Health inspection·August 28, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some not make her own daily decisions. She was noted to not have any physical or verbal behaviors towards others but wandered daily that intruded on the privacy or activity of others. Her active diagnoses included Alzheimer's Disease (a brain condition that gradually destroys memory and cognitive skills, interfering with daily life) and Insomnia (a common sleep disorder that can make it hard to fall asleep or stay asleep). Review of Resident #2's Physician's Orders, dated 08/27/25, reflected the following:- Ativan Gel 0.5mg q 12 hours prn apply topically every 12 hours as needed for agitation for 14 days- Seroquel Oral Tablet 25 MG Give 1 Tablet by mouth two times a day for agitation Review of Resident #2's Treatment Administration Record reflected the following: - Resident #2 was administered the Ativan Gel (which had an order start date of 08/13/25) on the following dates: 08/14/25, 08/16/25, 08/17/25, 08/18/25, 08/19/25, 08/20/25, 08/24/25, 08/25/25, and 08/26/25. - Resident #2 was noted to have behaviors on the following dates as monitored for psychoactive behaviors: 08/02/25, 08/03/25, 08/08/25, 08/09/25, 08/14/25, 08/16/25, 08/17/25, 08/20/25, 08/21/25, 08/23/25, 08/24/25, 08/25/25, and 08/26/25. - Resident #2 was administered the Seroquel (which had a start date of 08/25/25) on the following dates: 08/25/25, 08/26/25, and 08/27/25. Review of Resident #2's Progress Notes reflected the following entries: - LVN B wrote on 07/25/25 at 2:57 PM: Resident follow up on new admit, resident continue pacing down the hallway, attempt to push fire alarm during this shift, resident continue to monitor [sic] - LVN C wrote on 07/27/25 at 1:39 AM: The resident woke up, and was very agitated, throwing around everything she could come across in her room. She was yelling out at the staff when they were offering incontinent care to her. She was calmed down and laid back to bed but still kept on waking up and coming out of her room, and re-direction was done appropriately. - LVN D wrote on 07/27/25 at 8:49 PM: Resident combative with incontinent care. She came out from the room and started pushing dining table and chairs. Resident able to redirect, sleeping in bed at this time. No s/s of acute distress noted. Bed in low position, call light within reach. - LVN C wrote on 07/28/25 at 2:14 AM: The resident woke up and was banging stuff in her room and bathroom. Staff redirected her back to bed, but she was combative, and yelling. She was brought to the dining room via wheelchair but kept standing up and pushing the tables and chairs around. She wandered through the hallway back and forth. She was redirected back to her room and agreed to lay back in bed. Right now, she is resting in bed eyes closed. LVN B wrote on 08/07/25 at 8:47 AM: Resident going all other [sic] resident room [sic] attempting to pull them from the bed staffs [sic] continue redirecting the resident. - LVN A wrote on 08/08/25 at 1:01 AM: Resident is combative, non-compliant to care, yelling and destroying anything within her reach. Resident refused to sleep, attempting to pull roommate from the bed. All efforts to redirect resident is ineffective. NP and DON notified. - LVN C wrote on 08/10/25 at 6:29 AM: The resident pacing [sic] in the hallway entering into other patients' rooms and banging doors and throwing everything she comes across. At the dining room at the moment, throwing chairs all over and moving tables around. - LVN A wrote on 08/26/25 at 9:40 PM: Resident noted with aggressive behavior. She was seen by the CNA putting her hand around another resident's neck [Resident #1] in the dining room. Nurse and CNA immediately ran towards them and intervened. Resident was fighting and kicking staff while being redirected. PRN Ativan gel was applied with little effect. Resident also tried to pull her roommate from the bed earlier today per therapist. NP and DON notified. Resident's RP informed. Resident is currently on Q 15 mins checks for behavior. she [sic] is lying in bed in the room no behavior [sic] noted at this time. - LVN C wrote on 08/27/25 at 1:10 AM: The resident is on aggressive behavior monitoring q 15 minutes. Resident is in bed at the moment sleeping. - LVN C wrote on 08/27/25 at 5:15 AM: The resident woke up and started throwing stuff in her room. The nursing staff tried to redirect and offer incontinent care, but the resident was extremely (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 2 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some aggressive/combative. The staff left the room. The resident kept yelling from her room. Review of Resident #2's care plan, revised on 08/14/25, did not reflect anything regarding her aggressive behaviors. Review of Resident #2's Psychiatric Initial Assessment, dated 07/30/25, reflected the following: .Patient referred for medical management services for sx including Agitation, Adjustment Disorder, Noncompliance, Verbal Aggression, Physical Aggression. Patient made eye contact with provider when approached, but was unable to appropriately participate/interact. Staff report frequent periods of anxiousness/restlessness and difficulty with redirection being exhibited by patient.At this time, recommend increasing frequency of Ativan to 0.5 mg/TID per frequent symptoms of anxiety and difficulty with redirection. Review of Resident #2's Psychiatric Subsequent Assessment, dated 08/06/25, reflected the following: .During previous visit, Ativan frequency increased to TID due to reported periods of agitation and behavioral concerns. Staff states agitation decreased but continues during periods of care. Staff also report patient frequently pacing throughout secured unit and wandering into other residents rooms. Staff reports patient being aggressive and difficult to calm/redirect.At this time, due to reported continued periods of agitation and aggression during periods of care, recommend initiation of Ativan gel 0.5 mg/Q12 HR PRN X 14 days for acute agitation/aggressive behavior. Review of Resident #2's Psychiatric Subsequent Assessment, dated 08/20/25, reflected the following: .Staff reports continued behavioral concerns being exhibited by patient. Per ADON, patient reported to have ‘taken the tank off of her toilet and breaking it, as well as tearing soap dispensers off the wall.' Nursing staff within secured unit report patient often ‘easily agitated and physically aggressive. Staff states patient will attempt to hit staff during attempted periods of care. When attempting to initiate assessment, patient was found leaning over another resident within secured unit, whom was sitting on her wheelchair, and pushing her down the hall.'.At this time, due to reported symptoms of disorganized/delusional thoughts reported, Recommend [sic] initiation of Seroquel 25 mg/BID. Review of Resident #2's Psychiatric Subsequent Assessment, dated 08/27/25, reflected the following: .During previous visit, Seroquel 25 mg/BID order recommended.Staff states the day prior to exam, patient exhibited ongoing physically aggressive behaviors and ‘Choked [sic] another resident.' Per note in [EHR], on 8/26, patient was observed by the CNA ‘putting her hand around another resident's neck' in the dining room of the secured unit. During attempted intervention by nurse and CNA, patient was ‘fighting and kicking staff' during attempted redirection. Resident was placed on Q15 min safety checks, and staff denied observing physically aggressive behaviors being exhibited prior to today's assessment.Due to minimal symptom relief with currently ordered Ativan, recommend discontinuation of Ativan and initiation of clonazepam 0.5 mg/TID with consent from POA. Observation and attempted interview on 08/27/25 at 10:35 AM with Resident #2 revealed she was sitting in a chair in the dining room mumbling to herself. Resident #2 did not look the state surveyor's way or at the state surveyor until the state surveyor continued trying to talk to her. Resident #2 appeared calm but was not able to answer any questions. Phone interview on 08/28/25 at 9:32 AM with the Psych NP revealed Resident #2 was physically aggressive during moments of agitation and was difficult to redirect. The Psych NP said staff had been communicating with him about the increase in her behaviors and he added orders for a PRN Ativan gel and Seroquel more recently. The Psych NP said he noticed during his meetings with her that she was uncooperative, non-compliant, and had disorganized speech and he was not sure what