Health inspection·May 30, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm active 03/31/23) and her medical director was MD F (date active 04/12/23). It also reflected that she had two family members as her essential caregivers and contacts. Neither of those family members were designated power of attorney by the facility. Review of the Resident #1's clinical chart revealed no evidence of a medical power of attorney. Residents Affected - Few Review of Resident #1's clinical chart from March 2022 through May 2023 (including nursing notes, medication/lab/x-ray orders and emergency notification for change in conditions from March 2022 through May 2023), reflected that MD E was the previous attending physician until 05/24/22, when he issued Resident #1 a discharge from services letter. Additionally, there was no documentation by the facility or physician in Resident #1's medical records to indicate any conflict with the family, conflict relating to medications or course treatments made by the family members or conflicts in care with PHY D. Review of MD E's discharge letter dated 05/24/22 reflected, An effective patient-physician relationship is essential to providing good primary care. Based on recent and on-going events, it is clear the therapeutic relationship we shared no longer exists. As a result of this, I can no longer serve as your physician. Therefore, effective 30 days after the date of this letter, our patient-physician relationship will terminate. You will need to discuss with Crestview Court which other primary care physicians in the facility are available to attend to your regular healthcare needs. Moreover, my services to you will be available only for emergency purposes during the next 30 days. I recommend you establish care with a new provider as soon as possible and continue to receive healthcare services. [Signed MD E]. An interview with Resident #1's family member on 04/27/23 at 9:13 AM revealed there had been four facility-initiated discharge notices given to Resident #1 and her responsible parties due to the facility not having a doctor available to provide medical care, all which went to a hearing and were overturned by the hearing officer. The family member said the facility had stated that since Resident #1 did not have an attending physician anymore in the facility, but still had a primary care physician in the community, then they would contact that physician for routine visits and emergencies. However, if he was not reachable, they told the family member they would send Resident #1 to the hospital emergency room. The family member stated, I know part of the state and federal regulations states they have to have a physician. The family member said there had been several incidents with MD E, but there was one in particular where he failed to prescribe an antibiotic when she had double pneumonia. The family member said the facility had done an -x-ray on Resident #1 and MD E was aware of the results, but he did not start her on any antibiotics. The family member said MD E told the family he overlooked it because he was reading the x-ray results on his phone. The family member stated he/she was upset and told MD E that was no excuse and he could have killed Resident #1. A complaint was lodged with HHSC and an investigation was conducted and the family member stated MD E was upset that a complaint on him had been made. The family member stated there was another time MD E was negligent of providing standard care to Resident #1 around late September 2021 when the facility nurses and MD E did not notice that the resident had an infected toe down to the bone. The family member stated that HHSC ended up completing an investigation in April 2022 related to the complaint and cited/fined the facility and they were angry. On 05/26/22, The family member stated on 5/26/22 the facility ADM notified the RP that MD E was terminating his care due to an HHSC P1 complaint being lodged against him. The family member stated, He [MD E] did not want to own up to his mistakes and would only provide emergency care. The family member stated, They tried to put her out three or four times. They are saying it is because she doesn't have a physician. It is against state and federal laws. [Ombudsman] has drilled this over and over at the hearings. The family member stated 05/26/22 was when the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 2 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility issued the first discharge notice and as soon as the hearing officer ruled for Resident #1 to stay, the facility kept issuing more discharge notices. The family member felt like the situation was [NAME] to harassment. The family member said Resident #1 did have a doctor in the community, PHY D, who would always see her if needed, but the facility tried to say during the discharge hearings that he was going to be her attending physician, which was a lie. The family member said the same thing kept being brought up at each discharge hearing, but PHY D never agreed to be the attending physician. The family member stated, I mean this, god forbid something happens to [Resident #1] without physician care. It is to the point where they are harassing her. They are upset because of what had transpired starting with the toe thing. The family member also felt the facility was retaliating against the family and Resident #1. The family member stated that she received an email (no date given) from the ADM that was very concerning where it was said that PHY D would be her attending physician and they could reach him up to 7 pm or 8 pm at night, but after that time, they would contact a new assistant doctor at another facility to see her on an emergency basis. The family member stated, So in essence, [Resident #1] doesn't have a physician. I am so worried, you are going to just sit there and let her die or not render aid. I pray to god nothing happens. The family member said prior to MD E stopping his services for Resident #1, he had been her physician since 2016. Now, the family member stated on a day-to-day basis, no physician was overseeing her care. The family member said the facility claimed they had contacted other doctors to be the attending physician for Resident #1 but the said no. The family member said one of the doctors asked by the facility to be Resident #1's attending physician worked with MD E and the family member felt MD E told that potential doctor a lot of negative things about Resident #1 and the family, which caused that doctor to say no, even though he had never seen Resident #1. The family member said after the most recent attempt to discharge Resident #1 in 2023 due to the facility stating she did not have an attending physician, the family appealed and won, however, the family was notified after that that MD E would not even provide care for emergencies for Resident #1. The family member said PHY D had been Resident #1's outside physician during the seven years she had been at the facility and she periodically went to see him during those years because she was comfortable with him, but not for everyday care. The family member stated the Ombudsman would say the situation was retaliation and even the disability lawyer at the hearing said it was retaliation. The family member stated, They want her out, [MD E] got in trouble, I do not trust them, this doctor thing is huge, god forbid somethings happens to my [Resident #1] and she doesn't have the care. This is very hurtful for [Resident #1], she feels like they don't want her there. Her friends are there, that is all she knows. Review of an email exchange provided by Resident #1's family member to the facility's DON, ADM, Ombudsman, VP of Clinical Operations, VP of Operations dated 04/12/23 reflected, We are requesting that the new co medical director [MD F} be designated as [Resident #1]'s attending physician. The ADM responded back to the family member on 04/12/23, [MD F] does not want to be attending, sorry. I asked him and he emailed saying he didn't want to. An interview with the local Ombudsman on 04/27/23 at 4:41PM revealed the facility had not issued a subsequent discharge notice to Resident #1 since the last hearing on 03/30/23, however, subsequent to the hearing and after the hearing decision was issued, the facility issued another email indicating they did not have a doctor for Resident #1. The Ombudsman stated, The facility keeps doing this because he doesn't want to be the attending, which he has the right to be. The other doctor there, he doesn't want to do it because of the consultation with [MD E]. At the end of the day, the resident needs an attending physician. Her doctor, who she has seen in the community for years, he does not want to be credentialed by the facility. The Ombudsman said there had been a recent communication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 3 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few in the past couple of weeks where the ADM stated the facility had a new co-medical director [MD F]. The family responded saying they were okay with that new co-medical director being Resident #1's attending physician, but the response from the facility was that he did not want to do it. The Ombudsman stated the situation was bordering on discrimination and she was concerned Resident #1 was going to be discriminated against if she ever did have to move to other facilities in the metroplex where MD E and MD F had affiliations directly or with other doctors in their practice. The Ombudsman stated, I didn't find anything in the regs that residents can be discharged because a doctor doesn't want to provide care. That's why we are back to the regs. They are responsible for providing an attending physician. Who is overseeing her medical care now? Who is writing orders for her? The Ombudsman said after 03/30/23 when the hearing officer reversed the facility's action related to discharge, Resident #1's two RP's were sent an email from the ADM informing them that if any emergencies happened to Resident #1, they would contact PHY D or send Resident #1 to the hospital ER for treatment and the staff had been informed to contact the family if they were unable to contact the outside physician. At that time, the facility requested a care plan meeting to ensure everyone was on the same page. The Ombudsman said that email was sent on 03/30/22 and then the vice president of operations responded in an email to the RPs that the facility had not heard back from them regarding the care plan meeting about the physician issues and that MD E would no longer be the physician, even for emergency situations. The email also stated, per the Ombudsman, We have attempted to find another physician but were unsuccessful. You have identified [PHY D] as attending of choice, this includes after business hours. At this time [PHY D] has not provide us with after-hours information. The Ombudsman said that meant any emergencies for clinical issues would be to contact PHY D and if no response, then send Resident #1 to the hospital. The Ombudsman said the family did not know what to do because they had no opposition to any of the doctors at the facility being the attending physician because the resident must have an attending in the nursing home. So the issue then is back to the resident does not have a doctor available to oversee her care while in the nursing home. The Ombudsman said there was another email from the ADM dated around 04/10/23 where she notified Resident #1's RPs that MD F agreed to see her for emergencies only when the attending is not available and had agreed to speak with the POA if any emergencies come about and the DON had reached out to PHY D who agreed to see Resident #1 twice a month, do health and physical assessments, and progress notes and would be available until 8pm, and provided an after-hours number, but we still want a care plan meeting to discuss any issues. However, further inquiry by Resident #1's RPs to PHY D revealed he did not agree to any of that. On 04/12/23, Resident #1's RPs notified the DON that PHY D did not agree to anything and requested the new co-medical director [MD F], be designated as her attending physician but was told in writing by the ADM that he did not want to be. The Ombudsman stated, So we have a resident in the building with no attending physician; a [AGE] year-old resident, been there 7 years, no issues with the resident, only with the family. They [facility] have to work with them, there is no threat on life, so where are you going to discharge her to? I am telling you, this I reaping of discrimination. The Ombudsman said she went through Resident #1's clinical chart for the appeal hearing and there was no documentation from MD E to indicate he was going to terminate his relationship with her, which was brought up in the hearing, only a letter was issued, but nothing in the chart, nothing documented. The Ombudsman said she told Resident #1's RP that if MD E did not want to provide care or services, the regulations allowed that. However, that was not the issue, the issue was the regulation that the facility provided a doctor for Resident #1, The facility must assist the resident or the resident's representative in finding a replacement. [Facility] is a large company and there is something (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 4 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few unethical in discharging resident, who's to say you won't come in contact with that same doctor at a sister facility or another facility because the doctor is still affiliated or had doctors they are connected with who don't want to work with the resident. She is being blackballed, you have a person, the resident, who hasn't been resistant. This is about not having a doctor. Resident needs care, has permanent medical necessity and who is overseeing her care? They are required to do H&Ps, write medication orders, do all those kinds of things, who does it? .the communication says they will just send her to the hospital. Review of Resident #1's clinical chart (including her physician visits in the facility) revealed the last time she was seen for a face to face visit by MD E was 06/07/22 for shoulder pain. There were no changes made in her care management as Resident #1 stated it only hurt when she raised her arm over her head. Her range of motion was not affected. The exam reflected MD E remained her supervisor and rendering provider. Review of Resident #1's progress notes reflected she was not seen by MD E face to face for required physician visits or by his extenders from June 7, 2022, through April 2023 (10 months). An interview with the ADM on 04/27/23 at 1:14 PM revealed one of the family members drives care and had been like that for a long time. Last year in the fall, the ADM said the family member had words with MD E and he felt like she was treating him like a child, the ADM did not witness the interaction. However, she said as a result of that conversation, MD E issued Resident #1 a discharge notice saying he would not provide any more care to her due to a non-therapeutic relationship with the family member and that the family member was controlling over Resident #1's care. The ADM stated, If he wants to order a pill, she will take the resident to [PHY D] in the community who will reverse it. The ADM said the family member would not let MD E do his job, overstepped and changed what his treatment of medications were, she wants PHY D's second opinion, So [MD E] figured what is the point, she doesn't trust me. The ADM stated the facility recently got a new co-medical director (MD F), But you know how doctors talk, he talked to [MD F], as well as a physician I reached out to at another facility and they know from [MD E] that the family member is going to cause problems so they say no. The ADM stated that MD F had not met Resident #1 yet but said he would agree to see her on an emergency basis only but would require a care plan meeting with the medical POA to discuss it. Regarding PHY D, the ADM stated he said he would see Resident #1 in person at his office when needed and would be available for orders, H&P, progress notes and so forth, but he was only available from 8am-8pm and refused to get credentialed to contract with the facility because that would mean he would be on call, which he did not want to do. The ADM stated, At this time, [MD E] agreed to maybe be available for emergency only after a care plan meeting is held with the POA first. The ADM said it was not an issue with the resident, she never refused any doctors or anything, it was the family member causing the issues that made the attending physician not want ot be her doctor. The ADM stated, [MD E] is not going to put his license at risk and he has rights. An interview with the DON on 04/27/23 at 1:48 PM revealed she never talked directly to MD E, only the receptionist at his office on 04/10/23. She asked the receptionist where the facility could send the current month's physician's orders and that the facility needed a current H&P and progress notes from the visits Resident #1 had with MD E because she had been to see him a few times. The DON said there was some miscommunication between the family of Resident #1 and the facility on how often the resident needed to be seen and that the facility said MD E would see the resident every two weeks, but the DON said that was not what she had said, and she had never talked to him. The DON said, I have never been able to talk to [MD E] to this day. She said the facility had a written statement from him because at one point last year when the facility issues a discharge notice to Resident #1 due (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 5 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to not having an attending physician, MD E wrote a letter stating that Resident #1 did not need to leave the facility because she had dementia and he agreed to be our primary care provider. The DON said she did not know if MD E or MD F talked to PHY D. She said MD E had been seeing Resident #1 for years and when the DON and ADM came to work at the facility in May 2022, we walked into this situation, [MD E] was already trying to remove himself as her doctor. The DON stated at this point, MMD F had agreed to be contacted for any life threatening or