Health inspection·October 30, 2025

F 0686 Level of Harm - Actual harm Residents Affected - Some offloading heels, a wound to her sacrum that measures 4.0 cm x 3.5 cm x 0.1 with 2.7 cm x 2.4 cm eschar and treatment of calcium alginate, medihoney and cover with hydrocolloid dressing every Monday and Thursday, and a blister to her left heel that measured 5.0 cm X 8.5 cm with skin prep daily and to offload heels. Record review of Resident #1's care plan dated 10/13/25 indicated she had an actual wound to her sacrum, an abrasion to her right heel, and a blister to her left heel with interventions in place to encourage resident to get into bed and off sacrum, resident would be see by the wound doctor weekly, monitor wounds and report changes to the doctor, and heels would be floated at all times. Record review of Resident #1's order summary report dated 10/28/25 with orders since the admission date of 08/05/25 indicated an order for:1. May apply barrier cream as needed every shift with a start date of 08/05/25 and no other skin or wound care orders were noted until 10/13/25. Record review of Resident #1's order summary report, dated 10/28/25, indicated orders since the admission date of 08/05/25 reflected an order to:1 Apply skin prep to the abrasion on the right heel daily one time a day for Wound Healing with a start date of 10/13/2025 but now discontinued on an unknown date. 2 Apply skin prep to the blister on the left heel daily one time a day for Wound Healing with a start date of 10/13/2025 but now discontinued on an unknown date. 3 Cleanse the stage 3 on the left heel with wound wash, pat dry, and apply collagen powder, and cover with gauze island dressing every Monday, Wednesday, Friday and PRN if soiled or dislodged one time a day every Monday, Wednesday, Friday for Wound Healing with a start date of 10/24/2025 and no end date. 4 Apply skin prep to the unstageable DTI (deep tissue injury) on the right heel 3 times a week one time a day every Mon, Wed, Fri for Wound Healing with a start date of 10/29/2025 but now discontinued on an unknown date. 5 Apply skin prep to the unstageable DTI (deep tissue injury) on the right heel daily one time a day every Monday, Wednesday, Friday for Wound Healing with a start date of 10/29/2025 and no end date. 6 Cleanse wound to sacrum with normal saline pat dry, apply medihoney, calcium alginate, and cover with hydrocolloid every Monday and Thursday, and PRN if soiled or dislodged one time a day every Monday and Thursday for wound healing with a start date of 10/16/2025 but now discontinued on an unknown date. 7 Cleanse unstageable wound to sacrum with normal saline pat dry, apply medihoney, calcium alginate, and cover with hydrocolloid every Monday and Thursday, and as needed if soiled or dislodged one time a day every Monday, Thursday for wound with a start date of 10/20/2025 but now discontinued on an unknown date. 8 Cleanse unstageable wound to sacrum with normal saline pat dry, apply medihoney, calcium alginate, and cover with hydrocolloid every Monday, Wednesday and Friday, and as needed if soiled or dislodged one time a day every Monday, Wednesday, Friday for wound healing with a start date of 10/24/2025 but now discontinued on an unknown date. 9 Cleanse unstageable wound to sacrum with normal saline pat dry, apply med honey, Flagyl, and cover with hydrocolloid every Monday, Wednesday and Friday, and PRN if soiled or dislodged one time a day every Monday, Wednesday, Friday for wound healing with a start date of 10/29/2025 and no end date. Record review of Resident #1's administration record for October 2025 indicated there was no administration of the order:1. May apply barrier cream as needed every shift with a start date of 08/05/25 and no other skin or wound care orders were noted until 10/13/25. Record review of the facility schedule dated 10/09/25 and 10/10/25 for the 6:00 PM-6:00 AM shift indicated LVN QQ, CNA HH, CNA D, CNA B, and CNA C were scheduled to work on the east wing which was Resident #1's location. Observation of Resident #1's video camera footage dated from 10/9/25 at approximately 7:00 PM until 10/10/25 at approximately 6:51 AM indicated she was not turned, repositioned, nor provided incontinent care. Observation of Resident #1's video camera footage dated from 10/10/25 at approximately 7:41 PM until 10/11/25 at approximately 6:25 AM indicated she was not turned, repositioned, nor provided incontinent care. During an observation on 10/27/25 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676241 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 676241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenhill Villas 2530 Greenhill Rd Mount Pleasant, TX 75455 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 0686 Level of Harm - Actual harm Residents Affected - Some 3:33 PM Resident #1 was sitting up in bed with a low-pressure loss mattress being utilized. Resident #1 had a wedge under her left side and both feet floated on two pillows. The Treatment Nurse donned gloves and assisted by hospice sitter they rolled Resident #1 over, removed