Health inspection·November 25, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assessment, dated 11/17/2025, reflected a BIMS score of 15 indicated intact cognition. During an interview on 11/25/2025 at 11:36 a.m., Resident #1 revealed that CNA D is acting like she is the boss around here and not very patient with her. She stated that CNA D took her coffee cups and milk carton from her table without asking her first. She stated that she told RN A regarding CNA D's rude behavior several times and specifically on 11/25/2025.During an interview on 11/25/2025 at 12:05pm, Resident #2 stated that CNA D behaved like she did not want to help her. When Resident #2 asked CNA D for pain medication last night, she answered the call light stating, what do you want now?, I told you to be patient. She stated that she did not want CNA D to take care of her anymore because she was not patient and was rude to her. She stated she tried to talk to CNA D nicely and she could not understand why she treated her that way. She stated that the behavior of CNA made her feel sad. She stated she told RN A without recalling exact dates about CNA D and did not report her to anybody else. During interview on 11/25/25 at 2:35 p.m. with CNA D she said she worked with nursing staffing agency sending her to different facilities and on as needed bases she worked at this facility since 2020. She stated that she worked on hall 100 for a while on 2-10 p.m. shifts. She stated that she always asked residents if they were done eating before taking their trays and coffee cup if they were dirty to clean resident's tables. She took two cups of coffee from Resident #1's table because she had too many cups on her table. She stated that she did not remember when she had her ANE training. She stated that she knows different types of abuse, neglect and exploitation. She gave an example of verbal abuse when staff talked to residents with disrespect and using offensive words toward them. She said that any signs of ANE should be reported to the administrator immediately. She stated that Resident #1 was using offensive words towards her several times, and she was always professional towards her or any other residents she worked with. During an interview on 11/25/2025 at 11:58 a.m. social worker stated she had worked at this facility for seven months. She stated that she did not hear any complaints about abuse, neglect or exploitation from residents or staff. She had ANE training in September this year where she learned what abuse is, signs of abuse and reporting immediately to administrator. She stated that when she was interviewing residents on 100 hall, Resident #2 today, 11/25/2025, she told her that CNA D was impatient with her and impolite. During an interview on 11/25/2025 at 1:40pm, RN A revealed that Resident #1 did not complain to her about somebody physically abusing her. Resident #1 told her on multiple occasions that CNA D was acting like she was a boss around her, taking her tray without asking her. RN A stated that she talked to CNA D last Monday regarding her approach to Resident #1 and asked to modify it. She stated that she brought Resident #1's complaints to the morning clinical meeting with the DON on 11/25/2025. She stated that DON told her she will look into this complaint. She said that one more resident complained to her regarding CNA D's attitude. She stated that she had ANE training a month ago and periodically through the year. She stated that any signs of abuse, neglect and exploitation should be reported immediately to Administrator. During interview on 11/25/2025 at 1:47 p.m., with CNA B, she stated that she had ANE training last month. She learned the different types of abuse and being mindful while transferring residents explaining what they were doing before providing care. Signs of abuse when residents looked scared of staff. She said if she noticed something unusual in residents' behavior, ask this resident, and report it to a charge nurse. Notify the abuse coordinator, which is the administrator. During interview on 11/25/2025 at 1:56 p.m., LVN C revealed that he did not recall Resident #1 reporting any ANE signs and symptoms. He stated that he had ANE in service in last three months, where he learned to report any suspected ANE to the administrator immediately. During an interview on 11/25/2025 at 5:12 p.m., the DON said she was trained on ANE sometimes in September 2025 and stated any signs of abuse, neglect (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676226 If continuation sheet Page 2 of 3 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 676226 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cypress Healthcare and Rehabilitation Center 1351 Sadler San Marcos, TX 78666 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and exploitation including suspected ANE should be reported to the administrator, who is abuse coordinator, immediately. She stated that verbal abuse including yelling at the patient, demeaning them, bossing around, providing care without explanation would be considered abuse. She stated that RN A did not talk to her regarding complaint of Resident 1 during the morning meeting. RN A came at 11:30 a.m. to her office doorway and stated that Resident 1 had issues with her tray being taken away without specifically pointing to CNA D's actions. She stated that she was going to investigate that report later that day. She stated that she never heard any ANE allegations from any residents or staff regarding CNA D before. During interview on 11/25/2025 at 5:27 p.m., the administrator revealed that she worked as the administrator at this facility for 1 year and had ANE training in October 2025 including ANE definitions, types, and who to report and conduct investigations. If suspected ANE, it should be reported to her within 2 hrs. Examples of verbal abuse would be calling names, yelling, perception of tone of voice, how they were spoken to. She stated that she considered CNA D one of her best CNAs and intended to promote her to staffing coordinator. She stated that she suspended CNA D immediately after learning of allegations from the surveyor and reported those allegations to the HHSC and started investigation. The administrator stated she never had any complaints regarding CNA D before and even considered her for the staffing coordinator position. CNA D sent her an e-mail regarding an incident last night, 11/24/2025, describing the situation when she took a tray from Resident #1's room and Resident #1 got upset.The undated Policy titled Abuse Prevention and Investigation indicated verbal abuse is the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance, regardless of their age, ability to comprehend, or disability. Under #9 of this policy: All employees are required to report any observed, known, or suspected instances of resident abuse or neglect to their supervisors, the Administrator or the Director of Nursing. Any report, grievance, or complaint that indicates residents abuse or the potential for resident abuse will be reported to the Administrator and investigated as needed in order to protect all residents. The timeframe required for reporting (immediately but not later than 2 hours after forming suspicion requirements for reporting). Record Reviews of facility's grievances in last three months did not reveal any ANE grievances with CNA D. Event ID: Facility ID: 676226 If continuation sheet Page 3 of 3