was causing all of these behaviors. The Psych NP said staff also explained to him how difficult Resident #2 was to manage and control, that she had taken off the tank to the toilet and the soap dispensers from the walls, she was wheeling another unknown resident down the hall in her wheelchair in an aggressive manner, and now she had choked another resident (Resident #1). The Psych NP said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 3 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Resident #2's behaviors were quite frequent and often from what he had witnessed and was told. The Psych NP said from what he was told and understood, staff were trying to minimize her behaviors the best they could and limited her interactions with others. The Psych NP said it was almost to the point that she needed 1:1 care because her behaviors were so severe. The Psych NP said he was working to get her on the right medication regiment hoping that would help to reduce her behaviors. Interview on 08/27/25 at 10:23 AM with LVN B revealed she got report from the night nurse this morning that Resident #2 attacked or scratched Resident #1 yesterday. LVN B said Resident #1 had some redness to her neck that looked like it was a scratch but she was not sure if it was from the incident with Resident #2 or not. LVN B said Resident #2 wandered a lot around the unit and was a difficult resident to handle. LVN B said Resident #2 would get mad and yell and be agitated for no reason. LVN B said staff were monitoring Resident #2 every 15 minutes right now by just keeping an eye on her in general and noting where she was or what she was doing. LVN B said Resident #2 tried to touch other residents but staff usually intervened before anything could happen because if anyone was near her anything could set her off. LVN B said when Resident #2 started to show agitation, staff would try to calm her down by singing with her, taking her for a walk outside, or getting her something to eat or drink. LVN B said Resident #2's behaviors were unpredictable and there was no trigger for it. LVN B said she was not sure if she had been trained on what to do specifically with Resident #2 in order to decrease her behaviors or reduce her agitation. LVN B said she had never seen Resident #2 be physically aggressive with another resident during her shift. Follow-up interview on 08/27/25 at 10:40 AM with LVN B revealed she saw Resident #1's reddened areas to her neck and cheek but could not recall if the reddened areas were there yesterday or not. LVN B said she did not pay much attention to Resident #1 yesterday, so she was not sure if the reddened areas were a result of the incident with Resident #2 or not. Attempted phone interview on 08/27/25 at 11:04 AM with CNA D, who worked with Residents #1 and #2 on 08/26/25, was unsuccessful as she did not answer or call back prior to exit. Attempted phone interview on 08/27/25 at 11:05 AM with LVN C, who worked with Residents #1 and #2 on 08/26/25, was unsuccessful as she did not answer or call back prior to exit. Phone interview on 08/27/25 at 11:08 AM with LVN A revealed she was at the nurses' station when she heard CNA E yelling, She's about to choke the resident. LVN A said she and CNA E ran towards Residents #1 and #2 and when they got to them, Resident #2's hand was round Resident #1's neck. LVN A said her and CNA E were able to pull Resident #2's hand away from Resident #1's neck, but Resident #2 continued to fight staff while trying to redirect her. LVN A said when she assessed Resident #1 she saw there were reddened and open areas on Resident #1's neck and cheek, but she did not think that was related to the incident, but that it was a rash. LVN A said Resident #2 had physically aggressive behaviors such as she pushed another unknown resident in the dining room on Monday, which was reported to the Abuse Coordinator, but the resident did not sustain any injuries. LVN A said she communicated with the Psych NP about Resident #2's behaviors and PRN Ativan gel was added to her orders. LVN A said when Resident #2 became agitated and unable to be redirected, she would apply the gel. Follow-up interview on 08/27/25 at 3:03 PM with LVN A revealed she did not check Resident #1's skin prior to the incident and did not know if it was due to the incident or a rash. LVN A said she only noticed the rash after the incident because she had to do a skin assessment. LVN A was unable to say how long Resident #1 had the rash to her skin and could not describe what it looked like. LVN A said Resident #2 was having an increase in her agitation and physical behaviors. LVN A said when Resident #2 first came to the facility, she was flinging chairs and tables around the dining room. LVN A said she reported this to the NP who ordered new medications, but Resident #2's behaviors did not change. LVN A said that was when the NP (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 4 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some ordered the PRN Ativan gel but it did not work either. LVN A said she did communicate with the DON when she saw Resident #2 become physically aggressive with other residents. LVN A showed a text message exchange between her and the DON from 08/08/25 discussing Resident #2's agitation and physically aggressive behaviors regarding resisting care and destroying anything within her reach. LVN A said she knew to report any incident to the DON immediately that concerned residents. Phone interview on 08/27/25 at 11:21 AM with CNA E revealed Resident #2 was very aggressive last night and very agitated. CNA E said Resident #2 was trying to pull the table and chairs in the dining room. CNA E said she tried to move closer to Resident #2 and get her to calm down by talking to her but the resident refused. CNA E said she also tried redirecting her but again, Resident #2 refused. CNA E said when she moved closer to Resident #2, Resident #2 moved closer to Resident #1 and grabbed her neck, choking her. CNA E said she rushed towards the residents and tried to separate them and pulled Resident #2's hands off Resident #1's neck. CNA E said this behavior was normal for Resident #2 because she was always agitated and aggressive. CNA E said when Resident #2 became agitated she would try to calm her down, move close to her, and talk to her. CNA E said Resident #2 was very strong and would fight staff during care and drag staff to the ground because she was so strong. CNA E said staff would have to act fast to be near her to make sure she did not harm other residents. CNA E said she did everything she could to try and keep Resident #2 from hurting others, but nothing seemed to work. Follow-up interview on 08/27/25 at 2:42 PM with CNA E revealed Resident #2 had physically aggressive behaviors towards others ever since she arrived at the facility. CNA E said especially the last few days, Resident #2 had been showing signs of agitation and aggression. CNA E said Resident #2 pushed another resident in the dining room the other day and then had choked Resident #1 last night while she was upset. CNA E said Resident #2 would get upset and staff had to calm her down. CNA E said staff had to be alert and watch Resident #2 closely when she became agitated because when she got angry she was very strong and tried to push tables, chairs, and throw things. CNA E said staff would redirect her during these behaviors, but the redirection did not work and Resident #2 would continue her behaviors. CNA E said when these behaviors occurred, she would tell the nurse and assumed the nurse would let the ADON/DON know. Interview on 08/27/25 at 11:43 AM with CNA F revealed she cared for Resident #1 yesterday (08/26/25) and did not see any redness or scratches to her cheek or neck. CNA F said when she came to work this morning, she heard a fight happened between Residents #1 and #2. CNA F said she figured the scratches and redness to Resident #1's cheek and neck happened from the incident with Resident #2. CNA F said since the incident happened, the nurse was monitoring Resident #2 every 15 minutes, but she was not informed to do anything different regarding Resident #2. CNA F said Resident #2 was calm this morning, but she did start to yell. After going to the resident's side and talking to her, the resident calmed down. CNA F said Resident #2 was always agitated, wild, and out of control. CNA F said when Resident #2 got that way staff tried to calm her down by giving her something to drink or taking her somewhere else to calm down. CNA F said sometimes