Inspection·December 17, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The HAB inquired immediately about names, timeframes, and other details. The HAB asked [Resident #1] multiple times for additional information; however, [Resident #1] was only able to provide the limited information below. On [DATE] at 9:00 AM, Resident #1 reported a white man, after dinner, hit my head. In addition, Resident #1 showed gestures of penetration by moving her arms and pelvis to reenact the rape. Additional details were unknown to Resident #1 when probed further by the HAB. The HAB reports that Resident #1 was unable to provide other demographics about the white male, unable to articulate an exact date or timeframe of the rape, and not able to provide details about a head injury. On [DATE], after 9:00 AM, after the above interaction, the HAB informed facility [ADON] about what just occurred. The [ADON] was not concerned and told the HAB that it was a recurring behavior history that [Resident #1] exhibits. On [DATE], after 9:00 AM, the [ADON] left and came back informing the HAB that he looked in [Resident #1's] facility file to see if there was any documentation indicating that [Resident #1] had been raped recently. The [ADON] reported to the HAB that [Resident #1] has a tendency to have flashbacks of when she was previously raped and is possibly reliving it. The HAB remains concerned that a rape potentially occurred recently due to allegations of rape not being a pattern of behavior that [Resident #1] has exhibited in front of the HAB in the past. Since 2024, the HAB has never observed any type of flashback behaviors or allegations of rape from [Resident #1] while working with her as indicated by the [ADON]. The HAB wishes for [State Surveyor] to confirm if a rape occurred or if it was a previous memory as indicated by the [ADON]. Observation on [DATE] at 9:30 AM revealed Resident #1 sitting in the lobby in her wheelchair. Resident #1 appeared happy as she smiled and waved at State Surveyor. Resident #1 stated, You my friend, give me a hug. Resident #1 was clean and appropriately dressed for the weather. Resident #1 did not have any visible marks or bruises. During an interview on [DATE] at 9:00 AM, the HAB stated she was assigned to Resident #1 in 2024 through [her mental health facility] and she met with Resident #1 once a week on Tuesdays. The HAB stated Resident #1 had never mentioned being raped or displayed any behaviors to her before. The HAB stated she escorted Resident #1 to the front of the facility. The HAB stated she informed the ADON that Resident #1 wanted to speak with someone. The HAB stated Resident #1 told the ADON that someone raped her. The HAB stated Resident #1 would only say after dinner, but she could not provide a date or time. The HAB stated she asked Resident #1 if it was yesterday or last week and Resident #1 just kept repeating after dinner. During an interview on [DATE] at 10:40 AM, Resident #1 stated she was fine, and staff treated her good. Resident #1 showed me her nails and stated they were pretty. Resident #1 stated no one had hurt her. Resident #1 stated she was not afraid of anyone and that she felt safe at the facility. Resident #1 provided short answers without great detail. During an interview on [DATE] at 11:10 AM, the Psych NP stated he had treated Resident #1 since [DATE]. The NP stated Resident #1 never mentioned being raped to him. The NP stated he saw Resident #1 last week, and the facility asked him to see her again ([DATE]) due to the allegations Resident #1 made to her HAB. The NP stated he spoke with Resident #1 in her room, and he asked her about being raped and she responded, Not me. The NP stated he asked Resident #1 if she was sure and she responded, a black man and started laughing. The NP stated Resident #1 did not appear distressed, upset or angry. The NP stated Resident #1 was pleasant, smiling and laughing. The NP stated Resident #1 had a history of making up stories. The NP stated Resident #1 pointed at the ADON's door and said the ADON was her husband. The NP stated he corrected Resident #1 and told her that the ADON was not her husband. The NP stated then Resident #1 changed her story and said he was her husband. The NP stated he believed Resident #1 made up [NAME] stories. The NP stated Resident #1 appeared at her baseline and she could not elaborate on any details. The NP stated he then asked Resident #1 about the allegations again and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 2 of 5 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 12/17/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she repeated, Not me. The NP stated he did not know where the story stemmed. The NP stated Resident #1 appeared very comfortable and not agitated. The NP stated, in his opinion, he felt the accusation was not deemed probable and he did not make any medication adjustments. The NP stated it was