Health inspection·May 21, 2025

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few code status and status had been entered into the record. Progress note also revealed advanced care planning material was provided and discussed with the resident. During interview on [DATE] at 1:35 p.m., the DON said Resident #302 was a full code. The DON said the advance directive section on the electronic medical record should be updated on admission and should go on the care plan within 24 hours of admission. The DON said the order for advance directives generated the information in the electronic medical record. The DON said the social worked updated the resident's care plan for information regarding advance directives. The DON said the nurses were instructed that residents who did not have a DNR were automatically a full code. The DON said the admitting charge nurse was responsible to generate the advance directive order as part of the resident's admission orders. The DON said if advance directives were not updated then it could cause miscommunication of their wishes and might not be handled per the resident's wishes. During interview on [DATE] at 8:50 a.m., the Social Worker said the residents were always a full code unless they had a DNR. The Social Worker said the charge nurse put in the order for residents who were full code. The Social Worker said she entered information into the residents' care plan if they were full code or DNR. The social worker said she completed the paperwork if a resident wished to be a DNR but would notify the nurse to obtain the order. During interview on [DATE] at 8:54 a.m., LVN G said the admitting nurse can update advance directive order if changed. LVN G said she was trained all the time regarding advance directives and training was part of admission training. During interview on [DATE] at 9:06 a.m., LVN H said the admitting nurse would put the order for advance directives on admission. LVN H said all residents were a full code unless they came to the facility with a DNR or until the social worker saw the resident and they wanted to be a DNR. LVN H said she had in-services regarding advance directives. During interview on [DATE] at 9:18 a.m., the ADON said the nurse that did the admission should enter the order for advance directives. The ADON said advance directive information should be completed dur the admission process and usually was entered on the care plan within 24 hours of admission. The ADON said nurses have training regarding advance directives in orientation and in their yearly review. The ADON said if an order for advance directives was not entered then care could go against the resident's wishes. During interview on [DATE] at 9:32 a.m., the MDS Coordinator said the nurses put in orders for advance directives on admission. During interview on [DATE] at 9:43 a.m., the Administrator said they should have orders for advance directives and nursing put information for advance directives on the care plans. The Administrator said the effect on residents if there were not orders or information entered into the care plan for advance directives then there would be lack of communication to the nursing staff. Record review of facility's policy Advance Directives revised [DATE] revealed Information about whether or not the resident has executed an advance directive shall be displayed prominently in the medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 2 of 9 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 676309 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Baywood Crossing Rehabilitation & Healthcare Cente 5020 Space Center Blvd Pasadena, TX 77505 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 observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objective and time frames to meet a resident's medical, nursing, mental and psychosocial needs for 2 (Resident #69 and Resident #302) of 7 residents reviewed for care plans. 1. The facility failed to ensure Resident #69's care plan included information regarding assist rails. 2. The facility failed to ensure Resident #302's care plan included information regarding her use of CPAP and advance directives information. The failure could place residents at risk of not receiving appropriate care and interventions to meet their needs. Findings included: Record review of Resident #69's face sheet dated [DATE], revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Displaced Intertrochanteric Fracture of Right Femur (right hip fracture), Muscle Weakness and Difficulty in Walking. Record review of Resident #69's quarterly MDS dated [DATE] revealed a BIMS score of 6 that indicated severe cognitive impairment. MDS also revealed admission performance for functional abilities in Section GG of partial/moderate assistance for sit to stand and char/bed-to-chair transfers. Record review of Resident #69's Order Summary Report dated [DATE] revealed no physician's orders regarding bed or assist rails. Record review of Resident #69's Order Summary Report dated [DATE] revealed physician's order Resident may have an assist rail(s) as an assistive device to maximize independence in bed mobility and/or transfer ability with order date of [DATE]. Record review of Resident #69's care plan printed [DATE] revealed no mention regarding side or assist rails. Record review of Resident #69's care plan printed [DATE] revealed The resident may use an assist rail(s) to aid in turning/repositioning. Observation on [DATE] at 9:33 a.m. revealed bed rails near the head to both sides of Resident #69's bed in the up position. Record review of Resident #302's face sheet dated [DATE], revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Acute on Chronic Diastolic (Congestive) Heart Failure (disorder when the heart does not pump blood as well as it should) and Obstructive Sleep Apnea (disorder where people repeatedly stop and start breathing while they sleep). