Health inspection·June 12, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to Resident #282 during her stay at the facility. The Wound Care physician stated Resident #282 entered the facility with wounds on her sacrum and had developed pressure areas on her right and left heel while at the facility on 05/10/2024. The Wound Care physician stated she had had met with the family and had instructed them on how a different type of mattress would be better than the mattress brought from the hospital, but the family felt the hospital's mattress was better. The Wound Care physician stated the resident was mobile in the bed and she would remove the pillows the staff was using to offload her feet and legs; the resident would throw them on the floor. The Wound care physician stated the mattress should have been changed this could have prevented the further develop of other wounds on the resident, and if we did not try how would we have known if it would work or not. In an interview on 06/12/2025 at 12:30 p.m. with the DON revealed the MDS Coordinator was responsible for all MDS assessments and comprehensive care plans and she (the DON) could not believe there was no mention of Resident #282's behaviors/family refusal related to her pressure areas treatment and prevention in the care plan. The DON stated she was aware of Resident #282's behaviors related to throwing the pillows on the floor that had been placed under her feet and legs, and the family refusing to use the ordered mattress by the Wound Care physician. The DON stated she wished the family would have agreed to the low air loss mattress. She stated the facility had tried to get the family to be involved, but they were not interested. The DON stated everything that was discussed should have been documented by the nursing staff and then placed in the plan of care. In an interview on 06/12/2025 at 1:00 p.m. with the MDS Coordinator revealed she was responsible for developing and implementing residents' care plans. The MDS Coordinator revealed she received her information about resident changes through the staff, the documentation or observation. MDS coordinator stated, Resident #282's behaviors related to her pressure ulcers (throwing the repositioning pillows on the floor and the family refusing to use the ordered mattress by the Wound Care physician)were unknown to her. If there were behaviors to address, she would certainly want to know and should have been told by the nursing staff. Review of the facility's Policy and Procedure Comprehensive Care Plans dated October 2022 reflected, . Compliance Guidelines: 3. The comprehensive care plan will describe, at a minimum, the following: a. The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychological well-being. B. Any services that would otherwise be furnished but are not provided due to the resident's exercise of his or her right to refuse treatment. 7. The physician, other practitioner, or professional will inform the resident and/or resident representative of the risks and benefits of proposed care of treatment, and treatment alternative/options. The facility will attempt alternate methods for refusal of treatment and services and document such attempts in the clinical record, including discussions with the resident and/or resident representative. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 2 of 8 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 676243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of Richardson 1350 E Lookout Dr Richardson, TX 75082 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as possible for one (Resident #63) of three residents reviewed for adequate supervision to prevent accidents. The facility failed to ensure resident safety, as evidenced by: The facility failed to ensure supplies for glucometer testing (blood sugar) and intravenous supplies (to give medication through veins) were secured or attended by authorized staff when LVN A's medication cart for Hall 100 was left with glucose testing solution, glucose testing strips, alcohol swabs, and clave connectors (to connect tubing for intravenous medication delivery) sitting on top of the cart. This failure could result in resident access and ingestion of prescribed treatment medications and obtaining harmful supplies leading to a risk for harm. Findings included: An observation on 06/10/2025 at 10:20 a.m. revealed LVN A was preparing to administer an intravenous antibiotic to a Resident #29 on Hall 100. LVN A told the surveyor she had to step away from her medication cart. The Hall 100 medication cart was left in the hallway outside of room [ROOM NUMBER] locked, not in direct site of the LVN in charge of the hallway. LVN A left the medication cart with: 1) Evencare glucose control solution (2 vials), 2) Evencare blood Glucose test strips (one box), alcohol swap pad (4), and calve connectors for intravenous tubing connectors (2) on top of the medication cart. An observation and interview on 06/10/2025 at 10:25 a.m. revealed an unidentified resident walking up to the unattended medication cart on Hall 100 and picking up one of the boxes of glucose testing solution. The unidentified resident told the surveyor he was just checking out what that