Inspection·July 25, 2025

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete contributed to the altered cardiovascular status. Resident #143 Record review of the admission Record for Resident #143 revealed he was [AGE] years old and was admitted to the facility on [DATE]. Diagnoses included, but were not limited to, acute respiratory failure, severe sepsis with septic shock, and pneumonia. His code status was reflected as Full Code. The baseline care plan dated 07/17/25 for Resident #143 read, in part, Resident request Code Status of [Specify]: Full Code/DNR. Date initiated 07/17/25. The baseline care plan did not reflect the resident's code status. The baseline care plan dated 07/17/25 for Resident #143 read, in part, The resident expresses (SPECIFY) desire for/little or no activity involvement r/t Date initiated 07/17/25 The baseline care plan did not specify the possible reason for the decreased desire to participate in activities. The baseline care plan dated 07/17/25 for Resident #143 read, in part, The resident has an ADL self-care performance deficit r/t Date initiated 07/17/25. The baseline care plan did not specify a possible reason for the deficit. The baseline care plan dated 07/17/25 for Resident #143 read, in part, The resident wishes to (SPECIFY return/be discharged ) to (SPECIFY home, another facility) Date initiated: 07/17/25 The baseline care plan did not specify where the resident wished to be discharged to. The baseline care plan dated 07/17/25 for Resident #143 read, in part, The resident has impaired cognitive function/dementia or impaired thought processes r/t Date initiated 07/17/25 The baseline care plan did not reveal the possible cause of the impaired thought processes. The baseline care plan dated 07/17/25 for Resident #143 read, in part, .The resident has a communication problem r/t Date initiated: 07/17/25 The baseline care plan did not provide a possible reason or description of the communication problem. The baseline care plan dated 07/17/25 for Resident #143 read, in part, The resident has an infection of the (SPECIFY) Date initiated 07/17/25 The baseline care plan did not specify where the infection was. In an interview on 07/24/25 at 12:12 p.m., the DON said MDS Coordinator A was responsible for care plans. He said he reviewed care plans, but had not had a chance to review the new admission (baseline) care plan. He said the care plans were used to document patient care and goals. It was used to address acute issues and how the facility would address them.At that time, the DON reviewed the baseline care plan for Resident #139. He confirmed there was no care plan for the enteral feeding tube. He reviewed the baseline care plan for the tracheostomy. The DON said Looks pretty short. Only Enhanced Barrier Precautions. He should have an area for the trach care plan. He said a possible outcome would be the resident would not receive proper care. He said It could be bad for their health and treatment goals. The DON reviewed he baseline care plans of Residents #140 and #143. He said he could not tell the code status of either resident from the baseline care plan. He said the baseline care plans should be personalized, and should have specific information. The facility policy Care Plans - Baseline (revised March 2022) read, in part, .The baseline care plan includes instructions needed to provide effective, person-centered care of the resident that meet professional standards of quality care and must include the minimum healthcare information necessary to properly care for the resident including, but not limited to the following:. Initial goals based on admission orders and discussion with the resident/representative;1. Physician orders;2. Dietary orders;. Event ID: Facility ID: 676310 If continuation sheet Page 2 of 7 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 676310 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solera at West Houston 2101 Greenhouse Road Houston, TX 77084 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 that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment for 2 (Resident #9 and #47) of 21 residents reviewed for comprehensive care plans. The facility failed to ensure that Resident #47 has a comprehensive care plan that included all care areas triggered on her assessment. The facility failed to ensure that Resident #9 comprehensive care plan included her hospice service and oxygen. These failures could place residents at risk of not receiving proper care and service to develop and improve their mental, physical and psychosocial well-being. Findings Included Resident#47 Record review of Resident#47 admission face sheet dated 7/25/2025 revealed she was an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included urinary tract infection(infection of the urinary tract), hypertension (high blood pressure), osteoporosis(a disease of the bone) , gastro esophageal reflux disease (heart burn), chronic obstructive pulmonary disease ( a lung disease that blocks air flow making it difficult to breath), chronic kidney disease (the inability to filter from the blood), atrial fibrillation (irregular/rapid heart rate that causes poor blood flow. , protein calorie malnutrition ( insufficient intake of both protein and calories), muscle weakness(decrease strength in the muscle) and lack of coordination (impaired balance due to damage nerves, brain of muscles). Record review of Resident #47's admission MDS dated [DATE] revealed she coded as having a BIMS score of 14 indicating she was cognitively aware, was occasionally incontinent of bladder and bowel and had a fall with fracture in the last 6 months. Further record review revealed Resident #47 was triggered for incontinence, pressure sore, nutrition, activities of daily living, falls and dehydration. Record review of the care plan initiated 6/18/2025 revealed it did not address falls dehydration and incontinent care. Further record review revealed the care plan was updated on 7/25/2025 to address dehydration and falls but did not address incontinent care. Observation on 7/22/2025 at 10:00am Resident #47 was observed in her room she was alert and oriented and good make her needs known. She was clean and without any offensive odor. Call light was observed to be reached. In an interview on 7/22/2025 at 10:00am, Resident #47 said they