Health inspection·September 14, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation of room [ROOM NUMBER] on 09/12/23 at 11:25 AM and on 09/14/23 at 11:20 AM revealed, the bathroom floor was dirty and stained with some dark spots, the floor around the toilet was dirty, and the toilet was stained. A wall in the bathroom near a basket stand, displayed brownish stains on the wall. The walls on the right side of the air condition unit in the room had dark water stains alongside it. Interview on 09/13/23 at 2:15 PM with Environmental Specialist, C, revealed, she was shown the pictures of the concerns in the resident rooms. She stated she spoke very little English and used a language application (Spanish) to assist with communication. She stated that they clean the resident rooms at least once a day and they clean it from top to bottom. She stated she had only been cleaning the resident rooms in the 300- hall for a month. She stated she had attempted to clean the dark spots in the bathrooms but had no luck. She could not explain why the walls were not wiped down. She was asked if she tried stripping the floor and she said no. She stated she tries to do a good job when cleaning the room because contamination could spread. Interview on 09/14/23 at 12:10 PM with Housekeeping Supervisor, revealed she had been the supervisor for 2 months. She stated that she was aware of the conditions of the floor and had brought it to the Administrator's attention and was told that the floors needed to be replaced. She stated that she and her team do the best they could to clean the floors. She was shown pictures of stains on the walls in the resident rooms and bathrooms, and she stated that her team should had wiped down the walls if they are stained. She stated that her team does not have a checklist, but she does meet with them and instruct them on everything they needed to clean in the resident rooms and cleaning the bathroom and wiping down the walls are two of the things that should be done every day. She stated the risk to the residents being in a dirty room is a contamination concern. Interview with Administrator on 09/14/23 at 12:30 PM, revealed he was shown the pictures of the concerns discovered in the rooms observed for clean and sanitary environment. He advised that his Housekeeping Supervisor is new in her role and training a new housekeeping staff. He advised he would be meeting with her to address the concerns observed. He advised that the bathroom floors were not dirty, but needed replacement, which he had already advised corporate office. He advised that he was a little concerned to hear that there were concerns with the cleanliness of the resident rooms. He advised that he expects his facility to be cleaned thoroughly daily, from top to bottom. He advised that these concerns were not considered a clean and homelike environment for resident and could make residents ill if not clean and sanitary. Review of the facility's Homelike Environment dated 02/2021, revealed The facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. The Characteristics include clean, sanitary, and orderly environment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 2 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0635 Provide doctor's orders for the resident's immediate care at the time the resident was admitted. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that residents had physician's orders for the resident's immediate care for one (Resident #16) of two residents reviewed for admission orders. Residents Affected - Few The facility failed to provide physician's orders for oxygen supplement for Resident #16 at the time of admission. The facility failed to provide physician's orders for CPAP for Resident #16 at the time of admission. These failures could place the resident at risk of not receiving necessary care and services upon admission that could result to worsen condition. Findings included: Review of Resident #16's Face Sheet dated 09/14/2023 reflected that resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included acute (disease with recent onset) and chronic (disease that continues over an extended period of time) respiratory failure with hypoxia (deficiency in the amount of oxygen in the body tissues), obstructive sleep apnea (temporary cessation of breathing while asleep), unspecified emphysema (a lung condition that causes shortness of breath because the air sacs in the lungs are damaged), and shortness of breath. Review of Resident #16's Comprehensive MDS dated [DATE] reflected that resident #16 had a moderately intact cognition with a BIMS score of 12. Resident required an extensive assistance for bed mobility, transfer, locomotion on unit, locomotion off unit, dressing, toilet use, and personal hygiene. Resident also needed supervision for eating. The Comprehensive MDS also indicated debility, cardiorespiratory conditions as the primary reason for admission. Resident #16's primary medical conditions were acute and chronic respiratory failure with hypoxia, hypertension, and respiratory failure. The Comprehensive MDS also specified that Resident #16 utilized oxygen supplement and non-invasive mechanical ventilator (BiPAP [bilevel positive airway pressure]/CPAP [continuous positive airway pressure]) while not a resident of the facility and when she became a resident of the facility. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for continuous oxygen administration. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for oxygen supplement as needed. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for when to change the cannula and oxygen tubing. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order to keep the oxygen cannula and tubing in a bag when not in use. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for when to change the humidifier. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 3 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0635 Level of Harm - Minimal harm or potential for actual harm Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order to wash filters from oxygen concentrator every seven days with soap and water, rinse, and squeeze dry. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for what to assess like redness to nares (openings of the nose where the prongs of the cannula are inserted). Residents Affected - Few Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for CPAP. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for when and how to clean the CPAP. Review of Resident #16's Discharge Assessment/Plan from hospital dated 07/28/2023 reflected the use nasal cannula to maintain SaO2 (oxygen saturation level: percentage of how much oxygen the blood is carrying) 88% to 92% and to use CPAP at night. Review of Resident #16's Discharge Assessment/Plan from hospital dated 07/28/2023 reflected RT (respiratory therapist) Oxygen details: nasal cannula as oxygen delivery device. Review of Resident #16's Discharge Assessment/Plan from hospital dated 07/29/2023 reflected RT (respiratory therapist) BiPAP/CPAP treatment mode: CPAP, with mask type of full face, and mask size of medium. Review of Resident #16's admission Notes dated 07/29/2023 reflected, res (resident) admitted from . , s/p (status post: treatment or diagnosis that a patient has experienced) acute on chronic respiratory failure d/t (due to) pe (pulmonary embolism), CHF (chronic heart failure) exacerbation . HX (history) COPD, emphysema (, OSA (obstructive sleep apnea) . Res . lungs diminished, . o2 via NC (nasal cannula) @ 2 lpm (liter per minute) . Review of Resident #16's admission Orders on 09/12/2023 reflected no orders for continuous oxygen. Review of Resident #16's admission Orders on 09/12/2023 reflected no orders for oxygen as needed. Review of Resident #16's admission Orders on 09/12/2023 reflected no orders for CPAP. Review of Resident #16's Nursing Notes dated 08/01/2023 reflected, BIPAP for the resident came this night and this nurse had machine put on her. Resident stated she was comfortable. Review of Resident #16's Daily Skilled Notes of dated 09/03/2023 reflected respiratory assessment showed Resident #16 has SOB (shortness of breath) on exertion. The Skilled Notes indicated that the reasons for skill were acute and chronic respiratory failure with hypoxia and chronic obstructive pulmonary disease. The Skilled Notes also specified that continuous oxygen was in use at 2 - 3 LPM and that BiPAP/CPAP is one of the interventions Resident #16 received. Review of Resident #16's Daily Skilled Notes of dated 09/11/2023 reflected respiratory assessment showed Resident #16 had SOB (shortness of breath) on exertion, when lying flat, and at rest. The Skilled Notes also specified that continuous oxygen was in use at 3 LPM via nasal cannula and that BiPAP/CPAP is one of the interventions Resident #16 received. The Skilled Notes indicated that the respiratory problems of Resident #16 were COPD (chronic obstructive pulmonary disease), emphysema, acute and chronic respiratory failure with hypoxia, and sleep apnea. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 4 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #16's Daily Skilled Notes of dated 09/12/2023 reflected respiratory assessment showed Resident #16 had SOB (shortness of breath) on exertion, when lying flat, and at rest. The Skilled Notes also specified that continuous oxygen was in use at 3 LPM via nasal cannula and that BiPAP/CPAP is one of the interventions Resident #16 received. The Skilled Notes indicated that the respiratory problems of Resident #16 were COPD (chronic obstructive pulmonary disease), emphysema, acute and chronic respiratory failure with hypoxia, and sleep apnea. Review of Resident #16's O2 Sats (oxygen saturation) Summary dated 07/31/2023 to 09/12/2023 reflected that the method of delivery for oxygen was via nasal cannula. Observation on 09/12/2023 at 11:00 AM, revealed that Resident #16 was on bed with O2 at 3 LPM via nasal cannula. The nasal cannula was connected to an oxygen concentrator. It was also observed that resident had a CPAP machine sitting on the bedside table. Interview with LVN W on 09/12/2023 at 11:00 AM, LVN W stated that Resident #16 is on continuous oxygen and CPAP. LVN W said that the night nurse put the CPAP on at night and AM nurse would take it off in the morning. Interview with Resident #16 on 09/13/2023 at 9:52 AM, Resident #16 said that she had been on oxygen since she cannot remember. Resident #16 said that she uses the oxygen at all times for respiratory failure. She had the oxygen even when she was still living on her home and from the hospital before coming to the facility. She also said that she uses CPAP at night for sleep apnea. Resident #16 said that when she was at home, she would change her oxygen tubing once a month and clean her CPAP mouthpiece once a week by soaking it warm water. Interview with LVN W on 09/13/2023 at 10:05 AM, revealed that she had been with the facility for a year. She had cared for Resident #16 since the resident was admitted to the facility, approximately four weeks ago. She stated that the primary diagnosis of Resident #16 were respiratory failure, emphysema, and sleep apnea. LVN W said that residents with respiratory failures usually had an oxygen supplement as physician's order. LVN added that residents with sleep apnea usually uses CPAP or BiPAP. LVN W added that Resident #16 came in the facility with oxygen via nasal cannula. When asked if she can see the orders for oxygen supplement, LVN W stated that she cannot find the order for oxygen. When asked if she can see the orders for CPAP, LVN W stated that she cannot find the order for CPAP. Observation on 09/13/2023 at 10:05 AM, LVN W was trying to look for the order for oxygen supplement and CPAP by scrolling the facility's tablet downward and upward. Interview with LVN W on 09/13/2023 at 10:10 AM, revealed that the order for oxygen supplement and CPAP were not on the daily MAR (medication administration record). LVN W said that it is important to have a physician's order to know what to do, what to assess, and what are the treatment plan. LVN W added that this will put the resident at risk of not having the medications, treatments, and services they needed. Interview with DON on 09/13/2023 at 12:10 PM, the DON stated that there should be an order to know what to do and what to assess. The DON added that residents with active diagnosis of respiratory failure usually utilize oxygen supplement. Residents with active diagnosis of sleep apnea usually use CPAP. The DON said that if a resident uses these intervention, the orders should be on the PCC. If the order where were not on the system, the staff will not know that it should be done, and the nurse will not know what to execute. This can cause additional medical issues. The DON stated that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 5 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few orders are important for patient safety and necessary to eliminate medication errors or treatment errors. If the resident came with oxygen supplement and there was no order on the discharge summary, the nurse should have notified the physician that the resident was on oxygen and there was no order in the discharge summary. The DON said that if the resident uses a CPAP and there was no order, the nurse should have notified the physician that the resident uses CPAP. The DON further stated that whoever is the nurse receiving the resident is supposed to assess the resident thoroughly and enter the orders on PCC. The expectation is for the staff to follow the best practice and put the necessary orders in PCC. Interview with LVN O on 09/14/2023 at 7:55 AM, LVN O stated the physician's orders are for the protection of the resident. LVN O said that the orders serve as proof that the facility are caring for the residents. LVN O added that without the orders, the nurses will not know what to do for the resident. This will put the resident at risk of not having the medical care needed. Interview with ADON on 09/14/2023 at 10:57 AM, the ADON stated that she has been with the facility for a year and a half. The ADON said that some of the orders for a resident with an active diagnosis of respiratory failure would be aerosol, nebulizer, and oxygen supplement, whether continuous or as needed. The ADON said that one of the orders for resident with sleep apnea would be BiPAP or CPAP. The ADON said that these orders should be in the PCC so that the staff would know the course of treatment and what are the medications that the resident needed. The ADON said that the nurse that received the resident upon admission does further assessment. The ADON said that the nurse receiving the resident upon admission transcribe the orders in the PCC. Interview with the