Health inspection·August 28, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm was responsible for answering the call lights. She said the CNAs were responsible for ensuring the call lights were within reach after they provided care to the resident. Record review of the facility's policy Bedrooms revised May 2017, indicated .6. All resident rooms are equipped with a resident call system that allows residents to call for staff assistance. Calls are directed to either a staff member or to a centralized work area. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 2 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the resident mail was delivered promptly and unopened for 1 of 10 residents (Resident #62) reviewed for communication. The facility failed to ensure that mail was delivered to Resident #62 unopened. This failure could place residents at risk of not receiving mail in a prompt and private manner and could result in a loss of personal property, frustration, and loss of dignity for the residents who reside at the facility.Findings included:Record review of Resident #62's face sheet, dated 08/28/25, reflected Resident #62 was a [AGE] year-old female readmitted to the facility on [DATE] with a diagnosis which included COPD (chronic inflammatory lung disease that causes obstructed airflow from the lungs). Record review of Resident #62's quarterly MDS assessment, dated 07/23/25, reflected Resident #62 usually made herself understood, and usually understood others. Resident #62's BIMS score was 13, which reflected her cognition was intact. Record review of Resident #62's comprehensive care plan, revised on 03/12/25, reflected Resident #62 had an ADL self-care performance deficit related to disease processes. The care plan did not reveal that the resident needed any assistance with opening packages. During a group meeting on 08/26/25 at 10:46 a.m., Resident #62 stated she ordered some items from amazon and the nurse opened her box without asking. Resident #62 stated the nurse told her I just wanted to make sure you didn't have any medications inside it. Resident #62 stated she told the nurse, I could have opened it in front of you, you didn't have to open my package. During an interview on 08/26/25 at 2:55 p.m., LVN A stated she was not aware residents were supposed to receive unopened mail. LVN A stated she was told by the receptionist she believed it was medicine because of the way the package sounded when it was shaken. LVN A stated when she opened the package it was makeup brushes. LVN A stated Resident #62 was upset when she delivered her package opened. LVN A stated that it would be against their rights if she did not get permission. During an interview on 08/26/25 at 2:58 p.m., Resident #62 stated, I was offended when she told me why the packaged was opened. Resident #62 stated she was aware she was not supposed to have medication delivered to the facility. During an interview on 08/27/25 at 8:52 a.m., the receptionist stated she was the only receptionist that delivered mail to residents. The receptionist stated she did not recall telling LVN A she thought Resident #62 packaged included medications. The receptionist stated whenever she delivers mail to residents the packages were unopened. The receptionist stated it was their right to receive unopened mail. During an interview on 08/28/25 at 1:50 p.m., the DON stated the receptionist takes the mail to the social worker to distribute the mail. The DON stated she was made aware this week that LVN A opened Resident #62 without her being present because she was thought it was medication. The DON stated if there was a policy and procedure regarding mail distribution the policy should be followed. The DON stated it was Resident #62 right to received mail unopened. During an interview on 08/28/25 at 3:39 p.m., the Administrator stated her expectation was for staff to deliver the mail to the resident unopened. The Administrator stated she was not aware LVN A opened the mail prior to delivering the resident. The Administrator stated if she had of known she would have given her three days of suspension and would have reported to HHSC. The Administrator stated she monitored by daily rounds by engaging with residents. The Administrator stated it was important residents received their mail unopened because it was their right. Record review of the facility's policy titled, Resident Rights, revised 12/2016 reflected. 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: cc. access to a telephone, mail and email. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 3 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure PRN orders for psychotropic drugs were limited to 14 days for 1 of 5 residents reviewed for unnecessary psychotropic drugs (Resident #9). The facility failed to ensure Resident #9's PRN Ativan (antianxiety medication) was discontinued within 14 days or reevaluated by the prescribing practitioner. This failure could place residents at risk of receiving unnecessary psychotropic medications with possible medication side effects, adverse consequences, decreased quality of life and dependence on unnecessary medications.Findings included: Record review of Resident #9's face sheet dated 08/28/25, indicated a [AGE] year-old female who initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #9 had diagnoses of Alzheimer's disease (a progressive brain disorder that causes memory loss, confusion, and other cognitive decline), diabetes mellitus type 2 (chronic metabolic disorder characterized by high blood sugar levels), and dysphagia (difficulty swallowing). Record review of Resident #9's significant change in status MDS assessment dated [DATE], indicated she was usually understood and usually understood others. Resident #9's BIMS score of 3, which indicated her cognition was severely impaired. The MDS assessment did not reflect Resident #9 had received an antianxiety medication within the 7-day look back period. Record review of Resident #9's comprehensive care plan revised 07/10/25, indicated Resident #9 received an antihistamine related to her anxiety. The care plan interventions indicated to administer antihistamine medications as ordered by the physician and to monitor for side effects and effectiveness every shift. Record review of Resident #9's order summary report dated 08/28/25, indicated she had an order for Ativan 0.5mg one tablet every 6 hours as needed for anxiety with a start date of 07/29/25. The order did not have an end date. Record review of Resident #9's nurse MAR dated 08/01/25-08/31/25, indicated Resident #9 had received one tablet of Ativan 0.5mg on the following days:*08/12/25 at 3:20 PM*08/13/25 at 4:00 PM*08/20/25 at 6:45 AM Record review of the psychotropic and sedative/hypnotic utilization by resident report dated 08/14/25, indicated Resident #9 was receiving Ativan 0.5mg every 6 hours PRN anxiety. The report indicated the need for a time frame from hospice. During an interview on 08/28/25 at 12:57 PM, the DON said when a resident was admitted to hospice and the PRN Ativan order does not have a stop date, they reached out to the hospice company for clarification. She said the ADON and herself review psychotropic medications every Wednesday as well as the pharmacy recommendations. She said she was unsure of how the medication was missed. She said the pharmacy recommendations did not indicate Resident #9 needed a time frame for her PRN anxiety medication. The DON reviewed Resident #9's EMR and said she could not find a hospice note to indicate the need for continued use of PRN Ativan. During an interview on 08/28/25 at 1:16 PM, the Administrator said the hospice companies usually wrote a note which indicated the reason for the extended use of the medication. The Administrator said after that the medication was reassessed for continued use. She said failure to reassess the need for the continued medication could place the resident at risk for adverse reactions. She said the Director of Nurses was over the clinical team was responsible for ensuring the PRN psychotropic medications included a stop date. During an interview on 08/28/25 at 1:44 PM, the Pharmacist said PRN psychotropic medications were to be written for 14 days per CMS guidelines. She said the facility reached out to hospice at day 14 to prompt them to provide the documentation for extended use. She said she reviewed the pharmacy recommendations for the month of August 2025, and the nursing recommendation did not populate for Resident #9's recommendation for needing a time frame from hospice. Therefore, the facility was unaware of needing a stop date. The Pharmacist said it was the hospice responsibility to include the stop date when the orders were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 4 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete written. Record review of the facility's policy Psychotropic Medication Review dated 04/2020, indicated .IDT will emphasize the importance of seeking an appropriate dose and duration of each psychotropic medication, with careful assessment as to whether the medication is necessary and pharmacologically appropriate. 1. The community will make every effort to comply with state and federal regulations related to the use of psychopharmacological medications, to include regular review of continued need, appropriate dosage, side effects, risk and/or benefits. Monitors psychotropic drug use to ensure that medications are not used in excessive doses or for excessive duration. Event ID: Facility ID: 676210 If continuation sheet Page 5 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure assessments accurately reflected the resident status for 1 of 1 resident (Resident #94) reviewed for MDS assessment accuracy. The facility incorrectly coded Resident #94's discharge MDS assessment dated [DATE] reflected Resident #94 was discharged to a short-term general hospital when the resident was discharged home. This failure could place residents at risk for not receiving care and services to meet their needs. Findings included: Record review of Resident #94's face sheet, dated 08/28/25, reflected Resident #94 was a [AGE] year-old male readmitted to the facility om 05/29/25 with a diagnosis which included end stage renal failure (a condition in which the kidneys lose the ability to remove waste and balance fluids). Record review of Resident #94's discharge MDS assessment, dated 06/13/25, reflected in Section A2105 (discharge status) coding of 04 which means discharge to short term general hospital. Record review of Resident #94's physician Discharge summary, dated [DATE], reflected Resident #94 was dc' d home with medications and belonging. During an interview and record review on 08/28/25 at 11:28 a.m., the MDS Coordinator stated she was responsible for Resident #94's discharge MDS assessment. After reviewing Resident #94's electronic medical records, the MDS Coordinator stated the discharge assessment should have been coded discharge to home/community. The MDS Coordinator stated it was important to ensure the assessment was coded correctly to see whether the resident was dc' d home/community, hospital or another facility. The MDS Coordinator stated there was no policy and procedures regarding MDS assessment accuracy. The MDS Coordinator stated the facility followed the RAI manual. During a telephone interview on 08/28/25 at 12:45 p.m., the Regional Clinical Reimbursement Coordinator stated the MDS Coordinator should have coded Resident #94's discharge assessment to home/community. The Regional Clinical Reimbursement Coordinator stated he generated a report every 30 days and certain things were monitored on the discharge assessment such as if the resident was going to return or not when they were sent out to the hospital but not the discharge status. The Regional Clinical Reimbursement Coordinator stated it was important to ensure the correct discharge status was completed to see where the resident went to and for their own statistics. During an interview on 08/28/25 at 1:50 p.m., the DON stated she expected the correct discharge status was completed on the discharge assessment. The DON stated the MDS Coordinator was responsible for ensuring the correct discharge status was completed. The DON stated it was important to ensure the correct discharge status was completed for accuracy. During an interview on 08/28/25 at 3:39 p.m., the Administrator stated she expected Resident #94's discharge assessment to be coded correctly. The Administrator stated the MDS Coordinator was responsible for ensuring the correct discharge status was coded. The Administrator stated the [NAME] Clinical Reimbursement Coordinator was responsible for monitoring. The Administrator stated there was no harm with not having the correct discharge status. Record review of the Resident Assessment Instrument 3.0 User's Manual, last revised October 2024, reflected. Item Rationale . This item documents the location to which the resident is being discharged at the time of discharge. Coding Instructions. Code 01, Home/Community: if the resident was discharged to a private home, apartment, board and care, assisted living facility, group home, transitional living, or adult foster care. A community residential setting is defined as any house, condominium, or apartment in the community, whether owned by the resident or another person; retirement communities; or independent housing for the elderly. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 6 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **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 baseline care plan for each resident that included the instructions needed to provide effective and person-centered care for 1 of 6 residents (Resident #99) reviewed for baseline care plans. The facility failed to develop a baseline care plan that addressed Resident #99's use of a wound VAC (machine that promotes wound healing by applying negative pressure to the wound area by helping to draw the edges together and remove excess fluid) to her right thigh wound. This failure could place residents at risk of not receiving care and services to meet their needs.Findings included: Record review of a face sheet dated 08/28/2025 indicated Resident #99 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included non-pressure chronic ulcer of unspecified part of right lower leg with unspecified severity (wound of the right lower leg not caused by pressure). Record review of Resident #99's Comprehensive MDS assessment dated [DATE] indicated she was usually understood by others and usually understood others. The MDS assessment indicated Resident #99's BIMS was an 11, which indicated her cognition was moderately impaired. The MDS assessment indicated Resident #99 had a surgical wound and required surgical wound care. Record review of Resident #99's Order Summary Report dated 08/27/2025 indicated right posterior thigh cleanse with Vashe (wound cleanser), pat dry, apply wound VAC cut foam to fit in wound bed, secure in place with drape, cut small hole in drape over foam, place port over hole, connect to wound VAC at 125 mmhg continuous one time a day every Monday, Wednesday, and Friday with an order date of 08/22/2025. Record review of Resident #99's Baseline Care Plan dated 08/23/2025 did not indicate Resident #99 required a wound VAC. During an observation on 08/25/2025 at 9:24 AM, Resident #99 was in her bed with a dressing on her right thigh attached to a wound VAC set at 125 mmhg. During an interview on 08/25/2025 at 2:13 PM, the DON said the baseline care plan was completed by the nurses, the social worker, dietary, and then she reviewed the baseline care plan and completed the summary. The DON said Resident #99's use of a wound VAC should have been included in her baseline care plan. The DON said she thought Resident #99's wound VAC was on the baseline care plan. The DON said the wound VAC should be included on the baseline care plan for communication, and that the baseline care plan was the resident's plan of care. During an interview on 08/25/2025 at 2:38 PM, the Administrator said the baseline care plan should include components of the residents' needs. The Administrator said Resident #99's use of a wound VAC should have been included in her baseline care plan. The Administrator said the DON was responsible for ensuring the baseline care plan included the residents' needs. The Administrator said it was important for a wound VAC to be included in the baseline care plan because it was part of the plan of care and for continuity of care. Record review of the facility's policy titled, Baseline Care Plan, dated 11/01/2019, indicated, A baseline care plan is required to be completed within 48 hours of admission The baseline care plan must include.Physician Orders.The facility must provide the resident and their representative with a summary of the baseline care plan to include as a minimum. any services and treatments administered by the facility and personnel acting on behalf of the facility. Event ID: Facility ID: 676210 If continuation sheet Page 7 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews the facility failed to develop and implement a comprehensive person-centered care plan for each resident, 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 2 of 24 residents (Resident #8 and Resident #9) reviewed for care plans. 