those interventions helped Resident #2 calm down, and sometimes they did not. CNA F said when redirection did not work, they would leave Resident #2 alone and just monitor her closely because she would try to go to other resident's rooms. CNA F said one day she saw Resident #2 trying to get into her roommate's bed and was trying to get the roommate out of the bed. CNA F said she rushed into the room to stop Resident #2 from hurting the roommate and nothing happened. Interview on 08/27/25 at 1:24 PM with CNA H revealed she had only been working at the facility for a month but knew Resident #2 was easily agitated. CNA H said she never seen Resident #2 be physically aggressive with another resident. CNA H said she knew to follow closely behind Resident #2 and make sure she was safe and not going to hurt anyone (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 5 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some because she wandered around a lot. CNA H said Resident #2 was on every 15-minute checks right now because of what happened. CNA H said if she saw any resident trying to hurt another resident she would separate them and call for the nurse. CNA H said she knew when Resident #2 got upset, staff needed to help calm her down by offering her something to drink or eat. Interview on 08/27/25 at 2:49 PM with CNA I revealed Resident #2 was very erratic at times and when she got that way she would try to hurt other residents and staff. CNA I said staff would try to redirect Resident #2 to calm her down but it did not work because she did not want to be redirected. CNA I said last night specifically, Resident #2 was very upset and was behaving so badly, she was sitting at a table trying to push it away and knock residents out of their wheelchairs while hitting and swinging at them. CNA I said Resident #2 put her hands around Resident #1's neck to choke her. CNA I said when she saw Resident #1 before the incident, she did not have any marks on her cheek or neck but after the incident, Resident #1 had red spots on her cheek and neck. CNA I said Resident #2 also had a habit of wanting to get in her roommate's bed even while the resident was in the bed and if staff tried to stop her she would get more upset. CNA I said Resident #2's roommate was moved out of her room last night so she would be safe. CNA I said Resident #2's behaviors were unpredictable in that she would be walking around and then walk up to a resident and start trying to be physical towards them. CNA I said there was not a trigger causing Resident #2's behaviors that she could identify. CNA I said Resident #2 acted this way ever since she got to the facility, but her behavior was getting worse. CNA I said she had not talked to anyone in management about Resident #2's behaviors because she was told to just redirect her even though she refused the redirection. CNA I said the nurse on shift knew about Resident #2's behaviors and she thought the nurse would report everything to management. CNA I said before Resident #2 choked Resident #1, she had not harmed or hurt any other resident. Follow-up interview on 08/27/25 at 4:08 PM with CNA I revealed after Resident #2 had choked Resident #1, Resident #1 was very upset and scared. CNA I said she herself was also scared after the incident, and Resident #1 seemed very emotional afterwards asking why someone would do that to her. CNA I said she tried to calm her down and assured her she was safe. Interview on 08/27/25 at 2:37 PM with the MDS Coordinator revealed she was ultimately responsible for updating the resident's care plans, but all nurses could update them as well. The MDS Coordinator said she had not heard Resident #2 had behaviors towards others so she did not know to update her care plan to address them. The MDS Coordinator said she attended all the clinical morning meetings where staff would discuss such behaviors and then she would update the resident's care plan then. Interview on 08/27/25 at 1:10 PM with ADON G revealed she understood Resident #2 had sporadic behaviors at times, like when she went towards Resident #1 and grabbed her neck. ADON G said staff were able to separate the two residents during the incident. ADON G said they were dealing with Resident #2 because she got agitated but they thought it was because she was in a new environment since she was a newer admit and needed time to adjust. ADON G said Resident #2 had these sporadic moments where staff did not know what was going to happen, so they closely monitored her. ADON G said she was not sure if the redness and scratches to Resident #1's cheek and neck were from the incident with Resident #2 or not, because she had not seen them for herself yet. Follow-up interview on 08/27/25 at 1:41 PM with ADON G revealed she saw Resident #1 and noticed she had 4 dots, two of which were prominent but dried up and closed now. ADON G said she thought the redness to Resident #1's skin was from a scratch but she could not be sure. ADON G said Resident #2 was physically aggressive with staff before the incident with Resident #1 but she had swung towards other residents before, just never made contact with them. ADON G said Resident #2 had also pushed another resident on Monday (08/25/25) in the dining room but the resident did not sustain any injuries. ADON G (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 6 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some said she was not sure what interventions were put in place to keep other residents safe from Resident #2's physically aggressive behaviors but she would have the Psych NP review her medications again. ADON G said she knew the Psych NP already ordered PRN Ativan gel and Seroquel to help with Resident #2's behaviors but staff reported the medications were not working. ADON G said she was going to have to meet with the IDT to see what the next steps were for Resident #2. ADON G said she also received a report that Resident #2 tried to get in her roommate's bed and move the roommate out of the bed but the CNA intervened and stopped it from happening. ADON G said right now, Resident #2 was being monitored every 15 minutes by the nurse until the facility could decide what next steps to take with her regarding her behaviors. ADON G said what happened between Residents #1 and #2 was considered physical abuse. ADON G said all residents had the right to be free from abuse. ADON G said staff were in-serviced regarding abuse as they went over who the abuse coordinator was for the facility, the types of abuse, and what to do when someone abused someone and how quickly to report abuse. Interview on 08/27/25 at 2:06 PM with the DON revealed she was told last night Resident #2 tried to choke Resident #1 but staff were able to separate the two residents. The DON said Resident #2 was placed on every 15-minute checks by the nurse and then she, herself, came to the building. The DON said Resident #2 had a roommate at the time who was moved out of the room for her safety. The DON said staff also gave Resident #2 a shower and she fought during that, which was normal behavior for her. The DON said after Resident #2 went to bed. The DON said the NP was contacted and responded a psychiatric evaluation needed to be completed. The DON said the Psych NP came today (08/27/25) to meet and evaluate Resident #2. The DON said Resident #2 was just ordered Seroquel a few days ago and had not had the chance to become effective. The DON said she looked at Resident #1 and she was upset but calmed down and sat at the nurse's station. The DON said she noticed two spots on Resident #1's neck and cheek but she was not sure if they were caused by the incident with Resident #2 or not. The DON said the two spots looked dry and scabbed over. The DON said she knew about Resident #2's behaviors because she was told on Monday the resident pushed another resident. The DON said she was told by staff Resident #2 was resistive to care and would fight with staff but never tried to attack residents. The DON said if the staff did not tell her what was happening with Resident #2, she could not fix anything or address her behaviors. The DON said sometimes she reviewed staff's charting and the 24-hour report but it was not a regular occurrence for her. The DON said the plan to address Resident #2's behaviors now were that the Psych NP was going to adjust her medications after his evaluation. The DON said she knew to help clam Resident #2 down, she liked to go outside when she was agitated so that was an intervention staff could use. The