Inspection·March 2, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 03/02/2023 at 9:02 AM with Director of Nursing (DON)- She stated the entire IDT team was responsible for care planning. She stated Resident #36's contact isolation should have been care planned and she was not sure why it was not included. She stated the risk of it not being in the care plan is infection and not showing what services the resident needs. Interview on 03/02/2023 at 9:51 AM with Assistant Director of Nursing (ADON)-B revealed she had been employed at the facility since the middle of October of 2022. She stated Resident #36 was diagnosed with C-Diff and stated the MDS Coordinator was responsible for adding it to the care plan. She stated she added the infection to the care plan on 03/01/2023. She stated she was doing her monthly audit for infection control and added it once when she did not see it in the care plan. She stated she did not know if it would be a risk of the diagnosis and contact isolation not being included in the care plan because everyone in the facility knows that the resident has C-Diff because the was staff in-serviced (trained). Review of the facility's policy on Comprehensive Resident Centered Care Plan, dated January 2022, revealed It is the policy of this facility that the interdisciplinary team (IDT) shall develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676137 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 676137 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 8902 West Rd Houston, TX 77064 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure activities designed to meet the interests of and support the physical, mental, and psychosocial well-being of 1 out of 5 residents. Residents Affected - Some 1.The facility failed to ensure Resident #1 was provided with opportunities to participate in activities on the weekends. These failures placed residents who desired to participate in activities on the weekends at risk of adverse effects to their physical, mental, and psychosocial well-being. Findings included: Record review of Resident #1's face sheet, dated 3/1/2023, revealed she was a [AGE] year-old female who was admitted to the facility on [DATE] from her home. She was diagnosed with Hemiplegia and Hemiaparesis (paralysis of one side of the body) affecting the left side, Type 2 Diabetes, Major Depressive Disorder, and Anxiety and Depressed Mood. Record review of Resident #1's care plan, undated, revealed she had potential to deviate from facility planned activities due to Resident #1's desire to initiate activities of her choice independently. Further Review of the care plan revealed animals and pets were important to Resident #1, and that pet visits would be regularly scheduled. Record review of Resident #1's MDS, dated [DATE] revealed she had a BIMS score of 15 (cognitively intact); she required moderate assistance or supervision from staff with bed mobility, transfers, ambulation via wheelchair, dressing, toilet use, personal hygiene, and bathing. In an observation on 3/1/23 at 12:10 PM the following was revealed: Resident #1 was observed outside in the front area of the facility. Resident #1 was well-groomed and very vocal. Resident #1 was able to transport herself in her wheelchair outside. Resident #1 briefly spoke with each of the residents also outside. Resident #1 returned to the inside of the facility. In an interview with Resident #1 on 2/28/23 at 12:15 PM, she said she had been living at the facility for 11 years. She said she tried to be as independent as she possibly could, but staff were always willing to assist when she needed it. She said the food had improved over the years and was usually really good. She said the Clam Chowder served for dinner the night before was so good, she asked for two additional servings. Resident #1 said she didn't get out of bed on the weekends, by choice. She said the only time she got out bed on the weekends was to use the restroom. She said she chose to stay in bed because there were no activities offered on the weekends. She said the facility really needed to have something for all the residents to do on the weekend. She said she loved music, and always was able to listen to it whenever she wanted. She said she had TV and watched TV on the weekends too. She said she could choose to listen to music and watch TV, but there was only so much music and TV she could take on the weekends. She said her music and TV should have been options for her to choose when she wanted throughout the weekend, in between activities, before or after activities, or if she decided not to participate in an activity. She said the only thing for residents to do on the weekends was sit around and talk to each other. She said that was boring to her and just rather stayed in bed. She said she wanted to be able to leave the facility, even if it was for a short time, at least sometimes on the weekend. She said she was the [NAME] President of the Resident Council (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676137 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 676137 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 8902 West Rd Houston, TX 77064 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and spoke her mind. She said the Activities Director was aware of the resident's concerns about activities on the weekend. She said she knew activities were not offered on the weekend because the Activity Director didn't work weekends and didn't have any assistance. Resident #1 said she thought the facility should hire another person to do activities on the weekends. In an interview with the Activities Director on 03/01/23 