Inspection·October 3, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 9/26/2025: Cue, reorient and supervise or assist me as needed. Discuss concerns about confusion, disease process, transition issues, andcommunity placement with all team members. Observe for and report to the nurse any changes in cognitive function, specificallychanges in: decision-making ability, memory, recall and general awareness, difficulty, expressing self, difficulty understanding others, level of consciousness, and mentalstatus. Review of Resident #2's care plan, dated 09/26/2025 reflected the following focus: I have episodes of adverse behavior(s): Sexually inappropriate behavior (has held hands and attempted to kiss others, shows preference to one resident);Interventions:Anticipate behavior(s) and redirect when in close proximity to others that mightinvoke aggression.Ensure family/MD/aware of behaviors and/or any increase in behaviors noted.Ensure staff is aware of physical/sexual behaviors and interventions.Redirect/remove when approaching/being approached by particular female residentMonitor and chart behaviors q shift and report to MD.Resident will be placed one to one until IDT determines one to one is no longer inneed. During an interview on 9/26/2025 at 3:10 pm, LVN C stated she found Resident #1 and Resident #2 lying in bed together on 9/18/2025. She stated the residents were lying side by side on top of the covers, fully clothed and Resident #2 had his hand on Resident #1's leg. She stated Resident #2 wasn't trying to engage in anything. She stated she had no suspicion of ANE because she did not see him try to grab at nothing or try to touch [Resident #1] in an inappropriate way - he did not seem malicious or vicious at that time[ . She stated she was easily able to redirect him from the situation and denied seeing Resident #1 and Resident #2 in bed together prior to that. She stated she did not] report the incident as ANE because they weren't naked and didn't have their hands in each other's pants - nothing like that going on, they were fully clothed and weren't trying to do anything. LVN C stated she notified the DON but did not remember if she called either resident's RP. During an interview on 9/27/2025 at 12:00 pm, the ADM stated she was not aware of the incident last week on 9/18/2025 between Resident #1 and Resident #2 when they were found on the bed together. She stated it was her expectation that staff would report it immediately to her and notify the RPs of both residents. She was unaware that the RP's had not been notified. During an interview on 9/27/2025 at 1:39 pm, the FM for Resident #1 stated he was notified about an incident of sexual behavior that occurred on 9/24/2025 but never received a call about a previous incident on 9/18/2025. He stated when he was contacted by the facility on 9/24/2025 there was no indication there were any previous incident between [Resident #1} and {Resident #2] or any other male residents. The FM stated he was Resident #1's POA and it was very upsetting that they had not notified him about the incident on 9/18/2025. Review of facility Policy Resident Rights, dated February 2021, reflected: 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include tl1e resident's right to:a. a dignified existence;b. be treated with respect, kindness, and dignity;c. be free from abuse, neglect, misappropriation of property, and exploitation;k. appoint a legal representative of his or her choice, in accordance with state law;o. be notified of his or her medical condition and of any changes in his or her condition;p. be informed of, and participate in, his or her care planning and treatment; Event ID: Facility ID: 676295 If continuation sheet Page 2 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the residents had the right to be free from abuse and neglect for three residents (Resident #1, Resident #2 and Resident #4) of seven reviewed for abuse. The facility failed to:1) Ensure Resident #1 did not engage in sexual activity with Resident #2 on 9/24/2025.2) Ensure Resident #2 did not engage in inappropriate behavior on 9/18/2025, 9/19/2025 and 9/24/2025.3) Ensure CNA D did not grab Resident #4's wrist forcefully and shake her arm in the presence of therapy staff on 9/3/2025. On 9/26/2025 at 6:40 pm an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 10/3/2025, the facility remained at a level of actual no actual harm at a scope of pattern that is not immediate jeopardy due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. These failures could place residents at risk of abuse, injury, and psychosocial harm.Findings included: 1. Review of Resident #1's face sheet, dated 9/26/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including dementia (group of brain disorders that cause progressive cognitive decline), anemia (low blood iron level), insomnia (problems falling and staying asleep), hypokalemia (low blood levels of potassium), and acute respiratory failure. Review of Resident #1's admission MDS assessment, dated 9/5/2025, reflected she had a BIMS score of 4 suggesting severe cognitive impairment. Review of Resident #1's progress notes for the date of 9/18/2025, reflected no mention of her being found in bed with Resident # 1 on 9/18/2025 Review of Resident #1 's progress note dated 9/25/2025 at 4:14 am, by LVN E reflected: CNA reported that this resident was lying in bed with female resident [Resident #1] sitting on top of him with both of their pants off. CNA told residents to stop and redirected the female resident into the dining room. Review of Resident #1's care plan dated 9/26/2025 (the only care plan in the EMR) on 9/26/2025 , reflected the focus area initiated on 9/11/2025: I reside in the Secure/ Memory unit and am at risk for injury from wandering in an un- safe environment R/T DX of dementia AEB impaired safety awareness. I am at risk for injury from others while residing in secure/ memory unit D/T altered cognition with interventions to Administer meds[ per order, monitor labs- report abnormals to MD. Ensure family/ MD aware of behaviors and/or any increase in behaviors noted, Keep environment free of possible hazards. 2. Review of Resident #2's face sheet, dated 9/26/2025, reflected an [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including dementia (group of brain disorders that cause progressive cognitive decline), Parkinson's disease (progressive neurological disorder that affect movement, balance and coordination), hypotension (low blood pressure), anxiety disorder and benign prostatic hyperplasia (BPH - enlarged prostate gland). Review of Resident #2's MDS screen in the EMR on 9/26/2025 and 10/3/2025 reflected there was no MDS assessment. Review of Resident #2's progress note, dated 9/18/2025 at 2:30 pm, by LVN C, reflected: In a female room lying in bed with another female. This is not either resident room. Lying on top of the blanket and fully clothed. He had his hand on her leg. This nurse assisted him to his chair and told him that he cannot lay in the bed with anyone. Redirected this resident to his room. Review of Resident #2's progress note, dated 9/25/2025 at 4:14 am, by LVN E, reflected: CNA reported that this resident was lying in bed with female resident sitting on top of him with both of their pants off. CNA told residents to stop and redirected the female resident into the dining room. During an interview on 9/26/2025 at 2:39 pm, CNA B stated she worked Wednesday night on 9/24/25 and about 7:30 pm she discovered Resident #1 and Resident #2 in Resident #2's room. Resident #2 was sitting in his wheelchair and was naked from the waist down with Resident #1 on top of him also naked from the waist down and they were engaged in sexual activity. She stated she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 3 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some separated and redirected residents and took female resident across the hall to her room and helped her put her clothes back on. She called LVN E, the charge nurse, and told her what happened. She stated she had not thought it was abuse at the time because both residents had dementia and did not really know what they were doing. She had no suspicion of ANE because the residents were confused. She stated she did not call ADM because she reported it to LVN E and thought LVN E would call and report this to ADM. She stated she was trained on ANE and all incidents of ANE were to be reported immediately to the ADM. She stated- she did not do that and now she realizes it was ANE and should have been reported. She thought because they were confused it could not be ANE. During an interview on 9/26/2025 at 3:10 pm, LVN C stated she found Resident #1 and Resident #2 lying in bed together on 9/18/2025. She stated the residents were lying side by side on top of the covers, fully clothed and Resident #2 had his hand on Resident #1's leg. She stated Resident #2 wasn't trying to engage in anything. She further stated she had no suspicion of ANE because she did not see him try to grab at nothing or try to touch [Resident #1] in an inappropriate way - he did not seem malicious or vicious at that time. She stated she was easily able to redirect him from the situation and denied seeing Resident #1 and Resident #2 in bed together prior to that. She stated she did not report the incident as ANE because they weren't naked and didn't have their hands in each other pants - nothing like that going one, they were fully clothed and weren't trying to do anything. LVN C further stated she notified the DON but was not sure if she notified the ADM. During an interview on 9/26/2025 at 3:28 pm, LVN E stated she worked the evening of 9/24/2025 and received a call from CNA B around 7:30 pm or 7:45 pm about two residents found having sex. She stated she went to the memory care unit and assessed both residents and did not find any physical injuries . She stated she called the ADON around 9:20 pm and told her what happened. She said the ADON stated to do an incident report but there was no discussion about ANE or reporting to the ADM. She called the DON and told her what happened, and the DON said to complete a head-to-toe, put in a progress note in the system and notify families. She stated there was no discussion or guidance from the DON to call ADM or notify the abuse coordinator about the incident, so she was not sure how to handle it. She stated she did not have any suspicion of ANE because neither the ADON nor DON discussed it with her, so she did not think there was any ANE. She stated she had multiple in-services on ANE and they were supposed to report all incidents of ANE to the ADM who was the AC . She did not report it because no one said it was ANE. During an interview on 9/27/2025 at 12:00 pm, the ADM stated she was not aware of the incident last week on 9/18/2025 between Resident #1 and Resident #2 when they were found on the bed together. She stated it was her expectation that staff would follow the facility policy and report any ANE to her immediately. She stated she was aware of the incident on 9/24/2025; but she was not notified until the next morning when she went to work. The ADM stated she immediately began an investigation and reported it to the state agency. She stated staff should have notified her the night before right after it happened and not waited until the next day. During an interview on 9/27/2025 at 1:39 pm FM of Resident #1 stated the NF called an informed them of the incident between Resident #1 and Resident #2 on 9/24/3035. FM stated they were shocked by this behavior as it was very unlike Resident #1 to engage in behaviors like that. FM stated Resident #1's cognition is impaired and that she doesn't have the capacity for true consent. FM stated her cognition was so impaired they would have to remind her to eat and make sure she would bathe. FM stated this incident was extremely upsetting as Resident #1 does not engage in this sort of behavior. During an interview on 10/1/2025 at 12:07 pm, the ADON stated LVN E called her on 9/24/2025 between 9:22 pm and 9:25 pm and told her about the incident with Resident #1 and Resident #2. She stated she told LVN E to separate the residents, assess them and notify the DON. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 4 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some stated she had not discussed the possibility of ANE or reporting to the ADM with LVN E at that time; she just told her to call the DON and get guidance. She stated she had been trained to report any ANE immediately to the ADM and was not sure why this was not reported. 