Health inspection·October 12, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few residents. She said residents could feel forced to eat or make them not want to eat if staff were standing while feeding them. She said going forward she would ensure staff had chairs on the halls for them to use if needed to feed residents. During an interview on 10/12/2023 at 9:40 AM, the DON said he started an in-service on 10/10/2023 about feeding residents. Staff should be at their level sitting. He said going forward unit managers would be making observation rounds daily. He said residents may not be pleased and it was a dignity issue. During an interview on 10/12/2023 at 10:49 AM, the Administrator said they staff should be at eye level with the resident when feeding. Staff should be sitting with the bed lowered. He said going forward he would continue to in-service staff and observe staff daily to ensure residents are being treated with dignity. Record review of an In-service dated 10/10/2023 conducted by the DON to all staff indicated, .You cannot stand over a resident and feed them. You must sit in a chair next to them and feed them. This is a dignity issue . Record review of a facility policy titled Resident Rights with a revised date of October 2009 indicated, .Employees shall treat all residents with kindness, respect, and dignity . Record review of a facility policy titled Quality of Life Dignity with a revised date of August 2009 indicated, .Each resident shall be care for in a manner that promoted and enhances quality of life, dignity, respect and individuality. 2. Treated with dignity means the resident will be assisted in maintained and enhancing his or her self-esteem and self-worth . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 2 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to refer all residents with newly evident or possible serious mental disorder, intellectual disability, or a related condition for level II resident review upon a significant change of condition for 1 of 6 Residents (Resident #6) reviewed for PASSAR (Preadmission Screening and Resident Review Services) in that: Resident #6 did not have a PASSR level II evaluation with diagnosis of psychotic disorder(abnormal thinking and perceptions) and major depressive disorder(persistent feeling of sadness or loss of interest). The MDS Coordinator failed to refer Resident #6 for a resident review after being diagnosed with major depressive disorder on 1/23/2023 and psychotic disorder on 5/16/2023. These failures could place residents at risk of not receiving the needed PASSAR services to meet their individual needs and could result in a decrease quality of life. The findings were: Record review of a PL1 (PASSR Level 1 Screening) dated 6/8/2022 for Resident #6 indicated she was negative for mental illness, intellectual disability, and developmental disability. Record review of an admission Record dated 10/10/2023 for Resident #6 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of dementia (loss of memory, language, problem-solving and other thinking abilities that affect daily life), psychotic disorder (abnormal thinking and perceptions) on 5/16/2023, and major depressive disorder (persistent feeling of sadness or loss of interest) on 1/23/2023. Record review of a Quarterly MDS assessment dated [DATE] for Resident #6 indicated she had severe impairment in thinking with a BIMS score of 4. She had psychiatric/mood disorders of depression and psychotic disorder. A referral to the local contact agency was not needed. Record review of an Annual MDS assessment dated [DATE] for Resident #6 indicated she had severe impairment in thinking with a BIMS score of 4. She had psychiatric/mood disorders of depression and psychotic disorder. A referral to the local contact agency was not needed. Record review of a care plan for Resident #6 dated 6/23/2023 indicated she had delusion disorder and used antipsychotic medications. During an interview on 10/12/2023 at 9:04 AM, the interim MDS nurse said she had been employed with the company for 12 years and was filling in to assist. She said when a resident was admitted to the facility, the facility should have a PL1. She said if there were any discrepancies with the diagnosis, then the facility should complete the form 1012 that would be signed by the physician that alerts the local authority about a new diagnosis. She said the local authority would complete a PE and make a determination. She said if a resident admitted with a negative PL1 and later identified new mental illness diagnosis, the facility should complete the form 1012, contact local authority and have them complete a PE if needed. She said the MDS nurse was responsible for coordination of PASSR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 3 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few services. She said there could be a risk to staff and others if residents were having behaviors. Residents could miss out on services. She said she was unaware that Resident #6 was not referred to the local authority for her new mental illness diagnosis. During an interview on 10/12/2023 at 9:40 AM, the DON said the MDS nurse was responsible for coordination of PASSR. He said Resident #6 should have been evaluated by the local authority when she had a new diagnosis of mental illness. He said going forward any new diagnosis with a psychological diagnosis from the physician that he wanted to know to ensure new diagnosis were not missed. He said the risk to residents could be missing out on screenings or what they needed if they qualified for services. During an interview on 10/12/2023 at 10:46 AM, the Administrator said the MDS nurse and SW were responsible for PASSR coordination. He said the facility hired a new MDS nurse that would start on 10/18/2023. He said he was not aware of the new diagnosis for Resident #6. Record review of a Mental Illness/Dementia Resident Review Form 1012 undated indicated Resident #6 had a primary diagnosis of dementia that was not signed by the physician. The nursing facility action was blank and did not indicate if the PL1 remained negative and no new PL1 needed to be completed or if a new positive PL1 was submitted. Record review of a PASSR Clinical Policy with a revised date of May 2014 indicated, .The PASSR level 1 (PL1) Screening form is designed to identify persons who are suspected to having Mental Illness (MI), Intellectual Disability (ID) of a Developmental Disability (DD) also referred to as related conditions. The PASSR Evaluation (PE) is designed to confirm the suspicion of MI, ID, or DD/RC and ensure the individual is placed in the most integrated residential setting receiving specialized services needed to improve and maintain the individual's level of functioning . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 4 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 - Minimal harm or potential for actual harm Residents Affected - Few 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 interview and record review the facility failed to develop and implement comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident medical and nursing needs to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being for 1 of 6 residents (Resident #13) reviewed for care plans in that: The facility failed to implement a comprehensive person-centered care plan for Resident #13 addressing PTSD. This deficient practice could place residents in the facility at risk of not receiving the necessary care or services and having personalized plans developed to address their needs. Findings included: Record review of an admission Record dated 10/11/2023 for Resident #13 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of COPD (a group of lung diseases that affect breathing), bipolar disorder (a condition that causes extreme mood swings), and PTSD (a mental health condition that is triggered by a traumatic event) on 2/13/2023. Record review of an Annual MDS Assessment for Resident #13 dated 5/16/2023 indicated she did not have any impairment in thinking with a BIMS score of 13. She had psychiatric/mood disorder of anxiety disorder, bipolar disorder, and PTSD. A referral was made to the local contact agency. Record review of a physician progress note dated 2/13/2023 for Resident #13 indicated she had diagnosis of PTSD, bipolar disorder, and generalized anxiety disorder. Record review of a care plan for Resident #13 dated 5/25/2022 with a revision dated of 6/15/2022 indicated she had impaired cognitive function related to bipolar and MDD. She used psychotropic medications due to bipolar disorder dated 6/14/2023 with interventions to administer medications as ordered. Monitor/document for side effects and effectiveness. The care plan did not address the new diagnosis of PTSD. During an interview on 10/10/2023 at 10:35 AM, the SW said PTSD was a new diagnosis for Resident #13 as of February 2023. She said the resident told her she had abusive relationships in the past, with poor men choices who were verbally abusive towards her and now men intimidate her. She said she was currently receiving counseling services that had been seeing her since 2/2/2023. She said she was not aware Resident #13 did not have PTSD on her care plan. During an interview on 10/12/2023 at 9:04 AM, the interim MDS from a sister facility said she had been employed with the company for 12 years. She said the DON or RN created the care plans and the IDT team members that included the SW, Treatment nurse, MDS, Dietary Manager and Activities all contributed to the comprehensive care plans. She said if changes were to be made it depended on the situation. She said if a new diagnosis was added, the MDS nurse, ADON, DON or unit managers should be entering it in and updating the care plans. She said she was not aware that Resident #13 had a new diagnosis of PTSD but would update the care to reflect the change. She the risk to the resident was that staff would not know that residents could have the potential of behaviors according to their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 5 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 diagnosis. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/12/2023 at 9:40 AM, the DON said the MDS nurse was responsible for updating the comprehensive care plans. He said currently the facility was without a fulltime MDS nurse and had been without one for about 3 months. He said he had been helping as much as he could with updating the care plans but was unaware that Resident #13 had a new diagnosis of PTSD that was not addressed in her care plan. He said they had been trying to get the care plans updated. He said going forward they have hired a MDS nurse that was supposed to start on 10/16/2023. He said the risk to residents would be staff not being able to follow the plan of care. Residents Affected - Few During an interview on 10/12/2023 at 10:44 AM, the Administrator said the facility had been without a full time MDS nurse for about 3 months. He said he was surprised the care plan were not updated. Record review of a facility policy titled Care Plans-Comprehensive with a revised date of December 2009 indicated, .An individualized comprehensive care plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychological needs is developed for each resident. 2. The comprehensive care plan is based on a thorough assessment that includes but is not limited to the MDS. 3. Each residents' comprehensive care plan is designed to: e. Reflect treatment goals, timetables, and objectives in measurable outcomes . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 6 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to implement a comprehensive person-centered care plan to meet resident's medical, nursing, mental and psychosocial needs identified in the comprehensive assessment for 1 of 5 residents (Resident #55) reviewed for care plans. The facility failed to ensure Resident #55's care plan was updated to indicate her gastrostomy tube status. This failure could place the resident at increased risk of not having their individual needs met and a decreased quality of life. Findings included: Record review of Resident #55's face sheet, dated 10/11/23, indicated Resident #55 was a [AGE] year-old female, originally admitted to the facility on [DATE] and subsequently readmitted on [DATE] with diagnoses including: gastrostomy (an opening into the stomach from the abdominal wall, made surgically for the introduction of food), osteomyelitis (an infection in the bone), and hypertension (high blood pressure). Record review of Resident #55's order summary report, dated 10/11/23, indicated 11 orders for treatments, feedings, and care to gastrostomy tube. Record review of Resident #55's quarterly MDS dated [DATE] indicated that she had a BIMS score of 11, which means that she had a moderate cognitive impairment. Section K of Resident #55's MDS revealed that she had a feeding tube and 51% or more of her total calories by tube feeding during the previous 7 days. Record review of an operative report for Resident #55 dated 8/7/23 indicated that on 8/4/23 Resident #55 had a percutaneous esophagogastroscopy tube inserted. Record review of Resident #55's care plan, with last care plan review date of 9/14/23, indicated the care plan was not updated to include her gastrostomy tube insertion and care needs. During an interview on 10/12/23 at 9:05 am interim MDS nurse said that she had been doing MDS's for around 12 years. She said that as far as updating care plans, it would depend on which section needed to be updated as to which member would do the