Inspection·November 17, 2025

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with kerlix wrap as directed and PRN. *10/31/25: Wound Treatment - Dry Dressing everyday shift for Wound healing. Cleanse right heel eschar with betadine, then apply moist to dry betadine gauze followed by ABD, Secure w/ kerlix wrap qd. Record review of CR#1's progress notes documented by WCN on 09/24/25 stated that her skin was assessed with no open areas and the heels were clear. Record review of CR#1's progress notes documented by the NP on 10/2/25, the NP identified calluses during examination (location unspecified) and CR#1 was started on Tylenol after complaints of pain during her PT sessions. Record review of CR#1's progress notes documented on 10/7/25, the NP documented complaints of worsening foot pain contributed to bilateral lower extremity edema with marked swelling and multiple large, thick calluses present on both feet, particularly prominent on pressure-bearing areas. The calluses appeared dry, hyperkeratotic, and well-established, causing discomfort and contributing to her pain. Skin was noted as noticeably discolored and had chronic venous changes consistent with chronic venous insufficiency. Record review of CR#1's progress notes documented on 10/9/25 by the NP indicated the chronic venous skin changes was consistent with pressure related changes, with difficulty lifting lower right extremity. Record review of CR#1's progress notes documented on 10/15/25, the NP identified the wound on the right heel as a Stage 2 pressure ulcer with drainage and partial thickness skin loss involving the epidermal. Wound management initiated. Record review of CR#1's progress notes documented by the WCN on 10/15/25, that on 10/14/25, a skin issue identified as a blister had appeared on CR#1's right heel after it burst during PT. CR#1 stated that she tried telling PT on 10/13/25 but they could not hear her and in PT again on 10/14/25, she felt pain and stated that her heel started bleeding and draining because the blister popped. WCN assessed the skin issue on 10/15/25 and the area measured 4.5x7.5. The open area measured 2.5x3.5 and was bruised with dark brown discoloration surrounded by maroon tissue with no drainage. NP notified and doppler ordered. Skin was prepped, xeroform applied to bruised area, followed by ABD, and wrapped with kerlix. Prevalon boot in place and monitored for pain and discomfort. NP was notified of doppler results. Record review of CR#1's progress notes documented on 10/22/25 by WCN identified a new skin issue on the right heel. The issue type was a blister and progress had stalled, where previously improving wound characteristics plateaued. Wound acquired in-house. Signs and symptoms of infection: Non-healing. Painful: No. Staged by: Health care provider. Length (cm): 3.5 Width (cm): 3.5 Depth (cm): 0 Undermining: No. Tunneling: No. Epithelial: 10%. Eschar: 90. Exudate amount: None. Periwound temperature: Normal. Cleansing solution: Povidone iodine. Other primary dressing was iodosorb gel, ABD, Kerlix wrap, and utilized prevalon boots. Record review of CR#1's progress notes documented on 10/29/25 by WCN identified a new skin issue on the right heel. The issue type was a blister and progress had stalled, were previously improving wound characteristics plateaued. Wound acquired in-house. Signs and symptoms of infection: Smell increased. Signs and symptoms of infection: Size has increased. Signs and symptoms of infection: Non-healing. Painful: No. Staged by: Health care provider. Length (cm): 4.5 Width (cm): 4.5 Depth (cm): 0 Area (cm2): 0 Undermining: No. Tunneling: No. Granulation: 20%. Eschar: 80%. Exudate amount: None. Periwound temperature: Normal. Cleansing solution: Povidone iodine. Other primary dressing was ABD, Kerlix wrap, and utilized prevalon boots. In a telephone interview with CR #1 and CR#1's family member on 11/8/25 at 12:57 p.m., CR#1 stated she had complained about pain to her foot for 3 weeks before it began to bleed during physical therapy. CR#1 stated that she complained of pain to the nurses, the NP, and the PT. She stated upon admission, her mattress looked like it had a sunken hole in it and was very uncomfortable and the facility told her it could not be replaced. CR#1 and her family member denied the presence of a wound upon admission and CR#1's family member stated that when CR#1 went to her orthopedic appointment on 11/4/25 at 3p.m., she requested the Orthopedic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 2 of 14 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 11/17/2025 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few doctor to examine CR#1's foot. CR#1's family member explained that when the doctor saw her foot, he was shocked and immediately advised that she be admitted to the hospital for further evaluation. Both stated that they had not seen the wound in some time and were shocked that it had gone from the size of a quarter to the whole heel, with black and blue tissue. When asked about wound care at the facility, CR#1 stated that she was not getting wound care every day and someone only unwrapped her foot for wound care once a week. In an observation and interview on 11/10/25 at 9:36 a.m. while visiting CR#1 in the hospital, she stated that she was not feeling too well, and her stomach was hurting. She explained that she was currently waiting on the hospital to give her an MRI. She said at the facility, a woman would come in once a week to put what she perceived was Vaseline on it. She did remember seeing a NP and she stated that she could not recall how often she would see the WCN, but she knew it was not every day for sure and stated, I know they were not coming as often as they have been coming at the hospital to do wound care. When she was at the facility, she constantly told them her foot was killing her, but nobody listened and the gave her pills to help with the pain, but they put her to sleep. She also recalled seeing the WCNP at some point as well. In an interview on 11/10/25 at 9:49 a.m. with HRN in the hospital, she stated that they were currently awaiting approval for CR#1 to receive an MRI because she had a pacemaker and the cardiologist had to sign off on it. The MRI would determine if the wound was infected or not and whether her foot could be saved by antibiotics or she needed amputation. Currently, she explained the wound was unstageable because of all the slough on it. She said that it looked pretty bad, and they were providing wound care on it