3. Record review of Resident #4's admission record, dated 10/02/25, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #4's diagnoses included unspecified dementia (loss of memory, language, problem solving and other thinking abilities), muscle weakness (lack of physical or muscle strength), and major depressive disorder(feeling of sadness, hopelessness, and loss of interest or pleasure in activities). Record review of Resident #4's Quarterly MDS assessment, dated 09/01/25, revealed the resident had a BIMS score of 0 indicating severe cognitive impairment. Record review of Resident #4's care plan, dated 09/29/25, revealed Resident #4 was care planned for impaired communication r/t often just mumbled, yelled, growled, or shook head for communication and episodes of adverse behaviors physically aggressive, hitting, pinching, kicking, and throwing objects. Review of Resident #4's progress notes written by the ADON, dated 09/03/25 at 5:45 pm, reflected, RP notified by this nurse and DON of incident of abuse reported. Skin assessment and head to toe completed by this nurse all normal. No s/s of distress. An attempted interview with Resident #4 on 10/01/25 at 12:24pm, Resident #4 made a growling noise several times. The interview was not completed. Resident #4 was nonverbal. An attempted interview with Resident # 4's FM was unsuccessful. Left Resident #4's FM voice messages on 10/02/25 at 4:18pm, 10/03/25 at 9:40pm, and 10/03/25 at 6:00pm. Resident #4's FM did not return the call by facility exit on 10/03/25. During an interview on 10/01/25 at 12:39 pm, the PT stated she reported to the ADM on 09/03/25 immediately after she witnessed the incident with Resident #4 and CNA D. The PT stated she was in Resident #4's room helping her get ready for therapy. The PT stated CNA D entered Resident #4's room loudly saying she was going to change Resident #4. The PT stated CNA D moved to Resident # 4's face and repeated that she was going to change her. The PT stated Resident #4 attempted to push CNA D away and Resident #4 slapped CNA D in the face. The PT stated CNA D grabbed Resident #4's wrists forcefully down and shook Resident #4's arm. The PT stated CNA D said to Resident #4 that they were going to get this done and you are not going to be slapping me. The PT stated that she intervened to separate CNA D and Resident #4. The PT stated she told CNA D that she could not hold Resident #4's wrist down in that manner. The PT stated after the incident Resident #4 was emotional and no longer wanted to get dressed. The PT stated Resident #4 cried and did not want to go to therapy. Resident #4 did not return to her baseline until the next day 09/04/25. An interview with CNA D on 10/01/25 at 1:53pm stated on 09/3/25 she went into Resident #4's room to change her. CNA D stated the PT was at the foot of Resident #4's bed and told her to back off and leave Resident #4 alone while she was agitated. CNA D stated she was trying to get Resident #4 changed. CNA D stated she was eye level with Resident #4 sitting Indian style in her bed and asked Resident #4 what was wrong and Resident #4 slapped her in the face and she placed her right hand over Resident #4's left hand to prevent Resident #4 from further slapping her. CNA D stated Resident #4 acted like she was going to slap her again, so she placed her left hand on Resident #4's right hand. CNA D stated she did not hold Resident #4's wrists back or shake her arm. CNA D stated she did her job and was not disrespectful to any of the residents. CNA D stated immediately after the incident the ADM told her to clock out due to the investigation and the ADM called her by phone could not recall the date and was told her they had to let her go due to the incident. An interview with the SW[ on 10/03/25 at 12:06 pm stated she was not aware of the incident with Resident #4 and CNA D when it occurred on 09/03/25. The SW stated she was made aware of the incident after it occurred and the ADM conducted the investigation on. An interview with the interim DON on 10/03/25 at 12:20pm stated the PT reported the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 5 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some incident with Resident #4 and CNA D immediately to the ADM after the incident occurred. The interim DON stated the ADM made her aware of the incident on 9/03/25. The interim DON stated she did not notice a difference with Resident #4's behavior after the incident. The interim DON stated Resident #4 was nonverbal and it was expected for her to be free from any abuse. An interview with the ADM on 10/03/25 at 12:40pm stated the PT notified her on 09/03/25 after the incident occurred with Resident #4 and CNA D. The ADM stated the PT stated CNA D pinned Resident #4's wrists back to prevent Resident #4 from slapping her. The ADM stated Resident #4 was nonverbal and it was expected for CNA D not to have pinned Resident's #4's wrist back. Review of CNA D's personnel file reflected that she was terminated on 09/03/25. Review of the facility's investigation, dated 09/03/25, reflected a thorough investigation was completed, and the allegation of physical abuse was confirmed. Review of the facility's policy, dated April 2021, titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program reflected:Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms.The resident abuse, neglect and exploitation prevention program consists of a facility-wide commitment and resource allocation to support the following objectives:1.Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to:a. facility staff.b. other residents.C. consultants.d. volunteers.e. staff from other agencies.f. family members.g. legal representatives.h. friends.i. visitors; and/orj. any other individual. Ensure adequate staffing and oversight/support to prevent burnout, stressful working situations and high turnover rates.Establish and maintain a culture of compassion and caring for all residents and particularly those with behavioral, cognitive or emotional problems. This was determined to be an Immediate Jeopardy (IJ) on 10/01/2025 at 4:53 pm. The Administrator was notified. The ADM was provided with the IJ template on 10/01/2025 at 4:53 pm .The following Plan of Removal submitted by the facility was accepted on 10/02/25 at 4:54pm Immediate Jeopardy (IJ) states as follows: 1--The facility failed to keep Resident #1 and Resident #2 from abuse and neglect when both residents were observed engaging in sexual activity on the memory care unit on 9/24/2025 about 7:30 pm.2-- Resident #5 free from misappropriation when the Business Office Manager took his benefits card and spent $3,700. The facility immediately implemented the following plans: F600Free from Abuse/Neglect Action (Immediate): 1--Resident 1 and Resident 2 were immediately separated from each other. Residents 1 and 2 received head to toe assessments performed by charge nurse and an emotional assessment performed by social worker. The social worker performed trauma informed care assessment. No adverse findings noted. Medical Director was notified, and orders obtained for psychiatric services.Residents 1 and 2 were evaluated by Psychiatric services and medication changes were implemented. Resident 1 and 2 care plans and Kardex were updated to reflect the resident's history of resident-to-resident sexual activity. 2-The Business Office Manager was immediately terminated from employment at the facility, and the local police department was notified of the misappropriation of resident funds. The BOM was terminated on 09/17/25. The resident's funds were replaced by the facility on 9/18/25. Person(s) Responsible: Administrator and/or Director of Nursing Completion Date: 10/1/2025 Action (Identification): 1--All residents with behaviors documented as an incident report and/or in the progress notes for the previous 90 days will be reviewed to identify any other residents that may exhibit sexually inappropriate behaviors. If any behavioral events are identified the resident care plan and Kardex will be reviewed and updated, and interventions will be placed immediately. Zero out of 60 incident reports reviewed showed no adverse/inappropriate behavior. Daily audit of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 6 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some resident behaviors and interventions will be reviewed and noted in resident chart. Daily audits will be conducted for behavioral events for 14 days, then weekly X30 days. 2. The Regional Business Office Director completed an audit for 70 residents trust funds with no discrepancies noted. This was completed at the corporate level by the Regional Business Office, as the facility BOM was terminated. There were no discrepancies noted from this audit. Person(s) Responsible: Administrator and/or Director of NursingCompletion Date: 10/1/2025 Action (Identification): Staff assigned to the secured unit, in which there are consistent staff members, other facility staff including PRN staff and agency staff will be interviewed for any additional incidents or residents that may have been affected by resident-to-resident abuse. Person(s) Responsible Administrator and/or Designee Completion Date: 10/1/2025 Action (Prevention): 1--Education provided to Administrator and Director of Nursing on the abuse policy, investigating and reporting abuse per HHS and CMS regulations. Testing and discussion were utilized to assess the knowledge retention of the Administrator and the Director of Nursing.2-One-time weekly audits over the next 30 days by the Regional Business Office Manager. Resident Fund Management Service will be audited weekly for the next 30 days. Person(s) Responsible: Regional Nurse ConsultantCompletion Date: 10/1/2025 Action (Prevention): Education provided to all staff by the Administrator:1. Abuse and Neglect: Types of abuse, including sexual abuse and when/who to report to (immediately & the administrator- abuse coordinator)1. Resident to Resident: Recognizing behaviors, triggers, and how to effectively intervene. Staff will be educated to immediately separate the residents and implement 1:1 observation until instructed otherwise by the Administrator and/or Director of Nursing. All Facility staff will complete prior to working their next shift. New employees and agency staff will be educated upon hire and/or prior to working a shift. Knowledge will be verified via test and verbal discussion with affirmative feedback2. Staff that handle resident funds, Business Office and Human Resources Director will undergo retraining on financial policies, ethical standards, and proper fund management procedures. This training was completed on 9/18/25 by the Regional Business Office Director, with the Human Resources Director. Person(s) Responsible: Administrator and/or Designee Completion Date: 10/01/25 Action (Prevention): Education provided to Nursing Staff by the Director of Nursing on:1. Resident Kardex that will contain the updated care plans and interventions following behavioral events. Staff will be notified of behavioral events through shift-to-shift report and/or the Director of Nursing and/or Assistant Director of Nursing. 2. Testing and verbal confirmation are utilized to assess knowledge retention.3. Annual training via Relias regarding resident's rights, theft, misappropriation and abuse. All Facility staff, new hire and agency will complete prior to working their next shift. Knowledge will be verified via test and verbal discussion with affirmative feedback. Person(s) Responsible: Administrator and/or Designee Completion Date: 10/1/25 Action (Monitoring): 1--During daily meeting, Director of Nursing, Assistant Director of Nursing, and/or Designee will review all progress notes and event reports to ensure effective care plans/interventions are in place following any resident-to-resident or other inappropriate behavior. Will be reviewed during daily meeting x 30 days and then weekly thereafter. 2-Weekly and as needed reconciliation of resident trust fund by the Business Office Manager/Regional Business Office Manager. This will be ongoing. Person(s) Responsible: Director of Nursing, Assistant Director of Nursing, and/or Designee Completion Date: 10/1/2025Action (QAPI): Medical Director informed of this plan at the Ad Hoc QAPI. At this time no other recommendations have been made. Person(s) Responsible: Administrator Completion Date: 10/1/2025 The surveyor monitored the POR as follows: Record Review of abuse, neglect, exploitation Inservice completed by 10/03/25 Record Review of copy of cashier's check totaling in the amount of $3700 paid out to Resident #5's RP. An interview with CNA F on 10/03/25 at 12:00pm stated she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 7 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete completed her abuse, neglect, exploitation inservice this morning and was giving a test after completion. CNA F was able to provide types of abuse physical, sexual, financial, and gave examples such as stealing a resident's money. CNA F knew to report immediately if ever witnessed to the ADM. An interview with RN G on 10/03/25 at 12:15pm stated she was given in-service this morning over abuse, neglect, and exploitation. RN G knew to contact the ADM immediately if ever witnessed. RN G knew types of abuse such as taking funds, sexual abuse, and talking bad to residents. RN G knew the signs of abuse/neglect, gave examples of not changing the residents and not caring for them. An interview with CNA H on 10/03/25 at 1:42pm stated as soon as she walked in the door this morning she was provided the abuse, neglect, exploitation training along with a test. CNA H gave examples of abuse /neglect such as yelling at a resident, ignoring call light, sexual, mental, and stealing money from a resident. CNA H stated she was aware last week sometime that a resident had something stolen. An interview with MA I on 10/03/25 at 2:03pm stated she received her in-service on by 10/3/25 over abuse, neglect, and exploitation. MA I was able to give the types of abuse such as physical, mental, and financial. MA I was able to give an example of financial abuse by stealing or borrowing. MA I was able to give signs of abuse/neglect examples such as not changing residents, not feeding, or caring for them. An interview with HK J on 10/03/25 at 2:36pm stated that she received the in-service over abuse, neglect, and exploitation today. HK J knows to report to the ADM if she ever witnessed any abuse or neglect. HK J was able to give examples of abuse /neglect such as resident-to-resident aggression, verbal abuse, not wanting to help a resident, exploitation (stealing money). An interview with the DM on 10/02/25 at 2:53pm stated that she just had her in-service over exploitation in the DON's office. The DM stated taking a resident's magazine would