Health inspection·December 8, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few meals per staff. Independent with staff supervision for meals. Weight of 159.4 on 11/1/23, gain of +2.57% x 1 month, +2.44% x 3 months and +3.78% x 6 months. Review of Resident #63's face sheet dated 12/06/2023 revealed she was an [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnoses included cerebral infarction (disruption of blood flow to the brain due to problems with the blood vessels that supply the brain,) malaise (general feeling of discomfort,) edema (swelling caused by too much fluid trapped in the body's tissues,) stage 2 kidney disease (mild kidney damage,) flaccid hemiplegia affecting the left side (decreased muscle tone that cannot be actively moved by the patient,) dementia (group of conditions characterized by impairment of brain functions,) and epilepsy (disorder of brain activity.) Review of Resident #63's admission MDS dated [DATE] revealed she was unable to complete the BIMS assessment but was documented as having short- and long-term memory problems. Resident #63 required extensive assistance of two or more staff members for bed mobility and transfers. She required extensive assistance of one staff member for eating. Review of Resident #63's comprehensive care plan on 12/06/2023 at 3:05 PM revealed she had altered nutritional status . 11/27/2023 . related to dentures, chewing difficulty, and use of diuretics, laxatives, and/or cardiovascular drugs. Her goal included she would maintain her weight over the next 90 days. Relevant intervention included provide necessary assistance with food and fluids. Review of Resident #63's vital signs on 12/06/2023 at 2:59 PM revealed she weighed 157.8 pounds on 12/04/2023 at 10:41 AM. In observation on 12/05/2023 at 12:19 PM, CNA Z was sitting in a chair in the dining room, positioned between Resident #26 and Resident #63. CNA Z assisted Resident #26 and Resident #63 by taking her right hand, obtaining resident spoon, and providing a spoon full of food to their mouth. CNA Z assisted Resident #26 with eating then helped Resident #63; going back and forth while feeding them. This was repeated approximately 7 times during the dining observation. In interview with CNA Z on 12/05/2023 at 12:37 PM, she stated that she was aware it was not best practice to assist two residents simultaneously. She stated she did not know why necessarily, but it was not best practice. She stated that she had to assist two residents today because of short staffing. She stated the need to assist multiple people at once does not occur very often, but it occurred that day. She stated she did not seek out leadership or other staff for additional assistance and did not provide any reason or potential outcome upon follow-up inquiry. Attempts to interview Resident #26 and Resident #62 occurred 12/05/2023 at 1:00 PM and 12/06/2023 3:00 PM were unsuccessful due to residents' communication and cognitive limitations. In interview with ADON K on 12/07/2023 at 3:29 PM, she stated her expectations were for staff to only help one resident at a time but did not give specifics as to the reason. She stated that the facility had been well staffed and would have expected CNA Z to come to her for more help if she needed it. In interview with ADON E on 12/07/2023 at 3:30 PM, she stated her expectations were for staff to only provide assistance to one resident at a time for dignity purposes. She denied any staffing issues and stated she would have preferred if CNA Z asked her for help to get each resident assisted individually and in a timely manner. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 2 of 48 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 12/08/2023 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 0550 Level of Harm - Minimal harm or potential for actual harm In interview with DON on 12/07/2023 at 3:39 PM she stated she prefers staff not to provide assistance for two residents in the dining room at the same time. She stated her facility had been well staffed and denied any staffing issues. She stated she expected CNA Z to request additional help from leadership instead of assisting multiple residents at the same time. She stated it could be a dignity issue if each resident was not assisted individually. Residents Affected - Few Review of the facility's policy, Assisting Residents with Eating, dated 01/12/2018 revealed Standard of Practice: Qualified nursing staff . will assist the Resident who is unable to feed self in order to promote adequate nutrition and to help the resident enjoy a satisfying meal . Procedure: Perform Hand Hygiene . Provide assistance to resident . Perform Hand Hygiene. Review of facility policy, Resident Rights, rev. 08/14/2023 revealed Staff will abide by resident rights as outlined within the CMS State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities (Rev. 11-22-17. Review of CMS State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities rev. 11/22/2017 revealed F550 (Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17) §483.10(a) Resident Rights. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section. §483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 3 of 48 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 12/08/2023 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 0558 Reasonably accommodate the needs and preferences of each resident. 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 right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for four (Resident #91, Resident #92, Resident #93, and Resident #48) of eight residents reviewed for reasonable accommodation of needs. Residents Affected - Some The facility failed to ensure the call light system in Resident #91, #92, #93 and #48's rooms were in a position that was accessible to the residents. This failure could place the residents at risk of being unable to obtain assistance when needed and help in the event of an emergency. Findings included: Resident #91 Review of Resident #91's Face Sheet, dated 12/07/2023, reflected that resident was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses included unspecified transient ischemic attack (mini strokes) and generalized muscle weakness. Review of Resident #91's Quarterly MDS Assessment, dated 10/11/2023, reflected Resident #91 had a moderately impaired cognition with a BIMS score of 12. Resident #91 required extensive assistance for bed mobility, transfer, and toilet use. Review of Resident #91's Comprehensive Care Plan, dated 10/28/2023, reflected Resident #91 had a risk for falls and one of the interventions was to keep the call light and most frequently used personal items within reach. Review of Resident #91's Fall-Risk Assessment, dated 11/09/2023, reflected Resident #91 was at high risk for falls. Review of Resident #91's Incident Report denoted Resident #91 had falls on 06/18/2023 and 08/21/2023. Observation and Interview on 12/05/2023 at 10:18 AM revealed Resident #91 was sitting on the right side of her bed with her walker in front of her. Resident #91's call light was hanging on the left side of the bed with the call light button almost touching the floor. Resident #91 stated the CNA who just fixed her bed forgot to put the call light on top of the bed where she could reach it even though she was not lying on the bed. Resident #91 said she needed to stand up, go around her bed, and stoop down just to get her call light. Resident #91 added it was hard for her to bend over because of back pain and weakness. Resident #91 further said she hoped the CNA will put the call light on top of the bed even though she was out of the bed. Resident #93 Review of Resident #93's Face Sheet, dated 12/06/2023, reflected resident was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included hemiplegia (paralysis of one side of the body) and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 4 of 48 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 12/08/2023 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some hemiparesis (weakness on one side of the body) following cerebral infarction (insufficient oxygen in the brain causing stroke) affecting right dominant side, and unspecified pain. Review of Resident #93's Quarterly MDS Assessment, dated 10/16/2023, reflected Resident #93 had a severe cognitive impairment with a BIMS score of 00. Resident #93 was totally dependent for bed mobility, transfer, and toilet use. Review of Resident #93's Comprehensive Care Plan, dated 10/29/2023, reflected Resident #93 had a risk for falls and one of the interventions was to keep the call light and most frequently used personal items within reach. Review of Resident #93's Fall-Risk Assessment, dated 10/29/2023, reflected Resident #93 was at high risk for falls. Review of Resident #93's Incident Report denoted Resident #93 had falls on 08/21/2023, 08/30/2023, 09/04/2023, and 09/28/2023. Observation on 12/05/2023 at 11:43 AM revealed Resident #93 was on his bed sleeping. The call light was noted on the bedside table of Resident #93's roommate. Observation on 12/05/2023 at 1:34 PM revealed resident was lying on the bed awake. The call light was still noted on the bedside table of Resident #93's roommate. Observation on 12/06/2023 at 2:34 PM revealed resident was on his bed awake. The call light was still noted on the bedside table of Resident #93's roommate. Resident #48 Review of Resident #48's Face Sheet, dated 12/06/2023, reflected resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included arthritis with unspecified site, pain in the left knee, and muscle weakness. Review of Resident #48's Quarterly MDS Assessment, dated 11/21/2023, reflected Resident #48 had a moderate cognitive impairment with a BIMS score of 08. Resident #48 required extensive assistance for bed mobility, transfer, walk in room, walk in corridor, dressing, toilet use, and personal hygiene. Review of Resident #48's Comprehensive Care Plan, dated 08/11/2023, reflected Resident #48 had a risk for falls and one of the interventions was to keep the call light and most frequently used personal items within reach. Observation on 12/06/2023 at 9:36 AM revealed Resident #48 was sitting at the right side of her bed. Resident's call light was coiled and was hanging by the wall near the privacy curtain. Resident #48 said she could not find her call light and said the CNA forgot to put it on top of her bed again. Resident went out of the room and said she will find somebody to look for her call light. Resident #92 Review of Resident #92's Face Sheet, dated 12/08/2023, reflected resident was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses included unspecified lack of coordination, weakness, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 5 of 48 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 12/08/2023 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some age-related osteoporosis (A condition when bone strength weakens and is susceptible to fracture) without current pathological fracture (a broken bone that is caused by a disease). Review of Resident #92's Quarterly MDS Assessment, dated 11/21/2023, reflected Resident #92 had a severe cognitive impairment with a BIMS score of 04. Resident #92 required extensive assistance for bed mobility, transfer, and toilet use. Review of Resident #92's Comprehensive Care Plan, dated 11/22/2023, reflected Resident #92 had a risk for falls and one of the interventions was to keep the call light and most frequently used personal items within reach. Review of Resident #92's Fall-Risk Assessment, dated 12/12/2022, reflected Resident #92 was at high risk for falls. Review of Resident #92's Incident Report denoted Resident #91 had falls on 01/10/2023, 02/20/2023, 04/20/2023, 05/01/2023, 08/18/2023, and 09/30/2023. Observation and interview with Resident #92 on 12/06/2023 at 1:11 PM revealed the resident was on her bed resting. Resident #92's call light was on top of the right bedside table. Resident #92 stated the call light was on the table since she came back to the room after lunch. The resident said it was hard for her to reach it. The resident started to reach for the call light but was not able to reach it. The resident started to shake her head and went back to lay down on her bed. In an interview with CNA Y on 12/06/2023 at 1:46 PM, CNA Y stated that the call light should be within the reach of the residents at all times. CNA Y said that for some residents, the call light is their sense of protection. The call light gave them the notion that when they were in danger or there was an emergency, they could call the staff to help them. CNA Y added that the resident could fall if they tried to get to their call light that was far from them to call for assistance. CNA Y stated she might have forgotten to put the call lights on top of the bed when she made the residents bed. CNA Y said she would go for her rounds to check the call lights on her hall. In an interview with LVN A on 12/06/2023 at 1:52 PM, LVN A stated that the call light should not be on the table, hanging from the bed, or hanging by the wall. These placements were far from the residents, and they would have a hard time getting to them. LVN A said the call lights must be by the residents at all times. LVN A explained the call light was a method of communication between the resident and the staff. This was how the resident would communicate to the staff if they needed something and this was how the staff would know the residents needed something. LVN A said that without the call lights, the residents might try to get what they needed by themselves, and it could result in a fall, injury, and frustration. LVN A said she would check to see if her residents had their call lights. In an interview with ADON E on 12/07/2023 at 7:32 AM, ADON E stated the call lights were the resident's source of help, which was why the call lights should always be within the reach of the resident. ADON E said their call light was the lifeline of the residents. The residents use the call lights for basic reasons such as a glass of water, they need their remote, or they needed to be changed. ADON E added the call light could be used by the residents if they were not feeling well. If the call lights were far from the residents, the residents would not be able to call the staff and these needs would not be addressed. If the call lights were not with the residents, it could result in a fall, dehydration, and annoyance. ADON E said the expectation is for the staff to make sure the call (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 6 of 48 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 12/08/2023 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some lights were within the reach of all the residents and the call lights be placed on top of the bed when the residents were up. In an interview with Administrator on 12/07/2023 at 7:51 AM, the Administrator stated that it was not acceptable for the call lights to be far from the residents. The Administrator said the basic needs of the residents would not be addressed. The Administrator added the call light should be answered in a timely manner. The Administrator added he would monitor the staff for this concern and would re-educate the nurses and the CNAs to ensure call lights were within reach of the residents. In an interview with the DON on 12/07/2023 at 8:16 AM, the DON stated the call lights were inside the rooms for when the residents needed something, the residents could call the staff. The DON said the residents needed their call lights to let the staff know they needed a glass of water, a pain medication, or they needed to be changed. The DON added without the call lights, the residents would not be able to tell the staff they were thirsty, needed a snack, they were in pain, they need to go to the bathroom, or they were not feeling well. The DON further added that when the call lights were not within the reach of the residents, unfavorable incidents like falls, minor hurts, or major injuries could happen. The DON said the expectation was for the staff to ensure that the call lights were within reach of the residents. The DON concluded that moving forward, she would be on top of this issue to make sure the staff would make certain the call lights were with the residents at all times. In an interview with RN P on 12/07/2023 at 9:26 AM, RN P stated the call lights should be within the reach of the residents at all times. RN P said the call lights were used by the residents to call the attention of the staff, if they needed help to go to the restroom, if they needed a pain pill, or a refill on their water pitcher. If the call lights were far from the residents, the residents might try to get what they needed themselves and fall in the process. RN P then added she would be doing her rounds to check the call lights of the residents. In an interview with CNA Z on 12/07/2023 at 9:40 AM, CNA Z stated call lights were important for the residents because it was what they use to call when they need assistance. CNA Z said the call lights should be in a place where the residents could reach it and press the red button of the call light. If the call lights were not with the residents, they would not be able to call the staff. This may result in a fall. CNA Z said after fixing the bed, the call light should be placed on top of the bed. Record review of facility's policy Call Lights Answering, Clinical Operations, rev. January 19. 