Administrator on 09/14/2023 at 2:36 PM, the Administrator stated that he was with the facility since July 1st of this year. The Administrator stated that there should be an order for everything that is being done for the resident. The administrator added that there should be an order for medications, treatments, diet, therapy, and laboratory tests. The administrator further said that the expectation is that the staff would follow the best practice so that the resident will not have additional medical issues and so that the facility could provide the services the residents needed. There should be orders so that the condition of the residents could be evaluated. This is also to check if the treatments are effective or needed to be changed. Record review of facility's policy, Ordering Medications, Pharmacy Policy & Procedure Manual 2003 revealed The nurse that receives a new . order, should be responsible for the following . order must be transcribed accurately to the MAR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 6 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 observation, interviews, and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for a resident for 2 of 6 residents (Resident #16 and #28) reviewed for Care Plans. The facility failed to ensure Resident #28's diagnosis and treatment for epilepsy was care planned. The facility failed to ensure Resident #16's diagnosis and treatment for the use of oxygen supplement was care planned. These failures could place residents at risk of needs not being met. Findings include: Record review of Resident #28's Face Sheet, dated 09/13/23, revealed she was an 87 -year-old female admitted on [DATE]. Relevant diagnoses included Acute Respiratory Failure (impaired lungs), Epilepsy (seizures), and Syncope and Collapse (fainting). Record review of Resident #28's Physician Orders dated 06/05/23/23 revealed she had the following orders to treat her Epilepsy: Levetiracetam Oral Tablet 250 MG; Give 1 tablet by mouth two times a day related to EPILEPSY Review of Resident #28's Comprehensive Care Plan revised on 08/22/2023 reflected no care plan for Epilepsy diagnosis. Review of Resident #16's Face Sheet dated 09/14/2023 reflected that resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included acute (disease with recent onset) and chronic (disease that continues over an extended period of time) respiratory failure with hypoxia (deficiency in the amount of oxygen in the body tissues), obstructive sleep apnea (temporary cessation of breathing while asleep), unspecified emphysema (a lung condition that causes shortness of breath because the air sacs in the lungs are damaged), and shortness of breath. Review of Resident #16's Comprehensive MDS dated [DATE] reflected that resident #16 had a moderately intact cognition with a BIMS score of 12. Resident required an extensive assistance for bed mobility, transfer, locomotion on unit, locomotion off unit, dressing, toilet use, and personal hygiene. Resident also needed supervision for eating. The Comprehensive MDS also indicated debility, cardiorespiratory conditions as the primary reason for admission. Resident #16's primary medical conditions were acute and chronic respiratory failure with hypoxia, hypertension, and respiratory failure. The Comprehensive MDS also specified that Resident #16 utilized oxygen supplement and non-invasive mechanical ventilator (BiPAP [bilevel positive airway pressure]/CPAP [continuous positive airway pressure]) while not a resident of the facility and when she became a resident of the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 7 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 Review of Resident #16's Comprehensive Care Plan dated 07/31/2023 reflected no care plan for the use of oxygen supplement. Review of Resident #16's Comprehensive Care Plan dated 07/31/2023 reflected no care plan for the use of CPAP. Residents Affected - Few Observation on 09/12/2023 at 11:00 AM, revealed that Resident #16 was on bed with O2 at 3 LPM via nasal cannula that was connected to an oxygen concentrator. It was also observed that resident had a CPAP machine sitting on the bedside table. Interview with LVN W on 09/12/2023 at 11:00 AM, LVN W stated that Resident #16 is on continuous oxygen and CPAP. LVN W said that the PM nurse put the CPAP on, and the AM nurse would take it off in the morning. Interview with Resident #16 on 09/13/2023 at 9:52 AM, she said that she had been on oxygen since she cannot remember. Resident #16 said that she uses the oxygen at all times for respiratory failure. She had the oxygen even when she was still living on her home and from the hospital before coming to the facility. She also said that she uses CPAP at night for sleep apnea. Resident #16 said that when she was at home, she would change her oxygen tubing once a month and clean her CPAP mouthpiece once a week by soaking it warm water. Interview with LVN W on 09/13/2023 at 10:05 AM, revealed that she had been with the facility for a year. She cared for Resident #16 since the resident was admitted to the facility, approximately four weeks ago. She stated that the primary diagnosis of Resident #16 were respiratory failure, emphysema, and sleep apnea. LVN W said that residents with respiratory failures usually had an oxygen supplement as physician's order. LVN W added that residents with sleep apnea usually uses CPAP or BiPAP. When asked if she can check the care plan, LVN W stated that the oxygen supplement and the CPAP were not on the care plan. Observation on 09/13/2023 at 10:05 AM, LVN W was trying to look for the care plan for oxygen supplement and CPAP by scrolling her tablet downward and upward. Interview with LVN W on 09/13/2023 at 10:10 AM, revealed that the care plan for Resident #16 for oxygen supplement and CPAP were not on PCC. When asked if it is important for the resident to have a care plan, LVN W replied that a care plan will measure the effectiveness of the care. LVN W added that without the care plan, the residents will not get the right level of care needed. Interview with DON on 09/13/2023 at 2:55 PM, the DON said that care planning is a team approach. The DON stated that the MDS nurse does the care plan. The DON added that the risk of not having a care plan is that the disease process will not be managed accordingly. The DON further stated that the care plan should be correct and up to date. It should be done upon admission, quarterly and when there is a change of condition in the part of the residents. Interview on 09/14/23 at 11:00 AM revealed, the MDS Coordinator was advised Care Plan for Resident #28, and it not having a Care plan for diagnosis of seizures, and she stated that it should have been care planned but it was not. She stated it was her, the ADON, DON, and the Charge nurse's responsibility to update care plans appropriately. She stated the risk of Care plans not being updated appropriately and timely could result in residents not receiving required care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 8 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 Interview with LVN O on 09/14/2023 at 7:55 AM, LVN O stated that the care plan helps the facility and the staff to plan accordingly based on the conditions of the resident. LVN O said that when there is a care plan, the staff will be able to provide adequate and high quality care. Interview with ADON on 09/14/2023 at 