be exploitation. The DM know to report immediately to the AM if she witnessed any abuse or neglect. An interview with the DA on 10/02/25 at 3:07pm stated she was in the DON's office just a while ago for in-service. The DA know who to report abuse, neglect, and exploitation to the ADM immediately. While the IJ was removed on 10/03/25 at 5:12pm, the facility remained out of compliance at a level of no actual harm at a scope of pattern because the facility's need to evaluate the effectiveness of the corrective systems Event ID: Facility ID: 676295 If continuation sheet Page 8 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents had the right to be free from misappropriation of property and exploitation for 1 of 6 (Resident #5) reviewed for misappropriation and exploitation, in that: The facility failed to ensure Resident #5 was free from exploitation when the BOM took Resident #5's net spend credit card and used the card for personal use. The BOM used Resident #5's credit card and withdrew funds totaling $3700. This failure could place residents at risk of financial hardships and a decrease in resident's quality of life.Findings included: Residents Affected - Few Record review of Resident #5's admission record dated 10/02/25 documented a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #5 had diagnoses included major depressive disorder (sadness), cognitive communication deficit (inability to communicate effective), and hypertension (high blood pressure). Record review of Resident #5's Quarterly MDS assessment, dated 09/23/25, revealed the resident had a BIMS score of 0 indicating the resident had severe cognitive impairment. Record review of Resident #5's care plan, dated 09/29/25, revealed Resident #5 was care planned for visually impaired and required secure storage of personal items/medications in a lock box to ensure safety and prevent misuse or loss. An attempted interview with the BOM was made 10/02/25 at 4:30pm, 10/03/25 at 11:49am, and 10/03/25 at 3.37pm. A voice message was left and the BOM did not return call prior to facility exit 10/03/25. An interview with the Marketing Director on 10/01/25 at 10:44am stated on 09/15/25 Resident # 5's RP came to the facility to pick up Resident #5's wallet and the RP noticed there was a credit card missing. The Marketing Director stated she was a witness with the BOM to count out the large amount of cash that was in Resident #5's wallet. Resident #5's RP told the BOM there was a card missing and the BOM asked what card. The Marketing Director stated it was alerted to staff that Resident #5's card may have been misplaced and to be on the lookout. Resident #5's RP stated there was no activity on the card because they had not received any alerts on the card. The Marketing Director stated the next day, 09/16/25,she was speaking with the BOM over the phone and she asked her what was going on because she had given short responses. The Marketing Director stated the BOM asked her if they could meet and they met around 6:08pm. The Marketing Director stated when she opened the BOM's car door she was sobbing and told her she “fucked up” with Resident #5's money and she took Resident #5's card. The Marketing Director stated the BOM stated she received a fraud notification claim and she Resident #5's card. The Marketing Director stated the BOM initially told her she used $2,000 then she went to $3,000 and told her she could not get the money back to Resident #5. The Marketing Director asked what she used Resident #5's card for and she stated on things she could not get back. The BOM stated once she started using the card she could not stop and she had set up a pin for the card. The Marketing Director stated the BOM stated she would be shown on camera using Resident #5's card at locations and she gave her the office key as she was not going back to work because the police would be there. The Marketing Director stated the next morning 09/17/25 around 9:00am when she went to work she reported the incident to the ADM. The Marketing Director stated she did not report to the ADM immediately after it happened because she was trying to process what the BOM told her. The Marketing Director stated it was expected for her to contact the ADM immediately after the BOM confessed to taking Resident #5's credit card and used it for her personal use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 9 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0602 Level of Harm - Minimal harm or potential for actual harm An interview with Resident #5 on 10/02/25 at 4:00pm stated his RP told him someone had taken his card out of his wallet and spent $3,700. Resident #5 stated he did not know who took his card and used it but the person who used the card had paid the $3,700 back to him. Resident #5 stated his RP did not tell him who used his credit card but he was upset about it Resident #5 stated he spoke with police and did not press charges because he received the money back. Residents Affected - Few An interview with Resident #5's RP on 10/02/25 at 4:49pm stated she was told by the ADM the BOM took Resident #5's card out of his wallet and spent $3,700. Resident #5's RP stated the wallet was locked up in the business office when Resident #5 was in the hospital. Resident #5's RP stated when Resident #5 returned from the hospital on [DATE] he told his RP that his wallet was in the business office. Resident #5's RP stated she went to the business office to retrieve the wallet from the BOM. Resident #5's RP stated the BOM and another unidentified woman counted the money out to her that was in Resident #5's wallet. Resident #5's RP stated that she had noticed a credit card was missing. Resident #5's RP stated they had not received any card alerts that Resident #5 had used the card. Resident #5 ‘s RP stated when the account was checked it was a total of $3,700 that was used. Resident #5's RP stated Resident #5 did not want to press charges because he received the money back. Resident #5 stated if it was up to her she would have pressed charges on the BOM. Resident #5's RP stated Resident #5 in his right mind, and he had received the $3700 back and did not want to file charges. Resident #5's RP stated the check for $3,700 was written out to her An interview with the SW on 10/03/25 at 12:06pm stated she was not aware of the incident with the BOM using Resident #5's credit card. The SW stated that she did not know the exact date she found out, but it was after the incident had occurred when she and the ADM went to Resident #5's room to return the credit card along with a cashier's check. The SW stated it was expected for the BOM to have not used Resident #5's credit card for her personal use. The SW stated the negative outcome of the BOM using Resident #5's credit card would cause financial hardship to the resident. An interview with the interim DON on 10/03/25 at 12:20pm stated she was not made aware that the BOM had used Resident #5's credit card for her personal use until 09/17/25. The interim DON stated the negative outcome would be loss of control of Resident #5's credit card that would affect Resident #5 emotionally. An interview with the ADM on 10/03/25 at 12:40pm stated she did not find out until 09/17/25 around 10:30am that the BOM confessed to the Marketing Director that she had taken Resident #5's credit card and spent $3700 for her personal use. The ADM stated on 09/15/25 Resident's #5's RP reported the credit card missing from Resident #5's wallet. The ADM stated it was expected that the Marketing Director's reported to her immediately when the BOM confessed of taking and using Resident #5's card. The ADM stated the Marketing Director met with the BOM the evening on 09/16/25 and she had confessed to the Marketing Director that she had taken the card and used the card for personal use. The ADM stated the police were called out to the facility on [DATE] and the resident did not want to press charges because the $3700 was returned back to him . The ADM stated the police did not make any reports due to Resident #5 not wanting to press charges with the credit card being used. The Adm stated the negative outcome with the incident would cause debt to Resident #5 and could effect Resident #5 emotionally and financially. The ADM stated it was expected for the BOM not have took Resident #5's credit card and used it for her personal use. Review of the BOM's personnel file reflected she was terminated on 09/17/25. Review of cashier's check pay to the order of Resident #5's RP with remitter BOM in the amount of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 10 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0602 $3700 dated 09/18/25. Level of Harm - Minimal harm or potential for actual harm Review of facility's investigation dated 09/18/25 reflected a thorough investigation was completed, and the allegation of misappropriation was confirmed. Residents Affected - Few Review of facility's policy, dated April 2021, titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program reflected: Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. The resident abuse, neglect and exploitation prevention program consists of a facility-wide commitment and resource allocation to support the following objectives: 1. Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to: a. facility staff. b. other residents. c. consultants. d. volunteers. e. staff from other agencies. f. family members. g. legal representatives. h. friends. i. visitors; and/or j. any other individual. Develop and implement policies and protocols to prevent and identify theft, exploitation, or misappropriation of property”. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 11 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the residents had the right to be free from abuse and neglect for three residents (Resident #1, Resident #2 and Resident #4) of seven reviewed for abuse. The facility failed to:1) Ensure Resident #1 did not engage in sexual activity with Resident #2 on 9/24/2025.2) Ensure Resident #2 did not engage in inappropriate behavior on 9/18/2025, 9/19/2025 and 9/24/2025.3) Ensure CNA D did not grab Resident #4's wrist forcefully and shake her arm in the presence of therapy staff on 9/3/2025. On 9/26/2025 at 6:40 pm an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 10/3/2025, the facility remained at a level of actual no actual harm at a scope of pattern that is not immediate jeopardy due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. These failures could place residents at risk of abuse, injury, and psychosocial harm. Findings included: 1. Review of Resident #1's face sheet, dated 9/26/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including dementia (group of brain disorders that cause progressive cognitive decline), anemia (low blood iron level), insomnia (problems falling and staying asleep), hypokalemia (low blood levels of potassium), and acute respiratory failure. Review of Resident #1's admission MDS assessment, dated 9/5/2025, reflected she had a BIMS score of 4 suggesting severe cognitive impairment. Review of Resident #1's progress notes for the date of 9/18/2025, reflected no mention of her being found in bed with Resident #1 on 9/18/2025 Review of Resident #1 's progress note dated 9/25/2025 at 4:14 am, by LVN E reflected: CNA reported that this resident was lying in bed with female resident [Resident #1] sitting on top of him with both of their pants off. CNA told residents to stop and redirected the female resident into the dining room. Review of Resident #1's care plan dated 9/26/2025 (the only care plan in the EMR) on 9/26/2025, reflected the focus area initiated on 9/11/2025: I reside in the Secure/ Memory unit and am at risk for injury from wandering in an un- safe environment R/T DX of dementia AEB impaired safety awareness. I am at risk for injury from others while residing in secure/ memory unit D/T altered cognition with interventions to Administer meds per order, monitor labs- report abnormals to MD. Ensure family/ MD aware of behaviors and/or any increase in behaviors noted, Keep environment free of possible hazards. 