acute changed in condition for Resident #1, she had no current H&P from MD E. The DON said there were no residents in the facility currently that had ever seen an attending physician in the community only and not a facility physician for every day care. The DON stated, At this point, it stands that the family now wants [MD F] as attending. We are waiting for a care plan meeting, the family is not responding for multiple requests for a meeting. The DON said she did not know if MD E, as the medical director for the facility, had reached out to PHY D to discuss the situation. The DON said that during one of the discharge hearings for Resident #1, the fine print stated that the medical director had to specifically state why he did not want to continue with care, I don't know if he did. I think legal from corporate is handling it now. The DON conformed that Resident #1 had no H&P since February 2022, which was completed by MD E. The DON said the last note MD E wrote for Resident #1 was on 06/07/22. She said she asked PHY D for any documentation on Resident #1 but only received medical documentation from 2020 and 2021, nothing current. An interview with MD E on 04/27/23 at 3:56 PM revealed he was the medical director for the facility and had been the attending physician for Resident #1 for the past five to six years but was no longer her attending physician. MD E stated the circumstances that caused him to cease being Resident #1's attending physician were cumulative and I think it was more differences in our philosophies in care was our biggest difference. It had been many years and it came to an aggressive stance with the [family member], I am not sure which [family member], but it was mainly [name]. MD E said Resident #1's family member behaved in a way that was more like harassment, questioning his decisions, send her out to the hospital then come back, I don't think she trusted my care. She is the only resident I have had to part ways with. I have been doing this for ten years. The MD said he worked in a large physicians' group in general, but for the facility, it was himself, his PA and NP. When asked what does being a physician for emergencies entail, MD E replied, That is kind of funny, I am still trying to figure out if I am there for emergencies I am getting my legal involved so we can figure out what it entails. If I see something as a medical director, I would intervene. I just don't know what that means legally. MD E said if a facility physician refused to see a resident as a patient, their care would have to be monitored by an outside physician. MD E said Resident #1 had PHY D for many years and she would follow up with him as well, So I think she resumed care with [PHY D] and I think the facility transports to him now every 60 days. MD E was asked what was his responsibility as the medical director of the facility to assist the facility in locating another attending physician for Resident #1. MD E stated, You know what, that is a great question, I don't know if as a medical director, is that something I have to do a responsibility. I think the facility has to do it, like trying to recruit another physician but I don't think in my medical director's contract it is in there. MD E confirmed that is a resident did not have an attending physician, then it was the medical director's role to oversee that resident's care. MD E said he had not personally contacted any doctors to see if they could be Resident #1's attending physician. MD E stated, I guess because she had a doctor. It's a tough situation, I guess it is confusing to me. It was kind of like a distrust or conflict of our philosophy. MD E said he had not talked to MD F since he had taken over as co-medical director and that the facility decided who would have which residents on their caseload for both he and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 6 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few MD F. MD E was asked if he felt refusing to be her attending physician was punitive to the resident when she had no other physician available to see her int eh facility. MD E stated, You know it's hard to say because I think [PHY D] can do everything I do. It seems like they follow up with him even when I was still her physician. I would say something, like he prescribed and antibiotic I didn't agree with. They were comfortable with him so I thought, then you have a provider and if I am there, I am never going to withhold care on someone, but there is also a time for mental well-being for physicians. I felt they were badgering me, the family. [PHY D] was doing what I am doing, we would probably manage it the same. MD E stated most of the time when something happened with Resident #1 medically, the family requested her to be sent out, for example, when there was a snow storm and Resident #1 missed dialysis. MD E said he told the facility was okay for her to miss a couple of days of dialysis but the family send her to the ER and she came back with no new orders. He said one a Hoyer mechanical lift bumped Resident #1, a x-ray on her ribs was done, there was a question of pneumonia, his NP saw it and the resident was asymptomatic but the family wanted to send her out. MD E stated, The family will supersede whatever I say. If there is an emergency situation, one of us is going to handle it. And I have. I am not going to withhold care. It's difficult to figure out what do we do now. Maybe I just don't need to be medical director there anymore. MD E was asked if he had reached out to PHY D in anyway, to discuss continuity of care for Resident #1 and he replied no. A follow up interview with the ADM on 04/27/23 at 5:31 PM revealed MD F had been referring a lot of his patients from the hospital he worked at so she wanted to ask him to be the medical director. He agreed to come over and take over as the attending physician for the residents he had referred to the facility, which were skilled residents and he initially did not want to be the attending physician for those residents once they went long-term, but he agreed to be, if they were his skilled residents prior. The ADM stated MD F said he would consider being Resident #1's attending for emergencies, If the family would meet with him first. The ADM was asked where does it state in the facility's policy or medical director/attending physician contract that a doctor has to meet a with resident and their RP prior to deciding if he would accept them. The ADM stated, He agreed to see his patients only that he referred from the hospital. I am not going to lose him over this family. The ADM was asked if MD F was able to contact the family via phone to talk about Resident #1 and she said a care plan meeting had been requested by him. The ADM continued to state that PHY D agreed to be Resident #1's attending physician and she had the letter confirming it and would look for it, however she was unable to provide any evidence. An interview with MD F on 04/27/23 at 5:40 PM revealed he did not deny Resident #1 as his patient. MD F stated, I guess she didn't' want to see or had some issues with [MD E] so basically, they gave her to me until I guess something worked out, so I didn't deny her. I understand she had to have someone so I went and picked her up. MD F said he had not seen Resident #1 face to face yet but she had been put on his caseload. MD F stated, I have no problem with it. People from time to time, it happens quite a bit, they might not gel with one physician but might gel better. I guess the family didn't want to see him anymore or he dropped care. [ADM] came to me and asked me and I said yeah, I will pick her up until something else happens or if nothing else happens, we are good. I want to talk to them before I see [Resident #1] to see what the issues were from their stand point in regards from care, that was all, so I wanted to get an overall of what was happening. MD F said the facility told him what happened with caseload assignment was when a new resident arrived at the facility, the facility would contact him and say he had a new patient and he added them to his list. MD F stated, But in this case, I was at the facility when they came up and told me what the issue was. They asked me and I said yes. MD F said in the past, he had to drop a resident from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 7 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few his caseload before, like if there was unprofessional language being heralded at him. MD F stated, None of us need to deal with that especially after long days, patients and stress, so if you are being cursed out, explicit language, unprofessional conduct, flirtations, sexual advances, making any threats to my license or safety. With disagreement with care, as a provider, you have to ask then what are your concerns, next questions why don't you want the treatment and maybe it could be explained by the family as to why they don't agree, it's an opportunity to teach. I want to make the family feel like they are included in the care. They may be lay people but it's an opportunity as a physician to teach, which is what I love teaching So to me, it's always a teaching point and I think that's an obligation as physician. An interview with the ADM on 04/27/23 at 6:01 PM occurred where she stated, I am willing to take a tag on this at this point. No other state investigators have tagged me though because they say as long as she has a doctor and her needs are being met, even if a doctor in the community, it's okay. I don't want to lose [MD F] over this. The same thing will end up happening, where the [family member] will do the same thing she was doing to [MD E] to [MD F] and he is going to leave as our medical director. I am now out of it because of the complaints the family has against me, corporate is the one making the decisions. A confidential interview with a facility staff member on 05/01/23 occurred where they were familiar with Resident #1 and wanted to state that the facility did not exactly create this whole situation to try and get her discharged for not having an attending physician, per say, but they saw it as an opportunity and didn't do anything to prevent it from happening, in trying to work it out and help find a doctor. Attempted to contact the VP of Operations for the facility on 05/01/23 at 2:39 PM with no success. An interview on with the SW on 05/01/23 at 3:22 PM revealed she had not received any grievances from the family for Resident #1, but she had only started employment in January 2023. She said the last time they approached her, it was about a laundry issue and it was taken care of immediately. The SW said she did not know anything about issues with not having an attending physician but started seeing communications about it because she was cc'ed in emails by the facility. Then the SW said she remembered what happened, that Resident #1's family wanted both physicians, one on the outside and one on the inside, but the outside physician would cancel orders MD E wrote and that is how this whole thing got started. The SW could not remember the circumstances but thought it had happened more than once related to an issue with some lab results or x-rays, or a combination of things. The SW said she did not make the decision on doctors but would work with families or residents if the wanted a different doctor then they had. She said Resident #1 and her family had never asked to be assigned a different doctor. The SW said when a resident or family member requested a new attending physician at the facility, it was not normal practice to have a care plan meeting prior, to decide if the doctor was accept the resident on their caseload. She said typically when a resident or family wanted a new doctor, she would just rea[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 8 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0555 Honor the resident's right to choose his or her attending physician. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the facility must ensure that each resident remains informed of the name, specialty, and way of contacting the physician and other primary care professionals responsible for his or her care for one (Resident #1) of five residents reviewed for physician services and resident rights. Residents Affected - Few The facility failed to provide Resident #1's RPs with MD F's contact information when they chose him to be the resident's physician on 04/12/23. The failure could place residents at an increased risk of not receiving quality care and treatment due to their lack of free choice. Findings included: Review of Resident #1's quarterly MDS assessment dated [DATE] reflected she was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #1's active diagnoses included Alzheimer's disease, hypertension, heart failure, atrial fibrillation (an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart), coronary artery disease and anxiety disorder. Resident #1 had clear speech, no hearing issues or impaired vision and her BIMS score was 08, which indicated moderate cognitive impairment. Resident #1 had no signs or symptoms of delirium, mood issues, or behaviors (which included psychosis and rejection of care). Review of Resident #1's Face Sheet (not dated) reflected her attending physician was PHY D (date active 03/31/23) and her medical director was MD F (date active 04/12/23). It also reflected that she had two family members as her essential caregivers and contacts. Neither of those family members were designated power of attorney by the facility. Review of the Resident #1's clinical chart revealed no evidence of a medical power of attorney. Review of Resident #1's clinical chart (including nursing notes, medication/lab/x-ray orders and emergency notification for change in conditions), reflected that MD E was the previous attending physician until 05/24/22, when he issued Resident #1 a discharge from services letter. Review of MD E's discharge letter dated 05/24/22 reflected, An effective patient-physician relationship is essential to providing good primary care. Based on recent and on-going events, it is clear the therapeutic relationship we shared no longer exists. As a result of this, I can no longer serve as your physician. Therefore, effective 30 days after the date of this letter, our patient-physician relationship will terminate. You will need to discuss with Crestview Court which other primary care physicians in the facility are available to attend to your regular healthcare needs. Moreover, y services to you will be available only for emergency purposes during the next 30 days. I recommend you establish care with a new provider as soon as possible and continue to receive healthcare services. [Signed MD E]. Review of an email exchange provided by Resident #1's family member to the facility's DON, ADM, Ombudsman, VP of Clinical Operations, VP of Operations dated 04/12/23 reflected, We are requesting that the new co medical director [MD F} be designated as [Resident #1]'s attending physician. The ADM responded back to the family member on 04/12/23, [MD F] does not want to be attending, sorry. I asked (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 9 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0555 him and he emailed saying he didn't want to. Level of Harm - Minimal harm or potential for actual harm An interview with the local Ombudsman on 04/27/23 at 4:41PM revealed there had been a recent communication in the past couple of weeks where the ADM stated the facility had a new co-medical director [MD F]. The family responded saying they were okay with that new co-medical director being Resident #1's attending physician, but the response from the facility was that he did not want to do it. The Ombudsman said there was another email from the ADM dated around 04/10/23 where she notified Resident #1's RPs that MD F agreed to see her for emergencies only when the attending is not available and had agreed to speak with the POA if any emergencies come about and the DON had reached out to PHY D who agreed to see Resident #1 twice a month, do health and physical assessments, and progress notes and would be available until 8pm, and provided an after-hours number, but we still want a care plan meeting to discuss any issues. However, further inquiry by Resident #1's RPs to PHY D revealed he did not agree to any of that. On 04/12/23, Resident #1's RPs notified the DON that PHY D did not agree to anything and requested the new co-medical director [MD F], be designated as her attending physician but was told in writing by the ADM that he did not want to be. Residents Affected - Few Review of Resident #1's progress notes reflected she was not seen by MD E face to face for required physician visits or by his extenders from June 7, 2022 through April 2023 (10 months). An interview with the ADM on 04/27/23 at 1:14 PM revealed the facility recently got a new co-medical director (MD F), but MD F had not met Resident #1 yet but said he would agree to see her on an emergency basis only but would require a care plan meeting with the medical POA to discuss it. An interview with the DON on 04/27/23 at 1:48 PM MD E had been seeing Resident #1 for years and when the DON and ADM came to work at the facility in May 2022, we walked into this situation, [MD E] was already trying to remove himself as her doctor. The DON stated at this point, MMD F had agreed to be contacted for any life threatening or acute changed in condition for Resident #1, she had no current H&P from MD E. The DON said there were no residents in the facility currently that had ever seen an attending physician in the community only and not a facility physician for every day care. The DON stated, At this point, it stands that the family now wants [MD F] as attending. We are waiting for a care plan meeting, the family is not responding for multiple requests for a meeting. A follow up interview with the ADM on 04/27/23 at 5:31 PM revealed MD F had been referring a lot of his patients from the hospital he worked at so she wanted to ask him to be the medical director. He agreed to come over and take over as the attending physician for the residents he had referred to the facility, which were skilled residents and he initially did not want to be the attending physician for those residents once they