Health inspection·January 9, 2026

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few exhibit appropriate behaviors within the Nursing Home. LBSW will encourage (Resident #1) to exhibit appropriate behaviors towards Staff and other Residents. LBSW will encourage (Resident #1) to verbalize in a calm, and appropriate manner his feelings, thoughts, needs, problems, concerns, etc., within the Nursing Home. LBSW will provide linkage to Resources/Referral Agencies as needed within the Nursing Home. Review of the progress notes for Resident #1 from 12/05/2025 to 12/08/2025 reflected the following:*12/06/2025 at (12:16 AM) written by LVN F Pt became extremely agitated and attempted to go out for a cigarette at 00:16. SN attempted to redirect pt. with little success. Offered snacks and diversion to behavior. Raised voice pushed W/C into wall. Pt settled and was assisted with snacks and drinks back to his room. He believes he can go out at all hours of the NOC. Re-educated about appropriate schedule smoke break times. (FM) suppose to visit on Sat.12/6/2025 to bring belongings and cigarettes for this resident. *12/06/2025 at (12:21 PM) written by LVN B This nurse discussed resident's recent behaviors/outbursts with FM and family. Resident's (FM) stated, anytime he is acting out just call me and he will settle down. (FM) stated that resident eats a lot and needs larger portions. (FM) gave permission to d/c order for nicotine patch due to resident unable to smoke when he was in the hospital. Family provided nursing staff with more cigarettes for resident. (FM) also requested that resident have lab work done (CBC (type of blood test measuring the number of certain blood cell types)), CMP (type of blood test measuring metabolic function), HGBAIC (blood test that measures the level of sugar in your blood over the previous three months), VALPROIC ACID (sedative medication used for seizures and agitation)) to check levels. (FM) explained that resident responds better to being called, (Resident #1 nickname). *12/08/2025 at (02:05 PM) written by LBSW On this date, Administrator, reported for LBSW to see if we can get Resident, (Resident #1) accepted into (Behavioral Hospital) in (city, state), for he has been having behaviors within the Nursing Home. Administrator, reported he will call his (FM) to let her know that Resident, (Resident #1) is in need of going to (Behavioral Hospital) in (city, state) due to his behaviors. Therefore, LBSW contacted (Behavioral Hospital) in (city, state) and talked to Admissions and she suggested to have the required paperwork sent to their email address: Therefore, Resident, (Resident #1) paperwork was sent to their email address for (Behavioral Hospital) in (city, state) to see if they will accept Resident, (Resident #1) admission. Later, LBSW received a call from Admissions (staff) at (Behavioral Hospital) in (city, state) Admissions asked if Resident, (Resident #1) is ambulatory, and can he do his own ADLs, and LBSW informed her that Resident, (Resident #1) walks and he does his own ADL's. Therefore, Admissions (staff) reported that they have accepted Resident, (Resident #1) into (Behavioral Hospital) in (city, state). Therefore, LBSW traveled to County Courthouse and visited with Judge and he signed the Emergency Detention forms as required, at this time. Therefore, ([NAME] agent) transported Resident, (Resident #1) to (Behavioral Hospital) in (city, state). LBSW called (Behavioral Hospital) in (city, state) and informed Admissions (Staff) that County Officer, ([NAME] agent) is transporting Resident, (Resident #1) and enroute to (Behavioral Hospital) at this time. Also, informed Admissions (staff) that ([NAME] agent) has the required Emergency Detention Paperwork, and all other paperwork as needed. LBSW offered support and offered any assistance needed. Review of the behavioral health hospital records for Resident #1 dated 12/23/2025 reflected he was continuing with angry behavior and had to be monitored for aggression but was ready for discharge. Review of physician orders for Resident #1 with a date range of 12/05/2025 to 12/31/2025 reviewed on 01/08/2026 reflected no order related to Resident #1's discharge. Review of assessments for Resident #1 from 12/05/2025 to 12/31/2025 reflected no discharge assessment or summary signed by a physician. Review of miscellaneous documents for Resident #1 from 12/05/2025 to 12/31/2025 reflected no discharge summary or discharge order signed by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676086 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676086 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldthwaite Health & Rehab Center 1207 S Reynolds St Goldthwaite, TX 76844 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few a physician. During an interview on 01/08/2026 at 09:30 AM, the ADM stated Resident #1 arrived on a Friday (12/05/2025), and they had a horrible weekend with his behaviors. The ADM stated he was getting calls from residents and their families that they would have to leave the facility if the behavior continued. He stated Resident #1 was refusing his medications and would not calm down. He stated