2. Review of Resident #2's face sheet, dated 9/26/2025, reflected an [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including dementia (group of brain disorders that cause progressive cognitive decline), Parkison's disease (progressive neurological disorder that affect movement, balance and coordination), hypotension (low blood pressure), anxiety disorder and benign prostatic hyperplasia (BPH - enlarged prostate gland). Review of Resident #2's MDS screen in the EMR on 9/26/2025 and 10/3/2025 reflected there was no MDS assessment. Review of Resident #2's progress note, dated 9/18/2025 at 2:30 pm, by LVN C, reflected: In a female room lying in bed with another female. This is not either resident room. Lying on top of the blanket and fully clothed. He had his hand on her leg. This nurse assisted him to his chair and told him that he cannot lay in the bed with anyone. Redirected this resident to his room. Review of Resident #2's progress note, dated 9/25/2025 at 4:14 am, by LVN E, reflected: CNA reported that this resident was lying in bed with female resident sitting on top of him with both of their pants off. CNA told residents to stop and redirected the female resident into the dining room. During an interview on 9/26/2025 at 2:39 pm, CNA B stated she worked Wednesday night on 9/24/25 and about 7:30 pm she discovered Resident #1 and Resident #2 in Resident #2's room. Resident #2 was sitting in his wheelchair and was naked from the waist down with Resident #1 on top of him also naked from the waist down and they were engaged in sexual activity. She stated she separated and redirected residents and took female Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 12 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some resident across the hall to her room and helped her put her clothes back on. She called LVN E, the charge nurse, and told her what happened. She stated she had not thought it was abuse at the time because both residents had dementia and did not really know what they were doing. She had no suspicion of ANE because the residents were confused. She stated she did not call ADM because she reported it to LVN E and thought LVN E would call and report this to ADM. She stated she was trained on ANE and all incidents of ANE were to be reported immediately to the ADM. She stated- she did not do that and now she realizes it was ANE and should have been reported. She thought because they were confused it could not be ANE. During an interview on 9/26/2025 at 3:10 pm, LVN C stated she found Resident #1 and Resident #2 lying in bed together on 9/18/2025. She stated the residents were lying side by side on top of the covers, fully clothed and Resident #2 had his hand on Resident #1's leg. She stated Resident #2 wasn't trying to engage in anything. She further stated she had no suspicion of ANE because she did not see him try to grab at nothing or try to touch [Resident #1] in an inappropriate way - he did not seem malicious or vicious at that time. She stated she was easily able to redirect him from the situation and denied seeing Resident #1 and Resident #2 in bed together prior to that. She stated she did not report the incident as ANE because they weren't naked and didn't have their hands in each other pants - nothing like that going one, they were fully clothed and weren't trying to do anything. LVN C further stated she notified the DON but was not sure if she notified the ADM. During an interview on 9/26/2025 at 3:28 pm, LVN E stated she worked the evening of 9/24/2025 and received a call from CNA B around 7:30 pm or 7:45 pm about two residents found having sex. She stated she went to the memory care unit and assessed both residents and did not find any physical injuries[. She stated she called the ADON around 9:20 pm and told her what happened. She said the ADON stated to do an incident report but there was no discussion about ANE or reporting to the ADM. She called the DON and told her what happened, and the DON said to complete a head-to-toe, put in a progress note in the system and notify families. She stated there was no discussion or guidance from the DON to call ADM or notify the abuse coordinator about the incident, so she was not sure how to handle it. She stated she did not have any suspicion of ANE because neither the ADON nor DON discussed it with her, so she did not think there was any ANE. She stated she had multiple in-services on ANE and they were supposed to report all incidents of ANE to the ADM who was the AC. She did not report it because no one said it was ANE. During an interview on 9/27/2025 at 12:00 pm, the ADM stated she was not aware of the incident last week on 9/18/2025 between Resident #1 and Resident #2 when they were found on the bed together. She stated it was her expectation that staff would follow the facility policy and report any ANE to her immediately. She stated she was aware of the incident on 9/24/2025; but she was not notified until the next morning when she went to work. The ADM stated she immediately began an investigation and reported it to the state agency. She stated staff should have notified her the night before right after it happened and not waited until the next day. During an interview on 10/1/2025 at 12:07 pm, the ADON stated LVN E called her on 9/24/2025 between 9:22 pm and 9:25 pm and told her about the incident with Resident #1 and Resident #2. She stated she told LVN E to separate the residents, assess them and notify the DON. She stated she had not discussed the possibility of ANE or reporting to the ADM with LVN E at that time; she just told her to call the DON and get guidance. She stated she had been trained to report any ANE immediately to the ADM and was not sure why this was not reported. 3. Record review of Resident #4's admission record, dated 10/02/25, revealed an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #4's diagnoses included unspecified dementia (loss of memory, language, problem solving and other thinking abilities), muscle weakness (lack of physical or muscle strength), and major depressive disorder(feeling of sadness, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 13 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some hopelessness, and loss of interest or pleasure in activities). Record review of Resident #4's Quarterly MDS assessment, dated 09/01/25, revealed the resident had a BIMS score of 0 indicating severe cognitive impairment. Record review of Resident #4's care plan, dated 09/29/25, revealed Resident #4 was care planned for impaired communication r/t often just mumbled, yelled, growled, or shook head for communication and episodes of adverse behaviors physically aggressive, hitting, pinching, kicking, and throwing objects. Review of Resident #4's progress notes written by the ADON, dated 09/03/25 at 5:45 pm, reflected, RP notified by this nurse and DON of incident of abuse reported. Skin assessment and head to toe completed by this nurse all normal. No s/s of distress. An attempted interview with Resident #4 on 10/01/25 at 12:24pm, Resident #4 made a growling noise several times. The interview was not completed. Resident #4 was nonverbal. An attempted interview with Resident # 4's FM was unsuccessful. Left Resident #4's FM voice messages on 10/02/25 at 4:18pm, 10/03/25 at 9:40pm, and 10/03/25 at 6:00pm. Resident #4's FM did not return the call by facility exit on 10/03/25. During an interview on 10/01/25 at 12:39 pm, the PT stated she reported to the ADM on 09/03/25 immediately after she witnessed the incident with Resident #4 and CNA D. The PT stated she was in Resident #4's room helping her get ready for therapy. The PT stated CNA D entered Resident #4's room loudly saying she was going to change Resident #4. The PT stated CNA D moved to Resident # 4's face and repeated that she was going to change her. The PT stated Resident #4 attempted to push CNA D away and Resident #4 slapped CNA D in the face. The PT stated CNA D grabbed Resident #4's wrists forcefully down and shook Resident #4's arm. The PT stated CNA D said to Resident #4 that they were going to get this done and you are not going to be slapping me. The PT stated that she intervened to separate CNA D and Resident #4. The PT stated she told CNA D that she could not hold Resident #4's wrist down in that manner. The PT stated after the incident Resident #4 was emotional and no longer wanted to get dressed. The PT stated Resident #4 cried and did not want to go to therapy. Resident #4 did not return to her baseline until the next day 09/04/25. An interview with CNA D on 10/01/25 at 1:53pm stated on 09/3/25 she went into Resident #4's room to change her. CNA D stated the PT was at the foot of Resident #4's bed and told her to back off and leave Resident #4 alone while she was agitated. CNA D stated she was trying to get Resident #4 changed. CNA D stated she was eye level with Resident #4 sitting Indian style in her bed and asked Resident #4 what was wrong and Resident #4 slapped her in the face and she placed her right hand over Resident #4's left hand to prevent Resident #4 from further slapping her. CNA D stated Resident #4 acted like she was going to slap her again, so she placed her left hand on Resident #4's right hand. CNA D stated she did not hold Resident #4's wrists back or shake her arm. CNA D stated she did her job and was not disrespectful to any of the residents. CNA D stated immediately after the incident the ADM told her to clock out due to the investigation and the ADM called her by phone could not recall the date and was told her they had to let her go due to the incident. An interview with the SW on 10/03/25 at 12:06 pm stated she was not aware of the incident with Resident #4 and CNA D when it occurred on 09/03/25. The SW stated she was made aware of the incident after it occurred and the ADM conducted the investigation on. An interview with the interim DON on 10/03/25 at 12:20pm stated the PT reported the incident with Resident #4 and CNA D immediately to the ADM after the incident occurred. The interim DON stated the ADM made her aware of the incident on 9/03/25. The interim DON stated she did not notice a difference with Resident #4's behavior after the incident. The interim DON stated Resident #4 was nonverbal and it was expected for her to be free from any abuse. An interview with the ADM on 10/03/25 at 12:40pm stated the PT notified her on 09/03/25 after the incident occurred with Resident #4 and CNA D. The ADM stated the PT stated CNA D pinned Resident #4's wrists back to prevent Resident #4 from slapping her. The ADM stated Resident #4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 14 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some was nonverbal and it was expected for CNA D not to have pinned Resident's #4's wrist back. Review of CNA D's personnel file reflected that she was terminated on 09/03/25. Review of the facility's investigation, dated 09/03/25, reflected a thorough investigation was completed, and the allegation of physical abuse was confirmed. Review of the facility's policy, dated April 2021, titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program reflected:Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms.The resident abuse, neglect and exploitation prevention program consists of a facility-wide commitment and resource allocation to support the following objectives:1.Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to:a. facility staff.b. other residents.C. consultants.d. volunteers.e. staff from other agencies.f. family members.g. legal representatives.h. friends.i. visitors; and/orj. any other individual. Ensure adequate staffing and oversight/support to prevent burnout, stressful working situations and high turnover rates.Establish and maintain a culture of compassion and caring for all residents and particularly those with behavioral, cognitive or emotional problems. This was determined to be an Immediate Jeopardy (IJ) on 10/01/2025 at 4:53 pm. The Administrator was notified. The ADM was provided with the IJ template on 10/01/2025 at 4:53 pm .The following Plan of Removal submitted by the facility was accepted on 10/02/25 at 4:54pm Immediate Jeopardy (IJ) states as follows: 1--The facility failed to keep Resident #1 and Resident #2 from abuse and neglect when both residents were observed engaging in sexual activity on the memory care unit on 9/24/2025 about 7:30 pm.2-- Resident #5 free from misappropriation when the Business Office Manager took his benefits card and spent $3,700. The facility immediately implemented the following plans: F600- Free from Abuse/Neglect Action (Immediate): 1--Resident 1 and Resident 2 were immediately separated from each other. Residents 1 and 2 received head to toe assessments performed by charge nurse and an emotional assessment performed by social worker. The social worker performed trauma informed care assessment. No adverse findings noted. Medical Director was notified, and orders obtained for psychiatric services.Residents 1 and 2 were evaluated by Psychiatric services and medication changes were implemented. Resident 1 and 2 care plans and Kardex were updated to reflect the resident's history of resident-to-resident sexual activity. 2-The Business Office Manager was immediately terminated from employment at the facility, and the local police department was notified of the misappropriation of resident funds. The BOM was terminated on 09/17/25. The resident's funds were replaced by the facility on 9/18/25. Person(s) Responsible: Administrator and/or Director of Nursing Completion Date: 10/1/2025 Action (Identification): 1--All residents with behaviors documented as an incident report and/or in the progress notes for the previous 90 days will be reviewed to identify any other residents that may exhibit sexually inappropriate behaviors. If any behavioral events are identified the resident care plan and Kardex will be reviewed and updated, and interventions will be placed immediately. Zero out of 60 incident reports reviewed showed no adverse/inappropriate behavior. Daily audit of resident behaviors and interventions will be reviewed and noted in resident chart. Daily audits will be conducted for behavioral events for 14 days, then weekly X30 days. 2. The Regional Business Office Director completed an audit for 70 residents trust funds with no discrepancies noted. This was completed at the corporate level by the Regional Business Office, as the facility BOM was terminated. There were no discrepancies noted from this audit. Person(s) Responsible: Administrator and/or Director of NursingCompletion Date: 10/1/2025 Action (Identification): Staff assigned to the secured unit, in which there are consistent staff members, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 15 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some other facility staff including PRN staff and agency staff will be interviewed for any additional incidents or residents that may have been affected by resident-to-resident abuse. Person(s) Responsible Administrator and/or Designee Completion Date: 10/1/2025 Action (Prevention): 1--Education provided to Administrator and Director of Nursing on the abuse policy, investigating and reporting abuse per HHS and CMS regulations. Testing and discussion were utilized to assess the knowledge retention of the Administrator and the Director of Nursing.2-One-time weekly audits over the next 30 days by the Regional Business Office Manager. Resident Fund Management Service will be audited weekly for the next 30 days. Person(s) Responsible: Regional Nurse ConsultantCompletion Date: 10/1/2025 Action (Prevention): Education provided to all staff by the Administrator:1. Abuse and Neglect: Types of abuse, including sexual abuse and when/who to report to (immediately & the administrator- abuse coordinator)1. Resident to Resident: Recognizing behaviors, triggers, and how to effectively intervene. Staff will be educated to immediately separate the residents and implement 1:1 observation until instructed otherwise by the Administrator and/or Director of Nursing. All Facility staff will complete prior to working their next shift. New employees and agency staff will be educated upon hire and/or prior to working a shift. Knowledge will be verified via test and verbal discussion with affirmative feedback2. Staff that handle resident funds, Business Office and Human Resources Director will undergo retraining on financial policies, ethical standards, and proper fund management procedures. This training was completed on 9/18/25 by the Regional Business Office Director, with the Human Resources Director. Person(s) Responsible: Administrator and/or Designee Completion Date: 10/01/25 Action (Prevention): Education provided to Nursing Staff by the Director of Nursing on:1. Resident Kardex that will contain the updated care plans and interventions following behavioral events. Staff will be notified of behavioral events through shift-to-shift report and/or the Director of Nursing and/or Assistant Director of Nursing. 