Health inspection·October 31, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some for poor mood stability, increased depression, and poor quality of life with an intervention dated 08/20/25 discuss with the resident any concerns or issues regarding health and/or emotional well-being.Review of Resident #6's Quarterly MDS dated [DATE], reflected a BIMS score of 13 indicating no cognitive impairment.Review of Resident #7's face sheet dated 10/31/25 reflected a [AGE] year old male admitted on [DATE] and readmitted on [DATE] with diagnoses including Dementia (a group of conditions that cause a decline in cognitive abilities, such as memory, thinking, problem-solving, and language), anorexia (an eating disorder that causes people to weigh less than is considered healthy for their age and height, usually by excessive weight loss), and epilepsy (a chronic neurological disorder characterized by recurrent seizures, which are sudden, uncontrolled electrical discharges in the brain). Record review of Resident #7's care plan reflected a problem dated 06/21/22 of Resident #7has a history of depression, bipolar disorder (a mental health condition characterized by extreme mood swings between periods of high energy (mania or hypomania) and low energy (depression) and psychosis (mental health condition characterized by a loss of touch with reality). Review of Resident #7's Quarterly MDS dated [DATE], reflected a BIMS score of 09 indicating moderate cognitive impairment. Record review of TULIP (an online system used by the Texas Health and Human Services Commission for long-term care licensing, applications, and reporting) facility self-report dated 07/09/25 reflected that on 07/09/25 Resident #4 told a staff member (name of staff member not listed) that about a week prior to this date CNA G told him he would she would, take him outside on the grass and whoop his butt. CNA G was suspended pending the outcome of the investigation. CNA G submitted her resignation prior to the investigation being completed. Facility conducted resident life satisfaction rounds regarding care provided by CNA G and facility revealed that, the results weren't favorable regarding [CNA G's] attitude.Record review of facility resident Life Satisfaction Rounds dated 07/10/25 and 07/11/25 for investigation involving CNA G reflected:Resident #4 said, I Don't want her as my CNAResident #5 said, She is very abrupt. In the morning she states its too early to be asking her questionsResident #6 She has a rude approach. For example: she tells me Im getting in the shower instead of asking meRecord review of email dated 07/09/25 from CNA G to the Administrator reflected CNA G said what Resident #4 said about her was not true and she would never say anything like taking somebody to the grass and CNA G and Resident #4 clowned and joked and laughed when she passed trays. Review of statement dated 07/10/25 by the SSA reflected on 07/08/25 she asked Resident #4 if the staff treated him and he said, That [CNA G] is no good, I don't want her as my CNA. SSA said she asked him what he meant by that, and he stated she made the comment about him getting out of bed and told SSA that CNA G told him, you better get out of bed before I whoop your butt. SSA asked him if he thought CNA G would hurt him and he said he did not know but did not want her as his CNA. SSA asked him if he felt threatened by that comment and he said he was not threatened as in harm for his life but threatened as in that comment rubbed him the wrong way because he did not want to get up and she kept making comments to get out of the bed. Resident #4 said CNA G had never tried to harm him, but he did not want her as his CNA.Record review of an email dated 07/14/25 from CNA G to the Administrator revealed she was resigning from her employment with the facility. Interview on 10/30/25 at 8:17 am with Resident #4 reflected he had a problem with CNA G and CNA G said she wanted to fight him, and a family member came to the facility to tell the facility about it. He did not have a problem with any more staff members. Attempted to contact CNA G on 10/30/25 at 5:32 pm. Left CNA G a telephone voice mail message and a text message and received no response.Interview on 10/30/25 at 5:36 pm with Resident #7 reflected the staff treated him respectfully now that [CNA G] was gone. He said CNA G did not treat him respectfully and did not treat him like a human. Resident #7 said she hurt his feelings. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 2 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some #7 said he could not remember what CNA G said but he remembered how she made him feel. He said CNA G spoke to him in a mean manner and he felt like she was verbally abusive. Interview on 10/30/25 at 5:39 pm with Resident #6 reflected CNA G did not treat her respectfully and said she would get mad when Resident #6 asked about anything and seemed not to like people to ask her things. She said CNA G hurt her feelings and her feelings were easy to hurt because she was bipolar. She said she told a person who was a psychiatrist about how CNA G spoke with her, but that psychiatrist was no longer at the facility. She said CNA G's tone when she talked was boisterous and she would talk roughly. She said CNA G, when she spoke with you, she sounded like she did not want to do whatever you asked her to do. She said the sound of CNA G's voice when she was speaking with her was explosive and made Resident #6 feel bad. Interview on 10/31/25 at 9:42 am with Resident #5 reflected CNA G was really rough and she did not like for you to ask any questions. She said that CNA G kind of hurt her feelings, and CNA G more or less treated her like she was a child. She said CNA G did not physically hurt her, but she was never able to tell her she liked something one way or another