1. The facility failed to ensure Resident #8's care plan included her fall on 04/03/25 and interventions.2. The facility failed to ensure Resident #9's care plan included the antianxiety medication prescribed for her anxiety. These failures could have placed residents at risk for not having their needs met. Findings included: 1.Record review of Resident #8's face sheet dated 09/03/25 indicated she was a [AGE] year-old female who re-admitted to the facility on [DATE] with diagnoses history of falls, dementia (group of conditions that cause a decline in cognitive abilities), anxiety, and high blood pressure. Record review of Resident #8's annual MDS dated [DATE] indicated she usually understood others and was usually understood by others. The MDS also indicated she had a BIMS score of 6 which meant she had severe cognitive impairment. The MDS also indicated she required moderate assistance from staff for bed mobility, transfers, bathing, and she required setup for eating. Record review of Resident #8's care plan revised 08/25/25 indicated she was at risk for falls and had a history of falls but had no mention of her actual fall on 04/03/25. The care plan did not indicate any interventions in place after the fall on 04/03/25. Record review of Resident #8's fall dated 04/03/25 indicated she was in the dining room and was attempting to tie her shoe and fell from her wheelchair to the floor. During an observation and interview on 08/28/2025 at 2:47 PM the MDS nurse said she was responsible for care plans and the management nurses (ADON, DON, and MDS nurse) normally resolved the care plans over unknown time. She said if it was an acute care plan, the charge nurse that was in the dining room at the time should have updated the care plan after the fall and then the management nurses should have discussed the fall in the standards of care meeting they have weekly on the following Wednesday (04/09/25) to ensure it was care planned. The MDS nurse and ADON reviewed the EMR for Resident #8 to find the care plan was never updated. The MDS nurse said the failure placed a risk for the Resident #8 falling again. During an interview on 08/28/2025 at 4:13 PM the DON said she expected Resident #8's fall and interventions to be included in her care plan. She said when the nurses notified her of falls, she would normally discuss what measures to put in place for residents and the nurse should have should updated the care plan. The DON said the management nurses then discussed falls in the morning meeting to ensure it was completed but she guessed Resident #8's fall was missed. The DON said the failure placed a risk for Resident #8 having more falls. During an interview on 08/28/2025 at 4:29 PM the Administrator said she expected the care plan to be updated to include intervention and goals after Resident #8's fall. She said the MDS was responsible for ensuring the care plans were updated. The Administrator said the failure placed risk for falls happening again. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 8 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 2. Record review of Resident #9's face sheet dated 08/28/25, indicated a [AGE] year-old female who initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #9 had diagnoses of Alzheimer's disease (a progressive brain disorder that causes memory loss, confusion, and other cognitive decline), diabetes mellitus type 2 (chronic metabolic disorder characterized by high blood sugar levels), and dysphagia (difficulty swallowing). Residents Affected - Few Record review of Resident #9's significant change in status MDS assessment dated [DATE], indicated she was usually understood and usually understood others. Resident #9's had a BIMS score of 3, which indicated her cognition was severely impaired. The MDS assessment did not reflect Resident #9 had received an antianxiety medication within the 7-day look back period. Record review of Resident #9's comprehensive care plan revised 07/10/25, indicated Resident #9 received an antihistamine related to her anxiety. The care plan interventions indicated to administer antihistamine medications as ordered by the physician and to monitor for side effects and effectiveness every shift. The care plan did not reflect Resident #9 received Ativan PRN for anxiety. Record review of Resident #9's order audit report dated 08/28/25, indicated the order for hydroxyzine 25mg one tablet by mouth every 8 hours as needed was discontinued by the DON on 07/15/25. Record review of Resident #9's order summary report dated 08/28/25, indicated she had an order for Ativan 0.5mg one tablet every 6 hours as needed for anxiety with a start date of 07/29/25. During an interview on 08/28/25 at 12:57 PM, the DON said expected the care plans to be updated with any changes. The DON said the care plan was the plan of care for the resident and failure to update them placed the resident risk for staff to be unaware of how to care for the resident. The DON said the MDS nurse was responsible for ensuring the care plans were updated. During an interview on 08/28/25 at 1:16 PM, the Administrator said she expected the care plans to be revised and updated with any changes. She said the care plan was geared to the resident with the expectations and outcomes. The Administrator said the MDS Coordinator was responsible for revising the care plans. She said failure to revise the resident's care plan placed them at risk for not abiding by their wishes and quality of life. Record review of the facility policy Comprehensive Care Plan last revised 04/25/2021 indicated Policy Every resident will have an individualized interdisciplinary plan of care in place. A baseline plan of care to meet the resident's immediate needs shall be developed for each resident within forty-eight (48) hours of Admission. The Interdisciplinary Team will continue to develop the plan in conjunction with the RAI (MOS 3.0) and CAAS, completing and conducting Comprehensive Care Plan Meeting and Reviews by day 21 after Admission. The Care Plan is revised every quarter, significant change of condition, Annual or as the resident condition changes on an individualized basis. The Care Plan process is an ongoing review process. The resident's Care Plan will include participation from residents' representatives, external partners PASRR, Hospice, Therapy, Clinicians and not as all-inclusive. Procedure. 5. The Interdisciplinary Team will review the healthcare practitioner's notes and orders (e.g., dietary needs, medications, routine treatments, etc.) and implement a Comprehensive Care Plan to meet the residents' immediate care needs including but not limited to.h. Fall Prevention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 9 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure a resident who was unable to carry out activities of daily living, received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 of 24 residents (Residents #63) reviewed for ADL care.The facility failed to ensure Resident #63 was assisted with her personal hygiene to ensure she was free of body odor and had a clean gown on 08/25/2025. This failure could place residents at risk of not receiving services or care, decreased quality of life, and decreased self-esteem.Findings included: Record review of a face sheet dated 08/28/2025 indicated Resident #63 was a [AGE] year-old female initially admitted to the facility on [DATE] with diagnoses which included hemiplegia and hemiparesis following other cerebrovascular disease affecting right dominant side (weakness and paralysis to the right side of the body caused by a medical condition that affects the blood vessels and circulation of the brain) and aphasia (communication disorder due to damage to the areas of the brain responsible for language). Record review of Resident #63's Quarterly MDS assessment dated [DATE] indicated she sometimes understood and was usually understood by others. The MDS assessment indicated Resident #63 had a BIMS score of 0, which indicated her cognition was severely impaired. The MDS assessment indicated Resident #63 required partial/moderate assistance with showering/bathing, dressing, and personal hygiene. Record review of Resident #63's care plan revised 08/26/2025 indicated she had an ADL self-care performance deficit related to disease processes a stroke. Resident #63's care plan indicated she required extensive assistance by one staff with bathing/showering and personal hygiene three times a week and as necessary. Record review of Resident #63's bathing task record for the month of August 2025 indicated she received her baths as scheduled on Monday, Wednesday, and Friday for the month of August 2025. During an observation and interview on 08/25/2025 at 10:43 AM, Resident #63 was in her bed, her gown had stains on it and white specks, and she had a strong, musty odor. Resident #63 was only able to answer yes or no questions due to her aphasia. When asked if she was receiving her baths, she replied, no and grabbed her gown and started pointing at it. When asked if staff was changing her clothes every day, she replied, no. During an interview on 08/27/2025 at 2:18 PM, CNA L said Resident #63 received bed baths on Monday, Wednesday, and Friday. CNA L said Resident #63 did not refuse any of her baths that she was ready to get them. CNA L said she probably missed some of Resident #63's baths because she had been at the facility for about a month, and she was not familiar with the bathing schedule. CNA L said she had worked over the weekend and changed Resident #63's clothes, but she was not sure if the night shift had changed her. CNA L said it was important to keep up the resident's hygiene to make sure they were getting taken care of properly. During an interview on 08/27/2025 at 2:42 PM, LVN M said she was not aware of Resident #63 missing any bed baths, and she had not noticed any hygiene issues with her. LVN M said the CNAs were responsible for providing bathing and ADL care. LVN M said it was important for the residents to be clean for infection control. During an interview on 08/28/2025 at 2:15 PM, the DON said the charge nurses were responsible for ensuring the residents received proper ADL care. The DON said she made rounds randomly to check on the residents ADL care, and she had not noticed any issues. The DON said it was important for the residents to receive proper ADL care for their personal hygiene, upkeep, and because it was their right to be clean. During an interview on 08/28/2025 at 2:41 PM, the Administrator said she expected for the residents to be bathed on their day or as requested, and she had not had any complaints about the residents not being clean. The Administrator said the staff should assist the residents with ADL care when it was not their bath day. The Administrator said it was important for infection control and to Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 10 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 prevent the breakdown of skin. During an interview on 08/28/2025 at 12:29 PM, the DON said the facility did not have a policy on ADLs. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 11 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for 1 of 4 (Resident #99) residents reviewed for quality of care. The facility failed to ensure Resident #99's wound treatment to her right posterior thigh was performed on 08/22/2025. This failure could place residents of risk for not receiving appropriate care and treatment, a decreased quality of life, and wound deterioration.Findings included: Record review of a face sheet dated 08/28/2025 indicated Resident #99 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included non-pressure chronic ulcer of unspecified part of right lower leg with unspecified severity (wound of the right lower leg not caused by pressure). Record review of Resident #99's Comprehensive MDS assessment dated [DATE] indicated she was usually understood by others and usually understood others. The MDS assessment indicated Resident #99's BIMS was an 11, which indicated her cognition was moderately impaired. The MDS assessment indicated Resident #99 had a surgical wound and required surgical wound care. Record review of Resident #99's Order Summary Report dated 08/27/2025 indicated right posterior thigh cleanse with Vashe (wound cleanser), pat dry, apply wound VAC cut foam to fit in wound bed, secure in place with drape, cut small hole in drape over foam, place port over hole, connect to wound VAC at 125 mmhg continuous one time a day every Monday, Wednesday, and Friday with an order date of 08/22/2025. Record review of Resident #99's care plan revised 08/25/2025 indicated she required enhanced barrier precautions due to a chronic wound or skin opening that required a dressing change. Resident #99's care plan did not further address her wound or wound care treatment. During an observation and interview on 08/25/2025 at 9:24 AM, Resident #99 was in her bed with a dressing on her right thigh dated 08/20/2025 attached to a wound VAC set at 125 mmhg. Resident #99 said her last wound treatment was at the hospital that the wound dressing had not been changed while she was at the facility. Resident #99 said she did not remember when they were doing the wound treatments at the hospital or the frequency of the treatments. During an interview on 08/28/2025 at 8:14 AM, the Treatment Nurse said Resident #99 admitted to the facility with the wound VAC on Thursday, 08/21/2025. The Treatment Nurse said she had not done the wound care on Friday, 08/22/2025 because when she assessed Resident #99, she thought the dressing was dated 08/21/2025. The Treatment Nurse said it was important to ensure wound care treatments were completed as ordered so there was no delay in care, and the wound did not decline. During an interview on 08/28/2025 at 2:10 PM, the DON said the Treatment Nurse was responsible for completing the treatments. The DON said not performing wound care treatments as ordered could delay the healing of the wound. During an interview on 08/28/2025 at 2:37 PM, the Administrator said she expected for the wound treatments to be completed as ordered. The Administrator said the treatment nurse was responsible for completing the wound care treatments. The Administrator said not completing the wound treatments could be a decline in care and could cause an infection. Record review of the facility's policy titled, Skin Management: Prevention and Treatment of Wounds, revised 10/06/2022, indicated, The purpose of this procedure is for prevention and treatment of skin breakdown such as pressure injuries, diabetic ulcers, arterial ulcers, and skin wounds. The policy did not further address providing wound care treatments. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 12 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents maintained acceptable parameters of nutritional status for 3 of 24 residents (Residents #27, #8 and #23) reviewed for nutrition. 1.The facility did not ensure dietary recommendations was implemented for Resident #27. 2.The facility failed to ensure orders for fortified oatmeal was implemented for Resident #8. 3.The facility failed to ensure Resident #23 had water in his cup to drink on 08/25/25. These failures could place residents at risk for decreased nutritional status, decline in health, serious illness, or hospitalization.Findings included: Residents Affected - Some 1. Record review of Resident #27's face sheet, dated 08/28/25, reflected Resident #27 was a [AGE] year-old female, readmitted to the facility on [DATE] with diagnoses which included partial intestinal obstruction (partial blockage in the intestines that prevent food, stool, and gas from passing through normally). Record review of the order summary report dated 08/28/25 reflected Resident #27 had an order for fortified cereal with breakfast and 4 oz fortified oatmeal with lunch with a start date 07/23/24. Record review of Resident #27's quarterly MDS assessment, dated 08/22/25, reflected Resident #27 usually made herself understood and usually understood others. Resident #27's BIMS score was 10, which reflected her cognition was moderately impaired. The assessment reflected Resident #27 had a weight loss of 5% or more in the last month or loss of 10% or more in the last 6 months. Resident #27 was not a physician-prescribed weight loss regimen. Record review of Resident #27's undated comprehensive care plan reflected Resident #27 had an alteration in gastro-intestinal related to disease process. The care plan interventions included avoid lying down for at least 1 hours after eating and avoid food or beverages that tend to irritate esophageal (muscular tube that connects the throat to the stomach) lining. Record review of Resident #27's nutrition note completed by the dietitian dated 08/18/25 reflected Recommend to add fortified oatmeal to breakfast for additional calories and protein daily. Record review of Resident #27's meal ticket dated 08/27/25 reflected resident request cereal only for breakfast/fortified cereal. During an observation on 08/27/25 at 9:00 a.m., Resident #27 received a bowl of dry cereal and a glass of milk instead of fortified cereal. During an interview on 08/27/25 at 9:07 a.m., the Dietary Manager stated Resident #27 requested dry cereal for breakfast. The Dietary Manager stated the fortified cereal was oatmeal which included evaporated milk and brown sugar for additional calories and protein. The Dietary Manager stated her assumption was if Resident #27 not eating the fortified oatmeal she should be ordered med pass 2.0 (provide supplement calories and protein) but she assumed the nursing department would know to offer it. The Dietary Manager stated the Dietician has never told her to offer med pass 2.0 but she assumed the nursing department would know to offer it based off assumption. The Dietary Manager stated she did not know anything about her receiving fortified with oatmeal with lunch. The Dietary Manager stated that was an error that need to be corrected. The Dietary Manager stated she had not contacted the Dietitian to inform her Resident #27 preferred dry cereal over the fortified cereal. The Dietary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 13 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0692 Manager stated not following the dietary recommendation could possibly prevent weight loss. Level of Harm - Minimal harm or potential for actual harm During an interview on 08/27/25 at 9:07 a.m., LVN A stated she had no clue why Resident #27 should receive fortified cereal. LVN A stated she was unaware that med pass 2.0 should be offered with dry cereal to replace the fortified cereal. LVN A stated usually if med pass 2.0 need to be offered it would be on their meal ticket. LVN A stated it was important for her to receive her fortified cereal to prevent weight loss. Residents Affected - Some During an interview on 08/27/25 at 9:11 a.m., Resident #27 stated she did prefer dry cereal for breakfast over oatmeal. Resident #27 stated if the facility would have offered the med pass 2.0, she would try it, but she had never been offered it. During a telephone interview on 08/27/25 at 9:38 a.m., the Dietitian stated she added the fortified meal to her breakfast on last week because Resident #27 triggered for weight loss, and the Dietitian would like her for to receive additional calories and protein. The Dietician stated the first line of treatment would be to add fortified cereal in addition to her breakfast. The Dietician stated if the resident did not like the fortified cereal, she would put in a note to have the cereal change to med pass 2.0. The Dietitian stated she should have been notified that Resident #27 requested dry cereal for breakfast, and she would have documented and changed for her to receive med pass 2.0. The Dietician stated med pass 2.0 was given with medication administration. The Dietitian stated it was important to follow the recommendation to prevent further weight loss. During an interview on 08/28/25 at 1:50 p.m., the DON stated she became aware this week that Resident #27 did not like the fortified cereal. The DON was unable to give the exact date. The DON stated staff should have notified her if she did not prefer the fortified oatmeal to discuss with the dietitian and offer the resident a different option. The DON stated she monitored dietary recommendations during the SOC meetings on Wednesday evenings to discuss any issues with the care of the resident. The DON stated it was important for recommendations to be followed so the resident can receive nutrients and to maintain her weight. During an interview on 08/28/25 at 3:39 p.m., the Administrator stated her expectation was Resident #27 received the fortified cereal with the dry cereal. The Administrator stated if Resident #27 did not like the fortified cereal the CNA should report it to the charge nurse, and the charge nurse should report it to the DON. The Administrator stated the DON was responsible for monitoring dietary recommendation. The Administrator stated it was important for the dietary recommendation to be followed to prevent weight loss and to see what a substitute for her preference would be to maintain the calorie intake. 2. Record review of Resident #8's face sheet dated 09/03/25 indicated she was a [AGE] year-old female who re-admitted to the facility on [DATE] with the diagnoses of history of falls, dementia (group of conditions that cause a decline in cognitive abilities), anxiety, and high blood pressure. Record review of Resident #8's annual MDS dated [DATE] indicated she usually understood others and was usually understood by others. The MDS also indicated she had a BIMS score of 6 which meant she had severe cognitive impairment. The MDS also indicated she required moderate assistance from staff for bed mobility, transfers, bathing, and she required setup for eating. Record review of Resident #8's care plan revised 08/25/25 indicated she required a mechanical soft carb-controlled diet with fortified oatmeal at lunch and supper with interventions to serve diet as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 14 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0692 ordered and offer substitute if less than 50% is eaten. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #8's order summary report dated as of 08/28/25 indicated she had an order for: Residents Affected - Some Carb controlled diet mechanical soft texture, regular consistency, (no added salt) and 4 ounces fortified oatmeal with lunch and supper with a start date of 06/20/24 and no end date. Record review of Resident #8's order audit report dated 08/26/25 indicated her dietary order was updated on 08/25/25 after surveyor intervention from resident receiving 4 ounces of pudding with lunch and dinner to 4 ounces of fortified oatmeal at lunch and dinner completed by the DON. Record review of Resident #8's meal tray card dated 08/26/25 indicated her tray was supposed to include 4-ounce fortified pudding. During an observation on 08/25/25 at 12:34 PM during the lunch meal Resident #8 was sitting in the dining room with her tray. The meal tray card indicated fortified pudding and a health shake and the tray did not have a shake nor fortified pudding on it. During an observation on 08/26/25 at 12:20 PM during the lunch meal Resident #8 was sitting in the dining room with her tray. The tray did not have fortified oatmeal nor fortified pudding on it. During an interview on 08/27/2025 at 2:20 PM the Dietary Manager said the cook on duty was responsible for ensuring the residents had the proper supplements on the trays matching their meal tray cards and the nurse was to ensure the card matched what was on the tray. She said she expected the cook to make fortified potatoes on 08/25/25 and Resident #8 should have gotten med pass 2.0 as a substitute for a shake because the facility no longer gets shakes due to a nationwide outage. The Dietary Manager said Resident #8 should have had potatoes on 08/26/25 as well and the cards just needed updated. She said the failure placed Resident #8 at risk of weight loss and not getting the proper nutrition. During an interview on 08/28/2025 at 4:05 PM the DON said she expected all residents to be served supplements as ordered. She said she discussed diets and supplements with the Dietary Manager weekly at the standards of care meeting and the DON told her what to input on the meal tray cards. The DON said the failure placed a risk for Resident #8 having weight loss or prevent resident from receiving the proper nutrition. During an interview on 08/28/2025 at 4:35 PM the Administrator said she expected Resident #8 to receive her meal with the proper supplements ordered. The Administrator stated it was important for the diet orders to be followed to prevent weight loss. 3.Record review of Resident #23's face sheet dated 08/28/25 indicated he was a [AGE] year-old male who admitted to the facility on [DATE] and re-admitted to the facility on [DATE] with the diagnoses of Guillain-Barre syndrome (a condition in which the autoimmune system attacks the nerves), acute kidney failure, systemic sclerosis (a rare disease that causes the body to produce too much collagen causing contractures ad skin thickening), benign prostatic hypertrophy (enlarged prostate gland causing difficult urination), and need for assistance with personal care. Record review of Resident #23's quarterly MDS dated [DATE] indicated he was usually able to make (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 15 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some himself understood and usually understood others. The MDS also indicate he had a BIMS score of 13 which meant he was cognitively intact. The MDS also indicated he required moderate assistance from staff for toileting, bed mobility and bathing and required setup for eating. The MDS also indicated he was incontinent of bowel and bladder. Record review of Resident #23's care plan revised on 07/28/25 indicated he had a potential discomfort, and complications related to a diagnosis benign prostatic hypertrophy with interventions to encourage adequate fluid intake to reduce the risk of UTI. During an observation and interview on 08/25/2025 at 11:08 AM Resident #23 had no water in his water cup and he said he had not had any all day. During an interview on 08/28/2025 at 4:01 PM the DON said she said she expected the water was being passed by the CNAs. The DON said she did spot check at times to ensure it was being completed. She said the failure placed a risk for Resident #23 to have dehydration. During an interview on 08/28/2025 at 4:37 PM the Administrator said her expectation was for the CNAs to pass water to the residents every shift. The administrator said Resident #23 would usually voices his concerns with her, but he should have water. She said the failure placed Resident #23 at risk for dehydration. Record review of the facility policy Supplements revised 6/2025 indicated: Policy The community may provide additional nutrients to the residents through the use of physician ordered supplements. Procedure 1. Recommendations for house supplements may be initiated by the interdisciplinary care team. 2. All supplements must be ordered by a physician.3. Fortified items must be implemented as recommended.5. Supplements ordered from the kitchen are noted on the tray card. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 16 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that a resident who needed respiratory care was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences for 1 of 5 residents (Resident #67) reviewed for respiratory care. The facility failed to ensure Resident #67's oxygen was set at 3 liters per nasal cannula as ordered on 08/28/25. This failure could place residents who receive respiratory care at risk of developing respiratory complications and a decreased quality of care.Findings included: Record review of Resident #67's face sheet, dated 08/28/25, indicated a [AGE] year-old female who was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included Chronic Obstructive Pulmonary Disease also known as COPD (a chronic lung disease that causes inflammation and narrowing of the airways, leading to airflow obstruction), anxiety (a feeling of fear, dread, and uneasiness), and Depression (a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with your daily life). Record review of Resident #67's quarterly MDS assessment, dated 08/21/25, indicated Resident #67 usually understood and was usually understood by others. Resident #67's BIMS score was 14, which indicated she was cognitively intact. The MDS indicated Resident #67 required assistance with dressing, personal hygiene, toileting, bathing, bed mobility, transfers, and set-up/supervision for eating. The MDS during the 7-day look-back period indicated Resident #67 was receiving oxygen. Record review of Resident #67‘s physician orders dated 04/17/25 indicated oxygen at 3 liters per minute via nasal cannula continuously. Record review of Resident #67‘s care plan dated 04/21/25 indicated she required oxygen. The intervention was for staff to apply oxygen at 3 liters per minute via nasal cannula, continuously, and change oxygen tubing as needed. During an observation and interview on 08/28/25 at 11:00 a.m., Resident #67 was sitting on the side of her bed, wearing oxygen at 2.5 liters per nasal cannula. Resident #67 said her oxygen should be set at 3 liters. During an observation and interview on 08/28/25 at 11:09 a.m., LVN B verified that Resident #67 was receiving oxygen at 2.5 liters per nasal cannula. She said it was her responsibility to ensure the oxygen was set at the correct rate. She said she had not checked Resident #67's oxygen before the state surveyor's intervention. She said it was important to ensure the oxygen was at the correct rate ordered to help maintain an effective airway. During an interview on 08/28/25 at 2:34 p.m., the DON said the charge nurses were responsible for ensuring the oxygen was set at the ordered rate. She said they had monitoring in place with an assigned department head on their focus rounds, responsible for ensuring the oxygen was set at the correct rate. She said if the oxygen rate were too low, it could cause respiratory distress. During an interview on 08/28/25 at 3:13 p.m., the Administrator said if a resident had an order for oxygen, it should be applied. She said the nurses were responsible for ensuring the oxygen was set at the ordered rate, and nurse managers were the overseers. She said failure to follow the oxygen order could cause respiratory issues. Record review of facility policy titled, Oxygen Administration, revised 4/2021, indicated, Policy: It is the policy of this community to ensure all oxygen administration is conducted in a safe manner. Procedure #1. Verify there is an order for Oxygen administration to include: a. Method of Delivery, b. Flow Rate, c. Oxygen saturation parameters if indicated. #3. Assess the resident's respiratory status. # 4e Post NO SMOKING sign on the outside of the door to the resident's room. 5. Check the tubing connected to the oxygen concentrator to ensure that it is free of kinks. 