resident #14's face sheet dated 02/18/2025 revealed resident was admitted to the facility on [DATE], age [AGE] years old; Resident had a diagnosis of Candida auris dated 05/21/2024. Record review of infection control binder provided by IP B revealed the facility was not able to show evidence the facility established/implemented a surveillance plan, for identifying, tracking, monitoring and/or reporting of infections, communicable diseases, and outbreaks. Record review of the facility furnished list, indicating positive Candida Auris results for 28 residents. List reflected there was 12 facility acquired candida auris positive residents and 28 total positive residents on the 3 of 4 hallways. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676064 If continuation sheet Page 2 of 9 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 676064 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Katy 1480 Katy Flewellen Katy, TX 77494 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 - Immediate jeopardy to resident health or safety Observation on 02/14/2025 at 11:40 AM, LVN M was observed entering contact precaution room [ROOM NUMBER]. without the appropriate Personal Protective Equipment, which included gloves and gowns while administering medication to Resident #7. Upon exiting Resident #7 room, proper hand hygiene measures were not implemented. Residents Affected - Some Observation on 02/14/2025 at 11:50 AM, CNA B was observed inside contact precaution room [ROOM NUMBER] with Personal Protective Equipment obtaining Resident #2 vitals while wearing gloves and a gown. After obtaining vitals, CNA B did not remove the gloves, sanitize or wash her hands or clean equipment prior to exiting Resident #2's room. CNA B proceeded to enter room [ROOM NUMBER] and did not remove the gloves, gown, sanitize or wash her hands, and clean equipment before attending to Resident #3. CNA B obtained Resident #3 and Resident #4 omitting proper hand hygiene, cleaning equipment, and changing PPE between obtaining Resident #3 and Resident #4 vitals. Using the same contaminated gloves and gown, CNA B entered room [ROOM NUMBER] and proceeded to obtain Resident #5 and Resident #6 vitals without washing and sanitizing hands, cleaning equipment, and changing PPE between obtaining Resident #5 and Resident #6. Interview conducted on 02/14/2025 at 11:13 AM, IP B stated the presence of active C. auris cases within the facility, initially detected in April 2024. IP B expressed uncertainty regarding the number of residents who tested positive for C. auris and was also unsure about the total number of residents tested for the infection. She stated she recently was hired as the facility's IP. She stated the pervious IP was terminated approximately a week prior. She stated the DON and pervious IP (IP A) worked with the health department in testing residents monthly. She stated she was made aware of the Candida auris outbreak when she onboarded approximately a week ago. She stated she was not sure of the health department's recommendations. She stated the DON received the health department's recommendations and reports after each. She stated she was not provided with the plan of correction and recommendation from the health department. She could not articulate a plan to mitigate the risk at the time of the interview. She could not provide proof the facility established and implemented a surveillance plan. She stated when she stepped into the role, she was informed by the DON there were many gaps in the tracking and monitoring of infection within the facility. She did not explain the gaps when asked. She could not explain what actions she had taken to close the gaps. She stated she would follow up with the DON regarding the health departments recommendations. Interview on 02/14/2023 at 11:55am, LVN M verablized the error of failing to don PPE and wash hands. LVN M stated that Resident #7 was on Contact Precautions due to testing positive for Candida auris. She verbalized an understanding that the transmission of infection can occur when PPE and hand hygiene protocols were not followed. She stated that such error put residents and staff at risk for infection. LVN M mentioned receiving infection control training, some time ago. She stated that contact precaution required her to put wear a glow and gloves and wash or sanitize her hands before and after enter contact isolated rooms. She stated that the facility supplied adequate PPE. She stated that that the facility had not provided training on Candida auris, but she had knowledge of the infection. She did not identify why she failed to implement proper transmission precautions. She stated by failing to don PPE and wash hands she placed residents at risk for being exposed to the infection and the infection could rapidly spread. Interview on 