Health inspection·October 7, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few investigation report dated 11/26/24 indicated on 11/19/24 Resident #1 had a fall and had initial signs of a laceration to her nose. Resident #1 was having significant pain and EMT's isolated her neck with a collar then transferred her by board to stretcher. The Administrator and DON interviewed CNA A. CNA A explained that she transferred Resident #1 from the bed to the chair, with one assist per plan of care. CNA A said Resident #1 leaned forward. CNA A was unable to stabilize the resident and she fell forward to floor. The investigation indicated that a gait belt was not in use at time of transfer. Resident #1 received a C-1 and C-2 fracture and will be required to wear a neck brace for a period of time. During an interview on 10/06/25 at 03:56 p.m. LVN B said she was coming on shift when the incident involving Resident #1 occurred. She said CNA A called and said she needed assistance to transfer Resident #1 so she and the night shift nurse went down to the room and Resident #1 was on the floor. She said CNA A said Resident #1 started falling and she tried to catch her. LVN B said Resident #1 had a cut on her nose. LVN B said Resident #1 complained of pain so EMS was contacted to send her to the hospital. LVN B said Resident #1 complained of pain to her neck when EMS arrived so they put a cervical collar on her. LVN B said she was contacted by Resident #1's family that she was being care flighted to another hospital due to a broken neck. She said Resident #1 usually was a 2-person transfer. She said a gait belt should always be used with 1 or 2 person transfers. During an interview on 10/06/25 at 04:32 p.m., the ED said CNA A was transferring Resident #1 without using the gait belt and a second staff on 11/19/24. She said Resident #1 fell forward hitting her face. She said the resident complained of pain and was sent to the local hospital emergency room. She said the family notified the facility the resident was being sent to another hospital because her neck was broken. She said CNA A was suspended from 11/19/24 through 11/26/24 and allowed to return to work after she received 1:1 training on gait belt use and transferring residents. She said all staff were trained on transfers with gait belt when hired. During an observation and interview on 10/07/25 at 02:25 p.m. Resident #1 was in her room sitting up in her chair. She was clean, neatly groomed, and had no offensive odors. She was not able to turn her head completely to the left to look at surveyor. She was not wearing a collar at the time. She said she was doing fine. She said the girl was helping her to go to the bathroom and she fell hurting her neck. She said she only had to wear the collar sometimes especially if she was riding in a vehicle. She said there are 2 staff that help her transfer and they put a belt on her. Record review of a Procedural Guideline #39-Assisting Resident to Transfer to Chair or Wheelchair revised 01/22 indicated 1. Purpose: To transfer resident to chair or wheelchair without trauma or avoidable pain. 2. Guidelines and Precautions for Moving an Lifting Residents:.C. Request assistance as needed prior to the move and use good body mechanics.4. Assisting Resident to Transfer to Chair or Wheelchair using Transfer Belt:.B. Show the resident the transfer belt and explain its use as a safety device. C. Apply the transfer belt over the resident's clothing around the waist and check the fit by inserting your fingers under it.E. Grasp the transfer belt with an under-hand grip and move the resident forward so his or her feet are flat on the floor.The surveyor attempted to contact CNA A for an interview on 10/07/25 10:45 a.m. There was a provider message saying the customer you are trying to reach was either restricted or unavailable. Surveyor was not able to leave a message for the CNA. On 10/07/25, the surveyor confirmed the facility implemented appropriate measures to ensure the safety of residents after the incident on 11/19/24 involving Resident #1 by: Record review of an Educational Summary Report dated 11/19/24 indicated staff were in-serviced regarding transfers and gait belt use.Record review of an In-Service Training Report dated 11/25/24 indicated staff were in-serviced regarding transfers and gait belt use.Record review of an In-Service Training Report dated 11/26/24 indicated CNA A had 1:1 training regarding transfers and gait (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676109 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Calder Woods 7080 Calder Beaumont, TX 77706 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few belt use. Record review of an In-Service Training Report dated 12/05/24 indicated staff were in-serviced regarding transfers and gait belt use.Record review of Proficiency Trainings provided to staff upon hire and annually which included training on Transferring