her brief to expose bandage (large Tegaderm bandage in place dated 10/27/25 with initials). The Treatment Nurse peeled back bandage to expose wound. It appeared to be an unstageable, full thickness wound to Resident #1's sacrum present. The wound measured (Length x Width x Depth) 6.0 cm x 6.5 cm x not measurable due to necrosis (death of tissue due to no blood supply). The Eschar (thick layer of dead skin that forms over a wound, often appearing black) measurement was 3 cm x 2.5 cm x not measurable (due to necrosis). There was a tunnel at 12 o'clock that was 0.7 cm. and a tunnel at 2 o'clock that was 0.5 cm. The Treatment Nurse placed the bandage back over wound and then re-enforced with another bandage. The Treatment Nurse failed to use other PPE during care. There was no sign for PPE use visible. During an interview on 10/27/25 at 3:46PM the Treatment Nurse said the Wound NP came every Thursday and he had been seeing Resident #1. The Treatment Nurse said the Wound NP measured weekly and Hospice nurse measured Resident #1's wounds on Mondays when she came to visit and received the reports on Thursdays. The Treatment Nurse said Resident #1 had a wound to her Sacrum and then to the right buttocks that appeared as 1 wound. She said Resident #1's wound had worsened and had places where it is tunneling on 10/27/25 but last Thursday (10/23/25) it was not. The Treatment Nurse said the CNAs, to her knowledge, were supposed to be turning her and repositioning her every 2 hours. The Treatment Nurse said she had not had any complaints specifically but at times night and day staff say each other do not turn and reposition residents and clean them as they were supposed to. The Treatment Nurse said they do not have a system in place to ensure that the CNAs were turning and repositioning the residents but when she works the floor as a charge nurse, she did monitor to ensure the CNAs were turning and repositioning the resident by rounding on the hallways. The Treatment Nurse said charge nurses were responsible for ensuring the CNAs were turning and repositioning all the residents to prevent skin breakdown.During an interview with the facility doctor on 10/28/25 at 10:12 AM he said he was familiar with Resident #1, but he was unable to elaborate on her wounds, the status, or the cause because he was not notified of the wounds or involved in the care of the wounds. During an interview on 10/28/25 at 10:35 AM Hospice RN LL said she saw Resident #1 on Mondays and Thursdays weekly. She said on 10/6/25 Resident #1 had some breakdown noted but it was only excoriation, and she notified the unknown facility nurse at the time to ensure to apply the barrier cream when providing incontinent care and to ensure the CNAS were turning and repositioning Resident #1. She said she said Resident #1 on 10/9/25 and the area to her bottom continued to require just barrier cream. Hospice Rn LL said there were no openings to her buttocks and no wounds to her heels. Hospice RN LL said she had talked to the Administrator and the DON about Resident #1 and the staff needing to turn and reposition her, and about her brief not being changed in a timely manner. Hospice RN LL said Resident #1's buttocks went from excoriation to an unstageable wound in 2 weeks, which she saw on 10/13/25. Hospice RN LL said the wound would have been preventable if the staff had been turning, repositioning and providing incontinent care as they were supposed to. During an interview on 10/28/25 at 2:56 PM, LVN A said she worked on 10/10/25 and 10/11/25 from 6:00 AM- 6:00 PM on the east wing with Resident #1. She said she placed a call to Resident #1's hospice company about a change in condition and Hospice RN KK came out to see Resident #1. LVN A said she talked to Hospice RN KK and got orders from her, but she could not remember what the orders were. LVN A said she also called the Treatment Nurse about orders. LVN A said the nurses always called hospice and the hospice nurse called the hospice doctor. She said they never called the facility NP since Resident #1 was on hospice. LVN A said she missed placing a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676241 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 676241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenhill Villas 2530 Greenhill Rd Mount Pleasant, TX 75455 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 0686 Level of Harm - Actual harm Residents Affected - Some progress note and inputting the orders for Resident #1's wound care on 10/11/25[. She said the failure placed the risk for no one else knowing the resident had wounds or treatments in place and could place the resident at risk for infection or wounds worsening. During an interview on 10/29/25 at 11:23 AM the Administrator said she expected the CNAs to be rounding the halls during the shift every 2 hours and to provide incontinent care as needed. She said she was not aware of the staff not providing any care for Resident #1 on 10/09/25 and 10/10/25. The Administrator said she had talked to Resident #1's family member on an unknown date