02/14/2025 at 12:10, CNA B expressed uncertainty regarding why proper PPE measures was not utilized, hand hygiene practices were neglected, and disinfectant measures were not implemented. CNA B stated Residents #1, #2, #3, #4, #5, and #6 were on Contact Precautions due to testing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676064 If continuation sheet Page 3 of 9 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 676064 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Katy 1480 Katy Flewellen Katy, TX 77494 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 - Immediate jeopardy to resident health or safety Residents Affected - Some positive for Candida auris. CNA B also acknowledged the risk of infection transmission in the absence of proper PPE, hand hygiene and disinfectant measures. CNA B mentioned undergoing training previously but was unable to articulate the specifics or content of the training provided. CNA B stated that she had not received training on caring for Residents with Candida auris. Interview on 02/14/2025 at 12:20 PM, Local Health Department Epidemiologist A stated the health department began working with the facility in April 2024. Epidemiologist A stated the facility initially (April 2024) had approximately 4 residents who tested positive for Candida auris. Epidemiologist A stated she was not aware of the current number of residents who were positive at the facility. She stated a plan of correction along with recommendations was provided by the local health department to the facility in April 2024, in the effort to mitigate the spread of the infection. She stated when visiting the facility monthly, the Local Health Department tested residents who had not been previously tested and identified as positive residents. She stated results were then provided the facility. She stated the facility continued to have positive test results during each visit and there was a continued outbreak at the facility. She stated the Health Department witnessed staff entering and exiting contact precaution rooms with implement PPE and proper hand hygiene. Epidemiologist A stated she had been working with the DON and the Infection Preventionist (IP) for several months. She stated the continued outbreak could be a result of the facility staff not implementing TBPs. She stated not implementing PPE and hand hygiene put all residents at risk of being exposed to the infection. Interview attempt on 02/14/2025 at 12:26 PM, to the DON by telephone was unsuccessful. Interview attempt on 02/14/2025 at 12:40 PM, to IP A by telephone was unsuccessful. Interview conducted on 02/14/2025 at 5:00 PM, the Administrator could not articulate a structured system designed to effectively mitigate the risk of C. auris transmission. He stated the DON was working with the health department and was aware of the health department's recommendation. He could not explain who was monitoring to ensure the plan and recommendations were being followed. The Administrator stated he was not aware of the number of residents effected with C. auris. Interview conducted on 02/14/2025 at 5:30 PM, the Regional Corporate Nurse stated staff were expected to follow contact precautions when dealing with residents with Candida auris to prevent its spread. This included using personal protective equipment (PPE) such as gloves and gowns, hand washing, properly disinfecting surfaces, and isolating infected or colonized patients when necessary. He stated when failure to use proper TBP placed other residents at risk for being exposed to the infection. Interview conducted on 02/15/2025 at 10:00 AM, IP B was not able to articulate how staff were monitored for compliance. Infection Preventionist B (IP B) stated the DON resigned after being contacted on 02/14/2025 regarding the health department's recommendation and plan of correction. IP B stated she reached out to the health department's Epidemiologist A to request the plan of correction on 02/14/2025, after the state surveyor requested the information. Infection Preventionist B (IP B) stated she was working with the Regional Corporate Nurse and weekend Supervisor to complete an audit of residents who had acquired the infection at the facility. Interview conducted on 02/15/2025 at 12:00 PM, the Administrator said staff were notified of the Candida auris outbreak when he onboarded in 11/2024. The Administrator could not provide a plan to mitigate the risk at the time of the meeting. The Administrator stated the facility would adhere to infection control policy moving forward. The Administrator did not have knowledge of what the infection control policy indicated. The Administrator stated the DON resigned yesterday, 02/14/2024, after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676064 If continuation sheet Page 4 of 9 