2. Testing and verbal confirmation are utilized to assess knowledge retention.3. Annual training via Relias regarding resident's rights, theft, misappropriation and abuse. All Facility staff, new hire and agency will complete prior to working their next shift. Knowledge will be verified via test and verbal discussion with affirmative feedback. Person(s) Responsible: Administrator and/or Designee Completion Date: 10/1/25 Action (Monitoring): 1--During daily meeting, Director of Nursing, Assistant Director of Nursing, and/or Designee will review all progress notes and event reports to ensure effective care plans/interventions are in place following any resident-to-resident or other inappropriate behavior. Will be reviewed during daily meeting x 30 days and then weekly thereafter. 2-Weekly and as needed reconciliation of resident trust fund by the Business Office Manager/Regional Business Office Manager. This will be ongoing. Person(s) Responsible: Director of Nursing, Assistant Director of Nursing, and/or Designee Completion Date: 10/1/25 Action (QAPI): Medical Director informed of this plan at the Ad Hoc QAPI. At this time no other recommendations have been made. Person(s) Responsible: Administrator Completion Date: 10/1/2025 The surveyor monitored the POR as follows: Record Review of abuse, neglect, exploitation Inservice completed by 10/03/25 Record Review of copy of cashier's check totaling in the amount of $3700 paid out to Resident #5's RP. An interview with CNA F on 10/03/25 at 12:00pm stated she completed her abuse, neglect, exploitation inservice this morning and was giving a test after completion. CNA F was able to provide types of abuse physical, sexual, financial, and gave examples such as stealing a resident's money. CNA F knew to report immediately if ever witnessed to the ADM. An interview with RN G on 10/03/25 at 12:15pm stated she was given in-service this morning over abuse, neglect, and exploitation. RN G knew to contact the ADM immediately if ever witnessed. RN G knew types of abuse such as taking funds, sexual abuse, and talking bad to residents. RN G knew the signs of abuse/neglect, gave examples of not changing the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 16 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete residents and not caring for them. An interview with CNA H on 10/03/25 at 1:42pm stated as soon as she walked in the door this morning she was provided the abuse, neglect, exploitation training along with a test. CNA H gave examples of abuse /neglect such as yelling at a resident, ignoring call light, sexual, mental, and stealing money from a resident. CNA H stated she was aware last week sometime that a resident had something stolen. An interview with I on 10/03/25 at 2:03pm stated she received her in-service on by 10/3/25 over abuse, neglect, and exploitation. MA I was able to give the types of abuse such as physical, mental, and financial. MA I was able to give an example of financial abuse by stealing or borrowing. MA I was able to give signs of abuse/neglect examples such as not changing residents, not feeding, or caring for them. An interview with HK J on 10/03/25 at 2:36pm stated that she received the in-service over abuse, neglect, and exploitation today. HK J knows to report to the ADM if she ever witnessed any abuse or neglect. HK J was able to give examples of abuse /neglect such as resident-to-resident aggression, verbal abuse, not wanting to help a resident, exploitation (stealing money). An interview with the DM on 10/02/25 at 2:53pm stated that she just had her inservice over exploitation in the DON's office. The DM stated taking a resident's magazine would be exploitation. The DM know to report immediately to the AM if she witnessed any abuse or neglect. An interview with the DA on 10/02/25 at 3:07pm stated she was in the DON's office just a while ago for in-service. The DA know who to report abuse, neglect, and exploitation to the ADM immediately. While the IJ was removed on 10/03/25 at 5:12pm, the facility remained out of compliance at a level of no actual harm at a scope of pattern because the facility's need to evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 676295 If continuation sheet Page 17 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately but not later than 2 hours after the allegation is made if the events that cause the allegation involve abuse or not later than 24 hours if the events that cause the allegation do not involve abuse to the Administrator for 3 of 7 residents (Resident #1, Resident #2, Resident #5) reviewed for Abuse and Neglect.[KS1] [LP2] The facility staff failed to immediately report abuse and neglect to the Administrator when: 1) Resident #1 was observed engaging in sexual activity with Resident #2 on 9/24/2025.2) Resident #2 was observed engaging in inappropriate behavior with Resident #1 on 9/18/2025 and 9/24/2025.An Immediate Jeopardy (IJ) was identified on 9/29/2025. The IJ template was provided to the facility on 9/29/2025 at 2:00 pm. While the IJ was removed on 10/3/2025, the facility remained out of compliance at a severity level of no actual harm with potential for more than minimal harm that is not IJ and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems.3) The BOM confessed to the Marketing Director that she had taken Resident #5's credit card and spent $3700 for personal useThis failure placed residents at risk of not being protected from abuse, neglect, or exploitation.Findings included: 1.) Resident #1 Review of Resident #1's face sheet dated 9/26/2025 reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including Dementia (group of brain disorders that cause progressive cognitive decline), Anemia (low blood iron level), Insomnia (problems falling and staying asleep), Hypokalemia (low blood levels of potassium), and acute respiratory failure. Review of Resident #1's admission MDS assessment dated [DATE] reflected she had a BIMS score of 4 suggesting severe cognitive impairment. Review of the behavior section revealed no behaviors were noted. Review of Resident #1's progress notes on 9/18/2025, reflected no mention of her being found in bed with Resident #2 on 9/18/2025. Review of Resident #1's progress notes dated 9/25/2025 at 4:14 am by LVN E reflected: CNA reported that this resident was lying in bed with female resident [Resident #1] sitting on top of him with both of their pants off. CNA told residents to stop and redirected the female resident into the dining room. Review of Resident #1's care plan (the only care plan in the EMR) on 9/26/2025, reflected the focus area initiated on 9/11/2025:I reside in the Secure/ Memory unit and am at risk for injury from wandering in an un- safe environment R/T DX of dementia AEB impaired safety awareness. I am at risk for injury from others while residing in secure/ memory unit D/T altered cognition.with interventions Administer meds per order, monitor labs- report abnormals to MD. Ensure family/ MD aware of behaviors and/or any increase in behaviors noted, Keep environment free of possible hazards. 2.) Resident #2 Review of Resident #2's face sheet dated 9/26/2025 reflected an [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including Dementia (group of brain disorders that cause progressive cognitive decline), Parkinson's disease (progressive neurological disorder that affects movement, balance and coordination), hypotension (low blood pressure), anxiety disorder and Benign Prostatic Hyperplasia (BPH - enlarged prostate gland). Review of Resident #2's MDS screen in the EMR on 9/26/2025 and 10/3/2025 reflected there was no MDS assessment. Review of Resident #2's progress note dated 9/18/2025 at 2:30 pm by LVN C reflected: In a female room lying in bed with another female. This is not either resident room. Lying on top of the blanket and fully clothed. He had his hand on her leg. This nurse assisted him to his chair and told him that he cannot lay in the bed with anyone. Redirected this resident to his room. Review of Resident #2's progress note dated 9/25/2025 at 4:14 am by LVN E reflected: CNA reported that this (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 18 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some resident was lying in bed with female resident sitting on top of him with both of their pants off. CNA told residents to stop and redirected the female resident into the dining room. During an interview on 9/26/2025 at 2:39 pm, CNA B stated she was working Wednesday night on 9/24/25 and about 7:30 pm she discovered Resident #1 and Resident #2 in Resident #2's room. Resident #2 was sitting in his wheelchair and was naked from the waist down with Resident #1 on top of him also naked from the waist down and they were engaged in sexual activity. She stated she separated and redirected residents and took the female resident across the hall to her room and helped her put her clothes back on. She called LVN E, the charge nurse, and told her what happened. She stated she had not thought it was abuse at the time because both residents had dementia and did not really know what they were doing. She had no suspicion of ANE because the residents were confused. She stated she did not call the ADM because she reported it to LVN E and thought she would. She stated she has had training on ANE and all incidents of ANE are to be reported immediately to the ADM. She did not do that and now she realizes it was ANE and should have been reported. She thought because they were confused it could not be ANE. During an interview on 9/26/2025 at 3:10 pm, LVN C stated she found Resident #1 and Resident #2 lying in bed together on 9/18/2025. She stated the residents were lying side by side on top of the covers, fully clothed and Resident #2 had his hand on Resident #1's leg. She stated Resident #2 wasn't trying to engage in anything. She further stated she had no suspicion of ANE because she did not see him try to grab at nothing try to touch [Resident #1] in an inappropriate way - he did not seem malicious or vicious at that time. She stated she was easily able to redirect him from the situation and denied seeing Resident #1 and Resident #2 in bed together prior to that. She stated she did not report the incident as ANE because they weren't naked and didn't have their hands in each other pants - nothing like that going on, they were fully clothed and weren't trying to do anything. LVN C further stated she notified the DON but was not sure if the DON notified the ADM. During an interview on 9/26/2025 at 3:28 pm, LVN E stated she had been working the evening of 9/24/2025 and received a call from CNA B around 7:30 - 7:45 pm about two residents found having sex. She stated she went to the memory care unit and assessed both residents and did not find any physical injuries. She stated she called the ADON around 9:20 pm and told her what happened. The ADON told her to do an incident report. There was no discussion about ANE or reporting to the ADM. She referred to the DON. She called the DON and told her what happened, and the DON told her to complete a head to toe assessment, put a progress note in the system and notify families. She stated there was no discussion or guidance from the DON to call the ADM or notify the abuse coordinator about the incident, so she was not sure how to handle it. She stated she did not have any suspicion of ANE because neither the ADON nor DON discussed it with her, so she did not think there was any ANE. She stated she has had multiple in-services on ANE and they were supposed to report all incidents of ANE to the ADM who is the AC. She did not report it because no one said it was ANE. During an interview on 9/27/2025 at 12:00 pm, the ADM stated she was not aware of the incident last week on 9/18/2025 between Resident #1 and Resident #2 when they were found on the bed together. She stated it was her expectation that staff would follow the facility policy and report any ANE to her immediately. She stated she was aware of