DON said Resident #2's care plan did not address her behaviors because before this incident she was not aware of them. The DON said the ADON and the MDS Coordinator were responsible for updating a resident's care plan if they knew what to update it with. The DON said the purpose of the care plan was to know what interventions should be used to address the situation or behavior. The DON said if the care plan was not updated for a resident, then staff would not know how to manage the resident's behavior and things could escalate. The DON said what happened between Residents #1 and #2 was considered physical abuse. The DON said all residents should be free from abuse. The DON said all staff were responsible for ensuring all residents were free from abuse. The DON said if residents were not free from abuse, they were at risk of potential injury, death, and being harmed. The DON said all staff were trained on the facility's policy regarding abuse, specifically going over who to report abuse to, the types of abuse, and the timeliness to report abuse. Interview on 08/27/25 at 3:15 PM with the Administrator revealed she was told by the DON Resident #2 had put her hands around Resident #1's neck. The Administrator said she and the DON got to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 7 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete facility to get the statements from the nurse and CNA about what happened. The Administrator said the CNA told her she was nearby Resident #2 who walked towards Resident #1 and started grabbing her neck. The Administrator said the CNA quickly removed Resident #2's hands from Resident #1 and then separated the residents. The Administrator said Resident #2 was placed on every 15-minute checks by the nurse after everything was settled. The Administrator said the DON started an abuse in-service with staff that went over who to report abuse to, the types of abuse, and how quickly staff were supposed to report abuse. The Administrator said she did not look to see if Resident #1 had any injuries from Resident #2 or not. The Administrator said the 6 AM to 2 PM nurse, LVN B, came to the morning clinical meetings and would explain the resident got agitated with staff and she would be redirected and kept away from other residents. The Administrator said no other shift nurses reported to the clinical meetings, it was only the 6 AM to 2 PM shift nurses. The Administrator said other shift nurses reported things on the 24-hour report or would call the DON to let her know what was going on, such as if a resident began to have behaviors. The Administrator said she knew CNA's were told to redirect Resident #2 and get her involved in some type of activity, take her outside, or play some music. The Administrator said she heard Resident #2 pushed another resident a few days ago but the resident did not have any injuries from the situation. The Administrator said she was not told Resident #2 had been swinging at or trying to hit other residents. The Administrator said she could only intervene if she knew what was happening and since she did not know about Resident #2's behaviors, she could not put things in place. The Administrator said she expected staff to communicate with her when a resident showed signs of increased agitation and behaviors. The Administrator said if she knew about the extent of Resident #2's behaviors she could have taken other steps to ensure the residents' safety, such as transferring her to be evaluated. The Administrator said Resident #2's care plan was not updated either to reflect her behaviors because the management staff did not know about it. The Administrator said she was the abuse coordinator for the facility, and this situation was considered physical abuse. The Administrator said all residents had the right to be free from abuse and all staff were responsible for making sure they were. The Administrator said if residents were not free from abuse they would be harmed or have some type of trauma happen to them up to and including death. Review of the facility's policy, revised 06/24/24, and titled Abuse, Neglect and Exploitation reflected: Definitions: ‘Abuse' means the willful infliction of injury, unreasonable confinement, intimidation, or punishment Event ID: Facility ID: 676141 If continuation sheet Page 8 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing, and psychosocial needs that are identified in the comprehensive assessment that describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 5 residents (Resident #2) reviewed for care plan accuracy. The facility failed to develop and implement a care plan revised on 08/14/25 for Resident #2, which addressed her physically aggressive behaviors towards others between 08/02/25 to 08/26/25. LVN A and CNA E were able to pull Resident #2's hand away from Resident #1's neck on 08/26/2025. An IJ was identified on 08/27/25. The IJ template was provided to the facility on [DATE] at 5:18 PM. While the IJ was removed on 08/28/25, the facility remained out of compliance at a scope of pattern and a severity level potential for more than minimal harm that is not Immediate Jeopardy, due to the facility's need to implement corrective systems. This failure placed residents at risk of not receiving needed services due to inaccurate comprehensive care plans. Findings included: Review of Resident #2's admission MDS Assessment, dated 07/29/25, reflected she was a [AGE] year-old female who was admitted to the facility on [DATE]. Her BIMS score could not be conducted, but it was noted she had both short-term and long-term memory problems and could not make her own daily decisions. She was noted to not have any physical or verbal behaviors towards others, but did wander daily that intruded on the privacy or activity of others. Her active diagnoses included Alzheimer's Disease (a brain condition that gradually destroys memory and cognitive skills, interfering with daily life) and Insomnia (a common sleep disorder that can make it hard to fall asleep or stay asleep). Review of Resident #2's care plan, revised on 08/14/25, revealed it did not reflect anything regarding her aggressive behaviors. Review of Resident #2's Physician's Orders reflected the following:- Ativan Gel 0.5mg q 12 hours prn apply topically every 12 hours as needed for agitation for 14 days- Seroquel Oral Tablet 25 MG Give 1 Tablet by mouth two times a day for agitation Review of Resident #2's Treatment Administration Record reflected the following:- She was administered the Ativan Gel on the following dates: 08/14/25, 08/16/25, 08/17/25, 08/18/25, 08/19/25, 08/20/25, 08/24/25, 08/25/25, and 08/26/25. - She was noted to have behaviors on the following dates as monitored for psychoactive behaviors: 08/02/25, 08/03/25, 08/08/25, 08/09/25, 08/14/25, 08/16/25, 08/17/25, 08/20/25, 08/21/25, 08/23/25, 08/24/25, 08/25/25, and 08/26/25.- She was administered the Seroquel on the following dates: 08/25/25, 08/26/25, and 08/27/25. Review of Resident #2's Progress Notes reflected the following:- LVN B wrote on 07/25/25 at 2:57 PM: Resident follow up on new admit, resident continue pacing down the hallway, attempt to push fire alarm during this shift, resident continue to monitor [sic]- LVN C wrote on 07/27/25 at 1:39 AM: The resident woke up, and was very agitated, throwing around everything she could come across in her room. She was yelling out at the staff when they were offering incontinent care to her. She was calmed down and laid back to bed but still kept on waking up and coming out of her room, and re-direction was done appropriately.- LVN D wrote on 07/27/25 at 8:49 PM: Resident combative with incontinent care. She came out from the room and started pushing dining table and chairs. Resident able to redirect, sleeping in bed at this time. No s/s of acute distress noted. Bed in low position, call light within reach.- LVN C wrote on 07/28/25 at 2:14 AM: The resident woke up and was banging stuff in her room and bathroom. Staff redirected her back to bed, but she was combative, and yelling. She was brought to the dining room via wheelchair but kept standing up and pushing the tables and chairs around. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 9 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some wandered through the hallway back and forth. She was redirected back to her room and agreed to lay back in bed. Right now, she is resting in bed eyes closed.- LVN B wrote on 08/07/25 at 8:47 AM: Resident going all other [sic] resident room [sic] attempting to pull them from the bed staffs [sic] continue redirecting the resident.