6e Start Oxygen flow at the rate as ordered. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 17 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure dialysis services were provided consistently with professional standards of practice for 1 of 2 resident reviewed for dialysis services. (Resident #7) The facility did not provide ongoing assessments after Resident #7's dialysis treatments and did not keep ongoing communication with the dialysis facility. This failure could place residents who received dialysis at risk for complications and not receiving proper care and treatment to meet their needs.Findings included: Record review of Resident #7's face sheet dated 08/28/25 indicated he was an [AGE] year-old male who re-admitted to the facility on [DATE] with the diagnoses of end stage renal disease (disease in which the kidneys lose ability to remove waste and balance fluids), dementia (a group of conditions that cause a decline in cognitive abilities, such as memory), high blood pressure, and heart failure. Record review of Resident #7's quarterly MDS dated [DATE] indicated he was usually understood and usually made himself understood by others. The MDS also indicated he had a BIMS score of 4 which meant he had severe cognitive impairment. The MDS also indicated he received dialysis treatment while in the facility. Record review of Resident #7's care plan revised on 07/15/25 indicated he required dialysis three times a week for renal failure with interventions for staff to monitor signs and symptoms of depression, PRN any signs and symptoms of infection to access site: Redness, Swelling, warmth or drainage, PRN for signs and symptoms of renal insufficiency: changes in level of consciousness, changes in skin turgor (elasticity of the skin that measures dehydration), oral mucosa (how moist the inside of the mouth is), changes in heart and lung sounds, signs and symptoms of the following: bleeding, hemorrhage (bleeding out), bacteremia (blood poisoning), septic shock (infection causing organ failure), document, and report any changes to the medical doctor. Record review of Resident #7's order summary report dated 08/28/25 indicated he had an order for: 1) Dialysis Tuesday/Thursday/Saturday at dialysis center and address @3:10 PM every shift coordinate medication administration times on dialysis days with a start date of 11/24/24 and no stop date. Record review of the medical record for Resident #7 indicated there were no documented before and after assessments and ongoing communication with the dialysis service for Resident #7 on the following dates she had dialysis services provided:07/05/2507/08/2507/12/2507/15/2507/22/2508/05/2508/16/2508/23/25 During an interview on 08/28/25 at 4:20 PM, the DON said her expectation was for the communication to be completed on each day a resident attends dialysis. She said her expectation was now going to be to bring the communication sheets to her from the weekend to ensure they were completed. She said the failure placed a risk of missing communication with the dialysis that ensured the resident was stable and had no change of conditions after dialysis was completed. During an interview on 08/28/2025 at 4:23 PM, the Administration said her expectation was for the nurses to have assessed the resident and documented the information on the communication form and turned it into the medical records on dialysis days. She said if the facility did not receive the form from dialysis, she expected the nurse to have called the dialysis company and retrieved the information to have been available in the facility. The Administrator said the failure placed a risk for the nurse missing a change in condition which could have caused Resident #7 to have been in harm's way and the failure also caused the medical record to be incomplete. Record review of the facility policy Dialysis General Guidelines and Management, dated 04/2021, indicated:PolicyIt is the policy of the facility community that residents in need of dialysis services will receive services as per physician orders and will be monitored accordingly. NURSING INTERVENTION 1. Avoid wearing constrictive clothing of limb containing access.3. Prior to dialysis treatments assess vitals, edema, access site, mental status, complaints of pain/discomfort, blood Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 18 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0698 sugar (if ordered), and administer meds as directed by the dialysis center. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 19 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate dispensing and administering of all drugs and biologicals to meet the needs of each resident for 1 of 10 residents (Resident #91) and 1 of 2 medication rooms reviewed for pharmacy services. 1. The facility failed to reorder Resident #91's hydrocodone 7.5/325mg (pain medication) tablet timely resulting in Resident #91 having 3 days without medication. 2. The facility did not ensure the plastic bag of Lorazepam 2mg/ml (antianxiety medication) syringes in the station 2 refrigerator we reconciled. These failures could place the residents at risk of not having medications available for use, drug diversion, not receiving their medications as ordered, and exacerbation of their disease processes. Findings included: 1.Record review of Resident #91's face sheet dated 08/27/25 indicated she was a [AGE] year-old female who re-admitted to the facility on [DATE] with the diagnoses diabetes mellitus (disease in which the body has too much sugar in the blood), pain unspecified, anxiety, and high blood pressure. Record review of Resident #91's quarterly MDS dated [DATE] indicated she usually made herself understood and was usually able to understand others. The MDS also indicted she had a BIMS score of 10 which meant she had moderate cognitive impairment. The MDS also indicated that Resident #91's pain rarely limited her day to day activities. Record review of Resident #91's care plan dated 07/10/25 indicated she had a potential for pain related to muscle spasms with interventions to assess characteristics of pain: Location, Severity, on a scale of 1-10, type and frequency, discuss with resident factors that precipitate pain and what may reduce it, administer pain medications as ordered, and discuss with resident the need to request pain medications before pain becomes severe. Record review of Resident #91's order summary report dated 08/27/25 indicated she had an order for:1)Monitoring of pain-if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 -medication, 2 re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift with a start date of 06/05/2024 and no end date. 2)Hydrocodone-Acetaminophen Tablet 7.5-325 MG Give 1 tablet by mouth every 12 hours as needed for pain with a start date of 01/12/2025 and no end date. Record review of Resident #91's licensed nurse MAR for 08/01/25-08/31/25 indicated resident did not have any Hydrocodone 7.5/325mg tablets administered on 08/16/25 or 08/17/25 and her pain levels were documented as 0 on 08/16/25 and 08/17/25. Record review of Resident #91's narcotic count sheet for hydrocodone 7.5/325mg tablets received 06/17/25 indicated she took the medication nightly, and her last dose received was 08/15/2025 at 7:53 PM. Record review of Resident #91's narcotic count sheet for hydrocodone 7.5/325mg tablets received 08/18/25 indicated she received the first dose on 08/18/25 at 8:30 PM. During an interview on 08/25/2025 at 3:54 PM, Resident #91 was sitting in her room on the bed and did not appear to be in any pain. She said the facility ran out of her pain medication for 3 days around 08/16/25 and she did not receive the medication until the following Monday 08/18/25. She said she was in pain, but the nurse gave her Tylenol as needed that helped decrease her pain level and called the doctor and ordered an antianxiety medication to help with her sleeping. She said she had been getting her hydrocodone as needed since the incident. During an interview on 08/28/2025 at 4:05 PM, the DON said she expected the nurses and the medication aides to ensure the residents had their medications and they should have notified the doctor in enough time to ensure the medication did not run out. The DON said she also expected the Hydrocodone 7.5/325mg tablets to be followed up on by the nurses. She said the failure placed a risk for Resident #91 to have increased pain. During an interview on 08/28/2025 at 4:31 PM, the Administrator said her expectation was for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 20 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resident to have the medication changed to routine since she was taking like routine. The Administrator said the nurses or medication aides should have been calling to request refill within 6-7 doses remaining to ensure the medication would have been in the facility when Resident #91 needed it. The Administrator said the failure placed a risk for Resident #91 having increased pain, but the facility did have breakthrough medication Tylenol and administered it and it was effective. 2. During an observation and interview on 08/26/25 at 3:54 PM, the station 2 medication room refrigerator contain a plastic bag of 6 Lorazepam 2mg/ml syringes with no narcotic count sheet in the narcotic book. LVN A said the medication was discontinued on 08/20/25 but the medication was not counted today because she had been off and did not know the medication was in there. During an observation and interview on 08/28/25 at 1:31 PM, LVN S found the plastic bag of 6 Lorazepam 2mg/ml syringes in the station 2 medication room refrigerator and said she did not count the medication when she completed her narcotic count because she did not know there was medication in the refrigerator. She said the failure placed a risk for the medication to be lost or stolen. During an interview on 08/28/2025 at 4:11 PM, the DON said she expected the nurses to count the narcotics daily to ensure accuracy. The DON said when the medications were discontinued the nurse should have given them to her to record and lock in her box. She said the failure placed a risk for a medication error or misappropriation. During an interview on 08/28/2025 at 4:43 PM the Administrator said her expectation was for all narcotics to be accounted for and signed off. She said the failure placed a risk for the medication to leave the facility and misappropriation of narcotics. During an interview on 08/28/25 at 1:40 PM the corporate nurse said the facility did not have a policy on controlled medications. Event ID: Facility ID: 676210 If continuation sheet Page 21 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure that all drugs and biologicals used in the facility were labeled and stored in accordance with professional standards for 1 of 24 residents (Resident #23) and 1 of 10 medication carts (Station 1 Medication Cart) reviewed for drugs and biologicals. 1. The facility failed to ensure MA P secured the Station 1 Medication Cart, when it was not in use and unattended on 08/25/2025. 2. The facility failed to ensure Resident #23 did not have a container of zinc oxide, a package of hydrocortisone cream, and a 30-milliliter medicine cup filled with white cream in his room on the bedside table. These failures could place residents at risk of not receiving drugs and biologicals as needed, medication errors, medication misuse, and drug diversion.Findings included: 1. During an observation on 08/25/2025 starting at 1:18 PM, the Station 1 Medication Cart was unlocked an unattended on the hall. There were residents nearby the unlocked medication cart, and multiple staff walked by it. MA P was observed coming down the hallway to the Station 1 Medication Cart. MA P said it was her medication cart, and the last time she left she thought she had locked it. MA P said leaving the Station 1 Medication Cart unlocked was an accident. MA P said the medication cart should be locked every time she left it. MA P said it was important for the medication carts to be locked when unattended so the residents could not get in the medication cart. MA P said leaving the medication cart unlocked could result in missing medications because somebody could take them. During an interview on 08/28/2025 at 2:31 PM, the DON said the person who was responsible for the medication cart should ensure it was locked. The DON said the medication carts should be locked anytime the staff was away from it. The DON said she monitored by making rounds in the hallways throughout the day. The DON said if the medication cart was left unlocked someone could go into the medication cart and take medications. During an interview on 08/28/2025 3:03 PM, the Administrator said the medication carts should be locked at all times when not in use because they could have a resident come by and have access to the medication cart. The Administrator said nobody should have access to the medications that were on the medication carts. The Administrator said the person responsible for the medication cart should be ensuring it remained locked when not in use, and the DON and ADON should be monitoring. 