10:57 AM, The ADON stated that she has been with the facility for a year and a half. The ADON said that some of the orders for a resident with an active diagnosis of respiratory failure would be aerosol, nebulizer, and oxygen supplement, whether continuous or as needed. The ADON said that active diagnosis should be care planned so that the multidisciplinary team will be on the same page and the staff will know what to do. The ADON said that if it is on the MDS, it should be care planned. The ADON further said that MDS nurse makes the care plan. According to the ADON, without the care plan, the residents will not get the care they needed and could result to a serious the medical condition. Interview with the Administrator on 09/14/2023 at 2:36 PM,the Administrator stated that he was with the facility since July 1st of this year. The administrator said that there should be a care plan for each resident or else the residents will not have care needed. There should be a plan of care to evaluate the condition of the residents, to see if the treatment was effective, or to assess if care should be modified. The Administrator further explained that the care plan serves as the communication between the multidisciplinary team. The Administrator added that the expectation is that each resident will a have a care plan designed to their specific needs. Review of facility's policy regarding Care Planning dated March 2022, revealed The Interdisciplinary team is responsible for the development of resident care plans. The comprehensive, person-centered care plan is developed within 7 days of the completion of the required MDS assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 9 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 observation, interviews, and record reviews, the facility failed to ensure the timeliness of each resident's person-centered, comprehensive care plan, and to ensure that the comprehensive care plan is reviewed and revised by an interdisciplinary team composed of individuals who have knowledge of the resident and his/her needs, and that each resident and resident representative, if applicable, is involved in developing the care plan and making decisions about his or her care for 1 of 6 residents (Resident #9) reviewed for revised Care Plans. The facility failed to ensure Resident #9's discharge from Hospice on 09/24/21 was removed from the care plan. This failure placed residents at risk of needs not being met. Findings include: Record review of Resident #9's Face Sheet, dated 09/13/23, revealed she was a 97 -year-old female admitted on [DATE]. Relevant diagnoses included Transient Cerebral Ischemic Attack (mini strokes), Epilepsy (seizures), and Dementia (impaired memory). Record review of Resident #9's Physician Orders dated 09/13/23 revealed Resident #9 had Hospice orders effective 05/11/2021 and discharged [DATE]. Record Review of Resident #9's Care Plan on 09/13/23, which was last reviewed 07/26/23, revealed the Resident was Care Planned for Hospice Care. Interview on 09/14/23 at 11:00 AM revealed, the MDS Coordinator was advised of the concern of Resident #9's Hospice Care, which was care planned, but she was discharged since 09/24/21. She stated it was her, the ADON, DON, and the Charge nurse's responsibility to update care plans appropriately but, it was not updated. She advised that the hospice plan was overlooked. She advised that it was reviewed quarterly and when there were changes to the resident's condition. She stated the risk of Care plans not being updated appropriately and timely could result in residents not receiving required care. Interview with the DON on 09/13/2023 at 2:55 PM, the DON said that care planning is a team approach. The DON stated that the MDS nurse does the care plan. The DON added that the risk of not having a care plan is that the disease process will not be managed accordingly. The DON further stated that the care plan should be correct and up to date. It should be done upon admission, quarterly and when there is a change of condition in the part of the residents. Interview with ADON on 09/14/2023 at 10:57 AM, The ADON stated that she has been with the facility for a year and a half. The ADON said that some of the orders for a resident with an active diagnosis of respiratory failure would be aerosol, nebulizer, and oxygen supplement, whether continuous or as needed. The ADON said that active diagnosis should be care planned so that the multidisciplinary team will be on the same page and the staff will know what to do. The ADON said that if it is on the MDS, it should be care planned. The ADON further said that MDS nurse makes the care plan. According to the ADON, without the care plan, the residents will not get the care they needed and could result (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 10 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 to a serious the medical condition. Level of Harm - Minimal harm or potential for actual harm Interview with the Administrator on 09/14/2023 at 2:36 PM, the Administrator stated that he was with the facility since July 1st of this year. The administrator said that there should be a care plan for each resident or else the residents will not have care needed. There should be a plan of care to evaluate the condition of the residents, to see if the treatment were effective, or to assess if care should be modified. The Administrator further explained that the care plan serves as the communication between the multidisciplinary team. The Administrator added that the expectation is that each resident will a have a care plan designed to their specific needs. Residents Affected - Few Review of facility's policy regarding Care Planning dated March 2022, revealed the following: The Interdisciplinary team is responsible for the development of resident care plans. The Interdisciplinary Team reviews and updates the care plan: a. When there is significant change in the resident's condition at least quarterly, in conjunction with the required quarterly MDS assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 11 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 3 of 6 residents (Residents #26, #28, and #143) reviewed for Activities of Daily Living (ADLs) care provided to dependent residents. Residents Affected - Some The facility failed to ensure Residents #26, #28, and #143 received baths or showers consistently for past 30 days of records reviewed for documented resident showers. This failure placed residents at risk of not receiving necessary services to maintain good personal hygiene, skin integrity, or decreased self- esteem. Findings Included: Record review of Resident #26's Face Sheet, dated 09/14/23, revealed she was a 75 -year-old female admitted on [DATE]. Relevant diagnoses included Sepsis (bacterial infection), Urinary Tract Infection, Muscle Weakness, and Heart Failure. Record review of Resident #26's Minimum Data Set (MDS) on dated 09/14/23 revealed she had a Brief Interview for Mental Status (BIMS) score of 13 (cognitively impaired) and for ADL care it stated, For transfers, toileting, and bathing, the resident required a Two + person physical assist. Requested Records on 09/14/23 of Resident #26's Bath/Shower Sheets for the past 30 days revealed no documentation of any baths/showers provided to the resident. Interview on 09/12/23 at 11:06 AM with Resident #26 revealed, she had concerns of