Inspection·March 13, 2024

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #2's admission MDS, dated [DATE], revealed a BIMS score of 15, indicating he was cognitively intact. His Behavioral Assessment indicated he had no changes in his behaviors. His Functional Status indicated he was independent in his ADLs except for bathing which required partial assistance. Review of Resident #2's care plan, dated 12/18/23, revealed he had not been placed at risk for inappropriate behaviors. Residents Affected - Few Review of Resident #3's undated admission Record revealed the resident was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included diabetes, prostate cancer, and presence of genital implants. Review of Resident #3's quarterly MDS, dated [DATE], revealed a BIMS score of 15, indicating he was cognitively intact. His Behavioral Assessment revealed no changes in his behaviors. His Functional Status indicated he required a wheelchair for mobility and he required partial assistance with most of his ADLs except eating and hygiene. Review of Resident #3's care plan, dated 12/11/23, indicated he had a behavior occurrence, with interventions including intervening as necessary to protect the rights and safety of others and monitoring of behaviors episodes to identify the underlying cause. Review of the facility's Provider Investigation Report revealed on 02/23/24 about 3:00 AM Resident #2 was observed exiting Resident #1's room and returning to his room. The CNA that observed this notified the nurse who entered Resident #1's room to find her in bed with her private area exposed. Resident #1 stated he took it off when asked why her brief was pulled down. Notifications were made to the DON and the Administrator. The DON questioned Resident #1 and asked if Resident #2 had tried to have sex with her, Resident #1 stated he tried but it was too tight. Resident #2 was placed on 1:1 observation and the police were called. The police interviewed Resident #1 and she denied anything had happened, so they opted not to press charges against Resident #2. Resident #1 was sent to the hospital for a SANE exam. The exam was not done because the family declined it, and there was not a police agency to take possession of any evidence collected. The resident was returned to the facility. Resident #2 was emergently discharged that same day. Interview on 03/12/24 at 9:10 AM the Administrator revealed he interviewed Resident #2, and he stated Resident #2 knew there had to be consent before he could do anything with another resident. Resident #1's ability to consent was questionable because of her BIMS score, she did not call out for help, and her story changed when the police questioner her. Safe Surveys of all residents revealed no other victims. The Administrator stated talking to Resident #2 was like talking to a [AGE] year-old. Interview on 03/12/24 at 11:35 AM, Resident #1 was hesitant to answer questions, even with a female surveyor present to interview her. Resident #1 stated she woke up to see an unknown male in her room, when he pulled the sheets back he thought he was a staff member coming to do a procedure. She did not object until he penetrated her vagina, at which time she told him to stop and get out of her room. Resident #1 stated he left her room in a hurry. Resident #1 stated she did not know something was wrong until she was repeatedly interviewed by multiple people. Resident #1 stated she just tries to put it out of her mind and not think about it. Interview on 03/12/24 at 12:24 PM, the Social Worker stated there had been multiple incidences of Resident #2 engaging in possibly inappropriate behavior with other female residents. Twice he was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 2 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 noted to kiss two female residents. He spent a lot of time in female resident rooms, would hold the hand of female residents in the hallway, and one incident of a female resident getting into his bed, fully clothed, while Resident #2 was in the shower. The Social Worker stated there had been multiple conversations with Resident #2 about appropriate behavior and personal space. She stated none of the incidences were reported because they involved residents that could consent. The only incident that involved someone not able to consent was the incident with Resident #1. Residents Affected - Few Interview on 03/12/24 at 12:50 PM, CNA A stated she had been walking down the 200 Hall around 3:00 AM on 02/23/24 to retrieve linen for a resident that had vomited in her bed when she observed Resident #2 leaving Resident #1's room in a hurry. When CNA A asked why he had been in Resident #1's room he seemed very nervous and stumbled over his words. Resident #2 finally stated his roommate needed to be changed. CNA A checked the roommate who denied needing to be changed. CNA A then went to Resident #1's room and observed Resident #1 exposed from