Inspection·May 22, 2025

F 0552 received Ativan as ordered on 05/17/25. Level of Harm - Minimal harm or potential for actual harm Record review for Resident #66's consent for use of psychotropic medication, Ativan, was not documented in his chart as having consent to be administered. Residents Affected - Few During an observation and interview on 05/19/25 11:14 a.m., Resident #66 was sitting up in his wheelchair. Resident #66 was unable to say what medication he was receiving but was able to say he was going to dialysis on Tuesday, Thursday, and Saturday. During an interview on 05/22/25 at 11:44 a.m., LVN H said she was the charge nurse for Resident #66. She said the process for obtaining consents was for the nurse to put in the order, and the ADON to call the family to get the consent. She said Resident #66 had recently started on Ativan, because he was anxious before going to dialysis. She said the medication was not supposed to be given until consent was obtained. She said the resident or family had the right to be informed of the medication changes to determine if they wanted the medication or not. During an interview on 05/22/25 at 12:01 p.m., the ADON brought the consents she had in a book for Resident #66. She said those were all the consents she had. She said she did not see a consent for Resident #66's Ativan. The ADON said the process for obtaining consents was for the nurses to put in the order, and she would call the family to obtain consent. She said she was unaware of Resident #66 starting on Ativan. She looked into his electronic medical records and said he started Ativan on Saturday (05/17/25). She said she should have called the family on Monday (05/19/25), but since the state surveyors were in the facility, she had not. She said she would call the family now (05/22/25). She said the consent was supposed to be obtained before the medication was given. During an interview on 05/22/25 at 12:05 p.m., the DON said consents should be signed before administering any psychoactive medication. The DON said consents were obtained to inform the family about the risks and benefits before receiving medications. The DON said the charge nurse who received the order was responsible for obtaining consents, and the ADONs were the overseers. The DON said failure to obtain the consents could cause the resident or families not to have all the information about the medication or a choice about the resident's care. During an interview on 05/22/25 at 12:16 p.m., the Administrator said he expected the DON or clinical team to ensure the consent form was filled out for any psychotropic medications. The Administrator said he felt the consents should be done but was not sure of what could happen if it was not done. Record review of the facility's policy titled Psychotropic Medication updated 08/17, indicated It is the policy of this facility to ensure that residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record. Policy and Procedure: #7 Upon change of condition or initiation of a new order for psychoactive medications, the Licensed Nurses shall complete the Verification of Informed Consent form prior to the initiation of the new medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 2 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure all residents had the right to formulate an advance directive for 1 of 21 residents (Resident #24) reviewed for advanced directives. The facility failed to complete Resident #24's DNR (Do Not Resuscitate) or Out-of-Hospital do-not-resuscitate (OOH-DNR) form correctly on 07/26/24. This failure could place residents at risk for not having their end-of-life wishes honored and for incomplete records. Findings included: Record review of Resident #24's face sheet, dated 05/22/25, revealed an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses to include stroke, dementia (progressive loss of intellectual functioning), atrial fibrillation (irregular or rapid heartbeat that causes poor blood flow), and Congestive heart failure, or heart failure,(is a long-term condition in which your heart can't pump blood well enough to meet your body's needs). Record review of Resident #24's face sheet, dated 05/22/25, revealed DNR code status. Record review of Resident #24's quarterly MDS assessment, dated 04/30/25, indicated Resident #24 usually understood and was usually understood by others. Resident #24's BIMS score was 04, which indicated she was severely cognitively impaired. The MDS indicated Resident #24 required assistance with toileting, bed mobility, dressing, personal hygiene, transfers, and eating. Record review of Resident #24's physician order dated 07/26/24 revealed a DNR code status. Record review of Resident #24's care plan, revised on 07/31/24, revealed Resident #24 had a DNR status. The intervention was for staff not to resuscitate in the event of cardiac arrest and to review code status quarterly and as needed. Record review of Resident #24's Out of Hospital Do Not Resuscitate form dated 07/26/24 revealed at the bottom of the form All persons who have signed above must sign below, acknowledging that this document has been properly completed. The document had not been signed by the two witnesses above, agreeing that this form had been completed properly. During an interview on 05/22/25 at 11:20 a.m., the Social Worker said she was responsible for completing the residents' DNRs. She looked at Resident #24's DNR and said it was not filled out correctly. She said the two witnesses did not sign below, indicating the form had been completed correctly. She said she did not know why the form was not completed correctly because she was not employed at the time the consent was obtained. She said since the DNR was not filled out correctly, it could potentially go against the resident's wishes. During an interview on 05/22/25 at 12:05 p.m., the DON said she expected the DNRs to be filled out completely. She said the Social Worker was responsible for ensuring the form was complete. She said failure to complete a DNR correctly could potentially affect the resident's wishes not being honored. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 3 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 05/22/25 at 12:05 p.m., the Administrator said he thought the Social Worker was responsible for ensuring the DNRs were completed. He said he expected the DNRs to be complete and all appropriate and applicable areas on the form completed. He said the potential negative outcome would be that the wishes of the resident or family would not be honored. Record review of the facility's policy, Advance Directives, Revised 12/23, indicated, Policy: It is the policy of this facility that a resident's choice about advance directives will be recognized and respected. Further, it is the policy of this facility to inform and provide written information to all adult residents concerning the right to accept or refuse medical or surgical treatment and, at the resident's option, formulate an advance directive. The facility recognizes and respects the resident's right to choose their treatment and make decisions about care to be received at the end of their life. It is the policy of this facility to implement the resident decisions and directives that are in compliance with State and/or Federal Law and the policies of this facility. Record Review of the Instructions for Issuing An OOH-DNR Order (Undated) revealed the following: INSTRUCTIONS FOR ISSUING AN OOH-DNR ORDER PURPOSE IMPLEMENTATION: A competent adult person, at least [AGE] years of age, or the person's authorized representative or qualified relative may execute or issue an OOH-DNR Order. The person's attending physician will document existence of the Order in the person's permanent medical record. The OOH-DNR Order may be executed as follows: Section B - If an adult person is incompetent or otherwise mentally or physically incapable of communication and has either a legal guardian, agent in a medical power of attorney, or proxy in a directive to physicians, the guardian, agent, or proxy may execute the OOH-DNR Order by signing and dating it in Section B. Section C - If the adult person is incompetent or otherwise mentally or physically incapable of communication and does not have a guardian, agent, or proxy, then a qualified relative may execute the OOH-DNR Order by signing and dating it in Section C . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 4 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0583 Keep residents' personal and medical records private and confidential. 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 the residents' right to privacy during personal care for 1 of 22 residents (Resident #24) reviewed for privacy. Residents Affected - Few The facility failed to ensure RN A provided privacy to Resident #24 when she administered Resident #24's medication via her PEG tube (tube placed in the stomach to administer feedings and medications) on 05/20/2025 when RN A did not close the privacy curtain and she did not close the door. This failure could place residents at risk of having their bodies exposed to the public, low self-esteem, and a diminished quality of life. Findings included: Record review of a face sheet dated 05/21/2025 indicated Resident #24 was a [AGE] year-old female admitted to the facility o 07/19/2024 with diagnoses which included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side and right dominant side (weakness and paralysis after a stroke which affected the left and right side of the body) and gastrostomy status (presence of an artificial opening to the stomach and a tube is inserted to administer feedings and medications). Record review of Resident #24's Quarterly MDS assessment dated [DATE] indicated she was sometimes understood by others, and she was sometimes able to understand others. The MDS assessment indicated Resident #24 had a BIMS score of 4, which indicated her cognition was severely impaired. The MDS assessment indicated Resident #24 was dependent on staff for all ADLs. The MDS assessment indicated Resident #24 had a feeding tube. Record review of Resident #24's Order Summary Report dated 05/21/2025 indicated Tylenol 325 mg give 2 tablets via PEG tube every 6 hours for pain with a start date of 01/06/2025. Record review of Resident #24's care plan with a target date of 07/20/2025 indicated she had a potential for acute and chronic pain to administer pain medication as per orders. During an observation and interview on 05/20/2025 starting at 11:03 AM, RN A went into Resident #24's room, lifted her gown, and administered 2 tablets of Tylenol 325 mg via her PEG tube. RN A did not close the privacy curtain and she did not close the door. RN A said she should have shut the door for privacy. RN A said she forgot to close the door. During an interview on 05/20/2025 at 11:17 AM, Resident #24 said she would rather the door be closed when medications were administered to her via her tube. During an interview on 05/22/2025 at 10:48 AM, the DON said the staff should provide privacy when providing care. The DON said she in serviced the staff on providing privacy, and she asked the residents to ensure the staff was providing privacy. The DON said she had no complaints about RN A or the staff not providing privacy. The DON said it was important for the staff to provide privacy to the residents for the residents' dignity, and because the residents should have privacy in their home. During an interview on 05/22/2025 at 11:45 AM, the Operation Manager said he expected the staff to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 5 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete provide proper care and follow the proper precautions when administering medications. The Operation Manager said nursing was responsible for ensuring the residents' wishes were respected. The Operation Manager said