difficult to extract information from Resident #1 and when he tried to get her to elaborate, she repeated Not me. The NP stated with Resident #1's baseline, you never knew what you would get from her. The NP stated Resident #1 had very childlike behavior. The NP stated honestly, he had no concerns, and he came to visit Resident #1 due to the facility requesting him to speak with her regarding the statement she made. During an interview on [DATE] at 11:35 AM, FAM A stated she was unaware of Resident #1 experiencing any type of sexual abuse when they were children. FAM A stated when Resident #1 lived in the group home, she was not made aware of incidents of sexual abuse. FAM A stated she could not confirm any of the information as their [family members] were both deceased . During an interview on [DATE] at 1:50 PM, CNA A stated Resident #1 liked to go into other residents' rooms, and staff would have to remove her. CNA A stated Resident #1 liked to touch and hug people. CNA A stated that sometimes at night, Resident #1 would wake up, stand up, and scream. CNA A stated it was documented in Resident #1's Care Plan that she screamed. CNA A stated Resident #1 had never made any allegations to her about being inappropriately touched or sexually assaulted. CNA A stated if Resident #1 had told her the allegations, she would have reported it to the Charge Nurse and the ADM. CNA A stated they took mistreatment of residents very seriously. CNA A stated since she had worked at the facility for the last five months, there had not been any incidents of inappropriate behavior by any residents. CNA A stated she did not know why Resident #1 would say she was raped, but based on her screaming at night, maybe she had had some past trauma. CNA A stated she had received training on all types of abuse and neglect, including Dementia. CNA A stated she did not have any concerns for Resident #1 as far as anyone abusing her. CNA A stated Resident #1's roommate was very vocal, and if she heard or saw something, she would call out for help. During an interview on [DATE] at 2:40 PM, the ADON stated Resident #1's HAB told him that Resident #1 said she had been raped after dinner. The ADON stated he went and told the ADM immediately. The ADON stated him and the ADM spoke with Resident #1 in the office and asked her who did it and Resident #1 said that white lady [name]. The ADON stated they did not have anyone that worked at the facility by the name Resident #1gave. The ADON stated they then asked Resident #1 when it happened, and she said, A long time ago. The ADON stated he informed the HAB that Resident #1 was care planned related to relived trauma in 2023. The ADON stated since the information of the past trauma was shared with the facility in 2023, Resident #1 was Care Planned, but she had not had any episodes. The ADON stated there could be people sitting around and if Resident #1 became angry, she would stand up and say, That girl yelled at me. The ADON stated, but in actuality, no one had yelled at her. The ADON stated he knew Resident #1 well and he did not believe it was something that happened there at the facility. The ADON stated it was included in her Care Plan, and it was up to the ADM to report it. The ADON stated by the time he went and looked at the Care Plan and returned to the lobby, Resident #1 and her HAB had already moved to the day room and were listening to music. The ADON stated that when he joined them, Resident #1 smiled and told him to come sit down and listen to the music. The ADON stated he believed Resident #1 was in a safe environment and was looked after well by staff. The ADON stated normally a Nurse would assess the Resident, they would contact law enforcement, send the Resident to the hospital to be examined, and file a report with the SA. The ADON said his expectations were for staff to report any suspicions or allegations of abuse or neglect immediately to the ADM. During an interview on [DATE] at 3:05 PM, the DON stated she was made aware yesterday afternoon ([DATE]) by the ADON that Resident #1 made an outcry to her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 3 of 5 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 12/17/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few HAB that she had been raped on an unknown date and time. The DON stated that the ADON said he informed the ADM. The DON stated because they truly knew Resident #1, they did not believe they swept the allegation under the rug. The DON stated her gut, and her heart told her it did not happen there in that facility. The DON stated things could have been did differently. The DON stated that moving forward even if a Resident was Care Planned for any type of trauma from prior abuse the facility should report it to the State within timeframe. The DON stated the worse thing was that it could be absolutely true. The DON said that due to Resident #1 being care