the waist down, knees bent, and her brief around her ankles. CNA A notified the nurse and another CNA. After CNA A cleaned her resident up she was assigned to monitor Resident #2 1:1, which she did until the end of her shift. CNA A stated she had been told to keep an eye on Resident #2 when he was around female residents because he seemed to be too friendly with them. She stated she had never heard of Resident #2 being sexually inappropriate with anyone. Interview on 03/12/24 at 1:15 PM, LVN B stated she had been called to Resident #1's room on 02/23/24 about 3:00 AM. When she observed Resident #1 exposed she asked her what had happened. Resident #1 stated he did it, indicating the male who had just left her room. LVN B attempted to ask more questions but Resident #1 seemed to be in shock and did not want to talk about it. When she spoke to Resident #2, he seemed nervous but denied doing anything other than going into Resident #1's room. She notified the DON immediately. LVN B stated Resident #2 was known to go into female resident rooms and had been told not to do that, and their monitoring had never indicated anything inappropriate had occurred. Interview on 03/12/24 at 1:40 PM, RN C stated Resident #2 was known to kiss on female residents, hold their hands, spend a lot of time in female resident rooms. These actions had been reported to the DON when they occurred, but the DON stated as long as both residents were consenting, they couldn't stop them. Resident #2's behaviors were documented in the 24-hour logbook. RN C stated the staff knew Resident #2 needed to be monitored because he knew what he was doing, and he was moving from female to female trying to find one that would be receptive to his advances. Review of Resident #2's psychiatry note for 2/22/24 reflected the resident was being treated for depression, anxiety, and coping skills. No indication of inappropriate or sexual behaviors had been reported to the psychologist. Review of the 200 Hall 24-hour logbook for February 2024 indicated: 02/01/24 - [Resident #2]. Watch for kissing female residents 02/02/24 - [Resident #2] Watch for behaviors. Watch for physically being inappropriate with females 02/04/24 - [Resident #2] Watch from going closer to [Resident #4] 02/05/24 - [Resident #4] In [Resident #2's] bed fully dressed asked to return to room. [Resident #2] Monitor behaviors. Inviting [Resident #4] to bed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 3 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 02/06/24 - [Resident #4] Monitor behaviors. [Resident #2] Monitor behaviors Level of Harm - Immediate jeopardy to resident health or safety 02/07/24 - [Resident #4] Monitor behaviors [Resident #2] Monitor behaviors Residents Affected - Few Interview on 03/12/24 at 2:15 PM, the DON stated when the police had questioned Resident #2 he admitted to touching Resident #1 in the private area after she had touched him in his private area. When the police questioned Resident #1 and she told them nothing had happened, the police informed the DON they would not press any charges against Resident #2. Resident #1 was sent to the hospital for an exam and was returned to the facility without the exam being done. Resident #2 had been placed on 1:1 monitoring in the facility's conference room while the investigation was done, and he was discharged that same afternoon. The DON stated when she asked Resident #2 why he had gone to Resident #1's room at 3:00 am he stated he went to check on his friend. Interview on 03/12/24 at 2:30 PM, the Administrator stated he thought he had done everything he could do to protect the residents. He stated there was a current resident (Resident #3) who exhibited the same behaviors as Resident #2, and he had tried to discharge him. Resident #3 appealed the discharge and won because nothing physical had occurred by Resident #3. The Administrator stated that made them hesitant to discharge Resident #2 when he was admitted and began to exhibit the same behaviors as Resident #3. Review of the facility's policy Abuse and Neglect dated 10/15/22, reflected: The facility will ensure that each resident has the right to be free from, among other things, physical or mental abuse and corporal punishment. The facility will provide a safe environment and protect residents from abuse. Sexual abuse is defined as non-consensual sexual contact of any type with a resident On 03/13/24 at 10:45 AM, the Administrator was notified that an Immediate Jeopardy in the areas of Abuse, Neglect, and Exploitation. The facility submitted the following acceptable Plan of Removal on 03/13/24 at 1:48 PM: Survey (Complaint) - 03/13/2024