once a day so that a lot of air would not get into it. HRN also provided a picture of the foot that was taken on 11/4/25 when CR#1 was admitted . Observation on 11/10/25 at 9:51 a.m. of the hospital admission photograph of CR#1's right heel dated for 11/4/25 at 5:27 p.m., the heel looked completely dark brown/black in color. The heels appeared to have some tunneling and dark burgundy tissue could be seen on the parameters of the heel. In an interview on 11/10/25 at 11:36 a.m., NP stated that when she began to visit CR#1, she was alert, oriented, and could answer questions but due to her diagnoses, she was weak and deconditioned. CR#1 had complaints of pain and when she examined her right heel upon admission it was not open. Due to her recent cancer diagnosis, NP stated that she was placed on two oncology medications. After she began taking them. She eventually could not get out of bed or sit in the dining room like she used to. The WCN told her it was a blister developed on her right heel and the WCN probably thought it was a blister because it burst. She explained she did not stage wounds and left that up to the experts and wound care, but she did monitor her wound and prescribed antibiotics and labs so that she would help treat it systemically. NP stated that she did not see the wound every visit and was only able to see the wound if she caught WCN providing wound care. Otherwise she would ask for an update from the WCN on it's progress. She encouraged interviewing CR#1 because she felt she would be able to accurately state what went on. In an interview on 11/10/25 at 1:02 p.m., WCN stated that she had been working at the facility since 2015 and she was currently treating 10 residents with wounds. She explained that when a resident was admitted , she does a skin assessment and identifies any wounds or abrasions. This assessment was documented and if she had any skin issues, she would contact their doctor and inform the WCNP who came to the facility every Thursday. She stated that she first noticed CR#1's wound on 10/14/25 but prior to then, the foot only had a lot of calloused skin. She explained that on 10/14/25, she was on employee leave, but she received a phone call from the ADON letting her know that the blister had popped and she advised her how to treat it. WCN stated that when the blister popped, there was fluid inside. When she examined the blister the next day, the blister measured 4.5x7.5 and the opened part measured 2.5x3.5 with no drainage or odor. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 3 of 14 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 11/17/2025 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few NP ordered a doppler to check for any arterial blockages. She explained that she diagnosed it as a blister initially and then it eschared over on 10/20/25. When asked if she consulted with the WCNP when the heel burst open, WCN stated that she consulted with the WCNP to see CR#1 on Thursday that week but she was not seen by the WCNP. She explained that she thought she might have had an oncology appointment that Thursday and it conflicted with his schedule. She also stated that NP would still see her often and she believed she would view the wound on every visit. Until then, skin prep was done around the outer area of the wound and xeroform was used for the wound itself. On 10/27/25, WCN noticed an odor to the wound the NP order doxycycline antibiotics to help treat a possible infection and she was seen by the WCNP that week on 10/30/25. Although she had orders to provide wound care every other day, she stated that she would check on the wound daily and make sure preventative measures like the boots were in place. On 11/3/25, WCN noticed the odor had returned and the NP stated that she wanted CR#1 to be sent out for evaluation. WCN stated the wound did not look any different from the last time she saw it, where it was still covered with eschar but it had a smell. She was aware of an appointment for CR#1 the following day (11/4/25) and was not sure why she was not sent out the day the NP requested further evaluation. Record review of CR#1's progress notes showed that on Thursday 10/16/25, no doctor's appointment was documented. Record review of CR#1's progress note documented on 11/3/25 by NP stated: Discussed wound care progress with the wound care nurse. The left foot wound has developed an odor, prompting the addition of a vascular surgery consultation for evaluation and management of the right lower extremity wound. Laboratory studies today reveal significant hyperglycemia with glucose readings ranging from 140-278 mg/dL throughout the day. Additional lab abnormalities include hemoglobin of 8.5 g/dL, elevated BUN of 29 mg/dL, creatinine of 1.49 mg/dL, and decreased eGFR of 36. In a follow up interview with the NP on 11/10/25 at 3:05 p.m., she explained that CR#1 had many things going on and because she had an odor to the right heel, she wanted her to see a specialist. She explained that it was better for her to see a specialist than go to the ER because they would provide a different type of care. Due to CR#1 being very deconditioned and having several comorbidities, care staff would have to take it easy with her. In an interview on 11/13/25 at 10:20 a.m., the WCNP stated that he visited the facility every Thursday and was given a list of each patient to review. He first saw CR#1 on 10/23/25 and again on 10/30/25. During his initial visit, the treatment order for the wounds iodozone and iodine paste and it was appropriate for the wound at that time. The pressure wound was a Stage 2, superficial, with scant to moderate drainage, and the frequency of treatment was 3xs a week because it was superficial. ABD and a floater. wrap with kerlix gauze, heel was off loaded, and a PRN order was in place. On the visit of 10/30/25, she was on doxycycline from the facility. The measurements were 4x5x0.1, with no tunneling or undermining. WCNP explained that he switched treatments from xeroform to Betadine because he noticed the wound had become dark and became eschar, and once the eschar comes off, the wound would be unstageable. He could not say that the wound had gotten worse in between visits but he used the betadine because he wanted to stable the wound. He felt that with her diagnoses, she was not a good candidate for debridement. If she had a blister, the facility should have let it pop naturally, and he would only see her once the wound had been opened. If he suspected there was an infection, he