but she never notified her of any nights with no care being provided. She said the failure placed a risk for skin breakdown. During an interview on 10/29/25 at 11:25 Am the DON said her expectation was for the charge nurse to round and for the CNAs for round the halls every 2 hours and turn and reposition residents as well as provide incontinent care as needed. She said Resident #1's family member did notify her of the CNAs going in the room and turned and repositioned her on some nights but did not check her bed or provide incontinent care. The DON said at the time she thought Resident #1 was not urinating as much die to a decline in status and may that be why they did not change her. She said the CNAs were responsible for ensuring the residents were provided care and clean and dry throughout the shift and the failure placed residents at risk for skin breakdown or skin worsening. She said she had never looked at any of the videos from the camera in Resident #1's room. The DON said she was not aware of the wounds being in place until 10/13/25 when she was notified by the Treatment Nurse. She said the facility discussed wounds daily in the morning meetings. During an interview on 10/29/25 at 12:18 PM CNA C said sometimes she was by herself and could not change the residents every 2 hours. CNA C said she did recall times when she was not able to go into Resident #1's room every 2 hours. She said she could not remember not going in there at all but she thought they were short staffed 10/9/25 and 10/10/25. CNA C said the failure placed Resident #1 and others at risk for bed sores, rashes, abuse and neglect. CNA C said she did not call anyone because she worked the night shift. CNA C said the charge nurse helped her with rounds on the hall. She said she was unsure if the charge nurse or herself told anyone how they were short staffed on the nights of 10/9/25 and 10/10/25 so that was considered neglect. CNA C said on 10/9/25 she was by herself until 10pm. She said she guessed she forgot to check on Resident #1. CNA C said she was busy answering call lights and putting other residents to bed. CNA C said the failure placed Resident #1 at risk for abuse and neglect and getting a bed sore. She said she knew Resident #1 had sores now, but she did not report the short staff and lack of care because she was not thinking about calling since it was nighttime. CNA C said she was watching the baby camera for Resident #1 that was at the nurse's station for if Resident #1 was getting up at times. During an interview on 10/30/25 at 12:16 PM CNA B said there had not been times that she had not taken care of Resident #1. CNA B said she recalled on 10/9/25 night shift it was super busy, and she came in late about 9:00 PM instead of 6:00 PM and did not get to see Resident #1 as much as she was supposed to. CNA B said it was really busy, and her and CNA C did not get to go in the room as much. When the surveyor mentioned the camera in the room showing the staff did not come in at all, CNA B said she did not realize she did not go in there at all. CNA B said the failure to change residents was neglect, and she said it could cause skin breakdown and bed sores. She said she was not aware that the resident had bed sores, but she knew Resident #1 was still going to the restroom the last time she worked. CNA B said she was unsure if she told anyone that she could not care for Resident #1 on the night of 10/9/25 and 10/10/25 but it placed the risk was for care being missed again. Record review of the facility's, undated, policy Pressure Injury: Prevention, Assessment and Treatment indicated:Procedure:1. Nursing personnel will continually aim to maintain the skin integrity, tone, turgor and circulation to prevent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676241 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 676241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenhill Villas 2530 Greenhill Rd Mount Pleasant, TX 75455 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 0686 Level of Harm - Actual harm Residents Affected - Some breakdown, injury and infection. 3. Upon assessment and identification of a pressure sore the staff nurse will notify the treatment nurse/designee. The treatment nurse/designee will:1. Notify the physician of pressure sore and obtain and follow any orders as directed by the physician. 2.Notify family and dietary department. Document Notification 4. Causes of Pressure Injuries:6. Nursing Action/Rationale:1. Prevention: The nurse can assist in the prevention of pressure injuries by performing the following nursing interventions: NOTE: Add any interventions to care plan. 1. Determine resident's skin tolerance to pressure and develop a turning schedule; residents should be turned every two (2) hours or more often if necessary and notify the Treatment Nurse/designee of any potential problems.3. Keep the bed clean, dry and free of wrinkles. 