way. She said CNA G was abrupt and Resident #5 did not like CNA G's attitude. She said she did not tell anyone about it and just learned to put up with it. Resident #5 said CNA G did not have to be so rough and CNA G was kind of hateful. Resident #5 did not like CNA G's attitude. Interview on 10/31/25 at 9:56 am with SSA reflected that she did the Life Satisfaction Rounds dated 07/10/25 and 07/11/25 for investigation involving CNA G and most residents did not know CNA G, but she had 2 (two) residents, she did not remember their names, who said CNA G was very abrupt with her approach to them. SSA said CNA G was not the most professional and had a strong accent that did not come off as pleasant. One resident stated CNA G just came in and said we are going to give you a shower and the resident said it was the way that CNA G spoke to her that the resident did not like. SSA said she spoke with the Administrator about the comments made in the Life Satisfaction rounds and the Administrator said she was doing an investigation. SSA said the Administrator was a little upset about the comments and was going to get with the DON. SSA said an example of verbal abuse would be to say derogatory statements to a resident. Interview on 10/31/25 at 10:32 am with CNA H reflected she did not work with CNA G. CNA H said residents have the right to say no to any kind of care, they have a right to feel safe, they have the right to be treated as adults, and they have a right to ask questions. She said if she worked with someone who she felt was unkind or hurt residents' feelings she would report this to the Administrator. She said residents have the right to feel safe. She said she was trained in resident rights when she was hired, and resident rights were highly important because the facility was their home. She said she felt residents should be treated like she would like someone to treat her loved one. She said it was the responsibility of everyone to protect resident rights and if there is a problem they take it to their Administrator.Interview on 10/31/25 at 10:36 am with CNA I reflected she worked with CNA G and did not hear CNA G speak unkindly to residents. She said she was trained in resident rights when she was hired at the facility. She said some examples of resident rights were the right to refuse care, the right to privacy, the right to speak about their concerns and choose what they ate. She said residents have the right to ask questions and not to be treated as children. She said if a resident's rights were violated, she would take a report and go straight to the nurse or the ADON. Interview on 10/31/25 at 10:56 am with LVN E reflected he had not heard that any staff member had been unkind to any residents, and he did not know CNA G. He said he was trained in resident rights when he was hired at the facility. He said when you speak with residents, you should speak to them respectfully and it would violate resident rights if a resident felt their feelings here hurt. He said it was not right for residents not to be able to ask questions about their care. He said residents have a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 3 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete right to feel like they are humans, and it was the responsibility of all staff to make sure that resident rights were protected. He said he would report to the Administrator if a resident's rights were not respected. He said a negative effect of not respecting resident rights might be that residents were affected emotionally. He said residents have the same rights as any other person.Interview on 10/31/25 at 11:02 am with LVN F reflected he worked with CNA G, and he felt like she was respectful to residents and no residents complained about the way she treated them. He said he was trained in resident rights when he was hired at the facility, and it was the responsibility of everyone to protect resident rights. He said examples of resident rights were the right to privacy, to be treated fairly and respectfully and to make decisions of their own choices. If a staff member did not allow a resident to ask questions that would be inconsiderate and disrespectful and was a violation of resident rights and borderline abusive. LVN F said if he felt a resident's rights were being disrespected, he would talk to the staff member who was not respecting the resident's rights then speak to the resident then let the ADON or DON know. Allegations of abuse and neglect were reported to the Administrator first and foremost and he would also report resident rights issues to the Administrator.Interview on 10/31/25 at 11:13 am with the DON reflected resident rights involved honoring residents' likes and dislikes and respecting and honoring residents' wishes. The DON said this included making sure Residents' feelings were not hurt and they were respected. She said residents have the right to know they have a say and for their voice to be heard. She said that after the SSA brought the Life Satisfaction results involving CNA G to her attention and the Administrator, they talked with the residents and let them know CNA G would not be back. She said it was the responsibility of everyone to protect the residents' rights, from the nurses to the CNAs to the dietary staff, everyone. Interview on 10/31/25 at 11:11 am with the Administrator reflected after the life satisfaction surveys were reported to her, she would have terminated CNA G's employment, but CNA G already resigned. She said, after hearing what Residents #4, #5, #6, and #7 felt about how CNA G made them feel, it was possible she violated their rights. She said the staff were trained in resident rights when they were hired and it was the responsibility of everyone to make sure residents had their rights protected. It was her expectation that