Health inspection·October 10, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete PM, Resident #3's RP revealed Resident #3 could be manipulative when she got mad and did not get her way. She revealed Resident #3 had a history of making up stories about her care in order to make it seem like Resident #3 had to come home instead of staying at the facility. Interview on 10/10/25 at 04:37 PM, the ADM and DON revealed they should have documented Resident #2 refused wound treatments in his care plan because care plans were person centered and reflected what care resident received. They further revealed for Resident #3 they did not document in her care plan that she made accusations and allegations of her care. (The ADM revealed these accusations and allegations were not reportable events.) They revealed Resident #3 had a history of making allegations about staff, and they had been working on helping this resident with these behaviors through psychiatric and psychological services. Interview on 10/13/25 at 03:54 PM, [Mental Health Organization] counselor revealed Resident #3 did not like being in the facility because she wanted to go home. She revealed Resident #3 had a history of making up accusations about care. She revealed if Resident #3 got into a bad mood, anything bothered her. She revealed the facility and she had been working on these behaviors with her. Record review of the facility's policy, titled Comprehensive Care Planning, undated, reflected The comprehensive care plan will describe the followingThe services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being; and the right to refuse treatment Event ID: Facility ID: 676121 If continuation sheet Page 2 of 7 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 676121 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 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 the resident environment remained as free of accident hazards as possible and each resident received adequate supervision to prevent accidents for 1 of 6 residents (Resident #1) reviewed for accidents and supervision. The facility failed to provide appropriate supervision for Resident #1 resulting in Resident #1 leaving the facility without the facility's knowledge on 08/28/2025 between 1:20 and 1:40 AM and being found face down on the ground in the facility parking lot. The noncompliance was identified as PNC. The Immediate Jeopardy (IJ) began on 08/28/25 and ended on 08/29/25. The facility had corrected the noncompliance before the investigation began.This deficient practice could place residents at-risk of harm, serious injury, or death. The findings included:Record review of Resident #1's admission Record, dated 10/08/25, reflected Resident #1 was an [AGE] year-old female admitted [DATE] with diagnoses to include dementia (loss of cognitive functioning that interferes with daily life and activities) and repeated falls. Record review of Resident #1's quarterly MDS assessment, dated 06/06/2025, reflected Resident #1 had a BIMS of 7 out of 15 indicating moderately impaired cognition. RR of Resident #1's quarterly Elopement Risk Assessment, dated 08/25/2025, reflected resident had statement and/or threats to leave facility, frequent request to go home, confused expressions related to tasks to complete, and verbalizes anger and frustration re: placement. Resident #1 scored 13, identifying her as an elopement risk. RR of Resident #1's care plan, undated, reflected Resident #1 was At risk for elopement and Actual elopement or elopement attempt Resident was confused and wandered outside the facility unattended, initiated on 08/28/2025. There were no interventions prior to this date. Record Review of the Provider Investigation Report for this incident, dated 08/28/25 and authored by the ADM, reflected the investigation summary On 08/28/2025 at 1:40am, the resident was found to be laying on the ground, outside the dining room door. The staff heard the door alarm and immediately started searching. Once the resident was located the staff, immediately assisted her and notified EMS due to her nose bleeding and having skin tears on her forehead and cheek. [Resident #1] was transferred to the local ED and returned a few hours later with no injuries noted. When [Resident #1] returned, she was placed on one on one monitoring and skin assessment was completed. Upon investigation, it was noted that the CNAs last saw her at 1:20am in the hallway with coffee in her hand while they were completing a round. Elopement protocol was immediately initiated and completed. On 8/29/2025, the resident was transferred to another facility with a secure unit. Observation on 10/08/2025 at 3:07 PM revealed the distance from the dining room exit door to the alleged spot where Resident #1 fell was 0.01 miles. Interview on 10/08/2025 at 2:40 PM, LVN A revealed she heard the alarm for the exit door in the dining room alarming. She revealed she went to the dining room door that was sounding and saw something that looked like possible bicycle wheels outside and went to get assistance. She further revealed when she came back with help, they saw a wheelchair and it appeared a resident had fallen. Interview on 10/09/2025 at 9:45 AM, Med Aide B revealed she was doing her rounds around 1:20 AM and had to escort Resident #1 back to her room. She revealed at 1:40 AM, she was told Resident #1 was on the ground, outside of the facility. She revealed she could not really hear the alarm. She further revealed Resident #1 was not exit-seeking prior to this event. Interview on 10/09/2025 at 10 AM, LVN AA revealed Resident #1 would wander and would be confused/looking for her family member at night but would stay around the nurse's station. She revealed she had never seen Resident #1 exit seek. Interview on 10/09/25 at 03:56 PM, the ADM and the DON revealed Resident #1 scored high on her elopement risk assessment because she was agitated from her family member's recent visit. They revealed if the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676121 If continuation sheet Page 3 of 7 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 676121 