the behavior was going on all hours of the night and day. He stated they finally sought a Peace Officer Emergency Detention from law enforcement and Resident #1 was taken to the behavioral health hospital. The ADM stated they were planning to admit him back once his medications were sorted out, but the behavioral health hospital reached out to them stating he was ready for discharge from their facility on 12/22/2025, and the clinical paperwork received from the behavioral health hospital still included similar behaviors occurring on 12/23/2025, so they did not feel it was safe to accept him back. The ADM stated they had a very quiet, older population, and Resident #1 should have gone to a facility with younger residents, more liberal smoking rules, and more residents with psychiatric issues. The ADM stated the referring hospital did not tell them the whole story, so they did not know they were admitting someone with the types of anger issues Resident #1 had. The ADM stated he spoke with the ombudsman about the situation, and she had told him she understood. He stated she provided him with a list of facilities that might accept Resident #1 and be a more suitable fit for him. He stated he had spoken to a couple of facilities after he had determined they could not readmit Resident #1 to help the behavioral health hospital find a suitable placement for him, and he had selected one alternate facility that was ready to accept Resident #1 once the ADM sent over his referral paperwork. The ADM stated he called Resident #1's FM to get her permission to send the paperwork, but she never returned his call. He stated he called her at least twice and did not have an email address for her. He stated after that, he had learned from the behavioral health hospital that the family decided to care for Resident #1 in the community/at home, so he stopped working on it. He stated this investigation was the first he had heard about it in two weeks. During an interview on 01/08/2026 at 12:31 PM, the MD stated she had not seen Resident #1 in person, because he was only at the facility over one weekend before being sent out. She stated he was sent to the behavioral health hospital. She stated that she had reviewed the notes and the behavioral health hospital notes and did believe that Resident #1 was a danger to other residents in the facility. She stated there was a danger of psychosocial harm from his verbal aggression and behaviors of slamming things down, pushing things off surfaces, and other types of physical aggression. She stated he could also escalate to physical aggression since he already demonstrated these other forms of aggression. She stated she regularly signed discharge summaries and was not sure why she was not asked to sign a discharge summary for Resident #1, but if she had received the paperwork, she would have signed it. She stated this was the first situation they had experienced at the facility like this, and it was because the referring hospital was not honest on his referral paperwork. She stated the facility would not have admitted him if the hospital had charted his behaviors honestly. During an interview on 01/08/2026 at 02:55 PM, LVN A stated many of the other residents were nervous around Resident #1 and did not feel comfortable with him due to his outbursts. She stated he himself voiced the facility was not a good place for him, because it had an older population and a quiet, peaceful environment. He would threaten to beat people up if he did not get to smoke whenever he wanted to. She stated he became physical with items on the halls and was throwing items down and slamming his hand on things. During an interview on 01/08/2026 at 03:09 PM, LVN B stated Resident #1 got ugly with the med aide on 12/07/2025 and he threatened to throw everything and was up and down the hallway yelling he was going to beat somebody's effing ass. She stated the residents were calling their RPs and telling them they were scared. She stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676086 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676086 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldthwaite Health & Rehab Center 1207 S Reynolds St Goldthwaite, TX 76844 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few they had admitted a new resident the day this was going on, and it was scary for the new resident for that to be the first thing they saw. She stated they had to corral all the residents to stay in their rooms while he was doing this, because they did not know what he could do if any residents got in his way. A telephone interview with the LBSW was attempted on 01/08/2026 at 03:15 PM. A voicemail was left with no reply as of 01/16/2026. During an interview on 01/09/2026 at 08:18 AM, CNA E stated she monitored Resident #1 during smoke breaks for the weekend he was in the facility. She stated he frequently got irritated, yelled, and cussed. She stated some of the residents were intimidated by him and did not go out to smoke while he was out there. She stated they generally had a very peaceful environment at the facility, and Resident #1's behaviors stood out. She stated they received