went long-term, but he agreed to be, if they were his skilled residents prior. The ADM stated MD F said he would consider being Resident #1's attending for emergencies, If the family would meet with him first. The ADM was asked where does it state in the facility's policy or medical director/attending physician contract that a doctor has to meet a with resident and their RP prior to deciding if he would accept them. The ADM stated, He agreed to see his patients only that he referred from the hospital. I am not going to lose him over this family. The ADM was asked if MD F was able to contact the family via phone to talk about Resident #1 and she said a care plan meeting had been requested by him. The ADM continued to sated stated that PHY D agreed to be Resident #1's attending physician and she had the letter confirming it and would look for it. An interview with MD F on 04/27/23 at 5:40 PM revealed he did not deny Resident #1 as his patient. MD F stated, I guess she didn't' want to see or had some issues with [MD E] so basically, they gave her to me until I guess something worked out, so I didn't deny her. I understand she had to have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 10 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0555 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few someone so I went and picked her up. MD F said he had not seen Resident #1 face to face yet but she had been put on his caseload. MD F stated, I have no problem with it. People from time to time, it happens quite a bit, they might not gel with one physician but might gel better. I guess the family didn't want to see him anymore or he dropped care. [ADM] came to me and asked me and I said yeah, I will pick her up until something else happens or if nothing else happens, we are good. I want to talk to them before I see [Resident #1] to see what the issues were from their stand point in regards from care, that was all, so I wanted to get an overall of what was happening. MD F said the facility told him what happened with caseload assignment was when a new resident arrived at the facility, the facility would contact him and say he had a new patient and he added them to his list. MD F stated, But in this case, I was at the facility when they came up and told me what the issue was. They asked me and I said yes. MD F said in the past, he had to drop a resident from his caseload before, like if there was unprofessional language being heralded at him. MD F stated, None of us need to deal with that especially after long days, patients and stress, so if you are being cursed out, explicit language, unprofessional conduct, flirtations, sexual advances, making any threats to my license or safety. With disagreement with care, as a provider, you have to ask then what are your concerns, next questions why don't you want the treatment and maybe it could be explained by the family as to why they don't agree, it's an opportunity to teach. I want to make the family feel like they are included in the care. They may be lay people but it's an opportunity as a physician to teach, which is what I love teaching So to me, it's always a teaching point and I think that's an obligation as physician. An interview with the ADM on 04/27/23 at 6:01 PM occurred where she stated, I am willing to take a tag on this at this point. No other state investigators have tagged me though because they say as long as she has a doctor and her needs are being met, even if a doctor in the community, it's okay. I don't want to lose [MD F] over this. The same thing will end up happening, where the [family member] will do the same thing she was doing to [MD E] to [MD F] and he is going to leave as our medical director. I am now out of it because of the complaints the family has against me, corporate is the one making the decisions. An interview with the ADM on 05/01/23 at 3:46 PM revealed if MD F and the facility had to meet with Resident #1 family in order for him to be the attending physician. The ADM responded no, that was why the VP of Clinical Operations said it was going to be to clarify and the family did not have to attend. The ADM said in the beginning, MD F did not want to pick up any long-term residents but the previous attending physician had too many complaints on him (PHY H) and is no longer the attending at the facility, so when MD F came over, MD E had too many residents and MD F had to have some of them assigned to his caseload. The ADM was asked again, if MD F refused to be the attending for Resident #1 and if she had documentation of him, as well as the other physicians she contacted saying no to being Resident #1' attending. She said she would look for the email exchanges. The ADM said, We want her to sit down and have [MD F] explain to the family what the expectations are. The ADM was asked if Resident #1 and her family were being treated differently than other residents regarding having to have a care plan meeting prior to getting an attending assigned. The ADM stated, They are being treated differently. All of our care plans are for the patient, what is different, we wouldn't give him this resident because he only took [PHY H's caseload], we are trying to avoid a nightmare. What is going to happen is he is not used to her questioning the labs and questioning [PHY D] and I am trying to be like hey, let's sit at the table, sit down and tell him what the issues are, then [MD F] is an advocate of the facility and we have to call him and do orders and do what he says so how can we all sit down and make a relationship? The ADM confirmed that no one had contacted the family to notify that MD F was assigned at Resident #1's physician and had not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 11 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0555 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few provided the family with his contact information. She said they tell the families what days the doctor will be here and if they want to talk to the doctor, we give the doctor that message. Review of an email exchange provided by the ADM on 05/01/23 between herself and MD F on 04/10/23 reflected, ADM-I am confirming out conversation regarding [Resident #1]. You agree that you are available to see the resident for emergency purposes or if the outside attending is not available. Due to previous concerns with Medical director, you do not want to be the attending only back up for emergencies. You also agree to only communicate with the facility staff and POA regarding the resident care. If this correct? To which MD F responded, I accept. Review of the facility's policy titled, Physician Services revised February 2021, reflected, Policy Statement: The medical care of each resident is supervised by a licensed physician. Policy Interpretation and Implementation: .2. Once a resident is admitted , orders for the resident's immediate care and needs can be provided by a physician, physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS); 3. Supervising the medical care of residents includes (but is not limited to): a. participating in the resident's assessment and care planning; b. monitoring changes in resident's medical status; c. providing consultation or treatment when called by the facility; d. prescribing medications and therapy; e. ordering transfer to the hospital if necessary; f. conducting routing required visits; g. delegating and supervising follow-up visits by non-physician practitioner (NPs, PA, CNS's); and h. overseeing a relevant plan of care for the resident; 4. Each resident remains under the care of a physician. An alternate physician supervises the care of residents when his or her attending physician is not available: a. The attending physician may designate another physician to act on his or her behalf when unavailable., b. If the attending physician does not delegate another physician, the facility will have a physician available to supervise the care of the resident; 5. The attending physician will determine the relevance of any recommended interventions from other disciplines. The physician is not obligated to accept those recommendations is he or she had clinically valid reasons for not doing so; 6. Physicians orders and progress notes are maintained in accordance with current OBRA regulations and facility policy; 7. Physician visits, frequency of visits, emergency care of resident, etc., are provided in accordance with current OBRA regulations and facility policy; 8. Consultative services are made available from community-based consultants or from a local hospital or medical center; 9. The medical director identifies attending physician qualifications and responsibilities, based on clinical and regulatory requirements and the recommendations of relevant professional associations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 12 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to permit the resident to remain in the facility, and not transfer or discharge the resident from the facility from the facility unless the transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility for one (Residents #1) of five residents reviewed for transfer and discharge requirements. The facility initiated a 30-day discharge to Resident #1 saying the facility could not meet her needs when Resident #1's attending physician resigned as her physician. This failure could result in residents being discharged without appropriate reasons and documentation communicated to help with the transition of care. Findings included: Review of Resident #1's quarterly MDS assessment dated [DATE] reflected she was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #1's active diagnoses included Alzheimer's disease, hypertension, heart failure, atrial fibrillation (an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart), coronary artery disease and anxiety disorder. Resident #1 had clear speech, no hearing issues or impaired vision and her BIMS score was 08, which indicated moderate cognitive impairment. Resident #1 had no signs or symptoms of delirium, mood issues, or behaviors (which included psychosis and rejection of care). Review of Resident #1's Face Sheet (not dated) reflected her attending physician was PHY D (date active 03/31/23) and her medical director was MD F (date active 04/12/23). It also reflected that she had two family members as her essential caregivers and contacts. Neither of those family members were designated power of attorney by the facility. Review of the Resident #1's clinical chart revealed no evidence of a medical power of attorney. Review of Resident #1's clinical chart (including nursing notes, medication/lab/x-ray orders and emergency notification for change in conditions), reflected that MD E was the previous attending physician until 05/24/22, when he issued Resident #1 a discharge from services letter. Review of MD E's discharge letter dated 05/24/22 reflected, An effective patient-physician relationship is essential to providing good primary care. Based on recent and on-going events, it is clear the therapeutic relationship we shared no longer exists. As a result of this, I can no longer serve as your physician. Therefore, effective 30 days after the date of this letter, our patient-physician relationship will terminate. You will need to discuss with Crestview Court which other primary care physicians in the facility are available to attend to your regular healthcare needs. Moreover, y services to you will be available only for emergency purposes during the next 30 days. I recommend you establish care with a new provider as soon as possible and continue to receive healthcare services. [Signed MD E]. An interview with Resident #1's family member on 04/27/23 at 9:13 AM revealed there had been several facility-initiated discharge notices given to Resident #1 and her responsible parties due to the facility not having a doctor available to provide medical care, all which went to a hearing and were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 13 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few overturned by the hearing officer. The family member said the facility had stated that since Resident #1 did not have an attending physician anymore in the facility, but still had a primary care physician in the community, then they would contact that physician for routine visits and emergencies. However, if he was not reachable, they told the family member they would send Resident #1 to the hospital emergency room. The family member stated, I know part of the state and federal regulations states they have to have a physician. The family member said there had been several incidents with MD E, but there was one in particular where he failed to prescribe an antibiotic when she had double pneumonia. The family member said the facility had done an -x-ray on Resident #1 and MD E was aware of the results, but he did not start her on any antibiotics. The family member said MD E told the family he overlooked it because he was reading the x-ray results on his phone. The family member stated he/she was upset and told MD E that was no excuse and he could have killed Resident #1. A complaint was lodged with HHSC and an investigation was conducted and the family member stated MD E was upset that a complaint on him had been made. The family member stated there was another time MD E was negligent of providing standard care to Resident #1 around late September 2021 when the facility nurses and MD E did not notice that the resident had an infected toe down to the bone. The family member stated that HHSC ended up completing an investigation in April 2022 related to the complaint and cited/fined the facility and they were angry. On 05/26/22, the family member stated the facility ADM notified the RP that MD E was terminating his care due to an HHSC P1 complaint being lodged against him. The family member stated, He [MD E] did not want to own up to his mistakes and would only provide emergency care. The family member stated, They tried to put her out three or four times. They are saying it is because she doesn't have a physician. It is against state and federal laws. [Ombudsman] has drilled this over and over at the hearings. The family member stated 05/26/22 was when the facility issued the first discharge notice and as soon as the hearing officer ruled for Resident #1 to stay, the facility kept issuing more discharge notices. The family member felt like the situation was [NAME] to harassment. The family member said Resident #1 did have a doctor in the community, PHY D, who would always see her if needed, but the facility tried to say during the discharge hearings that he was going to be her attending physician, which was a lie. The family member said the same thing kept being brought up at each discharge hearing, but PHY D never agreed to be the attending physician. The family member stated, I mean this, god forbid something happens to [Resident #1] without physician care. It is to the point where they are harassing her. They are upset because of what had transpired starting with the toe thing. The family member also felt the facility was retaliating against the family and Resident #1. The family member stated that she received an email (no date given) from the ADM that was very concerning where it was said that PHY D would be her attending physician and they could reach him up to 7 pm or 8 pm at night, but after that time, they would contact a new assistant doctor at another facility to see her on an emergency basis. The family member stated, So in essence, [Resident #1] doesn't have a physician. I am so worried, you are going to just sit there and let her die or not render aid. I pray to god nothing happens. The family member said prior to MD E stopping his services for Resident #1, he had been her physician since 2016. Now, the family member stated on a day-to-day basis, no physician was overseeing her care. The family member said the facility claimed they had contacted other doctors to be the attending physician for Resident #1 but the said no. The family member said one of the doctors asked by the facility to be Resident #1's attending physician worked with MD E and the family member felt MD E told that potential doctor a lot of negative things about Resident #1 and the family, which caused that doctor to say no, even though he had never seen Resident #1. The family member said after the most recent attempt to discharge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 14 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #1 in 2023 due to the facility stating she did not have an attending physician, the family appealed and won, however, the family was notified after that that MD E would not even provide care for emergencies for Resident #1. The family member said PHY D had been Resident #1's outside physician during the seven years she had been at the facility and she periodically went to see him during those years because she was comfortable with him, but not for everyday care. The family member stated the Ombudsman would say the situation was retaliation and even the disability lawyer at the hearing said it was retaliation. The family member stated, They want her out, [MD E] got in trouble, I do not trust them, this doctor thing is huge, god forbid somethings happens to my [Resident #1] and she doesn't have the care. This is very hurtful for [Resident #1], she feels like they don't want her there. Her friends are there, that is all she knows. Review of an email exchange provided by Resident #1's family member to the facility's DON, ADM, Ombudsman, VP of Clinical Operations, VP of Operations dated 04/12/23 reflected, We are requesting that the new co medical director [MD F} be designated as [Resident #1]'s attending physician. The ADM responded back to the family member on 04/12/23, [MD F] does not want to be attending, sorry. I asked him and he emailed saying he didn't want to. An interview with the local Ombudsman on 04/27/23 at 4:41PM revealed the facility had not issued a subsequent discharge notice to Resident #1 since the last hearing on 03/30/23, however, subsequent to the hearing and after the hearing decision was issued, the facility issued another email indicating they did not have a doctor for Resident #1. The Ombudsman stated, The facility keeps doing this because he