the incident on 9/24/2025; but she had not been notified until the next morning when she came into work and immediately began an investigation and reported it to the state agency. She stated staff should have notified her the night before right after it happened and not waited until the next day. During an interview on 10/1/2025 at 12:07 pm, the ADON stated LVN E called her on 9/24/2025 about 9:22-9:25 pm and told her about the incident with Resident #1 and Resident #2. She stated she told LVN E to separate the residents, assess them and notify the DON. She stated she had not discussed the possibility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 19 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some of ANE or reporting to the ADM with LVN E at that time; she just told her to call the DON and get guidance. She stated she had been trained to report any ANE immediately to the ADM and is not sure why this was not reported. The ADM was notified on 10/01/25 at 4:53 pm, that an Immediate Jeopardy had been identified due to the above failures and an IJ template was provided. The following POR was accepted on 10/02/25 at 4:53 pm. Plan of Removal Immediate Jeopardy F609On 09/26/2025 an abbreviated survey was initiated. On 09/26/202the surveyor provided an Immediate Jeopardy (IJ) notification that the Regulatory Services has determined that the condition at the facility constitutes an immediate jeopardy to resident health and safety. The notification of Immediate Jeopardy states as follows: 1-F609 The facility staff failed to immediately report suspicion of abuse and neglect to the Abuse Coordinator for Resident #1 and Resident #2 when both residents had been observed engaging in sexual activity on the memory care unit on 9/24/2025 at about 7:30 pm.2-- Resident #5 free from misappropriation when the Business Office Manager took his benefits card and spent $3,700.Action (Immediate): 1-Resident 1 and Resident 2 were immediately separated from each other. Residents 1 and 2 received head to toe assessments performed by charge nurse and an emotional assessment performed by social worker. The social worker performed trauma informed care assessment. No adverse findings noted. Medical Director was notified, and orders obtained for psychiatric services. Residents 1 and 2 were evaluated by Psychiatric services and medication changes were implemented. Resident 1 and 2 care plans and Kardex were updated to reflect the resident's history of resident-to-resident sexual activity. 2- The Business Office Manager was immediately terminated from employment at the facility on 9/17/25, and the local police department was notified on 9/17/25 of the misappropriation of resident funds.Completion Date: 10/1/2025Responsible: Administrator and/or Director of Nursing Action: (Identification) 1--All residents with behaviors documented as an incident report and/or in the progress notes for the previous 90 days will be reviewed to identify any other residents that may exhibit sexually inappropriate behaviors. If any behavioral events are identified the resident care plan and Kardex will be reviewed and updated, and interventions will be placed immediately. Zero out of 60 incident reports reviewed showed no adverse/inappropriate behavior. Daily audit of resident behaviors and interventions will be reviewed and noted in resident chart. Daily audits will be conducted for behavioral events for 14 days, then weekly x 30 days.2-- 2- On 9/18/25 The Regional Business Office director completed an audit for 70 residents' trust funds based on the immediate jeopardy, with no discrepancies noted. Start Date: 9/26/2025Completion Date: 10/1/2025Responsible: Administrator and/or Director of Nursing Action: (Prevention) 1--Education provided to Administrator and Director of Nursing on the abuse policy, investigating and reporting abuse per HHS and CMS regulations. Testing and discussion were utilized to assess the knowledge retention of the Administrator and the Director of Nursing.2--One-time weekly audits over the next 30 days by the Regional Business Office Manager. --One-time weekly Resident Funds Management Service audits over the next 30 days by the Regional Business Office Manager. If a discrepancy is found, it will be investigated by the regional business office manager, facility administrator, and Regional VP of Operations. This began on 9/19/25. Start Date: 9/26/2025 Completion Date: 10/1/2025Responsible: Administrator and/or Director of Nursing Action: (Prevention) 1. Abuse and Neglect: Types of abuse, including sexual abuse and when/who to report to (immediately & the administrator- abuse coordinator) 2. Resident to Resident: Recognizing behaviors, triggers, and how to effectively intervene. Staff will be educated to immediately separate the residents and implement 1:1 observation until instructed otherwise by the Administrator and/or Director of Nursing. All Facility staff will complete them prior to working their next shift. New employees and agency staff will be educated upon hire and/or prior to working a shift. Knowledge will be verified via test and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 20 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some verbal discussion with affirmative feedback. 2-- Staff that handle resident funds will undergo retraining on financial policies, ethical standards, and proper fund management procedures. Start Date: 9/26/2025 Completion Date: 10/1//2025Responsible: Administrator and/or Director of Nursing Action: (Monitoring) 1--The resident will be monitored for aggressive/inappropriate behaviors. When no longer exhibiting aggressive/inappropriate behavior that warranted the 1:1 observation the Interdisciplinary Team and Physician will collaborate for the discontinuation of 1:1 observation. 2--Weekly and as needed reconciliation of resident trust fund by the Business Office Manager/Regional Business Office Manager. Start Date: 9/26/2025Completion Date: 10/1/2025Responsible: Administrator and/or Director of Nursing/IDT/Physician The surveyor monitored the POR as follows: Record Review of abuse, neglect, exploitation Inservice completed by 10/03/25In an interview with CNA F on 10/03/25 at 12:00pm she stated she completed her abuse, neglect, exploitation in-service this morning and was given a test after completion. CNA F was able to provide types of abuse including physical, sexual, financial, and gave examples such as stealing a resident's money. CNA F Knew to report immediately if ever witnessed to the ADM.In an interview with RN G on 10/03/25 at 12:15pm she stated she was given in-service this morning over abuse, neglect, and exploitation. RN G knew to contact the ADM immediately if she ever witnessed and ANE. RN G knew types of abuse such as taking funds, sexual abuse, and talking bad to residents. RN G knew the signs of abuse/neglect and gave examples of not changing the residents and not caring for them.In an interview with CNA H on 10/03/25 at 1:42pm she stated as soon as she walked in the door this morning she was provided the abuse, neglect, exploitation training along with a test. CNA H gave examples of abuse /neglect such as yelling at a resident, ignoring call lights, sexual, mental, and stealing money from a resident. CNA H stated she was aware last week sometime that a resident had something stolen. CNA H stated she was aware she needed to report any ANE immediately to her Administrator.In an interview with MA I on 10/03/25 at 2:03pm she stated she received her in-service on 10/3/25 over abuse, neglect, and exploitation. MA I was able to give the types of abuse such as physical, mental, and financial. MA I was able to give an example of financial abuse by stealing or borrowing. MA I was able to give signs of abuse/neglect examples such as not changing residents, not feeding, or caring for them. MA stated she knew to report and ANE immediately to the ADM.In an interview with HK J on 10/03/25 at 2:36pm she stated that she received the in-service over abuse, neglect, and exploitation today. HK J knew to report to the ADM if she ever witnessed any abuse or neglect. HK J was able to give examples of abuse /neglect such as resident-to-resident aggression, verbal abuse, not wanting to help a resident, exploitation (stealing money).In an interview with the DM on 10/02/25 at 2:53pm she stated that she just had her inservice over exploitation in the DON's office. The DM stated taking a resident's magazine would be exploitation. The DM knew to report immediately to the ADM if she witnessed any abuse or neglect.In an interview with the DA on 10/02/25 at 3:07pm she stated she was in the DON's office just a while ago for in-service. The DA knew to report abuse, neglect, and exploitation to the ADM immediately. The DA gave an example of exploitation such as stealing money from a resident. While the IJ was removed on 10/03/25 at 5:12pm, the facility remained out of compliance at a level of no actual harm at a scope of pattern because the facility's need to evaluate the effectiveness of the corrective systems.Additional Findings included:3.) Resident #5Record review of Resident #5's admission record dated 10/02/25 documented a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #5 had diagnoses including: major depressive disorder (sadness), cognitive communication deficit (inability to communicate effective), and hypertension (high blood pressure).Record review of Resident #5's Quarterly MDS assessment, dated 09/23/25, revealed the resident had a BIMS score of 0 indicating the resident had severe cognitive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 21 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete impairment. Record review of Resident #5's care plan, dated 09/29/25, revealed Resident #5 was care planned for visually impaired and requires secure storage of personal items/medications in a lock box to ensure safety and prevent misuse or loss.An attempted interview with the BOM was made 10/02/25 at 4:30pm, 10/03/25 at 11:49am, and 10/03/25 at 3:37pm. Voice message was left and the BOM did not return call prior to facility exit 10/03/25.In an interview with the Marketing Director on 10/01/25 at 10:44am she stated that the BOM confessed to her on 9/16/25 around 6:00 PM that she took Resident #5's credit card and used it for her personal use. The Marketing Director stated the BOM stated that she had used $2000 and then stated $3000. The Marketing Director told the BOM that once she used the card she could not stop. The Marketing Director stated the BOM gave her the office key and stated she was not coming back to work because the police would be there. The Marketing Director stated she did not immediately report the incident to the ADM because she was still trying to process what the BOM just told her. The Marketing Director stated she reported to the ADM around 9:00am on 9/17/25. The Marketing Director stated it was expected for her to report to the abuse coordinator immediately after the BOM told her.In an interview with the ADM on 10/03/25 at 12:40pm she stated the Marketing Director did not contact her until the next day (could not recall the exact time, around 10:30am), after the BOM told her that she took Resident #5's credit card and used it for her personal use. The ADM stated it was expected for the Marketing Director to report to her immediately once she found out about the incident and not the next day.Review of facility policy Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, revised September 2022, reflected: Reporting Allegations to the Administrator and Authorities1. If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law and HHSC reporting guidelines.2. The administrator or the individual making the allegation immediately reports his or her suspicion to the following persons or agencies:a. The state licensing/certification agency responsible for surveying/licensing the facility;b. The local/state ombudsman;c. The resident's representative;d. Adult protective services (where state law provides jurisdiction in long-term care);e. Law enforcement officials;f. The resident's attending physician; andg. The facility medical director.3. Immediately is defined as:a. within 2 hours of an allegation involving abuse or result in serious bodily injury; orb. within 24 hours of an allegation that does not involve abuse or result in serious bodily injury. Event ID: Facility ID: 676295 If continuation sheet Page 22 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to conduct an initial comprehensive, accurate, standardized reproducible assessment of the resident's functional capacity within 14 days of admission for 1 (Resident #2) of 7 residents reviewed for Comprehensive Assessments being completed timely. The facility failed to complete a comprehensive assessment for Resident #2 within 14 days of admission. This failure placed newly admitted residents at risk of not having care and treatment needs assessed to ensure necessary care and services were provided to meet these needs.Findings included: Review of Resident #2's face sheet dated 9/26/2025 reflected an [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including Dementia (group of brain disorders that cause progressive cognitive decline), Parkinson's disease (progressive neurological disorder that affects movement, balance and coordination), hypotension (low blood pressure), anxiety disorder and Benign Prostatic Hyperplasia (BPH - enlarged prostate gland). Review of Resident #2's MDS screen in the EMR on 9/26/2025 and 10/3/2025 reflected there was no MDS assessment. During an interview on 10/3/2025 at 4:17 pm, the MDS Coordinator stated Resident #2 did not have an MDS assessment done yet. She stated she was running late