Health inspection·October 6, 2022

F 0584 clean one. This is to stop spread of infection and to maintain a homelike environment. Level of Harm - Minimal harm or potential for actual harm 4. Review of the facility's policy titled Hand Hygiene for Staff and Residents - Infection Control, revised January 2022, reflected, .Hand Hygiene is done after contact with soiled or contaminated articles . toileting or assisting others with toileting Residents Affected - Some 5. Review of the facility's policy titled, Aseptic Technique Infection Control, revised January 2022, reflected, .Environment - Routine cleaning and disinfection of the environment will be done FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 2 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 Based on interviews and record review the facility failed to implement their written policies and procedures that prohibit and prevent abuse and neglect for two (LVN Q and Laundry Aide P) of 10 employees reviewed for employee files. Residents Affected - Some 1. The facility failed to ensure an accurate criminal background check was completed upon hire for LVN Q. 2. The facility failed to conduct criminal background check prior to hire for Laundry Aide P. This failure could place residents at risk for abuse and receiving care from unemployable staff. Findings included: Review of facility's policy Criminal background screening - Texas dated 10/01/17 reflected the facility is to conduct criminal background checks on a post-offer, pre-employment basis for new employees .The community's criminal background check process must conform to all applicable law and regulations, including without limitation, The Texas Code regulations governing access to criminal history record information. 1. Review of LVN Q's personnel file reflected the hire date was 09/16/22 and a criminal background in his file completed on 09/16/22 was not ran with the correct name provided to facility. There was no criminal background check completed in his file with his correct name. 2. Review of Laundry Aide P's personnel file reflected the hire date was 08/19/22 and a criminal background check was completed on 08/23/22. Review of Laundry Aide P's timesheet reflected he was trained on 08/19/22 and started working on 08/21/22. 3. Interview with the HR Coordinator on 10/06/22 at 11:02 AM and 11:58 AM revealed criminal background checks should be completed upon hire. She stated she did not run the criminal background for LVN Q on 09/16/22 and the Administrator was the one responsible for completing it since she did not have access to the system to run them at the time. She stated the criminal background check completed on 09/16/22 for LVN Q did not have the correct name for LVN Q according to his employee file. She stated it should have been ran with the correct name to ensure the employee had no bars to employment upon hire. She stated LVN Q was a current employee at the facility. She stated Laundry Aide P's criminal background should have been completed on 08/19/22 when he started and his first day not in training was on 08/21/22. She stated criminal background checks should be completed with the correct information of the employee . Review of LVN Q's and Laundry Aide P's criminal background checks completed on 10/06/22 after surveyor intervention reflected both LVN Q and Laundry Aide P were employable and had no bars to employment. Interview on 10/06/22 at 12:03 PM with the Administrator revealed he did run LVN Q's criminal background on 09/16/22 with the incorrect name but did not realize he had put the wrong name on it. He stated it was ran today with the correct employee information. He stated new hires should have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 3 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 criminal background checks completed upon hire to ensure employees are employable. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 4 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0635 Provide doctor's orders for the resident's immediate care at the time the resident was admitted. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to have physician's orders for the resident's immediate care for one (Resident #94) of two residents reviewed for admission physician orders. Residents Affected - Few The facility failed to have physician's orders for Resident #94's foley catheter (a small tube inserted into the bladder to drain the urine into a collection bag) and care for the foley catheter. This failure could place residents at risk for not receiving appropriate care and urinary infection. Findings included: Review of Resident #94's quarterly MDS assessment dated [DATE] reflected an [AGE] year-old male readmitted to the facility on [DATE]. His cognitive states severely impairment. He was admitted without a foley catheter and was always incontinent of urine. Review of Resident #94's clinical notes dated 09/29/2022 in resident revealed LVN A entered Foley Catheter is replaced with 14 F, 30 cc Balloon. Secured Foley with adhesive tape on right thigh. Review of Resident #94's revised care plan dated 09/19/22 revealed he was always incontinent of bladder. The care plan did not address his need for foley catheter or care. Review of