F 600 Freedom from Abuse and Neglect Plan 1. Resident #1 was assessed with no injuries noted from abuse on 2/23/24 by , [LVN B] 2. Safe Survey Checks - were conducted and completed on 2/23/2024 on all residents by Administration staff to assess, identify and prevent abuse. Re evaluated 3/13/24 on all res by Social service/Nursing to ensure inappropriate behaviors are being identified and initiate monitoring. 3. Medical Director notified. 4. Once identified behaviors monitoring sheets specific kissing, spending time in res room, hand holding will be immediately initiated 3/13/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 4 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 5. Staff will be in-serviced on this process 3/13/24. Level of Harm - Immediate jeopardy to resident health or safety a. Safe Survey Checks will be conducted by Administrative designees on random residents weekly for 30 days, then monthly thereafter. Any negative finding will be reported to the Administrator and acted on immediately. Residents Affected - Few 6. The Safe Survey Checks were reviewed and checked by the Administrator for any abuse or mistreatment of residents on 3/13/24 a. Safe Survey Checks will be reviewed by Administrator weekly for 30 days then monthly thereafter. Any negative finding will be acted upon immediately. 7. The Director of Nursing and Administrator will in-service all scheduled employees on abuse and mistreatment starting immediate 3/13/24. a. All remaining employees will be in-serviced on abuse or mistreatment of residents prior to shift start, by Administrative or designee by 3/13/24. a. The Director of Nursing and Administrator will in-service all scheduled staff starting on 3/14/2024 on abuse prevention program/ behavior monitoring. 3/13/24 b. All remaining employees will be in-serviced on abuse prevention program prior to the shift start and behavior monitoring, by Administrative or designee by 3/14/2024. a. Administrator/Designee will do random Audits of with residents behaviors sheets to monitor for behaviors, Daily and PRN Starting 3/13/2024 8. Any negative findings from the behavior observation will be acted on by the Administrator immediately then report findings to the Q.A.P.I. weekly for 30 days, then monthly thereafter. 9. Estimated completion date 3/14/2024. 10. Should a resident of informed capacity be observed engaging in a behavior that might have the potential to be considered inappropriate with a resident of uninformed capacity: That resident's behavior will be care planed for a meeting with administration / designee discussing acceptable behavior and informed consent. Clinical monitoring documented thru behavioral sheets will occur per shift until experiences discharge or a clinical change of condition which would revaluate their plan of care. Resident RP, MD will be notified. Resident will be referred to social services for psycho social and psychological assessment for intervention. Administration / DON / Designee will review behavioral sheets in Morning QAPI each business day. Should similar behaviors continue the resident will be subject to immediate discharge. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 5 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 11. The observed residents with uninformed consent Care Plan will be updated to reflect: Level of Harm - Immediate jeopardy to resident health or safety The observed issues identified with a resident of informed consent. Residents Affected - Few Resident will be referred to social services for psycho social and psychological assessment for intervention. RP, and MD notification. Administration / DON / Designee will review behavioral sheets in Morning QAPI each business day. Monitoring of the Plan of Removal continued and included interviews with staff on day and evening shifts. Interview on 03/13/24 at 2:00 PM, CNAD, dayshift, stated she had been in-serviced on abuse, neglect and exploitation. All touching that is not social was to be reported to the DON or the Administrator. She was to intervene by separating the residents. She was to observe residents that had entered other resident rooms, especially residents that were not cognitive. Interview on 03/13/24 at 2:13 PM, RN C, day shift, stated she had been in-serviced on behaviors, inappropriate behaviors such as kissing and hugging. She was to notify the DON or Administrator if she observed such behavior. She was to make sure the residents involved had their care plans updated to reflect the behaviors. If the behavior appeared not to be consensual, separate the residents and report it. Monitor resident that went into other resident rooms. Interview on 03/13/24 at 2:16 PM, CNA E, day shift, stated she had been in-serviced on sexual abuse and encounters, monitoring resident for inappropriate behavior. She was to make sure any interactions between residents was consensual and if not to notify the DON or the Administrator. Interview on 03/13/24 at 2:24 PM, CNA F, day shift, stated she had been in-serviced on sexual abuse and what to do if she observed any inappropriate behavior with residents that were not cognitively intact. Any inappropriate behavior was to be reported to the DON or the Administrator. Interview