doesn't want to be the attending, which he has the right to be. The other doctor there, he doesn't want to do it because of the consultation with [MD E]. At the end of the day, the resident needs an attending physician. Her doctor, who she has seen in the community for years, he does not want to be credentialed by the facility. The Ombudsman said there had been a recent communication in the past couple of weeks where the ADM stated the facility had a new co-medical director [MD F]. The family responded saying they were okay with that new co-medical director being Resident #1's attending physician, but the response from the facility was that he did not want to do it. The Ombudsman stated the situation was bordering on discrimination and she was concerned Resident #1 was going to be discriminated against if she ever did have to move to other facilities in the metroplex where MD E and MD F had affiliations directly or with other doctors in their practice. The Ombudsman stated, I didn't find anything in the regs that residents can be discharged because a doctor doesn't want to provide care. That's why we back to regs. They are responsible for providing an attending physician. Who is overseeing her medical care now? Who is writing orders for her? The Ombudsman said after 03/30/23 when the hearing officer reversed the facility's action related to discharge, Resident #1's two RP's were sent an email from the ADM informing them that if any emergencies happened to Resident #1, they would contact PHY D or send Resident #1 to the hospital ER for treatment and the staff had been informed to contact the family if they were unable to contact the outside physician. At that time, the facility requested a care plan meeting to ensure everyone was on the same page. The Ombudsman said that email was sent on 03/30/22 and then the vice president of operations responded in an email to the RPs that the facility had not heard back from them regarding the care plan meeting about the physician issues and that MD E would no longer be the physician, even for emergency situations. The email also stated, per the Ombudsman, We have attempted to find another physician but were unsuccessful. You have identified [PHY D] as attending of choice, this includes after business hours. At this time [PHY D] has not provide us with after-hours information. The Ombudsman said that meant any emergencies for clinical issues would be to contact PHY D and if no response, then send Resident #1 to the hospital. The Ombudsman said the family did not know what to do because they had no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 15 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few opposition to any of the doctors at the facility being the attending physician because the resident must have an attending in the nursing home. So the issue then is back to the resident does not have a doctor available to oversee her care while in the nursing home. The Ombudsman said there was another email from the ADM dated around 04/10/23 where she notified Resident #1's RPs that MD F agreed to see her for emergencies only when the attending is not available and had agreed to speak with the POA if any emergencies come about and the DON had reached out to PHY D who agreed to see Resident #1 twice a month, do health and physical assessments, and progress notes and would be available until 8pm, and provided an after-hours number, but we still want a care plan meeting to discuss any issues. However, further inquiry by Resident #1's RPs to PHY D revealed he did not agree to any of that. On 04/12/23, Resident #1's RPs notified the DON that PHY D did not agree to anything and requested the new co-medical director [MD F], be designated as her attending physician but was told in writing by the ADM that he did not want to be. The Ombudsman stated, So we have a resident in the building with no attending physician; a [AGE] year-old resident, been there 7 years, no issues with the resident, only with the family. They [facility] have to work with them, there is no threat on life, so where are you going to discharge her to? I am telling you, this I reaping of discrimination. The Ombudsman said she went through Resident #1's clinical chart for the appeal hearing and there was no documentation from MD E to indicate he was going to terminate his relationship with her, which was brought up in the hearing, only a letter was issued, but nothing in the chart, nothing documented. The Ombudsman said she told Resident #1's RP that if MD E did not want to provide care or services, the regulations allowed that. However, that was not the issues, the issue was the regulation that the facility provided a doctor for Resident #1, The facility must assist the resident or the resident's representative in finding a replacement. [Facility] is a large company and there is something unethical in discharging resident, who's to say you won't come in contact with that same doctor at a sister facility or another facility because the doctor is still affiliated or had doctors they are connected with who don't want to work with the resident. She is being blackballed, You have a person, the resident, who hasn't been resistant. This is about not having a doctor. Resident needs care, has permanent medical necessity and who is overseeing her care? They are required to do H&Ps, write medication orders, do all those kinds of things, who does it? .the communication says they will just send her to the hospital. Review of Resident #1's clinical chart (including her physician visits in the facility) revealed the last time she was seen for a face to face visit by MD E was 06/07/22 for shoulder pain. There were no changes made in her care management as Resident #1 stated it only hurt when she raised her arm over her head. Her range of motion was not affected. The exam reflected MD E remained her supervisor and rendering provider. Review of Resident #1's progress notes reflected she was not seen by MD E face to face for required physician visits or by his extenders from June 7, 2022 through April 2023 (10 months). A follow up interview with the ADM on 04/27/23 at 5:31 PM revealed MD F had been referring a lot of his patients from the hospital he worked at so she wanted to ask him to be the medical director. He agreed to come over and take over as the attending physician for the residents he had referred to the facility, which were skilled residents and he initially did not want to be the attending physician for those residents once they went long-term, but he agreed to be, if they were his skilled residents prior. The ADM stated MD F said he would consider being Resident #1's attending for emergencies, If the family would meet with him first. The ADM was asked where does it state in the facility's policy or medical director/attending physician contract that a doctor has to meet a with resident and their RP prior to deciding if he would accept them. The ADM stated, He agreed to see his patients only that he referred from the hospital. I am not going to lose (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 16 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few him over this family. The ADM was asked if MD F was able to contact the family via phone to talk about Resident #1 and she said a care plan meeting had been requested by him. The ADM continued to sated state that PHY D agreed to be Resident #1's attending physician and she had the letter confirming it and would look for it. A confidential interview with a facility staff member on 05/01/23 occurred where they were familiar with Resident #1 and wanted to state that the facility did not exactly create this whole situation to try and get her discharged for not having an attending physician, per say, but they saw it as an opportunity and didn't do anything to prevent it from happening, in trying to work it out and help find a doctor. Attempted to contact the VPCO for the facility on 05/01/23 at 2:39 PM with no success. An interview with the ADM on 05/01/23 at 3:46 PM revealed MD F and the facility did not have to meet with Resident #1 family in order for him to be the attending physician. The ADM responded no, that was why the VP of Clinical Operations said it was going to be to clarify and the family did not have to attend. The ADM said in the beginning, MD F did not want to pick up any long-term residents but the previous attending physician had too many complaints on him (PHY H) and is no longer the attending at the facility, so when MD F came over, MD E had too many residents and MD F had to have some of them assigned to his caseload. The ADM said prior to PHY leaving, she asked him to be Resident #1's attending and he said no. She said she asked a doctor at a sister facility if he would do it, and he said no. The ADM was asked again, if MD F refused to be the attending for Resident #1 and if she had documentation of him, as well as the other physicians she contacted saying no to being Resident #1' attending. She said she would look for the email exchanges. The ADM said, We want her to sit down and have [MD F] explain to the family what the expectations are. The ADM was asked if Resident #1 and her family were being treated differently than other residents regarding having to have a care plan meeting prior to getting an attending assigned. The ADM stated, They are being treated differently. All of our care plans are for the patient, what is different, we wouldn't give him this resident because he only took [PHY H's caseload], we are trying to avoid a nightmare. What is going to happen is he is not used to her questioning the labs and questioning [PHY D] and I am trying to be like hey, let's sit at the table, sit down and tell him what the issues are, then [MD F] is an advocate of the facility and we have to call him and do orders and do what he says so how can we all sit down and make a relationship? The ADM confirmed that no one had contacted the family to notify that MD F was assigned at Resident #1's physician and had not provided the family with his contact information. She said they tell the families what days the doctor will be here and if they want to talk to the doctor, we give the doctor that message. Review of Resident #1's clinical documentation from PHY D reflected she was seen on 05/24/22 for a hospital follow up. The exam notes reflected Resident #1 originally went to the hospital after she was hit in the chest with a Hoyer lift and a chest x-ray showed infiltrates. She was diagnosed with pneumonia and antibiotics. She was noted to have a low fever at onset. PHY D documented Resident #1's visit diagnoses were : History of pneumonia, pressure injury of the right buttock-stage 3, hypertensive heart and kidney disease with HF and ESRD, ESRD on dialysis, chronic combined systolic and diastolic congestive heart failure, late onset Alzheimer's disease without behavioral disturbance and type 2 diabetes. No treatment or medications were ordered. Review of previous facility initiated discharge notices and fair hearing results provided by the ombudsman on 05/10/23 reflected: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 17 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A. Resident #1 was issued the first facility-initiated 30-day discharge letter on 05/26/22 due to physician termination of services and the facility not having another physician available to accept responsibility. A Fair Hearing was completed on 07/26/22. A Fair Hearing Decision, Appeal ID 3576402, dated 09/12/22 reflected the hearing officer reversed the facility's action. B. Resident #1 was issued a second facility-initiated 30-day discharge letter on 10/17/22 due to physician termination of services and the facility not having another physician available to accept responsibility. A Fair Hearing was completed on 12/01/22. A Fair Hearing Decision, Appeal ID 3605691, dated 12/16/22 reflected the hearing officer reversed the facility's action. The Hearing Officer stated in part, Evidence was not provided by the nursing facility showing documentation was made by the Appellant's physician prior to the discharge notice of the specific resident's needs that could not be met and the services available at the receiving facility to meet the Appellant's needs. C. Resident #1 was issued a third facility-initiated 30-day discharge letter on 12/19/22 due to physician termination of services and the facility not having another physician available to accept responsibility. A Fair Hearing was completed on 12/19/22. A Fair Hearing Decision, Appeal ID: 3624346, dated March 03/30/23 reflected the hearing officer reversed the facility's action. On 05/09/23, review of an HHSC complaint was reviewed that indicated Resident #1 had been issued a fourth facility-initiated 30-day discharge notice. Review of a facility initiated 30-day discharge notice dated 05/09/23 reflected, .I. This discharge is necessary for the resident's welfare as each and every available physician has either terminated their services to [Resident #1] or otherwise refused to take her as a patient. Despite efforts, the facility is not able to obtain an attending physician who will agree to take [Resident #1] as a patient. Without a physician overseeing [Resident #1]'s care, the facility cannot meet the needs of [Resident #1]. The physicians who have refused to take [Resident #1] as a patient include [MD E], [PHY M], [PHY N], [MD F] and [PHY D] (who was also [Resident #1's] outside primary care physician). Most recently, [MD F] declined to serve as [Resident #1]'s attending physician and is only seeing [Resident #1] on an 'as needed' basis; . [Resident #1] requires an attending physician. A physician treating her on an 'as needed basis' does not amount to an attending physician, does not meet [Resident #1's] needs, and does not allow the facility to adequately meet [Resident #1's] needs and welfare The facility has exhausted all possible credentialed attending physician provider sources beyond [MD F]. On 05/09/23, review of an HHSC complaint was reviewed that indicated Resident #1 had been issued a 30-day facility-initiated discharge notice. Review of a facility initiated 30-day discharge notice dated 05/09/23 reflected, .I. This discharge is necessary for the resident's welfare as each and every available physician has either terminated their services to [Resident #1] or otherwise refused to take her as a patient. Despite efforts, the facility is not able to obtain an attending physician who will agree to take [Resident #1] as a patient. Without a physician overseeing [Resident #1]'s care, the facility cannot meet the needs of [Resident #1]. The physicians who have refused to take [Resident #1] as a patient include [MD E], [PHY M], [PHY N], [MD F] and [PHY D] (who was also [Resident #1's] outside primary care physician). Most recently, [MD F] declined to serve as [Resident #1]'s attending physician and is only seeing [Resident #1] on an 'as needed' basis; . [Resident #1] requires an attending physician. A physician treating her on an 'as needed basis' does not amount to an attending physician, does not meet [Resident #1's] needs, and does not allow the facility to adequately meet [Resident #1's] needs and welfare The facility has exhausted all possible credentialed attending physician provider sources beyond [MD F]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 18 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 05/11/23 at 9:15 AM, HHSC re-entered the facility due to an additional complaint made related to Resident #1 being given another facility-initiated discharge notice on 05/09/23. A follow up interview on 05/11/23 at 9:30 AM with the ADM revealed since the completion of the HHSC's initial investigation on 05/01/23, the facility decided to issue Resident #1 a discharge notice because she did not have an attending physician and he got results and based of state surveyors and what is going on, he doesn't want to take the risk and he talked to [MD E] and after talking to the family, he didn't feel confident in taking them on. The ADM stated she sent MD F HHSC's preliminary findings for deficient practice after the state visit on 05/01/23 and the facility had a QAPI meeting. The ADM said he write wrote a note and since she was out of the discharge process, she sent it up to the facility's attorney and corporate and they were handling it at the corporate level. The ADM stated MD F agreed to see Resident #1 and did an H&P and told the family he would continue to see her as the facility needed, and he was listed as her doctor on her face sheet for nurses to call, but he did not want to say he was her attending. The ADM stated MD F was out of the country presently. The ADM was asked why she continued to stated she was out of it related to Resident #1's discharge. The ADM stated, I felt the need, I am still the ED and they have to discuss with me, but [family member]'s comments have gotten name calling and I do still send the emails, be very polite, but as far as discharge, going in from the appeals, I am letting the attorney's do that. The ADM stated MD F took on skilled patients now because MD E could not take them all, and that was the agreement when MD F agreed to be the co-medical director. She said MD F took some of PHY N's patients (who was a previous attending at the facility) because he was a part of his same group practice. The ADM said PHY N was removed from the building due to not visiting his residents and was having issues, so MD F stepped in and took over his residents already there, then the facility asked if he would be interested in being the co-medical director and he agreed. The ADM said first, MD F agreed to be available for emergency basis for Resident #1, then he talked to the family, I told him I didn't even want to know what happened with the family, I just wanted to know what the result was. He sent me a letter the next day. The ADM was queried if she felt the newest facility initiated discharge was retaliation towards Resident #1 and she responded no, she felt he facility did a great job of taking care of the resident, The discharge is more based off of the latest visit by State and findings. Her not having an attending has nothing to do with it, it is the dynamics between the physician, the physician is the one who gave is a discharge, [MD F] did not give