Health inspection·July 31, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Reported to PM&R MD on 7/22. No obvious abnormalities to palpation and inspection. Record review of CR#1's progress notes, dated 07/27/25, Author [NP], read in part .continued medical treatment with additional labs, KUB, venous doppler bilateral [non-invasive imaging test used to assess blood flow in the veins], UACS, breathing tx, and medications to address all concerns at this time with patient and [family member] multiple times. Patient continues to cuss at staff with [family member] at bedside often refusing care or treatment.GI consult, Vital vein consult [consultation with a vein treatment specialist], and psych consult have been ordered for further eval. Record review of emergency department provider notes, date of service 07/28/25 2:25 p.m., read in part .ED course, Diagnoses as of 07/29/25 0103 [p.m.], transient alteration of awareness, herpes zoster with complication, acute cystitis without hematuria [bladder infection without the presence of blood].Patient presents to the ER due to altered mental status and abdominal pain. On exam, she has a shingles rash to her right upper abdomen and is agitated. During a telephone interview on 07/30/25 at 10:27 a.m., CR #1's family member said he was told (names unknown) that they were going to look at her on Friday, 7/25/25, Saturday, 7/26/25, and Sunday, 7/27/25, but they did not. He said on Monday, 7/28/25, CR #1 was hurting greatly on her right side, hollering and screaming because she was in pain, and was not herself. He said on Monday, 07/28/25, he decided to take her to the hospital himself. He said he left the facility with the resident around 2:00 p.m. and went straight to the hospital. He said at the ER he was told the resident had shingles and a severe UTI. He said the resident got these while she was at the nursing facility. He said the day before he took her to the hospital, 07/27/25, they told him they did extensive blood work on Saturday, 07/26/25. He said on Sunday, 07/27/25, the NP came to the facility and said the resident's lab work was good. He said they asked the NP to look at the resident's side, but the NP said she did not need to look at her side because she was fine, and therefore, never looked at her side. He said they were supposed to do a urine culture on Friday, but it never got done. He said they told him on Saturday they ordered a clinical psychology evaluation. He said the NP said she was going to stop care because resident was hollering and screaming on Sunday and the NP said she would not be her doctor anymore. He said the resident was acting out of character and that she was a very sociable uplifting person. During an interview on 07/31/25 at 8:13 a.m., CR #1 said she told staff her right side was hurting but did not recall the name of the person she told. She said the NP saw her on Sunday, 7/27/25, and she told the NP she was in pain. CR #1 said she asked the NP to look at her side, but the NP said she did not need to look at her because her lab work was good. She said the NP's response pissed her off. During an interview on 07/31/25 at 10:13 a.m., CNA B said she gave CR #1 a bed bath on 07/28/25 around 1:00 p.m., after lunch. She said she noticed a little redness on her back, but not a rash. She described the redness from being when one has been lying down and something was pressing against it. She said the resident did not have any rashes or redness on her abdomen. She said the resident did not complain of any pain. She said she worked with the resident the day before and she did not complain of any pain. During an interview on 07/31/25 at 11:10 a.m., the NP said she saw CR #1 on Sunday, 07/27/25. She said she went over her lab work and the resident was very verbally abusive and told her to get her ass out of her room. She said CR #1 was complaining of right pain, and she ordered gas x, stool softener, and pain medication, and told them that she needed a GI consult, but resident said she did not need a GI consult. She said CR #1's family member said she had diarrhea for 4 days, but staff said that was never reported to them. She said the resident nor the resident's family member did not ask her to look at her abdomen on 07/27/25. She said usually shingles was along the nerve pathways and sometimes around the back area and sides. She said shingles are red bumps/marks that are painful. She said shingles was very painful and CR #1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676263 If continuation sheet Page 2 of 3 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 676263 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerbrook Skilled Nursing and Rehab Center 9250 Humble-Westfield Rd Humble, TX 77338 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 would have been in excruciating pain. During an interview on 07/31/25 at 1:35 p.m., Nurse B said she saw CR #1 and her family member leaving the facility around 2:08 p.m. on Monday, 7/28/25. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676263 If continuation sheet Page 3 of 3