Inspection·November 24, 2025

F 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medical record did not reveal any other dental notes from June to August 2025. Record review of Resident #1's Order Summary Report with active orders as of 10/15/25 revealed appointment with local dentist on 8/14/25 at 10:30 a.m. Record review of Resident #1's August 2025 MAR/TAR revealed appointment on 8/18/25 at 11 a.m. with a local dentist and appointment with oral surgeon on 8/22/25 at 1 p.m. Record review of Grievance/Complaint Report, dated 8/11/25, revealed grievance for Resident #1 by Resident #1's family member due to Resident #1 wanting to see a dentist. Grievance revealed Resident #1 was approved for a filling and was scheduled for 8/19/25. Record review of Resident #1's weights did not reveal any weight loss from June to August of 2025. Record review of Resident 2's quarterly MDS, dated [DATE], revealed a BIMS score of 15, which indicated cognition was intact. During interview on 10/14/25 at 12:56 p.m. with Resident #1's family member revealed he believed the tooth infection was taken care of at the time of the interview and was a huge ordeal. Resident #1's family member said Resident #1 had the infection for probably two months and there was no sense of urgency from the facility. Resident #1's family member said Resident #1 had a tooth extraction and something else. Resident #1's family member said Resident #1's other family member had to schedule those appointments. Resident #1's family member said the facility told them they had to take Resident #1 to the dentist and pay for the services. Resident #1's family member said Resident #1's tooth issues started during the summer of 2025 and was resolved in August of 2025. Resident #1's family member said Resident #1 had got to the point he did not want to tell anybody anything because the facility would not do anything, so he would just deal with it. Resident #1's family member said Resident #1 was not eating as much because of the pain and was not eating solid things. During interview and observation on 10/15/25 at 9:14 a.m., Resident #1 denied any current pain in his teeth and last went to the dentist about two weeks ago. Resident #1 said he had a tooth pulled about a month ago because it was chipped and started hurting and possibly decayed. Resident #1 said it was about a month from when his tooth started hurting to when it was pulled out. Resident #1 said he did not know why it took about a month from when the tooth started hurting to when it was pulled out, just that it took too long. No signs of distress were noted of Resident #1 during the interview. During interview on 10/15/25 at 11:15 a.m., the Social Worker said they started at the facility in the middle or end of June 2025. The Social Worker said the facility provided dental services via a contracted dentist or the resident could choose to see an outside dentist. The Social Worker said if a resident had a complaint before the facility's contracted dentist came then they would get residents an outside appointment and they would not make them wait. The Social Worker said if it was an emergency, and the resident could not eat the facility would have to get the resident out for an appointment. The Social Worker said they considered tooth pain an emergency because that could stop residents from eating. Regarding Resident #1, the Social Worker said she remembered Resident #1's family member had written a letter, and they did not remember any dental problems related to Resident #1 before the letter. The Social Worker said once Resident #1's family member wrote the letter we got on it. The Social Worker said she did not remember the nurse, Resident #1 or Resident #1's family notifying her regarding Resident #1 having dental pain. The Social Worker said if a nurse had a dental concern, the nurse would either come tell the Social Worker verbally or leave a note under the door and then they would add the resident to the list. Attempted phone interview with LVN A was unsuccessful and a call back from LVN A prior to the exit date was not received. During interview on 10/15/25 at 2:15 p.m., Resident #2, who was also roommates with Resident #1, said Resident #1's tooth pain started about 6-7 months ago. Resident #2 said it was a long time before Resident #1 was able to get the tooth fixed or pulled out and Resident #1 was in really bad pain . Resident #2 said Resident #1's tooth had chipped and hurt when he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676309 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676309 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 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 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete bit down. During interview on 10/15/25 at 2:35 p.m., the DON said referrals for dental services went through the social worker. During interview on 10/15/25 at 3:57 p.m., Resident #1 said the tooth that had hurt him was on the left upper side. During interview on 10/15/25 at 4:24 p.m., the Administrator said when they were made aware of dental issues on 8/12/25 with Resident #1, they were figuring out if he was seen and they called the facility's contacted dentist on 8/11/25 and Resident #1 was scheduled for a filing on 8/19/25. The Administrator said the facility's contracted dentist said Resident #1 did not want the tooth extracted so they had to take it back to get authorization for the filling and that was scheduled for when they were to come back out on 8/19/25. Record review of the facility's policy Dental Services, revised December 2016, revealed routine and 24 hour emergency dental services are provided to residents. Event ID: Facility ID: 676309 If continuation sheet Page 3 of 3