staff reported to her any knowledge of resident rights violation. She said the possible negative effect of resident's having their resident rights violated would be residents could regress and not feel they have rights in their living space. Review of facility Resident Right's Policy dated February 2021 reflected employees shall treat all residents with kindness, respect, and dignity.Policy Interpretation and Implementation1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the residents' right to: 1. a dignified existence;2. be treated with respect, kindness, and dignity;3. be free from abuse, neglect, misappropriation of property 4. communication with and access to people and services, both inside and outside the facility;exercise his or her rights as a resident Event ID: Facility ID: 676252 If continuation sheet Page 4 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 - Immediate jeopardy to resident health or safety 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 residents' environment remained as free of accident hazards as was possible and ensure each resident received adequate supervision and assistance devices to prevent accidents for one (Resident #1) of three residents reviewed for accidents and hazards.The facility failed to ensure CNA A, on 10/07/25, had a 2nd staff member assisting her when transferring Resident #1 from her bed to her wheelchair and failed to ensure the mechanical lift sling was free from defects. Resident #1 fell from her bed to the floor and sustained lacerations to her head resulting in 7 stitches to her left forehead and 5 staples to her posterior scalp.The noncompliance was identified as Past Noncompliance. The Immediate Jeopardy (IJ) began on 10/07/25 and ended on 10/08/25. The facility had corrected the noncompliance before the survey began.This deficient practice placed residents at risk of pain, injury, and hospitalization.Findings included:Review of Resident #1's face sheet dated 10/29/25 reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including other epilepsy, not intractable, without status epilepticus (a form of epilepsy (a chronic neurological disorder characterized by recurrent seizures caused by abnormal electrical activity in the brain) where seizures are not considered difficult to control with treatment), contracture, left knee (limiting movement and causing pain, stiffness, and an inability to fully extend the leg), and dementia in other diseases classified elsewhere, unspecified severity with agitation (dementia (a general term for a decline in mental ability that affects memory, thinking, and daily life) caused by another disease (like Alzheimer's or Parkinson's) who also exhibit agitation, such as restlessness, shouting, or aggression, and the severity of the dementia has not been specified). Review of Resident #1's care plan initiated on 03/18/21 and revised on 10/07/25 reflected Resident #1 had very limited mobility and required total assistance with all transfers via mechanical lift, putting her at risk for falls. Review of Resident #1's Quarterly MDS dated [DATE], reflected a BIMS score of 04 indicating severe cognitive impairment. Observation on 10/29/25 at 9:47 am of transfer by mechanical lift of Resident #1 from her bed to her wheelchair by CNA C and CNA D. Surveyor observed safe transfer and mechanical lift sling in good condition. During the observation of Resident #1 being transferred, Resident #1 told CNA C and CNA D, don't hurt me like you did the other day. Review of facility investigation statement dated 10/07/25 of CNA A reflected she was preparing to transfer [Resident #1] to her chair using a [mechanical lift] and sling. I positioned the sling under the resident while waiting on my coworker to assist with the transfer. As I set the resident in the sling above her bed the sling broke. She fell off the bed onto the floor. The incident happened before my coworker arrived. I immediately notified the nurse. Review of facility Accident/Incident Investigation Statement of CNA B dated 10/07/25 reflected on 10/07/25 at about 7:35 am CNA B was in the shower room assisting another resident when CNA A called and asked her to go help with a mechanical transfer. CNA B said she was finishing up with the shower and would come as soon as she could. When CNA B got to the room to help with Resident #1, Resident #1 was already on the floor. CNA A told CNA B that the sling had broken when she was waiting for help. The nurse was called right away and CNA A and CNA B stayed with Resident #1 until the nurse arrived. Review of facility investigation statement dated 10/07/25 of DON reflected at approximately 7:55 am she was called to Resident #1's room by CNA A who stated Resident #1 was on the floor at bedside. Resident #1 was on her back with a laceration above her left eyebrow and back of her head. Staff at bedside applied pressure. Resident #1 remained in the same position as when she fell from the mechanical lift. Vitals were taken and Resident #1 complained of pain to her bilateral lower extremity at a level of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 5 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 - Immediate jeopardy to resident health or safety Residents Affected - Few 4 out of 10 (Moderate pain, manageable). RP and MD notified, and orders received for emergency medical services transport for evaluation and treatment. Record review of hospital records dated 10/07/25 reflected [AGE] year-old female arrived by emergency medical service from nursing facility status post fall approximately 3 - 4 feet as patient was being carried over on a lift. Patient sustained left forehead laceration as well as posterior scalp not on any anticoagulation. Patient was at her baseline since the fall. No bruising to the rest of her body. Vital signs were stable per emergency medical