9. Assess for early signs of skin breakdown and report any abnormal findings. Early signs of pressure sores include redness, tenderness and swelling of the skin. Notify Treatment Nurse/designee of any potential problems by completing Skin Concern Notification Worksheet 10. Treatment Nurse/designee or Director of Nursing will assess site and evaluate for appropriate stage as listed in this procedure. Notify physician; obtain an order and monitor the site. Sign off on treatment sheet any treatment completed.11. Director of Nursing or designee to in-service nurses and CNA's on above prevention. This was determined to be an Immediate Jeopardy (IJ) on 10/29/25 at 1:31 PM. The Administrator was notified. The Administrator was provided with the IJ template on 10/29/25 at 1:37 PM. The following Plan of Removal submitted by the facility was accepted on 10/29/2025 at 05:30 PM. Plan of RemovalOctober 29, 2025F686 Treatment and Services to Prevent/Heal Pressure UlcersInterventions1. Resident #1 was assessed from head to toe by the DON and ADON. No additional skin issues were identified. Completed on 10/28/25. 2. Resident's #1 pressure wound was assessed, measured, and documented by the DON and ADON. The DON and ADON documented the measurements in PCC on the weekly ulcer assessment. Completed on 10/28/25.3. Resident #1's treatment orders, supplements, and care plan were reviewed by the Regional Compliance Nurse and DON for the appropriate intervention. Completed 10/28/25. 4. Head-to-toe assessments were completed on all residents by the DON and ADON. No additional pressure wounds were identified. Completed as of 10/28/25.5. All residents with pressure wounds were measured by DON and ADON as of 10/28/25. The MD was notified of all changes in measurements by the DON and ADON on 10/28/25. All measurements were documented in the chart by the DON and ADON as of 10/28/25. The physician was notified and all orders are current. 6. All residents with skin issues including pressure wounds had their care plans reviewed by the Regional Compliance Nurse, DON, ADON, and MDS Coordinator for appropriate interventions to prevent additional wounds and promote healing. All interventions were updated and implemented. Completed 10/28/25. 7. The MD was notified of the immediate jeopardy citation on 10/29/25 by the Administrator. 8. An ADHOC QAPI meeting with the IDT Team and Medical Director was held on 10/29/25 to discuss the immediate jeopardy and plan of removal. 9. The Administrator, DON and ADON were in-serviced 1:1 on the following topics below by the Regional Compliance Nurse. Completed 10/29/25. A. Pressure Prevention Policy- to include assessments, the causes of pressure injuries, interventions such as pressure relieving devices, providing incontinent care, turning and repositioning and treatments for the residents. B. Skin Assessment Policy- performing a head-to-toe assessment, measuring and documenting all skin issues including wounds. Skin assessments will be completed upon admission, readmission, weekly and as needed for any new skin issues. C. Documentation- to include accuracy and completeness of documentation. All skin issues including wounds will be documented accurately on the weekly skin assessment and/or weekly ulcer assessment.D. Notifying Change in Condition- the charge nurses will notify the MD and RP immediately of all changes in conditions to include any changes in wounds. Charge nurses will notify the MD for additional orders. Any additional orders by the MD will be implemented immediately by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676241 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 676241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenhill Villas 2530 Greenhill Rd Mount Pleasant, TX 75455 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 0686 Level of Harm - Actual harm Residents Affected - Some the charge nurse. If the charge nurse cannot notify the MD/RP immediately, the charge nurse will inform the DON or ADON to assist with notification. The nurse will notify the physician of any changes to wounds.E. Abuse/Neglect Policy- failure to provide incontinent care, turning and repositioning can be considered neglect and cause further skin breakdown. In-services 10. All staff will be in-serviced regarding the following topics below by the Regional Compliance Nurse, DON, and ADON. All staff who are not present will not be allowed to assume their duties until in-serviced. All PRN staff will be in-serviced prior to their next assignments. All new hires will be in-serviced on their date of hire, during facility orientation. All agency staff will be in-serviced prior to the start of their assignment. Completed 10/29/25.A. Pressure Prevention Policy- to include assessments, the causes of pressure injuries, interventions such as pressure relieving devices, providing incontinent care, turning and repositioning, and treatments for the residents. B. Skin Assessment Policy- performing a head-to-toe assessment, measuring and documenting all skin issues including wounds. Skin assessments will be completed upon admission, readmission, weekly and as needed for any new skin issues. C. Documentation- to include accuracy and completeness of documentation. All skin issues