- LVN A wrote on 08/08/25 at 1:01 AM: Resident is combative, non-compliant to care, yelling and destroying anything within her reach. Resident refused to sleep, attempting to pull roommate from the bed. All efforts to redirect resident is ineffective. NP and DON notified.- LVN C wrote on 08/10/25 at 6:29 AM: The resident pacing [sic] in the hallway entering into other patients' rooms and banging doors and throwing everything she comes across. At the dining room at the moment, throwing chairs all over and moving tables around.- LVN A wrote on 08/26/25 at 9:40 PM: Resident noted with aggressive behavior. She was seen by the CNA putting her hand around another resident's neck (Resident #1) in the dining room. Nurse and CNA immediately ran towards them and intervened. Resident was fighting and kicking staff while being redirected. PRN Ativan gel was applied with little effect. Resident also tried to pull her roommate from the bed earlier today per therapist. NP and DON notified. Resident's RP informed. Resident is currently on Q 15 mins checks for behavior. she [sic] is lying in bed in the room no behavior [sic] noted at this time.- LVN C wrote on 08/27/25 at 1:10 AM: The resident is on aggressive behavior monitoring q 15 minutes. Resident is in bed at the moment sleeping.- LVN C wrote on 08/27/25 at 5:15 AM: The resident woke up and started throwing stuff in her room. The nursing staff tried to redirect and offer incontinent care, but the resident was extremely aggressive/combative. The staff left the room. The resident kept yelling from her room. Review of Resident #2's Psychiatric Initial Assessment, dated 07/30/25, reflected the following: .Patient referred for medical management services for sx including Agitation, Adjustment Disorder, Noncompliance, Verbal Aggression, Physical Aggression. Patient made eye contact with provider when approached, but was unable to appropriately participate/interact. Staff report frequent periods of anxiousness/restlessness and difficulty with redirection being exhibited by patient.At this time, recommend increasing frequency of Ativan to 0.5 mg/TID per frequent symptoms of anxiety and difficulty with redirection. Review of Resident #2's Psychiatric Subsequent Assessment, dated 08/06/25, reflected the following: .During previous visit, Ativan frequency increased to TID due to reported periods of agitation and behavioral concerns. Staff states agitation decreased but continues during periods of care. Staff also report patient frequently pacing throughout secured unit and wandering into other residents rooms. Staff reports patient being aggressive and difficult to calm/redirect.At this time, due to reported continued periods of agitation and aggression during periods of care, recommend initiation of Ativan gel 0.5 mg/Q12 HR PRN X 14 days for acute agitation/aggressive behavior. Review of Resident #2's Psychiatric Subsequent Assessment, dated 08/20/25, reflected the following: .Staff reports continued behavioral concerns being exhibited by patient. Per ADON, patient reported to have ‘taken the tank off of her toilet and breaking it, as well as tearing soap dispensers off the wall.' Nursing staff within secured unit report patient often ‘easily agitated and physically aggressive. Staff states patient will attempt to hit staff during attempted periods of care. When attempting to initiate assessment, patient was found leaning over another resident within secured unit, whom was sitting on her wheelchair, and pushing her down the hall.'.At this time, due to reported symptoms of disorganized/delusional thoughts reported, Recommend [sic] initiation of Seroquel 25 mg/BID. Review of Resident #2's Psychiatric Subsequent Assessment, dated 08/27/25, reflected the following: .During previous visit, Seroquel 25 mg/BID order recommended.Staff states the day prior to exam, patient exhibited ongoing physically aggressive behaviors and ‘Choked [sic] another resident.' Per note in [EHR], on 8/26, patient was observed by the CNA ‘putting her hand around another resident's neck' in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 10 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some the dining room of the secured unit. During attempted intervention by nurse and CNA, patient was ‘fighting and kicking staff' during attempted redirection. Resident was placed on Q15 min safety checks, and staff denied observing physically aggressive behaviors being exhibited prior to today's assessment.Due to minimal symptom relief with currently ordered Ativan, recommend discontinuation of Ativan and initiation of clonazepam 0.5 mg/TID with consent from POA. Observation and attempted interview on 08/27/25 at 10:35 AM with Resident #2 revealed she was sitting in a chair in the dining room mumbling to herself. Resident #2 did not look the surveyor's way or at the surveyor until the surveyor continued trying to talk to her. Resident #2 appeared calm but was not able to answer any questions. Review of Resident #1's Quarterly MDS Assessment, dated 05/02/25, revealed she was a [AGE] year-old female who was admitted to the facility on [DATE]. Her BIMS score was 05, indicating severe cognitive impairment. Her MDS indicated she did not have any physical or verbal behaviors towards others. Her active diagnoses included Alzheimer's Disease (a brain condition that gradually destroys memory and cognitive skills, interfering with daily life) and Depression (a mood disorder that causes persistent sadness and changes in how you think, sleep, eat, and act). Review of Resident #1's care plan, revised 11/17/24, reflected: Focus: The resident is/has potential to be physically/verbally aggressive and resistive to care r/t Dementia.Interventions/Tasks: When the resident becomes agitated: Intervene before agitation escalates; Guide away from source of distress; Engage calmly in conversation; If response is aggressive, staff to walk calmly away, and approach later. Review of Resident #1's Progress Notes reflected the following:- LVN A wrote on 08/26/25 at 7:48 PM: The resident was attacked by an aggressive resident in the dining room. The aggressive resident was seen by the CNA putting her hand around the resident's neck (Resident #1) in the dining room. Nurse and CNA immediately ran towards them and intervened. Upon assessment, no injury noted. resident [sic] denies pain. Resident was redirected and taken to another seat away from the aggressive resident. NP and DON notified. Review of Resident #1's skin assessment, dated 08/27/25, reflected she had redness and an open spot on the right side of her neck and redness/spot to her right cheek. Observation and interview on 08/27/25 at 10:40 AM with Resident #1 revealed she was sitting in a chair in the dining room. Resident #1 said she was doing great today. Resident #1 was observed to have redness to the right side of her neck that appeared to be a bruise that was about two inches long and an inch wide with a small open area. Resident #1 also appeared to have a small scratch to the right side of her cheek on her jawline that was also reddened. Resident #1 said she did not know what happened to her cheek or neck but it did not bother her. Interview on 08/27/25 at 10:23 AM with LVN B revealed she got report from the night nurse this morning that Resident #2 attacked or scratched Resident #1 yesterday. LVN B said Resident #1 had some redness to her neck that looked like it was a scratch but she was not sure if it was from the incident with Resident #2 or not. LVN B said Resident #2 had wandered a lot around the unit and was a difficult resident to handle. LVN B said Resident #2 would get mad and yell and be agitated for no reason. LVN B said staff were monitoring Resident #2 every 15 minutes right now by just keeping an eye on her. LVN B said Resident #2 tried to touch other residents but staff usually intervened before anything could happen because if anyone was near her anything could set her off. LVN B said when Resident #2 started to show agitation, staff would try to calm her down by singing with her, taking her for a walk outside, or getting her something to eat or drink. LVN B said Resident #2's behaviors were unpredictable and there was no trigger for it. LVN B said she was not sure if she had been trained on what to do specifically with Resident #2 in order to decrease her behaviors or reduce her agitation. LVN B said she had never seen Resident #2 be physically aggressive with another resident during her shift. Follow-up