updating. She said that it would fall on the administrative nurses to update nursing portions of the care plans with new diagnoses or medical needs. She said that the risks to residents include staff not knowing about behaviors, preferences and other things that flow over to the [NAME], and staff possibly not knowing about proper care for tubes. During an interview on 10/12/23 at 9:20 am DON said that they were without an MDS nurse at the moment, but that the MDS nurse would be the one to do care plans. He said that in the meantime, he had been having care plan meetings with the IDT team members to get care plans updated. He said that he could not think of any risks to not having the gastrostomy tube on the care plan because his nursing staff would check the orders and not the care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 7 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0657 Record review of facility policy titled Care plans - comprehensive dated 2001, revised on December 2009, Level of Harm - Minimal harm or potential for actual harm read .an individualized comprehensive care plan that includes measurable objectives and timetables to meet the resident's medical, nursing, mental and psychological needs is developed for each resident . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 8 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assures the accurate acquiring, receiving, dispensing, and administering of medications for 1 of 5 residents (Resident #69) and 2 of 5 (medication cart for halls 300 and 400 and nurse medication cart for halls 100 and 200) reviewed for pharmacy services. The facility did not ensure medications were properly administered to Resident #69. The facility failed to remove a bottle of levothyroxine (thyroid medication) 50 mcg tablets that expired on 6/14/2023 for Resident #52 from the medication cart for halls 300 and 400. The facility failed to remove 4 bottles of Glucerna 1.5 Cal with a used by date of September 1, 2023 from the medication cart for halls 100 and 200. These failures could place residents at risk for the unsafe administration of medications, not receiving prescribed doses of ordered medications and not receiving the intended therapeutic benefit of the medications. Findings included: 1.Record review of facility face sheet dated 10/10/2023 indicated Resident # 69 was a [AGE] year-old female admitted to facility on 09/11/2023 with diagnosis of cerebral infarction (stroke) and pneumonia (lung infection). Record Review of comprehensive care plan dated 9/11/2023 indicated Resident # 69 had an alteration in gastrointestinal status and to give medications as ordered, had arthritis (pain in joints) and to give analgesics as ordered, and had acute ischemic stroke and give medications as ordered. Care plan did not indicate Resident # 69 could safely self-administer medications. Record review of admission MDS dated [DATE] indicated Resident # 69 had a BIMS of 15 indicating intact cognition. Record review of consolidated physician orders dated 10/10/2023 indicated Resident #69 had an order for acetaminophen (Tylenol) 500 mg give 2 tablets by mouth daily, atorvastatin 40mg give 1 tablet by mouth at bedtime, docusate sodium 100mg give 1 capsule by mouth two times a day, omeprazole 40mg give 1 capsule by mouth daily, and Plavix 75mg give 1 tablet by mouth daily with start date of 9/11/23 and stop date of 9/12/23. During an observation on 10/09/23 at 09:45 am Resident # 69 was observed with medications in a medicine cup inside open drawer of nightstand. She stated she does not always take her medicine when the aide gives them to her because she knew what they are and took them at specific times in the morning depending on her breakfast. She stated the pills were Plavix, omeprazole, a stool softener, Tylenol, and atorvastatin. She stated the doctor stopped the Plavix, but she never took it because she did not feel she needed it to begin with. She stated she had not told anyone she was not taking her medicine when they gave them to her. She stated she was smart enough to know her medicine and how and when she wanted to take them. She stated she did leave her room unattended when she was at therapy (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 9 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 but was mostly in her room. Level of Harm - Minimal harm or potential for actual harm During an observation on 10/09/2023 at 9:55 am Resident #69 had the following medications identified at bedside: two white round tablets with imprint R 196 (Plavix), a brown capsule with imprint E69 (omeprazole), a white and red capsule (docusate sodium), a white oblong tablet with imprint M2A4-57344 (acetaminophen) and a white oblong tablet with imprint APO ATV40 (atorvastatin). Residents Affected - Some During an interview on 10/11/2023 at 8:33 am MA A stated she had been a medication aide for 20 years and at the facility for 8 months. She stated she worked Monday through Friday. She stated she administered medications to Resident #69 on 10/09/2023 and she watched Resident #69 take her medicine that morning. She stated when medications were given, the medicine had to be taken with medication aide present and medicine was not to be left at the bedside. She stated she was not aware Resident #69 had not taken her medicine. She stated she had been trained on proper administering of medications and not leaving medications at bedside. She stated the purpose of ensuring medications were taken, was to ensure another resident did not get the medicine and proper action of the medicine. Record review of competency training for MA A on 01/24/2023 indicated all criteria met including, #14. medications are not left on top of the cart or at resident's bedside. During an interview on 10/11/2023 at 8:45 am LVN B stated she had been at the facility since February 2023. She stated the medication aides administered most oral medications, but it was the nurse's responsibility to ensure medications were being given. She stated when medications were administered whoever gave the medicine were responsible for ensuring the resident took them before leaving the room and if they did not take them or refused the medication the medication aide was to tell the nurse. She stated she was not aware Resident #69 had not been taking her medicine when they were administered. She stated the risk could be resident health and ineffective disease management. During an interview on 10/11/23 at 4:04 PM the DON stated the nurse and medication aides were responsible for making sure residents were taking their medicine. He stated the staff were to stay with the resident until the medications were taken and the staff had been trained on proper administering of medications. The DON stated he oversaw the nursing staff and all training. He stated if medications were not taken when administered could cause ineffective disease management, or another resident could accidently take medicine left in a resident room. He stated all staff would be in-serviced and rounds would be made regularly to check for medications in resident rooms. 