it was important for privacy to be provided during procedures to ensure the resident felt dignified in their care. Record review of the facility's Policy/Procedure-Nursing Administration, Section: Resident Rights, Subject: Dignity and Respect, revised 10/2025, indicated, Residents shall be examined and treated in a manner that maintains the privacy of their bodies. A closed door or drawn curtain shields the Resident from passers-by. Event ID: Facility ID: 676190 If continuation sheet Page 6 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to provide a safe, clean, comfortable, and homelike environment, which allowed residents to use his or her personal belongings to the extent possible for 1 of 22 residents (#27) reviewed for environment. The facility did not ensure Resident #27's bathroom drains were free from a foul sewage odor. These failures could place the residents at risk for embarrassment due to the room having a foul odor. Findings include: During an interview and observation on 05/19/25 at 2:16 p.m., two state surveyor observed a foul sewage odor coming from Resident #27's bathroom. Resident #27 stated the smell was worse at night and when it gets hot outside. Resident #27 stated the Maintenance Supervisor and Administrator was aware. Resident #27 was unsure of when the odor issue started but stated, I tell them almost daily about this odor. Resident #27 stated he had never been offered to change rooms. During an interview on 05/19/25 at 2:25 p.m., Housekeeping N stated the bathroom smelled like sewage and she just poured a substance in the sink to get rid of the smell. During an interview on 05/21/25 at 4:16 p.m., the Maintenance Supervisor stated Resident #27 had reported the foul sewage odor to him on several occasions. The Maintenance Supervisor stated the odor was coming from the sink drain due to the water not being ran enough. The Maintenance Supervisor stated this issue had been going on for a year and half. The Maintenance Supervisor stated he the smell was worse in the summer when it got hot. The Maintenance Supervisor stated he poured an enzyme down the sink to mask the smell. The Maintenance Supervisor stated he had not called a plumber because this was not an emergency. During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated he was not made aware of the sewage issue until 05/12/25. The Administrator stated he spoke with Resident #23 and confirmed if there was any smell, and he did notice the smell in the bathroom. The Administrator stated he reached out to the Maintenance Supervisor, and he provided a cleaning solution to pour down the drain to eliminate the small. The Administrator stated he followed up the next day and Resident #23 stated it was ok. Record review of the facility's policy titled Safe/Comfortable/Homelike Environment revised 01/22 indicated . Residents are provided with a safe, clean, comfortable, and homelike environment . 2. The facility staff and management shall maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. The characteristics include e. Pleasant, neutral scents . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 7 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #23 Residents Affected - Few Record review of Resident 23's face sheet dated 05/27/25, reflected Resident #23 was a [AGE] year-old male, readmitted to the facility on [DATE] with a diagnosis which included recurrent depressive disorders. Record review of Resident #23's quarterly MDS assessment, dated 04/18/25, reflected Resident #23 made himself understood, and understood others. The assessment did not address Resident #23's BIMS score. The MDS reflected Resident #23 had no behaviors or refusal of care during the look-back period. Record review of Resident #23's comprehensive care plan, revised on 11/06/23, reflected Resident #23 had antidepressant medication use related to depression. The care plan interventions included anti-depressant side effects, anti-depressant targeted behavior code and give antidepressant medications as ordered by physician. Resident #47 Record review of Resident #47's face sheet dated 05/27/25, reflected Resident #47 was a [AGE] year-old male, admitted to the facility on [DATE] with a diagnosis which included vascular dementia (reduce blood flow to the brain) with behavioral disturbance. Record review of Resident #47's quarterly MDS assessment, dated 03/03/25, reflected Resident #47 usually made himself understood, and usually understood others. Resident #47's BIMS score was 1, which indicted his cognition was severely impaired. The MDS reflected Resident #47 had no behaviors or refusal of care during the look-back period. Record review of Resident #47's comprehensive care plan, revised on 03/30/25, reflected Resident #47 had a potential for a behavior problem by wandering in rooms looking for remote control. The care plan interventions included: approach in a calm manner and stop and talk with resident when passing by. Record review of an untitled form dated 05/02/25 reflected Resident #23 came by Resident #47. Resident #23 stated Resident #47 spit on him at the nurse's station. After being notified by the charge nurse the Administrator called and spoke with Resident #23. The form stated Resident #23 expressed frustration without acknowledging how the even transpired and declined to describe details of where, even prompting the event, and details to the location where he was spit on by Resident #47, stating it did not matter and not to even worry about it. During an interview on 05/19/25 at 02:33 p.m., Resident #47 was sitting up in his wheelchair, alert but difficult to understand. During an interview on 05/19/25 at 3:02 p.m., Resident #23 stated he was spit on by Resident #47. Resident #23 stated the Administrator was aware of the incident. Resident #23 expressed frustration and stated, he was down on himself for not doing nothing to him. During an interview on 05/20/25 at 3:06 p.m., MA M stated she was at the nursing station getting ready to administer medication to another resident. MA M stated she noticed Resident #23 leaned over (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 8 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to Resident #47 and stated something. MA M stated she did not hear what was stated. MA M stated she saw spit leave Resident #47 mouth did not know where it landed. MA M stated she went and got the ADON to inform her of the incident. MA M stated Resident #23 left to go to the dining room and Resident #47 was helped back to his room. During a group meeting on 05/21/25 at 10:00 a.m., Resident #23 stated he felt that the facility did not address the issue involving him and Resident #47 in a timely manner. Resident #23 then stated, I should've taken care of him while balling up his fist holding it in the front of him. During an interview on 05/22/25 at 1:57 p.m., the ADON stated she was making rounds down the hall when MA M came, got her, and told stated there was something going on between Resident #23 and #47. The ADON stated Resident #47 had spit towards Resident #23, but she did not know where it landed. The ADON stated after checking on both residents, she immediately called the Administrator. The ADON stated Resident #23 was very upset such as cussing and stating, Motherfucker spit on me. The ADON stated she asked him where and he stated, it doesn't matter where he spit on me. During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated at the moment of the event, he spoke to Resident #23 and confirmed if he felt safe or concerns of safety or harm. The Administrator stated Resident #23 acknowledge he was ok. The Administrator stated in the moment there was no perceived physician or emotional harm, and he did not feel this should have been reported to HHSC. Record review of the facility's policy titled, Abuse: Prevention of and Prohibition Against revised 12/2023, indicated, .Allegations of abuse, neglect, misappropriation of resident property, or exploitation will be reported outside the facility and to the appropriate state or federal agencies in the applicable timeframe, as per this policy and applicable regulations. Based on interview and record review, the facility failed to implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents, for 3 of 22 residents (Resident #23, Resident #32 and Resident #47) reviewed for abuse. 1.The facility failed to follow their policy to report to HHSC when Resident #32 alleged a hospital staff member hit her while in the hospital on 5/10/2025. 2. The facility did not implement their policy on reporting abuse to state agency for a resident-to-resident altercation that occurred on 05/02/25 between Resident #23 and Resident #47. These failures could place residents at risk of abuse, physical harm, mental anguish, and emotional distress. Findings included: Record review of the facility's policy titled, Abuse: Prevention of and Prohibition Against revised 12/2023, indicated, .Allegations of abuse, neglect, misappropriation of resident property, or exploitation will be reported outside the facility and to the appropriate state or federal agencies in the applicable timeframe, as per this policy and applicable regulations. 1.Record review of a face sheet dated 05/20/2025, indicated Resident #32 was a [AGE] year-old female, initially admitted on [DATE], and readmitted on [DATE] with the diagnoses of type 2 diabetes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 9 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few mellitus with hyperglycemia (high blood sugar, was a common feature of type 2 diabetes and can lead to various complications if left unmanaged), essential (primary) hypertension (high blood pressure where no specific underlying cause can be identified), acquired absence of unspecified leg below the knee (high blood pressure where no specific underlying cause can be identified). Record review of the comprehensive MDS assessment dated [DATE], indicated Resident #32 was able to make herself understood. Resident # 32 had a BIMS score of 15, which suggest cognition intact. The MDS indicated Resident #32 did not have any behavior issues or reject care. Record review of the care plan dated 04/14/2025, indicated Resident #32 did not have any behaviors. During an interview on 05/20/2025 at 9:00 a.m., Resident #32 stated while she was in the hospital on 5/10/2025, she had been asking for someone to call her family member. Resident #32 stated a CNA came into her room, hit her on her wrist and leg, then told her to shut up you. Resident #32 stated she told the facility transportation driver about the incident on the way to a doctor's appointment on 5/12/2025. Resident#32 stated she did not know she should have told someone when she returned from the hospital. During an interview on 05/20/2025 at 3:00 p.m., the transportation driver stated on Monday 05/12/2025 she was taking Resident #32 to a doctor's appointment and during transport Resident #32 told her she was treated badly in the hospital. The transportation driver stated Resident #32 told her a CNA at the hospital hit her twice and told her to shut up. The transportation driver stated as soon as she got Resident #32 into her doctor's appointment she called and reported the incident to the Administrator and gave a written statement when she returned to the facility. During an interview on 05/22/2025 at 11:00 a.m., the DON stated Resident #32 did not report the incident that happened at the hospital until she was on the transportation van going to a doctor's appointment. The DON stated as soon as the incident was reported even though it happened at the hospital an investigation was started. The DON stated the Administrator read the regulation and understood the incident did not need to be reported within two hours. The DON stated important to report an allegation of abuse on time to make sure the resident was protected and free of harm. The DON stated she did not feel like there was a failure because it was reported within 24 hours. During an interview on 05/22/2025 at 11:20 a.m., the Administrator stated the allegation was reported to him on May 12, 2025, after the transportation driver took Resident #32 to a doctor's appointment. The Administrator stated when the allegation was reported to him, he stated an investigation, notified the hospital of the allegation and the police. The Administrator stated he read the regulation and understood he had 24 hours to report. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 10 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Resident #23 Residents Affected - Few Record review of Resident 23's face sheet dated 05/27/25, reflected Resident #23 was a [AGE] year-old male, readmitted to the facility on [DATE] with a diagnosis which included recurrent depressive disorders. Record review of Resident #23's quarterly MDS assessment, dated 04/18/25, reflected Resident #23 made himself understood, and understood others. The assessment did not address Resident #23's BIMS score. The MDS reflected Resident #23 had no behaviors or refusal of care during the look-back period. Record review of Resident #23's comprehensive care plan, revised on 11/06/23, reflected Resident #23 had antidepressant medication use related to depression. The care plan interventions included anti-depressant side effects, anti-depressant targeted behavior code and give antidepressant medications as ordered by physician. Resident #47 Record review of Resident #47's face sheet dated 05/27/25, reflected Resident #47 was a [AGE] year-old male, admitted to the facility on [DATE] with a diagnosis which included vascular dementia (reduce blood flow to the brain) with behavioral disturbance. Record review of Resident #47's quarterly MDS assessment, dated 03/03/25, reflected Resident #47 usually made himself understood, and usually understood others. Resident #47's BIMS score was 1, which indicted his cognition was severely impaired. The MDS reflected Resident #47 had no behaviors or refusal of care during the look-back period. Record review of Resident #47's comprehensive care plan, revised on 03/30/25, reflected Resident #47 had a potential for a behavior problem by wandering in rooms looking for remote control. The care plan interventions included: approach in a calm manner and stop and talk with resident when passing by. Record review of an untitled form dated 05/02/25 reflected Resident #23 came by Resident #47. Resident #23 stated Resident #47 spit on him at the nurse's station. After being notified by the charge nurse the Administrator called and spoke with Resident #23. The form stated Resident #23 expressed frustration without acknowledging how the even transpired and declined to describe details of where, even prompting the event, and details to the location where he was spit on by Resident #47, stating it did not matter and not to even worry about it. During an interview on 05/19/25 at 02:33 p.m., Resident #47 was sitting up in his wheelchair, alert but difficult to understand. During an interview on 05/19/25 at 3:02 p.m., Resident #23 stated he was spit on by Resident #47. Resident #23 stated the Administrator was aware of the incident. Resident #23 expressed frustration and stated, he was down on himself for not doing nothing to him. During an interview on 05/20/25 at 3:06 p.m., MA M stated she was at the nursing station getting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 11 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm ready to administer medication to another resident. MA M stated she noticed Resident #23 leaned over to Resident #47 and stated something. MA M stated she did not hear what was stated. MA M stated she saw spit leave Resident #47 mouth did not know where it landed. MA M stated she went and got the ADON to inform her of the incident. MA M stated Resident #23 left to go to the dining room and Resident #47 was helped back to his room. Residents Affected - Few During a group meeting on 05/21/25 at 10:00 a.m., Resident #23 stated he felt that the facility did not address the issue involving him and Resident #47 in a timely manner. Resident #23 then stated, I should've taken care of him while balling up his fist holding it in the front of him. During an interview on 05/22/25 at 1:57 p.m., the ADON stated she was making rounds down the hall when MA M came, got her, and told stated there was something going on between Resident #23 and #47. The ADON stated Resident #47 had spit towards Resident #23, but she did not know where it landed. The ADON stated after checking on both residents, she immediately called the Administrator. The ADON stated Resident #23 was very upset such as cussing and stating, Motherfucker spit on me. The ADON stated she asked him where and he stated, it doesn't matter where he spit on me. During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated at the moment of the event, he spoke to Resident #23 and confirmed if he felt safe or concerns of safety or harm. The Administrator stated Resident #23 acknowledge he was ok. The Administrator stated in the moment there was no perceived physician or emotional harm, and he did not feel this should have been reported to HHSC. Based on interviews and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported immediately, but not later than 2 hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, or not later than 24 hours if the events that caused the allegation did not involve abuse and did not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with state law through established procedures for 3 of 22 residents (Resident #23, Resident #32, and Resident #47) reviewed for abuse. 1.The facility failed to report abuse timely to the state agency on behalf of Resident #32. 2. The facility did not report to HHSC for a resident-to-resident altercation that occurred on 05/02/25 between Resident #23 and Resident #47. This failure could place the residents at risk for neglect due to unreported and uninvestigated allegations of neglect. Findings include: 1.Record review of a face sheet dated 05/20/2025, indicated Resident #32 was a [AGE] year-old female, initially admitted on [DATE], and readmitted on [DATE] with the diagnoses of type 2 diabetes mellitus with hyperglycemia (high blood sugar, was a common feature of type 2 diabetes and can lead to various complications if left unmanaged), essential (primary) hypertension (high blood pressure where no specific underlying cause can be identified), acquired absence of unspecified leg below the knee (high blood pressure where no specific underlying cause can be identified). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 12 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Record review of the comprehensive MDS assessment dated [DATE], indicated Resident #32 was able to make herself understood. Resident # 32 had a BIMS score of 15, which suggest cognition intact. The MDS indicated Resident #32 did not have any behavior issues or reject care. Record review of the care plan dated 04/14/2025, indicated Resident #32 did not have any behaviors. Residents Affected - Few During an interview on 05/20/2025 at 9:00 a.m., Resident #32 stated while she was in the hospital on 5/10/2025, she had been asking for someone to call her family member. Resident #32 stated a CNA came into her room, hit her on her wrist and leg, then told her to shut up you. Resident #32 stated she told the facility transportation driver about the incident on the way to a doctor's appointment on 5/12/2025. Resident#32 stated she did not know she should have told someone when she returned from the hospital. During an interview on 05/20/2025 at 3:00 p.m., the transportation driver stated on Monday 05/12/2025 she was taking Resident #32 to a doctor's appointment and during transport Resident #32 told her she was treated badly in the hospital. The transportation driver stated Resident #32 told her a CNA at the hospital hit her twice and told her to shut up. The transportation driver stated as soon as she got Resident #32 into her doctor's appointment she called and reported the incident to the Administrator and gave a written statement when she returned to the facility. During an interview on 05/22/2025 at 11:00 a.m., the DON stated Resident #32 did not report the incident that happened at the hospital until she was on the transportation van going to a doctor's appointment. The DON stated as soon as the incident was reported even though it happened at the hospital an investigation was started. The DON stated the Administrator read the regulation and understood the incident did not need to be reported within two hours. The DON stated important to report an allegation of abuse on time to make sure the resident was protected and free of harm. The DON stated she did not feel like there was a failure because it was reported within 24 hours. During an interview on 05/22/2025 at 11:20 a.m., the Administrator stated the allegation was reported to him on May 12, 2025, after the transportation driver took Resident #32 to a doctor's appointment. The Administrator stated when the allegation was reported to him, he stated an investigation, notified the hospital of the allegation and the police. The Administrator stated he read the regulation and understood he had 24 hours to report. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 13 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure assessments accurately reflected the resident status for 2 of 22 residents (Residents #23 and #27) reviewed for MDS assessment accuracy. Residents Affected - Few 1. The facility failed to interview Resident #23 regarding his mood on his 04/18/25 quarterly MDS assessment. 2. The facility failed to accurately reflect Resident #27's active diagnoses to not include a diagnosis of depression (a mood disorder characterized by persistent feelings of sadness and loss of interest or please in activities) on his 04/19/25 quarterly MDS assessment. These failures could place residents at risk for not receiving care and services to meet their needs. Findings included: 1. Record review of Resident 23's face sheet dated 05/27/25, reflected Resident #23 was a [AGE] year-old male, readmitted to the facility on [DATE] with a diagnosis which included recurrent depressive disorders. Record review of Resident #23's quarterly MDS assessment, dated 04/18/25, reflected Resident #23 made himself understood, and understood others. The assessment did not address Resident #23's BIMS score. The assessment reflected Section D0100 (Mood Section) asked Should Resident Mood Interview be Conducted? This section was marked - which meant the interview was not conducted. The assessment reflected Resident #23 had an active diagnosis of depression. Record review of Resident #23's comprehensive care plan revised on 11/06/23, reflected Resident #23 had antidepressant medication use related to depression. The care plan interventions included anti-depressant side effects, anti-depressant targeted behavior code and give antidepressant medications as ordered by physician. Record review of Resident #23's physician order summary report, dated 05/22/25, reflected an active physician's order for trazodone HCI 50 mg: 1 tablet by mouth at bedtime for anxiety/depression with a start date 10/31/24. 