2. Record review of Resident #23's face sheet dated 08/28/25 indicated he was a [AGE] year-old male who admitted to the facility on [DATE] and re-admitted to the facility on [DATE] with the diagnoses Guillain-Barre syndrome (a condition in which the autoimmune system attacks the nerves), acute kidney failure, systemic sclerosis (a rare disease that causes the body to produce too much collagen causing contractures ad skin thickening), and need for assistance with personal care. Record review of Resident #23's quarterly MDS dated [DATE] indicated he was usually able to make himself understood and usually understood others. The MDS also indicate he had a BIMS score of 13 which meant he was cognitively intact. The MDS also indicated he required moderate assistance from staff for toileting, bed mobility and bathing and required setup for eating. The MDS also indicated he was incontinent of bowel and bladder. Record review of Resident #23's care plan revised 07/28/25 indicated he was incontinent of bowel (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 22 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 and bladder, and he was at risk for skin breakdown with interventions for the staff to monitor every 2 hours, promptly change, and apply protective skin barrier. Record review of Resident #23's order summary report dated 08/28/25 indicated he had an order for: 1) Cream-SMBC (cream that contains hydrocortisone, nystatin, zinc oxide) 1/1/1 cream apply to buttock topically three times a day for excoriation of the buttock until healed with a start date of 08/26/25 and no end date. 2) Hydrocortisone External Cream 0.5 % (Hydrocortisone (Topical)) Apply to bilat antecubital topically four times a day for rash with a start date of 06/12/25 and no end date. The order summary did not indicate an order for zinc oxide barrier cream. During an observation and interview on 08/25/2025 at 10:15 AM, Resident #23 was sitting in his bed and had a 30-milliliter medication cup filled with white cream and a package of hydrocortisone cream on his bedside table. Resident #23 said the nurse placed the cream on his bedside table and left for the resident to apply it. Resident #23 said they left the white cream for his ass and a package of hydrocortisone cream he said was for the rash on arm. During an observation and interview on 08/27/2025 at 12:15 PM, Resident #23 continued to have the hydrocortisone cream packet as well as a container of zinc oxide on his bedside table. Resident #23 said the nurse gave him the zinc oxide for his buttocks. During an observation and interview on 08/28/2025 at 2:11 PM, Resident #23 had the bottle of zinc oxide and a 30-milliliter cup of the white cream on his bedside table. He said the nurse brought the cream into him and told him to have the CNA to apply it when she came in to change him. During an observation and interview on 08/28/2025 at 2:15 PM, LVN S said she left the 30-mililiter medicine cup of white cream and the packet of hydrocortisone cream on accident, but no medication should be left at any resident's bedside. LVN S said the white cream was a prescribed medication Cream-SMBC (hydrocortisone, nystatin, zinc oxide) 1/1/1 that was ordered for a treatment for excoriation on Resident #23's buttocks. LVN S said the failure placed a risk for any person or resident getting the medications and ingesting or using incorrectly because you cannot identify what was in the medicine cup. During an interview on 08/28/2025 at 3:58 PM, the DON said she expected the charge nurses to administer and apply the medication when they go into the resident's room with the medications, and she expected the nurses to never leave medications in the residents' rooms. She said the facility staff had daily focus rounds, and the nurses completed rounds to prevent things like medications being left in the room from happening. The DON said the failure placed a risk for other residents getting the medications and ingesting it or using it while not knowing what it was. During an interview on 08/28/2025 at 4:34 PM, the Administrator said no medications should be left at the residents' bedside. She said the nurses were expected to stay in the room and administer if Resident #23 declined, and they should leave the room with the medication at hand. The Administrator said Resident #23 had not been care planned for medication at bedside. She said the failure placed a risk of Resident #23 and other residents entering the room have access to the medication and could ingest or take the medication. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 23 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of the facility's policy titled, Storage of Medications, dated 08/2024, indicated, Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. 2. Only licensed nurses, pharmacy personnel, and those lawfully authorized to administer medications (such as medication aides) are permitted to access medications. Medication rooms, carts, and medication supplies are locked when they are not attended by persons with authorized access. Event ID: Facility ID: 676210 If continuation sheet Page 24 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview, and record review, the facility failed to follow the menu according to 2 of 3 resident councils and 1 of 1 meal (the lunch meal) reviewed. 1. The facility failed to follow the menu for the lunch meal served on 08/25/25. 2. The facility failed to serve what was printed on the residents' tray cards or posted in the kitchen as mentioned in resident council meetings held on 06/03/25 and 08/26/25. These failures could place residents who consume food prepared by the facility's kitchen at risk of not having their nutritional needs met and/or experiencing weight loss.Findings included: During an interview on 08/25/25 at 11:57 a.m., Resident #65 said she was tired of not getting what was printed on the menu. She said they hardly ever had what was printed on her tray card. During an interview on 08/25/25 at 12:10 p.m., CNA C said Resident #65 was correct. She said often what was written on their tray cards was not what was being served. CNA C said residents often got upset because of what was served versus what was supposed to have been served. She said she would often have to go to the kitchen and get the residents a substitute. Record review of the weekly menu provided by the facility revealed the lunch meal scheduled for Monday, 08/25/25, Day #25 of the third week: chicken fried steak, green beans, mashed potatoes, strawberry cake, and roll. There was no sign posted indicating any deviations from the menu. During an observation on 08/25/25 at 12:30 p.m., the lunch meal served to residents in the dining room revealed they were served chicken-fried steak, mixed vegetables, au gratin potatoes, bread, and Jello. Record review of the facility's resident council minutes dated 06/03/25 indicated, menus not followed. During the resident council meeting held by the state surveyor on 08/26/25, starting at 10:00 am, revealed that 10 of 10 residents agreed that meals were not served as posted on the menu. During an interview on 08/27/25 at 9:45 a.m., the Registered Dietitian consultant said she expected staff to follow the menu. She said the facility was supposed to notify her of any substitutes, and she would let the facility know what to serve. She said she visited the facility weekly and was not aware of any substitutes lately . She said any changes should have been posted properly in the dining room so residents would know what they would be served. During an interview on 08/27/2025 at 11:28 a.m., [NAME] G said she had not had to alter the menu, but maybe on Mondays when they were waiting on the food delivery truck to arrive. She said if she had to deviate from the menu, she would call the Dietary Manager and she would tell her what to use, or if possible, the Dietary Manager would go pick it up from the local store. She said that when she did deviate from the menu, she only wrote it on the kitchen menu. She said she did not write it on the residents' board posted in the dining room. During an interview on 08/27/25 at 2:17 p.m., the Dietary manager said she did not know why the menus had been changed on Monday (08/25/25) because she was not at the facility. She said she knew the menu had been changed (unknown dates), mostly over the weekend, because the staff had let her know after the fact. She said she had done in-services and write-ups with staff in the past, but none lately on following the menu. She said they could not locate the substitution approval form log for August 2025. She said it was her responsibility to ensure meals were served according to the menu posted and signed by the consultant Regional Dietitian for any changes. She said it was important to follow the menu for her budget and the right nutrition. She said if the residents were not getting the right nutrition, it could lead to weight loss. During an interview on 08/28/25 at 2:34 p.m., the DON said she expected the dietary staff to serve and follow the scheduled menu. She said it was the Dietary Manager's responsibility to ensure the dietary staff was serving the correct menu. She said she knew the residents had expressed to the Administrator that the dietary staff was not following the menus. She said the kitchen should communicate any changes because it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 25 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete causes the residents to be upset and could potentially result in residents not eating or losing weight. During an interview on 08/28/25 at 3:13 p.m., the Administrator said she was aware that the facility was not serving meals as posted on the weekly menu in the past, as noted in the resident council minutes. She said she had placed the Dietary Manager on a performance improvement plan some months past, but thought the dietary department was doing better by following the menus. She said the Dietary Manager was aware that if any substitutions were done, they needed to be logged on a menu substitution approval form and approved by the Regional Dietitian . She said any changes should also be posted on the menu in the dining room for effective communication with the staff and residents. She said food was important for the residents, and failure to follow the menu could lead to residents not eating. Record review of the Menu Substitution Approval Form was not produced by the facility . This form must contain the following: Menu date and service date (the date the substitution was being served), Original Menu Item: (The meal item that was being replaced), the reason for the Substitution, and the full name of the qualified dietitian approving the change. Nutritional Equivalency: A statement confirming that the substitute was comparable in nutrient content to the original item. The signature of the dietitian, the date the substitution was approved, which must be before the meal was served. Facility documentation: The facility must record and retain all substitution forms with the menu as served. Menus, including any substitutions, must be kept on file for at least 30 days. During an interview on 08/28/25 at 3:30 p.m., the Regional Nurse Consultant said they did not have a policy on menus or substitutions but provided a policy on meal service. Record review of the facility's policy titled, Meal Service, reviewed 04/2022, indicated, Policy: The dining experience will enhance the resident's quality of life and recognize the resident's needs during dining to achieve a nutritional meal. Resident meals will be posted and served at regular times not to exceed 14 hours. Procedure: .#19. Alternatives are offered to residents who express a dislike for any of the food items. The alternative is from the same group as the food/foods refused. Food and Nutrition Services posts the alternates available prior to the meal. Event ID: Facility ID: 676210 If continuation sheet Page 26 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide food that was palatable and served at an appetizing temperature for 2 of 23 residents (Resident #67 and Resident #87) and 1 of 1 lunch meals reviewed for palatability. The facility failed to provide food that was palatable and attractive to Resident #67 and Resident # 87, who complained the food was not good, cold, hard, and overcooked. This failure could place residents who ate food from the kitchen at risk of weight loss, altered nutritional status, and diminished quality of life. Findings included: Record review of Resident #67's face sheet, dated 08/28/25, indicated a [AGE] year-old female who was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included Chronic Obstructive Pulmonary Disease also known as COPD (a chronic lung disease that causes inflammation and narrowing of the airways, leading to airflow obstruction), anxiety (a feeling of fear, dread, and uneasiness), and Depression (a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with your daily life). Record review of Resident #67's quarterly MDS assessment, dated 08/21/25, indicated Resident #67 usually understood and was usually understood by others. Resident #67's BIMS score was 14, which indicated she was cognitively intact. The MDS indicated Resident #67 required assistance with dressing, personal hygiene, toileting, bathing, bed mobility, transfers, and set-up/supervision for eating. The MDS did not indicate any weight loss in the last sixty days. Record review of Resident #67‘s physician orders dated 05/16/25 indicated she required a NAS (No Added Salt) diet Regular texture, Regular consistency. Record review of Resident #67‘s care plan dated 04/21/25 indicated she required an altered diet. The intervention was to serve the diet as ordered. During an interview on 08/25/25 at 11:57 AM, Resident #67 said the food was not good, and sometimes it was served cold. Resident #67 said she reported this to staff but could not recall their names. During an interview on 08/25/25 at 09:40 AM, Resident #87 said the food was not good. Record review of resident council minutes dated 07/21/25 indicated the residents complained about the food not being good, eggs being burnt, corn being cold, and bread being hard. Record review of resident council meeting held by a state surveyor on 08/26/25 at 10:45 AM, indicated 10 residents complained about the food not being good. During an observation and interview on 08/26/25 at 1:22 p.m., a lunch tray was sampled by the Dietary Manager and 5 surveyors. The sample tray consisted of lemon herb chicken, rice, mixed vegetables, pudding, and bread. The Dietary Manager said the tray was not appealing to look at, the lemon herb chicken and rice were too salty, the mixed vegetables were mushy, and the pudding was watery. During an interview on 08/27/25 at 2:17 p.m., the Dietary Manager said she had complaints regarding the food being nasty. She said she had hired at least four cooks in the past year, and the residents complained about them all. She said the cooks only get 2 days of training in the kitchen and felt they needed more training. She said she thought the residents were tired of the same food over and over. She said she had talked with the cooperate dietitian about the menu, and some things were changed. She said she tried to cater to the residents as much as she could. She said she monitored the food and randomly sampled the food, which had not been an issue for her. The Dietary Manager said it was important to ensure the food was palatable and had an appetizing temperature to prevent weight loss or malnutrition. During an interview on 08/28/2025 at 11:15 a.m., CNA C said she had residents to complain about the food. She said they have said it was nasty, no season, and they eat the same things over and over. She said she had let the (unknown) dietary staff know about the residents' complaints. During an interview on 08/28/25 at 2:34 p.m., the DON said the dietary staff was responsible for the palatable and appetizing food. She said she had heard the residents complain about the food not being good Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 27 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete but could not recall anything in particular. She said she had not tasted the food. She said that if the residents did not like the food, it could cause them not to eat and lose weight. During an interview on 08/28/25 at 3:13 p.m., the Administrator said she expected the food to be served at the correct temperature, and the food was seasoned and cooked according to the recipe. She said she was aware of some of the residents' complaints from the resident council about the food not being good. She said she had already addressed the issue with the Dietary Manager but may need to come up with a different plan. The Administrator said it was important to ensure food was palatable and had an appetizing temperature because it was their right and to prevent potential weight loss. Record review of the facility's policy titled, Meal Service, dated 04/2022, indicated, Policy: The dining experience will enhance the resident's quality of life and recognize the resident's needs during dining to achieve a nutritional meal. Resident meals will be posted and served at regular times not to exceed 14 hours. Procedure: #1. Residents will be provided with nourishing, palatable, attractive meals that meet the residents' daily nutritional needs.