the Resident #94's admission physician's orders dated 07/30/22 did not include a diagnosis for the need of a foley catheter and no care for the foley catheter. Review of Resident #94's the consolidated physician orders dated from 08/01/2022 to 10/31/22 did not include a diagnosis for the need of a foley catheter and no care for the foley catheter. Observation on 10/04/22 at 9:20 AM, physical therapy staff was assisting Resident#94 back to bed from wheelchair noted foley catheter intact. Resident unable to answer question related to his foley catheter. Review of Resident #94's Treatment Record dated 08/01/22 -10/31/22 did not reveal orders for change of foley catheter or care. Review of Resident #94's nurses noted dated 09/29/22 revealed Foley Catheter is replaced with 14 F, 30 cc Balloon. Secured Foley with adhesive tape on right thigh. Interview on 10/05/22 at 1:50 PM with the DON revealed she was not aware Resident #94's had an foley catheter. The DON reviewed the resident chart and was unable to find physician orders or care for foley catheter and no proper diagnosis for a use of a foley catheter. The DON stated the resident was sent to the hospital and was re-admitted to the facility with the foley catheter on 07/30/22. Interview on 10/05/22 at 2:05 PM with Charge Nurse A revealed she did replace Resident #94's foley catheter on 09/29/22. She stated she was not aware there was not an order for a foley catheter at the time she replaced it. She stated she forgot to call the physician to obtain an order for the catheter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 5 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview with the DON on 10/06/22 at 10:20 AM revealed Resident #94 foley catheter will be removed after he has been checked for residual of urine by clamping off the tubing for 15 minutes and releasing then reclamping for 24 hours. The DON stated then re-insert a catheter to check for urine residual by reinserting catheter and if more than 400 fluid ounces of residual urine was seen, leave in place and notify provider. Review of the admission Physician Orders policy dated January 12,2020 revealed the licensed nurse will obtain and transcribe orders. The licensed nurse reviews orders from the transfer record from an acute care hospital . a call is placed to the physician to confirm the orders and request any additional orders as needed Event ID: Facility ID: 676192 If continuation sheet Page 6 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan with services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and social well-being for one (Residents #94) of five residents reviewed for care plans. The facility failed to have a care plan for Resident #94's care regarding foley catheter ( a small tube inserted into the bladder to drain the urine into a collection bag) insertion and care. These failures could place residents at risk for infection. Findings included: Review of Resident #94's quarterly MDS assessment dated [DATE] reflected an [AGE] year-old male readmitted to the facility on [DATE]. His cognitive reflected he was severely impaired. He was admitted without a foley catheter and was always incontinent of urine. Review of Resident #94's revised care plan dated 09/19/22 revealed he was always incontinent of bladder. The care plan did not address his need for foley catheter or catheter care. Review of Resident #94's admission physician's orders dated 07/30/22 revealed the orders did not include a diagnosis for the need of a foley catheter and no care for the foley catheter. Review of the consolidated physician's orders dated from 08/01/2022 to 10/31/22 revealed the orders did not include a diagnosis for the need of a foley catheter and no care for the foley catheter. Observation on 10/04/22 at 9:20 AM revealed physical therapy staff assisting Resident#94 back to bed from his wheelchair and his foley catheter was intact. The resident was unable to answer questions related to his foley catheter. Review of Resident #94's Treatment Record dated 08/01/22 -10/31/22 did not reveal orders for the change of the foley catheter or care. Review of Resident #94's clinical notes dated 09/29/2022 in resident revealed LVN A entered Foley Catheter is replaced with 14 F, 30 cc Balloon. Secured Foley with adhesive tape on right thigh. Interview on 10/0/22 at 1:50 PM the DON revealed the DON was not aware that Resident #94 had a foley catheter. The DON reviewed the resident's chart and was unable to find physician's orders or care plan for his Foley catheter and no proper diagnosis for a use of a foley catheter. The DON stated the resident was sent to the hospital and was re-admitted with the foley catheter on 07/30/22. The DON stated there should be a care plan for a foley catheter for Resident #94. Review of facility's policy undated Person Centered Care Plan revised 2017 reflected the comprehensive care plan will be reviewed and updated as new needs are identified and after each MDS assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 7 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 provide the necessary services to maintain good personal hygiene to a resident who is unable to carry out activities of daily living for one (Resident #29) of one resident