including wounds will be documented accurately on the weekly skin assessment and/or weekly ulcer assessment. orders by the MD will be implemented immediately by the charge nurse. D. Notifying Change in Condition- the charge nurses will notify the MD and RP immediately of all changes in conditions to include any changes in wounds. Charge nurses will notify the MD for additional orders. Any additional orders by the MD will be implemented immediately by the charge nurse. If the charge nurse cannot notify the MD/RP immediately, the charge nurse will inform the DON or ADON to assist with notification. The nurse will notify the physician of any changes to wounds.E. Abuse/Neglect Policy- - failure to provide incontinent care, turning and repositioning can be considered neglect and cause further skin breakdown. If you identify abuse or neglect, then you need to report it to the abuse coordinator/Administrator. Staff that worked from October 10th and 11th have been educated by the DON and Administrator on rounding, providing incontinent care, turning and repositioning as it can be considered neglect and cause further skin breakdown if these tasks are not provided to the resident. Completed on 10/29/2025. Monitoring of the POR included the following:Interview 10/30/25 at 9:22 AM with MD of the facility indicated the facility notified him of the immediate jeopardy citations on 10/29/25. During interviews conducted on 10/30/25 at 9:59 AM- 10/30/25 at 1:57 PM with the Administrator, DON, ADON, Business Office Manager, Activity Director, Social Worker, Dietary Manager, LVN A, CNA B, CNA C, CNA D, Housekeeping E, LVN F, CNA G, LVN H, LVN K, CMA L, CNA M, CMA N, LVN O, COTA P, Medical Records Director, Laundry R, Maintenance Director S, LVN T, CNA U, CNA V, Housekeeping Supervisor W, Housekeeping Supervisor X, CNA Y, CMA Z, CMA AA, CNA BB, CNA CC, Dietary cook DD, Floor Maintenance EE, ADON FF, CNA GG, and CNA HH indicated they had been in-serviced on the facilities abuse and neglect policy, the pressure prevention policy, the skin assessment policy, documentation, notifying change of condition, and rounding to be completed in the facility. Record review of Resident #1's skin assessment indicated it was completed on 10/28/25 with no new skin issues noted and signed by the DON. Record review of Resident #1's pressure ulcer assessment indicated it was completed on 10/28/25 with no new concerns and signed by the DON. Record review of Resident #1's treatment orders, supplements, and care plan indicated they were completed with orders in place and care plan updated as of 10/28/25. Record review of all resident head-to-toe assessments completed by the DON and ADON with no concerns noted as of 10/28/25. Record review of 6 residents with pressure ulcers with completed ulcer assessments completed with no concerns noted on 10/28/25. Record review completed on10/30/25 of copies of all residents with updated care plans with interventions put in place for wounds. Record review of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676241 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 676241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenhill Villas 2530 Greenhill Rd Mount Pleasant, TX 75455 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 0686 Level of Harm - Actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete signature sheet for the ADHOC QAPI meeting that was held on 10/29/25 indicated the medical director and the IDT team were in attendance. Record review of the 1:1 in-service provided to the Administrator, DON, and ADON completed on 10/29/25 indicated they were in-serviced over the pressure prevention policy, the skin assessment policy, documentation, notifying change of condition, abuse and neglect, and rounding in the facility. Record review of the staff in-services related to the IJ provided indicated the staff that had been to work were in-serviced over the pressure prevention policy, the skin assessment policy, documentation, notifying change of condition, abuse and neglect, and rounding in the facility. The Administrator was informed that the Immediate Jeopardy was removed on 10/30/2025 at 1:57 PM. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that was not Immediate Jeopardy and a scope of isolated due to the facility's need to monitor the implementation of the plan of removal. Evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 676241 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 676241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenhill Villas 2530 Greenhill Rd Mount Pleasant, TX 75455 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 observations, interviews, and record reviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 6 residents (Resident #1, Resident #2 and, Resident #3) room reviewed for infection control practices and enhanced barrier precautions. 1) The facility failed to ensure the Treatment nurse implemented enhanced barrier precautions and used PPE while providing care for Resident #1 on 10/27/25. 