Health inspection·August 29, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few following: admit date and Time: 8/26/2025/4:49 AMHistory of present illness: [Resident #1] is a 66 y.o. male and presents with new back pain after [Resident #1] fell out of his bed early this morning August 26, 2025 at his nursing home and also present with new confusion. Bedside nurse also reports recent administration of IV glucose as [Resident #1] is hypoglycemic (low blood sugar) with blood sugar in the 50s.POCT Glucose:-08/26/25 at 5:32 AM- 91 (reference range 70-110 mg/dL)-08/26/25 at 8:31 AM- 74 (reference range 70-110 mg/dL). An interview on 08/29/25 at 08:00AM was attempted with Resident #1's RP; however, she was unavailable to be interviewed. In an interview and observation at the local hospital on [DATE] at 08:25AM, Resident #1 stated he was at the hospital due to hurting his back from a fall. Resident #1 stated he fell out the bed on 08/26/25 at approximately 4:00AM when he attempted to turn over. Resident #1 could not recall if he felt weak or fatigued at the time of fall. Resident #1 stated he was diabetic, and the facility was aware. Resident #1 stated he told the facility that he needed a snack at 12:00AM and 4:00AM due to low blood sugar; however, he could not remember if he was receiving them. He also stated the facility did not check his blood sugars. Resident #1 was expressive and receptive to language; however, he seemed to have confusion regarding details of events. Resident #1 was lying in hospital bed with no visible marks, bruises or obvious injuries. In an interview on 08/29/25 at 12:32 PM, CNA A stated she was employed at the facility for 5 months. She stated she worked on the first floor East and West. She also stated she picked up additional shifts but mainly worked in the morning. She stated she worked the night shift on 08/25/25. CNA A stated she first worked with Resident #1 on the night on 08/25/25, and she was not aware that the resident was diabetic. CNA A stated she did not know that Resident #1 was supposed to get a snack at nighttime. She stated the nurses gave snacks to the diabetic residents. She stated there were snacks in a refrigerator available for all residents. CNA A stated she did not know Resident #1 if Resident #1 was getting his blood sugar checked because the nurses were responsible for doing it if needed. In an interview on 08/29/25 at 01:30PM, the MD stated he had been a doctor for over two decades. The MD stated Resident #1 was his patient at the local hospital as well as the facility. The MD also stated he was familiar with the case. The MD stated although resident was diagnosed with type II diabetes, he was not insulin-dependent; therefore, he did not need an order for any insulin or oral medication for diabetes. The MD stated he refused to order treatment or monitoring for Resident #1's diagnosis of type II diabetes. He stated Resident #1 had previously refused medication for his diabetes. The MD also stated resident was non-compliant with care and would not have allowed staff to check his blood sugar, so he was not going to order it. The MD also stated Resident #1's diabetes was diet-controlled; however, he was unable to say how Resident #1's diabetes was monitored without any MD orders in place. The MD stated resident received bloodwork when he was in the hospital and his A1C levels (test to measure average amount of sugar in blood) indicated he was no longer diabetic. The MD stated Resident #1 had problems of weakness which caused his falls due to renal failure and non-compliance with dialysis and had nothing to do with the MD or facility doing anything wrong. The MD stated even at home, Resident #1 was non-compliant with dialysis and did not his check blood sugar. The MD stated low blood sugar could possibly cause weakness. He stated some other symptoms included was sweating, shakiness and confusion. The MD contributed Resident #1's overall weakness and decline in health to end-stage renal failure and non-compliance with dialysis and care but was unable to state how diabetes was being ruled out since it was not being monitored. In an interview on 08/29/25 at 1:54 PM, the DON stated Resident #1 was a diagnosed with diabetes and he was also on dialysis. She stated Resident #1 was very non-compliant with his dialysis treatments. She stated Resident #1 was also a fall risk because he thought he could still do things independently and refused to call for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 2 of 4 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 08/29/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few help. The DON stated Resident #1 went to the hospital on [DATE] after the nurse found that he was not acting like himself and was less responsive, and he was currently at the hospital after having a fall on 08/26/25. The DON stated Resident #1 also had a fall the previous day on 08/25/25, and both falls occurred around 