interview on 08/27/25 at 10:40 AM with LVN B revealed she saw (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 11 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Resident #1's reddened areas to her neck and cheek but could not recall if they were there yesterday or not. LVN B said she did not pay much attention to Resident #1 yesterday so she was not sure if the reddened areas were a result of the incident with Resident #2 or not. Phone interview on 08/27/25 at 11:04 AM with CNA D, who worked with Residents #1 and #2 on 08/26/25, was unsuccessful as she did not answer or call back prior to exit. Phone interview on 08/27/25 at 11:05 AM with LVN C, who worked with Residents #1 and #2 on 08/26/25, was unsuccessful as she did not answer or call back prior to exit. Phone interview on 08/27/25 at 11:08 AM with LVN A revealed she was at the nurses' station when she heard CNA E yelling, She's about to choke the resident. LVN A said she and CNA E ran towards Residents #1 and #2 and when they got to them, Resident #2's hand was round Resident #1's neck. LVN A said her and CNA E were able to pull Resident #2's hand away from Resident #1's neck, but Resident #2 continued to fight staff while trying to redirect her. LVN A said that when she assessed Resident #1 she saw there was a reddened and opened areas to her neck and cheek but she did not think that was related to the incident, but that it was a rash. LVN A said that Resident #2 had physically aggressive behaviors such as she pushed another resident in the dining room on Monday, which was reported to the Abuse Coordinator but the resident did not sustain any injuries. LVN A said she communicated with the Psych NP about Resident #2's behaviors and PRN Ativan gel was added to her orders. LVN A said Resident #2 became agitated and unable to be redirected, she would apply the gel. Follow-up interview on 08/27/25 at 3:03 PM with LVN A revealed she did not check Resident #1's skin prior to the incident and did not know if it was due to the incident or a rash. LVN A said she only noticed the rash after the incident because she had to do a skin assessment. LVN A was unable to say how long Resident #1 had the rash to her skin and could not describe what it looked like. LVN A said that Resident #2 had been having an increase in her agitation and physical behaviors. LVN A said when Resident #2 first came to the facility, she was flinging chairs and tables around the dining room. LVN A said she reported this to the NP who ordered new medications but Resident #2's behaviors did not change. LVN A said that was when the NP ordered the PRN Ativan gel but it did not work either. LVN A said she did communicate with the DON when she saw Resident #2 become physically aggressive with other residents. LVN A showed a text message exchange between her and the DON from 08/08/25 discussing Resident #2's agitation and physically aggressive behaviors regarding resisting care and destroying anything within her reach. LVN A said she knew to report any incident to the DON immediately that concerned residents. Phone interview on 08/27/25 at 11:21 AM with CNA E revealed Resident #2 was very aggressive last night and very agitated. CNA E said Resident #2 was trying to pull the table and chairs in the dining room. CNA E said she tried to move closer to Resident #2 and get her to calm down by talking to her but the resident refused. CNA E said she also tried redirecting her but again, Resident #2 refused. CNA E said when she moved closer to Resident #2, Resident #2 moved close to Resident #1 and grabbed her neck choking her. CNA E said she rushed towards the residents and tried to separate them and pull Resident #2's hands off Resident #1's neck. CNA E said this behavior was normal for Resident #2 because she was always agitated and aggressive. CNA E said when Resident #2 became agitated she would try to calm her down, move close to her, and talk to her. CNA E said Resident #2 was very strong and would fight staff during care and drag staff to the ground because she was so strong. CNA E said staff would have to act fast to be near her to make sure she did not harm other residents. CNA E said she did everything she could to try and keep Resident #2 from hurting others but nothing seemed to work. Follow-up interview on 08/27/25 at 2:42 PM with CNA E revealed Resident #2 had physically aggressive behaviors towards others ever since she arrived to the facility. CNA E said especially the last few days, Resident #2 had been showing signs of agitation and aggression. CNA E (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 12 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some said Resident #2 pushed another resident in the dining room the other day and then had choked Resident #1 last night while she was upset. CNA E said Resident #2 would get upset and staff had to calm her down. CNA E said staff had to be alert and watch Resident #2 closely when she became agitated because when she got angry she was very strong in trying to push tables, chairs, and throw things. CNA E said staff would redirect her during these behaviors but the redirection did not work and Resident #2 would continue her behaviors. CNA E said when these behaviors occurred, she would tell the nurse and assumed the nurse would let the ADON/DON know. CNA E said she had not been trained on anything specific to do with Resident #2 regarding her behaviors. Interview on 08/27/25 at 11:43 AM with CNA F revealed she cared for Resident #1 yesterday and did not see any redness or scratches to her cheek or neck. CNA F said when she came to work this morning, she heard that a fight happened between Residents #1 and #2. CNA F said she figured the scratches and redness to Resident #1's cheek and neck happened from the incident with Resident #2. CNA F said that since the incident happened, the nurse was monitoring Resident #2 every 15 minutes, but she was not informed to do anything different regarding Resident #2. CNA F said Resident #2 had been calm this morning but did start to yell and after going to her side and talking to her, the resident calmed down. CNA F said Resident #2 was always agitated, wild, and out of control. CNA F said when Resident #2 got that way staff tried to calm her down by giving her something to drink or taking her somewhere else to calm down. CNA F said sometimes those interventions helped Resident #2 to calm down, and sometimes they did not. CNA F said when redirection did not work, they would leave Resident #2 alone and just monitor her closely because she would try to go to other resident's rooms. CNA F said one day she saw Resident #2 trying to get into her roommate's bed and was trying to get the roommate out of the bed. CNA F said she rushed into the room to stop Resident #2 from hurting the roommate and nothing happened. Interview on 08/27/25 at 1:24 PM with CNA H revealed she had only been working at the facility for a month but knew Resident #2 was easily agitated. CNA H said she had never seen Resident #2 be physically aggressive with another resident. CNA H said she knew to follow closely behind Resident #2 and make sure she was safe and not going to hurt anyone because she wandered around a lot. CNA H said Resident #2 was on every 15-minute checks right now because of what happened. CNA H said if she saw any resident trying to hurt another resident she would separate them and call for the nurse. CNA H said she knew when Resident #2 got upset, staff needed to help calm her down by offering her something to drink or eat. Interview on 08/27/25 at 2:49 PM with CNA I revealed Resident #2 was very erratic at times and when she got that way she would try to hurt other residents and staff. CNA I said staff would try to redirect Resident #2 to calm her down but it did not work because she did not want to be redirected. CNA I said last night specifically, Resident #2 was very upset and was behaving so badly that she was sitting at a table trying to push it away and knock residents out of their wheelchairs while hitting and swinging at them. CNA I said Resident #2 put her hands around Resident #1's neck to choke her. CNA I said when she saw Resident #1 before the incident, she did not have any marks on her cheek or neck but after the incident, Resident #1 had red spots on her cheek and neck. CNA I said Resident #2 also had a habit of wanting to get in her roommate's bed even while the resident was in the bed and if staff tried to stop her she would get more upset. CNA I said Resident #2's roommate was moved out of her