Inspection·February 28, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm for generalized anxiety disorder, Mirtazapine 15 mg by mouth at bedtime for depression. Buspirone HCl 10 mg by mouth three times a day for anxiety disordered with order date of 3/7/24. Record Review of Resident 300's Progress Notes revealed order for Mirtazapine entered at 3/7/24 at 1:02 a.m. by LVN H that revealed LVN H was working overnight 3/6/24. Residents Affected - Few During interview on 2/28/25 at 11:26 a.m. with the DON, the DON said that she would have been the ADON during March of 2024 for Resident #300. The DON said that if a resident was admitted past 4 p.m. she would not have been at the facility, but she would have checked the resident's medication orders the next day. The DON said that the charge nurse is who is responsible for the medications to be given and she could not say what happened regarding Resident #300 not receiving her medications on 3/6/24. The DON said that psychiatric, blood pressure and antibiotics were examples of medications that should be given even if a resident was admitted in the evening. During interview on 2/28/25 at 12:15 p.m. with the DON, the DON said that medications can be obtained from the emergency kit or the automated medication dispensing system. The DON said that medications can be obtained from the pharmacy overnight if needed. The DON said that resident medications should be started in the evening unless there were extenuating circumstances. Surveyor left message for LVN H on 2/28/25 at 12:38 p.m. to follow up if she had any further information why Resident #300 would not have gotten medications on 3/6/24. During interview on 2/28/25 at 12:47 p.m. with Administrator A, Administrator A said it was the expectation that residents will get their medications if the medication was in hand and have consent if needed. Administrator A said they can obtain medication from the automated medication dispensing system if needed or the pharmacy but that may take more time depending on the situation. During interview on 2/28/25 at 2:58 p.m. with Administrator B, Administrator B said she just started work at the facility in February 2024. Administrator B said she could not remember any information regarding Resident #300. Record Review of facility's policy Medication Administration Procedures with revised date of 10/25/17 stated Defining the schedules for administering medications: Maximize the effectiveness (optimal therapeutic effect) of the medication. The policy also stated all orders are presumed to be administered on the first scheduled medication time following their arrival at the facility through the normal pharmacy delivery process. The policy also stated that the 10 rights of medication should always be adhered to which included the right time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 2 of 10 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 676239 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Toscana at Cypress Woods 15015 Cypress Woods Medical Dr Houston, TX 77014 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure that the medication error rate was not five percent or greater. The facility had a medication error rate of 18.52% based on 5 errors out of 27 opportunities, which involved three (Resident #26, Resident #37, and Resident #77) of seven residents reviewed for medication errors. Residents Affected - Some 1. The facility failed to ensure that Resident 26's Ferrous Sulfate 300 (60 Fe) mg/5ml and Calcium-Vitamin D 600-200 mg were available at the time of observation and administered as ordered. 2. The facility failed to ensure that Resident 37's Glucosamine HCL 500 mg was available at the time of observation and administered as ordered. 3. The facility failed to ensure that Resident 77's Fish Oil 1000 mg was administered correctly as Resident 77 was administered Fish Oil 1200 mg. The facility failed to ensure that Resident 77's Super B-Complex Oral Tablet (B-Complex w/Biotin & Folic Acid) was administered correctly. Resident 77 was administered Vitamin B-Complex and Folic Acid 400 mcg in place of the Super B-Complex Oral Tablet (B-Complex w/Biotin & Folic Acid). These failures could place residents at risk of not receiving the intended therapeutic benefits of their medications or not receiving them as prescribed, per physician orders. Findings include: Record Review of Resident #26's face sheet dated 2/25/25, revealed resident was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Aftercare Following Joint Replacement Surgery, Unspecified Osteoarthritis, Vascular Dementia, Age-Related Osteoporosis, Vitamin Deficiency, and Alzheimer's Disease. Record Review of Resident #37's face sheet dated 2/25/25, revealed resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Peripheral Vascular Disease (Narrowing of Peripheral Blood Vessels), Diabetes Mellitus, and Dementia. Record Review of Resident #77's face sheet dated 2/25/25, revealed resident was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Cerebral Atherosclerosis (Plaque Build-Up in the Brain), Unspecified Dementia, Mixed Hyperlipidemia (High Cholesterol), Spondylosis (Degenerative Changes in the Spine) and Other Intervertebral Disc Degeneration. Record Review of Resident #26's Order Summary Report dated 2/26/25 revealed Calcium-Vitamin D Tablet 