would have escalated it immediately. In a follow-up interview on 11/13/25 at 3:00 p.m., the WCN was asked questions based off her weekly skin assessments ordered to be completed every Monday on CR#1's TAR. She explained that when there was a new resident, she would normally see them on day they were admitted or on the following day. No note was present in the progress notes and WCN stated she could not explain why she did not document a progress note. Review of the progress notes showed that her first note on CR#1 was on 9/22/25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 4 of 14 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 11/17/2025 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and she stated that she could not explain why it had been 6 days post admittance that she documented assessing CR#1. In the middle of this interview, WCN stepped out to get her timecard from human resources and she confirmed that she was not absent on any of those days. Interview and record review on 11/13/25 at 3:33 p.m. of the skin assessment on 9/22/25, WCN marked E that identified an existing wound alteration, but on 9/29/25 she documented 0, which she identified to mean the skin was clear because it was not listed on the assessment's key. On 10/14/25, she explained that she was off the blister opened but review of the TAR showed that on 10/13/25, she documented that nothing was there. Review of the progress notes showed that WCN documented a late entry on 10/15/25 to explain the wound condition for 10/14/25. When asked if you were off on 10/14/25, how could she document a note on regarding the observation and treatment of the wound? WCN stated that she tried to convey to the reader that the wound occurred on 10/14/25. When asked why there was not a progress note from the ADON regarding her observation and treatment of the wound since she was the one who provided care when informed that it had burst, she could not speak to it, but she stated when she returned to work on 10/15/25 CR#1 was the first person she saw. WCN expressed that she did not initially check CR#1's clinical records prior to providing care and she did not know until her heel burst on 10/14/25 that her admittance hospital records had documented the presence of a wound to the right heel on 9/15/25 (admission date 9/18/25). She felt that 3 days was not enough time for a wound to heal and suspected that upon admission, perhaps the wound had healed on the outside but not on the inside. When asked if she did an SBAR for the heel's change in condition, she stated that she did not complete SBAR assessments and documented in the progress notes instead. On 09/24/25, WCN described the wound as a blister that was greyish white with a hole in the center and on 10/15/25, she documented the blister to be bruised with dark brown discoloration surrounded by maroon tissue. She said she had nothing but scar tissue on the balls of her feet and she had no idea where the blister came from. WCN stated that upon admittance, all she saw were calluses on her foot and no wounds. She stated that she felt like it was a blister because it had fluid in it when it burst. She felt that the wound was stable while she was at the facility and not out of her scope. She could not say why she documented the presence of a skin issue incorrectly on her weekly skin assessments and said it was a mistake. Review of hospital records, admittance date 11/4/25, progress note dated 11/12/25 stated CR#1 was admitted due to a necrotic right heel pressure ulcer and podiatry was consulted and pending the decision from family and CR#1 regarding possible amputation. In an interview on 11/18/25 at 8:22 a.m., CR#1's family member, she stated that CR#1 received surgery to amputate her right leg above the knee on 11/17/25. The surgery had gone well, but her family and CR#1 were exhausted and resting at that time. Record review of the facility's Skin Assessment Policy implemented on 10/01/25 stated that it was policy to perform a full body skin assessment as part of the systematic approach to pressure Injury prevention and management. A full body, or head to toe skin assessment will be conducted by a licensed or registered nurse upon admission/readmission, and weekly thereafter. Procedures stated to:1. Remove any special garments or devices, if not contraindicated or ordered to remain in place.2. Remove any dressings, using clean technique, unless contraindicated or ordered to remain in place, and note findings. 3. Note any skin conditions such as redness, bruising, rashes, blisters, skin tears, open areas, ulcers, and lesions. Documentation of a skin assessment consisted of:1. Include the date and time of the assessment, your name, position, and title.2. Document observations (skin conditions, how the resident tolerated the procedure, etc.)3. Document type of wound.4. Describe wound (measurements, color, type of tissue in wound bed, drainage, odor, pain).5. Document if resident refused assessment and why. 6. Document other information as indicated appropriate. Considerations for patients with darkly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 5 of 14 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 11/17/2025 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 0641 pigmented skin indicators were:1. Bogginess2. Skin discoloration Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 6 of 14 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 11/17/2025 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that residents with pressure ulcers receive necessary treatments and services, consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing for 1 (CR #1) of 5 residents reviewed for wound care. The facility failed to properly identify the pressure ulcer and provide immediate oversight by a wound care specialist when the wound was first identified as a Stage 2 Pressure Ulcer on 10/15/25. CR#1 was admitted to the hospital on [DATE] with a necrotic pressure ulcer to the right heel and the need for possible amputation of the lower right extremity. On 11/17/25, CR#1's family member stated that CR#1's right leg was amputated above the knee due to an infected pressure ulcer of her heel. An Immediate Jeopardy (IJ) was identified on 11/14/25. The IJ template was provided to the facility on [DATE] at 3:31 pm. While the IJ was removed on 11/15/25, the facility remained out of compliance at a scope of pattern and severity level of no actual harm with potential for more than minimal harm that is not IJ, due