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 676064 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Katy 1480 Katy Flewellen Katy, TX 77494 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 she was notified a state surveyor was in the facility. Level of Harm - Immediate jeopardy to resident health or safety Interview conducted on 02/15/25 at 1:00 PM with Administrator who stated the facility IP A and IP B were training on transmission-based precautions and were responsible for the tracking a trending of communicable diseases within the facility. He stated he was notified by the DON of concerns related to IP A's performance and ability to maintain the infection control responsibilities, a couple of weeks back (could not recall the specific date). He stated approximately a week ago Infection Preventionist B assumed the role of the facility's Infection Preventionist. He was unable to explain IP A's failures and what action were implemented to correct the failures since identified. He stated the Infection Preventionist role was to prevent and contain the spread of infections. He stated the DON was responsible for overseeing the Infection Preventionist duties and responsibilities were being implemented. The Administrator did not explain his active role of preventing and mitigating the spread of Candida auris and communicable diseases within the facility. The Administrator stated IP A was terminated from the facility this week but could not recall the date. The Administrator stated IP B assumed the role as the Infection Preventionist last week. The Administrator stated the DON was responsible for ensuring the tracking and trending was completed by the Infection Preventionist. He stated the Infection Preventionist and the DON had been working with the local health department epidemiologist, but he was not knowledgeable of the current recommendations. Residents Affected - Some Interview conducted on 02/15/2025 at 6:00 PM, the DNP (medical provider) stated failure to properly monitor and mitigate the spread of Candida auris could lead to severe adverse outcomes. Initially, infections may cause serious complications, particularly in immunocompromised individuals, leading to increased mortality rates and death. She stated staff were expected to follow contact precautions when dealing with Candida auris to prevent its spread. This included using personal protective equipment such as gloves and gowns, practicing strict hand hygiene. Failure to adhere to these precautions could further exacerbate the outbreak. She stated she was aware of the spread through the facility. She was not able to identify the total number of residents infected. She stated she believed staff implemented the appropriate contact precautions when dealing with resident Candida auris. She stated she could not attest to how often staff washed their hands or entered a contact isolation room without PPE. She could not explain why the facility had such an increase in residents who acquired the infection while admitted at the facility. Record review of local health department plan of correction, 04/2024 read advised to take the corrective actions listed in the recommendations below: 1. PPE: a. Patient should be on contact precautions. Staff should be using gowns and gloves upon entering the patients room. b. Clear signage to indicate patients are on TBPs with proper indications for precautions and PPE requirements. c. Follow transmission-based precautions, including the use of personal protective equipment by personnel and prefer single patient- use items. e. Making sure PPE, gowns, and gloves are accessible and used appropriately. 2. Handwashing: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676064 If continuation sheet Page 5 of 9 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 676064 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Katy 1480 Katy Flewellen Katy, TX 77494 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 a. Appropriate hand decontamination following cleaning of C. auris - exposed body fluids/areas. Level of Harm - Immediate jeopardy to resident health or safety b. Frequent handwashing by staff with soap and water, followed by alcohol-based hand rub. Residents Affected - Some 3. Cleaning: c. Monitor adherence of staff to hand hygiene practices. Shared medical equipment should be cleaned and disinfected thoroughly . Thes was determined to be an immediate jeopardy (IJ) on 02/15/23 due to the above failures. The administrator was notified and provided the IJ template on 02/15/23 at 6:45p.m. The immediacy was lowered on Tuesday, 02/18/2025 at 2:05p.m. with the facility Administrator and DON, the facility remained out of compliance at a scope of no actual harm with the potential for more than minimal harm, due to the facility's need to evaluate the effectiveness of the corrective