her any notice no 30-day notice. He was not her attending. The risk we take is the State continues to come and writes us tags for not having an attending, so we are forced to discharge her because we cannot continue to take tags. The ADM was asked if MD F had a problem directly with Resident #1. She replied, I don't think anyone has issues with [Resident #1]. An interview with the SW on 05/11/23 at 10:02 AM revealed her role presently was to help the family find a suitable facility for Resident #1 and she did not have any part of the discharge notice being issued. The SW stated there was supposed to be a scheduled care plan meeting that was postponed because someone couldn't make it, then it was re-scheduled but then MD F had an emergency and could not make it, So the plan was to discharge after the care plan meeting or pending the outcome of the care plan meeting but the meeting never happened. The meeting was to see if we could meet Resident #1's medical needs, meaning if she doesn't have a doctor, we are not meeting her needs. My understanding is we have to have a physician and my understanding is [MD F] would see her for emergency situations or something to that effect until she could find another physician. I have no idea why [MD F] said no, because we didn't have that meeting. The SW was asked if she felt Resident #1 was being retaliated against by the facility and she replied, No I do not. Because if we have done our very best we (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 19 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few can do and the family is still not happy with the care they are receiving here, it is my professional opinion they should seek a facility elsewhere that can meet her needs. The family has a right to file complaints with the state, that is what you are there for and I fully support that, but there have been numerous reports made by this family to the state and it's always the same thing, I don't think none of them have been substantiated. Therefore if the family is not happy, it is in the best interest of [Resident #1] to find an environment in which she would be happy and the family would be happy. An interview with MD E on 05/11/23 at 10:16 AM revealed when he gave Resident #1 a discharge notice a year ago, and he was still dealing with it, if that doesn't tell you why I don't want to deal with this, I told her it was a philosophical difference in our care. It is kind of exhausting, I have been dealing with this for a long time .the family dictates her care, so I guess they were driving her care clinically, so that is where the philosophical difference goes hand in hand MD E was asked to provide any previous clinical documentation that would show the specific issues, times and circumstances that caused him to stated they did not agree and he was not able to. He stated he had no more documentation and the 30-day notice should suffice. An interview with the VPCO on 05/11/23 at 10:27 AM revealed Resident #1 was given a facility initiated discharge because as it stated in the letter, the facility did not have a doctor as her primary physician and there was not another one to take her on and everyone that had been asked, said no. The VPCO stated she had not asked any physicians herself, to be Resident #1's doctor. The VPCO stated her expectation for the facility to find an attending physician was that normally, they had two tot here to three credentialed doctors with the facility and they ask them if they would like to take on a patient and if they would, easy breezy let's go, if not, then the facility would talk to the facility to see if there was one they would like and it would work out, but in this care, it's not. The VPCO stated she was in her position when MD E discharged Resident #1 and she recalled the resident had gone to the hospital, MD E was trying to get information and she believed the family said no which was alarming to him. The VPCO stated the family conflict with the doctor happened prior to the current ADM coming to the facility and there had been multiple meetings with the family, including the doctors, but the family would not show up or refused to. When a meeting has happened, the VPCO stated everyone tended to leave on a better note, but the family member sort of sleeps on it and gets angry again, so it's back to ground zero, so if we take a step forward, we take a step back. The VPCO stated she understood MD F to only do as needed basis for emergencies for Resident #1 until she discharged , but she had not spoken to him, so she did not know for sure. The VPCO stated, He does not want ot take it on. My understanding is he did speak to the facility on the phone so I don't [TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 20 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that each resident received adequate supervision and assistance devices to prevent accidents for one (Resident #1) of four residents reviewed for accidents and supervision. CNA J and CNA K failed to complete a proper Hoyer lift transfer with Resident #1, resulting in the Hoyer lift falling over and Resident #1 being struck in the face by the Hoyer lift and causing emotional distress. The failure placed residents at risk for accidents and injuries, limiting their quality of life. Findings included: Review of Resident #1's quarterly MDS assessment dated [DATE] reflected she was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #1's active diagnoses included Alzheimer's disease, hypertension, heart failure, atrial fibrillation (an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart), coronary artery disease and anxiety disorder. Resident #1 had clear speech, no hearing issues or impaired vision and her BIMS score was 08, which indicated moderate cognitive impairment. Resident #1 had no signs or symptoms of delirium, mood issues, or behaviors (which included psychosis and rejection of care). Resident #1 required extensive physical assistance of two or more staff for transfers to or from her bed, chair and wheelchair. Resident #1 weighed 164 pounds and was 64 inches tall (five foot, four inches). Review of Resident #1's care plan effective 05/28/19-present reflected Resident #1 was at risk for falls related to impaired mobility and cognition due to an active fall (no date given). The goal was to not have any signs or symptoms of harm or injury while in her wheelchair or transfers. The care plan also reflected that Resident #1 required extensive assistance with transfers with a Hoyer and two staff. Interventions included to explain the procedure during transfers, tell Resident #1 step by step what was happening and on-going education to staff and new staff including outside vendor staff about Hoyer lift and two person at all times while operating for safety; Meeting held with family 04/13/22 about concerns and interventions. Additionally, Resident #1's care plan reflected she had a diagnosis of osteoporosis/osteopenia (Osteopenia is a condition where people's bone density is lower than is usual for their age. Osteoporosis is a more severe case of bone loss that weakens the bones and makes them more likely to fracture) and was at risk for spontaneous fractures (a fracture that occurs in seemingly normal bone with no apparent blunt-force trauma)/falls. Interventions included to assist Resident #1 carefully when providing care. An interview with Resident #1's family member on 04/27/23 at 9:13 AM revealed Resident #1 was hit in the chest, head and face with a Hoyer lift bar in May 2022 and had been dropped during a Hoyer lift transfer in the past while at the facility. The family member said Resident #1's skin was thin and she could get hurt easily, so staff needed to stop, take a break, and regroup if the resident told them what they were doing was hurting her. A follow up written correspondence with Resident #1's family member on Sunday, 04/30/23 at 2:34 PM contained video footage through the AEM in her room the morning of 04/29/23 at 7:44 AM, where the family member felt it indicated the facility staffs' failure and negligence of Hoyer lift use. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 21 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 - Minimal harm or potential for actual harm Residents Affected - Few family member stated the Hoyer lift continued to be an ongoing issue and it had been brought the attention of the ADM many times. The family member stated, We are extremely concerned about transfers at the facility using the Hoyer lift improperly. The family member stated that Resident #1 had been dropped from the Hoyer lift in the past, hit in the head twice with the Hoyer bar, hit in the face twice with the Hoyer bar, hit in the chest with the Hoyer bar, and now hit in the face/head again. The family member stated that in the video footage included, the staff could be seen shoving Resident #1's wheelchair over the base legs of the Hoyer lift, which caused the wheelchair to hit her on the left side while she was in the sling without either staff holding the sling as she sat there. The family member felt the staff should have positioned the Hoyer lift and wheelchair properly to prevent the wheelchair from hitting her in her side. The family member stated, These actions once again, caused [Resident #1] pain and anxiety, she cried due to their actions. The family member stated after that, the video showed improper use again of the Hoyer lift, as the bar hit her in the head/face and the entire Hoyer lift flipped over as they placed her in the wheelchair. The family member stated, This could have been deadly. It's been statistically proven, improper use of Hoyer lifts for transfers and staff negligence have caused death of some of the most vulnerable nursing home residents. An interview with the ADM on 05/01/23 at 10:00 AM revealed there had been an incident over the weekend where the Hoyer lift lightly grazed Resident #1's forehead. The ADM stated there were staff in Resident #1's room and that in general, staff were nervous when they went in and provided care or did transfers because of the history with the family and they were always watching on the video camera. The ADM stated two staff were doing a transfer Saturday, 04/29/23 and at one point, the bar of the Hoyer lift grazed her [Resident #1]. MD F was contacted and was out of town, so his physician's extender told the facility out of an abundance of caution, he would order an x-ray. The ADM stated Resident #1 was not complaining of pain and did not remember anything happening, but the family chose to send her to the ER to make sure she was okay. Review of in-room video surveillance footage provided by the family member and time stamped 04/29/23 at 12:44PM through 12:45 UTC [which was 7:44 AM] and lasting about one and a half minutes, started with Resident #1 already in the Hoyer sling being lifted off her bed. CNA J and CNA K left the Hoyer lift's base legs partially under the bed with the lift not fully cleared from under the bed. The Hoyer lift's base legs were not observed to be fully opened. Both CNAs then are seen taking Resident #1's wheelchair and lift the wheelchair's front wheels over the left side of the Hoyer's left base leg. The motion shakes the Hoyer lift and Resident #1 can be heard saying, Oh my lord. When they get the wheelchair's front wheels over the base legs, Resident #1 cries out and says, Oooo, ow, you hit me in my thigh!. CNA K then tries tried to lift the back straps of Resident #1's Hoyer sling to center her in the wheelchair with one arm but let's her go. CNA K was not able to hold Resident #1's Hoyer sling straps to lift her up and place her into her wheelchair as she was only using her right arm. CNA K then went to the back of the Hoyer lift and CNA J went behind Resident #1's wheelchair. Resident #1 can be heard saying lord have mercy. When CNA K lifted up on the Hoyer sling straps (which are located under the sling on the back of Resident #1), the entire Hoyer lift immediately tilted to the left. CNA K can be seen unable to use her left arm to grab the Hoyer Lift stand to stabilize it. Resident #1 was still hanging in the sling when the Hoyer lift leaned and fell over to the left, which inadvertently placed Resident #1 in her wheelchair. The weight of the Hoyer lift could be seen resting partially on Resident #1's lower extremities, as she was still attached to lift via the sling. The right side of the Hoyer lift's two base legs and two wheels were entirely off the floor (front facing perspective) and reached to the top of her Resident #1's mattress, which showed how far the lift fell over. Resident #1 screamed out Oooow!, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 22 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 - Minimal harm or potential for actual harm Residents Affected - Few covered her face with both hands and started crying. After the Hoyer lift fell over, CNA J and CNA K were unable to immediately lift it off of Resident #1. Review of Resident #1's Accident/Incident Report reflected on 04/29/23 at 8:20 AM, CNA/LVN attempting to transfer resident via Hoyer lift to be for incontinent care. While moving Hoyer towards resident, lift bar moved and bumped resident on head. LVN immediately assessed with no visible injuries note. Attempted to notify [PHY D], unable to reach by phone, facility medical director notified with new order received to obtain skull series to R/O injury. RP/ED/DON notified of new orders received. Review of the witness statement by CNA J dated 04/28/23 [sic] and obtained by the facility as part of the incident report reflected, I [CNA J] was helping the patient in her chair when the Hoyer leaned and slightly touched her. We both immediately were able to avoid any errors, me and another CNA. We immediately notified the charge nurse and supervisor. Review of the witness statement by CNA K dated 04/29/23 and obtained by the facility as part of the incident report reflected, I [CNA K] was helping another CNA put a patient [Resident #1] in her chair when the Hoyer lift leaned and slightly touched her face. We both were immediately able to avoid any errors We immediately notified the charge nurse and supervisor. Review of Resident #1's hospital records post-incident dated 04/29/23 reflected she arrived at the emergency room at 11:02 AM via an ambulance with an admission type as Urgent; History: Fall with left knee injury, left knee pain, acute, initial episode. Resident #1 had an x-ray to her knees with no fracture indicated, however she was noted to have severe tri compartment osteoarthritis (a type of arthritis that affects the knee). Resident #1 also had a CT of the cervical spine CT of the head with no negative findings. An observation and interview with Resident #1 on 05/01/23 at 12:08 PM revealed she remembered going to the hospital the previous weekend (04/29/23). When asked what happened, Resident #1 stated the thing hit her in the face. She could not remember but stated it happened when they were moving her and it fell over. Resident #1 could not recall the who, when and time. Resident #1 could not remember where on her face the Hoyer lift hit her, she just remembered it hit her and it hurt. She said her family wanted her to go to the hospital. Resident #1 did not remember what happened at the hospital and stated she was not hurting anymore, but she was not sure if she was going to let those girls mess with me and that thing [Hoyer lift] going forward. Resident #1 stated, It scared me. An interview with CNA J on 05/01/23 at 12:36 PM revealed on the morning of the incident (04/29/23), she was working with CNA K, a new CNA who she did not normally work with. CNA J stated she was the assigned staff to Resident #1 and had gotten her up that morning to get her dressed and then called for help and CNA K was the only person that came to help her. CNA J said this was around 7:00 AM, because Resident #1 liked to get up early. CNA J stated she and CNA K put the sling around Resident #1, attached all four sides, lifted her up and when they lifted her, everything was open and the latch was open. She said, So we lifted her up, got latches/legs open, we had it all open. So when I had got her in the .no, what happened, I was leading the back and [CNA K] tried to put her in the chair but was struggling, [CNA K] don't have but one usable arm, I saw she was struggling, I said let's switch. I don't know what happened but I had the chair ready for her, but when I went to pull her back, the Hoyer started leaning . [CNA K] went to guide the button that goes up and down, the Hoyer remote. CNA J then stated, She [Resident #1] was already down in the chair. When in her wheelchair, the legs of the Hoyer, [Resident #1] was to the side and the legs were open for the chair or whatever, she was to the side because at that time, it was easier because the room was so congested and you (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 23 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 - Minimal harm or potential for actual harm Residents Affected - Few don't want to do too much. CNA J stated the Hoyer lift started to lean and she told CNA K to hold on. CNA J stated, If it was me, I would have prevented it. If it was me at the remote and [CNA K] putting her in her chair, I would have made some kind of way for it not to tip over. It happened so fast. Thank god the bar went over her head and the straps touched her face. CNA J stated the Hoyer lift did not fall all the way to the ground, it leaned. CNA J stated she kept apologizing to Resident #1, but She was fussing about it. She didn't say anything was hurting. She kept saying y'all is just crazy. Even after it happened, she forgot about it. CNA J said if she could have done things different, she would not have put Resident #1 in her wheelchair from the Hoyer lift from the side. CNA J stated they should have gotten Resident #1's wheelchair front-facing with the Hoyer lift instead of having the wheelchair pulled over the Hoyer legs coming from the side, But see because she was already fussy that morning, we just really wanted it to be simple for her. CNA J stated she had been employed at the facility for about a month. An interview with CNA K on 05/01/23 at 1:17 PM revealed she had been employed at the facility for four days and Saturday, 04/29/23 was her