to the need for the facility to evaluate the effectiveness of the corrective action. These failures could place residents at risk for delayed treatment, worsening of condition, hospitalization, and death.Findings Include:Record review of CR #1's facesheet revealed a seventy-six-year-old woman who was admitted to the facility on [DATE]. Her admitting diagnoses was a pulmonary embolism without acute pulmonale (blood clot in the lung), secondary malignant neoplasm of bone (cancer that has spread throughout the body), hyperlipidemia, difficulty walking, and the presence of a pacemaker. Record review of CR#1's admitting hospital records dated 09/15/25 documented that CR#1 had Type 2 Diabetes, a pressure injury to the right heel that was present upon admission, and a right arthroplasty of the and hip (hip replacement) on 8/18/25. Record review of CR #1's care plan initiated 09/18/25 documented pain management and interventions stated that if pain was present, LVN should assess and document the pain assessment including location, nature, intensity, and duration of pain. Pressure ulcer interventions included floating heels as tolerated and using a pressure redistribution mattress. Record review of CR#1's MDS dated [DATE] revealed a BIMS score of 11 (moderate cognitive impairment). Section GG titled Functional Abilities upon admission noted that CR#1 was dependent to sit to stand, transfer from chair to bed, toilet transfer, and walking 10, 50, and 150 feet. Section M titled Skin conditions documented that CR#1 was at risk at developing a pressure ulcer based off a formal and clinical assessment. In the subsection unhealed pressure ulcers/injuries, it was documented that CR#1 had no present skin conditions. Record review of CR#1's admission assessment completed on 9/18/25 by RN A, documented that no wound was present upon admission. She was marked as bed bound due to prior hip replacement surgery. Record review of CR#1's weekly head to toe assessment located on the TAR for September 2025 reflected on the following:* 09/22/25, WCN marked E that identified an existing wound alteration (location not specified). *09/29/25, WCN marked 0, which was not listed as an abbreviation on the assessment key. Review of the weekly skin assessments for October 2025 documented the following:*10/6/25, WCN marked 0*10/13/25, WCN marked 0*10/21/25, WCN marked E*10/27/25, WCN marked 0 Record review of CR#1's active orders as of 9/18/25 were as follows:*09/22/15: ordered weekly head to toe assessments every Monday where N=new, E= existing skin altercation, and C= clear. *10/16/25: Wound Treatment - Xeroform every day shift every other day for open blister. Cleanse open blister right heel with saline, pat dry, apply skin prep to skin of surrounding area, apply xeroform to bruised open wound, cover with ABD. Secure with kerlix wrap. Elevate and off load. Monitor for discomfort. This order was discharged on 10/22/25. *10/17/25: Doxycycline ordered.*10/23/25: Wound Treatment - Dry Dressing every day shift every other day for wound healing. Cleanse right heel Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 7 of 14 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 11/17/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some eschar wound with saline, pat dry, apply iodosorb gel to wound bed then cover with ABD, secure with kerlix wrap as directed and PRN. *10/31/25: Wound Treatment - Dry Dressing everyday shift for Wound healing. Cleanse right heel eschar with betadine, then apply moist to dry betadine gauze followed by ABD, Secure w/ kerlix wrap qd. Record review of CR#1's progress notes documented by the NP on 10/2/25, the NP identified calluses during examination (location unspecified) and CR#1 was started on Tylenol after complaints of pain during her PT sessions. Record review of CR#1's progress notes documented on 10/7/25, the NP, documented complaints of worsening foot pain contributed to bilateral lower extremity edema with marked swelling and multiple large, thick calluses present on both feet, particularly prominent on pressure-bearing areas. The calluses appeared dry, hyperkeratotic, and well-established, causing discomfort and contributing to her pain. Skin was noted as noticeably discolored and had chronic venous changes consistent with chronic venous insufficiency. Record review of CR#1's progress notes documented on 10/9/25 by the NP indicated the chronic venous skin changes was consistent with pressure related changes, with difficulty lifting lower right extremity. Record review of CR#1's progress notes documented on 10/15/25, the NP identified the wound on the right heel as a Stage 2 pressure ulcer with drainage and partial thickness skin loss involving the epidermal. Wound management initiated. Record review of CR#1's progress notes documented by the WCN on 10/15/25, that on 10/14/25, a skin issue identified as a blister had appeared on CR#1's right heel after it burst during PT. CR#1 stated that she tried telling PT on 10/13/25 but they could not hear her and in PT again on 10/14/25, she felt pain and stated that her heel started bleeding and draining because the blister popped. WCN assessed the skin issue on 10/15/25 and the area measured 4.5x7.5. The open area measured 2.5x3.5 and was bruised with dark brown discoloration surrounded by maroon tissue with no drainage. NP notified and doppler ordered. Skin was prepped, xeroform applied to bruised area, followed by ABD, and wrapped with kerlix. Prevalon boot in place and monitored for pain and discomfort. NP was notified of doppler results. Record review of CR#1's progress notes documented by WCN on 10/17/25 stated that the right heel wound was monitored frequently throughout the day by wound care/ charge nurses and CR #1's right heel was offloaded and elevated. No weight should be barred to the right heel until the blister was resolved. She was currently stable, no odor, the wound bed remained bruised to the center surrounded by pink tissue. The wound edges were detached and white in color. The skin was monitored for any new open areas, and no areas were currently noted. RP made aware of current progress. Record review of CR#1's progress notes documented on 10/20/25 by NP recorded that the clinical indication for the venous doppler found the appropriate compression and color flow throughout the visualized deep venous system with no evidence of deep venous thrombosis. Impression revealed no DVT identified in the visualized veins. Record review of CR#1's progress notes documented