services. Record review of TULIP (an online system used by the Texas Health and Human Services Commission for long-term care licensing, applications, and reporting) facility self-report dated 10/07/25 reflected Resident #1 had an observed fall. CNA A said as she was waiting for CNA B to come into Resident #1's room to assist CNA A with transferring Resident #1 from her bed to her wheelchair. While CNA A was waiting for CNA B to come, CNA A positioned the resident in the sling to get ready for CNA B to come and CNA A lifted the resident up about an inch above the bed, then she heard a pop, she noted the sling hooks on the side she was on had come undone, and the resident landed on the bed, then the resident rolled off the bed onto the floor. CNA B came into Resident #1's room when Resident #1 was on the floor and CNA B called for a nurse. When the nurse entered the room, she saw Resident #1 on her back with a laceration above her left eyebrow and the back of her head. When Resident #1 asked what happened, Resident #1 said she fell. Resident #1 was left in the same position as when she fell, her vitals were taken, her pain level was assessed, and emergency medical services were called. Resident #1 was transferred by emergency medical services to the hospital. CNA A was suspended pending the outcome of the investigation. Resident #1 received 7 stitches to her left forehead and 5 staples to her posterior scalp. Resident #1 returned to the facility the same day and was seen by the facility MD the following day. Resident #1 denied pain and was at her baseline. Resident #1 was monitored post fall. The facility conducted a life satisfaction survey regarding CNA A and survey revealed no negative statements from residents. The facility re-educated staff on facility abuse and neglect and activities of daily living transfer policies, audited mechanical lift slings, conducted activities of daily living transfer competencies, and terminated CNA A for not adhering to facility activities of daily living transfer procedures. Record review of in-service for mechanical lift sling audit beginning 10/08/25 reflected the ADON and DON will alternate inspection of all facility mechanical lift slings to confirm reliability and safety every 3 (three) months ongoing. Record review of mechanical lift sling audit signed by either the ADON or DON beginning 10/8/25 reflected audit will be conducted every 3 months ending indefinitely.Interview on 10/29/25 at 9:47 am with Resident #1 revealed shoot, yea it hurt when she fell out of bed the other day. Interview on 10/29/25 at 11:35 am with the DON reflected when CNA A was transferring Resident #1 from her bed to her wheelchair on 10/07/25, CNA A loaded [Resident #1] up into the mechanical lift without another person in the room. After Resident #1 was in the sling connected to the mechanical lift the straps came loose on both sides of the sling closest to the floor and Resident #1 hit the bed then fell to the floor. The DON said mechanical lifts were a 2-person process and their nurses and CNAs were re-educated that you cannot begin to load a resident onto a mechanical lift without a second person. She said they did a competency demonstration on how to safely operate and what to check when you are transferring a resident by mechanical lift. She said during the competency demonstration, all CNAs and nurses had to demonstrate using a dummy as a substitute resident how to properly check the sling and conduct a safe transfer. The DON said she and the ADON looked at every mechanical lift sling in the building, gathering slings from resident rooms, the laundry, and storage, and inspected them for defects or concerns that they could not bear the weight of any resident. Any slings that were found deficient were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 6 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 - Immediate jeopardy to resident health or safety Residents Affected - Few disposed of. Interview on 10/29/25 at 11:53 am with CNA B reflected on the day Resident #1 fell from the mechanical lift, CNA A asked for her help and CNA B told CNA A she was with another resident and to give her a minute. CNA B said CNA A began lifting the mechanical lift before CNA B got to the room. When CNA B entered the room Resident #1 was on the floor crying and shaking like Resident #1 was nervous. CNA B said there was blood on Resident #1's forehead. She said the nurse came in and applied pressure to Resident #1's forehead and checked Resident #1's vital signs. CNA B said staff were not supposed to start any part of a mechanical lift transfer by themselves and it took 2 (two) people all the time to transfer a resident by mechanical lift. She said she was re-inserviced the day after the incident on safe mechanical lifting. She said they did competency training using a dummy as a resident to demonstrate proper mechanical lift transfers. CNA B said she felt confident in conducting mechanical lift transfers. CNA B said during her in-service staff were taught to always have two people when you put the resident in a sling and to check the equipment before beginning the mechanical lift transfer. She said they were in-serviced to make sure the sling was in good condition and did not have any tears or fraying. She said if the sling did not look like it was in good condition staff were to throw it away and inform the ADON or DON. Interview on 10/29/25 at 1:43 pm with the Administrator reflected CNA A told CNA B she needed assistance to transfer Resident #1 and CNA B said she would be right there, but CNA A went ahead and put Resident #1 in the mechanical lift sling. The Administrator said CNA A told her Resident #1 was about 1 (one) inch off the bed and CNA A was holding Resident #1 steady over her bed and CNA A heard a pop and Resident #1 fell onto