2. Record review of Resident #27's face sheet, dated 05/27/25, reflected Resident #27 was a [AGE] year-old male, admitted to the facility on [DATE]. The face sheet did not reflect a diagnosis of depression. Record review of Resident #27's quarterly MDS assessment, dated 04/19/25, reflected Resident #27 made himself understood, and understood others. The assessment did not address Resident #27's BIMS score. The assessment reflected Section D0100 (Mood Section) asked Should Resident Mood Interview be Conducted? This section was marked - which meant the interview was not conducted. The assessment reflected Resident #27 had an active diagnosis of depression. Record review of Resident #27's comprehensive care plan revised on 09/14/21, reflected Resident #27 had potential for mood problem related to major depressive disorder. The care plan interventions (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 14 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0641 Level of Harm - Minimal harm or potential for actual harm included: behavioral health consults as needed, encourage to express feelings and monitor/record/report to MD mood patterns s/sx of depression, anxiety, or sad mood. Record review of Resident #27's physician order summary report, dated 05/22/25, reflected Resident #27 did not take an antidepressant. Residents Affected - Few During an interview on 05/20/25 at 11:15 a.m., the MDS Coordinator stated the social worker was responsible for completing the mood section of the MDS assessment. The MDS Coordinator stated Residents #23 and #27 both were in the facility during the time of the assessments to conduct an interview which D0100 (Mood Section) should have been coded yes. After reviewing Resident #27's electronic medical records, the MDS Coordinator stated there was no documentation to support an active diagnosis of depression. The MDS Coordinator stated Resident #27 was not on an antidepressant within the ARD (the end date of the observation or look back period used when completing the MDS assessment). The MDS Coordinator stated it was important for the assessments to be accurate to monitor depression. During an interview on 05/22/25 at 10:20 a.m., the MDS Resource stated she expected the mood section to be marked yes if the resident was interview able and in the facility during the time of the assessment. The MDS Resource stated the social worker was responsible for completing the mood section of the MDS assessment but if the MDS Coordinator had of notice the assessment was not completed by the ARD she could have completed the assessment. The MDS Resource stated if the diagnosis of depression was not active within the last 60 days, depression should not be coded. The MDS Resource stated she was responsible for monitoring and overseeing for accuracy or coding errors by random audits. The MDS Resource stated it was important for the assessments to be accurate and to make sure the facility was providing the care the resident may or may not need. During an interview on 05/22/25 at 11:25 a.m., the Social Worker stated she should have completed the mood section of the MDS assessment within the ARD. The Social Worker stated, honestly, I don't know why Residents #23's mood section on his MDS assessment was missed. The Social Worker stated it was important to complete the mood section to ensure the facility was providing the correct care in the event the resident was showing s/sx of depression. During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated he would expect the MDS to be coded accurately. The Administrator stated if the MDS was not coded accurately, the resident may not get the care that they needed. The Administrator stated the MDS Coordinator and social worker were responsible for ensuring the MDS was coded accurately. During an interview on 05/25/25 beginning at 1:20 p.m., the MDS Resource stated there was not a policy and procedure regarding MDS assessment accuracy. The MDS Resource stated the facility follow the RAI manual. Record review of the Resident Assessment Instrument 3.0 User's Manual, last revised October 2023, indicated . Section D: Mood . Intent: The items in this section address mood distress and social isolation It is particularly important to identify signs and symptoms of mood distress among nursing home residents because these signs and symptoms can treatable . Section I: Active Diagnoses . Intent: The items in this section are tended to code diseases that have a direct relationship to the resident's current functional status, cognitive statis, mood or behavior status One of the important functions of the MDS assessments is to generate an updated, accurate picture of the resident's current health status . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 15 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 observations, interviews, and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs, for 1 of 8 (Resident #29) residents reviewed for the care plans. The facility failed to ensure Resident #29's fall mat was beside her bed on 05/20/25. This failure could affect residents by placing them at risk of not receiving appropriate interventions to meet their current needs. Findings included: Record review of Resident #29's face sheet, dated 05/22/25, indicated she was a [AGE] year-old female re-admitted to the facility on [DATE] with diagnoses which included dementia (loss of memory), stroke, and history of falling. Record review of Resident 29's admission MDS assessment, dated 1/28/25, indicated Resident #29 understood and by others. Resident #29's BIMS score was 08, indicating her cognition was moderately impaired. The MDS indicated Resident #29 required total assistance with her ADL's including transfers and bed mobility. The MDS did not indicate she had a fall before admission. Record review of Resident 29's incident report revealed she had a fall from her bed on 04/19/25. The incident report indicated she often required repositioning from the edge of the bed, related to the resident bending her head and torso (core of the body) to the left and right. Record review of Resident #29's comprehensive care plan dated 01/28/25, revised 04/19/25, indicated Resident #29 had the potential for falls related to weakness and impaired mobility. The intervention was for staff to apply a fall mat at the bedside. Record review of Resident #29's physician's order dated 05/16/25, indicated a fall mat at the bedside. During an observation on 05/19/25 at 2:31 p.m., Resident #29 was in her bed without a fall mat beside her bed. During an interview on 05/22/25 at 11:44 a.m., LVN H said she was Resident #29's charge nurse. She said Resident #29 required a fall mat beside her bed. She said the aides were supposed to place the fall mat, but she was responsible for ensuring it was down by walking the halls. She said the fall mat was in place for safety. During an interview on 05/22/25 at 11:56 p.m., CNA K said Resident #29 required a fall mat because she had a history of leaning off the bed. She said she was supposed to put the fall mat down, and the nurse was supposed to ensure she did. During an interview on 05/22/25 at 12:05 p.m., the DON said Resident #29 was supposed to have a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 16 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 fall mat beside her bed because she had a fall and was at risk for further falls. She said the nursing staff was responsible for ensuring the fall mat was beside her bed. She said the fall mat was for fall prevention and to prevent an injury. During an interview on 05/22/25 at 12:05 p.m., the Administrator said if Resident #29 had a fall, then he expected the nursing staff to ensure her fall mat was beside her bed. He said the fall mat was for the prevention and safety of falls. Record review of the facility policy titled, Fall Management System, revised 12/23, indicated, Policy: It is the policy of this facility to provide an environment that remains as free of accident hazards as possible. It is also the policy of this facility to provide each resident with appropriate assessment and interventions to prevent falls and to minimize complications if a fall occurs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 17 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 observation, interview and record review the facility failed to ensure 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 1 of 22 residents (Resident #68) reviewed for ADL (activities of daily living) care. Residents Affected - Few The facility failed to provide nail care by removing black material from under fingernails for dependent female Resident #68 on 05/19/2025 and 05/20/2025. This failure could place residents at risk of not receiving care and services to meet their needs. Findings included: Record review of the face sheet, dated 05/19/2025, revealed Resident #68 was a [AGE] year old female with diagnoses which included type 2 diabetes mellitus without complications (person's blood sugar levels are high, indicating diabetes, but they haven't experienced any long-term health problems like kidney disease, nerve damage, or heart disease), essential (primary) hypertension (high blood pressure where no specific underlying cause can be identified), acute respiratory failure with hypoxia (occurs when the lungs are unable to deliver enough oxygen to the blood, leading to low oxygen levels in the body). Record view of the comprehensive MDS, dated [DATE], revealed Resident #68 had a BIMS of 14 indicating cognition was intact. Resident #68 required assistance for dressing, bathing, and personal hygiene ADLs, Resident #68 required assistance of two person for dressing, bathing, and personal hygiene ADLs. The MDS revealed Resident #68 did not reject care. During an observation on 05/19/2025 at 11:31 a.m. Resident #68 was observed with black material under her fingernails. During an observation on 05/20/2025 at 9:48 a.m. Resident #68 was observed with black material under her fingernails. During an interview on 05/20/2025 at 11:00 a.m., CNA O stated it was the CNAs responsibility to ensure the residents fingernails were clean during showers or when needed. CNA O stated it was important to keep resident fingernails clean to keep bacteria down. CNA O stated Resident #68 could put her hand in her mouth and the bacteria could get into her mouth and cause an infection. During an interview on 05/22/2025 at 10:40 a.m., LVN P stated it was the charge nurse's responsibility to ensure Resident #68 nails were cut and clean. LVN P stated it was important to keep resident fingernails clean to keep bacteria from getting into Resident #68 mouth when eating. LVN P stated if Resident #68 had feces under her fingernail it could make her sick. Stated she would monitor by rounds. During an interview on 05/22/2025 at 11:00 a.m., the DON stated it was the CNAs who usually cleaned the resident's fingernails on bath days. The DON stated it was important to keep Resident #68 fingernails clean for infection control and dignity. The DON stated she would monitor by making frequent rounds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 18 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview on 05/22/2025 at 11:20 a.m., the Administrator stated he expected CNAs to do nail care. The Administrator stated it was important to keep fingernails clean for dignity and good hygiene. The Administrator stated he was not clinical so he did not know what the harm would be. Record review of the facility's policy titled Nail Care revised 05/2007, it was the policy of this facility to promote cleanliness, safety, and net appearance of our residents place towel to catch trimmed nails. Remove any debris from under nails with file or orange stick . Event ID: Facility ID: 676190 If continuation sheet Page 19 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 - Few 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 interviews, and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate dispensing and administering of all drugs and biologicals to meet the needs of each resident for 1 of 22 residents (Residents #13) reviewed for pharmacy services. The facility did not ensure Resident #13 was given Tylenol (pain medication) 650 mg after a fall with complaints of lower back pain. This failure could place the resident at risk of not receiving medications as ordered. Findings included: Record review of Resident #13's face sheet, dated 05/27/25, reflected Resident #13 was a [AGE] year-old female, readmitted to the facility on [DATE] with a diagnosis which included muscle weakness, history of falling, and generalized osteoarthritis (degeneration of joint cartilage and the underlying bone). Record review of Resident #13's quarterly MDS assessment, dated 05/04/25, reflected Resident #13 made herself understood, and understood others. Resident #13's BIMS score was 15, which indicated her cognition was intact. Resident #13 required supervision or touching assistance with toileting, shower/bath, upper/lower body dressing and personal hygiene. Record review of Resident #13's comprehensive care plan revised on 08/31/21 reflected Resident #13 was at risk for falls related to muscle weakness, lack of coordination, abnormalities of gait/mobility and history of falls. The care plan interventions included: bed in lowest position, call light within reach and maintain a clear pathway, free of obstacles. The care plan reflected Resident #13 had an actual fall on 05/19/25 at 6:15 p.m. The care plan interventions included: continue interventions on the at-risk plan. Record review of Resident 13's physician order summary report, dated 05/22/25, reflected an active physician order for Tylenol 650 mg: 2 tablets by mouth every 6 hours as needed for pain with a start date 03/25/24. Record review of a progress note dated 05/19/25 written by RN E stated Resident with a fall in resident room Resident c/o pain to lower back pain, pain 5/10. Tylenol 650 mg po given. Record review of Resident #13's MAR, dated 05/01/25-05/31/25, indicated RN E did not administer Resident #13's Tylenol on 05/19/25. During an interview on 05/20/25 at 9:03 a.m., Resident #13 stated she had a fall on last night. Resident #13 stated she was trying to stand, and her legs gave out from under her. Resident #13 denied pain during interview. During an interview on 05/21/25 at 11:30 a.m., Resident #13 stated when she fell I was in pain, they picked me up. I don't remember them offering or giving me Tylenol. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 20 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 An attempted telephone interview on 05/21/25 at 2:44 p.m. with RN E, was unsuccessful. Level of Harm - Minimal harm or potential for actual harm During an interview on 05/22/25 beginning at 12:01 p.m., the DON stated she expected if the medication was given to be marked off on the MAR. The DON stated she and the ADON was responsible for monitoring and overseeing by a medication administration record audit and reviewing the incident reports daily. The DON stated when an error such as the nurse failed to mark off the medication, he/she would be in serviced. The DON stated it was important to ensure medications were given and clicked off on the MAR to prevent toxicity. Residents Affected - Few During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated he expected the nurse to click off the task once the medication was administered. The Administrator stated the nursing department heads were responsible for monitoring and overseeing. The Administrator stated it was important to ensure medications were given and documented to prevent toxicity. Record review of the facility's policy titled Medication Administration-Oral revised 05/2007 indicated . It is the policy of this facility to accurately prepare. Administrator and document oral medications . Administering Unit Doses and Previously Prepared Drugs: 8. Documents administration of medications . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 21 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure all drugs were stored in a locked compartment, only accessible by authorized personnel for 1 of 22 resident (Resident #22) reviewed for storage and labeling of medications. The facility did not ensure Resident #22's eye drops was properly secured. This failure could place residents at risk for misuse of medication, overdose, drug diversions, adverse reactions of medications, and not receiving the therapeutic benefit of medications. Findings included: Record review of Resident #22's face sheet, dated 05/27/25, reflected Resident #22 was a [AGE] year-old male, readmitted to the facility on [DATE] with diagnoses which included acute and chronic respiratory failure with hypercapnia (too much carbon dioxide in the bloodstream), and dry eye syndrome of bilateral lacrimal glands (tear glands). Record review of the order summary report dated 05/22/25 reflected an active physician order for Olopatadine HCl Ophthalmic Solution 0.2%: instill 1 drop in both eyes as needed for dry eyes unsupervised self-administration every as needed with a start date 05/19/25. Record review of Resident #22's quarterly MDS, dated [DATE], reflected Resident #22 made himself understood and understood others. Resident #22's BIMS score was 15, which indicated his cognition was intact. Record review of Resident #22's comprehensive care plan revised on 05/19/25 reflected Resident #22 could self-administration of medication to include eye drops and nasal spray. The care plan interventions included: determine the resident's ability to understand what refusal of medication is, and appropriate steps taken by staff to educate when this occurs, and ensure medication is safe and appropriate for self-administration. Record review of a Self-Administration of Medications Initial Evaluation dated 05/19/25 reflected Resident #22 could correctly administer eye drops or eye ointments according to proper procedure. During an interview and observation on 05/19/25 at 2:35 p.m., Resident #22 was sitting in his wheelchair. The 2 state surveyors observed a bottle that was labeled Olopatadine HCl Ophthalmic Solution 0.2%. Resident #22 stated he bought the medication himself for his itchy eyes. Resident #22 was unable to provide the date he purchased the eye drops. An attempted telephone interview on 05/20/25 at 4:53 p.m. with RN A, was unsuccessful. During an interview on 05/22/25 beginning at 12:01 pm., the DON stated she expected that if Resident #22 was able to self-administer that the resident be assessed, obtain and order for the resident to self-administer and provide a lock box prior to state surveyor intervention. The DON stated she was responsible for monitoring and overseeing medications at bedside by random rounds. The DON stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 22 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few there has not been any issues in the past 3 months with Resident #22 having medications at bedside. The DON stated angel rounds were also conducted Mon-Fri by the maintenance supervisor. The DON stated it was important to ensure medications were not left at bedside for resident safety. During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated his expectations were that all medications were left with the nurse unless the resident was assessed to self-administer. The Administrator stated the nursing department head was responsible for monitoring and overseeing. The Administrator stated it was important to ensure medications were not left at bedside for resident safety. The Administrator stated the Maintenance Supervisor was out 05/22/25 due to personal reasons. Record review of the facility's policy titled, Medication Access and Storage, revised 05/2007 reflected . It is the policy of this facility to store all drugs and biological in locked compartments . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 23 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure laboratory services were obtained to meet the needs of 3 of 22 residents (Residents #10, #13 and #27) reviewed for laboratory services. Residents Affected - Some 1. The facility did not obtain a physician's ordered BMP (test used to monitor the blood sugar levels, the balance of electrolytes and fluid as well as the health of kidneys) for Resident #10. 2.The facility did not obtain a physician's ordered Hgb A1C (measures the average blood sugar levels over the past 2-3 months) for Resident #13. 3. The facility did not obtain a physician's ordered CBC (used to measure different parts and features of blood) for Resident #27. These failures could place residents at risk of not receiving lab services as ordered and not managing medications at a therapeutic level. Findings included: 1. Record review of Resident #10's face sheet, dated 05/27/25, reflected Resident #10 was a [AGE] year-old female, readmitted to the facility on [DATE] with a diagnosis which included diabetes mellitus without hyperglycemia (chronic condition that affects the way the body processes blood sugar). Record review of Resident #10's annual MDS assessment, dated 04/25/25, reflected Resident #10 made herself understood, and understood others. Resident #10's BIMS score was 15, which indicated her cognition was intact. Resident #10 had a diagnosis of diabetes mellitus. Record review of Resident #10's comprehensive care plan revised on 07/21/23, reflected Resident #10 had diabetes mellitus. The care plan interventions included: diabetes medication as ordered by the doctor, monitor/document/report to MD PRN s/sx of hypo/hyperglycemia. Record review of Resident #10's physician order summary report, dated 05/22/25, reflected an active physician order for BMP every 3 months with a start date 01/16/25. Record review of Resident #10's electronic medical record indicated Resident #10 last BMP was drawn on 01/22/25. Resident #10's BMP should have been drawn for 04/25 according to the physician order. 2. Record review of Resident #13's face sheet, dated 05/27/25, reflected Resident #13 was a [AGE] year-old female, readmitted to the facility on [DATE] with a diagnosis which included diabetes mellitus without hyperglycemia (chronic condition that affects the way the body processes blood sugar). Record review of Resident #13's quarterly MDS assessment, dated 05/04/25, reflected Resident #13 made herself understood, and understood others. Resident #13's BIMS score was 15, which indicated her cognition was intact. Resident #13 had a diagnosis of diabetes mellitus. Record review of Resident #13's comprehensive care plan revised on 08/31/21 reflected Resident #13 had diabetes mellitus. The care plan interventions included: administer insulin per PCP orders, and monitor/document for side effects and effectiveness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 24 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0770 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #13's physician order summary report, dated 05/22/25, reflected an active physician order for Hgb A1C every 4 months with a start date 07/21/23. Record review of Resident #13's electronic medical record indicated Resident #13 last Hgb A1C was drawn on 11/05/24. Resident #13's Hgb A1C should have been drawn for 04/25 according to the physician order. Residents Affected - Some 3. Record review of Resident #27's face sheet, dated 05/27/25, reflected Resident #27 was a [AGE] year-old male, admitted to the facility on [DATE] with a diagnosis which included alcoholic cirrhosis (scarring of the liver due to chronic alcohol consumption) without ascites (excess abdominal fluid). Record review of Resident #27's quarterly MDS assessment, dated 04/19/25, reflected Resident #27 made himself understood, and understood others. The assessment did not address Resident #27's BIMS score. Record review of Resident #27's comprehensive care plan revised on 09/14/21, reflected Resident #27 had liver disease related cirrhosis and alcoholic dependence. The care plan interventions included: give medications as ordered, and obtain and monitor lab /diagnostic work as ordered by MD. Record review of Resident #27's physician order summary report, dated 05/22/25, reflected an active physician order for CBC every 3 months with a start date 03/01/24. Record review of Resident #27's electronic medical record did not reveal any CBC had been drawn. During an interview on 05/22/25 at 10:22 a.m., the Medical Director stated he expected labs to be drawn as ordered. The Medical Director stated he was unaware that the labs had been missed until state surveyor intervention. The Medical Director stated it was important to ensure labs were drawn to ensure the resident is not being undertreating or overtreating. During an interview on 05/22/25 beginning at 12:01 p.m., the DON stated the nurses were responsible for ensuring the standing orders were put in PCC. The DON stated her and the ADON were responsible for monitoring and reviewing labs orders and completed results by going into the lab portal for results. The DON stated the vendor did not complete scheduled lab orders and the facility was not able to monitor if the lab was completed or not. The DON stated the system was currently being reviewed with the vendor to ensure scheduled lab orders were completed in a timely manner. The DON stated it was important to ensure labs were drawn per the physician order to ensure residents were getting the best care for their diagnoses and all labs were in therapeutic range. During an interview on 05/22/25 beginning at 1:02 p.m., The Administrator stated he expected labs to be drawn per physician order. The Administrator stated the nursing department heads were responsible for monitoring and overseeing. The Administrator stated it was important to ensure labs were drawn as scheduled for their overall health. Record review of the facility's policy titled Diagnostic Test Results Notification reviewed 12/2023 indicated . It is the policy of this facility to obtain laboratory . 