last day of training. She stated she had finished her OJT and orientation. CNA K stated on 04/29/23 in the morning, she was doing a Hoyer transfer with Resident #1 and the lady she was with [CNA J] was holding the wheelchair and CNA K was trying to turn the wheelchair. CNA J told her to just leave the wheelchair where it was and lower the resident, so she leaned the resident down and lowered it. Then the wheelchair got caught on the Hoyer lift and made the lift tilt, So I had to catch it and it lightly grazed her head, the top of the Hoyer lift, not the black part, the arm, that white part that the arm that the arm is attached to. CNA K stated the Hoyer lift fell to the right side but did not fall all the way to the floor. CNA K stated, The lady that I was with, so the Hoyer lift, she didn't position the wheelchair properly. It wasn't between the legs, it was on the side of the Hoyer, so the front wheels were in the middle of the two legs, so it caught. I was trying to move it because I had the wheelchair first. I was trying to move the wheelchair between the legs, move the Hoyer, and she (CNA J) was just like 'no no no I got it, just lower it'. I said are you sure? She said yeah, so I lowered it. CNA K stated when CNA J pulled the wheelchair back was when it got caught and tilted over. CNA K stated she thought Resident #1 was scared more than anything, because the Hoyer lift lightly grazed her. CNA K stated Resident #1 did not have any scratches, bumps or bruises, It just shocked her more than anything. CNA K said she had recently gotten certified as CNA and was fully paralyzed on her left arm from birth, so when it comes to the Hoyer and sit-to-stand procedures, I make sure I do it properly because not only is it going to hurt you, it's going to hurt my arm, so I am not going to put myself in that situation. CNA K stated this incident occurred on her third day of training and it was her first time working with CNA J. CNA K stated, I was in training, not out of it. I felt like I was ready to do a Hoyer transfer because I have seen those before, it was just the [NAME] of the caregiver, not wanting to listen to someone new telling her something. If you would have followed what you were supposed to do .resident would not have bumped her head. An interview with CNA L on 05/01/23 at 2:16 PM revealed she was also the facility's staffing coordinator and did skills checks on the new hires. CNA L stated she was not present on 04/29/23 for the incident with Resident #1. CNA L stated she remembered seeing CNA K doing a Hoyer lift and she could only work the back end of the Hoyer, not the front end, and she could control the remote. Once a resident was up in the sling in the Hoyer, then CNA K could make sure that resident's legs were safe, however, CNA K could not be the person who pulled on the sling straps to place the resident into a wheelchair which would prevent the resident's legs from hitting the Hoyer lift. Review of the facility's Mechanical Lift education provided to staff (undated), reflected, Patient falls from lifts may cause injuries, including head (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 24 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 - Minimal harm or potential for actual harm Residents Affected - Few trauma, fractures and death .Prepare Environment: .Base legs are usually more stable in full open position, .Ensure there is space for lift to pivot and move freely to receiving area; .Lower the Patient: 1. Use gentle hands-on pressure to guide patient as you slowly move lift toward receiving surface- Holding or supporting patient's weight while in sling may cause straps or hooks to detach from lift; 2. Slowly lower patient toward receiving surface. Move patient's body into correct position on receiving surface before releasing body weight; 3. Release patient's weight, do not let sling bar hit patient Review of the facility's policy titled, Safe Patient Handling and Movement Program (not dated), reflected, compliance: It is the duty of employees to take reasonable care of their own health and safety, as well as that of their co-workers and Patients during Patient handling activities by following this policy .Procedures: .Use available mechanical lifting devices and other approved handling aids in accordance with instructions and training. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 25 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter or alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner or clinical nurse specialist for one (Resident #1) of five residents reviewed for physician services. Residents Affected - Few The facility failed to ensure Resident #1 was seen by the facility's attending physician and/or the physician's extender at least once every 60 days from December 2022 through April 2023. The failure could place residents at an increased risk of not receiving appropriate and adequate medical care. Findings included: Review of Resident #1's quarterly MDS assessment dated [DATE] reflected she was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #1's active diagnoses included Alzheimer's disease, hypertension, heart failure, atrial fibrillation (an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart), coronary artery disease and anxiety disorder. Resident #1 had clear speech, no hearing issues or impaired vision and her BIMS score was 08, which indicated moderate cognitive impairment. Resident #1 had no signs or symptoms of delirium, mood issues, or behaviors (which included psychosis and rejection of care). Review of Resident #1's Face Sheet (not dated) reflected her attending physician was PHY D (date active 03/31/23) and her medical director was MD F (date active 04/12/23). PHY D was not a contracted physician with the facility, he was a doctor in the community. Review of Resident #1's clinical chart (including nursing notes, medication/lab/x-ray orders and emergency notification for change in conditions), reflected that MD E was the previous attending physician until 05/24/22, when he issued Resident #1 a discharge from services letter. Review of MD E's discharge letter dated 05/24/22 reflected, An effective patient-physician relationship is essential to providing good primary care. Based on recent and on-going events, it is clear the therapeutic relationship we shared no longer exists. As a result of this, I can no longer serve as your physician. Therefore, effective 30 days after the date of this letter, our patient-physician relationship will terminate. You will need to discuss with [facility] which other primary care physicians in the facility are available to attend to your regular healthcare needs. Moreover, my services to you will be available only for emergency purposes during the next 30 days. I recommend you establish care with a new provider as soon as possible and continue to receive healthcare services. [Signed MD E]. Review of Resident #1's clinical chart (including her physician visits in the facility) revealed the last time she was seen for a face-to-face visit by MD E was 06/07/22 for shoulder pain. There were no changes made in her care management as Resident #1 stated it only hurt when she raised her arm over her head. Her range of motion was not affected. The exam reflected MD E remained her supervisor and rendering provider. Review of Resident #1's progress notes on 04/27/23 reflected she was not seen by MD E face to face (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 26 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0712 for required physician visits or by his extenders from June 7, 2022 through April 2023 (10 months). Level of Harm - Minimal harm or potential for actual harm An interview with Resident #1's family member on 04/27/23 at 9:13 AM revealed there had been several facility-initiated discharge notices given to Resident #1 and her responsible parties due to the facility not having a doctor available to provide medical care, all which went to a hearing and were overturned by the hearing officer. The family member said the facility had stated that since Resident #1 did not have an attending physician anymore in the facility, but still had a primary care physician in the community, then they would contact that physician for routine visits and emergencies. However, if he was not reachable, they told the family member they would send Resident #1 to the hospital emergency room. The family member stated, I know part of the state and federal regulations states they have to have a physician. Residents Affected - Few An interview with the DON on 04/27/23 at 1:48 PM revealed she never talked directly to PHY D, only the receptionist at his office on 04/10/23. She asked the receptionist where the facility could send the current month's physician's orders and that the facility needed a current H&P and progress notes from the visits Resident #1 had with PHY D because she had been to see him a few times. The DON said there was some miscommunication between the family of Resident #1 and the facility on how often the resident needed to be seen and that the facility said MD E would see the resident every two weeks, but the DON said that was not what she had said and she had never talked to him. The DON said, I have never been able to talk to [PHY D] to this day. The DON conformed confirmed that Resident #1 had not had no a H&P since February 2022, which was completed by MD E. The DON said the last note MD E wrote for Resident #1 was on 06/07/22. The DON said she asked PHY D (no date given) for any documentation on Resident #1 but only received medical documentation from 2020 and 2021, nothing current. An interview with MD E on 04/27/23 at 3:56 PM revealed he was the medical director for the facility and had been the attending physician for Resident #1 for the past five to six years but was no longer her attending physician. MD E stated the circumstances that caused him to cease being Resident #1's attending physician were cumulative and I think it was more differences in our philosophies in care was our biggest difference. MD E said Resident #1 had PHY D for many years and she would follow up with him as well, So I think she resumed care with [PHY D] and I think the facility transports to him now every 60 days. MD E confirmed that if a resident did not have an attending physician, then it was the medical director's role to oversee that resident's care. An interview with MD F on 04/27/23 at 5:40 PM revealed he was a new co-medical director for the facility as of April 2023 and he had not seen Resident #1 face to face yet but she had been put on his caseload. An interview with PHY D on 05/01/23 at 4:49 PM revealed he had not seen Resident #1 in about a year and prior to that, he had rarely seen her. He said looking back, it looked like 2020 was the first time they saw her as a patient and he only saw Resident #1 when the family brought her to his clinic. PHY D said, I assumed she was being seen there. I only see her on an outpatient basis. We have no treatment with her at the facility. I don't know what facility she is in. PHY D said his role in caring for Resident #1 was when the family brought her to him, that was it, that was the only care he provided for her. He said he had a few patients that lived in nursing homes and periodically, they could come and see him. PHY D said he was not Resident #1's attending physician, he was technically listed as her primary care provider, But I can't take care of someone who never sees me. Any care she needs at the facility had to be from a contracted physician. The facility had never asked me to be the attending and I never would. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 27 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0712 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #1's clinical documentation from PHY D reflected she was last seen on 05/24/22 for a hospital follow up. The exam notes reflected Resident #1 originally went to the hospital after she was hit in the chest with a Hoyer lift and a chest x-ray showed infiltrates (an abnormal substance that accumulates gradually within cells or body tissues). She was diagnosed with pneumonia and placed on antibiotics. She was noted to have a low fever at onset. PHY D documented Resident #1's visit diagnoses were : History of pneumonia, pressure injury of the right buttock-stage 3, hypertensive heart and kidney disease with HF and ESRD, ESRD on dialysis, chronic combined systolic and diastolic congestive heart failure, late onset Alzheimer's disease without behavioral disturbance and type 2 diabetes. No treatment or medications were ordered. Review of previous facility initiated discharge notices and fair hearing results provided by the ombudsman on 05/10/23 reflected: A. Resident #1 was issued the first facility-initiated 30-day discharge letter on 05/26/22 due to physician termination of services and the facility not having another physician available to accept responsibility. A Fair Hearing was completed on 07/26/22. A Fair Hearing Decision, Appeal ID 3576402, dated 09/12/22 reflected the hearing officer reversed the facility's action. B. Resident #1 was issued a second facility-initiated 30-day discharge letter on 10/17/22 due to physician termination of services and the facility not having another physician available to accept responsibility. A Fair Hearing was completed on 12/01/22. A Fair Hearing Decision, Appeal ID 3605691, dated 12/16/22 reflected the hearing officer reversed the facility's action. The Hearing Officer stated in part, Evidence was not provided by the nursing facility showing documentation was made by the Appellant's physician prior to the discharge notice of the specific resident's needs that could not be met and the services available at the receiving facility to meet the Appellant's needs. C. Resident #1 was issued a third facility-initiated 30-day discharge letter on 12/19/22 due to physician termination of services and the facility not having another physician available to accept responsibility. A Fair Hearing was completed on 12/19/22. A Fair Hearing Decision, Appeal ID: 3624346, dated March 03/30/23 reflected the hearing officer reversed the facility's action. On 05/09/23, review of an HHSC complaint was reviewed that indicated Resident #1 had been issued a fourth facility-initiated 30-day discharge notice. Review of a facility initiated 30-day discharge notice dated 05/09/23 reflected, .I. This discharge is necessary for the resident's welfare as each and every available physician has either terminated their services to [Resident #1] or otherwise refused to take her as a patient. Despite efforts, the facility is not able to obtain an attending physician who will agree to take [Resident #1] as a patient. Without a physician overseeing [Resident #1]'s care, the facility cannot meet the needs of [Resident #1]. The physicians who have refused to take [Resident #1] as a patient include [MD E], [PHY M], [PHY N], [MD F] and [PHY D] (who was also [Resident #1's] outside primary care physician). Most recently, [MD F] declined to serve as [Resident #1]'s attending physician and is only seeing [Resident #1] on an 'as needed' basis; . [Resident #1] requires an attending physician. A physician treating her on an 'as needed basis' does not amount to an attending physician, does not meet [Resident #1's] needs, and does not allow the facility to adequately meet [Resident #1's] needs and welfare The facility has exhausted all possible credentialed attending physician provider sources beyond [MD F]. On 05/11/23 at 9:15 AM, HHSC re-entered the facility due to an additional complaint made related to Resident #1 being given another facility-initiated discharge notice on 05/09/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 28 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0712 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview with the ADM on 05/30/23 at 11:42 AM revealed she was going to try and contact MD E and his NP to see if they had any documentation of visits made to Resident #1 when she had COVID-19 in 2022. A follow up interview with the ADM on 05/30/23 at 4:00 PM revealed she talked to the MD E and said Remember, you saw her when she got covid, and he was like, oh yeah, I did. The ADM said she asked MD E to write note from that visit. Review of MD E's progress note provided by the ADM and dated 11/09/22 reflected, patient assessed during rounds 11/08/2023, abnormal CXR, some report of cough, will go ahead and cover for bacterial pna in an abundance of caution. Please see nursing notes for full details. Review of MD E's nurse practitioner's visit progress note provided by the ADM dated 09/05/22 reflected he saw Resident #1 face to face. There were no more physician or physician extender visits from 11/10/22 through April 2023. An interview with MD F on 05/30/23 at 10:24 AM revealed he had seen Resident #1 for an H&P and was not required to see her but once a year and his mid-levels could see her every 60 days. He said, I don't have to see her if she is long term. He said if something acute was going on, I don't have to see her if I don't want to. If I want to, I can see her once a year as a custodial patient and my mid-levels can see her once a month if they want to. Review of the facility's policy titled, Physician Services revised February 2021, reflected, Policy Statement: The medical care of each resident is supervised by a licensed physician. Policy Interpretation and Implementation: .2. Once a resident is admitted , orders for the resident's immediate care and needs can be provided by a physician, physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS); 3. Supervising the medical care of residents includes (but is not limited to): a. participating in the resident's assessment and care planning; b. monitoring changes in resident's medical status; c. providing consultation or treatment when called by the facility; d. prescribing medications and therapy; e. ordering transfer to the hospital if necessary; f. conducting routing required visits; g. delegating and supervising follow-up visits by non-physician practitioner (NPs, PA, CNS's); and h. overseeing a relevant plan of care for the resident; .7. Physician visits, frequency of visits, emergency care of resident, etc., are provided in accordance with current OBRA regulations and facility policy . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 29 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0773 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to promptly notify the physician of laboratory results in accordance with facility policy and procedures for notification for one (Resident #2) of four residents reviewed for labs. The facility failed to check the laboratory portal containing Resident #2's STAT (At once; immediately usually used in medical situations, to connote extreme urgency) lab results collected on 05/02/23. The physician was not notified of the abnormal results causing a delay in the physician ordering necessary interventions to treat the resident's infection. As a result, Resident #2 was hospitalized on [DATE] with diagnoses of severe sepsis (the body's extreme response to an infection a life-threatening medical emergency), acute kidney injury, urinary tract infection, altered mental status, and hypotension (low blood pressure) due to hypovolemia (a state of low fluid volume, generally secondary to combined sodium and water loss). The resident remained in the hospital for 10 days where treatment included the administration of intravenous fluids and intravenous antibiotics and was subsequently transferred to another facility. An Immediate Jeopardy (IJ) was identified on 05/15/23. While the IJ was removed on 05/16/23, the facility remained out of compliance at a severity level of actual harm that is not immediate jeopardy and a scope of isolated, due to the facility continuing to monitor the effectiveness of their plan removal. This failure could affect residents by placing them at risk for untreated illnesses, delays in necessary care and deterioration in condition. Findings included: Review of Resident #2's admission MDS assessment, dated 04/22/23, revealed he was a [AGE] year-old male admitted to the facility on [DATE]. Diagnoses included heart failure, high blood pressure, benign prostatic hyperplasia (BPH-enlarged prostate), and Cerebrovascular Accident (Stroke). The MDS reflected he had a BIMS score (Brief Interview for Mental Status-a mandatory tool used to screen and identify the cognitive condition of residents upon admission into a long-term care facility) of 5 indicating severe cognitive impairment, required limited physical assistance of one person for toilet use, transfers and bed mobility, extensive physical assistance of one person for dressing and personal hygiene. Review of Resident #2's care plan dated effective from 04/25/23 to 05/02/23 revealed the risk for urinary tract infection, surgical site infection was addressed, and goals included remaining free of infection. Interventions included reporting any signs/symptoms of urinary tract infection to include temperature, pain, urine that looked cloudy, dark or with blood. Assessing for signs/symptoms of surgical site infection, obtaining, and monitoring any lab work ordered. Review of Resident #2's nursing progress notes revealed the following: 05/02/23 at 1:47 p.m. authored by LVN A Change of Condition noted at this time. Resident alert to person only, skin warn/dry with color normal for ethnicity, resident denies pain at this time, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 30 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0773 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few resident requiring feeding assistance with decreased appetite. Vitals:138/82, 98.8, 119, 20, 95% on Room Air. Upon command resident able to recite first name but unable to voice needs. Suprapubic catheter in place with moderate amount dark orange urine noted at this time. PA and RP notified of Change of condition and nursing assessment with new orders received for CBC (cbc-complete blood count-blood test that counts the cells that make up your blood: red blood cells, white blood cells, and platelets), BMP (bmp-basic metabolic profile- 8 individual blood tests that measures the blood's glucose levels, electrolyte, fluid balance, and overall kidney function), and UA with C&S (UA with C&S urine test-culture and sensitivity that identifies the microbes causing urinary infections and to which antibiotic the infectious agent (microbe) is susceptible). Lab requisition completed at this time and catheter bag changed in order to collect urine specimen. Review of Resident #2's physician's telephone order dated received by LVN A on 05/02/23 at 1:47 p.m. revealed orders to obtain a urinalysis with a C&S, CBC, and BMP labs. 05/02/23 at 9:30 p.m. authored by LVN B Resident temperature 101.6 and resident less responsive than normal. Physician notified of changes in resident behavior and vitals. New orders received for IV start normal saline at 60 ml/hr (60 milliliters per hour), cbc, bmp and ua. Resident resting quietly in bed at this time. Resident able to take all pm medications. Will continue to monitor. 05/02/23 at 10:15 p.m. authored by LVN C Report given by off going nurse of new orders received from physician [name] for normal saline IV. No peripheral line placed at this time. This nurse grabbed supplies to start peripheral IV access. Upon entering room resident sweating profusely. Labored breathing noted. B/P 102/56 P120 Temp 102 O2 74% on RA RR 24. O2 2-3 liters placed. Resident not easily aroused sternum rub initiated. Resident open both eyes slowly. [NAME] colored urine noted in catheter bag. Call placed to PA. New order to send to ER for further evaluation. Call placed to 911 for transport. Review of Resident #2's SBAR incorrectly dated 05/03/23 (should be 05/02/23) and timed 10:20 p.m. reflected the resident's condition had worsened. (SBAR-situation, background, assessment, and recommendation-a tool to aid in facilitating and strengthening communication between nurses and prescribers). Review of Resident #2's ambulance run notes revealed EMS arrived at the facility on 05/02/23 at 10:52 p.m. EMS assessed the resident to be diaphoretic (excessive sweating), elevated temperature of 100.2 degrees Fahrenheit, a low blood pressure of 94/58 millimeters of mercury and a rapid heart rate of 115 beats per minute. Facility nursing staff reported the resident's oxygen levels were low and he had not been breathing well. Nursing staff reported labs had been collected for Resident #2 for possible infection, but they did not have the results. The notes further reflected intravenous fluids were initiated in the ambulance. Review of Resident #2's STAT lab report dated 05/02/23 revealed the ordered labs and urine sample were collected on 05/02/23 at 2:43 p.m. and received in the lab at 4:48 p.m. The report reflected the following values were abnormal and out of reference range: sodium level 134 (reference range 136-145 millimoles per liter), white blood cells 29.8 cells/microliter (reference range 3.6-10.2 cells/microliter). Urine color brown (reference range -straw-yellow), urine clarity cloudy (reference range-clear), and urine blood large (reference range-negative). Review of Resident #2's hospital records revealed the resident admitted on [DATE] with diagnoses to include severe sepsis, urinary tract infection, elevated white blood cells, acute kidney injury, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 31 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0773 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few altered mental status and hypotension due to hypovolemia. He was treated with intravenous antibiotic and fluids and discharged on 05/11/23. Interview on 05/11/23 at 1:58 p.m. LVN A stated he was the charge nurse providing care for Resident #2 during the day shift on 05/02/23. He stated the resident was noted with a change in condition and was not as alert as usual. LVN A stated the resident's urine was dark, dark orange and his heart rate was a concern. He notified the PA and orders were received for STAT labs to include a urinalysis, CBC, and CMP (complete metabolic profile- 14 individual blood tests that measures the blood's glucose levels, electrolyte, fluid balance, and overall kidney function). He stated the lab company collected the labs before the end of his shift and STAT meant within 2 to 4 hours for collection of the labs. Interview on 05/11/23 at 2:40 p.m. LVN B stated she was the charge nurse providing care for Resident #2 during the evening on 05/02/23. She stated she made rounds with LVN A during the change of shift at 2:00 p.m. but she did not receive any report related to Resident #2's change in condition or labs. She stated through observation of the resident and looking through the resident's progress notes she noted he was experiencing a change in condition and there were orders for labs to be collected. She observed Resident #2 was less responsive than usual and had an elevated temperature. She notified the physician who was in the facility. The physician assessed the resident and ordered intravenous fluids, CBC, BMP, and a urinalysis to be collected. LVN B provided no explanation about why she did not check the lab portal for Resident #2's lab results and report the results to the physician. Interview on 05/11/23 at 3:01 p.m. the DON stated she was not able to determine if Resident #2's lab results had been seen by facility nurses. She stated the resident's physician was new to the facility and she was not sure if he had access to the lab portal. Nurses would have to follow-up, check the lab portal, obtain lab results, and report the results to the physician/PA. Interview on 05/11/23 at 4:09 p.m. the PA stated he gave facility nursing staff an order for labs and a urinalysis for Resident #2 on 05/02/23. He stated he was currently checking the resident's closed clinical records and did not see where he had been notified of the results of the labs and urinalysis he ordered. He stated he did not recall having a discussion related to the resident's lab results. When informed of Resident #2's abnormal lab results, the PA stated had he been notified of the abnormal results he would have taken some type of action. The PA stated actions at a minimum would have possibly included ordering fluids and an antibiotic for Resident #2 depending on how the resident presented. He stated if the resident had been unstable, he would have ordered facility staff send the resident to the hospital. When queried about what would be considered unstable, he stated if the resident was hypotensive (low blood pressure), experiencing tachycardia (rapid heart rate), fever that did not resolve with medication, and/or was having shortness of breath. He stated lab companies usually only made notifications for critical lab results. He further stated facility nursing staff would know when lab results were available and would typically notify the physician or PA whether results were abnormal or not. He stated he nor the physician had access to the facility's lab portal and the only way they would know when lab results were available was when they were notified by facility nurses. Interview on 05/11/23 at 4:25 p.m. the Administrator stated she did not know when the results of the labs collected for Resident #2 on 05/02/23 were finalized, uploaded to the portal and available for review. Interview on 05/12/23 at 6:11 p.m. LVN C stated she was the night shift nurse assigned to Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 32 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0773 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few #2 on 05/02/23. She stated she received report form LVN B of the resident's change in condition at approximately 10:15 p.m. on the night of 05/02/23. LVN B told her she had recently received an order from the physician to start IV fluids for the resident, but the order had not been implemented yet. LVN C stated she obtained the equipment to start the IV fluids but when she saw the resident he did not look good. She stated Resident #2 was sweating, his oxygen level was low, his temperature was elevated, and he was experiencing labored breathing. LVN C stated she notified the PA and orders were received to transfer the resident to the hospital. LVN C stated STAT labs were to be collected within 4 hours and the results were to be reported immediately when they were received by checking the lab portal. Interview on 05/15/23 at 9: 25 a.m. the Administrator stated the lab results for Resident #2 arrived after the physician had left on 05/02/23 at 9:30 p.m. and after the resident was sent to the ER. She stated the lab results were not available when the physician was in the facility on the night of 05/02/23. She further stated she would provide the fax confirmation for Resident #2's lab results but she did not know who, when or if anyone retrieved the faxed results prior to Resident #2's transfer to the hospital. Review of a fax confirmation provided by the Administrator on 05/02/23 revealed Resident #2's lab results were faxed to the facility on [DATE] at 8:48 p.m. Interview on 05/15/23 at 9:47 a.m. Resident #2's physician stated he did not recall the exact time of day he visited the facility on 05/02/23 when he was informed by nursing staff the resident was experiencing a change in condition. He was aware labs had been ordered earlier in the day but did not know what time the labs had been ordered. The physician stated he ordered IV fluids and an antibiotic for the resident due to possible UTI and did not want the resident to become septic. He stated there were no lab results back when he saw the resident and the resident was alert and talking when he saw him. He further stated his expectation was that facility staff should notify him or the PA of STAT and/or abnormal lab results quickly. He stated he did not recall re-ordering labs. Interview on 05/15/23 at 10:11 a.m. the Client Relations Manager for the facility's lab stated there was no way to determine when a lab result was available for review in the lab portal. She stated she might be able to check somethings on the back end of her system to determine when Resident #2's labs were available in the portal for review. Interview on 05/15/23 at 11:20 a.m. the Administrator stated she had communicated with the lab representative and had been informed Resident #2's lab results collected on 05/02/23 had been uploaded into the lab portal on 05/02/23 at 5:16 p.m. and were available for review at that time. The Administrator stated the lab portal did not interface with the facility's electronic health record system to provide notifications to facility staff that lab results were available. The Administrator further stated nurses were expected to frequently check the lab portal for results. Interview on 05/15/23 at 12:13 p.m. the Administrator stated she had been informed by the laboratory representative that it was an unspoken rule that the lab had four hours to provide lab results including STAT labs. She stated she was told it could depend on the weather or traffic and there was no guarantee for when the lab results would be available. The Administrator stated there was no additional facility P/P to address the time lab results should be available for review. Interview on 05/15/23 at 12:19 p.m. LVN A stated abnormal lab results should be reported to the physician as soon as the results were received. He stated he was aware to log into the lab portal, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 33 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0773 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few obtain lab results and report the results to the physician. He further stated the lab faxed results after they had been uploaded into the portal, and it had been his experience lab results were available for review in the portal within 1-2 hours after being collected. Interview on 05/15/23 at 3:50 p.m. LVN B stated she received verbal orders from Resident #2's physician on the night of 05/02/22. She stated the physician did not order any antibiotics for the resident. She stated it was her understanding that the lab had four hours to draw/collect labs including STAT labs and the results were to be reported to the physician as soon as they were received. She further stated there was no way to know when the results were available other than checking the fax machine or calling the lab to follow-up on the results after about 2 hours after the labs had been collected. Review of the facility's laboratory P/P dated 01/04/2016 reflected in part: STAT lab requests require the lab requisition be marked as such and the lab notified immediately. The prescribing physician is to be notified of the results of the laboratory tests ordered. Laboratory reports are returned to the facility by mail, by the laboratory technician or fax. Nursing staff is to review all laboratory reports and notify the prescribing physician of any abnormal results. Review of the facility laboratory agreement dated initiated 11/04/20 revealed in part: d. Laboratory will provide reference laboratory services during its regular business hours. Results will be transmitted back to the Facility. Electronic Medical Record (EMR) connectivity may require additional charges. e. Laboratory staff shall be available to consult with facility by telephone during normal business hours to discuss Laboratory's procedures and to provide the status of test results. .h. Upon request by Facility, Laboratory will provide STAT laboratory services as well as additional services for an additional charge. The P/P nor the lab agreement reflected any specific time frames for facility staff to obtain and/or report lab results to the physician. An Immediate Jeopardy was identified on 05/15/23 at 4:24 p.m. and the Administrator was informed of the IJ and the IJ template was provided via email at 4:28 p.m. The Plan of Removal was accepted on 05/16/23 at 10:36 a.m. and reflected: Nurses did not notify the PA/physician of the lab results in order for prompt intervention to be provided. Per the facility's P/P and the DON's expectations. Immediate action Please accept this as a Plan of Removal to remove the IJ Identified F773- Labs Services/Notification of Results initiated on 5/15/23 at: 5 P.M. Systematic Approach: 1. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 34 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0773 24-Hour Report Level of Harm - Immediate jeopardy to resident health or safety a. Residents Affected - Few b. All nurses will be given report from previous nurse on all residents when coming on shift. All nurses will read 24-hour report upon coming on shift. c. All nurses will check lab requisition book upon entering shift. 