the bed then onto the floor. The Administrator said CNA A told her she knew she needed 2 (two) people for a mechanical lift transfer. She said CNA A was suspended pending investigation and after the investigation CNA A's employment was terminated. She said all the mechanical lift slings were pulled from residents' room and the laundry rooms and all areas of the building and the ADON and DON inspected them for defects. She said any sling that looked like the loops were loose or torn or frayed were disposed of and 72 new slings in different sizes were ordered. Attempted interview via phone of CNA A on 10/30/25 at 8:45 am. Surveyor left CNA A a voice mail and sent a text message to her cell phone. No response from CNA A was received. Interview on 10/30/25 at 2:34 pm with the DON reflected it was her expectation that the staff followed the facility mechanical lift policy and made sure it was a 2 (two) person process because the policy was there for the residents' safety. She said CNA A was not following facility policy when she began the transfer without the other CNA. She said it was the responsibility of the Administrator, ADON and DON to make sure that the staff were following safe procedures when staff were transferring a resident who required a mechanical lift. She said the possible negative effects of not following facility policy for resident transfer using a mechanical lift were resident injury. Interview on 10/30/25 at 4:45 pm with the ADON reflected it was her expectation that when residents were being transferred using a mechanical lift, staff use 2 (two) people for safety measures. She said the sling needed to be inspected before being used to make sure it was in good condition and if it was not in good condition, to take it off the floor and give it to her or the DON. She said it was the responsibility of the DON, ADON, and charges nurses to make sure that staff were operating the mechanical lifts safely and with 2 (two) people. She said the possible negative effect of not having 2 (two) people was a resident could get injured; it could be a bad situation. A possible negative effect if there was something wrong with the sling was that the sling would break and the resident could fall and get hurt.Interview on 10/30/25 at 5:09 pm with the Administrator reflected it was her expectation for the staff to follow the facility mechanical lift policy that always required 2 (two) people when transferring a resident who needed a mechanical lift. Staff should have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 7 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 - Immediate jeopardy to resident health or safety Residents Affected - Few inspected the sling before using it to make sure it was in operable order with no fraying and no parts that were not connected completely. If staff needed assistance or had questions they should talk to the charge nurse. It was the responsibility of the individual staff members and leadership to make sure residents were transferred safely following facility policy when the mechanical lift was used to transfer residents. Record review of facility policy Safe Lifting and Movement of Residents Policy Statement dated July 2017 reflected in order to protect the safety and well-being of staff and residents, and to promote quality care, this facility uses appropriate techniques and devices to lift and move residents.Policy Interpretation and Implementation1. Resident safety, dignity, comfort and medical condition will be incorporated into goals and decisionsregarding the safe lifting and moving of residents.2. Manual lifting of residents shall be eliminated when feasible.3. Nursing staff, in conjunction with the rehabilitation staff, shall assess individual residents' needs fortransfer assistance on an ongoing basis. Staff will document resident transferring and lifting needs in thecare plan. Such assessment shall include the following:a. Resident's preferences for assistance;b. Resident's mobility (degree of dependency);c. Resident's size;d. Weight-bearing ability;e. Cognitive status;f. Whether the resident is usually cooperative with staff; andg. The resident's goals for rehabilitation, including restoring or maintaining functional abilities.4. Staff responsible for direct resident care will be trained in the use of manual (gait/transfer belts, lateralboards) and mechanical lifting devices.5. Mechanical lifting devices shall be used for heavy lifting, including lifting and moving residents when necessary.6. Only staff with documented training on the safe use and care of the machines and equipment used in this facility will be allowed to lift or move residents.7. Staff will be observed for competency in using mechanical lifts and observed periodically for adherence to policies and procedures regarding use of equipment and safe lifting techniques.8. Mechanical lifts shall be made readily available and accessible to staff 24 hours a day. Back-up battery packs on remote chargers shall be provided as needed so that lifts can be used 24 hours a day while batteries are being recharged.9. Enough slings, in the sizes required by residents in need, will be available at all times. As an alternative, residents with lifting and movement needs will be provided with single-resident use disposable slings.10. Maintenance staff shall perform routine checks and maintenance of equipment used for lifting to ensure that it remains in good working order.11. All equipment design and use will meet or exceed guidelines and regulations concerning resident safety and the use of restraints.12. Safe lifting and movement of residents is part of an overall facility employee health and safety program, which:a. involves employees in identifying problem areas and implementing workplace safety and injury prevention strategies;b. addresses reports