on 03/13/24 at 2:26 PM, CNA G, day shift, stated she had been in-serviced on abuse and inappropriate behaviors such as hugging and kissing. She was to separate the residents and report it to the DON or the Administrator. Interview on 03/13/24 at 2:50 PM, CNA H, evening shift, stated she had been in-serviced on sexual abuse and inappropriate behaviors such as kissing and hugging. Any such behaviors were to be reported to the DON or the Administrator. Interview on 03/13/24 at 4:14 PM, CNA I, evening shift, stated she had been in-serviced on abuse and inappropriate behavior such as inappropriate touching, kissing, etc. She was to separate the residents and notify the nurse, the DON, or the Administrator. Interview on 03/13/24 at 4:16 PM, CNA J, evening shift, stated she had been in-serviced on abuse and inappropriate behavior such as kissing or hugging between residents that appear non-consensual or inappropriate. She was to notify the DON or the Administrator. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 6 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 Interview on 03/13/24 at 4:20 PM, the Business Office Manager stated she had been in-serviced on abuse and inappropriate behaviors such as kissing or hugging between residents. If it seems inappropriate she was to notify the Administrator or the DON. Interview on 03/13/24 at 4:22 PM, the Business Office Assistant stated she had been in-serviced on abuse and inappropriate behavior such as hugging or kissing between residents. If it seemed inappropriate, she was to report it to the Administrator or the DON. Interview on 03/13/24 at 4:24 PM, the Admissions Director stated she had been in-serviced on abuse and inappropriate behaviors. She was to report any yelling, kissing, or touching between residents to the Administrator or the DON. Interview on 03/13/24 at 4:30 PM, the HR Director stated she had been in-serviced on abuse and inappropriate behavior. If she observed or suspected any abuse she was to report it to the Administrator or the DON. Interview on 03/13/24 at 4:38 PM, MA K, evening shift, stated she had been in-serviced on abuse and inappropriate behavior such as hugging and kissing between residents that did not appear to welcome the actions. Any suspected abuse was to be reported to the DON or the Administrator. Interview on 03/13/24 at 4:53 PM, RN L, evening shift, stated she had been in-serviced on abuse and inappropriate behavior such as touching, kissing, or hugging and she was to report any behavior to the DON or the Administrator. After the monitoring was completed, the Administrator was informed the Immediate Jeopardy was removed on 03/13/24 at 5:40 PM. The facility remained out of compliance at a severity level of Isolated and a scope of potential for more than minimal harm 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: 676101 If continuation sheet Page 7 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for 1 (Resident #2) of 5 residents reviewed for care plans. Residents Affected - Few The facility failed to ensure Resident #2's care plan included his behaviors and monitoring of his behaviors. An IJ was identified on 03/13/24. The IJ template was provided to the facility on [DATE] at 10:45 AM. While the IJ was removed on 3/13/24, the facility remained out of compliance at a scope of Isolated and a severity level of potential for more than minimal harm because all staff had not been trained on documenting inappropriate behavior. This failure could place residents at risk of inappropriate sexual behaviors from other residents. Findings included: Review of Resident #1's undated admission Record revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included Parkinson's Disease, stroke, and fluid on the brain. Review of Resident #1's quarterly MDS, dated [DATE], revealed a BIMS score of 7, indicating she was severely cognitively impaired. Her Functions Status indicted she require maximum assistance with toileting, and moderate assistance with bathing, hygiene, and dressing her lower body. Review of Resident #1's care plan, dated 12/22/23, revealed she was dependent on staff to meet her emotional, intellectual, physical and social needs related to cognitive deficits. Interventions included activities that do not involve demanding cognitive tasks. Resident #1 also had limited mobility related to Parkinson's. Family had requested no male residents in Resident #1's room and no sexual activity related to impaired cognition, with interventions including intervening as necessary to protect her rights and safety. Resident #1 also had impaired cognitive function related to her stroke. Resident #1 was being monitored for her psychosocial well-being related to alleged sexual contact. Review of Resident #2's undated admission Record revealed the resident was a [AGE] year-old male admitted on [DATE] with diagnoses that included heart failure, and diabetes. Review of Resident #2's admission MDS, dated [DATE], revealed a BIMS score of 15, indicating he was cognitively intact. His Behavioral Assessment indicated he had no changes in his behaviors. His Functional Status indicated he was independent in his ADLs except for bathing which required partial assistance. Review of Resident #2's care plan, dated 12/18/23, revealed he had not been placed at risk for inappropriate behaviors. Review of Resident #3's undated admission Record revealed the resident was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included diabetes, prostate cancer, and presence of genital implants. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 8 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of Resident #3's quarterly MDS, dated [DATE], revealed a BIMS score of 15, indicating he was cognitively intact. His Behavioral Assessment revealed no changes in his behaviors. His Functional Status indicated he required a wheelchair, for mobility and he required partial assistance with most of his ADLs except eating and hygiene. Review of Resident #3's care plan, dated 12/11/23, indicated he had a behavior occurrence, with interventions including intervening as necessary to protect the rights and safety of others and monitoring of behaviors episodes to identify the underlying cause. Interview on 03/12/24 at 12:24 PM, the Social Worker stated within a few weeks of Resident #2's admission staff began to report his behaviors of spending time with the female residents and holding their hands in the halls. The Social Worker stated there had been multiple conversations held with Resident #2 about appropriate behavior and personal space. Resident #2 indicted he understood each time but continued to have reports of inappropriate behavior with female residents of kissing, hugging, and spending time in their rooms. Staff observed Resident #2 but they never caught him doing anything with residents unable to consent. Interview on 03/12/24 at 1:40 PM, RN C stated reports of Resident #2 kissing other residents had been reported to the DON. The DON stated as long as both residents were consenting and able to consent, they had the right to have a relationship. Interview on 03/12/24 at 2:10 PM, the DON stated consenting cognizant residents had the right to develop relationships and Resident #2's actions had all been with consenting residents until the incident with Resident #1, so they had no reason to monitor his actions. The DON stated the MDS Coordinator was responsible for care plans and keeping them updated. Interview on 03/12/24 at 2:30 PM, the Administrator stated he was aware of Resident #2's penchant to hang around the female residents. The Administrator stated he had spoken with Resident #2 in the past about consent and who could consent, Resident #2 stated he understood. The Administrator stated he had no inclination that Resident #2 would escalate his behaviors like he had allegedly done with Resident #2. The Administrator stated he had another current resident (Resident #3) that had exhibited similar behaviors, but no physically inappropriate actions, and he had attempted to discharge that resident. The resident appealed the discharge and won, so the Administrator had no cause to discharge Resident #2 for the same behaviors until he crossed the line. Interview on 03/12/24 at 3:45 PM, the MDS Coordinator stated she was responsible for creating the comprehensive care plan based on the MDS assessment. Updates to the care plan were made when she was notified during morning meetings. The MDS Coordinator stated she was unaware of Resident #2's behaviors, only Resident #3's and that was why Resident #3's behaviors were added to his care plan. On 03/13/24, the Administrator was notified that an Immediate Jeopardy in the area of Comprehensive Resident Centered Care Plan. The facility submitted the following acceptable Plan of Removal on 03/13/24 at 1:48 PM: Survey (Complaint) - 03/13/2024

F 656 Comprehensive Care Plan (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 9 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 0656 Plan Level of Harm - Immediate jeopardy to resident health or safety 1. Resident #1 was assessed with no injuries noted from abuse on 2/23/24 by, [LVN B] Residents Affected - Few 2. Safe Survey Checks - were conducted and completed on 2/23/2024 on all residents by Administration staff to assess, identify and prevent abuse. Re evaluated 3/13/24 on all res by Social service/Nursing to ensure inappropriate behaviors are being identified and initiate monitoring. 3. Medical Director notified. 4. Once identified behaviors monitoring sheets specific kissing, spending time in res room, hand holding will be immediately initiated 3/13/24. 5. Staff will be in-serviced on this process 3/13/24. a. Safe Survey Checks will be conducted by Administrative designees on random residents weekly for 30 days, then monthly thereafter. Any negative finding will be reported to the Administrator and acted on immediately. 