2. In-Services a. DON was in-serviced on lab follow up by Regional Nurse Consultant. b. Clinical staff were in-serviced by the DON and/or designee on the following: i. Shift to shift Reporting process. Date completed 5/15/23. a) At shift change the charge nurse must report to oncoming nurse on all resident's status. b) As part of shift to shift report the charge nurse will read the 24-hour report. STAT LABs Date completed 5/15/23. c) All Stat labs received from physician require notification to DON/ADON. d) All Stat labs must be placed on 24-hour report. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 35 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0773 e) Level of Harm - Immediate jeopardy to resident health or safety All Stat labs must be checked every hour in lab portal upon lab drawing. Residents Affected - Few All Stat labs must be called in immediately to physician. f) 4. Monitoring a. The DON/ADON will receive texts or calls every hour after stat lab is drawn from nurse until doctor notified X 4 weeks. b. If stat labs are not received within 4 hours, nurse will call the lab company and notify DON/ADON. c. All Stat labs will be reviewed during stand up and stand down daily. 5. Quality Assurance a. A QA meeting will be held to review the monitoring process and effectiveness. b. All concerns regarding stat labs will be discussed with the Quality Assurance Committee for analysis and recommendations with input from the Medical Director going forward. 6. Completion date: 5/15/23. Interview on 05/16/23 at 10:04 a.m. the DON stated training related to labs was provided frequently during in-services and via conversations with nursing staff. She stated the last in-service training related to labs was in December 2022. She feels the IJ was due to a lack of communication and initiative from nursing staff. She stated it was important to notify the physician/PA or Nurse Practitioner of abnormal lab results and STAT lab results because lab results were part of the resident's health assessment and allowed the physician to determine what care the resident needed. If lab results (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 36 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0773 Level of Harm - Immediate jeopardy to resident health or safety were not reported timely, it could cause the resident to experience a change in condition, delay in care and could affect the overall health status of the resident including life threating consequences. The DON stated it was important for nurses to review the 24-hour nurse report because it relayed a picture of the resident's health status, and it was important to ensure nurses were aware of any changes in resident's health status. Monitoring of POR: Residents Affected - Few Review of in-service training dated 05/1/23 revealed education included nursing staff receiving and reporting lab results to the Nurse Practitioner and/or the physician in a timely manner of less than four hours, continued follow-up for completion of labs every 30 minutes to one hour and documentation of the follow-up. Charge nurses were trained on accessing the lab portal via the desktop computer and from the telephone. Walking rounds, with a printout and review of the 24-hour nurse report and discussions at shift changes about pending labs and other diagnostics. Interviews were conducted with facility nursing staff across multiple shifts on 05/16/23 from 12:13 p.m. to 12:30 p.m. to 3:26 p.m. Staff interviewed were LVN A, LVN B, RN O, LVN P, LVN Q, LVN R and LVN S. Interviews with nursing staff revealed they verbalized comprehension of the in-service training. They stated they had been in-serviced regarding reporting lab results to the Nurse Practitioner, PA and/or the physician in a timely manner. They were to follow-up pending labs results by checking the lab portal every 30 minutes to one hour and documenting the follow-up in the resident's records. They verbalized knowledge on how to access the lab portal and the new policy of performing walking rounds at shift change with the 24-hour nurses report printed and verbally reporting any pending labs results to on-coming nurse. The Administrator was notified on 05/16/23 at 4:30 p.m. that the Immediate Jeopardy was removed. However, the facility remained out of compliance at the severity level of potential for more than minimal harm that is not immediate jeopardy and at a scope of isolated due to the facility continuing to monitor the implementation and effectiveness of their plan of removal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 37 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0841 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the medical director was responsible for implementation of resident care policies and the coordination of medical care in the facility for one (Resident #1) of five residents reviewed for medical director. The facility's medical director failed to assist the facility to locate an alternate attending physician when he chose to discontinue being the attending physician for Resident #1. The failure placed residents at an increased risk of not receiving appropriate and adequate medical care in a timely fashion. Findings included: Review of Resident #1's quarterly MDS assessment dated [DATE] reflected she was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #1's active diagnoses included Alzheimer's disease, hypertension, heart failure, atrial fibrillation, coronary artery disease and anxiety disorder. Resident #1 had clear speech, no hearing issues or impaired vision and her BIMS score was 08, which indicated moderate cognitive impairment. Resident #1 had no signs or symptoms of delirium, mood issues, or behaviors (which included psychosis and rejection of care). Review of Resident #1's Face Sheet (not dated) reflected her attending physician was PHY D (date active 03/31/23) and her medical director was MD F (date active 04/12/23). Review of Resident #1's clinical chart (including nursing notes, medication/lab/x-ray orders and emergency notification for change in conditions), reflected that MD E was the previous attending physician until 05/24/22, when he issued Resident #1 a discharge from services letter. Review of MD E's discharge letter dated 05/24/22 reflected, An effective patient-physician relationship is essential to providing good primary care. Based on recent and on-going events, it is clear the therapeutic relationship we shared no longer exists. As a result of this, I can no longer serve as your physician. Therefore, effective 30 days after the date of this letter, our patient-physician relationship will terminate. You will need to discuss with [facility] which other primary care physicians in the facility are available to attend to your regular healthcare needs. Moreover, my services to you will be available only for emergency purposes during the next 30 days. I recommend you establish care with a new provider as soon as possible and continue to receive healthcare services. [Signed MD E]. An interview with Resident #1's family member on 04/27/23 at 9:13 AM revealed there had been several facility-initiated discharge notices given to Resident #1 and her responsible parties due to the facility not having a doctor available to provide medical care. The family member said the facility had stated that since Resident #1 did not have an attending physician anymore in the facility, but still had a primary care physician in the community, then they would contact that physician for routine visits and emergencies. However, if he was not reachable, they told the family member they would send Resident #1 to the hospital emergency room. The family member stated, I know part of the state and federal regulations states they have to have a physician. The family member stated, I mean this, god forbid something happens to [Resident #1] without physician care. The family member stated, I am (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 38 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0841 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few so worried, you are going to just sit there and let her die or not render aid. I pray to god nothing happens. The family member said prior to MD E stopping his services for Resident #1, he had been her physician since 2016. Now, the family member stated on a day-to-day basis, no physician was overseeing her care. The family member said the facility claimed they had contacted other doctors to be the attending physician for Resident #1 but they said no. The family member said one of the doctors asked by the facility to be Resident #1's attending physician worked with MD E and the family member felt MD E told that potential doctor a lot of negative things about Resident #1 and the family, which caused that doctor to say no, even though he had never seen Resident #1. The family member said after the most recent attempt to discharge Resident #1 in 2023 due to the facility stating she did not have an attending physician, the family appealed and won, however, the family was notified after that that MD E would not even provide care for emergencies for Resident #1. An interview with the DON on 04/27/23 at 1:48 PM revealed she never talked directly to MD E, only the receptionist at his office on 04/10/23, she stated I have never been able to talk to [MD E] to this day. The DON said she did not know if MD E talked to PHY D. She said MD E had been seeing Resident #1 for years and when the DON and ADM came to work at the facility in May 2022, we walked into this situation, [MD E] was already trying to remove himself as her doctor. The DON said she did not know if MD E, as the medical director for the facility, had reached out to PHY D to discuss the situation. An interview with MD E on 04/27/23 at 3:56 PM revealed he was the medical director for the facility and had been the attending physician for Resident #1 for the past five to six years but was no longer her attending physician. MD E stated the circumstances that caused him to cease being Resident #1's attending physician were cumulative and I think it was more differences in our philosophies in care was our biggest difference. It had been many years and it came to an aggressive stance with the [family member], I am not sure which [family member], but it was mainly [name]. MD E said Resident #1's family member behaved in a way that was more like harassment, questioning his decisions, sending her out to the hospital then coming back, I don't think she trusted my care. She is the only resident I have had to part ways with. I have been doing this for ten years. The MD said he worked in a large physicians' group in general, but for the facility, it was himself, his PA and NP. When asked what does being a physician for emergencies entail, MD E replied, That is kind of funny, I am still trying to figure out if I am there for emergencies I am getting my legal involved so we can figure out what it entails. If I see something as a medical director, I would intervene. I just don't know what that means legally. MD E said if a facility physician refused to see a resident as a patient, their care would have to be monitored by an outside physician. MD E said Resident #1 had PHY D for many years and she would follow up with him as well, So I think she resumed care with [PHY D] and I think the facility transports to him now every 60 days. MD E was asked what was his responsibility as the medical director of the facility to assist the facility in locating another attending physician for Resident #1. MD E stated, You know what, that is a great question, I don't know if as a medical director, is that something I have to do a responsibility. I think the facility has to do it, like trying to recruit another physician but I don't think in my medical director's contract it is in there. MD E confirmed that is if a resident did not have an attending physician, then it was the medical director's role to oversee that resident's care. MD E said he had not personally contacted any doctors to see if they could be Resident #1's attending physician. MD E stated, I guess because she had a doctor. It's a tough situation, I guess it is confusing to me. It was kind of like a distrust or conflict of our philosophy. MD E said he had not talked to MD F since he had taken over as co-medical director and that the facility decided who would have which residents on their caseload for both he and MD F. MD E (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 39 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0841 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was asked if he felt refusing to be her attending physician was punitive to the resident when she had no other physician available to see her in the facility. MD E stated, You know it's hard to say because I think [PHY D] can do everything I do. It seems like they follow up with him even when I was still her physician. I would say something, like he prescribed and antibiotic I didn't agree with. They were comfortable with him so I thought, then you have a provider and if I am there, I am never going to withhold care on someone, but there is also a time for mental well-being for physicians. I felt they were badgering me, the family. [PHY D] was doing what I am doing, we would probably manage it the same. MD E stated most of the time when something happened with Resident #1 medically, the family requested her to be sent out, for example, when there was a snow storm and Resident #1 missed dialysis. MD E said he told the facility it was okay for her to miss a couple of days of dialysis but the family sent her to the ER and she came back with no new orders. He said once a Hoyer lift bumped Resident #1, a x-ray on her ribs was done, there was a question of pneumonia, his NP saw it and the resident was asymptomatic (producing or showing no symptoms) but the family wanted to send her out. MD E stated, The family will supersede whatever I say. If there is an emergency situation, one of us is going to handle it. And I have. I am not going to withhold care. It's difficult to figure out what do we do now. Maybe I just don't need to be medical director there anymore. MD E was asked if he had reached out to PHY D to discuss continuity of care for Resident #1 and he replied no. Review of an email exchange almost a year ago, provided by the ADM on 05/01/23 between herself and PHY H on 05/25/22 reflected, ADM-I understand after out our discussion related to taking on this resident, you feel that that [sic] would not be a good choice for you due to the medical director concerns, is that correct? To which PHY H responded, I am very uncomfortable in taking care of this patient due to medical director concerns. Review of an email exchange provided by the ADM on 05/01/23 between herself and PHY I on 10/25/22 reflected, ADM-As discussed today about being attending physician for [Resident #1], I understand that you have chosen not to pick her up. To which PHY I responded, Correct, I have chosen not to be [Resident #1's] doctor. Review of an email exchange provided by the ADM on 05/01/23 between herself and MD F on 04/10/23 reflected, ADM-I am confirming our conversation regarding [Resident #1]. You agree that you are available to see the resident for emergency purposes or if the outside attending is not available. Due to previous concerns with Medical director, you do not want to be the attending only back up for emergencies. You also agree to only communicate with the facility staff and POA regarding the resident care. If this correct? To which MD F responded, I accept. Review of an email exchange provided by Resident #1's family member to the facility's DON, ADM, Ombudsman, VP of Clinical Operations, VP of Operations dated 04/12/23 reflected, We are requesting that the new co medical director [MD F] be designated as [Resident #1]'s attending physician. The ADM responded back to the family member on 04/12/23, [MD F] does not want to be attending, sorry. I asked him and he emailed saying he didn't want to. An interview with PHY D on 05/01/23 at 4:49 PM revealed he had not seen Resident #1 in about a year and prior to that, he had rarely seen her. PHY D said the family never asked him to be Resident #1's attending physician at the facility and the medical director (MD F) never reached out to him. PHY D stated, When she shows up here at the clinic, for acute care, there is little coordination between the nursing home and outpatient care. I don't have records for from the nursing home or a clue what they do with her there. I would be more of a second opinion type of person and there are limitations to that, especially when I don't know what the primary's opinion is. PHY D said he had not been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676112 If continuation sheet Page 40 of 41 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 676112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crestview Court 224 W Pleasant Run Rd Cedar Hill, TX 75104 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 0841 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete seeing Resident #1 for routine health care needs and there was no agreement or understanding with the facility that he would do any specific tasks. Review of the facility's Agreement for Medical Director Services dated 01/15/21 and signed by MD F, reflected, .I. Duties and Obligations of Program Director: A. Services-Medical Director agrees to provide administrative and professional services required as needed and requested and to assist the Facility to ensure the adequacy and appropriateness of the care rendered to patients of the Facility and to supervise the medical care of patients at the Facility; .2. Physician Services Policies-Medical Director shall participate as requested in the ongoing development of Physician Service Policies specifying the duties, responsibilities and rights of each physician attending patients of the Facility, including, but not limited to, the appropriate and timely intervals for physician visits. Event ID: Facility ID: 676112 If continuation sheet Page 41 of 41