Inspection·June 26, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few PM revealed the following note: Received report from the outgoing nurse that patient voiced concern regarding a CNA's approach during care. Patient reported that the assigned CNA was not gentle and continued to insist that he perform tasks independently, despite the patient stating he felt too weak and required two-person assistance. CNA reportedly attempted care initially alone, but eventually called for a second staff member to assist. During assessment, patient was noted with an existing bruise to the left upper arm that appeared to have reopened, resulting in a small amount of blood observed on the bedsheet. It remains unclear when the original injury occurred. Patient continued to express that the CNA was rough during care. Writer obtained statements from the involved CNA and requested the primary nurse to initiate an incident report for documentation and follow-up. Patient was repositioned and made comfortable in bed. The DON was notified of the incident and ongoing concerns. Will continue to monitor patient closely and follow up as needed. Record review of documentation supplied by ED that revealed, handwritten dated and time of employees termination on top of the Texas Board of Nursing records for each employee involved in the incident. The Director of Nursing (6/25/2025 at 7:29pm), LVN A (6/25/2025 at 8:29pm), RN A (6/25/2025 at 7:31pm), and CNA A (6/25/2025 at 7:36pm), were all terminated on 06/25/2025 for failure to immediately report abuse to the Abuse Coordinator. During an observation and interview on 6/24/25 at 9:15 AM, CR#1 was seated in his wheelchair at the entrance of his room and was observed with a bandage on his left forearm that had a small amount of blood on it. It had a written date of 6/24/2025. CR#1 was alert, orientated to person, place and event. CR#1 stated the injury occurred when CNA A tried putting him in bed by herself by pulling his arms to lift him out of the wheelchair. CR#1 stated he told CNA A he did not want to go to bed, but she insisted anyway and continued to pull on his arms. CR#1 stated CNA A told him she could put him in bed by herself and he told her it would take two people, but he was not ready to go to bed. He stated CNA A told him if she didn't put him in bed then he would be there all night even if he pooped on himself, and she would not bring him any food. He stated CNA A insisted on putting him in bed by herself and he told her he was unable to assist her due to how he was feeling. CR#1 stated during her pulling on his arms by herself, CNA A injured his left arm. CR#1 continued to tell CNA A not to pick him up by herself because it took two people. He stated she did not listen, but when she realized she couldn't she went and got CNA B. CR#1 stated he told LVN what occurred when she came to his room. He stated CNA A was rough with him. In a telephone interview on 6/24/2025 at 11:22 AM, LVN A stated she became aware of the incident by CR#1 on Saturday 6/21/2025 around 4:15PM-4:30PM while she was doing her rounds. She stated when she got to CR#1's room he was in bed which was unusual for him since he went to bed after dinner. LVN A went into the room, and she stated CR#1 looked as if he was crying. LVN A stated FM A informed her additional things that were going on like CR#1 had been treated mean and CR#1 stated CNA A hurt him. LVN A stated CR#1 told her CNA A told him if he didn't go to bed, she would let him sit in poop and would refuse to change him or feed him for the rest of the shift. LVN A stated CNA A attempted to transferred him from the wheelchair to the bed, which was an improper transfer as CR#1 was a 2 person assist. LVN A stated CR#1 told her CNA A tossed him in bed. After speaking with CR#1, LVN A stated she immediately notified RN A and told her to come to CR#1's room because he had a complaint and told her who the two CNA's (CNA A and CNA B) involved were. LVN A stated RN A arrived at CR#1's room, where he repeated what happened to him. RN A told LVN A to locate the WCN; however, she had gone home for the day, so LVN A stated she washed the wound and put a bandage on it until CR#1 could be seen Sunday 6/22/25 by WCN A. LVN A stated she telephoned the DON who told her she would call her back. LVN A stated the DON called back and only wanted to speak with RN A. LVN A stated during a telephone conversation between the DON and RN A she interrupted and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 2 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few told the DON and RN A that CNA A's actions were abuse and the abuse coordinator, ED needed to be called along with a report to the staff. She stated the DON said those words (Abuse) would result in severe consequences to her and never use that word in her facility again. LVN A stated the DON told her she didn't need to do anything as the situation would be handled. RN A told LVN A the situation was being taken care of and instructed her to leave for today (6/21/25) as her shift was ending; and return tomorrow (6/22/25) to complete documentation. LVN stated when she arrived for her shift the next day, 6/22/25, she viewed the nursing schedule and observed CNA A was scheduled to work and on 700 hall, which meant she would care for CR#1. LVN stated she called the DON and told her CNA A was scheduled to provide care to CR#1 when she abused him yesterday. LVN A stated she told the DON she was not going to work with CNA A and she was going to document in the nursing notes and file a police report. LVN A stated she requested the administrator's telephone number to report it and neither the DON nor RN A would provide it to her. She stated she obtained the ED's number from another staff member. LVN A stated FM A and FM B came to the facility to visit CR#1 and she was told by RN A she was not allowed to engage in the conversation with the family nor come into CR#1's room. LVN A stated on 6/22/25 she telephoned the ED and was informed she was suspended for not documenting timely, calling on 6/21/25 within 2 hours of being aware of the abuse and due to an immediate investigation. LVN A stated she tried to document in the nursing notes anyway, but her sign in and password were deactivated, which prompted her to call the police and make a report. In an interview on 6/24/2025 at 1:20 PM, the DOR stated CR#1 was evaluated on 6/18/2025 by the therapy department (PT, OT, and Speech) and CR#1 was totally dependent in the area of standing and transferring to the bed from the wheelchair or the wheelchair to the bed. She stated CR#1 should be transferred by 2 people using a gait belt or Hoyer lift. The DOR stated at no time should the resident be transferred by one person. She stated to transfer from the wheelchair, there should be two staff persons, one in the front and the other in the back of the resident. If the transfer was not done properly, with two people. it could cause injury to all involved. In a telephone interview on 6/24/2025 at 1:54 PM, RN A stated on the afternoon of 6/21/2025, LVN A called her and said CR#1 had a complaint. She stated she arrived at CR#1's room and observed his left forearm with blood on it. RN A stated CR#1 told her his left arm was injured during a transfer with another nursing staff. CR#1 told her he told CNA A he was a 2-person assist because she attempted to transfer him alone. CNA A called another aide (CNA B) to the room, and both CNAs transferred him to the bed. She stated CR#1 had an old bruise on his arm and she believed it re-opened during the transfer and the bruise began to bleed, which explains the blood on his bed sheet. She stated it was a healing bruise that opened. RN A stated she required a statement from both CNA's due to the wound. RN A stated she told LVN A to call WCN A to look at CR#1's wound. RN A stated CR#1 never told her CNA A was rough with him and admitted during her interview with him she didn't ask. RN A stated LVN A told her CNA A did not handle CR#1 correctly, but admitted she never asked LVN A to clarify rough. RN A stated on 6/22/25, LVN A told her CNA A should not work the 700 hall with CR#1 because she didn't treat CR#1 right yesterday (6/21/2025) because she was rough. RN A stated CR#1 told her he told CNA A to get someone to assist. RN A stated she was informed the resident was transferred safely by the CNA's but could not recall how the resident should be transferred. RN A stated she met with CR#1's family on Sunday 6/22/25 with both CNA's, A and B. RN A stated CR#1 told his family, through speaking Spanish, that one CNA B was nice and CNA A wasn't nice. She stated she did not report the incident or what CR#1 stated to his family or to the abuse coordinator, administrator, even though she knew who the abuse coordinator was. RN A stated she reported it to the DON instead. In a telephone interview on 6/24/2025 at 2:00 PM, CNA A stated she worked on Saturday, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 3 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 6/21/25. She stated CR#1 motioned her around 2:30 PM, while she was making her rounds, to come and put him in bed. CNA A stated CNA B assisted her with CR#1's transfer from his wheelchair to the bed. CNA A stated she was on the resident's right side and CNA B was on the left side. She stated after the transfer she walked on the left side and CNA B was on the right side and they both pulled CR#1 up toward the head of the bed. CNA A was asked why she switched sides, and she stated the left side was the remote control for the bed and call light. CNA A stated at 8:38 PM on 6/21/25, she received a text message from RN A who stated she needed a report on what happened in CR#1's room. CNA A stated she completed her written statement and handed it in to RN A who returned the report back to her and requested she changed her report and say she observed CR#1 had already had the bruise. CNA A refused and told RN A CR#1 did not have a bruise or sore on his left arm, and she would not be re-writing her statement. CNA A said LVN A told her and RN A CR#1's arm looked like abuse so they wanted to call the DON, but CNA A