of workplace injuries;c. provides training on safety, ergonomics and proper use of equipment; andd. continually evaluates the effectiveness of workplace safety and injury-prevention strategies.Review of facility policy Lifting Machine, Using a Mechanical July 2017 reflected the purpose of this procedure is to establish the general principles of safe lifting using a mechanical lifting device.It is not a substitute for manufacturer's training or instructions.General Guidelines1. At least two (2) nursing assistants are needed to safely move a resident with a mechanical lift.2. Mechanical lifts may be used for tasks that require:a. Lifting a resident from the floor;b. Transferring a resident from bed to chair;c. Lateral transfers;d. Lifting limbs;e. Toileting or bathing; [NAME]. Repositioning.3. Types of lifts that may be available in the facility are:a. Floor-based full body sling lifts;b. Overhead full body sling lifts; andc. Sit-to-stand lifts.4. Lift design and operation vary across manufacturers. Staff must be trained and demonstrate competencyusing the specific machines or devices utilized in the facility.Steps in the Procedure1. Before using a lifting device, assess the resident's current condition, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 8 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 - Immediate jeopardy to resident health or safety Residents Affected - Few including:a. Physical:(1) Can the resident assist with transfer?(2) Is the resident's weight and medical condition appropriate for the use of a lift?b. Cognitive/Emotional:(1) Can the resident understand and follow instructions?(2) Does the resident express fear or appear anxious about the use of a lift?(3) Is the resident agitated, resistant, or combative?2. Measure the resident for proper sling size and purpose, according to manufacturer's instructions.3. Select a sling bar that is appropriate for the resident's size and the task.4. Prepare the environment:a. Clear an unobstructed path for the lift machine;b. Ensure there is enough room to pivot;c. Position the lift near the receiving surface; andd. Place the lift at the correct height.5. Make sure the battery is charged.6. Test the lift controls. Ensure the emergency release feature works.7. Make sure the lift is stable and locked.8. Make sure that all necessary equipment (slings, hooks, chains, straps and supports) is on hand and in goodcondition.9. Double check the sling and machine's weight limits against the resident's weight.10. Place the sling under the resident. Visually check the size to ensure it is not too large or too small.11. Lower the sling bar closer to the resident.12. Attach sling straps to sling bar, according to manufacturer's instructions.a. Make sure the sling is securely attached to the clips and that it is properly balanced.b. Check to make sure the resident's head, neck and back are supported.c. Before resident is lifted, double check the security of the sling attachment.d. Examine all hooks, clips or fasteners.e. Check the stability of the straps.f. Ensure that the sling bar is securely attached and sound.Observation on 10/29/25 at 2:46 pm of transfer by mechanical lift of Resident #2 from her wheelchair to her bed by CNA E and CNA F. Surveyor observed safe transfer and observed mechanical lift sling in good condition.Observation on 10/29/25 from 12:39 pm until 2:45 pm of 10 mechanical lift slings located in resident beds or on resident wheelchair revealed all slings free of defects and appeared brand newRecord review of CNA A's Record of Employee Counseling dated 10/07/25 revealed CNA A's suspension for failure to follow policy related to use of mechanical lift, employee used [mechanical lift] unassisted.Record review of CNA A's Record of Employee Counseling dated 10/20/25 revealed that CNA A's employment was terminated via phone and reflected reason for termination improper use of equipment.Record review of facility Life Satisfaction Survey regarding CNA A for 5 (five) residents reflected CNA A never responded to residents in a negative manner, CNA A never made a resident feel as if their needs were not acknowledged, CNA A never provided activities of daily living care incorrectly, and CNA A never ignored residents' activities of daily living care or stated that she would not do their activities of daily living care.Record review of facility in-service training from the ADON on 10/07/25 revealed CNAs and nurses received in-servicing on facility Abuse and Neglect Policy and Procedures Record review of facility in-service training from the ADON on 10/07/25 revealed CNAs and nurses received in-servicing on staff should always operate mechanical lift with 2 (two) staff members and staff should verify mechanical lift if is fully functional and operating proper. If the mechanical lift is not functioning properly staff are to pull it off the floor, notify management/maintenance director and put a work order in TELS (a service request platform used by facilities for maintenance and operations) from the facility ADON.Record review of facility in-service training from the ADON on 10/07/25 revealed CNAs and nurses received in-servicing on staff are to check gait belts and slings daily every shift for any tears, holes, or thread unraveling. If any defects are noted to equipment staff are to pull it from the floor and notify DON/ADON immediately. Shower (mesh) slings are only to be used for residents when giving showers. They are not to be used for everyday get up to participate in daily activities. Staff to ensure batteries sufficiently charged before each use of mechanical lift/sit to stand before use to ensure they are functioning properly. Record review of facility competency transferring the resident using mechanical lift given to nursing and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 9 