systems. Plan of Removal - Infection Prevention and Control - Accepted 02/16/2025 at 11:00am 1. Candida auris Education The Regional Nurse Consultant initiated education on 02/15/2025 provided to all staff on Candida auris (including background/definition, PPE & isolation protocols (including co-horting), disinfectant protocols, equipment/clothes/linen handling, meal service, and methods to prevent the spread of Candida auris). Staff will be educated prior to initiating their next shift. Staff will show competency and understanding of education through testing. Education on Candida auris, including testing will occur in Facility Orientation. Education and Testing will be completed by 02/16/2025 2. Environmental Cleaning Education On 2/14/25 the Regional Nurse Consultant initiated education provided to housekeeping staff on cleaning schedules for residents affected by Candida auris and the requirement to clean/disinfect twice a day and using EPA-approved disinfectants effective against Candida auris per the county health department recommendations. Housekeeping staff will be educated prior to initiating their next shift. Education will be completed on 02/16/2025. The Administrator will ensure compliance. 3. Infection Control Education (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676064 If continuation sheet Page 6 of 9 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 676064 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Katy 1480 Katy Flewellen Katy, TX 77494 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 - Immediate jeopardy to resident health or safety The Regional Nurse Consultant initiated education on 02/14/2025 with all staff on Handwashing and Equipment Disinfection between resident rooms. Staff will be educated prior to initiating their next shift. Education will be completed by 02/16/2025 Residents Affected - Some 4. 1:1 Education The Regional Nurse Consultant provided 1:1 education with the Infection Preventionist, Weekend RN Supervisor, and Administrator on 2/15/25 on Candida auris, Infection Prevention Program Policy to include surveillance. 5. Medical Director Notification The Administrator notified the Medical Director on 02/15/2025 of the IJ template and will be updated on the POR as indicated. 6. Surveillance The Regional Nurse Consultant audited 100% of resident's charts on 02/15/2025 to identify residents with a presence of Candida auris and whether the infection was facility or community acquired. Outcome: (12) facility acquired & (16) Community acquired. Active surveillance listing will be maintained by the Facility Infection Preventionist from 02/15/2025 forward to include Infection Type and acquired status (Facility vs Community). 7. Sustainability The Administrator is responsible for reviewing all compliance reports (including health department recommendations) and taking immediate corrective action where needed. The Infection Preventionist or Weekend RN Supervisor will conduct Daily audits for PPE compliance and environmental cleaning logs will continue for 30 days and then as needed. The Infection Preventionist will collaborate with the health department as directed and will ensure recommendations are carried out timely. 8. Policy / Recommendation Review The Administrator reviewed the Infection Control Program Policy and Procedure and the Candida auris policy and procedure on 02/15/2025 and no updates were required. The Regional Nurse Consultant, IP, and Administrator reviewed the current Health Department recommendations on 02/14/2025 and initiated Candida auris training (see number 1) and increased environmental cleaning (see number 2). Completion date 2/16/2025. Monitoring of the plan of removal included the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676064 If continuation sheet Page 7 of 9 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 676064 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Katy 1480 Katy Flewellen Katy, TX 77494 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 - Immediate jeopardy to resident health or safety Residents Affected - Some Observation on 02/17/2025 at varies times, between 9:00am and 5:00am on the 100, 300 and 400 halls during rounds revealed contact precaution signs posted, bins were placed on outside their room doors, and bio-hazard box (boxes used to discard PPE) in the room. Staff were seen donning and doffing PPE, washing hands, and using hand sanitizer. Observation on 02/18/2025 at varies times, between 9:00am and 5:00am on the 100, 300 and 400 halls during rounds revealed all residents identified with Candida Auris were on isolations, with contact precaution signs posted, bins were placed on outside their room doors, and bio-hazard box in the rooms. Staff were seen donning and doffing PPE, washing hands and using hand sanitizer. Observation