on 10/22/25 by WCN identified a new skin issue on the right heel. The issue type was a blister and progress had stalled, were previously improving wound characteristics plateaued. Wound acquired in-house. Signs and symptoms of infection: Non-healing. Painful: No. Staged by: Health care provider. Length (cm): 3.5 Width (cm): 3.5 Depth (cm): 0 Undermining: No. Tunneling: No. Epithelial: 10%. Eschar: 90. Exudate amount: None. Periwound temperature: Normal. Cleansing solution: Povidone iodine. Other primary dressing was iodosorb gel, ABD, Kerlix wrap, and utilized prevalon boots. Record review of CR#1's progress notes documented on 10/29/25 by WCN identified a new skin issue on the right heel. The issue type was a blister and progress had stalled, were previously improving wound characteristics plateaued. Wound acquired in-house. Signs and symptoms of infection: Smell increased. Signs and symptoms of infection: Size has increased. Signs and symptoms of infection: Non-healing. Painful: No. Staged by: Health care provider. Length (cm): 4.5 Width (cm): 4.5 Depth (cm): 0 Area (cm2): 0 Undermining: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 8 of 14 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 11/17/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some No. Tunneling: No. Granulation: 20%. Eschar: 80%. Exudate amount: None. Periwound temperature: Normal. Cleansing solution: Povidone iodine. Other primary dressing was ABD, Kerlix wrap, and utilized prevalon boots. In a telephone interview with CR #1 and CR#1's family member on 11/8/25 at 12:57 p.m., CR#1 stated she had complained about pain to her foot for 3 weeks before it began to bleed during physical therapy. CR#1 stated that she complained of pain to the nurses, the NP, and the PT. She stated upon admission, her mattress looked like it had a sunken hole in it and was very uncomfortable and the facility told her it could not be replaced. CR#1 and her family member denied the presence of a wound upon admission and CR#1's family member stated that when CR#1 went to her orthopedic appointment on 11/4/25 at 3p.m., she requested the Orthopedic doctor to examine CR#1's foot. CR#1's family member explained that when the doctor saw her foot, he was shocked and immediately advised that she be admitted to the hospital for further evaluation. Both stated that they had not seen the wound in some time and were shocked that it had gone from the size of a quarter to the whole heel, with black and blue tissue. When asked about wound care at the facility, CR#1 stated that she was not getting wound care every day and someone only unwrapped her foot for wound care once a week. In an interview on 11/10/25 at 9:36 a.m. while visiting CR#1 in the hospital, she stated that she was not feeling too well, and her stomach was hurting. She explained that she was currently waiting on the hospital to give her an MRI. She said at the facility, a woman would come in once a week to put what she perceived was Vaseline on it. She did remember seeing a NP and she stated that she could not recall how often she would see the WCN, but she knew it was not every day for sure and stated, I know they were not coming as often as they have been coming at the hospital to do wound care. When she was at the facility, she constantly told them her foot was killing her, but nobody listened and the gave her pills to help with the pain, but they put her to sleep. She also recalled seeing the WCNP at some point as well. In an interview on 11/10/25 at 9:49 a.m., the HRN in the hospital, stated that they were currently awaiting approval for CR#1 to receive an MRI because she had a pacemaker and the cardiologist had to sign off on it. The MRI would determine if the wound was infected or not and whether her foot could be saved by antibiotics or she needed amputation. Currently, she explained the wound was unstageable because of all the slough on it. She said that it looked pretty bad, and they were providing wound care on it once a day so that a lot of air would not get into it. HRN also provided a picture of the foot that was taken on 11/4/25 when CR#1 was admitted . Observation on 11/10/25 at 9:51 a.m. of the hospital admission photograph of CR#1's right heel dated for 11/4/25 at 5:27 p.m., the heel looked completely dark brown/black in color. The heels appeared to have some tunneling and dark burgundy tissue could be seen on the parameters of the heel. In an interview on 11/10/25 at 11:36 a.m., NP stated that when she began to visit CR#1, she was alert, oriented, and could answer questions but due to her diagnoses, she was weak and deconditioned. CR#1 had complaints of pain and when she examined her right heel upon admission it was not open. Due to her recent cancer diagnosis, NP stated that she was placed on two oncology medications. After she began taking them. She eventually could not get out of bed or sit in the dining room like she used to. The WCN told her it was a blister developed on her right heel and the WCN probably thought it was a blister because it burst. She explained she did not stage wounds and left that up to the experts and wound care, but she did monitor her wound and prescribed antibiotics and labs so that she would help treat it systemically. NP stated that she did not see the wound every visit and was only able to see the wound if she caught WCN providing wound care. Otherwise, she would ask for an update from the WCN on its progress. She encouraged interviewing CR#1 because she felt she would be able to accurately state what went on. In an interview on 11/10/25 at 1:02 p.m., WCN stated that she had been working at the facility since 2015 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 9 of 14 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 11/17/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some and she was currently treating 10 residents with wounds. She explained that when a resident was admitted , she does a skin assessment and identifies any wounds or abrasions. This assessment was documented and if she had any skin issues, she would contact their doctor and inform the WCNP who came to the facility every Thursday. She stated that she first noticed CR#1's wound on 10/14/25 but prior to then, the foot only had a lot of calloused skin. She explained that on 10/14/25, she was on employee leave, but she received a phone call from the ADON letting her know that the blister had popped and she advised her how to treat it. WCN stated that when the blister popped, there was fluid