Residents, Use of Gait Belt with Transfers, and Abuse and Neglect.Record review of Proficiency Trainings provided to staff upon hire after the incident on 11/19/24 which included training for transfers and gait belt use received by MA E; CNA F and CNA G; and LVN C and LVN D. Record review of an In-Service on 11/19/24 after the incident on 11/19/24 included training for transfers and gait belt use received by LVN H, CNA J, CNA K, CNA L, CNA M, and CNA N.Record review of an In-Service on 11/25/24 after the incident on 11/19/24 included training for transfers and gait belt use received by CNA M, CNA N and CNA O.Record review of an In-Service on 12/05/24 after the incident on 11/19/24 included training for transfers and gait belt use received by LVN H, CNA J, CNA M, CNA N and CNA O.During an interview and record review on 10/06/25 at 02:16 p.m. indicated the Incident log from 11/19/24 through 10/07/25 there were 6 falls with injuries but only one of the falls with injury resulted in a fracture, Resident #1's fall. The DON said the other 5 injuries were bruises, abrasions, and skin tears. Observation of staff with transfer of Resident #2 on 10/06/25 at 02:34 p.m. indicated staff used 2 person for transfer and a gait belt was used. There were no observed concerns with transfer assistance. During an interview on 10/06/25 at 01:18 p.m. CNA J, CNA K, CNA L, CNA O, and CNA P said they worked the 06:00 a.m. to 06:00 p.m. shift. They said they were trained on gait belt use and transfers. They verbalized understanding of how to use the gait belt during a transfer. They said a manual transfer was 1 or 2 person depending on the residents' needs. During an interview on 10/06/25 at 01:35 p.m. LVN R said she was an agency nurse, She said she filled in 06:00 a.m. to 06:00 p.m. and 06:00 p.m. to 06:00 a.m. shifts at times. She said she received training on transfers and gait belt use with her staffing agency. She said all residents with manual transfers with 1 or 2 staff were to use a gait belt. She said she could find the information as to how many staff were needed to transfer a resident by looking in the resident chart or she could ask the staff working with the residents. During an interview on 10/06/25 at 01:45 p.m. MA E said she received training when hired on transfers and using a gait belt. She verbalized understanding of how to use the gait bet and how to properly transfer a resident using 1 or 2 staff members.During an interview on 10/06/25 at 03:56 p.m. LVN B said she received training on transfers and using a gait belt a couple of times after the incident on 11/29/24. She verbalized understanding of how to use the gait bet and how to properly transfer a resident using 1 or 2 staff members. During a phone interview on 10/07/25 at 07:00 a.m. LVN D said she received training when hired on transfers and using a gait belt. She verbalized understanding of how to use the gait bet and how to properly transfer a resident using 1 or 2 staff members.During a phone interview on 10/07/25 at 07:06 a.m. CNA N said she received training on transfers and using a gait belt several times after the incident on 11/29/24. She verbalized understanding of how to use the gait bet and how to properly transfer a resident using 1 or 2 staff members.During a phone interview on 10/07/25 at 07:07 a.m. CNA M said she received training on transfers and using a gait belt several times after the incident on 11/29/24. She verbalized understanding of how to use the gait bet and how to properly transfer a resident using 1 or 2 staff members.During a phone interview on 10/07/25 at 07:13 a.m. LVN C said she received training when hired on transfers and using a gait belt. She verbalized understanding of how to use the gait bet and how to properly transfer a resident using 1 or 2 staff members.During a phone interview on 10/07/25 at 07:35 a.m. CNA F said she was trained when hired on transfers and using a gait belt. She verbalized understanding of how to use the gait bet and how to properly transfer a resident using 1 or 2 staff members.During a phone interview on 10/07/25 at 10:50 a.m. CNA Q said she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676109 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676109 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Calder Woods 7080 Calder Beaumont, TX 77706 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 0689 Level of Harm - Immediate jeopardy to resident health or safety received training on transfers and using a gait belt several times after the incident on 11/29/24. She verbalized understanding of how to use the gait bet and how to properly transfer a resident using 1 or 2 staff members.The noncompliance was identified as PNC. The Immediate Jeopardy began on 11/19/24 and ended on 12/05/24. The facility had corrected the noncompliance before the investigation began. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676109 If continuation sheet Page 4 of 4