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 3 of 9 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 676309 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Baywood Crossing Rehabilitation & Healthcare Cente 5020 Space Center Blvd Pasadena, TX 77505 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 Record review of Resident #302's admission MDS dated [DATE] revealed a BIMS score of 14 that indicated cognition was intact. Record review of Resident #302's Order Summary Report as of [DATE] revealed physician's order for Full Code: Perform CPR with order date of [DATE] and Place CPAP machine on Resident at bedtime with order date of [DATE]. Record review of Resident #302's May MAR/TAR printed [DATE] revealed Place CPAP machine on Resident at bedtime Settings 35BPM with order date of [DATE] at 8:32 a.m. and for documentation to have started on [DATE]. Record review of Resident #302's care plan as of [DATE] revealed focus of Resident #302 had exercised their right to maintain a full code status with revision date of [DATE]. Record review also revealed focus of uses a CPAP machine brought from home with revision date of [DATE]. Record review of Resident #302's Nurse Progress Notes revealed Oxygen via CPAP under N Adv Skilled Evaluation dated [DATE] at 1:06 p.m. Record review also revealed CPAP was documented under admission Details dated [DATE] at 5:04 p.m. under respiratory section. Observation on [DATE] at 10:13 a.m. revealed CPAP machine on nightstand in Resident #302's room. During interview on [DATE] at 2:33 p.m., the DON said there should be an order for grab bars and should be documented on residents' care plan. The DON said Resident #302 should have of had an order for her CPAP on admission. During interview on [DATE] at 11:30 a.m., Resident #302 said she had worn her CPAP every night since arriving to the facility. During interview on [DATE] at 8:37 a.m., the DON said the nursing management team was responsible for placing information like advance directives, bed/assist rails or CPAPs on the residents' care plans. The DON said the nursing management team consisted of the DON, MDS nurse, ADON and wound care nurse. During interview on [DATE] at 8:54 a.m., LVN G said they assumed the MDS Coordinator put information regarding advance directives, CPAP, and bed rails on the care plan. LVN G said nurses did not add information to the care plans. During interview on [DATE] at 9:18 a.m., the ADON said the MDS Coordinator put information for bed rails and CPAPs on the care plans. The ADON said effects residents could experience if the CPAP was not documented on the care plan was the resident could have low O2 sats or not be able to sleep well. During interview on [DATE] at 9:32 a.m., the MDS Coordinator said she care plans everything that was triggered on the resident's MDS. The MDS Coordinator said all the managers had a hallway and check for new orders that need to be added to residents' care plans otherwise she would catch at the resident's next assessment. The MDS Coordinator said the managers did chart checks to ensure the orders were entered and were on the care plan and this typically occurs the next day. The MDS Coordinator said any of the administrative nurses can add information to the residents' care plans. The MDS Coordinator said she had meetings and in-services regarding ongoing training for care plans. The MDS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 4 of 9 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 676309 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Baywood Crossing Rehabilitation & Healthcare Cente 5020 Space Center Blvd Pasadena, TX 77505 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 Coordinator said if information like CPAP was not on the care plan, then the resident may not get the CPAP. Level of Harm - Minimal harm or potential for actual harm During interview on [DATE] at 9:43 a.m., the Administrator said nursing put information for bed rails, advance directives, and CPAPs on the care plans. The Administrator said the effect on residents if there was not information entered into the care plan for bed rails, advance directives, and CPAPs was there would be lack of communication to the nursing staff. Residents Affected - Some Record review of facility's policy Care Plans, Comprehensive Person-Centered revised [DATE] revealed The comprehensive, person-centered care plan will: describe the services that are to be furnished to attain or maintain the residents' highest practicable physical, mental, and psychosocial well-being. Record review also revealed The comprehensive, person-centered care plan will: reflect the resident's expressed wishes regarding care and treatment goals. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 5 of 9 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 676309 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Baywood Crossing Rehabilitation & Healthcare Cente 5020 Space Center Blvd Pasadena, TX 77505 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to attempt to assess residents for risk of entrapment from bed rails prior to installation, review the risks and benefits of bed rails prior to installation and obtain informed consent prior to installation for 2 (Resident #69 and Resident #5) of 8 residents reviewed for use of side rails. The facility failed to ensure Residents #69 and #5 had documentation and orders prior to installation of bed rails. This failure could place residents at risk of injury, not have adequate education regarding bed rails and/or staff not have adequate communication regarding residents' use of bed rails. Findings included: Record review of Resident #69's face sheet dated [DATE], revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Displaced Intertrochanteric Fracture of Right Femur (right hip fracture), Muscle Weakness and Difficulty in Walking. Record review of Resident #69's quarterly MDS dated [DATE] revealed a BIMS score of 6 that indicated severe cognitive impairment. MDS also revealed admission performance for functional abilities in Section GG of partial/moderate assistance for sit to stand and char/bed-to-chair transfers. Record review of Resident #69's Order Summary Report dated [DATE] revealed no physician's orders regarding bed or assist rails. Record review of Resident #69's Order Summary Report dated [DATE] revealed physician's order Resident may have an assist rail(s) as an assistive device to maximize independence in bed mobility and/or transfer ability. Record review of Resident #69's assessments did not reveal an assessment being conducted for rail usage. Record review of Resident #69's MAR/TAR printed [DATE] revealed resident may have an assist rail(s) as an assistive device to maximize independence in bed mobility and/or transfer ability with order date of [DATE]. Record review of Resident #69's care plan printed [DATE] revealed no mention regarding side or assist rails. Record review of Resident #69's care plan printed [DATE] revealed The resident may use an assist rail(s) to aid in turning/repositioning. Record review of Resident #69's Progress Notes from 4/21-[DATE] revealed on [DATE] at 12:35 p.m. that telephone consent was obtained from Resident #69's family member and the risks and benefits of assist rails were explained. On [DATE] at 12:21 p.m. Resident #69 was assessed for the use of assist (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 6 of 9 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 676309 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Baywood Crossing Rehabilitation & Healthcare Cente 5020 Space Center Blvd Pasadena, TX 77505 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 0700 rails. Level of Harm - Minimal harm or potential for actual harm Observation on [DATE] at 9:33 a.m. revealed bed rails near the head to both sides of Resident #69's bed in the up position. Residents Affected - Some During interview on [DATE] at 1:35 p.m., the DON said the rails on Resident #69's bed were grab handles but did not know if that was the technical term. The DON said they did not need orders for grab handles. The DON said he did not know if the grab handles needed to be on the care plan, but he would find out. Record review of Resident #5's face sheet dated [DATE] revealed a [AGE] year-old female admitted to the facility admission [DATE] with a re-admission of [DATE] with diagnoses Alzheimer's, High Blood Pressure and COPD (lung disease). Record review of Resident #5's Annual MDS dated [DATE] revealed a Staff Assessment of Mental Status completed. This revealed resident's cognition was severely impaired. Record review of Resident #5's Order Summary Report dated [DATE] revealed no physician's orders regarding bed or assist rails. Record review of Resident #5's assessments did not reveal an assessment being conducted for rail usage. Record review of Resident #5's care plan printed [DATE] revealed no mention regarding side or assist rails. Record review of facility incident report dated [DATE] revealed after bruising on the right side of chest that they covered the rails with foam. Observation of Resident #5's room on [DATE] at 3:30 PM revealed rails in up position covered with foam. Resident was not in her room. Resident #5 was observed in near nurses' station in her wheelchair waiting for her family member. She was unable to answer any questions. During interview on [DATE] at 3:45 PM, MA A said the Resident #5's rails have been there since her family member died. She said that was about 3 months ago. She said when the rails were first placed, she used them for help, but not now. She did not assist any longer with ADL's. During interview on [DATE] at 3:48 PM, CNA O said they do not leave rails up when residents were in bed. They put one up and one down. They then can still use for mobility but get out of bed. During interview on [DATE] at 3:55 PM, the DON said Resident #5 used the rails for mobility. If she did not need them, he would take them down. He said there were no orders or care plans for rails. He said these should be completed. During interview on [DATE] at 2:33 p.m., the DON said there should have been an order for grab bars and should have been on residents' care plan. The DON said that when the grab bars were in the up position, they were not considered a restraint. During interview on [DATE] at 8:37 a.m., the DON said the effect on residents of not having an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 7 of 9 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 676309 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Baywood Crossing Rehabilitation & Healthcare Cente 5020 Space Center Blvd Pasadena, TX 77505 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some order or documentation on the care plan regarding bed rails was a potential hazard to the resident like entanglement or the resident trying to get over the bed rail. The DON said they should assess the residents' ability to use the bed rails. The DON said they had in-services and online trainings but was not aware of trainings specific to bed/assist rails. The DON said they constantly educate staff and family regarding what could be a restraint and regarding possible restraint education. The DON said they put in orders and care planned all residents yesterday regarding assist rails. During interview on [DATE] at 8:54 a.m., LVN G said they did not know they needed an order for bed rails but bed rails needed to be care planned. LVN G said they had training about bed rails that was given verbally and by in-service. During interview on [DATE] at 9:06 a.m., LVN H said they needed an order for bed rails and usually got orders for bed rails on admission. LVN H said we usually did not use bed rails and said she had in-services regarding bed rails. During interview on [DATE] at 9:15 a.m., CNA M said most of the time they keep both bed rails up unless there was a reason to put one side down. During interview on [DATE] at 9:18 a.m., the ADON said there needed to be an order for bed rails and the nurse was responsible for obtaining orders for bed rails on admission. The ADON said if there was not an order or documentation on the care plan for bed rails then residents could receive a skin tear, bruising, and could hinder bed mobility, transfers, or positioning. The ADON said staff had training regarding bed rails in their yearly check offs. During interview on [DATE] at 9:43 a.m., the Administrator said they should have orders for bed rails and nursing put information for bed rails on the care plans. The Administrator said the effect on residents if there were not orders or information entered into the care plan for bed rails then there would be lack of communication to the nursing staff. During interview on [DATE] at 11:36 p.m., CNA N said residents would use the assist rails if they needed help sitting up, assistance returning to bed or turning side to side. CNA N said if both assist rails were in the down position it would be considered a restraint but that the nurse would let them know. Record review of facility's policy Bed Safety revised [DATE] revealed The staff shall obtain consent for the use of side rails from the resident or the resident's legal representative prior to their use. Record review also revealed Assist rails may be used if assessment and consultation with the attending physician has determined that they are needed. Record review also revealed Before using assist rails for any reason, the staff shall inform the resident and family about the benefits and potential hazards associated with side rails. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 8 of 9 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 676309 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Baywood Crossing Rehabilitation & Healthcare Cente 5020 Space Center Blvd Pasadena, TX 77505 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review the facility failed to ensure drugs and biologicals were stored in accordance with currently accepted professional principles for 1 of 1 medication fridges reviewed for storage of drugs. The facility failed to ensure that food items were not stored in the medication fridge per facility policy. This failure could place residents at risk of medications being cross contaminated with food items. Findings included: Observation on 5/19/25 at 2:50 p.m. revealed a 12 ounce can of Dr. Shasta cola in the door of the medication fridge in the facility's medication room. During interview on 5/19/25 at 2:50 p.m., the ADON said the drink probably belonged to a resident that does not like water and will only take their medications with soda. The ADON said the soda should have been in the nutrition room. During interview on 5/19/25 at 3:04 p.m. the DON said a soda can should not have been in the medication refrigerator and could result in cross contamination with the food contaminating the medications or the medications contaminating the food. Record review of facility's policy Storage of Medications revised November 2020 revealed Medications are stored separately from food and are labeled accordingly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 9 of 9