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few admission elopement risk was high, they would wait a couple of days until the resident got acclimated so they could understand resident's true behaviors. They let staff know if there was a resident who was at high risk for elopement via care plans and word of mouth.Interview on 10/10/25 at 02:11 PM, Resident #1's doctor revealed this facility took precautions to prevent elopements like letting people in at the entrance, and there were not any residents he was concerned would exit seek. He revealed it was important to stop people from eloping to prevent injuries. He revealed he did not think Resident #1 was an elopement risk because she did not try to exit the facility. The facility's policy, undated, reflected 2. All residents who are at risk for harm because of wandering (elopement) will be assessed by the interdisciplinary care planning team.3. The resident's current chart and assessments will be reviewed to determine what changes have occurred that would trigger elopement episodes.4. The resident's care plan will be modified to indicate the resident is at risk for elopement episodes.5. Interventions into elopement episodes will be entered onto the resident's care plan and medical record. The Administrator was notified on 10/10/25 at 11:27 AM, that a past non-compliance Immediate Jeopardy situation had been identified due to the above failure. The facility implemented the following interventions. Record Review of Monitoring Chart, dated 08/28/25 and 08/29/25, reflected Resident #1 was put on 1:1 monitoring every 15 minutes until her discharge to a facility with a secure unit on 08/29/2025. The facility completed an audit on all residents to determine other elopement risks on 08/28/2025. RR of Elopement Prevention QA checklist, dated 08/28/2025, reflected Alarm sounded but was not loud enough and added another alarm and lighting. Routine door lock/alarm monitoring was started on 08/28/2025. RR of in-service training report, dated 08/28/25, reflected that all staff were in-serviced 08/28/2025 on the elopement procedure and policy, additional alarm for the dining room door, and abuse/neglect. Interviews with staff on all shifts confirmed knowledge. RR of Elopement Drill or Actual Elopement Guide revealed elopement drills were conducted for staff on all shifts on 08/28/2025 for 2P-10P shift, 08/29/2025 for 10P-6A shift, 09/02/2025 for 6A-2P shift, 09/04/2025 for 6A-2P, 09/11/2025 for 2P-10P shift, 09/16/2025 for 10P-6A shift. Interviews with staff on all shifts confirmed these were done. Observation on 10/08/2025 at 03:07 PM revealed the exit door to the alleged spot that the Resident was found was 0.01 miles (52 ft, when taking the ramp) Observation on 10/08/2025 at 03:08 PM the alarm in the dining room was set off and nursing staff from 100/200 and 300/400 nurse's station went straight to this door. (approximately 10 staff members). Interview on 10/09/2025 at 10 AM, LVN AA (worked overnight) revealed she had been trained on elopement prevention and learned to monitor residents especially confused and exit seeking. She revealed the facility put a new, louder alarm for the emergency exit that Resident #1 exited. She revealed the ADM has performed an elopement drill on her shift. Interview on 10/09/2025 at 10:42 AM, LVN Z (worked PRN for all shifts) revealed she was trained on elopement prevention to include keeping eyes on all residents and monitoring their behaviors. She revealed if the alarm sounded, she would go outside immediately and check rooms on the way to the door. She revealed they did head counts after elopements. She revealed she had been through an elopement drill. Interview on 10/09/25 at 02:50 PM, RN C (worked 6AM-2PM) revealed she was trained on elopement response and knew how each door alarm sounded. She revealed they responded to exit alarm, investigated the situation, and performed a head count of all residents. She revealed the maintenance director tested every door frequently. She revealed when the alarm goes off, they responded right away.Interview on 10/09/25 at 03:47 PM, ADON AC (worked PRN for all shifts) revealed she was trained on the elopement policy. She revealed residents at risk for elopement would have interventions in their care plans, like having someone sitting with residents, finding placement in a secured unit if needed. She revealed she was trained on elopement response to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676121 If continuation sheet Page 4 of 7 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 676121 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few include following the door alarm sound and doing head counts after elopements. Interview on 10/09/25 at 06:15 PM, CNA D, NA E, LVN A revealed they were trained on elopement prevention/response and knowing how each exit door sounded in order to respond more quickly. They revealed there were no current residents that are exit seeking. They revealed if there were residents that started to wander around the facility, they'd tell all staff and monitor these residents.Interview on 10/09/2025 at 06:35 PM, ADON F (PRN, worked all shifts) revealed she was trained on elopement prevention and response. She revealed if there were exit doors that alarmed, she would respond immediately.Interview on 10/10/25 at 05:48 AM, RN G (PRN, worked all shifts) revealed he was trained on elopement procedures and to respond to door alarms right away. He revealed there were no current residents that were at risk for elopement or needed extra monitoring.Interview on 10/10/25 at 05:52 A, LVN H (worked overnight) and CNA I (worked overnight) revealed they were trained on elopements, how door alarms sound, and to respond to the door alarms immediately. They revealed they would report to the ADM right away and do head counts. They revealed nurses would assess resident. They further revealed there was no current resident who was at risk for elopement. Interview on 10/10/25 at 09:40 AM, SW (8A-5P) and PT J (worked day, night, and weekends) revealed they had been doing elopement drills. They revealed the code for