2. Record review of an admission Record dated 10/11/2023 for Resident # 52 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of COPD (a group of lung diseases that affect breathing), schizoaffective disorder (a combination of mood disorders such as depression or bipolar disorder), and bipolar disorder (a mental health condition that causes extreme mood swings). Record review of a physician order summary report dated 10/11/2023 for Resident #52 indicated there was no order for levothyroxine. Record review of an Annual MDS Assessment for Resident #52 dated 8/21/2023 indicated she did not have any impairment in thinking with a BIMS score of 15. During an observation on 10/10/2023 at 8:42 AM, the medication cart for halls 300 and 400 had a bottle of levothyroxine 50 mcg for Resident #52. The prescription was filled by a local pharmacy on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 10 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 6/14/2022, written on 3/8/2022 with a discard date of 6/14/2023. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/10/2023 at 8:45 AM, MA E said she had been employed at the facility for 3 months. She said she was designated to work halls 300 and 400 when she worked. She said the medication aides were responsible for checking the medication carts for expired and discontinued medications on a daily basis. She said she had been very busy and has been working extra shifts and did not check the medication cart. She said Resident #52 did not have an order to take levothyroxine and was not sure why the medication was in the cart. She said residents could have an adverse reaction if they took expired medications. Residents Affected - Some Record review of a medication administration observation report dated 7/27/2023 for MA E indicated her medication cart was observed for halls 200 and 400 and the medication cart did not have any missing or expired items. 3. Record review of a glucose testing competency observation report dated 5/31/2023 for LVN B indicated her medication cart was observed by the ADON for halls 100 and 200 and the medication cart did not have any missing or expired items. During an observation on 10/10/2023 at 11:25 AM, the nurse medication cart for halls 100 and 200 had four- 8 fluid ounce bottles of Glucerna 1.5 Cal (nutrition supplement) with a used by date of September 1, 2023. During an interview on 10/10/2023 at 11:30 AM, LVN B said she had been employed at the facility since February 2023. She said she worked the day shift on 6 am -2 pm shift and was assigned the nurse cart for halls 100 and 200. She said the nurses and unit managers were responsible for checking the nurse carts for expired medications and supplements. She said the carts were supposed to be check daily after every shift. She said she was trained by a previous LVN on medication administration and the pharmacist visited the facility and conducted random audit checks of medication carts monthly. She said the pharmacist conducted an audit with her about a month ago and she had some items that were expired or out of date in her cart at that time. She said if a resident drank supplements that were out of date, they could get sick. During an interview on 10/12/2023 at 8:30 AM, the ADON said she had been employed at the facility since December 2022. She said the medication aides and nurses were responsible for checking their carts daily and the unit managers were responsible for checking medication carts weekly for expired medications, supplements, or discontinued medications. She said the pharmacy consultant checked all carts a couple of weeks ago. She said she started an in-service on 10/10/2023 on cleaning out medication carts. She said for residents that admitted to the facility that had medications brought in from home such as Resident #52, the nurse should have contacted families about picking them up or if they wanted the facility to discard them. She said residents could get sick if they took medicine or supplements that were expired. During an interview on 10/12/2023 at 9:40 AM, the DON said the nurses and medication aides were responsible for checking carts every shift and should be looking for anything expired. He said the unit managers would be checking the carts weekly going forward. He said he conducted an in-service on 10/10/2023 about checking carts. He said residents could be at risk of taking expired medications. He said the pharmacist visited the facility monthly but did not have a copy of the report for the audit that was conducted a few weeks ago. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 11 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 10/12/2023 at 9:52 am the Administrator stated that the nurses and medication aides were responsible for administering medications per the regulation and it was everyone's responsibility on room rounds to report medications left in rooms. He stated if medications were left in resident's rooms the risk could be resident health and risk of another resident taking them. He stated he expected all medications to be administered as ordered and at the time of administration. He said going forward they would in-service staff and conduct random medication cart checks. He said residents could get hurt if a medication was no longer needed, then it needed to be discarded. Record review of an In-Service dated 10/11/2023 conducted by the DON for nurses and medication aides indicated, .You must watch resident swallow pills or document refusal. You will not leave meds in the room . Record review of an In-Service dated 10/10/2023 conducted by the DON for nurses and medication aides indicated, .You must check your cart at the beginning of each shift and ensure all items (meds, foods, etc.) are not expired. Everything must be dated . Record Review of facility policy dated December 2012 titled Administering Medications indicated, .3. medications must be administered in accordance with the orders, including any required time frame . Facility policy titled Storage of Medications with a revised date of April 2007 indicated, .The facility shall store all drugs and biologicals in a safe, secure, and orderly manner. 