2) The facility failed to ensure CNA OO and CNA PP used the proper enhanced barrier precautions while providing incontinent care to Resident #1. 3) The facility failed to ensure Resident #1 Resident #2 and Resident #3 had enhanced barrier precaution signage and PPE available for staff to be aware of EBP. These failures could place residents at risk for serious complications from a communicable disease that could diminish the resident's quality of life.Findings included: 1. Record review of Resident #1's face sheet, dated 10/27/25, indicated she was an [AGE] year-old female who admitted to the facility on [DATE]. Resident #1 had with the diagnoses which included artherosclerotic heart disease (plaque buildup in arterial walls causing them to narrow), anxiety (excessive worry, fear, and nervousness), depression (persistent feelings of sadness and loss of interest in things), and high blood pressure. Record review of Resident #1's admission MDS assessment, dated 08/15/25, indicated she could make herself understood and she was able to understand others. The MDS also indicated Resident #1 she had a BIMS score of 5, which meant she had severe cognitive loss. The MDS also indicated She required moderate assistance with toileting, bathing, transfers, and dressing, and supervision for eating and bed mobility. The MDS indicated Resident #1 was at risk for pressure ulcers but did not have any unhealed pressure ulcers. Record review of Resident #1's care plan, dated 10/13/25, indicated she had an actual wound to her sacrum, an abrasion to her right heel, and a blister to her left heel with interventions in place to encourage resident to get into bed and off the sacrum, resident would be seen by the wound doctor weekly, monitor wounds and report changes to the doctor, and heels would be floated at all times. The care plan did not indicate enhanced barrier precautions. Record review of Resident #1s order summary report dated 08/28/25 indicated she did not have an order for enhanced barrier precautions. During an observation on 10/27/25 at 3:33 PM revealed Resident #1 was sitting up in bed with a low-pressure loss mattress being utilized. Resident #1 had a wedge under her left side and both feet floated on two pillows. The Treatment Nurse donned gloves and assisted by the hospice sitter they rolled Resident #1 over, removed her brief to expose a bandage (large Tegaderm bandage in place dated 10/27/25 with initials). The Treatment Nurse peeled back bandage to expose the wound. It appeared to be an unstageable, full thickness wound to Resident #1's sacrum present. The wound measured (Length x Width x Depth) 6.0 cm x 6.5 cm x not measurable due to necrosis (death of tissue due to no blood supply). The Eschar (thick layer of dead skin that forms over a wound, often appearing black) measurement was 3 cm x 2.5 cm x not measurable (due to necrosis). There was a tunnel at 12 o'clock that was 0.7 cm. and a tunnel at 2 o'clock that was 0.5 cm. The Treatment Nurse placed the bandage back over wound and then re-enforced with another bandage. The Treatment Nurse failed to use other PPE during care. There was no sign for PPE or PPE cart for use visible. During an observation and interview on 10/28/2025 at 7:10AM revealed CNA OO and CNA PP went into Resident #1's room to start their morning rounds. There was no EBP sign on the door or PPE cart at door prior to entrance. CNA OO and CNA PP provided incontinent care for Resident #1, but no PPE was used except gloves. CNA OO and CNA PP said they were unaware of the enhanced barrier precautions. During an observation on 10/28/2025 at 10:00 AM revealed Resident #1 Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676241 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 676241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenhill Villas 2530 Greenhill Rd Mount Pleasant, TX 75455 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 was lying in bed on her right side and had no EBP sign on door or PPE at the door. 2. Record review of Resident #2's face sheet, dated 10/28/25, indicated she was a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #2 had with the diagnoses which included kidney disease (disease causing the kidneys to no work properly), diabetes mellitus (disorder characterized by high blood sugar), open wound to right buttocks, open wound to left buttocks, and dementia (brain disorder that cause decline in cognitive abilities). Record review of Resident #2's care plan, dated 10/13/25, indicated she had an actual wound to her left and right buttocks with interventions to monitor and report any adverse reactions or changes and report to doctor and to provide treatment as ordered. The care plan also indicated enhanced barrier precautions of gown and gloves should be used while providing linen change, wound care, bathing, and any other high contact activity. Record review of Resident #2's admission MDS assessment, dated 10/16/25, indicated she could make herself understood and she was able to understand others. The MDS also indicated she Resident #2 had a BIMS score of 11, which meant she had moderate cognitive impairment. The