answer her call light. She said she had to ask for help because she did not want to fall again. She said she fell at home and that was why she was in the facility for rehabilitation. She said she rehab was working with her, and she was able to move around much better. In an interview on 7/25/2025 at 10:15 am with the MDS Coordinator she said all triggered areas should be captured on the care plan. She said if the area were not captured on the care plan, they would not have a full picture on how to take care of the residents and they would not know what resident's daily needs were. She said moving forward they going to ensure that all triggered area were captured on the care plan and completed by day 21. Resident #9Record review of Resident #9's face sheet dated July 25th, 2025, revealed she was a [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included malignant neoplasm of the lungs(cancer that begins in the lungs), chronic obstructive pulmonary disease(lung disease that blocks air flow), hypertension(high blood pressure), acute metabolic acidosis (too much acid accumulates in the body), lack of coordination(impaired balance due to brain or muscle damage), chronic respiratory failure with hypoxia (lungs cannot adequately exchange oxygen and carbon dioxide leading to insufficient carbon dioxide and oxygen in the body), muscle weakness(decreased strength in the muscles)weak, lack coordination (impaired balance or coordination due to damage brain, nerves or muscle) hyperlipidemia (high levels of fat in the blood), acute kidney failure, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 3 of 7 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 676310 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solera at West Houston 2101 Greenhouse Road Houston, TX 77084 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 metastatic breast cancer with brain tumor(where the cancer cells spread from the original cancer cell to the brain, and atrial fibrillation (irregular/rapid heartbeat causing poor blood flow). Record review of Resident #9's admission MDS dated [DATE] revealed the resident was coded as having a BIMS score of 5 indicating she was severely impaired for cognition, For ADL's the resident was code as dependent of staff for eating, oral hygiene, toileting, shower, upper body dressing, putting/on taking off footwear, and personal hygiene. For Special Care she was coded as being on hospice care. For incontinence she was coded as always incontinent of bowel and bladder. Record review of Resident #9's admission nurses notes dated 6/26/2025 revealed the resident was admitted on respite care with hospice. Her primary diagnosis was metastatic breast cancer with brain tumor. Record review of physician order dated 6/26/2025 revealed order for 02 via nasal canula at 2LPM. Record review of the Resident #9's care plan initiated 7/1/2025 revealed the care plan did not address hospice care and oxygen use for Resident #9. Further review of Resident #9's care plan revealed the care plan was updated to address hospice care and oxygen use on 7/25/25 after the surveyor's intervention. In an interview on 7/25/2025 at 10:15am MDS Coordinator B said she was aware the resident was on respite care by a hospice company when she was first admitted to the facility. She said Resident #9 was a private paid resident then place on hospice. She said, the initial care plan should have address hospice care. She said not updating the care plan to address the resident's status will prevent the resident from getting the care and services needed to improve their quality of life. She said moving forward she was going to ensure that care plan captures all triggered areas and completed by day 21. In an interview on 07/25/2025 2:50 pm, the DON said the expectation of the MDS Nurses were to ensure all care areas that were triggered on the MDS should be captured on the care plan. He said the IDT team should come together along with the family and work on the plan of care. He said he will be in servicing the nursing staff on MDS and care plan accuracy, and ensuring they were done in a timely manner. Record review of the Care Plans Comprehensive Person-Centered dated March 2022 read in part.Policy StatementA comprehensive, person-centered care plan that includes measurable objectives, timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident.Policy Interpretation and Implementation1. The Interdisciplinary Team in conjunction with the resident and his/her family or legal representative develops and implements a comprehensive, person-centered care plan for each resident.2. The comprehensive person-centered care plan is developed within (7) days of the completion of the MDS assessment (admission, annual or significant change in status) and no more than 21 days after assessment. Event ID: Facility ID: 676310 If continuation sheet Page 4 of 7 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 676310 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solera at West Houston 2101 Greenhouse Road Houston, TX 77084 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments and permit only authorized personnel for three of five medication carts observed in common areas accessible to staff and residents. -Three unlocked and unattended medication carts were observed in areas accessible to residents, staff, and visitors. This failure could place residents at risk of ingesting medications not prescribed to them and placed the facility at risk for drug diversion. Findings included:Observation on 07/22/25 at 10:55 a.m. revealed an unlocked/unattended medication cart in front of room [ROOM NUMBER]. The cart was facing the door, which was closed. There was no staff visible from the cart. At 10:56 a.m. revealed MA A opened the door of room [ROOM NUMBER] and exited the room. MA A said the medication cart should have been locked. She said she thought she had locked it. MA A open the top drawer of the medication cart without using keys. Observation revealed the top drawer of the cart contained multiple plastic containers of various over the counter medications. Observation and interview on 07/22/25 at 11:33 a.m. revealed an unlocked/unattended medication cart in front of room [ROOM NUMBER]. The medication cart was facing the door, which was closed. There was no staff visible in the area. At 