Health inspection·June 13, 2025

F 0761 Docusate Sodium Oral Capsule 100 MG (for constipation) Level of Harm - Minimal harm or potential for actual harm Duloxetine HCL Oral Capsule Delayed Release Sprinkle 60 MG (for Major Depressive Disorder) Metformin HCL Oral Tablet 500 MG (for Diabetes) Residents Affected - Few Movantik Oral Tablet 25 MG (for constipation) Seroquel Oral Tablet 100 MG (for Schizoaffective Disorder, Bipolar type) Gabapentin Oral Capsule 300 MG (for chronic pain) Hydroxyzine HCL Oral Tablet 25 MG (for Pruritis) Alprazolam Oral Tablet 1 MG (for Anxiety Disorder) Cyclobenzaprine HCL Oral Tablet 10 MG (for chronic pain) All of the above morning medications, scheduled for 7 AM or morning, were marked as given, as scheduled, on the Medication Administration Record by the Medication Aide. In an observation and interview on 06/13/25 at 1:17 PM, Resident #1 was laying in her bed, with her tray table next to her, on the left side. On the tray table were two small, clear cups, the resident's plate of lunch, and a cup of orange-yellowish colored liquid in a clear cup, with a wooden stick in it. One cup had one pill and the other cup had six pills. Resident #1 stated she did not know what all the pills were, but she stated one of the pills was Gabapentin (medication used generally to prevent seizures or nerve pain). Resident #1 stated the staff usually waited with her to swallow her medication. She stated the medication had been there since this morning and stated the Medication Aide just put the pills and Arginaid (liquid nutritional supplement) down and left the room. In an interview with the ADM and the DON on 06/13/25 at 2:08 AM, the DON stated the Staffing Coordinator told her there were pills on Resident #1's tray table. The DON stated she went to Resident #1's room and removed the pills. The DON stated she asked the Medication Aide if she watched Resident #1 take her pills or if she saw any pills on her tray table after she initially passed the medications, and the DON stated Medication Aide told her, she did not see any pills in Resident #1's room. The DON stated the risk of leaving pills in a resident's room and not ensuring the medication was taken was Resident #1 not receiving the medication as ordered, which could exacerbate a symptom. The ADM stated she agreed with the risks the DON mentioned. In an interview on 06/13/25 at 2:34 PM, the Medication Aide stated she was the staff member that passed medications on Resident #1's hall. She stated she thought she watched Resident #1 take all of her pills this morning. The Medication Aide stated she was trained to watch all residents to ensure they took their medication. She stated if a resident refused their medication, she was trained to take the medication back with her to the medication cart. The Medication Aide stated she did give the Arginaid to Resident #1, but it was around lunch time when she gave it to her. The Medication Aide stated the risk of leaving medications with the residents was another residents or family member could get the pills and take them. The Medication Aide stated it could be an overall health risk to the resident if the pills were not taken as ordered or if it was taken at the wrong time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676276 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 676276 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakewest Rehabilitation and Skilled Care 2450 Bickers St Dallas, TX 75212 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the facility's policy titled, Medication Administration, with an original date of 12/2020 and a revision date of 01/2025 reflected the following: Policy: Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. 18. Observe resident consumption of medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676276 If continuation sheet Page 3 of 3