not receiving her scheduled showers, and she only received bed baths. Resident #26 stated she had missed her last 9 scheduled showers and although she had requested them from the nursing staff, but was being told that they will get to her but they are busy. She advised she had never refused any showers and would like them. Record review of Resident #28's Face Sheet, dated 09/13/23, revealed she was an 87 -year-old female admitted on [DATE]. Relevant diagnoses included Acute Respiratory Failure (impaired lungs), Epilepsy (seizures), and Syncope and Collapse (fainting). Record review of Resident #28's Minimum Data Set (MDS) on dated 09/14/23 revealed she had a Brief Interview for Mental Status (BIMS) score of 13 (cognitively intact) and for ADL care it stated, For transfers, toileting, and bathing, the resident required a Two + person physical assist. Requested Records on 09/14/23 of Resident #28's Bath/Shower Sheets for the past 30 days revealed no documentation of any baths/showers provided to the resident. Record review of Resident #143's Face Sheet, dated 09/14/23, revealed she was a 90 -year-old female admitted on [DATE]. Relevant diagnoses included Dementia (impaired memory), Heart Failure, and Age-related Physical Debility (frail body). Record review of Resident #143's MDS on dated 09/14/23 revealed she had a BIMS score of 6 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 12 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0677 Level of Harm - Minimal harm or potential for actual harm (cognitively impaired) and for ADL care it stated, For transfers, toileting, and bathing, the resident required a Two + person physical assist. Requested records on 09/14/23 of Resident #143's Bath/Shower Sheets for the past 30 days revealed no documentation of any baths/showers provided to the resident. Residents Affected - Some Interview on 09/13/23 at 2:00 PM with the DON revealed, she was advised of the concerns regarding ADLs for Residents #28, #26, and #143, and lack of documentation regarding bath/showers being administered to the residents. She stated that it is policy for staff to complete shower sheets on all residents, and it also had to be signed off by the floor nurse. She stated her nursing staff was inconsistent when completing the required form and was just inputting the information, without providing any notes. She stated the risk of resident not getting their baths or showers when scheduled could result in skin breakdown and it is not sanitary for the resident. Interview on 09/14/23 at 12:00 PM with CNA K revealed, she had been a CNA for two years. She was asked the process for giving resident showers and she stated that they were supposed to provide residents showers on their scheduled days (3 days a week) and they completed a shower sheet, but now she just goes to point click care and click that the resident received a bed bath or shower. She stated they are supposed to complete the shower forms, but she had not had time to complete them. She stated that she ensures residents are getting their scheduled showers unless they refuse. She was advised that residents are complaining about not receiving a shower. She stated that she ensured the residents assigned to her received their scheduled showers and the residents referenced had received bed baths or showers from her. She stated that she had received complaints from residents, and she had told the nurse every time any resident complained of not receiving their shower. She stated that Resident #28 received a bed bath on 09/11/23, Resident #143 received a bed bath on 09/06//23, but she was unable to provide any proof of Resident #26 receiving a shower or bed bath since the resident had been admitted . CNA K advised she was sure the resident received at least a bed bath. She stated the risk of the resident not receiving a scheduled shower could result in them being dirty and getting a skin infection. Interview on 09/14/23 at 12:10 PM with LVN Y revealed she had been at the facility since January 2023. She advised that she did manage the 300 hall and she stated that it was policy for staff to complete a shower sheet on all resident when providing them a shower on their scheduled day or whenever they are provided a shower. She advised that they are required to complete the form completely and right away. She advised that they are to get signatures from their floor nurse is there were any refusals. She stated that they had not been consistent on ensuring shower sheets were being completed. She stated the risk of residents not getting their scheduled showers could result in skin breakdown and it is a hygiene concern. She was advised of the three residents sampled of having no showers sheets and a complaint of not receiving showers and she stated that she was not aware of this. Interview with ADON on 09/14/2023 at 10:57 AM, she stated that she has been with the facility for a year and a half. The ADON was advised of the lack of shower sheets provided for Residents #26, #28, and #143 reviewed for the past 30 days and she advised that her the DON made her aware of this concern. She stated that they are trying to get to a paperless environment and are encouraging staff to document the resident's shower information; however, the current policy did require staff to complete a shower form for all scheduled showers. She stated she thinks her nursing staff are ensuring residents received their scheduled showers, but they may have a few staff that may not be consistent. She stated the risk of residents not receiving their scheduled showers could result in skin breakdown and not good hygiene for the resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 13 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with Administrator on 07/27/23 at 04:45 PM revealed, he was made aware of the concerns regarding baths/showers for Resident #26, #28, and #143 reviewed for the past 30 days. The Administrator advised that he expects all residents to receive their scheduled showers. He stated that he is sure residents are receiving them because he had not been made aware of any concern. He was advised that the nursing staff was unable to provide any shower forms for the residents referenced, and he started that the new owners are trying to go paperless and encouraging staff to input their documentation in the system or record. He was advised that there were no notes in the system of records that referenced the residents scheduled showers, and the facility's current policy required Documentation of Shower/tub bath performed. He stated the risk of residents not getting their baths/showers could result in having skin issues and dignity. Record review of facility policy on Bath, Bed, Tub, Shower, dated 02/2018, state the following: Documentation 1. The date and time the shower/tub bath performed 2. The name and title of the individual(s) who assisted the resident with the shower/tub. 3. All assessment data (e.g., any reddened areas, sores, etc., on the resident's skin) obtained during the shower/tub bath. 4. How the resident tolerated the shower/tub bath. 5. If the resident refused the shower/tub bath, reason(s). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 14 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to ensure that a resident who needed respiratory care was provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 (Resident #16) of 2 residents reviewed for respiratory care. Residents Affected - Some The facility failed to ensure Resident #16's oxygen concentrator had a humidifier. The facility failed to ensure that Resident #16 has Physician orders for oxygen and CPAP. These failures could place the resident at risk of not having their respiratory needs met. Findings included: Review of Resident #16's Face Sheet dated 09/14/2023 reflected that resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included acute (disease with recent onset) and chronic (disease that continues over an extended period of time) respiratory failure with hypoxia (deficiency in the amount of oxygen in the body tissues), obstructive sleep apnea (temporary cessation of breathing while asleep), unspecified emphysema (a lung condition that causes shortness of breath because the air sacs in the lungs are damaged), and shortness of breath. Review of Resident #16's Comprehensive MDS dated [DATE] reflected that resident #16 had a moderately intact cognition with a BIMS score of 12. Resident required an extensive assistance for bed mobility, transfer, locomotion on unit, locomotion off unit, dressing, toilet use, and personal hygiene. Resident also needed supervision for eating. The Comprehensive MDS also indicated debility, cardiorespiratory conditions as the primary reason for admission. Resident #16's primary medical conditions were acute and chronic respiratory failure with hypoxia, hypertension, and respiratory failure. The Comprehensive MDS also specified that Resident #16 utilized oxygen supplement and non-invasive mechanical ventilator (BiPAP [bilevel positive airway pressure]/CPAP [continuous positive airway pressure]) while not a resident of the facility and when she became a resident of the facility. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for continuous oxygen administration. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for oxygen supplement as needed. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for when to change the humidifier. Review of Resident #16's Physician's Order on 09/12/2023 reflected no physician's order for CPAP. Observation on 09/12/2023 at 11:00 AM, revealed that Resident #16 was in bed with O2 at 3 LPM via nasal cannula. The nasal cannula was connected to an oxygen concentrator. The oxygen concentrator did not have a humidifier. Observation on 09/12/2023 at 1:18 PM, revealed that Resident #16 was in bed with O2 at 3 LPM via (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 15 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some nasal cannula that was connected to an oxygen concentrator. The oxygen concentrator still did not have a humidifier. Interview with LVN W on 09/12/2023 at 1:18 PM, LVN W said that an oxygen concentrator needs a humidifier. When asked if the oxygen concentrator for Resident #16 has a humidifier, LVN W acknowledged that the oxygen concentrator does not have a humidifier. LVN W added that she would get a humidifier and connect it to the oxygen concentrator. Interview with Resident #16 on 09/13/2023 at 9:52 AM, Resident #16 said that she had been on oxygen since she cannot remember. Resident said that she uses the oxygen at all times for respiratory failure. She had the oxygen even when she was still living on her home and from the hospital before coming to the facility. Resident #16 also said that she also uses CPAP at night. Interview with LVN W on 09/13/2023 at 10:05 AM, revealed that she had been with the facility for a year. She had cared for Resident #16 since the resident was admitted to the facility, approximately four weeks ago. She stated that the primary diagnosis of Resident #16 were respiratory failure, emphysema, and sleep apnea. LVN W said that residents with respiratory failures usually had an oxygen supplement as an order. LVN W stated that an oxygen concentrator needs a humidifier, LVN W said it should have a humidifier to add moisture to the airflow of pure oxygen. Without the humidifier, the resident might suffer from nasal dryness, nasal irritation, itchy throat, and runny nose. Interview with DON on 09/13/2023 at 12:10 PM, the DON stated that an oxygen concentrator must have a humidifier to prevent dryness of the air passage. The humidifier in the oxygen concentrator keeps the air passage moistened. The expectation is for the staff to follow the best practice for the resident. When asked what is the best practice, the DON replied to put a humidifier on the oxygen concentrator. Interview with LVN O on 09/14/2023 at 7:55 AM, LVN O stated that the oxygen concentrator must have a concentrator to moisten the air passage. Without the humidifier, the air passage will dry up. LVN O added that when the air passage dries up, this could cause nasal irritation. Interview with the ADON on 09/14/2023 at 10:57 AM, the ADON stated that she has been with the facility for a year and a half. The ADON said that some of the orders for a resident with an active diagnosis of respiratory failure would be aerosol, nebulizer, and oxygen supplement, whether continuous or as needed. The ADON said that one of the orders for resident with sleep apnea would be BiPAP or CPAP. ADON said that it is important that an oxygen concentrator have a humidifier. This is to moisten the nasal pathway. The ADON said that if there is no humidifier, the nasal pathway will dry up and could cause nasal irritation. The ADON said that the expectation is that the nurses would make sure that the oxygen concentrator has a humidifier when being used by the resident. Interview with the Administrator on 09/14/2023 at 2:36 PM, the Administrator stated that he was with the facility since July 1st of this year. The Administrator said that the expectation is that the staff would follow the best practice so that the resident will not have additional medical issues and could have a decent quality of oxygen. Record review of facility's policy, Oxygen Administration, Nursing Policy & Procedure Manual 2003, rev February 13, 2007, revealed Oxygen therapy includes the administration of oxygen (O2) in liters/minute (l/min) by cannula or face mask to treat hypoxemic conditions . Common oxygen sources . include cylinder (portable or stationary) or wall system . All sources require humidification to prevent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 16 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0695 drying of mucous membranes and thickening of respiratory secretions if used routinely. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 17 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interviews and record reviews the facility failed to ensure food was stored, prepared, distributed and served in accordance with professional standards for food service safety for the facility's only kitchen reviewed for kitchen sanitation. The facility failed to ensure foods in the facility's dry storage area, refrigerator, and freezer were stored and dated according to guidelines. The facility failed to ensure proper discarding of expired food stored in the refrigerator and dry storage area. The facility failed to ensure all kitchen staff were wearing proper hair and/or beard coverings, while preparing food in the kitchen area. These failures could place residents at risk for cross contamination and other air-borne illnesses. Findings included : Observations on 09/12/23 at 09:20 AM in the facility's only kitchen include: Eight large trays of bacon and breakfast sausages were sitting in the refrigerator with just parchment paper placed on top of the trays and they were not sealed. Two unsealed 3 lb. bags of fries in freezer bags were unsealed One quart of lemon juice with an expiration date of 09/08/23. One small bag of sliced limes was undated. One Large box of sweet potatoes were stored under a kitchen preparation table located in the food preparation area. One Large box of bananas were stored under a kitchen preparation table located in the food preparation area. Approximately sixty 10.6-ounce cans of chicken noodle and tomato soups were stored under a kitchen preparation table located in the food preparation area. Approximately 24 64-ounce cans of cream of chicken noodle and tomato soups were stored under a kitchen preparation table located in the food preparation area. Observation and interview with Dishwasher J, Dietary Aide L, and [NAME] W on 09/12/23 at 09:25 AM revealed, Dishwasher J entering and exiting the kitchen area pushing a cart with Breakfast plates, and he was observed not wearing hair or a beard cover. They were walking around the kitchen area, where food was being plated, during breakfast. He had over 3 inches of hair in length and his beard was at least 2 inches in length. Dietary Aide L and [NAME] W were observed not wearing a hair covers. [NAME] W had hair length of approximately ¼ of an inch, and Dietary Aide L had a hair length of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 18 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many at least 3 inches. They were all asked where their head and face covering were at and they all scrambled to grab the appropriate head and face coverings. They were asked why they did not have the appropriate head and face covering and none of them replied. They were asked the risk of not wearing the appropriate head and face coverings and they advised that hair could fall into the food and contaminate it. Interview on 09/14/23 at 10:00 AM with Directory of Dietary Services revealed, he was informed of staff observed not wearing any head or face coverings while working in the kitchen and handling food. He advised that staff are supposed to wear the appropriate head and face coverings at all times when in the kitchen area. He was shown the pictures of the concerns observed in the kitchen and he stated that he would have it corrected. He stated that he is overall responsible for ensuring the kitchen complies. He stated that the risk of these concerns for the resident could be cross contamination. Interview with Administrator on 09/14/23 at 12:30 PM revealed he was shown the pictures of the concerns discovered in the facility's only kitchen. He advised that the kitchen is owned by the Assisted Living side of the facility, but he is aware that the kitchen needed to meet federal and state guidelines for Skilled Nursing Environments. He advised that the Dietary Manager had notified him of some of the concerns but not all. He advised that he would forward the concerns to the leadership staff on the Assisted Living side and discuss plan to correct the concerns observed. He advised the risk of the concerns identified could result in food contamination, and residents getting ill. Record review of the Facility's policy on Food Storage and Kitchen Sanitation dated 2012, revealed All foods will be stored according to Federal and State guideline. All refrigerated food are labeled, dated, and tightly sealed. Hairnets or hats covering the hairline are worn at all times. [NAME] guards are required for facial hair. all perishable food is refrigerated immediately to ensure nutritive value and quality. Food is stored a minimum of 6 inches above the floor and 18 inches from the ceiling on clean racks or shelves, and is protected from splash, overhead pipes, or other contamination. Review of the U.S. Food and Drug Administration (FDA) Code (2022) revealed, Except for containers holding FOOD that can be readily and unmistakably recognized such as dry pasta, working containers holding FOOD or FOOD ingredients that are removed from their original packages for use in the FOOD ESTABLISHMENT, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the FOOD. Processed reduced oxygen foods that exceed the use-by date or manufacturer's pull date cannot be sold in any form and must be disposed of in a proper manner. FOOD EMPLOYEES shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed FOOD; clean EQUIPMENT, UTENSILS, and LINENS; and unwrapped SINGLE-SERVICE and SINGLE-USE ARTICLES. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 19 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 1 (Resident #16) of 3 residents observed for infection control. Residents Affected - Few The facility failed to ensure that the two prongs of Resident #16's nasal cannula (a device used to deliver supplemental oxygen to an individual. It consists of a lightweight tube on which one is connected to the oxygen source and the other end splits into two prongs and are placed in the nostrils) was not touching the back of the wheelchair when not in use. The facility failed to ensure that the Resident #16's CPAP cushion was stored properly and not touching the top portion of the CPAP machine These failures could place the resident at risk of cross-contamination and development of infection. Findings included: Review of Resident #16's Face Sheet dated 09/14/2023 reflected that resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included acute (disease with recent onset) and chronic (disease that continues over an extended period of time) respiratory failure with hypoxia (deficiency in the amount of oxygen in the body tissues), obstructive sleep apnea (temporary cessation of breathing while asleep), unspecified emphysema (a lung condition that causes shortness of breath because the air sacs in the lungs are damaged), and shortness of breath. Review of Resident #16's Comprehensive MDS dated [DATE] reflected that resident #16 had a moderately intact cognition with a BIMS score of 12. Resident #16 required an extensive assistance for bed mobility, transfer, locomotion on unit, locomotion off unit, dressing, toilet use, and personal hygiene. Resident #16 also needed supervision for eating. The Comprehensive MDS also indicated debility, cardiorespiratory conditions as the primary reason for admission. Resident #16's primary medical conditions were acute and chronic respiratory failure with hypoxia and emphysema. The Comprehensive MDS also specified that Resident #16 utilized oxygen supplement and non-invasive mechanical ventilator (BiPAP [bilevel positive airway pressure]/CPAP [continuous positive airway pressure]) while not a resident of the facility and when she became a resident of the facility. Review of Resident #16's O2 Sats (oxygen saturation) Summary dated 07/31/2023 to 09/12/2023 reflected that the method of delivery for oxygen was via nasal cannula. Observation on 09/12/2023 at 11:00 AM, revealed that Resident #16 was on bed with O2 at 3 LPM via nasal cannula. The nasal cannula was connected to an oxygen concentrator. It was also observed that resident had a CPAP machine sitting on the bedside table. The cushion (a soft insert that goes inside the mask frame and touches the skin to create a seal that prevents air from leaking) of the CPAP mask was sitting on top of the machine with the cushion of the mask touching the top