11:38 a.m. revealed the DON was walking in the hallway approaching the cart. At that time LVN G exited room [ROOM NUMBER]. She said she did not have a key to the medication cart, and that the keypad lock was inoperable. She said a MA had the key. She said this was the second room she went to where she had to leave the cart unlocked. The DON was present, and told LVN G that she could not leave the medication cart unlocked and unattended.Observation and interview on 07/23/25 at 11:20 a.m. revealed an unlocked and unattended medication cart in front of room [ROOM NUMBER]. The medication cart was facing the door, which was closed. At 11:21 a.m. LVN H walked up to the medication cart. She stated it was unlocked. She said I stopped what I was doing because another resident needed me. In an interview on 07/24/25 at 12:12 p.m. the DON said the medication carts should have been secured. He said a resident could get into the medications and ingest medications that were not meant for them. The facility policy Security of Medication Cart (revised April 2007) read, in part, The medication cart shall be secured during medication passes.Policy Interpretation and Implementation1. The nurse must secure the medication cart during the medication pass to prevent unauthorized entry.1.4.Medication carts must be securely locked at all times when out of the nurse's view. Event ID: Facility ID: 676310 If continuation sheet Page 5 of 7 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 676310 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solera at West Houston 2101 Greenhouse Road Houston, TX 77084 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to ensure that foods are store, prepare, distribute, and serve food in accordance with professional standards for food service safety in one of one kitchen in that:1.Foods were not sealed, labeled, and dated.2.Plates with dried food particles were stored with clean plates.3. Food items on the steam table was not maintained at 135 degrees F and above.4. Equipment were clean.5. Dry storage room free of dented cans. These failures could place residents who ate food prepared by the kitchen at risk for food borne disease and illness. Findings included: Observation of the kitchen on 07/22/2025 at 9:10 AM revealed the following:1.The coffee machine had an accumulation of brown stains on the coffee machine. At the time the DM immediately started to clean the coffee machine.2.Plates and bowls with stains and food particles in them were stock with clean plates and bowls. Observation on 7/22/2025 at 9:30 am revealed the deep fat fryer had very dark oil and burnt food particles in it. Observation on 7/22/2025 at 9:35 am of the dry storage room revealed the following:1. 1- 6lbs. dented can of beans.2. 1 single serving plastic container of cheerios was open not sealed. Observation on 7/22/2025 at 9:40 am of the walk-in-freezer revealed the following:1. 1 plastic bag with chicken tenders that was open not sealed.2. 1 plastic bag with mixed vegetables open not sealed3. 1 box with French toast open not sealed. 4. Instant vanilla pudding and chocolate pudding mix not dated. Observation on 7/23/2025 at 12:15pm of the steam table revealed two menu items not at the correct holding temperature:1. Baked fish at 76 degrees 2. Cream pie was at 42 degrees.The fish was reheated to 160 and above and the cream pie was chilled to 41 degrees and below. In an interview on 7/22/2025 at 9:20 AM the Dietary Manager said the coffee machine was clean daily. The Dietary Manager said when cleaning the dishes they should pre rinse ensuring that there was no food in the plates and bowls, and then put in the machine to wash rinse and sanitized. He said after the washing procedure they should check to ensure there were no food particles in the plates and bowls and then they would pack them away. In an interview with the DM on 7/22/2025 at 10:00am he said all food particles should clean from the plates, and they should wash rinse and sanitized allow to air dry and then check to ensure they were clean with no food particles before they were packed away. The DM he said the deep fat fryer was cleaned on Fridays and the coffee machine was cleaned daily. He said he had used the fryer cooked the previous day to cook and that was why the oil was black. Interview with the DM on 7/22/2025 at 10:45 am he said he was going to in-service the staff ensuring that when foods were open, they should be sealed, labeled and dated. In an interview on 7/23/2024 at 12:45 PM Dietary Staff A said food not served at the correct food temperature could get resident sick. He said he was going to ensure that food was always at the correct temperature during meal service. Record review of the policy on Food Temperatures dated May 2008 read in part.Policy:The Dietary Services Manager shall check food temperature routinely.Procedures.1. All hot and cold food items must be served to the resident at a palatable temperature. All hot food must be held at a minimum of 145 degrees Fahrenheit.2. All cold foods must hold at 40 degrees F or below.6. Temperatures should be taken periodically to ensure hot foods stay above 145 degrees F and cold foods stay below 40 degrees F during the tray line period. Record review of the policy on Food Storage dated read in part. Policy: Sufficient storage facilities are provided to keep foods safe, wholesome, and appetizing. Food is stored, prepared, and transported at an appropriate temperature and by methods designed to prevent contamination. Refrigeration:a. Temperatures for refrigerators should be between 40 degrees Fahrenheit or lower. Thermometers should be checked at least twice daily. (See Freezer and Refrigerator Temperature Form).b. Every refrigerator must be equipped with an internal thermometer. e. All foods should be covered, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 6 of 7 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 676310 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solera at West Houston 2101 Greenhouse Road Houston, TX 77084 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 0812 labeled and dated.f. All foods should be stored to allow air circulation.g. Refrigerated foods should be stored upon delivery and careful rotation procedures should be followed Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 7 of 7