in getting assessments done. She further stated the facility has 14 days from admission to complete MDS assessments and Resident #2's did not get done. She stated she was the one responsible for making sure they got done. She stated she initially thought Resident #2 was respite because he was admitted on hospice services. During an interview on 10/3/2025 at 4:30 pm, the ADM stated she was unaware the MDS assessments were late and not getting done and unaware that Resident #2 did not have any MDS assessments done since his admission. She stated the MDS coordinator reported up to regional MDS staff but that at the local level the MDS coordinator reported directly to the ADM. She stated her expectation was that the MDS coordinator will complete MDS assessments on time per the facility policy. Review of Facility Policy Comprehensive Assessments with revision date February 2025 reflected: Comprehensive assessments are conducted to assist in developing person-centered care plans.1. Comprehensive assessments are conducted in accordance with criteria and time frames established in the Resident Assessment Instrument (RAI) User Manual.2. admission Assessment -The admission assessment is a comprehensive assessment for a new resident and, under some circumstances, a returning resident that must be completed by the end of day 14, counting the date of admission to the nursing home as day 1 if:a. this is the resident's first time in this facility, ORb. the resident has been admitted to this facility and was discharged return not anticipated, ORc. the resident has been admitted to this facility and was discharged return anticipated and did not return within 30 days of discharge. Event ID: Facility ID: 676295 If continuation sheet Page 23 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timetables to meet a resident's medical, nursing, and mental and psychosocial needs for 3 of 7 residents (Resident #1, Resident #2, Resident #3) reviewed for care plans. The facility failed to update Resident #1's care plan after she was seen in bed with Resident #2 on 9/18/2025[KS1] [LP2] and after a sexual activity incident on 9/24/2025. The facility failed to update Resident #2's care plan after inappropriate behaviors were noted on 9/18/2025, 9/19/2025 and 9/24/2025.[KS3] [LP4] The facility failed to care plan interventions to routinely monitor Resident #3 when an initial elopement assessment was completed 06/03/24[KS5] [LP6] . This failure placed residents at risk of not having their individualized needs met, a delay in services, and not receiving adequate care to meet their needs.Findings included: Resident #1 Review of Resident #1's face sheet dated 9/26/2025 reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including Dementia (group of brain disorders that cause progressive cognitive decline), Anemia (low blood iron level), Insomnia (problems falling and staying asleep), Hypokalemia (low blood levels of potassium), and acute respiratory failure. Review[KS7] [LP8] of Resident #1's admission MDS assessment dated [DATE] reflected she had a BIMS score of 4 suggesting severe cognitive impairment. No behaviors were noted in the behavior section of the MDS. Review of Resident #1's progress notes on 9/18/2025, reflected no mention of her being found in bed with Resident #2 on 9/18/2025[KS9] [LP10] Review of Resident #1's progress notes dated 9/25/2025 at 4:14 am by LVN E reflected: CNA reported that this resident was lying in bed with female resident sitting on top of him with both of their pants off. CNA told residents to stop and redirected the female resident into the dining room. Review of Resident #1's care plan (the only care plan in the EMR) on 9/26/2025, reflected the focus area initiated on 9/11/2025: I reside in the Secure/ Memory unit and am at risk for injury from wandering in an un- safe environment R/T DX of dementia AEB impaired safety awareness. I am at risk for injury from others while residing in secure/ memory unit D/T altered cognition.with interventions Administer meds per order, monitor labs- report abnormals to MD. Ensure family/ MD aware of behaviors and/or any increase in behaviors noted, Keep environment free of possible hazards. Resident #2 Review of Resident #2's face sheet dated 9/26/2025 reflected an [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including Dementia (group of brain disorders that cause progressive cognitive decline), Parkinson's disease (progressive neurological disorder that affects movement, balance and coordination), hypotension (low blood pressure), anxiety disorder and Benign Prostatic Hyperplasia (BPH - enlarged prostate gland). Review of Resident #2's MDS screen in the EMR on 9/26/2025 and 10/3/2025 reflected there was no MDS assessment. Review of Resident #2's progress note dated 9/18/2025 at 2:30 pm by LVN C reflected: In a female room lying in bed with another female. This is not either resident room. Lying on top of the blanket and fully clothed. He had his hand on her leg. This nurse assisted him to his chair and told him that he cannot lay in the bed with anyone. Redirected this resident to his room. Review of Resident #2's progress note dated 9/19/2025 at 8:27 am by LVN K reflected: resident was noted to be kissing a female resident on her hand. resident was redirected by this nurse redirection was successful. Review of Resident #2's progress note dated 9/19/2025 at 8:44 am by LVN K reflected: resident was noted kissing a female resident in the mouth by this nurse, resident was separated from female resident. and redirected. Review of Resident #2's progress note dated 9/25/2025 at 4:14 am by LVN E reflected: CNA reported that this resident was lying in bed with female resident [Resident #1] sitting on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 24 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some top of him with both of their pants off. CNA told residents to stop and redirected the female resident into the dining room. Review of Resident #2's care plan dated 9/26/2025 reflected no entries initiated prior to 9/22/2025 and there were no entries related to his sexual behaviors.The following focus that was initiated on 9/25/2025: I have memory loss/dementia r/t dementia, difficulty making decisions, disease process, Impaired decision making, neurological symptoms.With interventions initiated on 9/25/2025 and revised on 9/26/2025: Cue, reorient and supervise or assist me as needed. Discuss concerns about confusion, disease process, transition issues, andcommunity placement with all team members. Observe for and report to the nurse any changes in cognitive function, specificallychanges in: decision-making ability, memory, recall and general awareness, difficulty, expressing self, difficulty understanding others, level of consciousness, and mentalstatus. Review of Resident #2's care plan on 10/3/2025 reflected the following focus and intervention initiated on 9/26/2025: I have episodes of adverse behavior(s): Sexually inappropriate behavior (has held hands and attempted to kiss others, shows preference to one resident); Interventions:Anticipate behavior(s) and redirect when in close proximity to others that mightinvoke aggression.Ensure family/MD/aware of behaviors and/or any increase in behaviors noted.Ensure staff is aware of physical/sexual behaviors and interventions.Redirect/remove when approaching/being approached by particular female residentMonitor and chart behaviors q[KS11] [LP12] shift and report to MD.Resident will be placed one to one until IDT determines one to one is no longer inneed.[KS13] [LP14] During[KS15] [LP16] an interview on 10/3/2025 at 4:48 pm, the DON stated the former DON had been responsible for updating care plans. She stated when the state agency had been in the facility at the beginning of September 2025, they knew care plans needed to be updated, and she had been working through them but had not completed all of them yet. She stated she had not gotten to Resident #1 or Resident #2's care plans yet. During an interview on 10/3/2025 at 4:30 pm, the ADM stated she was unaware the care plans for Residents#1 and Resident #2 had not been updated[KS17] [LP18] . She stated her expectation was that nursing staff would update care plans to reflect changes in the residents per the facility policy. Resident #3 Record review of Resident #3's admission recorded dated 10/02/25 documented an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #3 had diagnoses including: unspecified dementia (loss of memory, language, problem solving and other thinking abilities), muscle weakness (lack of physical or muscle strength), and history of falling. Record[KS19] review of Resident #3's Quarterly MDS assessment, dated 09/02/25, revealed the resident had a BIMS score of 3 indicating the resident had severe cognitive impairment. Record review of Resident #3's care plan, dated 09/29/25, revealed Resident #3 was care planned for impaired cognitive function/dementia or impaired thought processes r/t dementia, at risk for falls r/t confusion, cognitive impairment, gait/balance problems, and unaware of safety needs. Review of an initial Elopement Risk Assessment dated 06/03/24[KS20] , reflected Resident #3 was not at risk for elopement and care plan interventions of routinely monitor resident. Record review of Resident #3's care plan, dated 09/29/25, revealed that there was no care plan interventions to routinely monitor Resident #3. In an interview with the MDS Coordinator on 10/03/25 at 4:25pm, she stated the agency nurse who no longer worked at the facility would have been responsible for letting her know that Resident #4 had care plan interventions once the initial elopement assessment was completed on 06/03/24[KS21] . The MDS coordinator stated it was expected for the agency nurse to let her know the care plan interventions so she could have entered on the care plan. The MDS Coordinator stated without the care plan interventions updated the staff would not have known to follow the intervention. In an interview with the ADM on 10/03/25 at 4:34pm, she stated she was not aware that the care plan did not reflect care plan interventions from the initial assessment completed on 06/03/24 to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 25 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete reflect to routinely monitor Resident #4[KS22] . The ADM stated it was expected for the MDS Coordinator to place the care plan intervention immediately after the elopement assessment was completed on 06/03/24[KS23] . The ADM stated with interventions not noted there would not have been anything to follow. Review of Facility Policy Care Planning - Interdisciplinary Team with revision date 12/2024, reflected: The interdisciplinary team is responsible for the development of resident care plans.1. Resident care plans are developed according to the timeframes and criteria established by S483.21.2. Comprehensive, person-centered care plans are based on resident assessments and developed by an interdisciplinary team (IDT).4. The resident, the resident's family and/or the resident's legal representative/guardian or surrogate are encouraged to participate in the development of and revisions to the resident's care plan. Event ID: Facility ID: 676295 If continuation sheet Page 26 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 interview and record review, the facility failed to ensure the residents environment remained as free of accident hazards as is possible and ensure each resident received adequate supervision to prevent accidents for 1 of 6 residents (Resident #3) reviewed for accidents and hazards.The facility failed to ensure Resident #3 did not elope from the facility on 09/10/25. The noncompliance was identified as PNC (past noncompliance). The Immediate Jeopardy (IJ) began on 09/10/25 and ended on 09/15/25. The facility had corrected the noncompliance before the survey began. This deficient practice placed residents at risk for falls, injuries, and hospitalization.Based on interview and record review, the facility failed to ensure the residents environment remained as free of accident hazards as is possible and ensure each resident received adequate supervision to prevent accidents for 1 of 6 residents (Resident #3) reviewed for accidents and hazards. The facility failed to ensure Resident #3 did not elope from the facility on 09/10/25. The noncompliance was identified as PNC (past noncompliance). The Immediate Jeopardy (IJ) began on 09/10/25 and ended on 09/15/25. The facility had corrected the noncompliance before the survey began. This deficient practice placed residents at risk for falls, injuries, and hospitalization. Findings included: Record review of Resident #3's admission recorded dated 10/02/25 documented an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #3 had diagnoses including: unspecified dementia (loss of memory, language, problem solving and other thinking abilities), muscle weakness (lack of physical or muscle strength), and history of falling. Record review of Resident #3's Quarterly MDS assessment, dated 09/02/25, revealed the resident had a BIMS score of 3 indicating the resident had severe cognitive impairment. Record review of Resident #3's care plan, dated 09/29/25, revealed Resident #3 was care planned for impaired cognitive function/dementia or impaired thought processes r/t dementia, at risk for falls r/t confusion, cognitive impairment, gait/balance problems, and unaware of safety needs. Resident #3's care plan did not reflect to routinely monitor the resident. Review of an initial “Elopement Risk Assessment” dated 06/03/24, reflected Resident #3 was not at risk for elopement and care plan interventions of routinely monitor