#3. The residents will be able to choose from the daily selections or the always available selections. #8. Proper handwashing practices will be followed according to the guidelines and recommendations provided by the state code. Event ID: Facility ID: 676210 If continuation sheet Page 28 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed ensure each resident received and the facility provides food that accommodates residents' food preferences for 1 of 24 residents (Resident #6) reviewed for food preferences and the accommodation of resident's meal choices. The facility did not honor Resident #6's preference for fruit punch on 08/25/25 and 08/26/25. This failure could result in a decrease in resident choices, diminished interest in meals, and weight loss. Findings included: Record review of Resident #6's face sheet, dated 08/28/25, reflected Resident #6 was a [AGE] year-old female, readmitted to the facility on [DATE] with a diagnosis which included cerebral palsy (group of conditions that affect movement and posture). Record review of Resident #6's significant change in status MDS assessment, dated 06/20/25, reflected Resident #6 usually made herself understood, and usually understood others. Resident #6's BIMS score was 15, which indicated her cognition was intact. Resident #6 required setup or clean-up assistance with eating. Resident #6 had not had a 5% weight loss or more in the last month or loss of 10% or more in the last 6 months. Record review of Resident #6's undated comprehensive care plan, reflected Resident #6 was on a NAS diet, regular texture and consistency/therapeutic diet. Resident #6 request fruit punch with lunch and supper. The care plan interventions included Dietary Manager to monitor/discuss food preferences. Record review of Resident #6's order summary report, dated 08/28/25 did not address Resident #6's request for fruit punch at lunch and supper. Record review of the meal ticket dated 08/25/25 and 08/26/25 for Resident #6 reflected beverage preference: fruit punch. During an observation and interview on 08/26/25 at 12:36 p.m., Resident #6 was sitting in the dining room eating her lunch and she stated she wanted some fruit punch. This surveyor went to ask Dietary Aide E about the fruit punch, and she stated they did not have any. The state surveyor told Resident #6 that they did not have any fruit punch, and then she stated they did not have any yesterday (08/25/25). Resident #6 stated it was on her card and she wanted it. The state surveyor looked at her printed tray card ticket and saw her preferred drink was fruit punch. During an interview on 08/26/25 at 2:15 p.m., Dietary Aide E stated the juice machine had been out for a week. Dietary Aide E stated when she tried to pour the juice into the cup, water was coming out instead of the juice. Dietary Aide E stated Resident #6 had asked her one-day last week why she was not receiving fruit punch with her lunch and supper meal. Dietary Aide E stated she did offer Resident #6 lemonade or cranberry juice. Dietary Aide E stated she had reported the issue to the Dietary Manager PRN F and the Dietary Manager. Dietary Manager E stated to the state surveyor she remembered a representative from the juice machine company coming out to check the machine but could not recall the exact date (within the last month), but the machine still did not work afterwards. Dietary Manager E stated it was important for Resident #6's food preference to be followed because it was her right. During an interview on 08/27/25 at 2:36 p.m., the Dietary Manager stated something was wrong with the machine and was informed by Dietary Aide E the fruit punch was coming out watery on 08/26/25. The Dietary Manager stated she expected her or the Dietary Manager PRN F to be notified when staff first noticed the juice was watery. The Dietary Manager stated she monitored once a week by running the machine and tasting the beverages. The Dietary Manager stated it was important for Resident #6's food preference to be followed because it was her right. During a telephone interview on 08/27/25 at 2:54 p.m., a Representative from the juice machine company stated nothing was popping up in his system a service call was made within the last three months. During an interview on 08/27/25 at 3:45 p.m., Dietary Manager PRN F stated she was unaware the fruit punch was coming out as water until 08/27/25 by the Dietary Manager. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 29 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Dietary Manager PRN F stated she expected staff to notify her as soon as the issue occurred. Dietary Manager PRN F stated it was important for Resident #6's food preference to be followed because it was her preference. During an interview on 08/28/25 at 12:56 p.m., the Regional Director of Clinical Operations stated there was no policy and procedures regarding preferences. During an interview on 08/28/25 at 1:50 p.m., the DON stated if Resident #6 preference was to received fruit punch with meals she should have gotten it. The DON stated the dietary staff were responsible for ensuring the correct juice was placed on the tray. The DON stated when it comes to the floor the nurse was responsible to return if the resident did not receive the correct juice and then if it was not available ask Resident #6 for an alternative option. The DON stated preferences was monitored by the Dietary Manager going and speaking with the residents about their preference. During an interview on 08/28/25 at 3:39 p.m., the Administrator stated her expectation were for the aides to notify the Dietary Manager if the machine was not working correctly. The Administrator stated she expected the staff to provide Resident #6's with the preference she desired. The Administrator stated the Dietary Manager should have contacted the machine representative as soon as the issue was noted. The Administrator stated staff could have even gone to the local store to purchase fruit punch to ensure that her preference was granted. The Administrator stated she monitored preference by engaging with the residents during meals and activities. The Administrator stated it was important for Resident #6's food preference to be followed because it was her right. Event ID: Facility ID: 676210 If continuation sheet Page 30 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide liquids consistent with the resident's needs for 1 of 23 (Resident #83) residents reviewed for liquid inconsistency. The facility did not ensure that staff served Resident #83 her 8-ounce water during her lunch meal on 08/26/25. This failure could place residents at risk for dehydration and loss of interest in eating. Findings included: Record review of Resident #65's face sheet, dated 08/28/25, indicated she was an [AGE] year-old female, admitted to the facility on [DATE] and re-admitted [DATE] with diagnoses which included Diabetes mellitus (a group of diseases that affect how the body uses blood sugar).COPD, or chronic obstructive pulmonary disease (a condition caused by damage to the airways or other parts of the lung), and Heart failure (occurs when the heart muscle doesn't pump blood as well as it should). Record review of the order summary report dated 08/28/25 indicated Resident #83 had the following orders: *Carb ohydrates Controlled diet, Regular texture, Regular Consistency with an order start date of 08/23/22. Record review of Resident #83's quarterly MDS, dated [DATE], indicated Resident #83 sometimes made herself understood and was usually understood by others. Resident #83's BIMS score was a 10, which indicated her cognition was moderately impaired. Resident #83 required setup or clean-up assistance with eating. Record review of the comprehensive care plan, revised 07/15/25, indicated Resident #83 had a carb-controlled diet, regular texture, therapeutic diet. The care plan interventions were for staff to provide and serve the diet as ordered. Record review of Resident #83's meal ticket dated 08/26/25 indicated Resident #83 would receive 8 ounces of water for her beverage during her lunch meal. During an observation and interview on 08/26/25 at 12:39 p.m., Resident #83 was served her lunch tray consisting of lemon herb chicken, rice, mixed vegetables, and bread. Resident #83 did not receive her 8 ounces of water. Resident #83 said she wanted ice water to help get her food down. She said she did not have water on her tray yesterday (08/25/25) either. During an observation and interview on 08/26/25 at 12:47 p.m., the state surveyor asked LVN B to review Resident #83's meal ticket for any missing items. After reviewing the meal ticket, LVN B stated Resident #83 had not received her water. LVN B stated Resident #83 should have received a glass of water when her tray was provided. LVN B stated it was important for Resident #83 to receive her water to prevent dehydration. During an interview on 08/27/25 at 1:35 p.m., dietary aide E said they did not serve water during lunch on 08/25/25 or 08/26/25 because they did not have enough cups. She said Dietary Manager F brought some plastic cups today (08/27/25) and they were able to provide water to the residents. During an interview on 8/27/25 at 1:43 p.m., LVN B said she checked trays in the dining room and on the hall on her assigned workdays, and said most of the time, residents did not have water on their trays. She said the residents who ate in their rooms had water in their rooms. She said at times the residents who ate in the dining room would ask for water, and they would get it for them. During an interview on 08/27/25 at 2:16 p.m., the Dietary Manager said the kitchen staff was responsible for putting water or the beverage of choice on the residents' trays during mealtimes. She said she was not aware that the staff did not have enough cups until today (08/27/25) when dietary aide E let her know. She said they usually had enough cups for all meals, but sometimes the cups were dropped or broke in the dishwasher. She said she would order more. She said it was important for the residents to receive water with their meals for hydration. During an interview on 08/28/25 at 2:34 p.m., the DON said she expected Resident #83's drink to be served with her meal. The DON said the nursing staff should ensure water was given to the resident when the tray was delivered. The DON said it was important to ensure residents received their drinks with their meal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 31 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete for hydration purposes. During an interview on 08/25/25 at 3:13 p.m., the Administrator said she expected drinks to be served with meals. The Administrator said whoever was assisting in the dining room was responsible for ensuring residents received their drinks. The Administrator said it was important to ensure drinks were given when the residents received their tray to prevent dehydration. Record review of the facility's policy titled Resident Hydration and Prevention of Dehydration, dated 10/2017,1 indicated . This facility will strive to provide adequate hydration and to prevent and treat dehydration. Event ID: Facility ID: 676210 If continuation sheet Page 32 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interviews, and record reviews, the facility failed to prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed. The facility failed to maintain proper kitchen sanitation when [NAME] D went outside the kitchen and returned without proper hand hygiene protocols. This deficient practice could place residents who were served from the kitchen at risk for health complications and foodborne illnesses.Findings included: During an observation on 08/27/25 at 11:30 a.m., [NAME] D had some keys on the kitchen counter. [NAME] D removed her keys from the kitchen counter to a container that contained individualized packages of sugar, salt, and pepper. [NAME] D then picked up her keys and went outside the kitchen, and returned without hand hygiene. [NAME] D went over to the counter where another staff member was preparing drinks for the residents, and put her hands near the glasses, and was about to help the other staff member when stopped by the state surveyor. During an interview on 08/27/25 at 11:45 a.m., [NAME] D said she was not supposed to have her personal keys in the kitchen. She said she was wrong for putting her keys in the sugar, salt, and pepper container and should have washed her hands when she returned to the kitchen. She said failure to wash her hands could lead to cross-contamination and foodborne illness. She said she would throw the sugar, salt, and pepper packages away. During an interview on 08/27/25, at 2:17 p.m., the Dietary Manager said staff were not supposed to have personal items in the kitchen. She said [NAME] D should not have placed her keys in the sugar, salt, and pepper containers or had her keys in the kitchen area. The Dietary Manager emphasized that all staff members must sanitize or wash their hands immediately after touching personal items (such as hair or their face) to uphold hygiene standards. Additionally, the Dietary Manager said all staff were aware of the critical role hand hygiene played in preventing foodborne illnesses. During an interview on 08/28/25 at 2:34 p.m., the DON said that when anyone entered the kitchen, they were supposed to wash their hands for sanitary reasons. She said the Dietary Manager was responsible for ensuring the dietary staff was following the policy on sanitation. During an interview on 08/28/25 at 3:13 p.m., the Administrator said all staff who enter the kitchen should have on a hair net, and they must wash their hands. She said the staff were not supposed to have any personal items in the kitchen. She said the Dietary Manager was responsible for ensuring the staff were trained on proper hand washing. She said if staff did not wash their hands, it could lead to foodborne illness. Record Review of Facility Policy titled, Sanitation, dated 11/2023, indicated Policy: Food & Nutrition Services Personnel will be responsible for maintaining the cleanliness and sanitation of the kitchen. Event ID: Facility ID: 676210 If continuation sheet Page 33 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for each resident receiving hospice services, to ensure quality of care for the resident, ensuring communication with the hospice medical director, the resident's attending physician, and others participating in the provision of care for 2 of 5 residents (Residents #'s 4 and 12) reviewed for hospice services. 