2020, revealed Policy: The staff will provide an environment that helps meet the resident's needs by answering call lights appropriately . Procedure . 7. When leaving the room, be sure the call light is placed within the resident's reach. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 7 of 48 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 12/08/2023 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 observations, interviews, and record review the facility failed to provide a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for areas in the facility for 12 (Resident #'s 5, 6, 13, 19, 35, 42, 48, 49, 71, 81, 83, and 101's) of 24 resident rooms observed for a safe, clean, comfortable, and homelike environment. The facility failed to ensure that Resident #'s 5, 6, 13, 19, 35, 42, 48, 49, 71, 81, 83, and 101's rooms were cleaned, sanitized, and maintained. This deficient practice could place residents at risk of infections and living in an uncomfortable environment leading to a decreased quality of life. Findings included: Observation of Residents #13 and #19's room on 12/05/23 at 10:50 AM revealed the wall alongside Resident #13's bed had grayish stains and the two deep scrapes mixed among the stains. Both bed side tables in the room had dried-up reddish fluid stains on the bottom of the frames. The bathroom wall between the sink and toilet had brownish and grayish stains midway and near the bottom of the wall. Observation of Residents #5 and #81's room on 12/05/23 at 10:59 AM revealed dark grayish stains on the corners of the bathroom floor, behind the toilet. There were grayish stains on the floor, along the edges of the toilet. There was a light brownish stain on the floor located in front of the toilet. The corner of the floor under the sink had dirt particles building up along the edges. Observation of Residents #42 and #71's room on 12/05/23 at 11:06 AM revealed a corner of the room floor, behind a waste basket, had white dirt particles and dust building up. The bathroom floor had a circular grayish stain behind the toilet, and in the corner of the floor behind the toilet had brownish and grayish stains. Observation of Residents #48 and #101's room on 12/05/23 at 11:10 AM revealed the bathroom floor had brownish and grayish stains going around the toilet. The bathroom floor in the corner of the room, behind the toilet, had yellowish and grayish stains. The handrails beside the toilet had black dirt particles and brownish stains. Observation of Residents #6 and #83's room on 12/05/23 at 11:19 AM revealed the top of the air-conditioned unit had black dirt particles sprinkled along the top. Just above the air-conditioned unit, along the wall had grayish stains sprayed along the wall. The bathroom floor had brownish stains going around the toilet. Observation of Residents #35 and #49's room on 12/05/23 at 11:25 AM revealed the wall alongside Resident 49's bed was scraped and measured about a 10-inch circle in diameter, and large grayish stains peppered along the wall. In an interview on 12/08/23 at 12:33 PM with the Housekeeping Supervisor, she stated she had been at the facility for almost two years but supervised for two months. She stated she used her tenured staff to assist in training the new hires. She stated staff were supposed to clean bathrooms, sweep, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 8 of 48 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 12/08/2023 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 0584 Level of Harm - Minimal harm or potential for actual harm mop, wipe walls, and the air conditioning unit. She stated housekeeping cleans the room daily and she checked the rooms maybe once a day but not every day. She was shown the pictures of concerns observed in the resident rooms and she stated that her staff should be cleaning the areas mentioned because if the rooms were not cleaned thoroughly, residents could get sick. She stated she does not use a checklist to clean the rooms. Residents Affected - Some In an interview on 12/08/23 at 12:45 PM with Housekeeper L, she stated she had been at the facility for three weeks. She stated she was trained by one of the oldest tenured housekeepers. She stated she was shown different areas of the facility to clean and was trained to clean rooms the days she started. She stated she was trained to dust the floor, sweep the floor, mop the floor, and tidy up. She stated she was trained to clean the air conditioning units, bed side tables, and walls if stained. She stated if she had observed anything damaged in the room, she would report it to the maintenance person. She stated if the rooms were not cleaned thoroughly, residents could get sick. She stated she does not normally clean the corners of the rooms on a regular basis . In an interview on 12/08/23 at 01:10 PM with the Director of Maintenance, he stated staff are to either place requests in the maintenance log or notify him. He was shown pictures of the scraped wall and he stated he was aware of the damages to the rooms mentioned and was trying to get to all of them. He stated that if things are not repaired correctly in the resident rooms, it would not be good because this is their home. In an interview on 12/08/23 at 01:33 PM with the Administrator, he stated he had not been made aware of any concerns regarding the cleanliness of rooms . He was shown pictures of the concerns observed in the rooms. He stated he would meet with his Housekeeping Supervisor to ensure the housekeeping staff were re-trained on thoroughly cleaning the rooms, including wiping down the walls, cleaning the floors thoroughly, and cleaning the corners of the rooms on the floors. He stated he was aware of repairs being needed and stated that maintenance was working their way around the facility making repairs based on priority. He stated the risk of these concerns not being addressed is not good for the residents. Review of the facility's policy on Resident Room Cleaning (November 2021) revealed To provide a clean, attractive, and safe environment for residents, visitors, and staff. High Dust Wall Articles: Damp Dust the Doors and Wall the tops of items along the resident's room and restroom walls (door frames, picture frames, clocks, over bed lighting, door closures, etc.) that are at or above your shoulder height. Clean and Disinfect the Room Furnishings: A. Clean all furnishings in the resident's room including the bed rails, IV poles, doorknobs, wheelchairs, walkers, and all other high contact surfaces. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 9 of 48 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 12/08/2023 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 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure the resident was free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms for 1 of 6 (Resident #49) residents reviewed for restraints. Residents Affected - Few The facility failed to ensure Resident #49 was not left sitting in a Geriatric (elderly) Chair (with the feeding tray still fully attached, while the resident was sitting in the media room. This failure could unnecessarily inhibit the resident's freedom of movement or activity. Findings included: Record review of Resident #49's Face Sheet, dated 12/08/23, revealed she was an 81 -year-old female admitted on [DATE]. Relevant diagnoses included Alzheimer's disease (severe memory loss), and difficulty in walking. Record review of Resident #49's MDS comprehensive assessment, dated 10/14/18, revealed she had a Brief Interview for Mental Status (BIMS) score of 05 (severe cognitive impairment) and for Activities for Daily Living (ADL) care it stated, for transfers, toileting, and bathing, the resident required assistance and a mechanical lift. Record Review of Resident #49's Care Plan, updated 09/28/23, stated the resident was at Fall risk and an intervention was to Assess for potential fall-related injury prevention. Observation on 12/05/23 at 09:30 AM of Resident #49 revealed, she was sitting in the media room in a Geri chair. The resident was not eating any food, but the feeding tray was still fully attached to the Geriry Chair. The tray was empty and had no food on it. In an interview on 12/08/23 at 01:25 PM with LVN J, she stated she observed Resident #49 had a feeding tray attached to her Geri chair on 12/05/23, while the resident was sitting in the media area. She stated she had removed the tray once it had been brought to her attention, but she did not think that the CNA was doing it as a form of restraint. LVN J stated she thought the CNA had just finished feeding the resident and forgot to remove the tray. She stated the risk of leaving the tray attached to the Geriry chair was a form of restraint and could harm the resident. In an interview on 12/08/23 at 01:45 PM with CNA S, she stated she had been at the facility for over 10 years. She stated she normally brought Resident #49 to the dining area for feeding assistance. She stated that the resident did have a feeding tray attached to her Geri chair to eat, and she usually removed it immediately after the resident finished eating. She stated she did not recall leaving the feeding tray attached to the Geri chair, but she remembered she had to assist another resident, and when she observed Resident #49 again the tray was gone. She stated she was not trying to restrain the resident, but she stated not removing the tray could restrict the resident's movement. In an interview on 12/08/23 at 03:09 PM with the DON, she stated she had been at the facility since 2019. She stated her staff informed her about Resident #49 observed on 12/05/23 in a Geri Chair while a feeding tray was attached, and she was not being fed. She stated the CNA should have removed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 10 of 48 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 12/08/2023 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 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the feeding tray once she was done feeding the resident. She stated the resident was a fall risk but had a decline in health, so she was not much of a fall risk now. She stated that it is a form of restraint, although it was not the intent. Record review of facility's policy on Restraint /Seclusion, dated January 18 2018, stated Chemical/Physical restraints shall only be used upon the written order of a physician and after obtaining consent from the resident and/or representative, WITH THE EXCEPTION OF TEMPORARY BEHAVIORAL EMERGENCY Event ID: Facility ID: 676192 If continuation sheet Page 11 of 48 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 12/08/2023 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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** Based on interviews, and record reviews, 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 for 1 of 1 Resident (Residents #12) reviewed for neglect, and exploitation or misappropriation. The facility failed to report Resident #12's fall to the Texas Department of Health and Human Services Commission (HHSC) on 11/23/23. This failure could place residents at risk of sustaining an injury and not receiving all services . Findings included: A record review of Resident #12's face sheet dated 12/08/23 reflected an [AGE] year-old female admitted on [DATE] with Diagnoses which included: Parkinson's disease (nervous system disorder), muscle weakness, and lack of coordination. Review of Resident #12's quarterly MDS assessment, dated 10/31/23, reflected resident had a BIMS of 13 (cognitively intact), and the Resident required assistance to perform ADL care. Review of Resident #12's Care Plan dated 11/15/23, reflected the resident was care planned for falls and the intervention included Resident at Risk for Falls resident safety will be maintained. Assist resident with toileting needs as needed. A record review of Resident #12's consolidated order dated 12/08/23 reflected additional diagnoses, including rheumatoid arthritis, restless legs syndrome. A record review of the Nurse Notes for Resident #12, dated 11/23/23 by RN L, reflected, 11/23/2023 At about 2am, this Nurse was notified by the assigned CNA that this resident was on the floor. This Nurse observed resident sitting on the floor in the resident's restroom by the commode. Resident stated that she slipped because of wet floor around the commode. Upon assessment, this nurse observed a hematoma to the front right side of head; skin tear to the right arm, and bruise to the right arm. Skin tear cleaned with normal saline, pat dry and sterile strip applied. NP notified; STAT skull series and right arm x-ray ordered. PRN pain medication administered. Vital signs obtained; temp=98.2, hr=63, 02=95%, bp=152/99. SON notified A record review of the Nurses Notes for Resident #12, dated 11/23/2023 by RN L reflected, [PRN Needed) Administration] 11/23/2023 02:57 AM acetaminophen 500 mg tablet (ACETAMINOPHEN) 1 tablet by mouth every 4 hours As Needed PAIN A record review of the Nurses Notes for Resident #12, dated 11/23/2023 by LVN M reflected, 11/23/2023 F/U (follow-up) related to fall in previous shift, Skull series and x ray to right arm is performed and waiting for results. Right arm bruised and seen 2 skin tears with steri strips and hematoma to right side of forehead. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 12 of 48 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 12/08/2023 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 0609 A record review of the Nurses Notes for Resident #12, dated 11/27/2023 by RN L reflected, 11/27/2023 Level of Harm - Minimal harm or potential for actual harm X-ray results collected. Impression shows negative result. Residents Affected - Few A record review of Wound Care Treatments for Resident #12, dated 11/27/23 by LPN /LVN R reflected, Start: 11/27/23 Skin Tear 1 time per day Skin tear to right forearm- clean with normal saline, pat dry, apply xeroform dressing and cover with dry protective dressing until it resolved Dx : Laceration without foreign body of right forearm, initial encounter In an interview on 12/05/23 at 12:25 PM with Resident #12, she stated her toilet had been leaking and she reported it to staff. She stated the Maintenance Director came to fix it, but he only caulked it. She stated the leaking started again, and she told her son about it and he reported it. She stated the bruise on her face was due to a fall she had in the bathroom, which was a result of her bending over to keep her clothes from getting wet from the water on the floor. She stated she lost her balance and fell. She stated her face hit the wall and she landed on her arm. She stated her arm had a dark bruise on it, but she was healing and there was only dark reddish/purplish bruising around the edge of what she said had been a much larger area. She stated staff came to help her up and they checked her out and helped her to bed. She stated they had X-rays taken and she had not broken anything. She stated she did not have to go to the hospital. She stated after her fall, the Maintenance Director came back to fix the leak again, and there hadn't been any more leaks. In an interview on 12/08/23 at 10:27 AM with Resident #12's Family Member, he stated that stated he did not know about the leaky toilet until after the resident's fall. He stated he talked to the Administrator about the leak and was told by him that they had re-caulked the base of the toilet; however, the toilet started leaking again, and the resident told the family member about her leaking toilet. The family member stated he had contacted the Administrator to let him know that the toilet was leaking again. He stated the Administrator followed up with him, after the fall to let him know that the seal had been replaced and there should be no more leaks. He stated the resident's fall was around Thanksgiving, but he could not recall the exact date. He stated the resident had not said anything else about the toilet leaking. In an interview on 12/07/23 at 11:22 AM with the Administrator, he stated he was aware of the incidents that occurred with Resident #12. He stated that Resident #12's injuries did not require her to receive hospitalization and no serious injury occurred, so he did not feel this was a reportable incident. He stated that the resident did sustain a head contusion as a result of her fall and he contacted notified Resident 12's Physician and Responsible party of the incident. He stated that the risk of not reporting reportable incidents according to Texas Department of Health and Human Services Commission (HHSC) guidelines, but he refused to state there was a risk because he felt that the incident was not reportable. He stated there was no policy and they followed stated guidelines on what was reportable and what was not. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 13 of 48 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 12/08/2023 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 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 interviews and record review, the facility failed to ensure each resident received an accurate assessment, reflective of the resident's status for 1 of 8 residents (Resident #26) reviewed for Accuracy of Assessments. Residents Affected - Few The facility failed to ensure Resident #26's Quarterly MDS assessment dated [DATE] and 10/29/2023 accurately reflected that Resident #26 had impairments to the upper extremity and lower extremity on one side of the body. This failure could place residents at risk for not receiving care and services to meet their needs, diminished function of health, and regressions in their overall health. Findings included: Resident #26 Review of Resident #26's Face Sheet, dated 12/06/2023, revealed she was an [AGE] year-old female re-admitted to the facility on [DATE]. One of the relevant diagnosis was unspecified joint contracture (tightening of the muscles, tendons, skin, and surrounding tissues that causes the joints to shorten and stiffen). Review of Resident #26's Quarterly MDS Assessment, dated 10/29/2023, revealed the resident had a severe impairment in cognition with a BIMS score of 02. Resident #26 was totally dependent upon two or more staff for bed mobility and transfers. She required limited assistance of one staff member for eating. Review of Resident #26's Comprehensive Care Plan, dated 11/02/2023, reflected the resident had a limited range of motion as evidenced by right shoulder subluxation (partial dislocation of your shoulder), right hand resting splint, and right ankle plantarflexion (movement of the foot in which the foot or toes flex downward toward the sole) due to foot drop (inability to raise the front of the foot due to weakness or paralysis). One of the interventions was to use devices, appliances, splints, or positioning pillows as indicated. Review of Resident #26's Physician's order for hand/wrist splint dated 10/26/2023 reflected MONITOR 1 time per day APPLY Right Hand/Wrist Splint in morning Please check skin integrity under splint. Review of Resident #26's Physician's order for hand/wrist splint dated 10/26/2023 reflected MONITOR at bedtime REMOVE Right Hand/Wrist Rest Splint at bedtime. Please check skin integrity under splint. Review of Resident #26's Physician Order on 12/06/2023 revealed no order for boots for resident's footdrop to right ankle. Review of Resident #26's Minimum Data Set, Section G - Functional Status G0400, dated 05/16/2023, revealed Resident #26 had no impairment to one side of the body in the upper extremity and lower extremity. Review of Resident #26's Minimum Data Set, Section GG - Functional Abilities and Goals GG0110, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 14 of 48 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 12/08/2023 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dated 10/29/2023,revealed Resident #26 had an impairment to one side of the upper extremity but no impairment to one side of the lower extremity. Observation on 12/07/2023 at 9:40 AM revealed Resident #26 was being transferred to the wheelchair via Hoyer lift. It was noted Resident #26 had a contracture to the right hand. Before transferring the resident to the wheelchair, CNA Y put a boot on Resident #26's right foot. It was noted there was a hand splint at the bed side table for Resident #26. In an interview with CNA Y on 12/07/2023 at 10:05 AM, CNA Y stated they put the boot on Resident #26 every time they would get her up. CNA Y said she was not sure the exact reason why but what she knew was the boot prevented Resident #26's foot from always pointing. CNA Y said the resident had the boot for a long time, but she could not remember exactly how long. CNA Y added they would put a pillow under Resident#26's right arm when in bed and when the resident was in the wheelchair. According to CNA Y, the nurse was the one that placedthe hand splint on as soon as the resident was up. CNA Y said she would inform the nurse the resident was already in her wheelchair. In an interview with RN P on 12/07/2023 at 11:19 AM, RN P stated she already placed the splint on Resident #26's right hand. RN P said she would put it on once the resident was up from the bed. RN P added the resident had a splint on because she had contractures on the right hand, and she had a boot on the right foot because of foot drop. In an interview with MDS Nurse R on 12/07/2023 at 1:54 PM, MDS Nurse R stated the MDS should reflect the current status of the resident. The functional status must reflect if the resident had any impairment or not. MDS Nurse R said Resident #26' care plan should also reflect the problem area and the specific interventions being done for the medical issue. MDS Nurse R added the assessments were done by the nurse during admission. The MDS Nurse R would base the MDS from the assessment of the nurse. She added every department had a role in completing the MDS. MDS Nurse R further added the care plan would be based on the MDS. She said an accurate MDS was important because it would be the basis of the care needed by the resident. If the assessment was not accurate, the current status of the resident would not be correct resulting to confusion in her care. This could also result in the resident not getting the appropriate care needed. In an interview with MDS Nurse I on 12/07/2023 at 2:12 PM, MDS Nurse I stated the nurses would do the assessment upon admission of the resident. The MDS would be triggered depending on the assessment. MDS Nurse I added that the care plan would be based on the MDS. She said she would also go to the resident and assess the resident. MDS Nurse I further added that the MDS should reflect what exactly was being done to the resident to make sure the resident was getting the treatment needed. If the assessment was not accurate, the staff would not know the resident needed the treatment and the current condition of the resident could worsen. MDS Nurse I stated she was aware Resident #26 has a splint to the right arm but was not aware Resident #26 was using a boot to the right foot. She said she would go to Resident #26 to further assess the resident. In an interview with ADON E on 12/07/2023 at 2:19 PM, ADON E stated the nurses did the assessment upon admission. She said the MDS nurse would look at the notes on the system to know what should be care planned. ADON E said if there were impairments to the upper extremity and lower extremity, the MDS should have a record of it. ADON E said there should be proper communication between the staff to ensure proper assessments were done. If there was no accurate assessment, there could be a confusion about the care needed by the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 15 of 48 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 12/08/2023 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 12/07/2023 at 2:25 PM revealed both MDS Nurses with Resident #26 at the activity area doing an assessment. In an interview with DON on 12/07/2023 at 2:36 PM, the DON stated she was not sure if the care plan was based on the MDS. The DON said the MDS should reflect the actual functionality of the resident. She said if the resident had an impairment, it should have been assessed accurately and reflected on the MDS. If the residents were not properly assessed, the proper care and needs would not be met. The DON said the expectation was the residents were properly assessed not only during admission but every day to see if there was a change in condition, any refusal of care, or resident acting different than usual. In an interview with OT O on 12/08/2023 at 9:42 AM, OT O stated Resident #26 had the splint to her right hand for almost five years. She said Resident #26 had a splint on the right hand due to a contracture. OT O said Resident #26 had a stroke that affected the right side of her body. OT O added she did an assessment when she came back from the hospital ont 10/24/2023. OT O said an accurate assessment was important to know if the resident was declining, if there was a change in function, or if the resident had more pain. If there was no proper assessment, the resident might have an increased debility. In an interview with PT A on 12/08/2023 at 9:58 AM, PT A stated an accurate assessment was important to be able to do a proper care plan. If the resident had impairments, it should be precisely reflected in the system to address goals and the interventions needed. Assessments were done to note if there were changes in condition, if there were changes in balance, if there was a pressure ulcer, or if there was a limitation in the range of motion. PT A stated if the assessment was not accurate, the needed care of the resident would not be met. PT A said Resident #26 had the boot for a year and a half. PT A said the assessment should reflect Resident #26 had impairment on her right upper and lower extremities. Record review of facility policy, Care Process, Clinical Operations, rev. February 12. 2020, revealed Standard of Practice: The interdisciplinary team will coordinate with the resident and their legal representative an appropriate care plan for the resident's needs or wishes based on the assessment and reassessment process within the required time frames . 4. Interdisciplinary Team meets & reviews the care plan as follows: Seven (7) days after the closure on the date of the admission MDS, Quarterly and annually, Within fourteen (14) days after a significant change MDS, and with any change of condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 16 of 48 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 12/08/2023 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 that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for one (Resident #26) of 20 residents reviewed for care plans. The facility failed to ensure the comprehensive care plan for Residents #26 was developed and identified and implemented goals and interventions to accurately address the resident's need for dining assistance. This failure could place residents that require dining assistance at risk for not receiving care and services to meet their needs. Findings Included: Review of Resident #26's Face Sheet dated 12/06/2023 revealed she was an [AGE] year-old female re-admitted to the facility on [DATE]. Relevant diagnoses included metabolic encephalopathy (syndrome of a chemical imbalance in the blood that causes neurological deficits,) right side contractures (abnormal thickening of the tissues which causes decease in movement and mobility), and aphasia following cerebral infarction (loss of ability to understand or express speech caused by brain damage). Review of Resident #26's quarterly MDS assessment dated [DATE] revealed she was severely cognitively impaired with a BIMS score of 02. She required limited assistance of one staff member for eating . Review of Resident #26's comprehensive care plan revealed no evidence of care interventions related to dining and/or assistance related to dining was determined. Resident #26's comprehensive care plan stated: she had altered nutritional status . 10/24/2023 Her goal included she would be comfortable with food and fluids provided over the next 90 days and would have snacks provided between meals . daily. Additional review revealed she had Impaired Physical Mobility 10/24/2023 . related to History of Stroke. Resident #26's goal included to maintain or improve physical function .locomotion, and ROM over the next 90 days. Related intervention included to Provide appropriate level of assistance to promote safety of resident. Review of Resident #26's vital signs on 12/06/2023 at 3:16 PM revealed she weighed 157.4 pounds on 12/01/2023 at 3:04 PM. No evidence of significant weight loss was determined. Review of Resident #26's Nutritional assessment dated [DATE] revealed resident is consuming ~75% of meals per staff. Independent with staff supervision for meals. Weight of 159.4 on 11/1/23, gain of +2.57% x 1 month, +2.44% x 3 months and +3.78% x 6 months. Review of Resident #63's face sheet dated 12/06/2023 revealed she was an [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnoses included cerebral infarction (disruption of blood flow to the brain due to problems with the blood vessels that supply the brain,) malaise (general feeling of discomfort,) edema (swelling caused by too much fluid trapped in the body's tissues,) stage 2 kidney disease (mild kidney damage,) flaccid hemiplegia affecting the left side (decreased (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 17 of 48 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 12/08/2023 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 muscle tone that cannot be actively moved by the patient,) dementia (group of conditions characterized by impairment of brain functions,) and epilepsy (disorder of brain activity.) Review of Resident #63's admission MDS dated [DATE] revealed she was unable to complete the BIMS assessment but was documented as having short and long-term memory problems. She required extensive assistance of one staff member for eating. Review of Resident #63's comprehensive care plan on 12/06/2023 at 3:05 PM revealed she had altered nutritional status . 11/27/2023 . related to dentures, chewing difficulty, and use of diuretics, laxatives, and/or cardiovascular drugs. Her goal included she would maintain her weight over the next 90 days. Relevant intervention included provide necessary assistance with food and fluids. Review of Resident #63's vital signs on 12/06/2023 at 2:59 PM revealed she weighed 157.8 pounds on 12/04/2023 at 10:41 AM. No evidence of significant weight loss was determined. In an observation on 12/05/2023 at 12:19 PM, CNA Z was sitting in a chair in the dining room, positioned between Resident #26 and Resident #63. CNA Z provided assistance to Resident #26 and Resident #63 by assisting Resident #26 then Resident #63 then going back to Resident #26 then back to Resident #63. This was repeated approximately 7 times during the dining observation. In interview with CNA Z on 12/05/2023 at 12:37 PM, she stated that she was not sure if Resident #26's comprehensive care plan included her dining assistance needs. She stated that she thought the ADONs were responsible for updating and implementing resident care plans. Attempts to interview Resident #26 and Resident #63 on 12/05/2023 at 1:00 PM and 12/06/2023 3:00 PM were unsuccessful due to residents' communication and cognitive limitations. In an interview with ADON K on 12/07/2023 at 3:29 PM, she stated it was the DONs responsibility to ensure resident comprehensive care plans were updated and accurately captured resident needs. In an interview with ADON E on 12/07/2023 at 3:30 PM, she stated that it was the DONs responsibility to ensure resident comprehensive care plans were updated and accurately captured resident needs. In an interview with the DON on 12/07/2023 at 3:39 PM, she stated Resident #26 required assistance for a while and that should have been reflected on her comprehensive care plan. She stated it was the ADONs responsibility to update resident care plans to ensure resident comprehensive care plans accurately captured resident needs. Review of facility census provided by the Administrator on 12/05/2023 revealed 108 residents residing at the facility upon entrance of the survey. Review of the email Requested Documents, authored by DON 12/08/2023 at 11:22 AM, she stated that approximately 20 residents required dining assistance in the facility. Review of facility staffing sheet, Amber Falls . Tuesday December 5, 2023, revealed 6 AM- 2 PM staffing on the unit: CMA (1,) Wound Nurse (1,) LVN (2,) and CNA (5.) Review of facility staffing sheet, Crystal Point . Tuesday December 5, 2023, revealed6 AM - 2 PM staffing on the unit: CMA (1,) Wound Nurse (1,) LVN (2,) and CNA (5.) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 18 of 48 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 12/08/2023 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 Review of facility policy, Care Plan - Process, dated 02/12/2020 revealed 6. The Plan of Care identifies the: Date, Problem, Goals measurable and realistic, Time frames for achievement, Interventions discipline specific services and frequency, Resolution/goal analysis, and Discharge option. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 19 of 48 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 12/08/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure the timeliness of each resident's person-centered, comprehensive care plan, and to ensure that the comprehensive care plan is reviewed and revised by an interdisciplinary team for 1 (Resident #26) of 6 residents reviewed for Revised Care Plan. The facility failed to ensure Resident #26's care plan was revised to reflect the specific devices used for Resident #26's impairment. This failure could place the resident at risk of needs not being met. Findings included: Review of Resident #26's Face Sheet dated 12/06/2023 revealed she was an [AGE] year-old female re-admitted to the facility on [DATE]. One of the relevant diagnosis was unspecified joint contracture. Review of Resident #26's Quarterly MDS Assessment, dated 10/29/2023, revealed the resident had a severe impairment in cognition with a BIMS score of 02. Resident #26 was totally dependent upon two or more staff for bed mobility and transfers. She required limited assistance of one staff member for eating. Review of Resident #26's Comprehensive Care Plan, dated 11/02/2023, reflected the resident had a limited range of motion as evidenced by right shoulder subluxation, right hand resting splint, and right ankle plantarflexion due to foot drop. One of the interventions was to use devices, appliances, splints, or positioning pillows as indicated. Review of Resident #26's Physician's order for hand/wrist splint, dated 10/26/2023, reflected MONITOR 1 time per day APPLY Right Hand/Wrist Splint in morning Please check skin integrity under splint. Review of Resident #26's Physician's order for hand/wrist splint, dated 10/26/2023, reflected MONITOR at bedtime REMOVE Right Hand/Wrist Rest Splint at bedtime. Please check skin integrity under splint. Review of Resident #26's Physician Order on 12/06/2023 revealed no order for boots for resident's foot drop to right ankle. Observation on 12/07/2023 at 9:40 AM revealed Resident #26 was being transferred to the wheelchair via Hoyer lift. It was noted Resident #26 had a contracture to the right hand. Before transferring the resident to the wheelchair, CNA Y put a boot on Resident #26's right foot. It was noted there was a hand splint at the bed side table for Resident #26. In an interview with CNA Y on 12/07/2023 at 10:05 AM, CNA Y stated they put the boot on Resident #26 every time they would get her up. CNA Y said she was not sure the exact reason why but what she knew was the boot prevented Resident #26's foot from always pointing. CNA Y said the resident had the boot for a long time, but she could not remember exactly how long. CNA Y added they would put a pillow under Resident#26's right arm when in bed and when the resident was on the wheelchair. According to CNA Y, the nurse was the one that placed the hand splint on as soon as the resident was up. CNA Y (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 20 of 48 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 12/08/2023 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 0657 said she would inform the nurse the resident was already on her wheelchair. Level of Harm - Minimal harm or potential for actual harm In an interview with LVN A on 12/07/2023 at 1:05 PM, LVN A said it was important the staff did an accurate assessment because this was where the order and the care plan would be based off of. She added she did not know about care planning. She added the care plans were done by the ADON. Residents Affected - Few In an interview with MDS Nurse R on 12/07/2023 at 1:54 PM, MDS Nurse R said Resident #26's care plan should reflect the problem area and the specific intervention being done. MDS Nurse R added the care plan should be revised to reflect the current status of the resident. If the care plan was not accurate, there could be a confusion in her care and there would be a risk of the resident not getting the care they needed. In an interview with MDS Nurse I on 12/07/2023 at 2:12 PM, MDS Nurse I added the care plan would be based on the MDS. She further added the care plan must be revised and updated if the resident had any change in condition or if there was a new diagnosis. She further added the care plan should reflect exactly what was being done to the resident to make sure the resident was getting the treatment needed. If the resident was wearing a splint, the care plan should reflect what kind of splint was being used. If the resident was using a boot, the care plan should reflect what kind of boot was being used. If the care plan was not accurate, the staff would not know the resident needed the treatment and the current condition of the resident could worsen. In an interview with DON on 12/07/2023 at 2:36 PM, the DON stated she was not sure if the care plan was based on the MDS. The DON said the care plan was important because this served as a guide for the staff to know what should be done for the resident. If the care plan was not accurate, the current needs of the resident would not be met. If there was a change in condition, fall, new diagnosis, the care plan should be updated. The DON added the care plan should precisely reflect the specific treatment being done for the resident. The DON concluded the expectation was the care plan was accurate and revised to display the current problem list of the resident and the current interventions being done to address the problems. In an interview with OT O on 12/08/2023 at 9:42 AM, OT O stated the care plan should contain accurate interventions for the resident. She said the care plan should specify what kind of splint or what kind of boots the resident was wearing. The intervention part should also reflect when to put it on and when to take it off. Since the resident was re-admitted on [DATE], the care plan should had been revised following the initial assessment. Since the resident had been with the facility for almost five years, the care plan should have been revised to reflect the exact treatment being done for the contracture and the foot drop. In an interview with PT A on 12/08/2023, PT A stated the care plan should reflect the kind of boot she was wearing as well when to put it on and when to take it off. When staff look at a care plan, the staff should have a clear picture of the treatment and not the general treatment. Record review of facility policy, Care Process, Clinical Operations, rev. February 12,. 2020, revealed Standard of Practice: The interdisciplinary team will coordinate with the resident and their legal representative an appropriate care plan for the resident's needs or wishes based on the assessment and reassessment process within the required time frames . 4. Interdisciplinary Team meets & reviews the care plan as follows: Seven (7) days after the closure on the date of the admission MDS, Quarterly and annually, Within fourteen (14) days after a significant change MDS, and With any change of condition FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 21 of 48 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 12/08/2023 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 observations, interviews, and record reviews the facility failed to ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 3 of 6 residents (Residents #49, #50, and #111) reviewed for ADLs care provided to dependent residents. Residents Affected - Some The facility failed to ensure Residents #49, #50, and #111 received showers consistently based on records reviewed for November 2023. This failure could place residents at risk of not receiving necessary services to maintain good personal hygiene, skin integrity, or decreased self- esteem. Findings Included: Record review of Resident #49's Face Sheet, dated 12/08/23, revealed she was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included Alzheimer's disease (severe memory loss), and difficulty in walking. Record review of Resident #49's MDS comprehensive assessment, dated 10/14/18, revealed she had a Brief Interview for Mental Status (BIMS) score of 05 (severe cognitive impairment) and for Activities for Daily Living (ADL) care it stated, for transfers, toileting, and bathing, the resident required assistance and a mechanical lift. Record Review of Resident #49's Care Plan, updated 09/28/23, stated the resident was at risk of skin breakdown and an intervention was to Inspect skin daily with care and bathing, and report any changes to the charge nurse. Observation on 12/05/23 at 11:24 AM of Resident #49, she was observed laying in her bed. Her hair looked ruffled and tangled. The white gown the resident was wearing appeared grimy as well as the linen on her bed. No bad odor was detected from her. Records review of Resident #49's Bath/Shower Sheets from 11/01/2023 - 11/30/2023, revealed the resident was scheduled to receive showers on Tuesdays, Thursdays, and Saturdays. The facility was unable to provide shower sheets for the resident. The only information provided was by the DON after she was advised that staff was unable to produce any documents indicating Resident #49 had received her scheduled showers for the month of November 2023. The DON provided the following document referencing the resident's ADL care. Report titled Result List, dated 12/08/23 reported the following for Bathing: 11/02/23: Does not indicate any type of bath given. 11/04/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. 11/07/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. 11/09/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 22 of 48 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 12/08/2023 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 11/11/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. Level of Harm - Minimal harm or potential for actual harm 11/14/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. 11/16/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. Residents Affected - Some 11/18/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. 11/21/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. 11/23/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. 11/25/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. 11/28/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. 11/30/23: Indicated a bath was provided; however, it does not indicate bed bath or shower. Record review of Resident #50's Face Sheet, dated 12/08/23, revealed she was a 70 -year-old female initially admitted on [DATE]. Relevant diagnoses included fracture of right ankle, muscle weakness, and difficulty in walking. Record review of Resident #50's MDS comprehensive assessment, dated 11/12/23, revealed she had a Brief Interview for Mental Status (BIMS) score of 15 (cognitively intact) and for Activities for Daily Living (ADL) care it stated, for transfers, toileting, and bathing, the resident required substantial assistance. In an interview on 12/05/23 at 11:54 AM with Resident #50, she stated she had been at the facility for nearly a month. She stated she was scheduled to received three showers a week on Tuesday, Thursday, Saturday. She stated she had only received two showers since she had been at the facility, and she would like more showers. She stated she had never refused any showers. She stated when she asked for showers, the CNAs would reply that they are very busy and would only be able to provide her a bed bath . Records review of Resident #50's Bath/Shower Sheets from 11/01/2023 - 11/30/2023, revealed the resident was scheduled to receive showers on Tuesdays, Thursdays, and Saturdays. The facility was unable to provide shower sheets for the resident. The only information provided was by the DON after she was advised that staff was unable to produce any documents indicating Resident #50 had received her scheduled showers for the month of November 2023. The DON provided the following document referencing the resident's ADL care. Report titled ADL Alert Report, dated 12/08/23 reported the following for Bathing: 11/09/23: The comments section stated RES. REFUSED 11/14/23: The comments section stated RES. REFUSED 11/16/23: The comments section stated RES. REFUSED (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 23 of 48 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 12/08/2023 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 11/18/23: The comments section stated RES. REFUSED Level of Harm - Minimal harm or potential for actual harm 11/21/23: The comments section stated RES. REFUSED 11/23/23: The comments section stated RES. REFUSED Residents Affected - Some 11/25/23: The comments section stated RES. REFUSED 11/28/23: The comments section stated RES. REFUSED 11/30/23: The comments section stated RES. REFUSED Record review of Resident #111's Face Sheet, dated 12/08/23, revealed she was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included muscle weakness, lack of coordination, and fall risk. Record review of Resident #111's MDS comprehensive assessment, dated 10/14/18, revealed she had a Brief Interview for Mental Status (BIMS) score of 15 (cognitively intact) and for Activities for Daily Living (ADL) care it stated, for transfers, toileting, and bathing, the resident required substantial assistance. Record Review of Resident #111's Care Plan, updated 11/18/23, stated the resident was at risk of skin breakdown and an intervention was to Inspect skin daily with care and bathing, and report any changes to the charge nurse. In an interview on 12/05/23 at 11:58 AM with Resident #111, she stated she had been at the facility for a few weeks and had not received a shower yet. She stated she had never refused any showers and had asked the CNA for a shower instead of a bed bath, but the CNAs advised her that they did not have someone else available to assist or they did not have time. She stated she would really like a shower . Records review of Resident #111's Bath/Shower Sheets from 11/01/2023 - 11/30/2023, revealed the resident was scheduled to receive showers on Tuesdays, Thursdays, and Saturdays. The facility was only unable to provide shower sheets for the resident . In an interview on 12/08/23 at 01:45 PM with CNA S, she stated Residents #49, #50, and #111 were to receive their showers on Tuesdays, Thursdays, and Saturdays. She stated the CNAs are required to complete a shower sheet every time they provide the resident a shower and the nurse signs off on it as well. She stated that if a resident refused a shower, they must document it and the nurse must also sign it. She stated the residents had received at least bed baths from her and she trieds to give them at least one shower a week. She stated she filled out a shower sheet and turned it into her nurse. She stated the risk of the resident not getting their scheduled showers could result in damage to the skin. She stated she did not provide showers to Residents 49, #50, and #111. In an interview on 12/08/.23 at 02:13 PM with CNA A, she stated she had been at the facility for over a year, and she covered the hall of Resident #49, #50, and #111's. She stated she was familiar with Resident #49, #50, and #111. She stated they are to receive their showers on Tuesday, Thursday, and Saturday. She stated the CNA must complete a shower sheet form and fill it out completely. She stated they must also input the information into the nurses' notes. She stated that if a resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 24 of 48 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 12/08/2023 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 - Some refuseds a shower, she would contacts a nurse, who attempted to get the resident to take a shower. She stated she had given the residents all their showers for the month of November, but she was unable to provide any shower sheets. In an interview on 12/08/23 at 02:43 PM with CNA C, she stated she had been at the facility for 3 years and had been covering Resident #49, #50, and #111's hall for three months. She stated she provided Resident #50 her showers on Tuesday, Thursday, and Saturdays in the afternoon. She stated the resident had been receiving her showers when she was working. She stated they were required to complete shower sheets and document everything. She stated the nurse had to review if the resident refused care. She stated the resident often refused showers. She stated she forgot to fill out the shower sheets for the resident, but she stated she provided at least two showers a week to the resident. She was asked the risk of the resident not receiving her showers and she stated the resident would not be clean and would not smell good. In an interview on 12/08/23 at 02:59 PM with CNA L, she stated she had been at the facility for two weeks. She stated she was unsure when all residents were scheduled to receive their showers. She stated the they were required to complete a shower sheet, whether the resident received a shower or refused. She stated if the resident refused a shower the they must notify the nurse, the nurse would try to talk to the resident, and if the resident still refused, the nurse would document it. She stated the they were required to fill out the shower sheets and the nurses checked to ensure that a shower was provided, and she knows it was being done because she got the shower sheets. She was asked about the shower sheets for Resident #49, 50 and #111 and she stated the CNA must have forgotten to fill it out. She stated the risk of the residents not receiving their showers could result in skin problems. In an interview on 12/08/23 at 03:05 PM with LVN J, she stated she was familiar with Resident #49, 50 and #111 and she stated that she thought the residents did receive their scheduled showers. She stated that the CNAs were not completing resident showers when scheduled so the ADON required all CNAs to complete shower sheets and enter the shower information into the nurses notes. She stated that CNAs are still not completing them consistently. She stated the reason the ADON wanted shower sheets completed was so that they could check the resident's body for any new marks, bruises, or wounds. She stated she was sure the residents had showers sheets filled out and she was sure showers were being conducted. She stated the risk of the resident not receiving their showers could result in skin breakdown. She stated the residents did have showers sheets and that she would locate them and bring them for review, but she never returned with the shower sheets . In an interview on 12/08/23 at 03:09 PM with the DON, she stated she had been at the facility since 2019. She stated residents were assigned even and odd days for showers, and their shifts can be on a Monday, Wednesday, and Friday, or Tuesday, Thursday, and Saturday. She stated residents were supposed to fill out an ADL plan of care which was the care plan that the CNAs work out of. She stated the ADON had an issue with showers not being done so she implemented a policy for the CNA to complete shower sheets. She stated Resident #49, 50 and #111 had received their scheduled showers or refused. She stated the ADON was out of the office and she could not follow up with her where the shower sheets were being stored. I advised her that residents had complained about not receiving their shower and she was also advised that the residents stated that they never refused a shower. The DON left the interview and returned with documents, but the documents did not indicate if the resident received a bed bath or shower. The form also showed resident #5 refused showers. The DON was unable to provide any shower sheets for any of the residents. She stated the risk of residents not receiving their showers could result in infection and skin damage . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 25 of 48 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 (X3) DATE SURVEY COMPLETED A. Building 12/08/2023 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 Record Review of facility policy on BATHING (NOT PARTIAL OR COMPLETED BED BATH), dated January 12, 2018, revealed Staff will provide bathing services for residents within standard practice guidelines. Document bath in EHR. Tasks commonly completed during the bathing process: Residents Affected - Some o Inspect skin, especially those that are showing redness or signs of breakdown o Observe Range of Motion during the bathing process o If discomfort is present, ask the resident to describe and rate the discomfort o Record the procedure in the record o Report abnormal findings to the nurse in charge or the health care provider Multiple refusals of bathing needs shall be discussed with the resident and responsible party during care plan meetings with the interdisciplinary team in order to identify and implement proper hygiene habits and promote resident rights and dignity. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 26 of 48 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 12/08/2023 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that the residents environment remained free of accident and hazards for 2 of 6 residents (Resident #12 and #97) reviewed for accident and hazard free environment. The facility failed to ensure a water leak in Resident #12's bathroom was properly repaired, and the Resident had an accident as a result of the continued water leak. Resident #12 had a hematoma to the front right side of head and a and a bruise to her right arm. The facility failed to prevent employees from bringing their personal dogs into the facility and allowed them to roam unsupervised in the facility's courtyard, which resulted in Resident #97 sustaining an injury. These deficient practices could place the residents at risk for harm, or serious injury. The findings were: A record review of Resident #12's face sheet dated 12/08/23 reflected an [AGE] year-old female admitted on [DATE] with Diagnoses which included: Parkinson's disease (nervous system disorder), muscle weakness, and lack of coordination. Review of Resident #12's quarterly MDS assessment, dated 10/31/23, reflected resident had a BIMS of 13 (cognitively intact), and the Resident required assistance to perform ADL care. Review of Resident #12's Care Plan dated 11/15/23, reflected the resident was care planned for falls and the intervention included Resident at Risk for Falls resident safety will be maintained. Assist resident with toileting needs as needed. A record review of Resident #12's consolidated order dated 12/08/23 reflected additional diagnoses, including rheumatoid arthritis, restless legs syndrome. A record review of the Nurse Notes for Resident #12, dated 11/23/23 by RN L, reflected, 11/23/2023 At about 2am, this Nurse was notified by the assigned CNA that this resident was on the floor. This Nurse observed resident sitting on the floor in the resident's restroom by the commode. Resident stated that she slipped because of wet floor around the commode. Upon assessment, this nurse observed a hematoma to the front right side of head; skin tear to the right arm, and bruise to the right arm. Skin tear cleaned with normal saline, pat dry and sterile strip applied. NP notified; STAT skull series and right arm x-ray ordered. PRN pain medication administered. Vital signs obtained; temp=98.2, hr=63, 02=95%, bp=152/99. SON notified A record review of the Nurses Notes for Resident #12, dated 11/23/2023 by RN L reflected, [PRN (as needed) Administration] 11/23/2023 02:57 AM acetaminophen 500 mg tablet (ACETAMINOPHEN) 1 tablet by mouth every 4 hours As Needed PAIN A record review of the Nurses Notes for Resident #12, dated 11/23/2023 by LVN M reflected, 11/23/2023 F/U (follow-up) related to fall in previous shift, Skull series and x ray to right arm is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 27 of 48 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 12/08/2023 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 performed and waiting for results. Right arm bruised and seen 2 skin tears with steri strips and hematoma to right side of forehead. Level of Harm - Actual harm A record review of the Nurses Notes for Resident #12, dated 11/27/2023 by RN L reflected, 11/27/2023 Residents Affected - Few X-ray results collected. Impression shows negative result. A record review of Wound Care Treatments for Resident #12, dated 11/27/23 by LPN /LVN R reflected, Start: 11/27/23 Skin Tear 1 time per day Skin tear to right forearm- clean with normal saline, pat dry, apply xeroform dressing and cover with dry protective dressing until it resolved Dx : Laceration without foreign body of right forearm, initial encounter In an interview on 12/05/23 at 12:25 PM with Resident #12, she stated her toilet had been leaking and she reported it to staff. She stated the Maintenance Director came to fix it, but he only caulked it. She stated the leaking started again, and she told her son about it and he reported it. She stated the bruise on her face was due to a fall she had in the bathroom, which was a result of her bending over to keep her clothes from getting wet from the water on the floor. She stated she lost her balance and fell. She stated her face hit the wall and she landed on her arm. She stated her arm had a dark bruise on it, but she was healing and there was only dark reddish/purplish bruising around the edge of what she said had been a much larger area. She stated staff came to help her up and they checked her out and helped her to bed. She stated they had X-rays taken and she had not broken anything. She stated she did not have to go to the hospital. She stated after her fall, the Maintenance Director came back to fix the leak again, and there hadn't been any more leaks. In an interview on 12/08/23 at 10:27 AM with Resident #12's family member, he stated that stated he did not know about the leaky toilet until after the resident's fall. He stated he talked to the Administrator about the leak and was told by him that they had re-caulked the base of the toilet; however, the toilet started leaking again, and the resident told the family member about her leaking toilet. The family member stated he had contacted the Administrator to let him know that the toilet was leaking again. He stated the Administrator followed up with him, after the fall to let him know that the seal had been replaced and there should be no more leaks. He stated the resident's fall was around Thanksgiving, but he could not recall the exact date. He stated the resident had not said anything else about the toilet leaking. A record review of Resident #97's face sheet dated 12/08/23 reflected a [AGE] year-old female admitted on [DATE] with Diagnoses which included: Dementia (mental impairment), Weakness of gait and mobility. Review of Resident #97's quarterly MDS assessment, dated 10/12/23, reflected resident had a BIMS of 10 (moderately cognitive), impaired vision, and required touching assistance with most ADLs. Resident required partial/moderate assistance with shower/bathe self and lower body dressing. Review of Resident #97's Care Plan dated 10/18/23, reflected resident was a fall risk and interventions including Assessing the environment to maximize safety. In an interview on 12/05/23 at 11:44 AM with Resident #108 (BIM: 15) he stated he had concerns with dogs running around outside in the courtyard unsupervised. He stated that he would like to go outside some days when it was nice, but he cannot because there were dogs running around, unsupervised, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 28 of 48 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 12/08/2023 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 and he did not want to be harmed by them or have an injury as a result of them. He stated that the dogs had been roaming the Resident courtyard since he had been admitted to the facility on [DATE]. Level of Harm - Actual harm Residents Affected - Few Observation on 12/05/23 revealed a medium sized black dog (poodle) was observed roaming the facility's only courtyard, unsupervised. On 12/06/23, two dogs were observed roaming around the facility's only courtyard unsupervised. One of the dogs was the same from the previous day and the other was a medium sized dog that was a pit bull mixed with another breed. Both dogs weighed approximately 50 to 60 LBS each. During the Survey Resident council meeting on 12/06/23 at 3:00 PM, seven of the nine Resident (Residents #97, #99, #96, #5, #58, #18, #16) voiced concerns for the dogs roaming around the courtyard most of the week unsupervised, because they were fearful of the dogs jumping up on them and causing them to fall or sustain an injury. During the Resident council meeting, Resident #97 stated she had an incident with the pit bull while she was out in the courtyard, and it resulted in her requiring first aid. An interview on 12/07/23 at 9:37 AM with Resident #97, she stated she could not remember when she got the skin tear from the dog. She stated she just remembered she was outside in the courtyard. She stated it was not a small dog, it was one of the two dogs who play in the courtyard. She stated she did not complain to anyone about the dogs because they were sweet dogs, and she did not fear them. She stated she only went to the nurse because she noticed her arm was bleeding and she tried to wipe the blood away with a tissue, but it continued to bleed. She stated she went to the nurse for help and the nurse asked her what happened. She stated kept a notebook of events to help her refer to what happened each day because she would forget. She looked in her book to see if she wrote anything on 11/22/23, which was the day she sustained the scratch. She had documented the event with the dog. She stated she believed it was the brown and white dog because the black one is more calm. She stated she could not really be sure. She then left her room and asked another resident if he remembered which dog, she said scratched her and he said the brown and white one. Her notation in the notebook read, [DATE] Wed. Got a scare from the dog, so they had to really do it up right. I will live. In an interview on 12/07/23 at 09:56 AM with Resident #40, he stated he and Resident #97 sat at the table together for meals. He stated she told them that the brown and white dog was jumping up a lot and she scratched her and caused her to arm to bleed, so the nurse had to fix her up. He stated she did not seem upset, just surprised. He stated she did not get an infection or anything from the scratch. He stated she said she was outside in the courtyard when the dog scratched her. In an interview on 12/07/23 at 11:39 AM with Resident #97's family member, she stated she was told that Resident #97 went out to play with the dogs and one of them jumped up on her while playing with her and accidentally scratched her arm. She stated they told her that the scratch broke the skin and they cleaned the area and put a bandage on it. She stated she came to the facility the next day, 11/23/23, to see her mother and she saw that her arm was clean and there was a folded square of gauze with a piece of clear tape across it, covering the scratched area. She stated the area was small, so she felt better about it, after seeing it. She stated her mother had told her about the two dogs a while ago and she spoke of them with excitement and said they were very playful. She stated the resident asked her to buy tennis balls, so she could throw them around while playing with the dogs. She stated she was not concerned about her mother's safety at the facility or around the dogs. In an interview on 12/07/23 at 12:46 PM with LVN N, she stated Resident #97 told her that the dog was playing with her out in the courtyard and the dog jumped up on her and scratched her on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 29 of 48 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 12/08/2023 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 - Actual harm elbow. She stated the injury was just a small scratch and the skin was slightly raised, and it was bleeding, not a lot, but it was bleeding. She stated she treated the wound by washing it with soap and water, then she bandaged it. She stated she then called the physician, the resident's family member, and she reported it to the Administrator and DON. She stated she did not witness the accident. Residents Affected - Few In an interview on 12/07/23 at 10:37 AM with the Resident #31, she stated the residents had not complained about the dogs. She stated they just talked about the dogs being playful and always jumping around. She stated she did not know if anyone ever reported a complaint or concern about the dogs to staff. She stated the only staff who knew what the residents said about the dogs, was the Activities Coordinator. An interview on 12/07/23 at 10:50 AM with the Activities Coordinator, she stated she had been bringing her dog to the facility for about a year. She stated the brown and white dog was her dog. She stated she would bring her dog on Mondays, Wednesdays, and Fridays. She stated the dog was usually either with her, in her office or outside in the courtyard. She stated she did not ask permission to bring the dog to the facility. She stated she knew that the Administrator loved dogs and he never told her that she could not bring the dog to the facility. She stated the dog had been fully vaccinated. She stated residents had not complained about the dog. She stated they usually just commented on the dog's activities, which they observed through the window. She stated she took the dog to the rooms of the residents who enjoyed seeing her. She stated she thought it was good for the residents because they seemed to light up when dogs were in the building. An interview on 12/07/23 at 11:22 AM with the Administrator, he stated they had a decade-long history of dogs being at the facility. He stated the two dogs observed, had been coming for at least a year. He stated the staff talked to him about bringing the dogs to the facility. He stated the dogs were puppies when they started coming to the facility, so they grew up there. He stated none of the residents had ever expressed any complaints or concerns about the dogs to him. He stated the dogs' owners told him the dogs were fully vaccinated (verified). He stated he had never been concerned about the residents' safety around the dogs. He stated he was not aware that some residents felt uncomfortable going to the courtyard. He stated had he known, he would have made accommodations because the residents came before the dogs. He stated a possible risk of the presence of the dogs in the facility, would depend on the dog, and if the dog showed aggression. He stated if a dog showed aggression toward residents, they would not be allowed at the facility. He was aware that Resident #97 was scratched by one of the dogs. He stated his understanding was that the resident was outside playing with the dog. He stated the feedback from the residents had always been positive. He stated the residents loved the dogs because they are loving, and the residents like to watch them play. In an interview on 12/07/23 at 10:00 AM with the Administrator, he stated he had no policy regarding employees bringing their pets into the facility, he stated he had no discussions with the employees regarding bringing pets into work, and the facility had no requirements for employee's pet to meet prior to gaining approval to bring pets into the facility. In an interview on 12/08/23 02:46 PM the Social Worker , she stated she had been bringing her dog for about eight months. She stated she did not bring her dog every day. She stated she brought her