1. Laboratory . will be arranged as ordered. 3. Notification of test results will be documented in the resident's clinical record . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 25 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed ensure each resident receives and the facility provides food that accommodates residents' food preferences for 1 of 22 residents (Resident #10) reviewed for food preferences and the accommodation of resident's meal choices. The facility did not honor Resident #10's preference for chocolate health shake. This failure could result in a decrease in resident choices, diminished interest in meals, and weight loss. Findings included: Record review of Resident #10's face sheet, dated 05/27/25, reflected Resident #10 was a [AGE] year-old female, readmitted to the facility on [DATE] with a diagnosis which included diabetes mellitus without hyperglycemia (chronic condition that affects the way the body processes blood sugar) and protein-calorie malnutrition. Record review of Resident #10's annual MDS assessment, dated 04/25/25, reflected Resident #10 made herself understood, and understood others. Resident #10's BIMS score was 15, which indicated her cognition was intact. Resident #10 was independent with eating. Resident #10 had a 5% weight loss or more in the last month or loss of 10% or more in last 6 months. Record review of Resident #10's comprehensive care plan revised on 05/03/25, reflected Resident #10 had potential nutritional problem related to diabetes mellitus (chronic condition that affects the way the body processes blood sugar) and malnutrition. The care plan interventions included: diet as ordered by the physician, honor resident rights to make personal dietary choices and provide supplements as ordered. The care plan reflected Resident #10 had an unplanned/unexpected weight loss related to acute illness and the interventions included: house supplements. Record review of Resident #10's physician order summary report, dated 05/22/25, reflected house supplement after meals by mouth, resident prefers chocolate with a start date 03/21/25. Record review of the lunch meal ticket dated 05/20/25 for Resident #10 reflected chocolate health shake with all meals. During an observation and interview on 05/20/25 at 5:34 p.m., Resident #10 received a vanilla health shake instead of chocolate. Resident #10 stated she did not like how the vanilla health shake taste. The state surveyors took the vanilla health shake to the kitchen and asked for a chocolate instead. The Dietary Manager stated to the kitchen staff she only gets chocolate health shakes. During an interview on 05/21/25 beginning at 7:41 a.m., the Dietary Manager stated she expected Resident #10 to receive a chocolate health shake with every meal. The Dietary Manager stated the dietary aide was responsible for ensuring the correct health shake was on the tray. The Dietary Manager stated she was responsible for overseeing by monitoring lunch meals. The Dietary Manager stated it was important for Resident #10's food preference to be followed to prevent the potential of weight loss. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 26 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated he expected for the meal tickets and for food preferences to be followed. The Administrator stated the Dietary Manager was responsible for overseeing. The Administrator stated it was important for their food preferences to be followed because it was their right and prevent weight loss. Record review of the facility's policy titled Food and Nutrition Service Menus revised 12/2023 indicated . it is the policy of this facility to assure that menus are developed and prepared to meet the nutritional needs of the residents and resident choices . Reasonable effort means assessing individual resident needs and preferences and demonstrating actions to meet those needs and preferences . Event ID: Facility ID: 676190 If continuation sheet Page 27 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure food was prepared in a form designed to meet individual needs and as prescribed by the physician for 1 of 22 residents (Resident #10) reviewed for therapeutic diets. The facility did not ensure Resident #10 was given double protein portion as ordered by the physician. This failure could place residents at risk for poor intake, weight loss, unmet nutritional needs, and a loss of dignity. Findings Included: Record review of Resident #10's face sheet, dated 05/27/25, reflected Resident #10 was a [AGE] year-old female, readmitted to the facility on [DATE] with a diagnosis which included diabetes mellitus without hyperglycemia (chronic condition that affects the way the body processes blood sugar) and protein-calorie malnutrition. Record review of Resident #10's annual MDS assessment, dated 04/25/25, reflected Resident #10 made herself understood, and understood others. Resident #10's BIMS score was 15, which indicated her cognition was intact. Resident #10 was independent with eating. Resident #10 had a 5% weight loss or more in the last month or loss of 10% or more in last 6 months. Record review of Resident #10's comprehensive care plan revised on 05/03/25, reflected Resident #10 had potential nutritional problem related to diabetes mellitus (chronic condition that affects the way the body processes blood sugar) and malnutrition. The care plan interventions included: diet as ordered by the physician, honor resident rights to make personal dietary choices and provide supplements as ordered. The care plan reflected Resident #10 had an unplanned/unexpected weight loss related to acute illness and the interventions included: house supplements. Record review of Resident #10's physician order summary report, dated 05/22/25, reflected regular texture, double portions with a start date 05/05/25. Record review of a progress note dated, 05/05/25, reflected the MD came in to see Resident #10 related to weight loss and gave an order for double portions at meals. During an observation and record review on 05/19/25 at 12:17 p.m., Resident received a single serving of the entrée which was corn dog, tater tots and vegetable soup. The meal ticket did not reflect double portion. During an interview, observation, and record review on 05/20/25 at 5:34 p.m., Resident #10 received a single serving of the entrée which was taco salad. The meal ticket did not reflect double portion. Resident #10 was asked by the state surveyors if she was to receive double portions, Resident #10 stated, I didn't know that. Resident #10 stated her family member had told her she needed double portions to help with the weight loss. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 28 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 05/21/25 at 7:41 a.m., the Dietary Manager stated she was not aware Resident #10 supposed to get double portions until state surveyor intervention. After reviewing Resident #10's electronic medical records and speaking to the dietician, the Dietary Manager stated all her food should be double portion. The Dietary Manager stated the double portion order was entered into PCC (electronic medical record) by the dietician, but she never received a written order by the nurse. The Dietary Manager stated she monitored by monthly audits. The Dietary Manager stated the May audit had not been completed due to being understaffed. The Dietary Manager stated if she had of completed the audit she would have caught the double portion order. The Dietary Manager stated this failure could potentially put Resident #10 at risk for further weight loss. During an interview on 05/21/25 at 2:36 p.m., the ADON stated she received an order from the MD and made a note of it. The ADON stated once the order was given, she would create a communication slip. The ADON stated she would either give the communication slip to the Dietary Manager, dietary staff or put it on the outside of the kitchen door. The ADON stated, I'm not going to lie, I do not remover if I gave the slip to the dietary staff or not. The ADON stated it was important to ensure residents received the correct diet order to prevent further weight loss. During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated he expected diet orders to be followed. The Administrator stated the Dietary Manager was responsible for monitoring diet orders. The Administrator stated it was important to ensure Resident #10 received double portions to prevent weight loss. Record review of the facility's policy titled Food and Nutrition Service Menus revised 12/2023 indicated . it is the policy of this facility to assure that menus are developed and prepared to meet the nutritional needs of the residents and resident choices . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 29 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food safety in the facility's only kitchen. Residents Affected - Some 1. The facility failed to ensure dented canned goods were removed from the pantry on 05/19/25. 