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete CNA staff for technique and safety beginning 10/07/25. Competency documentation showed that over 80% of the staff completed the training by 10/08/25. During interviews on 10/29/25 from 2:27 pm - 10/31/25 at 10:25 am, four LVNs, 1 LPN, and 10 CNAs from different shifts all stated they were in-serviced by the ADON and DON on 1. facility Abuse and Neglect Policy and Procedures2. always operate mechanical lift with 2 (two) staff members and staff should verify mechanical lift is fully functional and operating properly. If the mechanical lift is not functioning properly staff are to pull it off the floor, notify management/maintenance director and put a work order in TELS (a service request platform used by facilities for maintenance and operations).3. to check gait belts and slings daily every shift for any tears, holes, or thread unraveling. If any defects are noted to equipment staff are to pull it from the floor and notify DON/ADON immediately. Shower (mesh) slings are only to be used for residents when giving showers. They are not to be used for everyday get up to participate in daily activities. Staff to ensure batteries sufficiently charged before each use of mechanical lift/sit to stand before use to ensure they are functioning properly. Event ID: Facility ID: 676252 If continuation sheet Page 10 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - 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 residents receive parenteral fluids consistent with professional standards of practice and in accordance with physician orders, the comprehensive person-centered care plan, and the resident's goals and preferences for one resident (Resident #3) of 5 residents reviewed for treatments. The facility failed to follow facility protocol of cleaning and changing of the PICC line dressing for Resident #3, since his return from the hospital on [DATE] until he was readmitted to the hospital on [DATE]. This failure could lead to infections and related complications. Findings included:Record review of Resident #3's face sheet dated 10/30/25 revealed a [AGE] year-old male initially admitted on [DATE] and re admitted to the facility on [DATE]. His diagnoses included cellulitis (skin infections), dysphagia (difficulty to swallow) , type 2 diabetes, hemiplegia and hemiparesis (paralysis of one side), pain, muscle weakness, lack of coordination and reduced mobility.Record review of Resident #3's quarterly MDS dated [DATE] revealed a BIMS score of 8 indicating his cognition was moderately impaired.Record review of Resident #3's care plan dated 04/11/25 reflected Resident #3 was recently in the hospital and had a UTI and Sepsis[KS3] putting him at risk for having a recurrent UTI. The relevant intervention was giving antibiotic therapy as ordered. Monitor/document for side effects and effectiveness. Record review of the facility reported incident dated 07/16/25 revealed, on 07/14/25 Resident #3 was noted with an elevated temperature and was sent to the emergency room for evaluation. Upon examination Resident #3 was observed with an outdated dressing at IV site to right arm.Record review of progress notes in the E HR revealed Resident #3 was admitted to the hospital on [DATE] for UTI and discharged on 6/13/25 with PICC line[KS4] in place, after a course of IV antibiotics. He was readmitted to hospital on [DATE] as he was febrile (had a fever) and returned to facility on 7/21/25. On 07/14/25 at the hospital it was noticed that the date on the PICC line dressing was 06/11/25.Observation of the photograph of the PICC line dressing provided by FM revealed it was taken on 07/14/25. The date printed on the PICC line dressing was 06/11/25 .Record review of the MAR of June 2025 reflected:1. No order for changing the PICC line dressing.2. Imipenem/Cilastatin (Primaxin) 500mg/100ml ns injectable, 500mg/100ml mg/ml (Imipenem, Cilastatin) : Use 33.3 ml intravenously three times a day for IV ABT Therapy for 36 Administrations over 3 hours. -Start Date- 06/14/2025.Record review of the MAR for July 2025 reflected:1. PICC line dressing and cap change weekly using sterile technique per protocol: At bedtime every Sunday. -Start Date-07/27/2025 -D/C Date-08/21/2025.2. DAPTOmycin Intravenous Solution Reconstituted 500 MG(Daptomycin):Use 372 mg intravenously one time a day for Cellulitis/MRSA until 08/15/2025. Infuse 372mg q 24hrs. Original order: Daptomycin 6mg/kg q 24hr. Patient weighs 62kg (136lb). -Start Date- 07/22/2025 During an interview on 10/30/25 at 3:02pm the FM stated on 07/14/25 he had noticed the date on the PICC line dressing on Resident #3, and it was 06/11/25. He stated Resident #3 was in the hospital for IV antibiotic treatment and returned to the facility on [DATE] with the PICC line on him. The FM continued, this means the dressing was not changed at the facility ever since his return from the hospital. He stated he took a photo of the dressing, on 07/14/25 and showed it to DON. The FM stated he was not happy with this neglect from the facility side.During a telephone interview on 10/30/25 at 3:20pm LVN A stated she was the nurse who readmitted Resident #3 from hospital on 6/13/25 and probably had forgotten to get an order for changing PICC line dressing every week. She stated she was aware of the importance of changing the dressing to minimize infection. She stated, at the facility the PICC line dressing changes were scheduled every Sunday in the afternoon shift and were performed by the nurse in charge on that day. She stated she was not sure why she had forgotten to organize the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 11 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 0694 Level of Harm - Actual harm Residents Affected - Few order with the physician on duty on that day. She stated she