4. The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 12 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the drug regimen review recommendation from the pharmacy consultant were acted upon for 1 of 4 residents reviewed for drug regimen review. (Resident #31) -The facility did not follow up on the pharmacy consultant's recommendations for Gradual Dose Reduction dated 8/21/32 with the physician for Resident #31 until 10/03/23 to decrease Doxepin 6mg to Doxepin 3mg at bedtime. -The facility did not develop policies and procedures to address the timelines of the MRR. These failures could place residents being at risk for medication errors, unnecessary medications, and incorrect administration. Findings included: Record review of Resident #31's face sheet dated 10/11/23 indicated Resident #31 was [AGE] year-old female, admitted on [DATE] with diagnoses including dementia with other behavioral disturbances (altered thinking processes related to aging). Record review of the most recent MDS dated [DATE] indicated Resident #31 had a BIMS of 12 indicating mild cognitive impairment. Record review of the monthly pharmacy consultant medication regimen review (MRR) and recommendation dated 08/21/23, the review indicated: A recommendation: Reason for encounter: Gradual Dose Reduction Assessment for Psychopharmacological/Mood Altering Meds(s) This resident has been receiving Doxepin 6mg at bedtime for insomnia. Assessment/recommendation to consider for this resident gradual dose reduction to 3 mg at bedtime. Resident also receives Seroquel 25mg hour of sleep (HS) and Restoril 30mg HS. Record review of physician orders dated 10/11/23 indicated resident #31 was receiving Doxepin 6mg at bedtime until 10/03/23 when new order for Doxepin 3mg every HS was entered into the electronic ordering system. Record review of a medication administration record for resident #31 dated 10/11/23 indicated documentation of administration of Doxepin 6mg at bedtime until 10/03/23. Doxepin 3mg every HS was administered from 10/03/23 until 10/10/23. During an interview on 10/11/23 at 3:30 p.m. AM, the DON said he had worked at the facility since July 2023 and was responsible for obtaining the completed pharmacy reviews. He stated, This is the only policy we have; we have reached out to corporate, and this is the only policy we have at this time. The DON said not following up on recommendations timely could cause a delay in needed medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 13 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0756 Level of Harm - Minimal harm or potential for actual harm changes or other requested interventions and the recommendations for August 2023 were not sent out to the physician until three weeks later 09/15/23 due to his email not working due to a ransomware threat. The DON said he did not ask the Pharmacy Consultant to print them out to ensure they were addressed timely. The order was not obtained for GDR on Resident #31's recommendation until 10/03/23, after the next pharmacy review was conducted. Residents Affected - Few During an interview 10/12/23 09:30 AM, the Regional Nurse Consultant she said the policy for Gradual Dose Reduction (GDR) was in the process of being revised, but the prior policy stated that the review and GDR process should be complete before the next Pharmacy review. During an interview on 10/12/23 10:00 AM, the Administrator stated, This is the only policy we have. We have reached out to our corporate office and are waiting for a policy. The Administrator said we have no policy with a timeline for each of the steps/actions to be taken. The Administrator said the DON was responsible for completion of the MMR Process including GDR his expectation would be they are implemented before the next pharmacy review was conducted. A pharmacy services policy and procedure, with a revised date of October 1, 2019, indicated .Medication Regimen Reviews . 7. The Consultant Pharmacist will document his/her findings and recommendations on the Monthly drug/medication regimen review report. 8. The Consultant Pharmacist will provide a written report to Physicians for each resident with an identified irregularity. If the situation is serious to represent a risk to a person's life, health or safety, the consultant Pharmacist will contact the Physician directly to report the information to the Physician and will document such contacts. If the Physician does not provide a response, or the Consultant Pharmacist identifies that no action has been taken, he/she will then contact the Medical Director, or- if the Medical Director is the Physician of Record- the Administrator . 10. Copies of the drug/Medication regimen review reports, including physician responses, will be maintained as part of the permanent medical record . Requested a policy for Documentation of Consultant Pharmacist Recommendations and Procedures with timeline of Gradual Dose Reductions before exit on 10/12/23 at 12:00 p.m. none provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 14 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain and ensure safe and sanitary storage of residents' food items for 1 of 8 residents personal refrigerators reviewed for food safety (Resident #18). Residents Affected - Few The facility failed to ensure the refrigerator for Resident #18 did not contain an unlabeled, undated, or expired yogurt and cottage cheese. This failure could place residents at risk for food borne illnesses. Findings include: Record review of a resident face sheet dated 10/11/23 indicated that Resident #18 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: Alzheimer's disease (progressive memory loss), dementia (altered thinking due to aging), and anxiety (nervousness.) Record review of a BIMS assessment dated [DATE] for Resident #18 indicated that she had a BIMS score of 11 indicating that the resident had mild cognitive impairment. During an observation on 10/10/23 at 2:15 p.m., Resident #18's personal refrigerator was observed with a 16-ounce container of yogurt best by date 09/02/23 and 16-ounce container of cottage cheese best by date 09/26/23 in with no date and no label in personal refrigerator in room. During an observation and interview with Resident #18 on 10/11/23 08:53 AM the expired cottage cheese and yogurt was removed. Resident #18 said she only gets a coke out of the refrigerator sometimes and her family member brought snacks and gets them out for her. During an interview on 10/10/23 at 2:30 p.m. CNA C said that the CNA staff does not usually retrieve items from the personal refrigerators they are for the resident and family use. CNA C said the nurses clean them sometimes. CNA C said she did not clean them or access them. During an interview on 10/11/23 9:42 a.m. the ADON said that the resident refrigerators are assigned to administrative staff for room rounds and they call the family to come and remove items and clean the refrigerators if needed. She said administration was aware that expired items were found in residents' refrigerators and they are cleaning the refrigerators out. They will be in servicing staff and discarding expired items and cleaning