inside. When she examined the blister the next day, the blister measured 4.5x7.5 and the opened part measured 2.5x3.5 with no drainage or odor. NP ordered a doppler to check for any arterial blockages. She explained that she diagnosed it as a blister initially and then it eschared over on 10/20/25. When asked if she consulted with the WCNP when the heel burst open, WCN stated that she consulted with the WCNP to see CR#1 on Thursday that week but she was not seen by the WCNP. She explained that she thought she might have had an oncology appointment that Thursday and it conflicted with his schedule. She also stated that NP would still see her often and she believed she would view the wound on every visit. Until then, skin prep was done around the outer area of the wound and xeroform was used for the wound itself. On 10/27/25, WCN noticed an odor to the wound the NP order doxycycline antibiotics to help treat a possible infection and she was seen by the WCNP that week on 10/30/25. Although she had orders to provide wound care every other day, she stated that she would check on the wound daily and make sure preventative measures like the boots were in place. On 11/3/25, WCN noticed the odor had returned and the NP stated that she wanted CR#1 to be sent out for evaluation. WCN stated the wound did not look any different from the last time she saw it, where it was still covered with eschar but it had a smell. She was aware of an appointment for CR#1 the following day (11/4/25) and was not sure why she was not sent out the day the NP requested further evaluation. Record review of CR#1's progress notes showed that on Thursday 10/16/25, no doctor's appointment was documented. Record review of CR#1's progress note documented on 11/3/25 by NP stated: Discussed wound care progress with the wound care nurse. The left foot wound has developed an odor, prompting the addition of a vascular surgery consultation for evaluation and management of the right lower extremity wound. Laboratory studies today reveal significant hyperglycemia with glucose readings ranging from 140-278 mg/dL throughout the day. Additional lab abnormalities include hemoglobin of 8.5 g/dL, elevated BUN of 29 mg/dL, creatinine of 1.49 mg/dL, and decreased eGFR of 36. In an interview on 11/10/25 at 2:01 p.m., ADON stated that she had worked at the facility since June 2024 and she had begun to cover some of the DON responsibilities since his termination on 10/12/25. She stated that when there is a new wound, the WCN should assess it and put orders in. She should then reach out to their PCP or NP and get their orders and then let the WCNP know so that when they round on Thursdays, he can make his own assessment and give treatment recommendations. In a follow up interview with the NP on 11/10/25 at 3:05 p.m., she explained that CR#1 had many things going on and because she had an odor to the right heel, she wanted her to see a specialist. She explained that it was better for her to see a specialist than go to the ER because they would provide a different type of care. Due to CR#1 being very deconditioned and having several comorbidities, care staff would have to take it easy with her. In an interview on 11/12/25 at 8:24 a.m., CR#1's family member stated that she was very upset because she had just gotten news from the hospital that CR#1 would have to her right leg amputated due to an infection of her right heel. She stated the doctors initially told her that the amputation would occur below the knee, but now the amputation would occur above the knee. In an interview on 11/13/25 at 10:20 a.m., the WCNP stated that he visited the facility every Thursday and was given a list of each (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 10 of 14 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 11/17/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some patient to review. He first saw CR#1 on 10/23/25 and again on 10/30/25. During his initial visit, the treatment order for the wounds iodozone and iodine paste and it was appropriate for the wound at that time. The pressure wound was a Stage 2, superficial, with scant to moderate drainage, and the frequency of treatment was 3xs a week because it was superficial. ABD and a floater. wrap with kerlix gauze, heel was off loaded, and a PRN order was in place. On the visit of 10/30/25, she was on doxycycline from the facility. The measurements were 4x5x0.1, with no tunneling or undermining. WCNP explained that he switched treatments from xeroform to Betadine because he noticed the wound had become dark and became eschar, and once the eschar comes off, the wound would be unstageable. He could not say that the wound had gotten worse in between visits but he used the betadine because he wanted to stable the wound. He felt that with her diagnoses, she was not a good candidate for debridement. If she had a blister, the facility should have let it pop naturally, and he would only see her once the wound had been opened. If he suspected there was an infection, he would have escalated it immediately. In an interview on 11/13/25 at 1:28 p.m., the PT stated for the first 10 days of October, he only worked with CR#1. She had a lot of aches and pains but she was doing well with her walking and mobility. He recalled that she often complained of pain in her thigh but never recalled her mentioning her heel. Whenever he would come and get her for therapy, she was always dressed and wearing her shoes. After staff found out about the wound on her heel, she no was no longer able to participate in physical therapy because she could not bear weight on that heel to transfer. He stated that when he saw her heels, they appeared very soft and boggy and it was probably happening the whole time but it went undetected. In a follow-up interview on 11/13/25 at 3:00 p.m., the WCN was asked questions based off her weekly skin assessments ordered to be completed every Monday on CR#1's TAR. She explained that when there was a new resident, she would normally see them on day they were admitted or on the following day. No note was present in the progress notes and WCN stated she could not explain why she did not document a progress note. Review of the progress notes showed that her first note on CR#1 was on 9/22/25 and she stated that she could not explain why it had been 6 days post admittance that she documented assessing CR#1. In the middle of this interview, WCN stepped out to get her timecard from human resources and she confirmed that she was not absent on