dog sporadically at first and then more regularly. She stated the dog was fully vaccinated. She stated she did not ask permission because she was told the facility had been pet friendly for years. She stated having pets in the facility was pretty much encouraged by the Administrator. She stated residents would say that they enjoyed watching the dogs play from their windows, especially when they were small puppies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 30 of 48 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 12/08/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident who was incontinent of bladder received services and assistance to prevent urinary tract infections for one (Resident #4) of two residents reviewed for urinary incontinence. The facility failed to place Resident #4's indwelling urinary foley catheter device below the bladder. This failure placed the resident at risk for the development of new or worsening urinary tract infections. Findings included: Review of Resident #4's Face Sheet, dated 12/06/2023, reflected resident was an [AGE] year-old female admitted on [DATE]. One of the relevant diagnosis was neuromuscular dysfunction of bladder (The muscles and nerves that control the bladder do not work properly due to illness). Review of Resident #4's Quarterly MDS Assessment, dated 11/22/2023, reflected the resident had a moderate intact cognition with a BIMS score of 10. Resident #4 required extensive assistance for bed mobility, transfer, walk in, dressing, toilet use, and personal hygiene. Section H of the Quarterly MDS Assessment indicated Resident #4 had an indwelling catheter. Review of Resident #4's Comprehensive Care Plan, dated 09/23/2023, reflected the resident had a suprapubic catheter (device inserted into the stomach to the bladder to drain urine) and one of the interventions was keep catheter tubing placed below level of bladder. Review of Resident #4's Physician's order for suprapubic catheter, dated 10/15/2023, reflected Suprapubic catheter 18 Fr (French: unit used to indicate the size of the catheter) every shift continuous gravity drainage and catheter care. Observation on 12/05/2023 at 10:54 AM revealed, Resident #4 was sitting on her wheelchair. Resident #4's indwelling suprapubic catheter bag was positioned to the resident's right side, hanging on the right arm rest of the wheelchair. The catheter bag was at the level of the resident's navel and the tube of the catheter bag was noted on a U-shaped formation. Observation and interview with Resident #4 on 12/05/2023 at 1:34 PM revealed, Resident #4 was still sitting on her wheelchair. Resident #4's indwelling suprapubic catheter was still hanging on the right arm rest of the wheelchair. Resident #4 was noted to have difficulty responding but was able to answer the staff would sometimes put the catheter bag at the bottom of the wheelchair and sometimes at the side of the wheelchair. In an interview with LVN A on 12/06/2023 at 1:52 PM, LVN A stated the catheter bag should be placed below the bladder so the urine would drain effectively. If the catheter bag was higher than the bladder, the urine might not flow efficiently causing urine retainment and urinary bladder infection. LVN A said she would check the placement of the catheter bag for Resident #4. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 31 of 48 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 12/08/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm In an interview with ADON E on 12/07/2023 at 7:32 AM, ADON E stated the correct placement of the catheter bag was below the bladder, so the urine would drain better and would not result to urine retainment. ADON E said putting the catheter bag below the level of the bladder would help keep the urine from flowing back to the bladder. ADON E added if there was backflow of the urine, the resident could suffer from a urinary tract infection. Residents Affected - Few In an interview with the Administrator on 12/07/2023 at 7:51 AM, the Administrator stated he would let the clinician answer about the catheter. The Administrator said the staff should do the right practice with regards to catheter care and should adhere to the policy about catheter care to make sure they were providing the best care. In an interview with the DON on 12/07/2023 at 8:16 AM, the DON stated the catheter bag should be on the right level to ensure the urine would drain via gravity. The DON said the catheter bags should be positioned below the bladder to maintain an unobstructed flow of the urine and so that the bladder would be emptied appropriately. The DON added if the catheter bag is on the level of the bladder, the urine could flow back into the blader from the tubing, which could cause a urinary tract infection. The DON concluded the expectation was the staff would find a way to put the catheter bag below the bladder and said she would re-educate the staff about catheter care. Observation on 12/07/2023 at 5:02 PM revealed, Resident #4's catheter bag was placed at the bottom of the wheelchair. Resident #4 pointed at the catheter bag and made a thumbs up. No distress or refusal noted with the catheter bag being placed at the bottom of the wheelchair. Policy for catheter care and placement requested on 12/06/2023 and 12/07/203. No policy provided for Cather Care and placement but instead gave Care and Removal of an Indwelling Catheter. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 32 of 48 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 12/08/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based observation, interview, and record review the facility failed to ensure that three(Resident #4, Resident #91, and Resident #25) of six residents were provided pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of the residents. The facility failed to ensure CMA W re-ordered medications in a timely manner for Resident # 4 Resident #91, and Resident #25. This failure placed the residents at risk of not receiving medications as ordered by the physician. Findings included: Resident #4 Review of Resident #4's Face Sheet, dated 12/06/2023, reflected resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included unspecified hyperlipidemia (a condition in which there are high levels of fat particles in the blood) and essential (primary) hypertension. Review of Resident #4's Quarterly MDS Assessment, dated 11/22/2023, reflected the resident had a moderate intact cognition with a BIMS score of 10. Resident #4 required extensive assistance for bed mobility, transfer, walk in, dressing, toilet use, and personal hygiene. Review of Resident #4's Comprehensive Care Plan, dated 09/23/2023, reflected the resident was hypertensive. The Comprehensive Care Plan disclosed that Resident #4 was taking clonidine, lisinopril, amlodipine, and labetalol for hypertension. Review of Resident #4's Physician's order for amlodipine, dated 10/15/2021, reflected amlodipine 10 mg tablet (AMLODIPINE BESYLATE) 1 tablet by mouth 1 time per day Hold if Systolic BP Less than 100 Hold if Diastolic BP Less than 60 Hold if Pulse Less than 60 MD Call. Review of Resident #4's Physician's order for lisinopril dated, 09/16/2021, reflected lisinopril 40 mg tablet (LISINOPRIL) 1 tablet by mouth 1 time per day Hold if Systolic BP Less than 100 Hold if Diastolic BP Less than 60 Hold if Pulse Less than 60 * MD Call. Observation on 12/06/2023 at 7:29 AM revealed CMA W was preparing Resident #4's medication. It was noted resident's blister pack (a type of packaging in which a product is sealed in plastic, often with a cardboard backing) for lisinopril only had 3 tablets left and the blister pack for amlodipine had no medication left after CMA W took the last pill. Resident #91 Review of Resident #91's Face Sheet, dated 12/07/2023, reflected that resident was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses included overactive bladder (A bladder control problem which leads to a sudden urge to urinate) and unspecified major depressive disorder. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 33 of 48 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 12/08/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #91's Quarterly MDS Assessment, dated 10/11/2023, reflected Resident #91 had a moderately impaired cognition with a BIMS score of 12. Resident #91 required extensive assistance for bed mobility, transfer, and toilet use. Review of Resident #91's Comprehensive Care Plan, dated 10/28/2023, reflected Resident #91 was on antidepressant and one of the interventions was to administer medication as ordered. Review of Resident #91's Physician Order for sertraline, dated 05/02/2023, revealed sertraline 50 mg tablet (SERTRALINE HCL) 1.5 tablet by mouth 1 time per day give 1.5 tablets to =75mg. Review of Resident #91's Comprehensive Care Plan, dated 10/28/2023, reflected Resident #91 was with urinary incontinence medication and one of the interventions was to administer medication as ordered. Review of Resident #91's Physician Order for oxybutynin, dated 06/12/2023, revealed oxybutynin chloride ER (extend release: type of medication designed to slowly release a drug in the body over an extended period of time) 5 mg tablet, extended release 24 hr (OXYBUTYNIN CHLORIDE) 1 tablet extended release 24hr by mouth 1 time per day. Observation on 12/06/2023 at 7:52 AM revealed Resident #91's blister pack for oxybutynin had 3 tablets left and the blister pack for sertraline had 5 tablets left. Resident #25 Review of Resident #25's Face Sheet, dated 12/08/2023, reflected resident was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses included unspecified hypothyroidism and gastro-esophageal reflux disease without esophagitis. Review of Resident #25's Comprehensive MDS Assessment, dated 10/02/2023, reflected Resident #25 had severe impairment in cognition with a BIMS score of 03. Review of Resident #25's Comprehensive Care Plan, dated 10/21/2023, reflected resident with gastrointestinal discomfort and one of the interventions was to administer medication as ordered. Review of Resident #25's Physician Order for pantoprazole, dated 05/09/2023, reflected, pantoprazole 20 mg tablet, delayed release (PANTOPRAZOLE SODIUM) 1 tablet, delayed release by mouth 1 time per day. Observation on 12/06/2023 at 7:59 AM revealed Resident #25's blister pack for pantoprazole had 3 tablets left. In an interview on 12/06/2023 at 8:36 AM with CMA W, CMA W said he would check the overflow on the medication room to check if there were stocks of the medications that were almost done. He said if there were no stock in the medication room, the pharmacy should be informed so they could include the medications on the delivery. He said the medications should had been re-ordered when the tablets reach the dark blue portion of the blister pack. He added the CMAs and not nurses could re-order the medications. In an interview with ADON E on 12/06/2023 at 9:01 AM, ADON stated re-ordering the medications could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 34 of 48 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 12/08/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some be done in the system or through faxing. ADON E said CMAs and nurses must have a conscious effort to re-order the medications in a timely manner. They should not wait for the medications to run out before they re-order on the system or fax the pharmacy. ADON E said medications should not be re-ordered at the last minute because the residents would not have an adequate supply of medication in circumstances that the delivery was late. ADON E added if the residents do not have their medications, their medical concerns could get worse. ADON E said the expectation was the medications should be re-ordered in a timely manner to make sure that the residents have enough supply of medications. ADON said she would do a medication cart audit to check if the residents had ample number of medications needed. In an interview with LVN A on 12/06/2023 at 1:52 PM, LVN A stated the medications should have been re-ordered when the tablets reach the dark blue portion of the blister pack. LVN A said the medication should be re-ordered four to five days before the medications were consumed. LVN A said the staff who saw the medications were running low should re-order the medications. LVN A added if the medications were not re-ordered, the residents would not have any medications to take and skipping medications could result to exacerbation of the current medical concerns. In an interview on 12/006/2023 at 1:34 PM with CMA W, CMA W stated there were no blister packs in the medication room for Resident # 4 (Lisinopril and Amlodipine), Resident #91 (Oxybutynin and Sertraline), and Resident #25 (Pantoprazole). He said he would go ahead and re-order these medications to make sure the resident would not run out of medications. He said he needed to make sure Resident #4's amlodipine would be delivered today so the resident would have the medication for tomorrow. He added if the residents did not have their medications on time it could cause exacerbation of their current medical situation such as increased anxiety, pain, and blood pressure. In an interview with Administrator on 12/07/2023 at 7:51 AM, the Administrator stated he would let the clinicals answer the questions about re-ordering medications. The Administrator said the staff must make sure that the medications were re-ordered on a timely manner to make sure that the residents have the medications they needed. The Administrator stated the expectation is the resident would not run out of medications. In an interview with the DON on 12/07/2023 at 8:16 AM, the DON stated medications should be re-ordered 3 to 4 days before the pills run out. The DON said if the medications were not re-ordered in a timely manner, the resident would not have the medications they needed. The DON added if the resident did not have their medications, their condition could get worse. The DON said the expectation was to re-order the medications in a timely manner. Record review of facility policy, Ordering and receiving Non-Controlled Medications, Nursing Care Center Pharmacy Policy & Procedure Manual 2010 revealed Policy: Medications and related products are received from the provider pharmacy on a timely basis . b . Reorder routine medications by the re-order date on the label to assure an adequate supply is on hand. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 35 of 48 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 12/08/2023 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure the medication error rate was less than 5% for four medication administration errors identified out of 42 opportunities for one (Resident #26) out of five residents reviewed for pharmacy services. There were three medication errors out of forty two opportunities yielding a medication error of 7.14% Residents Affected - Some 1. The facility failed to ensure CMA W administered 3 capsules of Duloxetine to Resident #26 as ordered. 2. The facility failed to ensure CMA W read the alternate order for Omeprazole for Resident #26. 