600-200 mg with start date of 9/30/24 and Ferrous Sulfate Oral Solution (60 Fe) mg/5 ml with start date of 9/26/24. Record Review of Resident #27's Order Summary Report dated 2/26/25 revealed Glucosamine HCL 500 mg with start date of 12/19/24. Record Review of Resident #77's Orders Summary Report dated 2/26/25 revealed Fish Oil Capsule 1000 mg with start date of12/28/24 and Super B-Complex Oral Tablet (B-Complex w/Biotin & Folic Acid) with start date of 12/28/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 3 of 10 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 676239 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Toscana at Cypress Woods 15015 Cypress Woods Medical Dr Houston, TX 77014 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record Review of order printed 2/25/25 at 9:52 a.m. revealed on 2/25/25 at 9:49 new order for Resident #26 for Ferrous Sulfate Oral Solution (Ferrous Sulfate) Give 7.5 ml by mouth two times a day. Record Review of order printed 2/25/25 at 9:57 a.m. revealed on 2/25/25 at 9:54 new order for Resident #26 for Calcium 600+D3 Oral Tablet 600-10 mg-mcg (Calcium Carbonate-Cholecalciferol) Give 1 tablet by mouth one time a day for supplements Calcium D3-600 mg/10mcg. Record Review of order printed 2/25/25 at 10:01 a.m. revealed on 2/25/25 at 10:00 a.m. new order for Resident #37 for Glucosamine Sulfate Oral Tablet (Glucosamine Sulfate) Give 1000 mg by mouth one time a day for supplement. Observation on 2/25/25 at 8:44 a.m. revealed that Glucosamine 500 mg was not administered to Resident #37 as ordered. Observation and Interview with MA G on 2/25/25 at 8:44 a.m. revealed that MA G was unable to find Glucosamine 500 mg tablets on medication cart but was had Glucosamine 1000 mg tablets on medication cart. MA G said she would hold the Glucosamine since she did not have the correct dosage and would notify the nurse. Observation on 2/25/25 at 9:03 a.m. revealed that Ferrous Sulfate 300 (60 Fe) mg/5ml and Calcium-Vitamin D 600-200 mg was not administered to Resident #26 as was ordered. Observation and Interview of MA G on 2/25/25 at 9:03 a.m. revealed that MA G was unable to find medication bottles for Ferrous Sulfate 300 (60 Fe) mg/5 ml and Calcium-Vitamin D 600-200 mg on the medication cart. MA G said she would hold the Ferrous Sulfate and Calcium-Vitamin D since the medications and would notify the nurse. Observation on 2/25/25 at 9:15 a.m. revealed that MA G notified LVN G that she was unable to administer Glucosamine to Resident #37, and Ferrous Sulfate and Calcium-Vitamin D 600-200 mg to Resident #26. Observation on 2/25/25 at 10:22 a.m. revealed that Fish Oil 1200 mg, Folic Acid 400 mcg, and Vitamin B-Complex was administered to Resident #77. During interview with MA H on 2/25/25 at 10:22 a.m., MA H said that he was administering Folic Acid for Super B-Complex Oral Tablet (B-Complex w/Biotin & Folic Acid) per resident's MAR. During interview with the DON on 2/25/25 at 12:45 p.m., the DON said that the ADONs and the DON were usually the ones who will check medication orders to make sure the orders match the over the counter medications that the facility carries and will call the doctor to get updated orders. The DON said that the nurses can contact the doctor to fix the medications orders as well if needed. The DON said that if a medication was not available for medication pass then it would be an ineffective medication pass and the effect on the resident would depend on what the medication was for. During interview with MA G on 2/25/25 at 1:36 p.m., MA G said that the orders had been obtained for Glucosamine for Resident #37, and Ferrous Sulfate and Calcium-Vitamin D 600-200 mg to Resident #26. MA G provided surveyor with copies of the orders. During interview with LVN G on 2/25/25 at 1:39 p.m., LVN G said that if a medication was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 4 of 10 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 676239 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Toscana at Cypress Woods 15015 Cypress Woods Medical Dr Houston, TX 77014 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Level of Harm - Minimal harm or potential for actual harm available at time of medication pass then she would check if the medication was in the automated medication delivery system or the stock. LVN G said if the medication was not available then she would notify the resident's doctor. LVN G said that if a medication was not in stock at time of medication pass then the resident could have a change in condition and she would have to monitor the resident, document, and notify the resident's doctor. Residents Affected - Some During interview with ADON A on 2/26/25 at 9:13 a.m., ADON A said that if they do not have an OTC medication in stock then the pharmacy can supply. ADON A said that she would check with the doctor first and see if the order can be changed if needed. ADON A said that if an OTC medication was not available during medication pass then it could lead to complications. During interview with ADON B on 2/26/25 at 1:15 p.m., ADON B said that if an OTC medication was not available then it would depend on the medication for the effect and gave the example if a resident did not receive iron, then the resident's iron levels would continue to be low. During an observation and interview with MA H on 2/28/25 at 11:22 a.m., MA H showed surveyor the bottle that he uses to administer Fish Oil to Resident #77 and the bottle was labeled as Fish Oil 1200 mg. MA H also said that he gave Folic Acid and Vitamin B Complex for the order of Super B-Complex Oral Tablet (B-Complex w/Biotin & Folic Acid). Record Review of facility's policy Medication Administration Procedures with revised date of 10/25/17 revealed that the 10 rights of medication should always be adhered to which includes the right medication and the right dose. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 5 of 10 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 676239 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Toscana at Cypress Woods 15015 Cypress Woods Medical Dr Houston, TX 77014 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 - Some 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 must include the expiration date when applicable for five out of five residents (Resident #20, Resident #81, Resident #35, Resident #2, and Resident #299) reviewed for expired medication. The facility failed to ensure that Latanoprost eye drops (Latanoprost is used to treat certain types of Glaucoma and other causes of high pressure inside the eye) were labeled with expiration date for Resident #20, Resident #81, Resident #35, Resident #2, and Resident #299. This failure could place residents at risk of not receiving the intended therapeutic effects of prescribed medications or receiving potentially harmful side effects from prescribed medications. Findings include: Record Review of Resident 20's face sheet dated [DATE], revealed resident was a [AGE] year old female admitted to the facility on [DATE] with diagnoses including Paroxysmal Atrial Fibrillation (Irregular Heartbeat), Unspecified Glaucoma (Eye Condition that damages the Optic Nerve), Unspecified Amblyopia (Lazy Eye) of the left eye, and Blindness Right Eye Category 3. Record Review of Resident 20's Orders Summary Report dated [DATE] revealed order for Xalatan Ophthalmic Solution 0.005% (Latanoprost) with start date of [DATE]. Record Review of Resident 20's MAR printed [DATE] revealed resident had Latanoprost eyes drops administered on 2/1-[DATE]. Record Review of Resident 81's face sheet dated [DATE] revealed resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Other Sequelae Following Unspecified Cerebrovascular Disease (Aftereffect of a Stroke), Essential Hypertension (High Blood Pressure) and Liver Disease. Record Review of Resident 81's Orders Summary Report dated [DATE] revealed order for Latanoprost Ophthalmic Solution 0.005% (Latanoprost) with start date of [DATE]. Record Review of Resident 81's MAR printed [DATE] revealed resident had Latanoprost eyes drops administered on 2/4-[DATE]. Record Review of Resident 35's face sheet dated [DATE] revealed resident was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease, Dementia and Essential Hypertension (High Blood Pressure). Record Review of Resident 35's Orders Summary Report dated [DATE] revealed order for Latanoprost PF Ophthalmic Solution 0.005% (Latanoprost) with start date of [DATE]. Record Review of Resident 35's MAR printed [DATE] revealed resident had Latanoprost eyes drops administered on 2/1-[DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 6 of 10 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 676239 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Toscana at Cypress Woods 15015 Cypress Woods Medical Dr Houston, TX 77014 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 - Some Record Review of Resident 2's face sheet dated [DATE] revealed resident was a [AGE] year old female admitted to the facility on [DATE] with diagnoses including Acute on Chronic Systolic (Congestive) Heart Failure, Primary Open-Angle Glaucoma (Eye Condition that damages the Optic Nerve) and Legal Blindness. Record Review of Resident 2's Orders Summary Report dated [DATE] revealed order for Latanoprost Ophthalmic Solution 0.005% (Latanoprost) with start date of [DATE]. Record Review of Resident 2's MAR printed [DATE] revealed resident had Latanoprost eyes drops administered on 2/10-[DATE]. Record Review of Resident 299's face sheet dated [DATE] revealed resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Metabolic Encephalopathy (Condition in which Brain Function is Disturbed), Unspecified Dementia and Essential Hypertension (High Blood Pressure). Record Review of Resident 299's Orders Summary Report dated [DATE] revealed order for Latanoprost Ophthalmic Solution 0.005% (Latanoprost) with start date of [DATE]. Record Review of Resident 299's MAR printed [DATE] revealed resident had Latanoprost eyes drops administered on 2/25-[DATE]. Observation on [DATE] at 9:22 a.m. of 200/300 Hallway Medication Aide Medication Cart revealed that Latanoprost eye drops for Resident #20, Resident #81, Resident #35, and Resident #2 were not labeled with an open or expiration date. Resident #2's Latanoprost eye drops had a sticker that said, discard 42 days after opening. Observation on [DATE] at 9:45 a.m. of 100 Hallway Medication Aide Medication Cart revealed that Latanoprost eye drops for Resident #299 was not labeled with an open or expiration date. Resident #299's Latanoprost eye drops were not opened but was being stored at room temperature in the medication