portion of the machine. Observation also revealed that Resident #16 had a nasal cannula connected to a portable oxygen tank (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 20 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 that was at the back of the wheelchair. The nasal cannula was hanging on the backrest. The prongs of the nasal cannula were touching the back of the wheelchair. Interview with LVN W on 09/12/2023 at 11:00 AM, LVN W stated that Resident #16 is on continuous oxygen and CPAP. LVN W said that the PM nurse put the CPAP on, and the AM would take it off in the morning. Residents Affected - Few Observation on 09/12/2023 at 1:18 PM, revealed that Resident #16 was on bed with O2 at 3 LPM via nasal cannula. The nasal cannula was connected to an oxygen concentrator. The CPAP machine was still sitting on the bedside table with the cushion of the CPAP mask still touching the frame of the machine. The nasal cannula was still hanging on the backrest of the wheelchair. The prongs of the nasal cannula were still touching the back of the wheelchair. Observation on 09/13/2023 at 7:23 AM, revealed that Resident #16 was on bed ready to eat breakfast, with O2 at 3 LPM via nasal cannula that was connected to an oxygen concentrator. It was also observed that Resident #16's CPAP machine was sitting on the bedside table. The cushion of the CPAP mask was placed on top of the machine with the cushion touching the frame of the machine. Observation also revealed that Resident #16 had a nasal cannula connected to a portable oxygen tank that was at the back of the wheelchair. The nasal cannula was hanging on the backrest. The prongs of the nasal cannula were touching the back of the wheelchair. Interview with Resident #16 on 09/13/2023 at 9:52 AM, Resident #16 said that she had been on oxygen since she cannot remember. Resident #16 said that she uses the oxygen at all times for respiratory failure. She had the oxygen even when she was still living on her home and from the hospital before coming to the facility. She also said that she uses CPAP at night for sleep apnea. Resident said that when she was at home, she would change her oxygen tubing once a month and clean her CPAP mouthpiece once a week by soaking it warm water. Interview with LVN W on 09/13/2023 at 10:05 AM, LVN W said that she had been with the facility for a year. She had cared for Resident #16 since the resident was admitted to the facility, approximately four weeks ago. She stated that the primary diagnosis of Resident #16 were respiratory failure, emphysema, and sleep apnea. LVN W said that residents with respiratory failures usually had an oxygen supplement. LVN added that residents with sleep apnea usually uses CPAP or BiPAP. When asked that after removing the CPAP, where should it be placed, LVN W answered that it should be bagged or put it somewhere clean. When asked if the mask of the CPAP was bagged, LVN W answered it is not bagged. LVN W said that this could be an infection issue because the top of the CPAP is not clean. When asked where to put the nasal cannula when not in use, LVN W replied that the nasal cannula should be placed in a bag. When asked if the nasal cannula was bagged, LVN W replied the nasal cannula was not bagged. Interview with the DON on 09/13/2023 at 12:10 PM, the DON said that the nasal cannula should be placed in a bag or anywhere where it will not be contaminated. This should be done to prevent infection. The DON also said the mask of the CPAP should be placed in a bag to prevent infection especially of those residents that are immunocompromised (The immune system's defenses are low resulting to inability to fight off infections and diseases). Interview with LVN O on 09/14/2023 at 7:55 AM, LVN O said that the nasal cannula and CPAP should be bagged when not in use. LVN O stated that this should be done to prevent the development of infection and spread of infection. LVN O added that if the nasal cannula and the mask of the CPAP are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 21 of 22 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 676168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077 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 contaminated, the residents will be the one to suffer. Level of Harm - Minimal harm or potential for actual harm Interview with CNA P on 09/14/2023 at 8:09 AM. CNA P said that the nasal cannula should be placed in a bag if not in use. CNA P stated that the resident, visitors, and staff could trip from the tubing of the nasal cannula and fall. CNA P added that if the nasal cannula is touching something that is not clean, it could cause infection because the cannula will get contaminated. Residents Affected - Few Interview with CNA R on 09/14/2023 at 8:16 AM, CNA R said that the cannula should be placed in a bag or somewhere clean so that it will not get dirty. CNA R stated that if the nasal cannula is touching an area that is not clean, it could cause sickness and infection. Interview with CNA A on 09/14/2023 at 8:29 AM, CNA A said that the nasal cannula should not be on the floor or touching the back of the wheelchair because the floor and back of the wheelchair are not clean. CNA A pointed out that the nasal cannula should be placed in a bag if not in use. CNA A added that the resident might catch a disease if the nasal cannula is dirty. Interview with the ADON on 09/14/2023 at 10:57 AM, the ADON stated that she had been with the facility for a year and a half. The ADON said that some of the orders for a resident with an active diagnosis of respiratory failure would be aerosol, nebulizer, and oxygen supplement, whether continuous or as needed. The ADON said that one of the orders for resident with sleep apnea would be BiPAP or CPAP. The ADON said that after taking the mask of the CPAP off, it should be bagged. The ADON said that when the nasal cannula is not in use, it should be bagged. According to the ADON, if the mask of the CPAP and the nasal cannula were not bagged, the mask and the nasal cannula will be contaminated and could cause infection. The ADON said that all staff should adhere to the policy and procedure of infection control. Interview with the Administrator on 09/14/2023 at 1:16 PM, the Administrator stated that he was with the facility since July 1st of this year. The Administrator said that not putting the nasal cannula and the mask of a CPAP on a clean place could cause infection concerns. The Administrator stated that the expectation is that the staff would follow infection control policy to prevent infection issues. Record review of facility's policy Fundamentals of Infection Control Precaution, Infection Control Policy & Procedure Manual 2010, rev. 10.21.2022 revealed A variety of infection control measures are used for decreasing the risk of transmission of microorganism in the facility . resident care equipment and articles . 3. Routine cleaning and disinfection of resident care equipment. Record review of facility's policy, Department of Respiratory Therapy - Prevention of Infection, 2001 Med-Pass, Inc., rev. November 2011 revealed The purpose of this procedure is to guide prevention of infection . Infection Control Considerations Related to Oxygen Administration . 8. Keep the oxygen cannula and tubing . in a plastic bag when not in use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676168 If continuation sheet Page 22 of 22