elopements got called, everyone dispersed to look everywhere, and when residents were found they did head counts. They further revealed they always kept eyes on exit doors to ensure residents would not exit. They revealed to prevent elopements; they monitored residents if they were elopement/wandering risks. Interview on 10/10/25 at 09:45 AM, CNA K (worked 6AM-2PM) revealed she was trained on elopement response and prevention. She revealed if there was a resident that started wandering and elopement, they would alert all staff and monitor resident. She revealed if there were door alarms going off, they go straight to the door and split up tasks per the elopement response policy. She revealed they did head counts. She revealed they contacted ADM/DON/ADONs for elopements. Interview on 10/10/25 at 09:52 AM, CNA L (worked 6AM-2PM) and CNA M (worked 6AM-2PM) revealed there was a code orange for elopements. They revealed they were trained on responding to door alarms, searching for residents, and doing head counts of residents on all wings. They revealed they would report elopements to the ADM immediately. Interview on 10/10/25 at 09:55AM, NA N (worked 6AM-2PM), COTA O (worked days), and COTA P (worked days) revealed they have been having frequent elopement drills recently and knew what other door alarms sounded. They revealed if the alarm went off, they went to check to see if a resident went out and did head counts of all residents. They revealed they notified the ADM and charge nurse about elopements. Interview on 10/10/25 at 10:03 AM, OT Q (worked 8AM-4PM), PTA S (worked 8AM-4PM), HSK R (worked 6:30AM-2PM), Med Aide T (worked 6AM-2PM), and Rehab Director-COTA (worked 8AM-5PM) revealed they were trained on what to do for elopements, which were classified as a code orange. They revealed if there was an alarm, everyone goes to the alarm, they split up tasks, and given assignments to look for head counts/do rounds/go outside. They revealed they had multiple meetings during the day to discuss residents that needed to be monitored to prevent elopement. They revealed they would contact the ADM immediately. Interview on 10/10/25 at 10:09AM, RN U (worked 6AM-2PM) and CNA V (worked 6AM-2PM) revealed a code orange was for elopements. They revealed when a door alarm sounded, they followed the sound. They revealed they have done drills to include searching for a resident outside and doing head counts for all residents. They revealed they would notify the ADM immediately.Interview on 10/10/25 at 10:17 AM, Dietary Staff W, Dietary Staff X, [NAME] Y, HSK AB and HSK Supervisor revealed when there was an alarm they checked the door immediately. They revealed if a resident was outside then they reported it to the nurse right away. They knew to monitor residents if they exhibited behaviors of wandering or exit seeking, but there were no current residents that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676121 If continuation sheet Page 5 of 7 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 676121 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety had these behaviors. They further revealed they would report elopements to the ADM immediately. The noncompliance was identified as PNC. The Immediate Jeopardy began on 08/28/25 and ended on 08/29/25. The facility had corrected the noncompliance before the investigation began. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676121 If continuation sheet Page 6 of 7 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 676121 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure resident medical records were kept in accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete and accurately documented for 1 of 6 residents (Resident #2) reviewed for clinical records. The facility failed to ensure Resident #2's wound treatment was accurately documented from 10/01/25 to 10/06/25. These failures could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records. The findings included:Record review of Resident #2's admission record, dated 10/10/25, revealed resident was an [AGE] year-old male resident admitted [DATE] with diagnoses to include protein-calorie malnutrition. Record review of Resident #2's admission MDS assessment, dated 09/11/25, revealed Resident #2's had a BIMS score of 06 out of 15, indicating severe cognitive impairment. Record review of Resident #2's care plan reflected a focus The resident has a potential for pressure ulcer development., initiated 09/10/25, with interventions . [Resident #2] with hx of wound care refusal, initiated 10/07/25. Record review of Resident #2's October 2025 Wound Administration Record reflected WOUND CARE: unstageable PI to right buttock. one time a day for WOUND HEALING for Lib A (liberal in the AM shift meaning wound treatment could be done any time during the morning shift) did not have anything documented for 10/01/25 to 10/06/25. Interview on 10/09/2025 at 11:59 AM, LVN AD revealed in the last 2 weeks, Resident #2 had a history of refusing wound care and had to get Resident #2's family member to help Resident #2 agree to wound treatment. Interview on 10/09/25 at 02:50 PM, RN C revealed she did wound treatment for Resident #2 from 09/30/25 to 10/03/25 and 10/06/25. She revealed Resident #2 had a history of refusing wound care. She revealed she tried 2 or 3 times for wound treatment, but he continued to refuse wound treatment. She revealed they had to educate family member and Resident #2 every day about importance of wound treatment. Interview on 10/10/25 at 04:37 PM, the ADM and DON revealed Resident #2 refusing wound treatment should be documented in his administration record. They revealed this was important, so his records were accurate.Record review of the facility's policy Wound Treatment Management, dated 2021, reflected 7. Treatments will be documented on the Treatment Administration Record.Record review of facility's policy Documentation, undated, reflected 1. The facility will maintain complete and accurate documentation for each resident on all appropriate clinical record sheets. Event ID: Facility ID: 676121 If continuation sheet Page 7 of 7