the refrigerators. The ADON said if the resident ate the expired items it could cause illness. During an interview on 10/11/23 at 10:00 a.m., the DON said the resident's family was mainly responsible for maintaining foods in the residents in room refrigerators with the assistance of nursing staff. The DON said that eating expired food items could cause food borne illnesses. He said that department head rounds were also completed, and the assigned member should be checking for expired food items and discarding them. During an interview on 10/12/23 at 11:14 a.m., the Administrator said that he expected that his staff would routinely check the resident refrigerators to prevent residents from getting sick. He said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 15 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0813 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete that the administrative staff made rounds daily to check the refrigerators and other items in resident rooms. The Administrator said he would be in servicing staff to ensure expired items were discarded. Record review of facility policy titled Foods brought by family/visitors July 2017, indicated .7. b. Perishable foods must be stored in resealable containers with tightly fitted lids in a refrigerator. Containers will be labeled with the resident's name, the item and the use by date . 8. The nursing staff will discard perishable items on or before the use by date. Event ID: Facility ID: 676147 If continuation sheet Page 16 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 8 staff (MA E and LVN F) and 4 of 7 residents (Resident #8, Resident #18, Resident #58, and Resident #45) reviewed for infection control in that: Residents Affected - Some MA E did not clean the blood pressure cuff between residents (Resident #8, #18, #58) and she did not wash or sanitize her hands in between any of the residents (Resident #8, #58, #18 and #45) observed during medication administration . LVN F did not wash or sanitize her hand in between glove changes while checking the blood sugar of Resident #45. These failures could place residents at risk of exposure to communicable diseases and infections. Findings included: 1.Record review of an admission Record dated 10/11/2023 for Resident # 8 indicated he admitted to the facility on [DATE] and was [AGE] years old with diagnoses of PVD (decreased blood flow to legs and feet), type 1 diabetes (a condition where the pancreas produces little or no insulin), bipolar disorder (a condition that causes extreme mood swings), and hypertension (high blood pressure). Record review of a Quarterly MDS assessment dated [DATE] for Resident #8 indicated he did not have any impairment in thinking with a BIMS score of 15. He required extensive assistance with bed mobility and was totally dependent in transfers, dressing, toilet use and personal hygiene. Record review of a care plan dated 3/15/2023 for Resident #8 indicated he had hypertension with interventions to give anti-hypertensive medications as ordered. Observe for side effects such as orthostatic hypertension and increased heart rate and effectiveness. During an observation on 10/10/2023 at 7:48 AM, MA E was at the medication cart to administer medications to Resident #8. She had a blood pressure cuff sitting on the top of the medication cart and entered the room of Resident #8 and checked his blood pressure using a digital cuff. MA E did not wash or sanitize her hands before contact with Resident #8. MA E exited the room and placed the blood pressure cuff on top of the medication cart without sanitizing it. MA E unlocked the medication cart and placed the medications for Resident #8 in a plastic cup and went back into the room and administered the medications to Resident #8. MA E did not wash or sanitize her hands before or after contact with Resident #8. 2. Record review of an admission Record dated 10/11/2023 for Resident # 58 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of dementia (loss of memory, language, problem-solving that interferes with daily life) , heart failure (the heart's inability to pump effectively and efficiently), anemia (low red blood cells in the body), and hypertension (high blood pressure). Record review of a Quarterly MDS assessment dated [DATE] for Resident #58 indicated she had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 17 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some moderate impairment in thinking with a BIMS score of 10. She required extensive assistance with bed mobility, transfers, toilet use and personal hygiene. Record review of a care plan dated 3/2/2023 for Resident #58 indicated she had a diagnosis of hypertension with interventions to give antihypertensive medications as ordered. Observe for side effects such as orthostatic hypertension and increased heart rate and effectiveness. During an observation on 10/10/2023 at 7:58 AM, MA E was at the medication cart to administer medications to Resident #58. She had a blood pressure cuff sitting on the top of the medication cart and entered the room of Resident #58 and checked her blood pressure using a digital cuff. MA E did not wash or sanitize her hands before contact with Resident #58. MA E exited the room and placed the blood pressure cuff on top of the medication cart without sanitizing it. MA E unlocked the medication cart and placed the medications for Resident #58 in a plastic cup and went back into the room and administered the medications to Resident #58. MA E did not wash or sanitize her hands before or after contact with Resident #58. 3. Record review of an admission Record dated 10/11/2023 for Resident # 45 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of encephalopathy (disease that affects the brain), hypotension (low blood pressure), type 2 diabetes and Parkinson's disease (a brain disorder that causes unintended or uncontrollable movements and difficulty with balance and coordination). Record review of a Quarterly MDS assessment dated [DATE] for Resident #45 indicated she had a BIMS score of 12. She required supervision with bed mobility, transfers, and eating. She required limited assistance with all other ADL's. During an observation on 10/10/2023 at 8:08 AM, MA E was at the medication cart to administer medications to Resident #45. MA E unlocked the medication cart and placed the medications for Resident #45 in a plastic cup and went back into the room and administered the medications to Resident #45. MA E did not wash or sanitize her hands before or after contact with Resident #58. 