MDS also indicated She required total assistance with toileting, transfers, and bathing, and maximal assistance with bed mobility and setup with eating. During an observation on 10/28/25 at 6:28 AM revealed Resident #2 did not have an EBP sign on door or PPE outside the door. 3. Record review of Resident #3's face sheet, dated 11/4/25, indicated he was an [AGE] year-old male who re-admitted to the facility on [DATE]. Resident #3 had with the diagnoses which included diabetes mellitus (disorder characterized by high blood sugar), pressure ulcer of the sacral region stage 3, and neuromuscular dysfunction of the bladder (when an injury interrupts the signals between nervous system and bladder function). Record review of Resident #3's care plan, dated 06/20/25, indicated he had an indwelling catheter and required enhanced barrier precautions with interventions of gown and gloves should be used while providing linen change, wound care, bathing, and any other high contact activity. Record review of Resident #3's quarterly MDS assessment, dated 10/2/25, indicated he understood others and made himself understood. The MDS also indicated Resident #3 he had a BIMS score of 15, which meant he was cognitively intact. The MDS also indicated He required maximal assistance for bathing, toileting, and transfers, moderate assistance with bed mobility, and setup for eating. During an observation on 10/28/2025 at 6:28 AM, revealed Resident #3 did not have an EBP sign on the door or PPE outside of the door. During an observation and interview on 10/28/25 at 6:30 AM CNA Z began a round with Resident #3 and assisted him to the side of the bed with 1 person transfer to the wheelchair. CNA Z put gloves on to perform catheter care. CNA Z reports reported she did not get report from the night shift CNAs. CNA Z said she had to get a report from prior shift to know what precautions were needed so she was unaware of the EBP. During an interview on 10/30/25 at 3:09 PM, the DON said all CNAs and nurses should have been using gowns and gloves any time they were providing provided direct care while in the residents' room who had catheters, wounds, gastrostomy tubes, or IVs. ] The DON said she was responsible as well as whoever admitted the residents with any of the requirements for placing the signage on the doors for EBP and placing the carts out for PPE for the staff to know to use. The DON said charge nurses should ensure signage was in place as well. The DON said the failure placed a risk for spreading infection. During an interview on 10/30/25 at 3:14 PM, the Administrator said she expected the signage to be in place and expected all staff to use the proper PPE when providing care. The Administrator said the DON was responsible for ensuring the staff were aware of the residents who required EBP and ensuring the signage was in place. The Administrator said the failure placed a risk for the staff getting infections or spreading infection to the residents. Record review of the facility's, undated, facility policy Enhanced Barrier Precautions indicated:Multidrug-resistant organism (MDRO) transmission is common in long (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676241 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 676241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenhill Villas 2530 Greenhill Rd Mount Pleasant, TX 75455 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 FORM CMS-2567 (02/99) Previous Versions Obsolete term care (LTC) facilities. Many residents in nursing homes are at increased risk of becoming colonized and developing infections with MDROs. Enhanced Barrier Precautions (EBP) refer to an infection control intervention designed toreduce transmission of multidrug-resistant organisms that employ targeted gown and glove use during high contact resident care activities.EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing. A single set of PPE cannot be used for more than 1 patient. EBP are indicated for residents with any of the following:Colonization with a CDC-targeted MDRO when Contact Precautions do not otherwise apply (see MDRO list on page 3); orWounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a MDRO.Wounds generally include chronic wounds, not shorter-lasting wounds, such as skin breaks orskin tears covered with an adhesive bandage (e.g., Band-Aid(R)) or similar dressing. Examples of chronic wounds include, but are not limited to, pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and venous stasis ulcers.Indwelling medical device examples include central lines, urinary catheters, feeding tubes, andtracheostomies. A peripheral intravenous line (not a peripherally inserted central catheter) is not considered an indwelling medical device for the purpose of EBP.The facility will ensure PPE and alcohol-based hand rub are readily accessible to staff prior to entry to their room .Communication to Staff The facility will utilize postings outside the room and Point Click Care to communicate to staff if a resident requires EBP. Event ID: Facility ID: 676241 If continuation sheet Page 10 of 10