3:00 AM-4:00 AM. She stated Resident #1 had multiple comorbidities and the incidents could have been caused by many things including weakness related to low blood sugar, missing dialysis treatments, and even from receiving dialysis treatments. The DON could not recall the MD giving specific orders for Resident #1 to have overnight snack for his blood sugar; however, she stated snacks are always offered to residents at bedtime, especially residents with diabetes. In an interview on 08/29/25 at 02:57PM, RN B stated she worked at the facility for 8 years, 6:00AM-6:00PM shift. RN B stated she did not know Resident #1; however, she worked with other residents who were diagnosed with diabetes. She stated not all diabetics required insulin. She stated she checked blood sugar levels per the MD orders. RN B stated some residents had blood sugars checked often, and others were only checked as needed. RN B stated while on her shift, she would assess all residents with diabetes for symptoms of hyperglycemia/hypoglycemia. RN B stated symptoms of hypoglycemia was sweating, confusion, slurred speech, lethargic, shaking, and weakness. RN B also stated a resident with type II diabetes could have falls. She stated if any diabetic residents had symptoms, she checked their blood sugar even without doctor's orders based on her training as a nurse. In an interview on 08/29/25 at 04:24PM, LVN C stated she worked overnights with Resident #1 on 08/25/25. LVN C around 10:00PM, she gave Resident #1 3 cups of jello and a protein snack, and the resident finished all of it. She stated Resident #1 did not display any signs of hypoglycemia before going to bed. LVN C stated although she assessed Resident #1 for hypoglycemia, she did not document it anywhere. LVN C stated if a resident had a blood sugar monitoring tool ordered, it would show on the MAR for the nurses to sign off on; however, Resident #1 did not have one in place when she worked with him on 08/25/25-08/26/25. LVN C stated she found Resident #1 on the floor around 3:00 AM on 08/26/25, and the resident told her that he had fallen out of bed and was in pain. LVN C stated she completed an assessment and checked his vital signs, and Resident #1 did not have any symptoms of hypoglycemia.; however, he was sent to the hospital due to complaining of pain in his head and back. LVN C stated as a nurse she knew to check for symptoms of hypoglycemia during any assessment for residents who were diagnosed with diabetes, even if there was not an order in place to do so. LVN C was able to state symptoms of hypoglycemia included sweating, shaking, and confusion. Further interview on 08/29/25 at 06:32PM, the DON stated it was her responsibility to ensure that residents had appropriate orders in place, and if they did not she would have to discuss it with the MD. She stated the facility would put a monitoring tool in place to assess all residents with diabetes for hypoglycemia and hyperglycemia; however, Resident #1 went to the hospital on 8/20/25 and the system discontinued all his orders. She stated it was her responsibility to ensure that all of Resident #1's orders were made active as appropriate when he returned to the facility, but she was working the floor that day and forgot to check them. The DON stated if a resident was diagnosed with type II diabetes with no physician orders or hyperglycemia/hypoglycemia monitoring tool in place, it could place the resident at risk of being hyperglycemic/hypoglycemic. The DON stated not everyone had the same signs and symptoms of hypoglycemia; however, some of the signs and symptoms included confusion, sweating, shakiness, and unresponsiveness which could include weakness. In an interview on 09/02/25 at 05:13PM, Resident #1's RP stated Resident #1 was admitted to the facility on [DATE]. Resident #1's RP stated while at the facility, Resident #1 had an incident where his blood sugar was low, and he became extremely lethargic for two days and the facility allowed him to sleep. Resident #1's RP stated staff attempted to talk to Resident #1, but (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676243 If continuation sheet Page 3 of 4 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 08/29/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete he did not respond. Resident #1's RP stated he went to the hospital (on 8/20/25) and found out his blood sugar was low. The RP stated the facility was not checking the resident's blood sugars. The RP also stated there was a second incident at the facility when Resident #1 had a fall, and she believed that was also due to low blood sugar. The RP stated Resident #1 was currently still at the hospital with a fractured back. Investigator requested the facility's policy on diabetic care from the DON and was informed the facility did not have one. The DON stated they followed guidelines from American Diabetes Association. Event ID: Facility ID: 676243 If continuation sheet Page 4 of 4