1. The facility failed to obtain Resident #4's most recent updated hospice plan of care. 2. The facility failed to ensure Resident #12's hospice records were a part of their records in the facility. These deficient practices could place residents at-risk of receiving inadequate end-of-life care due to a lack of documentation, coordination of care and communication of resident needs.Findings included: 1. Record review of Resident #4's face sheet, dated 08/27/25, indicated a [AGE] year-old female who readmitted to the facility on [DATE] with diagnoses which included down syndrome (a disorder caused by having an extra chromosome), dysphagia (difficulty swallowing), and hypertensive heart disease (condition caused by high blood pressure) with heart failure (heart cannot pump efficiently enough to meet the body's need for blood). Record review of Resident #4's quarterly MDS assessment, dated 05/04/25, indicated Resident #4 was rarely/never understood and rarely/never understood others. Resident #4 had a BIMS score of 0, which indicated her cognition was severely impaired. The MDS assessment indicated Resident #4 received hospice care. Record review of Resident #4's comprehensive care plan, dated 03/22/25, indicated Resident #4 had a terminal prognosis related to hypertensive heart disease with heart failure. The care plan interventions included to work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical, and social needs were met. Record review of Resident #4's order summary report, dated 08/27/25, indicated an order for admit to [hospice company] with a diagnosis of hypertensive heart disease with heart failure with an order date of 03/18/25. Record review of Resident #4's hospice binder indicated Resident #4's last hospice plan of care was dated 07/03/25. During an interview on 08/27/25 at 10:28 AM, the Hospice DON said the hospice documents were typically brought to the facility by hospice staff every 60 or 90 days. She said sometimes they were brought sooner if requested from the facility. She said the IDT plan of care meetings were conducted every 2 weeks and updated with any changes. She said the plan of cares done every 2 weeks were the most recent. She said the case manager was responsible for delivering them to the facility. She said it was important for the most recent hospice documents to be at the facility, so everyone was on the same page and for coordination of care. During an interview on 08/28/25 at 12:57 PM, the DON said she expected the most recent hospice documents to be at the facility if that was the hospice policy. She said having the most recent documents kept the facility staff updated with the resident's plan of care. She said the SW was responsible to ensure hospice provided the documents timely but everyone else could have helped. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 34 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0849 Level of Harm - Minimal harm or potential for actual harm During an interview on 08/28/25 at 1:16 PM, the Administrator said she expected the hospice documents to be delivered to the facility in a timely manner, so her staff was aware of the care needed for the resident. She said the DON was responsible to ensure hospice documents were delivered to the facility. The Administrator said, by not having the most recent hospice documents, the staff would not be aware of any changes made to the resident's plan of care. Residents Affected - Few 2. Record review of Resident #12's face sheet, dated 08/28/25, reflected Resident #12 was an [AGE] year-old female, readmitted to the facility on [DATE] with diagnoses which included end stage heart failure (a condition where the heart is unable to pump enough blood to meet the body's needs). Record review of the order summary report dated 08/28/25 reflected Resident #12 had an order to admit to hospice with an order date 08/22/25. Record review of the significant change in status MDS assessment, dated 08/22/25, reflected Resident #12 usually made herself understood and usually understood others. Resident #12's BIMS score was 13, which reflected her cognition was intact. The assessment reflected Resident #12 had a life expectancy of less than 6 months and received hospice services. Record review of the undated comprehensive care reflected Resident #12 had a terminal prognosis related CHF (chronic condition in which the heart did not pump enough to give your body a normal supply). The care plan inventions included work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical and social needs are met. Record review of Resident #12's hospice binder, accessed by the state surveyor on 08/27/25 at 9:45 a.m. revealed no updated CTI, medication list, nurses, aides, social worker and chaplain notes since the last IDG meeting (08/15/25). During a telephone interview on 08/27/25 at 10:48 a.m., the BOM for the hospice company stated Resident #12 was admitted to hospice on 02/16/23 for end stage heart failure. The BOM stated the last visit was on 08/26/25. The BOM stated she was told by the Administrator they did not need updated visits just the initial paperwork when the resident first came on hospice. The BOM stated every other Friday she faxed over the IDG meetings notes which included the medication profile and POC from all disciplines. The BOM stated the last IDG meeting was on 08/15/25. The BOM stated the process for coordinating with the facility was via faxed. During an interview and observation on 08/28/25 at 1:50 p.m., the DON stated she was unaware the binders were not updated. The DON stated the social worker was responsible for ensuring the hospice book was updated with all required information by calling the hospice provider. The DON stated the updated POC, aides, nurses, chaplain, social services notes and IDG meetings notes should be included in the binder. After reviewing the hospice binder with the state surveyor, the DON stated the binder was not updated to include all information that was needed. The DON stated the charge nurses communicated verbally one on one with the hospice. The DON stated it was important to ensure recent hospice documentation was in the facility to keep communication between the facility and hospice for continuation of care. During an interview on 08/28/25 at 2:43 p.m., the Social Worker stated she was responsible for ensuring the hospice binder was updated. The Social Worker stated typically the process; was the hospice would email the documentation to medical records and then she would print it out and place it in the binder. The Social Worker stated medical records usually forward the email to her when received. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 35 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The Social Worker stated the hospice email documents quarterly. The Social Worker stated a random audit was completed for compliance and if there was an issue the hospice would be notified. The Social Worker stated it was important to ensure recent hospice documentation was in the facility for continuity of care. During an interview on 08/28/25 at 2:48 p.m., The Medical Records stated hospice send documentation every other month via email and she forward it to the social worker. The Medical Records stated all she had to do was to ensure the email was sent Social Worker. The Medical Records stated it was important to ensure recent hospice documentation was in the facility for continuity of care. During an interview on 08/28/25 at 3:39 p.m., the Administrator stated her expectation that all documents were updated and placed in the binder such as the POC, any recommendation on who to contact with a change of conditions, nurse/aides' visits and IDG meetings. The Administrator stated she did not recall telling the hospice provider she only needed the initial hospice documentation in the binder. The Administrator stated the social worker was responsible for ensuring the binder was updated via phone at least every other week. The Administrator stated it was important to ensure recent hospice documentation was in the facility for continuity of care. Record review of the Hospice Program, dated 07/2017, indicated, Hospice services are available to residents at the end of life. 12. Our facility has designed the hospice provider to coordinate care provided to the resident by out facility staff ad hospice staff. d. Obtaining the following information from the hospice: (1) the most recent hospice place of care specific to each resident; 2. Hospice election form; physician certification and recertification of the terminal illness specific to each resident. 6. Hospice medication information specific to each resident. e. Ensuring that our facility staff provided orientation on the policies and procedures of the facility, including resident rights, appropriate forms, and record keeping requirements, to hospice staff furnishing care to the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 36 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 4 residents (Residents #30 and Resident #65) and 1 of 3 halls (Hall 100) reviewed for infection control practices. 1. The facility failed to ensure CNA O performed proper hand hygiene and glove changes when providing incontinent care to Resident #30 on 08/25/2025. 2. The facility failed to ensure the Maintenance Supervisor wore PPE when entering Resident #65's room on 08/27/25, who was on contact isolation for C. diff (a highly contagious bacterium that causes diarrhea). The facility failed to ensure the proper disinfectant cleaner was used to clean Resident #65's isolation room with C. diff. 3. The facility failed to ensure linen was not placed on top of the dirty linen barrel on Hall 100 on 08/26/2025. These failures could place residents and staff at risk for cross contamination and the spread of infection.Findings included: 1. Record review of a face sheet dated 08/26/2025 indicated Resident #30 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses which included other specified diabetes mellitus with diabetic neuropathy (insulin resistance leading to high blood sugars which results in nerve damage cause by prolonged high blood sugar levels) and acquired absence of the left leg below the knee. Record review of Resident #30's Quarterly MDS assessment dated [DATE] indicated he usually understood others and was usually understood by others. The MDS assessment indicated Resident #30 had a BIMS score of 13, which indicated his cognition was intact. The MDS assessment indicated Resident #30 required setup or clean-up assistance with toileting hygiene, showering/bathing, dressing, and personal hygiene. The MDS assessment indicated Resident #30 was occasionally incontinent of urine and frequently incontinent of bowel. Record review of Resident #30's care plan revised 07/15/2025 indicated he had an ADL self-care performance deficit related to his disease processes, immobility, and balance problems. Resident #30's care plan indicated he required limited assistance of one staff for toileting and personal hygiene. Resident #30's care plan indicated he was frequently incontinent of bowel and occasionally of bladder to monitor for incontinence every two hours and as needed and to change promptly. During an observation on 08/25/2025 at 3:34 PM, CNA O provided incontinent care to Resident #30 while he was in bed. CNA O applied gloves and unfastened Resident #30's dirty brief and removed his soiled shorts. CNA O grabbed the wipes container with her dirty gloves and the clean brief and placed them on top of Resident #30's bed. CNA O then wiped Resident #30's front perineal area. Resident #30 had a bowel movement, and CNA O needed more wipes. CNA O grabbed the wipes container with her dirty gloves to get more wipes. CNA O removed Resident #30's dirty brief and put it on top of Resident #30's clean sheet. CNA O grabbed the clean brief with her dirty gloves, then put it down and changed gloves, and put on new gloves. CNA O failed to perform hand hygiene after removing her dirty gloves. CNA then placed the dirty brief in a bag and then applied the clean brief with her dirty gloves. CNA O, with her dirty gloves still on, looked for clean shorts in Resident #30's drawers, applied the clean shorts, and then assisted Resident #30 back to his wheelchair and returned the wipes container to the top of Resident #30's dresser. CNA O removed her dirty gloves, did not perform hand hygiene, grabbed the trash bag with the dirty brief and left Resident #30's room. During an interview on 08/25/2025 at 4:02 PM, CNA O said hand hygiene should be performed before care and before leaving the resident's room. CNA O said gloves should be changed when soiled. CNA O said hand hygiene should be performed in between glove changes. CNA O said she had not adequately performed hand hygiene because it slipped her mind. CNA O said wipes should be removed from the wipes container prior to providing care, and if Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 37 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 more wipes are needed gloves should be removed clean ones applied and more wipes removed from the container. CNA O said she had not properly obtained wipes because there was an issue with time. CNA O said touching the wipes container with dirty gloves and returning it to the resident's dresser was considered dirty and could cause cross contamination. CNA O said the dirty brief should be placed in a bag when removed. CNA O said she had not placed it in a bag because there was an issue with not having enough bags. CNA O said placing the dirty brief on top of the clean sheet made the linen soiled and contaminated. CNA O said not changing gloves properly during incontinent care and not performing hand hygiene when required could result in infections. 