lots of training on managing aggressive behavior, but none of the methods worked with Resident #1. During an interview on 01/09/2026 at 08:24 AM, MA C stated she worked the weekend Resident #1 was in the facility. She stated he was very demanding and if he was not given what he wanted, he would go into a cussing fit and slam his hand down on the medication cart or something else. MA C stated the charge nurse over the weekend was worried about her safety and after he was going to hit MA C. MA C stated she was not as afraid, but she did move into the nurse's station when the charge nurse (LVN B) asked her to instead of remaining by the medication cart. During an interview on 01/09/2026 at 10:33 AM, MA D stated she worked as the medication aide on 12/08/2025 when Resident #1 was sent to the behavioral health hospital. She stated all the residents were very upset that day, as he was loud, obnoxious, and aggressive. During an interview on 01/09/2026 at 10:52 AM, the ADM stated he did not know they had to get a signature from the physician on the documentation that explained the basis for the emergency discharge. He stated he felt confident that Resident #1 was not safe to be in the facility, but he was not aware of all the documentation requirements. He stated he had been the DON at the facility for ten years and had just started as the administrator a few months prior and was still learning. He stated the DON was the person responsible for ensuring all the aspects of the discharge process were compliant. He stated he monitored for compliance by reviewing every resident who went to the hospital, discharged home, expired, or transferred. He stated he did not think the failure to obtain a physician signature on the documentation for the emergency discharge would affect a resident, but it did make an incomplete medical record. During an interview on 01/09/2026 at 10:59 AM, the DON stated she had started in her position on 11/10/2025 and was still learning. She stated the person responsible for making sure the discharge process was compliant was her and the ADM as a backup. She stated she ensured compliance by making sure everything in the chart was reviewed and sent to interested parties as needed. She stated she could not think of the potential negative outcome of not having a physician signature on the documentation for emergency discharge, but it put them out of compliance. During an email interview on 01/09/2026 at 11:10 AM, Resident #1's FM stated she would not want Resident #1 to return to the facility. During a telephone interview on 01/09/2026 at 12:00 PM, Resident #1 stated he did not want to return to the facility and did not belong there. He stated he was doing well in a rental near his family, and they checked on him. He stated he was able to take care of his own ADLs and his family made sure he took his medications. He stated he was safe and comfortable where he was. Review of In-services from October 2025 through January 2026 reflected the following: Handling aggressive behavior 10/06/2025, 10/11/2025, and 10/28/2025. Review of facility policy dated October 2022 and titled Transfer or Discharge, Facility-Initiated reflected the following: Policy StatementOnce admitted to the facility, residents have the right to remain in the facility. Facility-initiated transfers, and discharges, when necessary, must meet specific criteria and require resident/representative notification and orientation, and documentation as specified in this (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676086 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676086 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldthwaite Health & Rehab Center 1207 S Reynolds St Goldthwaite, TX 76844 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete policy.Policy Interpretation and Implementation 1. Each resident will be permitted to remain in the facility, and not be transferred or discharged unless:c. The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;Notice of Transfer or Discharge (Emergent or Therapeutic Leave)3. Under the following circumstances, the notice is given as soon as it is practical, but before the transfer or discharge: A. The health and/or safety of individuals in the facility would be endangered due to the clinical or behavioral status of the resident;Notice of Discharge after TransferIf discharge is initiated by the facility after an emergency transfer to the hospital, the reason for discharge is based on the residence status at the time the residence seeks returned to the facility not at the time the resident was transferred to acute care.Documentation of Facility-Initiated Transfer or Discharge1. When a resident is transferred or discharged from the facility, the following information is documented in the medical record:a. The basis for the transfer or discharge;3. Should the resident be transferred or discharged for any of the following reasons, the basis for the transfer or discharge will be documented in the residence clinical record by a physician:A. The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident. Event ID: Facility ID: 676086 If continuation sheet Page 5 of 5