any of those days. During tan interview on 11/14/25 at 3:00 p.m., the WCN explained that she was off the day CR #1's blister opened but review of the TAR showed that on 10/13/25, she documented that nothing was there. Review of the progress notes showed that WCN documented a late entry on 10/15/25 to explain the wound condition for 10/14/25. When asked if she was off on 10/14/25, how could she document a note on regarding the observation and treatment of the wound? WCN stated that she tried to convey to the reader that the wound occurred on 10/14/25. When asked why there wasn't a progress note from the ADON regarding her observation and treatment of the wound since she was the one who provided care when informed that it had burst, she could not speak to it, but she stated when she returned to work on 10/15/25 CR#1 was the first person she saw. WCN expressed that she did not initially check CR#1's clinical records prior to providing care and she did not know until her heel burst on 10/14/25 that her admittance hospital records had documented the presence of a wound to the right heel on 9/15/25 (admission date 9/18/25). She felt that 3 days was not enough time for a wound to heel and suspected that upon admission, perhaps the wound had healed on the outside but not on the inside. When asked if she did an SBAR for the heel's change in condition, she stated that she did not complete SBAR assessments and documented in the progress notes instead. On 09/24/25, WCN described the wound as a blister that was greyish white with a hole in the center and on 10/15/25, she documented the blister to be bruised with dark brown discoloration surrounded by maroon tissue. She said she had nothing but scar tissue on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 11 of 14 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 11/17/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some balls of her feet and she had no idea where the blister came from. WCN stated that upon admittance, all she saw were calluses on her foot and no wounds. She stated that she felt like it was a blister because it had fluid in it when it burst. She felt that the wound was stable while she was at the facility and not out of her scope. She could not say why she documented the presence of a skin issue incorrectly on her weekly skin assessments and said it was a mistake. In a follow up interview on 11/13/25 at 4:39 p.m., the ADON stated that while CR#1 was in therapy, her heel had burst and someone from therapy had asked her to come and look at her foot. When she saw her heel, the fluid had already burst and no blood was present. She described the right heel to have a clear top layer of skin that was pulled back and there was no drainage. She called the WCN, and she was told to clean with normal saline, pat dry, and wrap with kerlix. She did not see anything on the bottom of her feet but noticed the skin issue on the back of her right achilleas. She stated that she did not document this in the progress notes or complete an assessment for it because she completely forgot. She was supposed to do an SBAR assessment, and a progress note but it was not documented. Review of hospital records, admittance date 11/4/25, progress note dated 11/12/25 stated CR#1 was admitted due to a necrotic right heel pressure ulcer and podiatry was consulted and pending the decision from family and CR#1 regarding possible amputation. In an interview on 11/18/25 at 8:22 a.m., CR#1's family member, she stated that CR#1 received surgery to amputate her right leg above the knee on 11/17/25. The surgery had gone well, but her family and CR#1 were exhausted and resting at that time. Record review of the facility's Skin Assessment Policy implemented on 10/01/25 stated that it was policy to perform a full body skin assessment as part of the systematic approach to pressure Injury prevention and management. A full body, or head to toe skin assessment will be conducted by a licensed or registered nurse upon admission/readmission, and weekly thereafter. Procedures stated to:1. Remove any special garments or devices, if not contraindicated or ordered to remain in place.2. Remove any dressings, using clean technique, unless contraindicated or ordered to remain in place, and note findings. 3. Note any skin conditions such as redness, bruising, rashes, blisters, skin tears, open areas, ulcers, and lesions. Documentation of a skin assessment consisted of:4. Include the date and time of the assessment, your name, position, and title.5. Document observations (skin conditions, how the resident tolerated the procedure, etc.)6. Document type of wound.7. Describe wound (measurements, color, type of tissue in wound bed, drainage, odor, pain).8. Document if resident refused assessment and why. 9. Document other information as indicated appropriate. Considerations for patients with darkly pigmented skin indicators were:10. Bogginess11. Skin discolorationThe ADM, Regional VP, and Regional Nurse were notified on 11/14/25 at 3:31 p.m., that an IJ had been identified and an IJ template was provided. The following POR was approved on 11/14/25 at 5:31 p.m.: Immediate JeopardyPlan of Removal11/14/2025F686 Pressure Ulcers CR#1 was admitted to the hospital on [DATE] with a necrotic pressure ulcer to the right heel and the need for possible amputation of lower right extremity. The facility failed to properly identify the pressure ulcer and provide immediate oversight by a wound care specialist when the wound was first identified as a Stage 2 Pressure Ulcer on 10/15/25. Immediate action:Please accept this as a Plan of Removal to remove the IJ Identified F686 Pressure Ulcers initiated on 11/14/2025.The facility took the following immediate actions to ensure there are no residents in jeopardy or threat of harm: Skin sweep of all residents to assess for any worsening or unidentified pressure ulcers to identify and provide treatment to all pressure ulcers. The skin sweep was completed by RDCS, DON, DON #2, UNIT MANAGER, and Treatment Nurse on 11/14/2025 with no new findings or negative outcomes. Conducted Emergency QAPI meeting on 11/14/2025 regarding pressure ulcers including notification to the medical director. On 11/14/2025 RDCS/DON/Designee audited new admissions and readmissions (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 12 of 14 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 11/17/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some for last 14 days to ensure any pressure injuries were identified