reviewed for ADL care. Residents Affected - Few The facility failed to provide Resident #29, who required extensive assistance, with timely and adequate incontinence care on 10/04/22 for at least an hour and allowed feces to dry and stick to Resident #29's thigh. This failure could place residents at risk of skin breakdown, pressure injuries, and urinary tract infections. Findings included: Resident #29's Quarterly MDS assessment dated [DATE] reflected he was a [AGE] year-old male admitted to the facility on [DATE], with the following diagnoses: Cerebrovascular Accident (stroke) Seizure disorder, Hypertension, and Hemiplegia (paralysis). He was frequently incontinent. He was mildly cognitively impaired. Review of Resident #1's Comprehensive Care Plan dated 10/05/22, reflected, . [Resident #29] is incontinent of bowel and bladder and is at risk for skin breakdown .Keep skin clean, dry, and free of irritants Review of the ADL flow sheet for Resident #29 for the 10:00 p.m. to 6:00 a.m. shift for 10/03/22 reflected no documentation for incontinence care. No documentation of incontinence care from 6:00 a.m. until 10:40 a.m. (observation of incontinence care on 10/04/22). In an interview with Resident #29 on 10/04/22 at 10:26 a.m. revealed the resident pushed the call light twice within the past hour of interview and someone came in to clear the call light and never came back. Resident #29 was unable to identify which staff members. Resident #29 stated it had been at least an hour since he pushed the call light the first time to get changed due to a bowel movement. In an observation 10/04/22 at 10:40 a.m. revealed CNA D and CNA E entered Resident #29's room and told the resident she was there to change the resident and get him up for the day. CNA D rolled the resident onto his left side revealing the resident had feces on the draw sheet and his right thigh. CNA D stated she was not assigned to the hall but was helping and stated the ADON came to ger her to change the resident. CNA D pulled the dirty brief off the resident and rolled it along with the draw sheet and sheet toward the resident. CNA D then took a peri wipe and wiped several times to remove the bowel movement and had to scrub to remove some stool revealing stool to be dried to Resident #29's right leg. CNA D then removed her gloves and put on new ones , and placed a clean brief under the resident. CNA D then had the resident roll onto his back, cleaned his scrotum area, turned to right side to fully remove the brief, draw sheet, and pad, and then the resident rolled back to his back . CNA D pulled up the clean brief and fastened it. CNA D and CNA E then assisted the resident to put on his pants and his shoes, and then they assisted him to his wheelchair. Interview with CNA D on 10/04/22 at 10:40 a.m. and 10:56 a.m. revealed that she was not working (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 8 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 Resident #29's hall today. CNA D stated the ADON came to get her to help with Resident #29. CNA D stated if staff a member turned the light off staff should be sure to come back to help the resident. In an interview with the DON on 10/05/22 at 10:29 a.m., she stated she expected staff to answer the call lights as soon as possible. She stated she did not have an issue with staff turning the light off as long as they intended to return to the resident, but if that was not their intention I am not okay with that. The DON stated residents should receive the help they need as soon as possible. Interview with the Administrator on 10/06/22 at 10:19 a.m. revealed he was unable to find a policy or training directly related to timely incontinent care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 9 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents receive adequate supervision and assistance devices to prevent accidents for one (Resident # 29) of one resident observed during a transfer. CNA D failed to transfer Resident #29 safely when she failed to use a gait belt and placed her arm under Resident #29's left armpit, and lifted him from the bed to wheelchair. This failure could affect the residents by placing the residents at risk for discomfort, pain and/or injury. Findings included: Resident #29's Quarterly MDS assessment dated [DATE] reflected he was a [AGE] year-old male admitted to the facility on [DATE], with the following diagnoses: Cerebrovascular Accident (stroke), Seizure disorder, Hypertension, and Hemiplegia (partial paralysis). He required two-person physical assist to transfer. He was mildly cognitively impaired. Resident # 29's Care Plan dated 10/05/2022 reflected, .Resident requires assistance with ADLs .as needed Care plan did not reflect how much assistance. An observation on 10/04/2022 at 10:40 a.m. revealed CNA D helped Resident #29 to sit on the edge of his bed with the wheelchair to his right side slightly turned and locked in preparation to transfer him from his bed to wheelchair. CNA D then placed her arm under the Resident #29's left arm pit and lifted the resident from his bed and pivoted him to his wheelchair. There was another CNA in room but they did not help to assist the resident to wheelchair. Two gait belts were observed on