room last night so that she would be safe. CNA I said Resident #2's behaviors were unpredictable in that she would be walking around and then walk up to a resident and start trying to be physical towards them. CNA I said there was not a trigger causing Resident #2's behaviors that she could identify. CNA I said Resident #2 had acted this way ever since she got to the facility, but her behavior was getting worse. CNA I said she had not talked to anyone in management about Resident #2's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 13 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some behaviors because she was told to just redirect her even though she refused the redirection. CNA I said the nurse on shift knew about Resident #2's behaviors and she thought the nurse would report everything to management. CNA I said before Resident #2 choked Resident #1, she had not harmed or hurt any other resident. Follow-up interview on 08/27/25 at 4:08 PM with CNA I revealed after Resident #2 had choked Resident #1, Resident #1 was very upset and scared. CNA I said she herself was also scared after the incident, and Resident #1 seemed very emotional afterwards asking why someone would do that to her. CNA I said she tried to calm her down and assure her she was safe. Interview on 08/27/25 at 2:37 PM with the MDS Coordinator revealed she was ultimately responsible for updating resident's care plans, but all nurses could update them as well. The MDS Coordinator said she had not heard that Resident #2 had behaviors towards others so she did not know to update her care plan to address them. The MDS Coordinator said she attended all the clinical morning meetings where staff would discuss such behaviors and then she would update the resident's care plan then. Interview on 08/27/25 at 1:10 PM with ADON G revealed she understood that Resident #2 had sporadic behaviors at times, like when she went towards Resident #1 and grabbed her neck. ADON G said staff were able to separate the two residents during the incident. ADON G said they have been dealing with Resident #2 because she gets agitated but they thought it was because she was in a new environment since she was a newer admit and needed time to adjust. ADON G said Resident #2 has these sporadic moments where staff did not know what was going to happen so they closely monitored her. ADON G said she was not sure if the redness and scratches to Resident #1's cheek and neck were from the incident with Resident #2 or not because she had not seen them for herself yet. Follow-up interview on 08/27/25 at 1:41 PM with ADON G revealed she saw Resident #1 and noticed she had 4 dots, 2 of which were prominent but dried up and closed now. ADON G said she thought the redness to Resident #1's skin was from a scratch but she could not be sure. ADON G said Resident #2 had been physically aggressive with staff before the incident with Resident #1 but she had swung towards other residents before, just never made contact with them. ADON G said Resident #2 had also pushed another resident on Monday (08/25/25) in the dining room but that resident did not sustain any injuries. ADON G said she was not sure what interventions were put in place to keep other residents safe from Resident #2's physically aggressive behaviors but she would have the Psych NP review her medications again. ADON G said she knew the Psych NP already ordered PRN Ativan gel and Seroquel to help with Resident #2's behaviors but staff were reporting that the medications were not working. ADON G said she was going to have to meet with the IDT to see what the next steps were for Resident #2. ADON G said she also received a report that Resident #2 tried to get in her roommate's bed and move the roommate out of the bed but the CNA intervened and stopped it from happening. ADON G said right now, Resident #2 was being monitored every 15 minutes by the nurse until the facility could decide what next steps to take with her regarding her behaviors. ADON G said what happened between Residents #1 and #2 was considered physical abuse. ADON G said that all residents had the right to be free from abuse. ADON G said that staff had been in-serviced regarding abuse as they went over who the AC was for the facility, the types of abuse, and what to do when someone abuses someone and how quickly to report abuse. ADON G said she did Interview on 08/27/25 at 2:06 PM with the DON revealed she was told last night that Resident #2 had tried to choke Resident #1 but staff were able to separate the two residents. The DON said Resident #2 was placed on every 15-minute checks by the nurse and then she herself came to the building. The DON said Resident #2 had a roommate at the time who was moved out of the room for her safety. The DON said staff also gave Resident #2 a shower and she fought during that which was normal behavior for her. The DON said after that Resident #2 went to bed. The DON said the NP was contacted and responded that a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 14 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some psychiatric evaluation needed to be completed. The DON said the Psych NP came today (08/27/25) to meet and evaluate Resident #2. The DON said Resident #2 was just ordered Seroquel a few days ago and had not had the chance to become effective. The DON said she looked at Resident #1 while she was here and she was upset but calmed down and sat at the nurse's station. The DON said she noticed two spots on Resident #1's neck and cheek but she was not sure if they were caused by the incident with Resident #2 or not. The DON said the two spots looked dry and scabbed over. The DON said she knew about Resident #2's behaviors because she was told on Monday that the resident had pushed another resident. The DON said she was told by staff that Resident #2 was resistive to care and would fight with staff but never tried to attack residents. The DON said if the staff did not tell her what was happening with Resident #2, she could not fix anything or address her behaviors. The DON said sometimes she reviewed staff's charting and the 24-hour report but it was not a regular occurrence for her. The DON said the plan to address Resident #2's behaviors now were that the Psych NP was going to adjust her medications after his evaluation. The DON said she knew to help clam Resident #2 down, she liked to go outside when she was agitated so that was an intervention staff could use. The DON said Resident #2's care plan did not address her behaviors because before this incident she was not aware of them. The DON said the ADON and the MDS Coordinator were responsible for updating a resident's care plan if they knew what to update it with. The DON said the purpose of the care plan was to know what interventions should be used to address the situation or behavior. The DON said if the care plan was not updated for a resident, then staff would not know how to manage the resident's behavior and things could escalate. The DON said what happened between Residents #1 and #2 was considered physical abuse. The DON said all residents should be free from abuse. The DON said all staff were responsible for ensuring all residents were free from abuse. The DON said if residents were not free from abuse, they were at risk of potential injury, death, and being harmed. The DON said all staff had been trained on the facility's policy regarding abuse, specifically going over who to report abuse to, the types of abuse, and the timeliness to report abuse. Interview on 08/27/25 at 3:15 PM with the Administrator revealed she was told by the DON that Resident #2 had put her hands around Resident #1's neck. The Administrator said she and the DON got to the facility to get the statements from the nurse and CNA about what happened. The Administrator said the CNA told her that she was nearby Resident #2 who walked towards Resident #1 and started grabbing her neck. The Administrator said the CNA had quickly removed Resident #2's hands from Resident #1 and then separated the residents. The Administrator said Resident #2 was placed on every 15-minute checks by the nurse after everything was settled. The Administrator said the DON started an abuse in-service with staff that went over who to report abuse to, the types of abuse, and how quickly staff were supposed to report abuse. The Administrator said she did not look to see if Resident #1 had any injuries from Resident #2 or not. The Administrator said the 6 AM to 2 PM nurse, LVN B, came to the morning clinical meetings and