2. Record review of Resident #65's face sheet, dated 08/28/2025, indicated he was a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included C. diff, Hyponatremia (a condition that happens when the level of sodium in the blood is lower than the typical range), Chronic Obstructive Pulmonary Disease, also known as COPD (a chronic lung disease that causes inflammation and narrowing of the airways, leading to airflow obstruction), and anemia (a condition in which there was a lower-than-normal number of red blood cells (RBCs) or hemoglobin in the blood). Record review of Resident #65's Comprehensive MDS assessment dated [DATE] indicated he was usually understood by others and usually understood others. Resident #65's MDS assessment indicated he had a BIMS score of 7, which indicated his cognition was severely impaired. The MDS assessment indicated Resident #65 required partial/moderate assistance with showering/bathing, personal hygiene, and dressing and was dependent on staff for toileting. The MDS assessment indicated Resident #65 was always incontinent of bowel and bladder. Resident #65's MDS assessment indicated he required isolation or quarantine for active infectious disease while a resident at the facility. Record review of Resident #65's Order Summary Report dated 08/27/2025 indicated: Isolation precautions contact and droplet every shift for C. diff and to ensure appropriate signage was posted on the doorway to indicate specific isolation, as well as donning/doffing PPE (refers to the critical procedures of donning (putting on) and doffing (taking off) personal protective equipment (PPE) correctly to ensure worker safety and prevent contamination) stations with a start date of 08/10/2025. Vancomycin HCl 25 milligram/milliliter solution reconstituted, give 5 milliliters by mouth every 6 hours for GI (gastrointestinal) with a start date of 08/20/2025 and end date of 08/28/2025. Record review of Resident #65's care plan, revised 08/20/2025, indicated he was on antibiotics related to C. diff for 10 days with interventions which included to give medication as ordered. Resident #65's care plan did not address isolation precautions for him. Record review of Resident #65's lab of stool re-drawn at the facility on 08/14/25 and received 08/16/25 indicated a positive result of C-Diff. During an observation on 08/25/2025 at 10:40 a.m., Resident #65 had a sign by his doorway that said isolation, along with how to don and doff PPE. The isolation cart was outside his door with gowns, gloves, and masks. Resident #65 was in his bed. During an observation on 08/26/2025 at 08:30 a.m., Resident #65 was in his bed. He said he was aware he was in contact isolation related to his bowels. He said staff usually wore a gown and gloves while in his room. Resident #65 had 2 boxes in his bathroom, 1 lined with a red bag and the other with a yellow bag. The red bag had briefs and other things, and the yellow bag had linen in it. During an observation on 08/26/2025 at 9:02 a.m., the Maintenance Supervisor was in Resident #65's room with gloves on and without a gown. Resident #65 had received his breakfast tray, and it appeared the Maintenance Supervisor was helping him set up his breakfast tray. The Maintenance Supervisor then picked up his clipboard and started writing with the same gloves on. The Maintenance Supervisor then removed his gloves and went into another room without washing his hands or sanitizing his clipboard. During an interview on 08/26/2025 at 11:04 a.m., the Maintenance Supervisor said he did not have to put on a gown while in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 38 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 Resident #65's room. He said he was aware Resident #65 was on contact precautions, but only had to wear gloves because he was not in contact with him. He said he would only need to wear a gown when he was in contact with the resident. He said he believed he helped Resident #65 remove his top to his cup for breakfast this morning, and maybe something else, but could not recall. He said he had on gloves while in Resident #65's room, and when he entered the next room, he applied gloves. He said he usually hand-sanitized with alcohol-based hand rub but could not say if he did or did not when he left Resident #65's room. He said he knew he did not wash his hands with soap and water after leaving Resident #65's room, but could not give a reason why. He said he knew if he did not wash his hands, he could potentially spread germs. During an interview on 08/27/2025 at 11:07 a.m., LVN A said Resident #65 was on contact isolation because he had C-diff. She said that anyone entering his room should wash their hands, apply a gown and gloves, and rewash before leaving the room to prevent the spread of infection. During an observation and interview on 08/28/2025 at 9:12 AM, Housekeeper N said she had been wearing PPE in Resident #65's room. Housekeeper N said she used the same cleaning products for all the rooms, including Resident #65's room. Housekeeper N brought her cleaning products, and they included Ecolab Rapid Multi-Surface disinfectant cleaner and Ecolab acid bathroom cleaner. Housekeeper N said it was important to ensure they were using the correct cleaning products so they would not make anybody sick, and to ensure the disinfectant was doing what it was supposed to do, disinfect. During an interview on 08/28/2025 at 9:45 AM, the Housekeeping Supervisor said he was not aware Resident #65's room required a specific cleaning solution. The Housekeeping Supervisor said he was informed PPE should be worn to clean his room because he was on contact isolation, but he was unaware that Resident #65's room required a specific cleaning disinfectant. The Housekeeping Supervisor said not using the correct cleaning products would not kill the bacteria and could cause spread of the bacteria. During an interview on 08/28/25 at 2:34 p.m., the DON said she expected all staff to follow the guidelines on the sign posted on the door. She said the staff were aware of Resident #65 being on contact precautions by the sign on the door and the setup outside the door. She said staff had to wear PPE (gown or gloves) when they entered Resident #65's room. The DON said she and other department heads made daily rounds to monitor for infection control issues. She said it was important for staff to wear PPE (gown and gloves), wash their hands before entering and exiting Resident #65's room to prevent infection control issues. During an interview on 08/28/25 at 3:13 p.m., the Administrator said staff should wear PPE (gown and gloves) when entering contact isolation rooms. She said the DON was the overseer of infection control. She said that for isolated residents, staff should practice hand hygiene before and after leaving the room to prevent infection. She said they wanted to contain the infection to one area as much as possible. 3. During an observation and interview on 08/26/2025 starting at 8:03 PM, there was a stack of clean bed pads, gowns, and bed linens on top of the dirty linen barrel on Hall 100 in front of the nurse's station. CNA H said she had placed the clean linen on top of the dirty linen barrel. CNA H said she placed it there because they did not have a linen cart. CNA H said the clean linen should not be placed on top of the dirty linen barrel because it would cause the clean linen to be contaminated. During an interview on 08/26/2025 at 8:09 PM, LVN K said the charge nurse was responsible for ensuring the CNAs stored linen properly. LVN K said the clean linen should not be placed on top of the barrels. LVN K said placing them on top of the barrels could contaminate them, and they could get bugs on them from the dirty linen and take it to the residents. LVN K said the CNAs were supposed to place linens in a bag and take them to the residents' rooms. LVN K said she did not notice clean linens had been placed on top of the dirty linen barrel. During an interview on 08/28/2025 at 2:18 PM, the DON said hand hygiene should be performed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 39 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 before providing care, in between glove changes, and before leaving the resident's room. The DON said gloves should be changed when touching anything considered dirty and when gloves were contaminated. The DON said the wipes should be removed from the container prior to the beginning of care. The DON said the CNAs were not supposed to touch the wipes container with their dirty gloves. The DON said when providing care, the dirty brief should be placed in a trash bag. The DON said when touching the dirty brief or gloves become dirty nothing clean should be touched. The DON said the CNAs should remove their dirty gloves, perform hand hygiene and apply new, clean gloves. The DON said not changing gloves when dirty, touching clean items with dirty gloves, and putting the dirty brief on the clean linen could result in cross contamination. The DON said not changing gloves properly and performing hand hygiene when required during incontinent care could result in a urinary tract infection. The DON said linen should be carried directly to the patients' rooms. The DON said the clean linen should not be placed on top of the barrels because it could result in cross contamination. The DON said the Administrator, or the Housekeeping Supervisor were responsible for ensuring the residents rooms were cleaned with the appropriate cleaning solution to disinfect properly. The DON said the Housekeeping Supervisor was in the morning meetings and should have been aware of Resident #65 having C. diff. The DON said not having the proper cleaning solution to disinfect against C. diff could cause reinfecting with the bacteria and it would not clear the bacteria. During an interview on 09/03/2025 at 2:47 PM, the Administrator said hand hygiene was a must, and her expectations were the CNAs used the skills they were trained to use. The Administrator said she expected for the staff to understand the importance of infection control by washing their hands, wearing the proper PPE, and discarding soiled briefs properly. The Administrator said during incontinent care the staff should not go from dirty to clean. The Administrator said this could result in the resident developing infections. The Administrator said touching clean items with dirty gloves resulted in the spread of germs. The Administrator said it was not true that they did not have enough trash bags. The Administrator said the housekeeping department was replacing the trash bags throughout the day. The Administrator said linen should not be sitting out. The Administrator said staff should get the linen they were using for the resident and that resident only. The Administrator said having the linen sitting out was an infection control issue that it should never be left out exposed. The Administrator said there were linen closets at the ends of the hallways, and the staff could go there and to the residents' rooms to take the linen. The Administrator said the Housekeeping Supervisor was responsible for ensuring the correct cleaning disinfectant was used to clean Resident #65's room. The Administrator said the clinical team was responsible for informing the Housekeeping Supervisor when a resident had an organism that required a specific cleaning product. The Administrator said using the correct cleaning products kept the disease from spreading to another residents' room. Record review of an untitled and undated document regarding the EPA numbers for the cleaning disinfectants used in Resident #65's room indicated: 73 Disinfecting Acid Bathroom Cleaner EPA# 1677-246 Neutral Disinfectant Cleaner EPA-registration 47371-1291677 Rapid Multi Surface Disinfectant Cleaner EPA# 1677-272Record review of the following site was accessed on 08/28/2025 and did not indicate the Disinfecting Acid Bathroom Cleaner, Neutral Disinfectant Cleaner, and Rapid Multi Surface Disinfectant Cleaner were effective against C. Diff bacteria: https://www.epa.gov/pesticide-registration/epas-registered-antimicrobial-products-effective-against-clostridioides. https://www3.epa.gov/pesticides/chem_search/ppls/001677-00246-20141028.pdf https://www3.epa.gov/pesticides/chem_search/ppls/001677-00273-20230315.pdf https://ordspub.epa.gov/ords/pesticides/f?p=PPLS:8:11987544152696::NO::P8_PUID,P8_RINUM:151710,47371-129-1677 Record review of the facility's policy titled, Transmission-Based Precautions for Infections, revised (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 40 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 10/24/2022, indicated, 1. Types of transmission-based precautions a. Contact- In addition to standard precautions, use Contact precautions (gown, gloves, mask or faceshield if splashing could occur) for residents known or suspected to be infected with microorganisms that can be easily transmitted by direct or indirect contact, such and handling environmental surfaces or resident-care items.The above includes epidemiologically important organisms (Multidrug-resistant organisms) such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), other highly transmissible infections such as Clostridium difficile.Resident's who are infected with or colonized with MDRO's should be in contact isolation when resident has wounds, secretions, or excretions that are unable to be covered or contained, or if ongoing transmission of MDRO's in units or community continue despite attempts to control the spread. b. Droplet- In addition to Standard Precautions, use droplet precautions (gown, gloves, mask) for a resident known or suspected to be infected with microorganisms transmitted by droplets that can be generated by the resident sneezing, coughing, talking, etc. and drop from the air. These incudes bacterial infections such as invasive H. influenza, invasive Neisseria meningitides, Mycoplasma Pneumonia, Streptococcus infection, and some viral infections, including corona virus, adenovirus, in influenza, mumps, and rubella. Spatial separation more than 6 feet and only co-horting residents with same virial infection in the same room with droplet route. If resident must leave room the resident should wear a surgical facemask. 11. Environmental cleaning and disinfection of frequently touched or visibly soiled surfaces in common areas, resident rooms, and at the time of discharge. Record review of the facility's policy titled, Infection Control, revised 10/25/2022, indicated, This communities' infection control policies and practices are intended to facilitate maintaining a safe, sanitary, and comfortable environment and to help prevent and manage transmission of diseases and infections.Provide guidelines for the safe cleaning and reprocessing of reusable resident-care equipment. Record review of the facility's policy titled, Hand Hygiene, revised 10/24/2022, indicated, Hand Hygiene is used to prevent the spread of pathogens in healthcare settings. Hand hygiene is a general term that describes hand washing using soap and water or the use of an alcohol-based hand rub (ABHR) to destroy harmful pathogens, such as bacteria or viruses, on the hands. 1. You should always perform hand hygiene: When you arrive for work and when you leave for the day Before touching your mouth, nose, or eyes Before applying and after removing personal protective equipment (e.g. gloves, gown, mask, face shield/goggles) Before and after providing any type of care. Record review of the facility's policy titled, Perineal Care, effective 10/01/2021, indicated, To provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition. Place the equipment on the bedside stand. Arrange the supplies so they can be easily reached.put on gloves.9. For a male resident: a. Use wipe and apply skin cleansing agent. b. Wash perineal area starting with urethra and working outward.e. Instruct or assist the resident to turn on his side with his upper leg slightly bent, if able. f. Use disposable wipe and apply skin cleansing agent. g. Use wipes on the rectal area thoroughly, including the area under the scrotum, the anus, and the buttocks. 10. Discard disposable items into designated containers. 11. Remove gloves and discard into designated container. Wash and dry your hands thoroughly. 12. Reposition the bed covers. Make the resident comfortable. 13. Place the call light within easy reach of the resident. 14. Clean the bedside stand. 15. Wash and dry your hands thoroughly. Record review of the facility's policy titled, Laundry and Linen processing, dated 10/24/2022, indicated, The purpose of this procedure is to provide a process for the safe and aseptic handling, washing, and storage of linen. Clean linen will remain hygienically clean (free of pathogens in sufficient numbers to cause human illness) through measures designed to protect it from environmental contamination, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 41 of 42 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 676210 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Summer Place 2485 S Major Dr Beaumont, TX 77707 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 such as covering clean linen carts. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676210 If continuation sheet Page 42 of 42