was in case he needed it and then smiled and stated, I was just kidding, I was looking for the nurse for some pain medications. An observation and interview on 06/10/2025 at 10:47 a.m. revealed LVN A walked back to the medication cart on Hall 100. The LVN A immediately stated, she was so sorry the supplies had been left on top of the cart. LVN A stated she had obtained the supplies as she needed them to use later. The LVN stated after she obtained her supplies, she should have locked them up in the medication cart. LVN A stated the medication cart must not have any supplies or medications left on top of the cart unattended, so the residents, staff, and visitors could not take the medication/supplies that were on the cart and be endangered. In an interview on 06/12/2025 at 12:20 p.m. with the DON revealed the medication carts should never have any supplies or medications left on top of them unattended. The DON stated there would be more in-services completed to remind the staff of the importance of drug/supplies security. If the residents were allowed to get supplies off of the top of the carts, it could cause danger and possible injury to the resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 3 of 8 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 676243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of Richardson 1350 E Lookout Dr Richardson, TX 75082 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Review of the Policy and Procedure Medication Carts and Supplies for Administering Meds revised October 2019 reflected, The facility maintains equipment and supplies necessary for the preparation and administration of medications to residents . med carts: 3. Do not leave the medication cart unlocked or unattended in the resident care areas procedure: 10. The licensed nurse or medication aide should maintain a clean top surface on the medication cart . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 4 of 8 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 676243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of Richardson 1350 E Lookout Dr Richardson, TX 75082 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the facility's only kitchen reviewed for food safety. 1. The facility failed to ensure food items in the freezers were stored, sealed, and not exposed to air in accordance with the professional standards for food service. 2. The facility failed to ensure dented cans were placed in a separate storage area. These failures could place residents at risk for food-borne illness and cross contamination. Findings Included: Observation of the walk-in freezer and dry storage on 06/10/2025 at 9:20 am revealed the following: 1 food service company name stamped on box with a date of 5/15, no other label on box to identify item, the bag of hot dog/sausage links was in a large bag inside of the box that was left open and it was not sealed. 1 6 lb 15 oz can of Pinto Beans best by date March 2027 dented on the front top right. 1 6 lb 15 oz can of Pinto Beans best by date April 2027 dented on the front top seal. During an interview with Assistant DM on 06/11/2025 at 11:17 am, she said kitchen staff who removed food items from the freezer were responsible for putting the food item back in freezer, labeled with open date and properly sealed. Assistant DM said if there was not a great big dent (on cans) we'll keep it. She said if dented cans were used nothing could potentially harm the residents. Interview with the DM on 06/11/2025 at 11:20 am, revealed all kitchen staff who remove food items from the freezer were responsible for putting the food item back, labeled and sealed properly. DM stated if there's a big dent we'll keep it. She clarified a big dent is two fingers. The DM stated if residents were served food from a dented can, it could potentially harm them with botulism. On 06/12/2025 at 1:25 pm a record review of the facility's Food Storage Policy, dated October 1, 2018, section 3e revealed: store frozen foods in moisture-proof wrap or containers that are labeled and dated. Record review of the facility's Food Storage Policy, dated October 1, 2018, there was nothing pertaining to can storage. On 06/12/2025 at 2:45 pm spoke to regional administration who stated the facility doesn't have a specific policy related to dented can's. Review of the U.S. FDA Food Code 2022 reflected: Definitions 3. Food Receiving and Storage - When (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 5 of 8 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 676243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of Richardson 1350 E Lookout Dr Richardson, TX 75082 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete food, food products or beverages are delivered to the nursing home, facility staff must inspect these items for safe transport and quality upon receipt and ensure their proper storage, keeping track of when to discard perishable foods and covering, labeling, and dating all PHF/TCS foods stored in the refrigerator or freezer as indicated. Review of the U.S. FDA Food Code Chapter 3 FDA considers food in hermetically sealed containers that are swelled or leaking to be adulterated and actionable under the Federal Food, Drug, and