4. Record review of an admission Record dated 10/11/2023 for Resident # 18 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of Alzheimer's disease, dementia, major depressive disorder, and hypertension. Record review of a Significant Change MDS assessment dated [DATE] for Resident #18. She had moderate impairment in thinking with a BIMS score of 11. She required extensive assistance with bed mobility, transfers, dressing, toilet use and personal hygiene. Record review of a care plan dated 12/9/2018 for Resident #18 indicate she had a diagnosis of hypertension with interventions to give antihypertensive medications as ordered. Monitor for side effects such as orthostatic hypotension and increased heart rate. During an observation on 10/10/2023 at 8:14 AM, MA E was at the medication cart to administer medications to Resident #18. She had a blood pressure cuff sitting on the top of the medication cart and entered the room of Resident #18 and checked her blood pressure using a digital cuff. MA E did not wash or sanitize her hands before contact with Resident #18. MA E exited the room and placed the blood pressure cuff on top of the medication cart without sanitizing it. MA E unlocked the medication cart and placed the medications for Resident #18 in a plastic cup and went back into the room and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 18 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some administered the medications to Resident #18. MA E did not wash or sanitize her hands before or after contact with Resident #18. During an interview on 10/10/2023 at 8:45 AM MA E said she had been employed at the facility for 3 months. She said during the observation of medication administration, she should have sanitized the blood pressure cuffs between residents and slowed down during the process. She said she was the designated medication aide on halls 300 and 400 on the 6 am-2 pm shift. She said she was checked off on medication administration before and was never told anything about cleaning equipment. She said she should have washed or sanitized her hands between residents, and she did not today because she was nervous. She said residents were at risk of infection if staff did not clean equipment or wash/sanitize their hands. Record review of a medication administration observation report dated 7/27/2023 for MA E indicated she followed proper hand washing technique/gloves at appropriate times. 5. Record review of an admission Record dated 10/11/2023 for Resident # 45 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of encephalopathy (disease that affects the brain), hypotension (low blood pressure), type 2 diabetes and Parkinson's disease (a brain disorder that causes unintended or uncontrollable movements and difficulty with balance and coordination). Record review of a Quarterly MDS assessment dated [DATE] for Resident #45 indicated she had a BIMS score of 12. She required supervision with bed mobility, transfers, and eating. She required limited assistance with all other ADL's. During an observation on 10/10/2023 at 10:50 AM, LVN F was at the door of Resident #45's room. LVN F placed wax paper on the over bed table and put a glucometer, test strips, and alcohol wipes on it. LVN F placed gloves on her hands but did not wash or sanitize them. She checked Resident #45's blood sugar and removed her gloves and placed them in the trash. LVN F went back to the medication cart that was at the doorway and unlocked the cart to get Resident #45's insulin. LVN F applied gloves to both hands and administered the insulin to Resident #45's left lower abdomen. LVN F removed her gloves and placed them in the trash and removed the needle from the insulin pen and placed it in the sharps container. LVN F cleaned the glucometer with a Clorox wipe and placed the wipe in the trash. LVN F removed her gloves and placed them in the trash and then sanitized her hands. During an interview on 10/10/2023 at 11:05 AM, LVN F said she had been employed at the facility since February 2023. She said during the medication administration, she should have washed or sanitized her hands before and after gloves changes. She said she did not have any sanitizer on the cart. She said residents could be at risk of infection or cross contamination if staff did not wash or sanitize their hands. She said she did not have any excuses why she did not wash or sanitize her hands. Record review of glucose testing competency dated 2/27/2023 for LVN F indicated she was observed by the ADON and washed her hands appropriately. During an interview on 10/12/2023 at 8:30 AM, the ADON said she had been employed at the facility since December 2022. She said she was the Infection Preventionist in the facility and staff were supposed to sanitize or wash their hands before and after glove changes and clean equipment used between residents. She said staff were observed on handwashing monthly. She said she would start doing check offs biweekly instead of monthly. She said residents could be at risk of infections if staff did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 19 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0880 not wash or sanitize their hands and clean equipment between residents. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/12/2023 at 9:40 AM, the DON said the ADON and Unit managers were responsible for making sure staff were trained on infection control and conducted check offs with them. He said staff should be washing or sanitizing their hands between gloves changes. He said staff had been in-serviced on hand hygiene and cleaning equipment and would schedule to have someone come in to train staff from an outside source. He said going forward, he would continue to educate staff. He said residents could be at risk of infection if staff did not wash or sanitize their hand between gloves changes or clean equipment between residents. Residents Affected - Some Record review of an In-Service titled Infection Control dated 10/10/2023 conducted by the DON indicated, .While using equipment between resident cuff, glucometer, etc. you must ensure it is cleaned with the provided wipes before and after each use . Record review of an In-Service titled Handwashing dated 10/10/2023 conducted by the DON indicated, .Remember when performing patient care when removing gloves to perform hand hygiene. Hand sanitizer is effective unless visibly soiled then use soap and water before donning another set of gloves. When in doubt wash your hands . Record review of a facility policy titled Handwashing/Hand Hygiene with a revised date of August 2015 indicated, .This facility considers hand hygiene the primary means to prevent the spread of infections. 