the chair to the left of the bed. A gait belt was not used during the transfer . An interview on 10/04/2022 at 10:56 a.m. CNA D stated she always uses her arm and hand to transfer him. CNA D stated she does not normally use a gait belt with this resident. He needed two person assist. An interview on 10/04/2022 at 10:58 a.m. Resident #29 stated that normally a gait belt is not used although it has been used. He is normally transferred with two people assist. Review of the OSHA Lift Program Skills Check - off Sheet - Gait/Transfer Belt, dated 6/3/22, reflected .note and confirm application of gait/transfer belt is proper for resident .I have successfully completed the procedures above for using the gait belt. I have demonstrated the tasks and understand that I need to use a gait belt with any lift or transfer except the Hoyer transfer and are to be used to comply with the policy and procedures for the Providence Park transfer program. The sheet reflected CNA D signature below the statement. An interview on 10/05/2022 at 10:29 a.m. the DON said it was the expectation that staff use a gait belt when providing any help with transfers. She stated if the resident is not independent a gait belt should be used. A gait belt should be used to prevent injury. They have trained all staff on using gait belts within the last few months. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 10 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview with the Rehabilitation Manager on 10/05/2022 at 10:10 a.m., she revealed the resident's armpits were not to be used during transfers because that could cause nerve damage or cause dislocated shoulder. Rehabilitation manager has not personally trained staff at the facility due to coming on board in July 2022 and was on medical leave for a month. Review of [NAME] and [NAME] Clinical Nursing Skills and Techniques 9th edition , 1/26/2017, page 276 reflected . Patients should never be lifted by or under their arms. Review of the facility's policy, ADL Care - Transfer Techniques, dated 02/12/20 reflected, Staff will provide safe and effective transfer techniques for residents .use stand-and-pivot technique with one caregiver .apply gait/transfer belt snugly and low so it circles the resident's waist FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 11 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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. Based on observation, interview, and record review the facility failed to ensure that medications were secure and inaccessible to unauthorized staff and residents for one (100/200 hall medication cart) of six medication carts reviewed for medication storage. 1. The facility failed to ensure medication supplies were secured or attended by authorized staff when the medication cart on hall 100/200 was left unlocked and unattended by LVN A. Theis failure could place residents at risk of having access to medications and/or lead to possible harm or drug diversion. Findings Included: 1. An observation on 10/04/22 at 10:42 a.m. revealed a medication cart #1 next to nurses' station with no nurse near the medication cart. The medication cart was unlocked . The narcotics book on top of the care reflected Nursing 200 & 100 Hall Narcotics counting book. The ADON walked by at the same time and locked cart. The ADON stated she knew whose cart it was and would address it. In an interview with LVN A on 10/04/22 at 03:27 p.m. revealed she left the cart unlocked on accident. LVN A stated, I know that it needs to be locked. I went to do something quickly and forgot. She stated that a resident could get into medication cart if left unlocked. In an interview on 10/05/22 at 10:29 a.m. with the DON, she stated, The medication cart should be locked at all times or within line of sight. The DON stated they have been trained on this and was unable to give a reason as to why it was not done. The DON stated not locking the cart could cause accidents like a resident getting into the medication cart. Review of the facility's policy titled Storage of Medication, dated September 2018, reflected, .medication rooms, cabinets, and medication supplies should remain locked when not in use or attended by persons with authorized access. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 12 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to obtain from hospice the most recent hospice plan of care specific to each patient, the physician certification and recertification of the terminal illness specific to each patient and hospice medication information specific to each patient for two (Residents #2 and #56) of three residents reviewed for hospice records. 1. The facility failed to obtain the required hospice documentation of the current physician certification of terminal illness, plan of care and medication list from Hospice P for Resident #56. 