2. The facility failed to ensure the outdated milk was removed from the refrigerator before it expired on 04/25/25. These failures could place residents at risk for food contamination and foodborne illness. Findings included: During an initial tour observation on 05/19/25 beginning at 10:00 a.m., the following were made in the kitchen refrigerator (1 of 1): -(1) carton of milk with an unopened date but an expired date of 04/25/25. During observations on 05/19/25 beginning at 10:00 a.m., the following were made in the kitchen pantry (1 of 1): -(2) dent cans (1) 6 pounds of Mandarin Oranges and (1) 6 pounds of Turnip Greens. During an interview on 05/21/25 at 7:43 a.m., the Dietary manager said the expired milk should have been removed on or before the expiration date. She said the dietary aide was supposed to check the refrigerator daily. She said the dietary aide on the evening shift usually put up the cans/supplies on Friday and would let her know if any cans were dented, and she would call the company to get credit. She said Mondays were her day to check the refrigerator and pantry for any outdated food or dented cans. She said she had not had the opportunity to check before the surveyor entered the kitchen. She said the outdated milk could potentially make a resident sick, and the dented cans could place residents at risk of contamination or foodborne illness. During an interview on 05/22/25 at 11:22 a.m., Dietary Aide G said she was supposed to check the fridge daily on her shift for expired items. She said she was not aware the milk was outdated. She said she checked and put up the cans, and if she saw one dented, she would usually notify the Dietary Manager. She said expired milk or dented cans could cause contamination. During an interview on 05/22/25 at 12:05 p.m., the DON said she expected anything expired not to be in the refrigerator. She said she knew they could not have dented cans but was not sure why. She said the Dietary Manager was responsible for ensuring the staff were removing expired items and not having dented cans. She said residents were at risk for foodborne illness. During an interview on 05/22/25 at 12:17 p.m., the Administrator said the dietary staff should be looking for expired items and dent cans. He said the Dietary Manager was responsible for the kitchen. He said expired food items and dented cans can cause illness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 30 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview on 5/22/25 at 12:30 p.m., the Dietary Manager said she did not have a policy on dented cans or labeling. Record review of the U.S Food and Drug Administration 2022 Food Code, revealed: 3-501.17 Ready -to-Eat, Time/Temperature Control for Safety Food, Date Marking. (B) Except as specified in (E) - (G) of this section, refrigerated, READY-TO-EAT TIME/TEMPERATURE CONTROL FOR SAFETY FOOD prepared and PACKAGED by a FOOD PROCESSING PLANT shall be clearly marked, at the time the original container is opened in a FOOD ESTABLISHMENT and if the FOOD is held for more than 24 hours, to indicate the date or day by which the FOOD shall be consumed on the PREMISES, sold, or discarded, based on the temperature and time combinations specified in (A) of this section and: (1) The day the original container is opened in the FOOD ESTABLISHMENT shall be counted as Day 1; and (2) The day or date marked by the FOOD ESTABLISHMENT may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on FOOD safety. Event ID: Facility ID: 676190 If continuation sheet Page 31 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain medical records for 1 of 22 residents (Residents #43). The facility failed to ensure the care plan was updated to reflect the discontinuation of Resident #43's fall mat. This failure could place residents at risk of not receiving appropriate interventions meet their current needs. The findings include: Record review of a face sheet dated 05/21/2025 indicated Resident #43 was a [AGE] year-old female initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included chronic kidney disease (a progressive condition where the kidneys gradually lose their ability to filter waste and excess fluid from the blood), end stage renal disease (a condition where the kidneys are no longer able to function effectively, leading to the buildup of waste and excess fluid in the body), acute respiratory failure with hypoxia ( occurs when the lungs are unable to deliver enough oxygen to the blood, leading to low oxygen levels in the body). Record review of the Quarterly MDS assessment dated [DATE] indicated Resident #43 was able to understand others and was able to make herself understood. The MDS assessment indicated Resident #43 had a BIMS score of 8, which indicated her cognition was severely impaired. The MDS assessment indicated Resident #43 required assistance with transfers. Record review of Resident #43's care plan last reviewed 01/11/2025, indicated fall mat at bedside. Record review of Resident #43's order summary indicted no current order for a fall mat at bedside. During an interview on 05/22/2025 at 10:50 a.m., the ADON stated herself and the DON were responsible for updating the care plan, The ADON stated it was important to update the care plan to the current information. The ADON stated there was no failure. During an interview on 05/22/2025 at 11:00 a.m., the DON stated she was responsible for updating the care plans. The DON stated she just forgot to remove the fall mat. The DON stated it was important to update the care plan because care plan was what the nursing staff uses to follow orders. The DON stated there was no failure by not removing the fall mat from the care plan. During an interview on 05/22/2025 at 11:00 a.m., the Administrator stated it was nursing's responsibility to update the care plans. The Administrator stated it was important to update the care plans to ensure interventions was in place according to the resident's needs. The Administrator stated there was no risk to the resident by not removing the fall mat from the care plan. Record review of the policy titled, Comprehensive Person-Centered Care Planning, dated 12/2003 indicated, .the resident's comprehensive plan of care will be reviewed and/or revised by the IDT after each assessment, including both the comprehensive and quarterly review assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 32 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to maintain a quality assessment and assurance committee consisting at a minimum of the required committee members for 3 of 6 meetings (10/21/24, 11/18/24, and 12/16/24) reviewed for QAA committee. Residents Affected - Some 1. The facility did not ensure the Administrator D, or a representative attended QAPI meetings on 10/21/24, and 12/16/24. 2. The facility did not ensure the DON attended QAPI meetings on 11/18/24, and 12/16/24. These failures could place residents at risk for quality deficiencies being unidentified, no appropriate plans of action developed and implemented, and no appropriate guidance developed. Findings include: Record review of the facility's QAPI Committee sign-in-sheets for 10/21/24 and 12/16/24 reflected the Administrator D or a representative did not sign in for the meetings. Record review of the facility's QAPI Committee sign in sheets for 11/18/24 and 12/16/24 reflected the DON did not sign in for the meetings. During an interview on 05/22/25 beginning at 12:01 p.m., the DON stated she had never missed a QAPI meeting. The DON stated this had to have been one of those meetings that did not start off with signing in but was told by the Administrator to sign before they left the meeting. The DON stated it was important to ensure she attended the meetings so she could be a part of addressing issues and systems improvement. During an attempted telephone interview on 05/22/25 at 1:56 p.m. with Administrator D, was unsuccessful. Record review of the facility's policy 2025-2026 Quality Assurance and performance Improvement Plan reviewed on 01/20/25 indicated . 2. Governance and Leadership . the department heads will meet monthly with the Administrator to discuss the QAPI . the QAPI Committee, which includes the medical director, is ultimately responsible for assuring compliance with federal and state requirements and continuous improvement in quality of care and customer satisfaction . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 33 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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** 3. The facility did not ensure CNA F followed enhanced barrier precautions while assisting Resident #10 with catheter care on 05/20/25. Residents Affected - Some Record review of Resident #10's face sheet, dated 05/27/25, reflected Resident #10 was a [AGE] year-old female, readmitted to the facility on [DATE] with a diagnosis which included diabetes mellitus without hyperglycemia (chronic condition that affects the way the body processes blood sugar). Record review of Resident #10's annual MDS assessment, dated 04/25/25, reflected Resident #10 made herself understood, and understood others. Resident #10's BIMS score was 15, which indicated her cognition was intact. Resident #10 was independent with eating. Resident #10 required supervision or touching assistance with toileting hygiene. Resident #10 had an indwelling catheter (thin, flexible tube inserted into the bladder to drain urine continuously). Record review of Resident #10's comprehensive care plan revised on 03/24/25, reflected Resident #10 had an indwelling catheter related to neuromuscular dysfunction of bladder (bladder's muscles and nerves did not communicate properly with the brain, leading to a loss of bladder control). The care plan interventions included: change catheter bag and tubing as ordered and use enhanced barrier precautions. Record review of the order summary report dated 05/22/25 reflected an active order for catheter care every shift for urinary retention with a start date 03/02/25. During an interview and observation on 05/20/25 beginning at 4:50 p.m., Resident #10 stated she performed her own catheter care every morning and night. Resident #10 stated she could show the two state surveyors how she performed catheter care. The two state surveyors observed CNA F donn (on) gloves without putting on a gown. CNA F assisted Resident #10 with pulling down her brief, which was a high-contact resident care activity. Resident #10 continued showing the state surveyors how she performed catheter care. CNA F assisted Resident #10 with pulling up her briefs, which was a high-contact resident care activity. During an interview on 05/20/25 at 5:10 p.m., CNA F stated she failed to use EBP when providing care with Resident #10. CNA F stated, I should have put a gown on, but I was in a rush. CNA F stated it was important that she wear a gown to prevent the spread of infection. During an interview on 05/22/25 beginning at 12:01 p.m., the DON stated she only expected CNA F to wear gloves not a gown when assisting with pulling down Resident #10 briefs because there was no body contact, and the resident was independent. The DON stated she and the ICP were responsible for monitoring and overseeing EBP by random rounds, in services and check offs. The DON stated she had not noticed any issues with staff not wearing the correct PPE with residents on EBP. The DON stated it was important the correct PPE was worn to prevent the spread of infection. During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated he agreed with the DON that CNA F only had to wear a gown when assisting Resident #10 with pulling down her briefs. The Administrator stated the nursing department was responsible for monitoring and versing. The Administrator stated it was important to ensure the correct PPE to prevent the spread of infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 34 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 Record review of the facility's Police/Procedure-Nursing Clinical, Section: Routine Procedures, Subject: Incontinent Care, revised 05/2007, indicated, Assist resident to turn on side with back toward you. Expose buttocks area. Wash, using front-to-back strokes, rinses, and dry exposed skin surfaces. Apply lotion. Remove soiled linen and replace clothing/linen as necessary .D. Cleanse perennial/rectal area and apply a new brief. Residents Affected - Some Record review of the facility's policy titled, Hand Hygiene, revised 10/22, indicated, Policy: It is the policy of this facility to provide the necessary supplies, education, and oversight to ensure healthcare workers perform hand hygiene based on accepted standards. Purpose: Hand hygiene is one of the most effective measures to prevent the spread of infection All personnel shall follow the handwashing/hand hygiene procedure to help prevent the spread of infections to other personnel, residents, and visitors. Record review of the facility's policy titled, Infection Control, revised 03/24, indicated, Policy: It is the policy of this facility to implement infection control measures to prevent the spread of communicable diseases and conditions. Procedure: Standard Precautions are infection prevention practices that apply to the care of all residents, regardless of suspected or confirmed infection or colonization status. They are based on the principle that all blood, body fluids, secretions, and excretions (except sweat) may contain transmissible infectious agents Enhanced Barrier Protection (EBP}: used in conjunction with standard precautions and expand the use of PPE through the use of gown and gloves during high-contact resident care activities that provide opportunities for indirect transfer of MDROs to staff hands and clothing then indirectly transferred to residents or from resident-to-resident. (e.g., residents with wounds and indwelling medical devices are at especially high risk of both acquisition of and colonization with MDROs). a. PPE: The use of gown and gloves for high-contact resident care activities is indicated when Contact Precautions do not otherwise apply, for nursing home residents with: i. Wounds and/or indwelling, but are not limited to . urinary catheters, or medical devices regardless of known MDRO infection or colonization. Based on observations, interviews, and record review, the facility failed to establish and 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 3 of 4 residents (Resident #24, Resident #36 and Resident #10) reviewed for infection control. 