attended an in service on IV care and monitoring sometime in July 2025 and did not remember the exact day.During a phone interview on 10/30/25 at 3:43pm LVN B stated she was not working in hall 400 where Resident #3 was admitted on [DATE]. She said she worked with Resident #3 afterwards however in the weekdays and had not noticed the date on the PICC line dressing. LVN B said the PICC line dressing changes were scheduled at the facility weekly on Sundays and completed by the respective nurses on that day. LVN B stated changing the PICC line dressing once a week or PRN when it is dirty is crucial to minimize infection. LVN B stated it was the responsibility of the nurse who admitted the resident to the facility to get the dressing order from the NP.During an interview on 10/30/25 at 1:38pm LVN C stated she was the wound nurse at the facility and worked Monday to Friday in the day shift. She stated she did not attend PICC line dressing changes unless there was any infection or skin complications. She stated PICC line dressing changes were the responsibility of the nurse in charge in the hall and generally conducted once a week every Sunday. She stated changing PICC line dressing routinely would minimize the risk of infection at the site.During an interview on 10/30/25 at 2:18pm, LVN D stated she was a PRN nurse at the facility since August 2023 and worked in all the halls from time to time. She stated she worked with Resident #3 in the past. LVN D stated, PICC line site should be assessed every shift for signs of infection and the dressing was to be changed once a week as per facility protocol. She stated she believed the dressing was changed every Sunday and did not look for the date on the dressing on Resident #3. During an interview on 10/30/25 at 12:10pm the MD stated, on 07/14/25 Resident #3 was sent out to the hospital due to high temperature and returned on 07/26/25 after being treated for sepsis. She stated as per the hospital records the cause of sepsis was unknown, however she believed it was most likely from his recurrent UTI as he had a long history of sepsis from UTI. She stated, Resident #3 was admitted to the hospital in the 1st week of June 2025 for IV antibiotic treatment for UTI and returned to the facility on [DATE] with PICC line in place. She stated Resident #3 continued with the IV antibiotic treatment at the facility until 06/28/25. She stated the family complained the PICC line was still on Resident #3 even after the IV antibiotic treatment completed and the dressing on it was not changed after returning from the hospital. The MD stated the PICC line could remain on the body for a month however the dressing should be changed frequently as per the protocol to minimize the chances of infection at the insertion site.During an interview on 10/30/25 at 1:10pm the DON stated Resident #3 went out to the hospital on [DATE] and was diagnosed and treated for sepsis. She stated he came back on 06/13/25 with a PICC line to continue with antibiotic treatment at the facility. She said Resident #3 was sent out to hospital again on resident's family's request on 07/14/25. She said while at the hospital the family had noticed the PICC line dressing was not changed at all at the facility. The DON stated on 07/14/25 the FM sent her the photo of the PICC line dressing while he was at the hospital with the resident. She said the date printed on the PICC line dressing was 06/11/25. The DON stated the dressing was not changed at the facility after Resident #3 was returned from the facility on 06/13/25 until he readmitted to the hospital on [DATE]. The DON stated the expectation was, changing the dressing at least once a week and inspecting the insertion site every day for infection. She stated this was a neglect from the nursing staff and she conducted an in-service with the nurses. She said, as per facility protocol all the PICC line and midline dressings were changed every Sunday by the nurses who worked in the afternoon shift. The DON stated the admitting nurse on 06/13/25 did not initiate to get an order for changing the dressing and later days no other nurses on duty had noticed that there was no order for dressing changes. She stated the nursing staff did not make the same mistake when he returned to the facility on [DATE]. She said she verified (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676252 If continuation sheet Page 12 of 13 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 676252 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Capstone Healthcare Estates at Veterans Memorial 1424 Fallbrook Drive Houston, TX 77038 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 0694 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete that the staff initiated and followed the PICC line dressing changes after his return from the hospital with another PICC line, on 07/21/25.Record review of the in-service file revealed on 07/16/25 the facility conducted an in service on IV care and Monitoring. The staff were educated on the following1. IVs are to be flushed Q shift as well as before and after med administration2. IV site to be cleaned and dressing changed Q Sunday and PRN3. IV site to be monitored Q shift and PRN for patency , infiltration, phlebitis [bleeding] and infection.4. Any and all change in condition to be reported to nurse management immediately and documentation completed . Record review of facility policy Midline Dressing Changes revised in April 2016 reflected: The purpose of this procedure is to prevent catheter related infections associated with contaminated , loosened or soiled catheter site dressings.1. Change midline catheter dressing 24hours after catheter insertion and every 5-7days , or if it is wet, dirty, not intact or compromised in any way . Event ID: Facility ID: 676252 If continuation sheet Page 13 of 13