2. The facility failed to obtain the required hospice documentation of the physician certification of terminal illness from Hospice N for Resident #2. These failures could result in services and treatments not being coordinated. Findings included: 1. Review of Resident #56's Quarterly MDS assessment dated [DATE] reflected Resident #56 was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses of hypertension, dementia and chronic obstructive pulmonary disease . She required hospice services while at the facility . Review of Resident #56's Hospice P book reflected Resident #56's hospice election form dated 12/13/21 reflected Resident #56 had a terminal diagnosis of chronic obstructive pulmonary disease. Resident #56's hospice book reflected the last plan of care dated 04/06/22 included medication profile list. Resident #56's hospice certification of terminal illness reflected a certification start date of 06/11/22 with a benefit period of 06/11/22 to 08/09/22. Resident #56's hospice documentation did not have a current hospice physician recertification of terminal illness, plan of care and medication list. 2. Review of Resident #2's Annual MDS assessment dated [DATE] reflected Resident #2 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of heart failure, hypertension and Alzheimer's disease. Resident #2 was on hospice services at the facility . Review of Resident #2's Hospice N book reflected Resident #2 was admitted on [DATE] to Hospice N. The Hospice book for Resident #2 reflected an election of benefit form dated 04/12/21. It reflected the last hospice physician certification of terminal illness dated 06/23/21 from 07/11/21 to 09/08/21. Resident #2's last hospice plan of care dated 09/06/22 reflected Resident #2 had diagnoses of Alzheimer's disease, dementia, hemiplegia affecting left nondominant side and heart disease with heart failure. There was no current re-certification of physician termination of illness. Interview on 10/06/22 at 11:18 AM with MDS Coordinator O revealed she was aware of the required hospice documentation needed for hospice residents. She stated she was the facility's hospice liaison and did not have access to Resident #2's and #56's hospice documentation. She stated she would have to contact Resident #2's and #56's hospice agencies to get the required hospice documentation which was missing. Review of facility's policy Hospice Program revised 01/12/20 reflected under procedure .6. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 13 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 0849 Level of Harm - Minimal harm or potential for actual harm Hospice Agency will provide the following documentation: .b. Hospice election form c. Physician certification and recertification of terminal illness .7. Documentation will be housed in the electronic health record under the Hospice tab, or if an electronic medical record system is not in place, documentation will be placed in the designated place determined by the Director of Nursing or designee. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 14 of 15 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 676192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garnet Hill Rehabilitation and Skilled Care 1420 McCreary Rd Wylie, TX 75098 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 Based on observation, interview and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one (Resident #29) of twenty-eight residents observed for infection control. Residents Affected - Some CNA A failed to perform hand hygiene between glove changes during incontinence care for Resident #29. These failures placed residents at risk for spread of infection through cross-contamination. Findings included: In an observation 10/04/22 at 10:40 a.m. revealed CNA D entered Resident # 29's room and told the resident she was here to change the resident and get him up for the day. CNA D rolled the resident onto his left side revealing the resident had feces on the draw sheet and his leg. CNA D pulled the dirty brief off the resident, and rolled it along with the draw sheet and sheet toward the resident. CNA D then took a peri wipe and wiped several times to remove the bowel movement and had to scrub to remove some stool revealing stool to be dried to Resident #29's leg. CNA D then removed her gloves and put on new ones without performing hand hygiene. CNA D then placed a clean brief under the resident. CNA D then had the resident roll onto his back, cleaned his scrotum area, turned to right side to fully remove the brief, draw sheet, and pad, and then rolled back to his back. CNA D pulled up the clean brief and fastened it. CNA D and CNA E then assisted the resident to put on his pants, and his shoes, and assisted him to his wheelchair. Interview with CNA D on 10/04/22 at 10:56 a.m. revealed she was supposed to perform hand hygiene after changing the dirty brief. She stated she did not have hand sanitizer on her. That she was pulled from another hall, was in a hurry, and did not have all the supplies she needed when she came to this resident's room. She stated she was to do hand hygiene to prevent contamination. Interview with the DON on 10/05/22 at 10:29 a.m. revealed she expected staff to wash their hands before care, when they went from dirty to clean, and after care was completed . Review of the facility's policy titled Hand Hygiene for Staff and Residents - Infection Control, revised January 2022, reflected, .Hand Hygiene is done after contact with soiled or contaminated articles . toileting or assisting others with toileting FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 15 of 15