planned for prior trauma since 2023, they did not feel the allegation of sexual assault/abuse was true. However, she realized, at that time, that the allegation should have been reported to HHSC within 2 hours of the alleged incident. The DON said her expectations were for the facility staff to report all suspicions or allegations of abuse immediately to the ADM, as the abuse coordinator. The DON said the incident should have been reported to the SA within 2 hours of the allegation. During an interview on [DATE] at 3:45 PM, LVN B stated Resident #1 had never mentioned anything to her about being assaulted. LVN B stated Resident #1 sat and talked with her at the nursing station every day. LVN B stated Resident #1 moved around freely using her wheelchair. LVN B stated Resident #1 was a very peaceful person, and did not like people to speak loudly. LVN B stated she did not have any concerns for Resident #1. LVN B stated she was trained on abuse and neglect and was aware of reporting any allegations of abuse to the ADM immediately. LVN B stated the facility should have reported the allegation to law enforcement and to the State. During an interview on [DATE] at 4:20 PM, the ADM stated on Tuesday ([DATE]), the ADON came to her office and told her that Resident #1's HAB informed him that Resident #1 said she had been raped. The ADM stated her and the ADON went and spoke with Resident #1, and Resident #1 said, I've been raped. The ADM stated she asked Resident #1 what was going on and by whom, and Resident #1 said [name]. The ADM stated she asked Resident #1 if that person worked at the facility, and Resident #1 said, No. The ADM stated she asked Resident #1 when it happened and Resident #1 responded, I don't know. The ADM stated she looked at the ADON and as far as she knew, they did not have anyone that worked at the facility by that name. The ADM stated the ADON questioned Resident #1, and she repeated the same responses. The ADM stated she spoke with the HAB and shared with her that Resident #1 had been Care Planned for an event related to sexual abuse that she experienced in her younger years, and that on occasion, she relived the trauma. The ADM stated Resident #1 then started joking and told the ADON, I feel safe with you, can I go home with you? The ADM stated the ADON told Resident #1 that she was safe at the facility and Resident #1 started laughing. The ADM said her and the ADON returned to their morning meeting, and she told the ADON to follow up with the HAB to let her know that Resident #1 was being followed by Psyche, and they would have Psyche come to the facility to assess Resident #1. The ADM said when the ADON went to tell them, he found them in the Day Room listening to music. The ADM said Resident #1 had already forgotten about the allegation and the HAB said she had already reported the concerns to her supervisor, and they were going to make a report to APS. The ADM said she told the HAB it was fine, and she understood they had protocols. The ADM stated, therefore, she did not believe that it needed to be reported. The ADM stated she was the Abuse and Neglect Coordinator and after working at the facility for 6 months, she knew Resident #1 well and everyone protected her. The ADM stated she did not report the allegations to law enforcement or the State because it was a past trauma reported by family and Resident #1 and the facility had Care Planned it in 2023. The ADM stated her expectations were for staff to report all allegations of abuse and neglect to her. Record review of the facility's Abuse, Neglect, Exploitation policy, revised [DATE], reflected the following, Policy Explanation and Compliance Guidelines: .2. The facility will designate an Abuse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676141 If continuation sheet Page 4 of 5 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 12/17/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Prevention Coordinator in the facility who is responsible for reporting allegations or suspected abuse, neglect, or exploitation to the state survey agency and other officials in accordance with state law. V. Investigation of Alleged Abuse, Neglect and Exploitation A. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur. VII. Reporting/Response A. The facility will have written procedures that include: 1. Reporting of all alleged violations to the Administrator, state agency, adult protective services and to all other required agencies (e.g., law enforcement when applicable) within specified timeframes: a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or . B. The Administrator will follow up with government agencies, during business hours, to confirm the initial report was received, and to report the results of the investigation when final within 5 working days of the incident, as required by state agencies. Event ID: Facility ID: 676141 If continuation sheet Page 5 of 5