7. Use an alcohol-based hand rub containing at least 62% alcohol; or alternatively, soap and water for the following situations: b. Before and after direct contact with residents; c. Before preparing or handling medications; l. After contact with objects (e.g., medical equipment) in the immediate vicinity of the resident; m. After removing gloves; 8. Hand hygiene is the final step after removing and disposing of personal protective equipment . Record review of a facility policy titled Cleaning and Disinfection of Environmental Surfaces with a revised date of June 2009 indicated, .Environmental surfaces will be cleaned and disinfected according to current CDC recommendations for disinfection of healthcare facilities and the OSHA Bloodborne Pathogens Standard. 1. c. Non-critical items are those that come in contact with intact skin but not mucous membranes. 2. Non-critical surfaces will be disinfected with an EPA-registered intermediate or low-level hospital disinfectant according to the label's safety precaution and use directions . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 20 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0944 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on interviews and record reviews, the facility failed to ensure Quality Assurance and Performance Improvement (QAPI) training that outlines and informs staff of the elements and goals of the facility's QAPI program for 14 of 14 employees (Administrator, DON, ADON, FSS, AD, LVN G, RN H, LVN J, DOR, CNA K, CNA L, CNA M, CNA N, and CNA D) reviewed for training, in that: The facility failed to ensure that quality assurance and performance improvement training was provided to the Administrator, DON, ADON, FSS, AD, LVN G, RN H, LVN J, DOR, CNA K, CNA L, CNA M, CNA N, and CNA D. This failure could place staff and residents at risk for not being aware of facility programs, implementation, and monitoring. Findings: Record review of personnel files indicated the following: The Administrator was hired 4/3/23, The DON was hired 7/5/23, The ADON was hired on 12/9/22, The DM was hired 12/2/16, The AD was hired 3/20/23, LVN G was hired 8/10/23, RN H was hired on 8/3/23, LVN J was hired 2/13/23, The DOR was hired 6/13/18, CNA K was hired 10/18/22, CNA L was hired 6/23/22, CNA M was hired on 9/1/23, CNA N was hired on 4/5/23, and CNA D was hired on 12/6/22. Record review of training records indicated the QAPI required training had not been completed on hire for the Administrator, DON, ADON, FSS, AD, LVN G, RN H, LVN J, DOR, CNA K, CNA L, CNA M, CNA N, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 21 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0944 and CNA D. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/12/23 at 9:20 am the DON said the ADON was responsible for staff trainings. He said that the risks for staff not receiving proper trainings included residents receiving incorrect care. Residents Affected - Many During an interview on 10/12/23 at 9:30 am the ADON said she was responsible for staff trainings and said that she was unaware of the requirements for QAPI trainings. She said she would get the trainings started and train the staff. During an interview on 10/12/23 at 10:40 am the Administrator said he did not know the requirements for QAPI training were to be done on hire and annually. He said he would be working on getting a system in place to ensure that all staff received required trainings. He said the risks to residents included the staff now knowing how to properly care for residents. Record review of facility policy Titled Staff Development dated 2001, revised December 2009 indicated, .The primary purpose of our facility's in-service training program is to provide our employees with an in-depth review of our established operational policies and procedures, their positions, methods and procedures to follow in implementing assigned duties, and to provide up-to-date information that will assist in providing quality care . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 22 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0946 Provide training in compliance and ethics. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide the required compliance and ethics training for 14 of 14 employees (Administrator, DON, ADON, FSS, AD, LVN G, RN H, LVN J, DOR, CNA K, CNA L, CNA M, CNA N, and CNA D) reviewed for training, in that: Residents Affected - Many The facility failed to ensure compliance and ethics training was provided to the Administrator, DON, ADON, FSS, AD, LVN G, RN H, LVN J, DOR, CNA K, CNA L, CNA M, CNA N, and CNA D. This failure could affect residents and place them at risk of poor care or victimization due to lack of staff training. Findings : Record review of personnel files indicated the following: The Administrator was hired 4/3/23, The DON was hired 7/5/23, The ADON was hired on 12/9/22, The DM was hired 12/2/16, The AD was hired 3/20/23, LVN G was hired 8/10/23, RN H was hired on 8/3/23, LVN J was hired 2/13/23, The DOR was hired 6/13/18, CNA K was hired 10/18/22, CNA L was hired 6/23/22, CNA M was hired on 9/1/23, CNA N was hired on 4/5/23, and CNA D was hired on 12/6/22. Record review of training report indicated the Compliance and Ethics required training was not completed on hire or annually for the Administrator, DON, ADON, FSS, AD, LVN G, RN H, LVN J, DOR, CNA K, CNA L, CNA M, CNA N, and CNA D. During an interview on 10/12/23 at 9:20 am the DON said that ADON was responsible for staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 23 of 24 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 676147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stallings Court Nursing and Rehabilitation 4616 NE Stallings Dr Nacogdoches, TX 75965 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 0946 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many trainings. He said that the risks for staff not receiving proper trainings included residents receiving incorrect care. During an interview on 10/12/23 at 9:30 am the ADON said that she was responsible for staff trainings and said that she was unaware of the requirements for compliance and ethics trainings. She said that she would get the trainings started and train the staff. During an interview on 10/12/23 at 10:40 am the Administrator said that he did not know the requirements for compliance and ethics training were to be done on hire and annually. He said that he would be working on getting a system in place to ensure that all staff received required trainings. He said that the risks to residents included the staff now knowing how to properly care for residents. Record review of facility policy Titled Staff Development dated 2001, revised December 2009 indicated, .The primary purpose of our facility's in-service training program is to provide our employees with an in-depth review of our established operational policies and procedures, their positions, methods and procedures to follow in implementing assigned duties, and to provide up-to-date information that will assist in providing quality care . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676147 If continuation sheet Page 24 of 24