Cosmetic Act. Depending on the circumstances, rusted, and pitted or dented cans may also present a serious potential hazard. Event ID: Facility ID: 676243 If continuation sheet Page 6 of 8 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 676243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of Richardson 1350 E Lookout Dr Richardson, TX 75082 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 one (Resident #29) of four resident's observed for infection control in that: Residents Affected - Few LVN A failed to clean the scissors prior to or after usage during Resident #29's treatments. Placing the unclean scissors back on the treatment cart. This failure could place residents at risk for spread of infection through cross-contamination. Findings included: Review of Resident #29's 5-day MDS assessment, dated 05/26/2025, reflected he was a [AGE] year-old male admitted to the facility on [DATE], with the following diagnoses: diabetes, diabetic wound of the right heel, post-surgical wound of the right, and heart failure. Resident #29 BIMs score of 15 indicated the resident had intact cognition. Review of the Resident #29's plan of care dated 05/21/2025 with updates reflected goals and approaches to include wound care to a surgical wound right planter foot and a diabetic wound to the right heel. Review of the consolidated physician orders dated May 2025 reflected: order dated 05/23/2025 cleanse diabetic wound right foot apply alginate calcium with silver once daily, cover with abdominal pad for the next thirty days, and cleanse the post-surgical wound of right planter foot daily and apply an abdominal pad and wrap with gauze roll daily for the next thirty days. Observation on 06/10/2025 at 1:00 p.m. revealed LVN A went to the treatment cart and started preparing to perform wound care for Resident #29's diabetic wound on the right foot and the post-surgical wound of the right planter foot. LVN A did use hand gel and washed her hands prior to collecting supplies. The LVN took the calcium alginate/silver from the package, took scissors out of the drawer, without cleaning the scissors cutting off the top of the package. The LVN put the scissors with the supplies without cleaning them. LVN A gathered her supplies and entered Resident #29's room. LVN A washed her hands, put on her gloves, and gown used the scissors to remove the gauze on the post-surgical wound. LVN A cleaned the wounds with normal saline and then applied the silver nitrate to the wound on the diabetic wound. LVN A did not clean the scissors prior to using to cut the clean gauze placed on the post-surgical wound on the right planter foot. LVN A placed the scissors on the overbed table, removed her gloves, washed her hands, then took the scissors out of the room placing them on top of the treatment cart, and then placed the scissors back in the drawer of the treatment cart without cleaning them. In an interview on 06/10/2025 at 1:20 p.m., LVN A stated she was to prepare before completing the treatment with gathering her supplies, placing them on a clean area in the room, wash her hands, and placed on her gown and her gloves. LVN A stated she did not think of cleaning the scissors prior to using them because they were on the treatment cart and she thought the scissors were already cleaned, she said she did not clean them afterwards because she was nervous about completing the treatments correctly. She stated the risk would be spread of infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 7 of 8 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 676243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of Richardson 1350 E Lookout Dr Richardson, TX 75082 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 - Few In an interview on 06/12/2025 at 12:25 p.m., the DON (also infection control coordinator) stated the expectation was for the staff to clean all equipment used prior to using on residents and after using on residents. That included all direct care equipment, which included scissors. The DON stated she would have to complete more infection control in-serves for equipment cleaning in between residents, she had just completed an in-service on infection control recently with all direct care staff. The DON stated the risk in not cleaning the scissors would be cross contamination. If performing treatments, the nurse was to provide a clean surface to place wound care supplies on, and equipment should always be sanitized before and after usage. Review of the in-services given in the past three months reflected an in-service dated May 10th, 2025, for infection control and cleaning of equipment. LVN A had attended the meeting. Review of the facility's policy Infection Prevention and Control Program dated May 2023, reflected, The facility has established and maintained an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the . of soiled contaminated equipment .development and transmission of communicable diseases and infections . 10. Equipment protocol. a. all reusable items and equipment requiring special cleaning, disinfection . shall be cleaned in accordance with our current procedures governing the cleaning. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 8 of 8