resident. Review of elopement incident report dated 09/10/25 at 6:10pm written by LVN C reflected “This nurse received a phone call that there was a possible resident of ours walking down the highway. This nurse went outside and resident was walking up with a male person. A lady in a car told me that she is bringing one of our residents back that was off the property. This nurse walked with the resident back into the facility. The resident sat down in the front lobby and was given some water to drink. Vital signs stable. Keeping the resident within sight at this time. No injuries observed at the time of the incident.” (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 27 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 Review of Resident #3's nursing progress note dated 09/10/25 written by LVN Cat 6:17pm reflected “This nurse received a phone call of a possible resident outside. This nurse went outside and there was a male walking up the sidewalk with the resident. The lady in the car stated that our resident was walking outside and they are bringing her back. This nurse notified the ADON while we are walking back into the facility because she is here at this time. Assisted the resident back in the facility and gave her some water. VS stable 167/52(blood pressure) 98(oxygen) 97.2(temperature) 98(pulse) O2 sat. She denies any pain and said that she did not fall while she was out. States that she just wanted to get away. She has no control over anything and needed to get away. This nurse was directed to send her back to the secure until to room [ROOM NUMBER] at this time. Notified the responsible party that she would be moving back there and what room she would be in. He states that he will be calling tomorrow and speaking with management”. In an interview with the former DON on 09/29/25 at 2:59pm, she stated she had received a call from the ADON on 09/10/25 around 6:00pm and could not recall the exact time that Resident # 3 was found outside at the road to the right of the facility by someone that passed by in their car. LVN C assessed Resident #3 with no injuries and Resident #3 was placed on the secured unit. The former DON stated there was no camera footage of Resident #3 when she had exited the facility as the cameras did not work. The former DON was advised by the ADON that Resident #3 went out of the facility when a visitor was holding the door open for CNA B to come into the facility. The former DON stated that CNA B did not recognize Resident #3 because she had worked the secured unit. CNA B stated Resident #3 did not reside on the secure unit. The former DON stated CNA B thought that Resident #3 was a visitor because she was dressed like a visitor and had a purse . The former DON stated it was expected for CNA B to recognize Resident #3, and the incident could have resulted in Resident #3 possibly being hit by a car while outside the facility. The former DON stated immediately after the incident on 09/10/25 the facility was trained on the missing resident policy, what to do when a resident elope, and to prevent elopement. In an interview with LVN C on 09/29/25 at 3:14pm, she stated on 09/10/25 she had received a call around 6:00pm during shift change from a lady whom she did not know to let her know there was an elderly person out at the road. LVN C stated at the same time the ADON was on the line with another facility in the area asking if they had a resident that was missing. LVN C stated when she got off the phone she and the ADON immediately went outside the facility. LVN C stated a lady was sitting in a blue car and a young man was bringing Resident #3 to the facility door. LVN C stated Resident # 3 was not outside the facility more than five minutes. LVN C stated she asked Resident #3 where she was going, and Resident #3 told her she just needed a break. LVN C gave Resident #3 some water and assessed her for any injuries, and none were noted. Resident # 3 was placed on the secured unit. LVN C stated anything could have happened to Resident #3 that could have caused harm while outside the facility. LVN C stated inservice on preventing elopement was completed after the incident on what to do in case of elopement. In an interview with CNA B on 09/29/25 at 4:08pm, she stated on 9/10/25 after 6:00PM (the exact time could not be recalled), as she was coming in the facility, a visitor that was leaving out of the facility had held the door open as she was coming in to work. CNA B stated shortly after she was on the secured unit an unidentified staff member had stated to her that Resident #3 went out of the facility earlier. CNA B stated she asked the unidentified person what did Resident #3 look like, and the unidentified person said the resident was dressed up and had a purse. CNA B then stated to the unidentified staff member “Oh My Gosh Resident #3 was coming out of the facility as she was coming into the facility”. CNA B stated Resident #3 did not look like a facility resident. CNA B stated she did not know Resident #3 was a facility resident because she had a dressy colorful dress (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 28 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 on, and had a purse, with big hair. CNA B stated she had never seen Resident #3 as she worked the secured unit. CNA B stated that she will take the blame for not recognizing it was Resident #3 coming out of the facility as she was coming in. CNA B expressed she was very sorry for that. CNA B received elopement training to prevent elopement after the incident over elopement procedures and the protocol to follow when there is an elopement. In an attempted interview with Resident #3 on 09/30/25 at 3:22pm, Resident #3 was sitting in the secured unit at the dining table, and she was not able to say if she was safe or not. Resident # 3 was not able to elaborate on if she had left the facility or how she got outside when she was found in the road. Resident #3 she was not able to recall the elopement incident, and she stated she was here and said she did not know. In an interview with Resident #3's RP on 10/01/25 at 9:25am he stated that he received a call on 9/10/2025 around 6:00pm that evening from a female (name unknown) at the facility advised that Resident #3 had been found outside at the road walking on the highway. Resident #3's RP stated the facility never told him how Resident #3 was let out of the facility. Resident #3's RP stated he had a problem with Resident #3 being let out of the facility and that Resident #3 was let out of the facility by staff. Resident #3's RP was very concerned because Resident #3 had dementia and that someone had let Resident #3 out and there was no way Resident #3 could have pushed that heavy door leading to the outside open. Resident #3's RP stated Resident #3 would not have known to return back to the facility if she was not found outside the facility. Resident #3's RP stated the Highway is a very busy highway and anything could have happened (possibly hit by a car) with Resident #3 being on the Highway if no one had found her. Resident #3's RP stated the problem he had was the facility door was not secured, and Resident #3 was able to get out of the facility. Resident #3's RP stated that residents could be able to walk out with employees because no staff was at the front area watching the door. Resident #3's RP stated he wanted the security to the door to be enforced for the safety of all the residents and to ensure this incident would not ever happen again. In an interview with the ADON on 10/01/25 at 11:55am she stated she was on the phone around 6:00pm (could not recall the exact time) on 09/10/25 talking with another facility in the area, and they were asking if they had a resident that was missing. The ADON stated while she was on the phone speaking with the other facility LVN C was on the line with the people that had Resident #3 outside the facility. The ADON stated once she and LVN C both got off the phone they went outside to the parking lot of the facility. The ADON stated there was a lady that was sitting in a blue car and a male gentleman was escorting Resident #3 back to the door of the facility. The ADON stated Resident #3 was back inside the facility by 6:15 pm. The ADON stated that Resident #3 may have gotten out of the facility with visitors. The ADON stated that Resident #3 dressed up every day and would not be recognized as a resident. The ADON stated when Resident # 3 was brought back inside the facility, Resident #3 sat in a chair, and was given water. The ADON stated that Resident #3 told LVN C that she just needed a break. The ADON stated Resident #3 was fully assessed by LVN C with no injuries and escorted Resident #3 to the secured unit. The ADON stated that Resident #3 was very confused and when she went out of the facility would not have known to come back into the facility. The ADON stated the speed limit in front of the facility was 55 miles per hour and the worst thing that could have happened was Resident #3 could have gotten run over by a car. The ADON stated immediately after the elopement incident elopement training was conducted on the protocol, procedure of elopement, and to monitor residents. In an interview with the ADM and interim DON on 10/01/25 at 5:30 pm they stated that when the state surveyor came in on 09/26/25 the elopement was completed. The ADM and Interim DON stated an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 29 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 elopement assessment was completed on all residents, the elopement book was updated and staff were in serviced on the location to find it. Inservice on the missing resident policy procedures (what to do) was completed with all staff. Care plans were updated for all residents that were elopement risks. The sign on the front door, dining area, and any door staff exit through was placed for all resident's safety. An assessment was completed on Resident #3 and the care plan was updated. Resident #3 was moved to the secure unit and staff statements and witness statements were conducted. A root cause analysis was completed by the interim DON along with a complete report of the elopement incident. An interview with the interim DON on 10/03/25 at 12:20pm reflected that Resident #3 was not recognized by CNA B when a visitor was holding the door open for her when she came to work on 9/10/25 which resulted in Resident #3 exiting the facility. The interim DON stated this could have resulted in potential harm if Resident #3 had a fall while outside the facility. The interim DON stated it was expected for staff to make sure Resident #3 was safe. An interview with the ADM on 10/03/25 at 12:40pm stated that Resident # 3 was let out by CNA B who did not recognize she was a resident on 09/10/25 around 6:00pm. The ADM stated that Resident #3 could have experienced a negative outcome with harm if she was hit by a car on the busy highway. The ADM stated it was expected Resident #3's admit assessment completed on 06/03/24 to be followed. The ADM stated Resident #3 was not an elopement risk at the initial assessment but required care plan to be routinely monitored. Review of the facility's “Safety and Supervision of Resident” policy, dated 2001, revealed “Our facility strives to make the environment as free from accident hazards as possible, Resident safety and supervision and assistance to prevent accidents are facility wide priorities. Policy Interpretation and Implementation Facility Oriented Approach to Safety 1. Our facility-oriented approach to safety addresses risks for groups of residents. Resident Risks and Environmental Hazards 1. Due to their complexity and scope, certain resident risk factors and environmental hazards are addressed in dedicated policies and procedures. These risk factors and environmental hazards include the following: e. unsafe wandering…” Review of the facility's “Wandering and Elopements” policy, dated 2001, revealed “The facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment for residents.” This noncompliance was identified as Past Noncompliance (PNC). The noncompliance began on 09/10/25 and ended on 09/15/25. The facility had corrected the noncompliance before the survey began. The facility took the following actions to correct the non-compliance: - Review of Wandering/Elopement Assessment was conducted on all residents was completed on 09/10/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 30 of 31 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 676295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Epic Nursing & Rehabilitation 3210 W Hwy 22 Corsicana, TX 75110 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 - Review of Inservice on missing resident policy and protocol to follow was completed on 09/10/25. Level of Harm - Immediate jeopardy to resident health or safety - Review of Elopement book and Inservice on where the book is located was completed on 09/10/25. Residents Affected - Few - Review of Signage on door in front door and any door staff exit through to make sure residents are not able to exit facility was observed on 09/10/25. - Review of Care plans updated on all residents that are an elopement risk was completed on 09/10/25. - Review of Assessment on Resident #3, Reviewed Resident #3's updated care plan, moved to the secure unit on 09/10/25. - Review of Staff statements/witness statements about the elopement incident was completed on 09/11/25. - Review of Root cause analysis was completed on the elopement was completed by DON on 09/11/25 - Review of Complete incident report on the elopement was completed on 09/15/25 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676295 If continuation sheet Page 31 of 31