on 02/18/2025 at 11:45 AM, revealed disposable trays we're being used to serve residents who were on contact isolation precaution. Trays were discarded bio-hazard box after use. Interview conducted on 02/17/2025 at 11:04 AM, RN E stated a resident with Candida Auris families were called and educated about the disease process. He said the nurses, CNAs, housekeeping, central supply, Respiratory Therapist were educated, about Candida Auris and TBPs. He staff knowledge and understanding was verified by taking and passing a facility provided test competency test. Interview conducted 02/17/2025 at 11:15 AM, the Housekeeping Supervisor stated she worked 6:00 AM to 3:00 PM and as needed. She said she was in-serviced on 02/15/2025 about Candida Auris, how it spread, hand washing, cleaning the equipment's, donning, and doffing PPE's. Identifying residents with Candida Auris with the sign posted. She said the facility had adequate bio-hazard box and bags. Interview conducted on 02/17/2025 at 11:25 AM, LVN M said residents' family were called and educated about Candida Auris disease process, contact isolation for Candida Auris, hand washing, cleaning the equipment's, donning and doffing PPE's and she care planned resident isolation with Candida Auris. Interview conducted on 02/17/2025 at 11:27 AM, revealed RT worked 6:30 AM to 7:00 PM, she had in-services on Candida Auris disease process, contact isolation for Candida Auris, hand washing, cleaning the blood pressure cuff, Accu checks equipment, donning and doffing PPE's. Interview conducted on 02/17/2025 at 11:33 AM, revealed LVN C worked 6:00 AM -2:00 PM for one year, had in-services on Candida Auris disease process, spray, contact isolation for Candida Auris, hand washing, cleaning the blood pressure cuff, Accu checks equipment , donning and doffing PPE's. Interview conducted on 02/17/2025 at 11:47 AM, CNA R stated she worked 6:00 AM to 2:00 PM and had in-services on Candida Auris disease process, spray, contact isolation for Candida Auris, hand washing, donning, doffing PPE's. CNA R was observed to don gloves and a gown to feed Resident #4 on contact isolation. In an interview with the Regional Nurse Consultant and the Facility Administrator on 02/18/2025 at 12:30 PM, the Administrator said the Medical Director was informed of the outbreak. Interview attempt on 02/18/2025 at 1:40 PM with the Medical Director by telephone was unsuccessful. Interview conducted on 02/18/2025 at various times, 9:00am - 5:00pm, with (LVN S, CNA Y, CNA D, CAN S, RT O) revealed they were able to verbalize understanding of all in-services provided on hand hygiene, donning and doffing PPE, contact precaution and transmission-based precautions, and verified (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676064 If continuation sheet Page 8 of 9 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 676064 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Katy 1480 Katy Flewellen Katy, TX 77494 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 knowledge of systems in place as of 02/18/2025. Level of Harm - Immediate jeopardy to resident health or safety Interview conducted on 02/18/2025 at various time, the Housekeeping Supervisor and Housekeeping staff verbalized TBPs to prevent the spread of Candida auris. All were verbalized knowledge of cleaning schedules for residents affected by Candida auris and the requirement to clean and disinfect twice a day using EPA-approved disinfectants effective against Candida auris per the county health department recommendations. Residents Affected - Some Record review revealed Regional Nurse Consultant provided education on 02/15/2025, 02/16/2025, 02/17/2025, and 02/18/2025 provided to all staff on Candida auris (including background/definition, PPE & isolation protocols (including co-horting), disinfectant protocols, equipment/clothes/linen handling, meal service, and methods to prevent the spread of Candida auris). Record review revealed daily cleaning audits logs were being conducted as of 02/17/2025, by Housekeeping Supervisor. Record review of trainings revealed Regional Nurse Consultant provided 1:1 education with the IP B, Weekend RN Supervisor, and Administrator on 2/15/2025 on Candida auris, Infection Prevention Program Policy to include surveillance. Record review of clinical documentation revealed the Regional Nurse randomly selected residents revealed the families was educated on Candida auris and the prevention measures to be used when entering and exiting residents isolation rooms. The Facility Administrator and Regional Nurse Consultant was informed the Immediate Jeopardy was removed on 02/18/2025 at 1:30 p.m. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate and a scope of a pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676064 If continuation sheet Page 9 of 9