08:52 AM, she said she worked as the facility Activity Director for nine years. She said was responsible for coordinating all resident involved activities. She said she was also responsible for creating and distributing the monthly activities calendar for the facility. She said she liked to ask residents what they did in their spare time at home. She said she used that information to incorporate activities based on resident's interests. She said she was aware residents had expressed concerns about activities on the weekend. She said residents told her it (the facility) was boring when the Activity Director was not there. She said more independent activities, like board games, cards or painting, were available to residents on the weekends. She said she had not been able to coordinate on site church services for residents since the pandemic. She said more organized, social activities occurred during the week, during the Activity Director's shift. She said she organized activities on the weekend from time to time, when her personal schedule permitted. She said she had a sorority visit and volunteer at the facility two weekends prior. She said at that time, there were no consistent, planned, staff-involved activities for the residents. Record review of the February 2023 Activities Calendar, revealed the following: 2/4/2023 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk 2/5/23 10:30 Ed Young Channel 11, 11:00 Lakewood Channel 13, 12:00 Music Hour, 2:30 Town Talk 2/11/2023 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk 2/12/23 10:30 Ed Young Channel 11, 11:00 Lakewood Channel 13, 12:00 Music Hour, 2:30 Town Talk 2/18/2023 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk 2/19/23 10:30 Ed Young Channel 11, 11:00 Lakewood Channel 13, 12:00 Music Hour, 2:30 Town Talk 2/25/2023 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk 2/26/23 10:30 Ed Young Channel 11, 11:00 Lakewood Channel 13, 12:00 Music Hour, 2:30 Town Talk Record Review of the December 2022 Activities Calendar, revealed the following: 12/3/22 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk 12/4/22 10:30 Ed Young Channel 11, 11:00 Lakewood Channel 13, 12:00 Music Hour, 2:30 Town Talk 12/10/22 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk 12/11/22 10:30 Ed Young Channel 11, 11:00 Lakewood Channel 13, 12:00 Music Hour, 2:30 Town Talk 12/17/22 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676137 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 676137 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 8902 West Rd Houston, TX 77064 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 0679 12/18/22 10:30 Ed Young Channel 11, 11:00 Lakewood Channel 13, 12:00 Music Hour, 2:30 Town Talk Level of Harm - Minimal harm or potential for actual harm 12/24/22 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk 12/25/22 10:30 Ed Young Channel 11, 11:00 Lakewood Channel 13, 12:00 Music Hour, 2:30 Town Talk Residents Affected - Some 12/31/22 10:00 Arm Chair Travels, 11:00 Independent Activities, 11:30 Music Hour, 2:30 Town Talk In an interview with the Activity Director on 3/1/2023 at 1:25 PM, she said arm chair travels and town talk were regular activities for the residents on the weekend. She said residents knew Arm Chair Travels and Town Talk were basically activities for the residents to sit and reminisce about things or talk amongst each other about whatever they wanted to at the time. She said she listed church services residents could watch on Sundays. She said if residents expressed interest in any of the church services, the aides working that day knew to turn the resident's television to the channel of their choice. In an interview with the Social Worker on 03/02/23 at 1:00 PM, she said she was not aware residents expressed concerns about the lack of organized activities on the weekends. She said Resident #1 was at risk of experiencing feelings of isolation and increased depression if Resident #1 chose to stay in bed on weekends as a result of a lack of activities that interested the resident. In an interview with the DON on 3/2/23 at 1:05 PM, she said she believed the residents had some activities to participate in on the weekends. She said she knew the Activity Director did not work on the weekends, but she periodically put together events and activities for residents on the weekend. She said a sorority group recently volunteered at the facility possibly two weekends ago. She said if Resident #1 was choosing to stay in her bed every weekend because she wasn't participating in activities, Resident #1 was at risk of depressed mood and progression of muscle weakness. In an interview with the Administrator on 3/2/23 at 1:45 PM, he said he wasn't aware residents had expressed concerns regarding resident activities taking place on the weekends. He said it was the Activity Director's responsibility to ensure resident activities took place. He said there was not concerted effort for activities to not take place on the weekends. He said he and the Activity Director would meet with residents and look at ways to improve resident's satisfaction with weekend activities. Record review of the facility policy, dated 11/2016, titled, Activities Programming Policy & Procedure, revealed the following: It is the policy of this facility to ensure activities are available to meet resident needs and interests . Further review of the policy revealed, Calendars will include a variety of activities designed to meet resident preferences and requests .will provide activity choices for weekends, as well as evening programming. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676137 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 676137 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 8902 West Rd Houston, TX 77064 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure services were provided or arranged by the facility, as outlined by the comprehensive care plan, that met professional standards of care for 1 of 18 residents (Resident #141) reviewed for services that met professional standards. The facility failed to administer blood pressure (BP) medication to Resident #141 as ordered by administering outside of parameters. This failure could place residents at risk of not receiving the care and services as ordered by their Physicians and could result in a decline in health status. Findings included: Record review of Resident #141's admission face sheet, undated, revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses which included: orthostatic hypotension (a form of low blood pressure that happened when standing up from sitting or lying down), congestive heart failure (a chronic condition in which the heart does not pump blood adequately). Record review of Resident #141's Physician Orders, dated 02/20/2023, revealed, Midodrine 5 mg Give one tablet by mouth every eight hours for orthostatic hypotension. Hold for systolic blood pressure (SBP) (the top blood pressure number which measures the pressure in the arteries when the heart beats) over 130. Record review of Resident #141's Minimum Data Set (MDS) dated [DATE] revealed the resident's Brief Interview for Mental Status (BIMS) scored 0 which indicted the resident's mental state was severely impaired. The resident required extensive assistance of one staff for his bed mobility, transfers, dressing, toilet use and personal hygiene. The MDS identified an active diagnosis of orthostatic hypotension. Record review of Resident #141's February 2023 Medication Administration Record (MAR) revealed, the resident was administered Midodrine 5 mg outside of physician set parameter of SBP over 130 on: 02/24/2023 at 6:00 AM with BP 131/76 by LVN M. 02/25/2023 at 2:00 PM with BP 144/89 by MA X. 02/27/2023 at 6:00 AM with BP 147/68 by LVN M. 2/28/2023 at 6:00 AM with BP 138/72 by MA C. Record review of Resident #141's care plan dated 03/02/2023 revealed: Focus: Resident #141 had orthostatic hypotension related to cardiac disease, congestive heart failure; Goal: Resident will remain free of complications related to hypotension (low blood pressure); (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676137 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 676137 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 8902 West Rd Houston, TX 77064 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 0755 Interventions: -Follow BP parameters prior to medication administration daily, Level of Harm - Minimal harm or potential for actual harm - Give medications as ordered. Residents Affected - Some Observation on 03/02/2023 at 8:45 AM revealed Resident #141 was sitting up in bed. Resident #141 was not interviewable. In an interview and record review on 03/02/2023 at 10:30 AM the DON reviewed Resident #141's MAR and stated the check mark and initials indicated the Midodrine was administered. The DON stated her expectations were the staff followed the five rights of medication administration. The DON stated she expected the resident's blood pressure to be checked and the physician's orders for holding or administering would be followed for safe medication administration. The DON continued and stated the nurse or medication aide (MA) administering the medication was the one responsible for administering the medication as ordered. The DON stated she monitored the medication administration by reviewing MARs for accurate medication administration. The DON stated this medication should have been held due to the resident's SBP being over 130. The DON stated she did not know why this happened. The DON stated the risk of giving the medication was it could cause the resident's blood pressure to go too high. The DON stated she will train on the basic 5 rights of medication administration and following the physician order. In an interview on 03/02/2023 at 10:56 AM MA C stated the MAR was checked and initialed to indicated she gave the mediation on 02/28/2023 but she did not know how this happened. MA C stated she checked the blood pressure and should not have given it based on the order to hold when over 130. The risk of giving the medication was the blood pressure could go too high since it was to be given for low blood pressure. In an interview on 03/02/2023 at 11:13 AM the ED stated he was made aware the Midodrine was administered when it should not have been. The ED stated this was a medication that had the potential to result in harm from causing the blood pressure to elevate too high. In a phone interview on 03/02/2023 at 12:05 PM MA X stated she administered the medication at 2:00 PM on 02/25/2023 for Resident 141. MA X stated she did not know why she gave it when it was outside the parameters. MA X stated the medication should not have been given. MA X stated the risk was it could affect the resident's blood pressure making it go too high. A phone interview was attempted on 03/02/2023 at 11:17 AM and 12:12 PM with LVN M without success. Record review of the facility policy titled Medication Administration revised, 05/2007, revealed, Policy: It is the policy of this facility that medications shall be administered as prescribed by the attending physician . Procedures: 2. Medications must be administered in accordance with written orders of the physician . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676137 If continuation sheet Page 7 of 7