appropriately, prevention measures in place, and treatment orders, as applicable. Completed in-services regarding pressure ulcers for all licensed nursing staff including head to toe skin assessments, newly identified wounds will be assessed and document with notifications to RP and medical provider, skin assessment will be completed by charge nurse treatment nurse for any new admission or readmission, and treatment orders will be obtained as applicable. This includes implementing quick interventions to prevent further breakdown of identified pressure ulcers by providing air mattresses for residents as applicable. In-services were completed on 11/14/2025 by RDCS, DON, ADON, and UM. Each Licensed Nurse will complete a post-test after their education was completed to ensure staff comprehend in-services. If the employee did not pass the test with at least 90% correctly answered the staff member was re-educated and re-tested until at least 90% pass rate was met. DON/Designee will utilize a staff roster to ensure 100% compliance with education. Licensed nurses will not be allowed to work until in-services completed by DON/Designee.Systematic Approach: Resident #1 was discharged on 11/4/2025. The facility plans to ensure quality of care for residents including: Head to toe skin assessments of all residents were completed on 11/14/2025 by the Director of Nursing (DON), Treatment Nurse, Assistant Director of Nursing (ADON), and Regional Compliance Nurse. No worsening or unidentified pressure ulcers were noted on any residents. All newly admitted residents will have a head-to-toe skin assessment completed by the licensed nurse or treatment nurse and verified by the DON/Designee to ensure all pressure ulcers are identified upon admission and readmission and ensure appropriate treatment. The nursing staff was in-serviced on 11/14/2025 by the RDCS, DON, ADON, UM and Treatment Nurse on these protocols. Completed in-services on 11/14/2025 regarding pressure ulcers for all licensed nursing staff including how to complete head to toe skin assessments, newly identified wounds will be assessed and document with notifications to RP and medical provider, skin assessment will be completed by charge nurse treatment nurse for any new admission or readmission, and treatment orders will be obtained as applicable. This includes implementing quick interventions to prevent further breakdown of identified pressure ulcers by providing air mattresses for residents as applicable Clinical staff will not be allowed to work their scheduled shift until they have completed all education related to the IJ. The Treatment Nurse or Nurse Manager designee will complete a head-to-toe assessment and document in the EMR to validate the findings of the initial skin assessment. Head-to-toe assessments must be completed weekly. The Treatment Nurse and Nurse Managers were in-serviced by the RDCS/DON on 11/14/2025 regarding these protocols. Any newly identified wounds will be addressed by the Treatment Nurse or Licensed Nurses to include assessment and documentation of the skin site and initiate appropriate clinical interventions. Notify the Patient's Representative and Medical Provider of any new or change in the existing wound(s) and document in EMR. The Treatment Nurse and Licensed Nurses were in-serviced on 11/14/2025 by the RDCS/DON on these protocols. A Wound Assessment will be completed by the Treatment Nurse or Licensed Charge Nurse and a narrative of each site will be documented weekly for any pressure injury. The Treatment Nurse and Licensed Nurses were in-serviced on 11/14/2025 by the DON on these protocols. RDCS/DON completed an audit of all findings to ensure implementation of skin system on 11/14/2025. The Medical Director was notified of the Immediate Jeopardy on 11/14/2025 by Executive Director. The facility conducted an emergency QAPI meeting on 11/14/2025 The Treatment Nurse received 1:1 education and counseling regarding identification of pressure ulcers including worsening of wounds and obtaining orders from the physician for appropriate treatments. This education was completed by the RDCS and DON on 11/14/2025 The treatment nurse will present a clinical wound report every day during the Clinical Stand-Up Meeting beginning 11/14/2025. The Treatment Nurse was in-serviced on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676310 If continuation sheet Page 13 of 14 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 11/17/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 11/14/2025 by the RDCS and DON on this protocol.Monitoring: DON/Designee will monitor new admissions during daily clinical IDT Stand Up meeting to ensure skin assessments has been completed upon admission and interventions and treatment orders are in place, as applicable. RN Weekend Supervisor will monitor new admissions on the weekend to ensure skin assessments has been completed upon admission and interventions and treatment orders are in place, as applicable.Policy and Procedures: Facility policies & procedures were reviewed by the DON, RDCS, VP of Operations, VP of Clinical Services and Director of Education on 11/14/2025. The following policies and procedures were reviewed and determined to be compliant with meeting the needs of residents. The policies and procedures were included in the staff in-servicing. Patient Care Management System #1 Skin Guidelines.Monitoring Day 1:Reviewed the QAPI and reflected that a facility wide skin sweep was completed on 11/13/25. QAPI and revisit the list for all staff in attendance. Reviewed all CNAs was in serviced on skin patient care management. Utilized the skin assessment policy for the in-service learning materials. WCN was in-serviced on 11/14/25 on skin patient care management. RN's and LVN's were also in serviced. Also had post skin assessment test completed by all RN's. Record review of all residents had skin sweeps on head-to-toe skin assessments completed on 11/14/25. Reviewed the residents with pressure ulcers or skin issues list with charting. Charting showed resident name, admission date, if a skin assessment was completed upon admittance, if there was a pressure ulcer on admission, if there was a tx order in place, and listed out what the preventative measures that have implemented. Staff Interviews: 11/15/2510:20 am- Interview with ADON. She stated that all facility staff had been in-service on Pressure Ulcers. Record review of the accepted POR, no concerns. 10 Event ID: Facility ID: 676310 If continuation sheet Page 14 of 14