1.The facility failed to ensure CNA L performed hand hygiene while providing incontinent care for Resident #24 on 05/21/25. 2. The facility failed to ensure CNA B and CNA C cleaned Resident #36's front perineal area when they provided incontinent care and failed to ensure CNA B followed enhanced barrier precautions when providing care on 05/19/2025. 3. The facility did not ensure CNA F followed enhanced barrier precautions while assisting Resident #10 with catheter care on 05/20/25. These failures could place any resident at the facility at risk for cross-contamination and spread of infection. Finding included: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 35 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 1.Record review of Resident #24's face sheet, dated 05/22/25, revealed an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses to include stroke, dementia (progressive loss of intellectual functioning), atrial fibrillation (irregular or rapid heartbeat that causes poor blood flow), and Congestive heart failure, or heart failure, is a long-term condition in which your heart can't pump blood well enough to meet your body's needs Residents Affected - Some Record review of Resident #24's quarterly MDS assessment, dated 04/30/25, indicated Resident #24 usually understood and was usually understood by others. Resident #24's BIMS score was 04, which indicated she was severely cognitively impaired. The MDS indicated Resident #24 required total assistance with toileting, bed mobility, dressing, personal hygiene, transfers, and eating. The MDS indicated she was always incontinent of bowel and bladder. Record review of Resident #24's comprehensive care plan revised on 01/29/25, indicated Resident #24 was incontinent of bowel/bladder. The care plan interventions were for staff to check frequently for wetness, soiling, and change as needed. During an observation on 05/20/25 10:48 a.m., CNA L was performing incontinent care on Resident #24. She cleaned Resident #24's peri area and then turned her to her side, touching her gown without hand hygiene or changing her gloves. During an interview on 05/20/25 11:13 a.m., CNA L said she did not realize she did not perform hand hygiene or change her gloves before turning Resident #24 from front to back or before touching her clean gown. She said she knew that without hand hygiene or removing dirty gloves, she could cause cross-contamination. During an interview on 05/22/25 at 11:44 a.m., LVN H said she was Resident #24's nurse. She said she expected the CNAs to perform incontinent care the correct way. She said she expected them to change their gloves between clean and dirty to prevent cross-contamination. During an interview on 05/22/25 at 12:05 p.m., the DON said she expected the CNAs to perform incontinent care correctly. She said she expected staff to change their gloves between clean and dirty and to use hand hygiene between glove changes. The DON said they went over incontinence care and hand washing upon hire, annually, and as needed. The DON said staff should change gloves and practice hand hygiene to prevent infection and cross-contamination. During an interview on 05/22/25 at 12:17 p.m., the Administrator said he expected all staff to use proper hand hygiene techniques between dirty and clean areas with all care. The Administrator said the clinical team was responsible for ensuring staff were trained on incontinent care and infection control. He said improper hand hygiene could place residents at risk for infection. Record review of CNA L's proficiency on incontinent care and handwashing was dated 01/25/25 and 05/04/25. 2. Record review of a face sheet dated 05/22/2025 indicated Resident #36 was a [AGE] year-old-female initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (paralysis and weakness of the left side of the body) and contractures of the left and right knee and left and right hip (shortening of the muscles, tendons, skin, and nearby soft tissues of the left and right knew and left and right hip which caused the joints to shorten and become very stiff, preventing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 36 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 normal movement). Level of Harm - Minimal harm or potential for actual harm Record review of the Quarterly MDS assessment dated [DATE], indicated, Resident #36 was understood by others and understood others. The MDS assessment indicated Resident #36 had a BIMS score of 13, which indicated her cognition was intact. The MDS assessment indicated Resident #36 was dependent on staff for bathing/showering, personal and toileting hygiene. The MDS assessment indicated Resident #36 had a functional limitation in range of motion to her lower extremity (hip, knee, ankle, foot) on both sides. Residents Affected - Some Record review of Resident #36's care plan indicated she had bowel/bladder incontinence related to impaired mobility to change her after each incontinent episode and as needed. Resident #36's care plan indicated she had a diabetic ulcer (wounds that arise due to poor circulation and nerve damage caused by diabetes) to use enhanced barrier precautions (infection control intervention used to reduce transmission of multidrug resistant organisms). During an observation and interview on 05/19/2025 starting at 4:25 PM, CNA B and CNA C provided incontinent care to Resident #36. CNA B and CNA C turned Resident #36 on her side and cleaned the stool off her buttocks and back perineal area. CNA B and CNA C removed gloves and performed hand hygiene and put on a clean brief. After applying the clean brief CNA B removed her gloves performed hand hygiene and only put one glove on. CNA B said she ran out of gloves. CNA B repositioned Resident #36 in the bed, covered her up, repositioned her head and pillows using only one gloved hand. CNA B said she did not clean Resident #36's front perineal area because she was contracted, and she had difficulty getting to it. CNA B said she usually was able to clean her front area. CNA B said since it was difficult to get to Resident #36's front area she should have wiped further down from behind to ensure she had cleaned Resident #36 well enough. CNA B said because she had not cleaned Resident #36's front area this placed Resident #36 at risk of getting a urinary tract infection. CNA B said she should have gotten more gloves and applied both of her gloves to reposition Resident #36 in the bed because she required enhanced barrier precautions. CNA B said it was important to follow the enhanced barrier precautions to not spread infection and to protect herself and the residents. CNA C said they did not clean Resident #36's front area because it was hard to get to it. CNA C said it was important to clean the resident's perineal area on the front and back to prevent bacteria from getting in the lady parts and to prevent urinary tract infections. During an interview on 05/22/2025 at 10:56 AM, the DON said when a resident required enhanced barrier precautions the staff should wear gloves anytime they were touching the resident. The DON said she conducted random daily check to ensure the staff were following the enhanced barrier precautions, and the staff had been wearing the appropriate PPE. The DON said it was important for the enhanced barrier precaution to be followed to prevent infections to the residents. During an interview on 05/22/2025 at 11:50 AM, the Operation Manager said he expected for the staff to provide the residents incontinent care fully and for the residents to be cleaned. The Operation Manager said he expected for the staff to follow the protocols for enhanced barrier precautions. The Operation Manager said nursing was responsible for ensuring the staff provided proper incontinent care and followed the enhanced barrier precautions. The Operation Manager said he was not clinical and was not aware of the risks associated with not providing proper incontinent care and not following the enhanced barrier precautions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 37 of 38 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 676190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillhouse Rehabilitation and Healthcare Center 2900 Stillhouse Road Paris, TX 75462 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 0926 Have policies on smoking. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to establish policies regarding smoking areas, and smoking safety for 1 of 1 smoking area. Residents Affected - Few 1. The facility did not ensure cigarettes were not discarded in the trash can designed for the disposing of trash. 2. The facility did not ensure trash was not discarded in the red trash can designed for the disposing of cigarettes. These failures could place residents who smoke at risk of physical harm and lead to an unsafe smoking environment. Findings Included: During an observation and interview on 05/20/25 at 10:30 a.m., there was a red can with trash observed inside the can located in the designated smoking area. CNA B stated the trash observed inside the can was the foil wrapper part of the cigarette box when you first open the box. CNA B stated the wrapper should be disposed in the trash can. CNA B stated whoever took the residents out to smoke should check the red can for trash. CNA B stated this failure could potentially cause a fire. During an observation on 05/20/25 at 10:38 a.m., a cigarette butt was observed approximately 30-40 ft from the designed smoking area. During an interview on 05/22/25 beginning at 1:02 p.m., the Administrator stated he expected trash and cigarette butts to be disposed in the proper receptacle. The Administrator stated the Maintenance Supervisor was responsible for monitoring and overseeing the smoking area. The Administrator stated it was important to ensure trash and cigarettes were disposed correctly to ensure a clean environment. The Administrator stated the Maintenance Supervisor was out 05/22/25 due to personal reasons. Record review of a facility's policy titled Smoking and Safety Measures, revised 05/2025, indicated . it is the policy of this facility to provide a smoke-free environment for residents and staff . 10. Safety code approved ashtrays are provided and are the only approved receptacle for disposing of smoking materials . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676190 If continuation sheet Page 38 of 38