3. The facility failed to ensure CMA W did not crush medication with do not crush instruction for Resident #26. These failures could place residents at risk of wrong medication administration, mismanagement of care, adverse effects, and physical harm. Findings included: Resident #26 Review of Resident #26's Face Sheet dated 12/06/2023 revealed she was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included major depressive disorder, gastro-esophageal reflux disease (stomach acid repeatedly flows back into the tube connecting your mouth and stomach) without esophagitis (inflammation of the esophagus), and overactive bladder. Review of Resident #26's Quarterly MDS assessment dated [DATE] revealed the resident had a severe impairment in cognition with a BIMS score of 02. Resident #26 was totally dependent upon two or more staff for bed mobility and transfers. She required limited assistance of one staff member for eating. Review of Resident #26's Comprehensive Care Plan dated 10/24/2023 reflected resident was receiving an antidepressant. No care plan noted for gastro-esophageal reflux disease without esophagitis and overactive bladder. Review of Resident #26's Comprehensive Care Plan dated 10/24/2023 reflected resident's medications were crushed due to altered nutritional status. Review of Resident #26's Physician's order for duloxetine dated 10/24/2023 reflected duloxetine 30 mg capsule, delayed release (DULOXETINE HCL) 3 capsule, delayed release(DR/EC) by mouth 1 time per day (3 caps= 90mg total). Review of Resident #26's Physician's order for omeprazole dated 10/24/2023 reflected omeprazole 20 mg capsule, delayed release (OMEPRAZOLE) 1 capsule, delayed release(DR/EC) by mouth 1 time per day ok to interchange omeprazole OTC tab 20 mg for capsule 20mg. Review of Resident #26's Physician's order for oxybutynin dated 10/25/2023 reflected oxybutynin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 36 of 48 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 12/08/2023 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some chloride ER 10 mg tablet, extended release 24 hr (OXYBUTYNIN CHLORIDE) 1 tablet by mouth 1 time per day. Observation and interview on 12/06/2023 with CMA W starting at 8:16 AM revealed CMA W was preparing the medications for Resident #26. CMA W said they crush the medications for Resident #26. It was observed CMA W was placing the medications to be crushed in a small plastic cup. CMA W said he would put the duloxetine in a separate cup because it was a capsule. During preparation, it was noted that CMA W placed 1 capsule of duloxetine in the small cup ( order said to give 3 capsules). CMA W continued to prepare for the other medications to be crushed. One of the medications he placed on the cup was oxybutynin. The blister pack of oxybutynin had an instruction of do not crush. CMA W continued to prepare for the medications to be crushed and was observed looking for the blister pack of omeprazole. CMA W said he did not have a blister pack for omeprazole. CMA W said he would not be able to give Resident #26 her omeprazole because it was not on the cart. CMA W crushed the medications, opened the capsule, put some apple sauce, and gave the medications to Resident #26. In an interview on 12/06/2023 at 1:32 PM with CMA W, CMA W was advised the blister pack for Resident #26's blister pack for oxybutynin indicated do not crush. CNA W stated he did not notice the instruction. He added there should have been an order for a crushable oxybutynin. CMA W said he should be careful and read the orders very well so he would give the right dosage and could follow the instructions. CMA W said that could have resulted in medication error and the residents would not receive the right medications. CMA W stated the medication error could lead to the residents not getting better. In an interview with ADON E on 12/07/2023 at 7:32 AM, ADON E stated in administering medications, the staff giving the medications should make sure they were reading the order and comparing the blister pack to the order in the system. Reading the order were needed to ensure it was the right resident, the right medication, the right dosage, the right route. This was also to check if there were instructions on how to give the medications. If the instruction said, do not crush, the medication should not have been crushed because the medication would lose its potency. If the order said to give three capsules, the staff should prepare 3 capsules of the medication because giving a less dose could make the medication ineffective. ADON E further added Resident #26's order indicated resident could have had over-the-counter omeprazole. ADON E continued CMA W must have missed it. ADON concluded she would monitor the staff administering the medications, give re-education, audit the medication carts, and make sure the medications correlate with the eMAR and the order in the package. In an interview with the Administrator on 12/07/2023 at 7:51 AM, the Administrator stated he would let the clinician answer about the administering medications. The Administrator said whatever the procedure was in giving the medications, it should have been followed to prevent any errors. In an interview with the DON on 12/07/2023 at 8:16 AM, The DON stated a medication should not be crushed if the instruction said do not crush. This would lessen the effectiveness of the medication. The DON said she called the MD to get an order for a crushable oxybutynin. The DON continued that whoever was administering the medications should read the order to ensure accurate medication preparation and if there was an alternate order. This should be done to prevent a medication error. The DON said the expectation was for the staff to check the orders to accurately prepare the medications. The DON concluded she would get on top of this issue, re-educate the staff, and conduct in-services. Observation and interview on 12/07/2023 at 8:39 AM with CMA W, CMA W stated he missed the order for Resident #26's order for omeprazole stating he could have given over-the-counter omeprazole. CMA W (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 37 of 48 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 12/08/2023 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 0759 opened the first drawer and took the medication bottle for omeprazole. Level of Harm - Minimal harm or potential for actual harm Record review of facility's policy Medication Administration, Nursing Care Center Pharmacy Policy & Procedure Manual 2007 revealed Policy: Medications are administered as prescribed in accordance with manufacturers' specifications, Residents Affected - Some good nursing principles and practices . 3. Prior to administration, review and confirm medication orders for each individual resident on the Medication Administration Record. Compare the medication and dosage schedule on the resident's MAR with the medication label. If the label and MAR are different, and the container is not flagged indicating a change in directions, or if there is any other reason to question the dosage or directions, the prescriber's orders are checked for the correct dosage schedule. Apply a direction change sticker to label if directions have changed from the current label . a. The need for crushing medications is indicated on the resident's orders and the MAR so that all personnel administering medications are aware of this need and the consultant pharmacist can advise on safety and alternatives, if appropriate, during Medication Regimen Reviews . b. Long-acting, extended release or enteric-coated dosage forms should generally not be crushed; an alternative should be sought . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 38 of 48 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 12/08/2023 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed the medication was labeled in accordance with currently accepted professional principles and include the appropriate accessory and cautionary instructions for one (Resident #4) of two residents reviewed for labelling of drugs and biologicals. The facility failed to ensure CMA W placed a change of instruction label for Resident #4's Phenytoin after a change to the order. This failure could place residents at risk of wrong medication administration, mismanagement of care, adverse effects, and physical harm. Findings included: Review of Resident #4's Face Sheet dated 12/06/2023 reflected the resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses include allergic rhinitis (an allergic reaction to tiny particles in the air called allergens) and seizures. Review of Resident #4's Quarterly MDS assessment dated [DATE] reflected resident had a moderately impaired cognition with a BIMS score of 10. Resident #4 required extensive assistance for bed mobility, transfers, walk in room, dressing, toilet-use, and personal hygiene. Review of Resident #4's Comprehensive Care Plan dated 09/23/2023 reflected resident was taking an anticonvulsant and one of the intervention was to administer medication as ordered. Review of Resident #4's Physician's order for phenytoin dated 11/27/2023 reflected phenytoin sodium extended 100 mg capsule (PHENYTOIN SODIUM EXTENDED) 1 capsule by mouth 3 times per day. Review of Resident #4's discontinued Physician's order for phenytoin dated 11/27/2023 reflected phenytoin sodium extended 100 mg capsule (PHENYTOIN SODIUM EXTENDED) 2 capsules by mouth 1 time per day. Observation and interview on 12/06/2023 starting at 7:29 AM with CMA W revealed CMA W was preparing the medications for administration to Resident #4. The CMA pushed one capsule for Phenytoin 100 mg. The blister pack indicated to give 2 capsules. CNA W said the order in the system said to give 1 capsule. CMA W said there should have been a change in instruction note placed on the blister pack to ensure the right dosage of medication and avoid medication error. In an interview with ADON E on 12/07/2023 at 7:32 AM, ADON E stated in administering medications, the staff giving the medications should make sure they were reading the order and comparing the blister pack with the order in the system. ADON E said if there was change in order, the blister pack should have a note of change of direction to avoid medication error, undermedication, overmedication, or confusion among the staff. ADON E added the nurses or the CMAs could place a change in order instruction. ADON concluded she would monitor the staff administering the medications, give re-education, audit the medication carts, and make (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 39 of 48 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 12/08/2023 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 sure the medications correlate with the eMAR and the order in the package. Level of Harm - Minimal harm or potential for actual harm In an interview with the Administrator on 12/07/2023 at 7:51 AM, the Administrator stated he would let the clinician answer about the administering medications. The Administrator said whatever the procedure was in giving the medications, it should have been followed to prevent any errors. Residents Affected - Few In an interview with the DON on 12/07/2023 at 8:16 AM, the DON stated the staff should have placed a change in order instruction on the blister pack to avoid confusion. The DON said the staff should have been alerted if he saw there was a difference with the order in the blister pack and the order in the system. The DON said the risk were overmedication or undermedication which could have an adverse effect for the residents. The DON said the expectation was to provide the right dosage of medication as per order. Record review of facility's policy Medication Administration, Nursing Care Center Pharmacy Policy & Procedure Manual 2007 revealed Policy: Medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices . 3 . If the label and MAR are different, and the container is not flagged indicating a change in directions, or if there is any other reason to question the dosage or directions, the prescriber's orders are checked for the correct dosage schedule. Apply a direction change sticker to label if directions have changed from the current label . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 40 of 48 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 12/08/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure food was stored, prepared, distributed and served in accordance with professional standards for food service safety for the facility's only kitchen reviewed for kitchen sanitation. The facility failed to ensure foods in the facility's dry storage area, refrigerators, and freezer were labeled and dated according to guidelines and in a sanitary manner. The facility failed to ensure damaged food can was discarded according to guidelines. The facility failed to ensure the Dietary Manager wore a hair cover for his head. The facility failed to ensure the kitchen was clean and sanitized. These failures could place residents at risk for cross contamination and other foodborne illnesses. Findings included: Observations on 12/05/23 from 09:10 AM to 09:30 AM in the facility's only kitchen revealed: The ice machine had dark black dirt stains along the inside door of the machine and along the inside walls of the machine. The lid of the ice machine hinges had rust and brownish dirt [NAME] in the springs of the door hinges. Just above the ice was a white panel that had black dirt grit sprinkled along the edge. The outside of the ice machine had white water stains going down the machine. Two large pitchers of a red liquid and one large pitcher of an orange liquid were unlabeled and undated in the stand-alone refrigerator. Three sandwiches (could not identify type) were unlabeled and undated. Four small bowls of puddings were not labeled and dated. Four serving containers containing four types of salad dressing, were unlabeled and undated. One serving container of syrup was dated 05/03. Six small cups of milk in a standalone refrigerator had a use by date of 12/04. One large container of cheerios was uncovered and exposed to the air pollutants in the dry storage room. A kitchen staff's purse was observed on a kitchen shelf next to an opened and exposed container of ground cinnamon. One container of white powdery substance was unlabeled and not concealed from air pollutants. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 41 of 48 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 12/08/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm The front of the dual stove/oven, including the knobs to the stove had built up grease stains. There was also thick grease dirt build up abelong the bottom vents of the stove/oven. The floor in the dry food storage area under the food racks had thick black dirt [NAME], especially along the back walls. Residents Affected - Many A large red cup with a white napkin covering it, belonging to a kitchen staff member, was in the dry storage area. A green jacket was laying on top of an opened box of foam plates. One 6 LB. can of salsa with a large dent. Two drawers full of serving utensils had dirt particles sprinkled along the bottom of the drawers. The grease in the fryer was dark brown in color and it had a burnt smell. Along the walls of the inside of the fryer had thick dark brown dirt greases. One of the fans in the freezer had thick ice built up between the blades. One loaf of Artisan Bread was undated and no visible expiration date. One package oif flour tortillas was undated and no visible expiration date. Fourteen individual bowls of yellowish pudding were unlabeled and undated. Eight individual bowls of a pinkish pudding were unlabeled and undated. One loaf of gluten free white bread was undated and no visible expiration date. The thermometer inside of the freezer showed a temperature of 54 degrees and the external thermometer attached to the freezer displayed a temperature of 41 degrees. Three package of corn tortillas with an expiration date of 09/28/23 was observed in the walk in refrigerator. In the walk-in refrigerator there was a Walmart bag with a can of coca cola and bottle of water in it. One zip locked bag of meat (unknown) was open to air pollutants and not concealed. One (approximately 1 lb.) loaf of ham was not concealed and opened to air pollutants in the walk-in refrigerator. One wrapped taco from a fast-food restaurant was in the walk-in refrigerator. One large tray containing a large stack of cheder cheese, a large stack of white cheese, a bowl of pickles, a bowl of red onions, a bowl of tomatoes, and a stack of lettuces was not concealed and was opened to air pollutants in the walk-in refrigerator. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 42 of 48 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 12/08/2023 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 0812 The kitchen floors had thick built-up black dirt particles along the corners of the walls. Level of Harm - Minimal harm or potential for actual harm Observation and interview with the Dietary Manager on 12/05/23 at 09:15 AM revealed, he was observed working in the kitchen area without a head covering for the hair on his head. The DM was observed to have of at least an eighth of an inch in length of hair. He stated he normally shaved his head and had forgotten to do so. He stated the risk of not wearing a head covering could result in hair falling in the food and contaminating it. He was shown the personal foods and items that appeared to belong to staff in the dry storage area and walk-in refrigerators and he stated that they did belong to the kitchen staff but should not have been in those areas. He stated there was a risk of cross contamination . Residents Affected - Many In an interview with the Dietary Manager on 12/07/23 at 2:00 PM, he stated he had addressed all of the concerns that were observed during the initial walk through. He advised that he had removed the expired foods and the damaged food cans. He stated he was still training his staff on proper labeling and dating the food as the inventory comes in and check for any foods that were expired. The DM was shown pictures referencing the cleanliness of the kitchen and he stated that they cleaned the kitchen weekly and had not cleaned it yet this week. He stated the concerns addressed could result in food contamination and the residents getting sick. He stated he had In-serviced his kitchen staff on food storage. In an interviews with the Administrator on 12/08/23 at 12:33 PM, he stated he had met with the Dietary Manager and advised of all the concerns observed on 12/05/23 in the facility's only kitchen and stated that he worked closely with the Dietary Manager to address the concerns observed. He stated the risk of not addressing the concerns could result in food contamination and residents getting sick. Record Review of the Facility's policy on Food Storage and Supplies dated August 1, 2018, revealed Sufficient storage facilities are provided to keep foods safe, wholesome, and appetizing. Food is stored, prepared, and transported at an appropriate temperature and by methods designed to prevent contamination. Air-tight containers or bags are used for all opened packages of food. All containers are accurately labeled with the item and date opened. All foods are covered, labeled, and dated. Temperature for the freezer is 0 degrees Fahrenheit or below. Foods are covered, labeled, and dated. Any item out of the original case must be properly secured and labeled. Food and nutrition staff wear hair restraints (hair net, hat, beard restraint, etc.) so that hair does not contact the food. Review of the U.S. Food and Drug Administration (FDA) Code (2022) revealed, PACKAGED FOOD shall be labeled as specified in LAW, including 21 CFR 101 FOOD Labeling, 9 CFR 317 Labeling, Marking Devices, and Containers, and 9 CFR 381 Subpart N Labeling and Containers, and as specified under § 3-202.18. FOOD shall be protected from contamination that may result from a factor or source not specified under Subparts 3-301 - 3-306. (A) Except as provided in (B) of this section, FOOD EMPLOYEES shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from FDA Food Code 2022 Chapter 2. Management and Personnel Chapter 2 - 22 contacting exposed FOOD; clean EQUIPMENT, UTENSILS, and LINENS; and unwrapped SINGLE-SERVICE and SINGLE-USE ARTICLES. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 43 of 48 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 12/08/2023 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based 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 3 (Residents #26, Resident #63, and Resident #4) of ten residents observed for infection control. Residents Affected - Some 1. The facility failed to ensure CNA Z performed hand hygiene between resident (Resident #26 and Resident #63) care in the dining room on 12/05/2023 between 12:19 PM and 12:40 PM. 2. The facility failed to ensure CMA W sanitized the blood pressure cuff between Resident #4 and Resident #26. 3. The facility failed to ensure CMA W washed her hands wore gloves before administering nasal spray to Resident #4. These failures could place the residents at risk of cross-contamination and development of infections. Findings included: 1. Review of Resident #26's Face Sheet dated 12/06/2023 revealed she was an [AGE] year-old female re-admitted to the facility on [DATE]. Relevant diagnoses included metabolic encephalopathy (syndrome of a chemical imbalance in the blood that causes neurological deficits,) right side contractures (abnormal thickening of the tissues which causes decease in movement and mobility,) and aphasia following cerebral infarction (loss of ability to understand or express speech caused by brain damage.) Review of Resident #26's Quarterly MDS assessment dated [DATE] revealed she was severely cognitively impaired with a BIMS score of 02. Resident #26 was totally dependent upon two or more staff for bed mobility and transfers. She required limited assistance of one staff member for eating. Review of Resident #26's comprehensive care plan revealed she had altered nutritional status . (dated) 10/24/2023 Her goal included she would be comfortable with food and fluids provided over the next 90 days and would have snacks provided between meals . daily. Additional review revealed she had Impaired Physical Mobility 10/24/2023 . related to History of Stroke. Resident #26's goal included to maintain or improve physical function .locomotion, and ROM over the next 90 days. Related intervention included to Provide appropriate level of assistance to promote safety of resident. There was no evidence of care interventions related to dining and/or assistance related to dining was determined. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 44 of 48 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 12/08/2023 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #63's face sheet dated 12/06/2023 revealed she was an [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnoses included cerebral infarction (disruption of blood flow to the brain due to problems with the blood vessels that supply the brain,) malaise (general feeling of discomfort,) edema (swelling caused by too much fluid trapped in the body's tissues,) stage 2 kidney disease (mild kidney damage,) flaccid hemiplegia affecting the left side (decreased muscle tone that cannot be actively moved by the patient,) dementia (group of conditions characterized by impairment of brain functions,) and epilepsy (disorder of brain activity.) Review of Resident #63's admission MDS dated [DATE] revealed she was unable to complete the BIMS assessment but she was documented as having short and long-term memory problems. Resident #63 required extensive assistance of two or more staff members for bed mobility and transfers. She required extensive assistance of one staff member for eating. Review of Resident #63's comprehensive care plan on 12/06/2023 at 3:05 PM revealed she had altered nutritional status . (dated) 11/27/2023 . related to dentures, chewing difficulty, and use of diuretics, laxatives, and/or cardiovascular drugs. Her goal included she would maintain her weight over the next 90 days. Relevant intervention included provide necessary assistance with food and fluids. In an observation on 12/05/2023 at 12:19 PM, CNA Z was sitting in a chair in the dining room, positioned between Resident #26 and Resident #63. CNA Z assisted Resident #26 and Resident #63 by taking her right hand, obtaining resident spoon, and providing a spoon full of food to their mouths. CNA Z assisted Resident #26 then Resident #63 then going back to Resident #26 then back to Resident #63. This was repeated approximately 7 times during the dining observation. CNA Z failed to perform hand hygiene between each resident contact. In an interview with CNA Z on 12/05/2023 at 12:37 PM, she stated that she was aware it was not best practice to assist two residents simultaneously. She stated she did not know why necessarily, but it was not best practice. She stated on that day she had to assist two residents because of short staffing. She stated she did not need to perform hand hygiene between resident care because she used a spoon with each resident and her hand was protected with use of the spoon. In an interview with ADON K on 12/07/2023 at 3:29 PM, she stated her expectations were for staff to only provide assistance to one resident at a time. She stated that she expected staff to perform hand hygiene between resident assistance because there could be an infection control risk. In an interview with ADON E on 12/07/2023 at 3:30 PM, she stated her expectations were for staff to only provide assistance to one resident at a time. She stated she expected staff to perform hand hygiene between resident care and contact because there could be a risk of cross contamination and infection control. In an interview with DON on 12/07/2023 at 3:39 PM she stated she prefers staff not to provide assistance for two residents in the dining room at one time. She stated that she expected staff to perform hand hygiene between resident assistance because of the risk for infection control concerns. 2. Review of Resident #4's Face Sheet dated 12/06/2023 reflected resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included unspecified hyperlipidemia and essential (primary) hypertension (blood pressure is consistently high). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 45 of 48 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 12/08/2023 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #4's Quarterly MDS assessment dated [DATE] reflected resident had moderate intact cognition with a BIMS score of 10. Resident #4 required extensive assistance for bed mobility, transfer, walk in, dressing, toilet use, and personal hygiene. Review of Resident #4's Comprehensive Care Plan dated 09/23/2023 reflected resident was hypertensive. The Comprehensive Care Plan disclosed that Resident #4 was taking clonidine, lisinopril, amlodipine, and labetalol for hypertension. Review of Resident #4's Physician's order for clonidine dated 04/20/2021 reflected clonidine HCl 0.1 mg tablet (CLONIDINE HCL) 1 tablet by mouth 3 times per day As Needed HIGH BP If Systolic BP Greater than 160 Or Diastolic BP Greater than 90 MD Call. Review of Resident #4's Physician's order for amlodipine dated 10/15/2021 reflected amlodipine 10 mg tablet (AMLODIPINE BESYLATE) 1 tablet by mouth 1 time per day Hold if Systolic BP Less than 100 Hold if Diastolic BP Less than 60 Hold if Pulse Less than 60 MD Call. Review of Resident #4's Physician's order for lisinopril dated 09/16/2021 reflected lisinopril 40 mg tablet (LISINOPRIL) 1 tablet by mouth 1 time per day Hold if Systolic BP Less than 100 Hold if Diastolic BP Less than 60 Hold if Pulse Less than 60 * MD Call. Review of Resident #4's Physician's order for labetalol dated 11/26/2023 reflected labetalol 200 mg tablet (LABETALOL HCL) 1.5 tablet by mouth 2 times per day GIVE 1.5 TABLETS TO = 300MG TOTAL Hold if Systolic BP Less than 100 Hold if Diastolic BP Less than 60 Hold if Pulse Less than 60 * MD Call. Review of Resident #26's Face Sheet dated 12/06/2023 reflected resident was an [AGE] year-old female with diagnoses of cognitive communication deficit and essential (primary) hypertension. Review of Resident #26's Comprehensive Care Plan dated 10/24/2023 reflected resident was hypertensive and was taking amlodipine, losartan, and metoprolol. Review of Resident #26's Physician's order for amlodipine dated 10/24/2023 reflected amlodipine 5 mg tablet (AMLODIPINE BESYLATE) 1 tablet by mouth 1 time per day Hold if Systolic BP Less than 100 Hold if Diastolic BP Less than 60 Hold if Pulse Less than 60 * MD Call. Review of Resident #26's Physician's order for losartan dated 10/24/2023 reflected losartan 100 mg tablet (LOSARTAN POTASSIUM) 1 tablet by mouth 1 time per day Hold if Systolic BP Less than 100 Hold if Diastolic BP Less than 60 Hold if Pulse Less than 60 * MD Call. Review of Resident #26's Physician's order for metoprolol dated 10/24/2023 reflected metoprolol tartrate 25 mg tablet (METOPROLOL TARTRATE) 1 tablet by mouth 1 time per day Hold if Systolic BP Less than 100 Hold if Diastolic BP Less than 60 Hold if Pulse Less than 60 * MD Call. Observation on 12/06/2023 at 7:29 AM revealed CMA W picked up the blood pressure cuff from the medication cart. CMA W placed the blood pressure cuff on Resident #4's arm. After the blood pressure reading was completed, CMA W placed the blood pressure cuff on top of the medication cart and then prepared and gave the medications to Residents #4. Observation on 12/06/2023 at 8:16 AM revealed CMA W picked up the blood pressure cuff from the medication cart. The blood pressure cuff was not sanitized after using it for Resident #4. CMA W placed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 46 of 48 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 12/08/2023 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the blood pressure cuff on Resident #26's arm. After the blood pressure reading was completed, CMA W placed the blood pressure cuff on the medication cart. CMA W prepared and gave the medications to Resident #26. In an interview and observation with CMA W on 12/06/2023 at 1:34 PM, CMA W stated he obtained the blood pressure of the residents before giving the medication for hypertension to know if the medication needed to be held or not. CMA W said the right thing to do was to wash or sanitize hands before and after giving medications. When asked what should be done after using the blood pressure cuff, CMA W replied the blood pressure cuff should be sanitized after using it and before using it on another resident. CMA W then acknowledged he forgot to sanitize the blood pressure cuff in between residents when he passed medications that morning. CMA W pulled the last drawer of the medication cart and took a sanitizing container with a purple top. CMA W stated not sanitizing the blood pressure cuff in between residents could cause infection to transfer from one resident to another. In an interview with LVN A on 12/06/2023 at 1:52 PM, LVN A stated all the items being used for the resident should have been cleaned. LVN A said the principle of infection control was true even with the nasal cannula, the breathing masks, their bed, or their wheelchair. If the blood pressure cuff was not sanitized, it could result in many and various kinds of infection. LVN A added if a resident already had an infection, that infection could be transferred to another resident because the reusable item was not sanitized. 3. Review of Resident #4's Face Sheet dated 12/06/2023 reflected the resident was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses include allergic rhinitis (an allergic reaction to tiny particles in the air called allergens). Review of Resident #4's Physician's order for Flonase dated 12/15/2022 reflected Flonase Allergy Relief 50 mcg/actuation nasal spray, suspension (FLUTICASONE PROPIONATE) 1 Spray, Suspension Instill in Both Nares (nostrils) 1 time per day. Observation and interview on 12/06/2023 starting at 7:29 AM with CMA W revealed CMA W was preparing the medications for administration to Resident #4. CMA W took the nasal spray from the top of the medication cart. CMA W went to Resident #4 and administered the nasal spray to both nostrils. CMA W did not wash his hands before administering the nasal spray and did not wear gloves during administration of nasal spray. CMA W also did not wash his hands after administering the nasal spray. CMA W acknowledged that he did not wash his hands prior to giving the nasal spray and did not wear gloves during the administration of the nasal spray. He said not wearing gloves could result to cross contamination. In an interview with ADON E on 12/07/2023 at 7:32 AM, ADON E stated that the blood pressure cuff should have been sanitized after every use or after every resident. ADON E said that if the blood pressure cuff is not sanitized, it could cause cross contamination and infection could spread. ADON E said that the expectation was for the blood pressure cuff to be sanitized in between residents. ADON E added when providing a nasal spray, the one providing should wash their hands and wear gloves during administration to prevent infection and cross contamination. ADON E said the staff should also wear gloves when administering eye drops or anything that had a possible contact with body fluid. In an interview with the Administrator on 12/07/2023 at 7:51 AM, the Administrator stated that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 47 of 48 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 12/08/2023 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some expectation was for the staff to wear gloves when giving nasal spray and clean the blood pressre cuff in between residents to prevent infection. The Administrator said all staff should adhere to the policy of infection control to ensure the safety of the residents. In an interview with the DON on 12/07/2023 at 8:16 AM, the DON stated that ADON E made her aware of the infection control issues. The DON stated that the blood pressure cuff should have been sanitized every after use. She said that not sanitizing the blood pressure cuff could cause cross contamination or development of new infections. The DON added this could clearly cause a lot of medical issues. The DON said the staff should have washed their hands before administering the nasal spray and wear gloves during the process of giving the nasal spray. She said this was a standard precaution when touching an area with possible bodily fluid. She said this should be done to prevent infection and cross contamination among the residents and among the staff as well. The DON further added she would re-educate the staff regarding infection control and closely monitor if they were following the policy and procedure of infection control. In an interview with RN P on 12/07/2023 at 9:26 AM, RN P stated that he had been with the facility for a year. RN P stated that the blood pressure cuff should have been sanitized in between residents. If the blood pressure cuff was not sanitized, it could cause cross contaminations and infection control issues. Review of facility policy, Assisting Residents with Eating, dated 01/12/2018 revealed Standard of Practice: Qualified nursing staff . will assist the Resident who is unable to feed self in order to promote adequate nutrition and to help the resident enjoy a satisfying meal . Procedure: Perform Hand Hygiene . Provide assistance to resident . Perform Hand Hygiene. Record review of facility's policy Cleaning, Disinfecting and Sterilizing Resident Care Equipment, Policy and Procedure rev. August 2018 revealed Policy: Equipment will be maintained and kept sanitized or disinfected in accord with acceptable policies . Such items include blood pressure cuffs and other medical accessories . it is imperative that these items are clean. Record review of facility's policy Medication Administration, Nursing Care Center Pharmacy Policy & Procedure Manual 2007 revealed 11. Hands are washed with soap and water and gloves applied before administration of topical, ophthalmic, optic, parenteral, enteral, rectal, and vaginal medications. Hands are washed with soap and water again after administration and with any resident contact. Antimicrobial sanitizer may be used in place of soap and water as allowed per state nursing regulations and facility policy. Note: Soap and water should always be used after. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676192 If continuation sheet Page 48 of 48