cart. During interview on [DATE] at 9:45 a.m., MA H said eye drops should be dated when they were opened. MA H said that residents could have negative effects if they were given eye drops that were expired because the open date was not documented. During interview on [DATE] at 12:45 p.m., the DON said that she did not know the policy by memory regarding medications being dated when opened but she would find out. The DON said that if an expired eye drop was given to the resident, then the medication might not be as effective. During interview on [DATE] at 1:39 p.m., LVN G said that eye drops should be dated when they were opened. LVN G said that an effect of eye drops not being dated when opened was that staff would not know if the eye drops were expired or when they were opened. LVN G said that a resident could experience a change in condition if they received expired eye drops. During interview on [DATE] at 9:13 a.m., ADON A said that eye drops should be dated when they were opened. ADON A said that if eye drops were given past their use by date, then it could cause burning sensation in the resident's eyes or infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 7 of 10 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 676239 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Toscana at Cypress Woods 15015 Cypress Woods Medical Dr Houston, TX 77014 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 - Some During interview on [DATE] at 1:15 p.m., ADON B said that eye drops should be labeled when they were opened. ADON B said that if a resident was given eye drops past their use by date, then the resident could have a reaction. Record Review of facility's Recommended Medication Storage policy with revised date of 7/2023 revealed that Medications that require an open date as directed by the manufacturer should be dated when opened in a manner that it is clear when the medication was opened. XALATAN (LANTANOPROST) OPHTHALMIC DROPS Refrigerate until initial use. Expires 6 weeks (42 days) when stored at room temperature. Refrigerated Xalatan remains effective up to expiration date on bottle. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 8 of 10 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 676239 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Toscana at Cypress Woods 15015 Cypress Woods Medical Dr Houston, TX 77014 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review the facility failed to store food in accordance with professional standards for food service safety in the facility's only kitchen reviewed for kitchen sanitation. Residents Affected - Some -The facility failed to label, and date left over foods items in 1 of 1 walk in-cooler in the kitchen. -The facility failed to ensure that expired food products were not stored in the food pantry (dry goods area). These failures could place residents at risk for food-borne illness and food contamination. The findings include: Observation and interview with the Dietary Manager on 02/24/25 at 10:15AM, revealedThe cooler in the kitchen had the following expired food products: - sour cream half container of 5 Ibs dated best by -01/18/2025 Cottage cheese 3Ibs container half use dated best by -02/14/25. Half container of pimento cheese dated best by 02/21/25. Observation of the dry good storage area revealed the following:. -6 one quart of high calorie protein supplements dated used by 02/04/25. -4-8oz containers of chipotle dated used by 06/12/2023. 8 oz bottle of imitation coconut extract dated used by 02/12/25. During an interview with the Dietary Manager on 02/24/25 at 10:40 AM, she said all food items out of original containers should be labeled and dated. She said the dairy products dated best by dates can still be used but she would not use them if the product smelled bad. During an interview with facility's Cooperate Dietitian on 02/24/25 at 2:00PM, she said the used by date and best by dates were used interchangeably in the company's policy and procedure for food storage. She said the Dietary Manager can determine when to use used by and best by dates. Record review of facility policy titled Dietary, service policy& procedure Manual 2012 read in partsAll facility storage areas will be maintained in an orderly manner that preserves the condition of food and supplies. We will ensure storage areas are clean, organized, dry and protected from vermin, and insects. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 9 of 10 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 676239 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Toscana at Cypress Woods 15015 Cypress Woods Medical Dr Houston, TX 77014 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 Procedure: Level of Harm - Minimal harm or potential for actual harm 4. Residents Affected - Some Open packages of food are stored in closed containers with covers or in sealed and dated as to when opened. 6. Best by or use by dates indicate when a product will have best flavor or quality and are not an indicator of the product's safety. As the quality may deteriorate after the date passes, the dietary manager should closely inspect any products that are past the best by date to determine if they are still good quality FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676239 If continuation sheet Page 10 of 10