would explain that she got agitated with staff and she would be redirected and kept away from other residents. The Administrator said no other shift nurses reported to the clinical meetings, it was only the 6 AM to 2 PM shift nurses. The Administrator said other shift nurses reported things on the 24-hour report or would call the DON to let her know what was going on, such as if a resident began to have behaviors. The Administrator said she knew CNA's were told to redirect Resident #2 and get her involved in some type of activity, take her outside, or play some music. The Administrator said she heard that Resident #2 had pushed another resident a few days ago but that resident did not have any injuries from the situation. The Administrator said she had not been told that Resident #2 had been swinging at or trying to hit other residents. The Administrator said she could only intervene if she knew what was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 15 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete happening and since she did not know about Resident #2's behaviors, she could not put things in place. The Administrator said she expected staff to communicate with her when a resident showed signs of increased agitation and behaviors. The Administrator said if she knew about the extent of Resident #2's behaviors she could have taken other steps to ensure the residents' safety, such as transferring her to be evaluated. The Administrator said Resident #2's care plan was not updated either to reflect her behaviors because the management staff did not know about it. The Administrator said she was the abuse coordinator for the facility, and this situation was considered physical abuse. The Administrator said all residents had the right to be free from abuse and all staff were responsible for making sure they were. The Administrator said if residents were not free from abuse they would be harmed or have some type of trauma happen to them up to and including death. Phone interview on 08/28/25 at 9:32 AM with the Psych NP revealed Resident #2 was physically aggressive during moments of agitation and was difficult to redirect. The Psych NP said staff had been communicating with him about the increase in her behaviors and he had added orders for a PRN Ativan gel and Seroquel more recently. The Psych NP said he noticed during his meetings with her that she was uncooperative, non-compliant, and had disorganized speech and he was not sure what was causing all of these behaviors. The Psych NP said staff also explained to him how difficult Resident #2 was to manage and control, that she had taken off the tank to the toilet and the soap dispensers from the walls, she was wheeling another resident down the hall in her wheelchair in an aggressive manner, and now she had choked another resident. The Psych NP said Resident #2's behaviors were quite frequent and often from what he had witnessed and was told. The Psych NP said from what he was told and understood, staff were trying to minimize her behaviors the be Event ID: Facility ID: 676141 If continuation sheet Page 16 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 each resident's drug regimen was free from unnecessary medications (is a medication used: without adequate indication for its use; or in the presence of adverse consequences which indicate the dose should be reduced or discontinued) for one of five residents (Resident #2) reviewed for unnecessary medications.The facility failed when ADON J did not ensure Resident #2, who had a diagnosis of Alzheimer's disease (dementia), was not prescribed an antipsychotic medication, Seroquel, without a diagnosis for the use of the antipsychotic and that was not approved for treatment of patients with dementia-related psychosis. The Psych NP said he had ordered the Seroquel for Resident #2's unspecified psychosis which he diagnosed her with after meeting Resident #2 a few times. Resident was administered Seroquel on 08/25/25, 08/26/25, and 08/27/25. This failure could place residents at risk for unintended, harmful events attributed to the use of a medication without the appropriate indication. Findings included: Review of Resident #2's admission MDS Assessment, dated 07/29/25, reflected she was a [AGE] year-old female who was admitted to the facility on [DATE]. Her BIMS score could not be conducted, but it was noted she had both short-term and long-term memory problems and could not make her own daily decisions. She was noted to not have any physical or verbal behaviors towards others but did wander daily that intruded on the privacy or activity of others. Her active diagnoses included Alzheimer's Disease (a brain condition that gradually destroys memory and cognitive skills, interfering with daily life) and Insomnia (a common sleep disorder that can make it hard to fall asleep or stay asleep). Review of Resident #2's Physician's Orders reflected the following:- Seroquel Oral Tablet 25 MG Give 1 Tablet by mouth two times a day for agitation with an active order date of 08/25/25 Review of Resident #2's Treatment Administration Record reflected the following:- Resident #2 was administered the Seroquel on the following dates: 08/25/25, 08/26/25, and 08/27/25. Observation and attempted interview on 08/27/25 at 10:35 AM with Resident #2 revealed she was sitting in a chair in the dining room mumbling to herself. Resident #2 did not look the surveyor's way or at the surveyor until the surveyor continued trying to talk to her. Resident #2 appeared calm but was not able to answer any questions. Phone interview on 08/28/25 at 9:32 AM with the Psych NP revealed Resident #2 was physically aggressive during moments of agitation and was difficult to redirect. The Psych NP said staff had been communicating with him about the increase in her behaviors and he had added orders for a PRN Ativan gel and Seroquel more recently. The Psych NP said he had ordered the Seroquel for Resident #2's unspecified psychosis which he diagnosed her with after meeting with her a few times. The Psych NP said he provides the facility with his notes and any additional new diagnoses as well as any new medication orders. The Psych NP said the order should have specified Resident #2's diagnosis for the medication. Interview on 08/28/25 at 3:51 PM with ADON J revealed he added Resident #2's order to her chart for Seroquel. ADON J said the indication for use of the medication was agitation but that was not the associating diagnosis. ADON J said he should have added the associating diagnosis to the order. ADON J said the purpose of this was to ensure the resident has appropriate medications for appropriate things. ADON J said if the diagnosis was not with the order, the wrong medication could be used for the resident. ADON J said he had been trained to make sure the diagnosis was included with the medication order. Interview on 08/28/25 at 4:21 PM with the DON revealed Resident #2's Seroquel order should have had an associating diagnosis instead of just the indication for use on it. The DON said normally the MDS Coordinator, the ADON's, and herself check resident's orders to ensure they are correct. The DON said ADON J would have been responsible for making sure the diagnosis was listed with the medication order since he was the one to add the order to her Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 17 of 18 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 676141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Matlock Place Health & Rehabilitation Center 7100 Matlock Rd Arlington, TX 76002 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete chart. The DON said the purpose of this was so that the medication was given for the right reason. The DON said if this was not done, the medication may be given for an inappropriate reason. The DON said all staff had been trained to ensure the diagnosis was always included with a medication order. Review of the facility's Psychotropic Medication Use policy, dated 2001, reflected it did not address having a diagnosis for a medication order. Review of the manufacturer's information, dated January 2025, for Seroquel (quetiapine fumarate) reflected the following black box warning: Increased Mortality in Elderly Patients with Dementia-Related Psychosis; and Suicidal Thoughts and Behaviors Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death.Seroquel (quetiapine) is not approved for the treatment of patients with Dementia-Related Psychosis. Event ID: Facility ID: 676141 If continuation sheet Page 18 of 18