6. The Safe Survey Checks were reviewed and checked by the Administrator for any abuse or mistreatment of residents on 3/13/24 a. Safe Survey Checks will be reviewed by Administrator weekly for 30 days then monthly thereafter. Any negative finding will be acted upon immediately. 7. The Director of Nursing and Administrator will in-service all scheduled employees on abuse and mistreatment starting immediate 3/13/24. a. All remaining employees will be in-serviced on abuse or mistreatment of residents prior to shift start, by Administrative or designee by 3/13/24. a. The Director of Nursing and Administrator will in-service all scheduled staff starting on 3/14/2024 on abuse prevention program/ behavior monitoring. 3/13/24 b. All remaining employees will be in-serviced on abuse prevention program prior to the shift start and behavior monitoring, by Administrative or designee by 3/14/2024. a. Administrator/Designee will do random Audits of with residents behaviors sheets to monitor for behaviors, Daily and PRN Starting 3/13/2024 8. Any negative findings from the behavior observation will be acted on by the Administrator immediately then report findings to the Q.A.P.I. weekly for 30 days, then monthly thereafter. 9. Estimated completion date 3/14/2024. 10. Should a resident of informed capacity be observed engaging in a behavior that might have the potential to be considered inappropriate with a resident of uninformed capacity: That resident's behavior will be care planed for a meeting with administration / designee (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 10 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 0656 discussing acceptable behavior and informed consent. Level of Harm - Immediate jeopardy to resident health or safety Clinical monitoring documented thru behavioral sheets will occur per shift until experiences discharge or a clinical change of condition which would reevaluate their plan of care. Resident RP, MD will be notified. Residents Affected - Few Resident will be referred to social services for psycho social and psychological assessment for intervention. Administration / DON / Designee will review behavioral sheets in Morning QAPI each business day. Should similar behaviors continue the resident will be subject to immediate discharge. 11. The observed residents with uninformed consent Care Plan will be updated to reflect: The observed issues identified with a resident of informed consent. RP, and MD notification. Resident will be referred to social services for psycho social and psychological assessment for intervention. Administration / DON / Designee will review behavioral sheets in Morning QAPI each business day. Monitoring of the Plan of Removal continued and included interviews with the DON and the MDS Coordinator regarding monitoring of care plans. Interview on 03/13/24 at 3:00 PM, the DON stated she would complete the in-service on care plans with the MDS Coordinator as she was the only nurse to make changes to the care plans. Interview on 03/13/24 at 3:45 PM, the MDS Coordinator stated she had been updated by the DON about keeping care plans up to date as soon as she was made aware of changes in the morning meetings. Review of Resident #3's updated care plan revealed a focus of the resident significantly intruding on the privacy of others. Going into other residents rooms and attempts to touch/kiss female residents Interventions included Redirect, and monitor resident location and 30 day discharge if needed Review of the facility's policy Care Plans, Comprehensive Person-Centered, dated December 2016, reflected: .1. The Interdisciplinary Team (IDT) in conjunction with the resident and his/her family develops and implements a comprehensive person-centered care plan for each resident. .8. g. Incorporate identified problem areas. 9. Areas of concern that are identified during the resident assessment will be evaluated before interventions are added to the care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676101 If continuation sheet Page 11 of 12 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 676101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgmar Medical Lodge 6600 Lands End Court Fort Worth, TX 76116 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 0656 .14. The IDT must review and update the care plan: Level of Harm - Immediate jeopardy to resident health or safety a. When there has been a significant change in the resident's condition. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete The Immediate Jeopardy was removed on 03/13/24. While the Immediate Jeopardy was removed on 03/13/24, the facility remained out of compliance at a scope of pattern and a severity of potential for more than minimal harm due to the facility's need to evaluate the effectiveness of the corrective systems of the plan of removal. Event ID: Facility ID: 676101 If continuation sheet Page 12 of 12