stated she told them she would call the abuse coordinator, ED. CNA A stated she called the ED on 6/21/2025, Saturday evening, and told her she was being accused of an improper transfer. She stated she did not mention LVN A accused her of abuse during this conversation. She stated she was suspended Sunday evening on 6/22/25. In a telephone interview on 6/24/25 at 3:32 PM, FM A and FM B stated CR#1 called them and told them CNA A was rough with him and informed them CNA A put him in bed early and he didn't want to go to bed that early. They indicated when CR#1 agreed to go to bed, CNA A attempted to put him in bed herself; however, he continuously told her he was unable to assist and she needed another person. They indicated CR#1 informed them CNA A threatened CR#1 that if he didn't go to bed early, she would leave him in the wheelchair and would not feed or change him. CR#1 told FM A and FM B, CNA A went to get CNA B to assist her in putting the resident in bed. The FMs stated CR#1 told LVN A what occurred with CNA A, and she immediately called RN A. FM A and FM B stated they were informed by LVN A she was prevented from calling in the complaint on the day of the incident (6/21/25) and was suspended on Sunday (6/22/25), which was when the police were called, and a report filed. They stated to be sure which CNA was involved, RN A brought both CNAs (A and B) in CR#1's room on 6/22/2025 to be identified. CR#1 told RN A and both FM's, CNA A was mean, and CNA B was nice. FM A and FM B stated the police came to the facility between 4PM - 5PM and spoke with CR#1 who told them what happened. FM A and FM B were asked by the police if they wanted to press criminal charges, but they declined because they wanted the facility to handle it. FM A and FM B stated before the two CNA's and RN A came into CR#1's room, CR#1 told FM A and FM B, CNA A came in his room about an hour early, before they arrived to the facility, and asked him if he told her supervisor she injured his arm. CR#1 told the FM he was afraid of CNA A and told her he didn't say anything to anyone. FM A and FM B stated this was clearly intimidation and felt the resident's safety was compromised by allowing CNA A to continue to work with and have access to CR#1. In a telephone interview on 6/24/2025 at 4:24 PM, CNA B stated on Saturday, 6/21/2025, she assisted CNA A with transferring CR#1 from his wheelchair to the bed. She stated CNA A grabbed CR#1 by his left hand and she held his right hand. CNA B stated after assisting with the transfer, she noticed an odd look on CR#1's face and asked him if he was okay and he nodded yes, then CNA A told her she could handle it from there, which was when she exited the room. CNA B stated during the transfer of CR#1 to the bed from the wheelchair, it was done appropriately, and no one was rough. CNA B stated she had to write an incident report but did not include her observation. She stated during the transfer she did not observe any wound on CR#1, but when she was called to return to his room by LVN A, she observed a wound on his left arm but didn't know how he got it. CNA B stated LVN A reported the incident to RN A, which was why she had to write the incident report. CNA B stated she never worked with CNA A prior to this date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 4 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and couldn't say what her behavior was with the residents. She stated CNA A was primarily assigned to 700 hallway, which was the hallway CR#1 was staying. She stated she was familiar with CR#1 because she worked with him on 600 hallway prior to his last hospitalization. She stated he typically went to bed after dinner. CNA B stated on 6/22/25 she was called to CR #1's room by RN A and when she arrived his family was also in the room. She stated CR#1 was asked about the CNA who injured him, and CR#1 told his family and RN A that CNA B was nice to him, and CNA A was the bad person and mean. CNA B stated she did not know who the abuse coordinator for the facility was because the last ED was no longer there; however, if she suspected abuse she would tell her immediate supervisor. CNA B stated abuse of any resident could be physical, verbal or mental. In an interview on 6/24/2025 at 6:15 PM, the DON stated on Saturday evening 6/21/25, she received a call from LVN A regarding CNA A and had an issue with her. The DON stated she called the supervisor to find out what occurred. She stated CNA A reported she asked LVN A to assist her in transferring a resident to bed because he was a two person assist. The DON stated LVN A refused, and CNA A got CNA B to assist. The DON stated she called RN A to find out what was going on and RN A stated the resident had an old wound that was opened during the transfer. The DON initially stated she never received a call from LVN A on Sunday, 6/22/25; then stated LVN A telephoned her on Sunday, 6/22/2025 afternoon between 3:00PM - 3:30PM and told her she would not work with CNA A because she was rough to a resident when she attempted to transfer CR#1 to the bed alone on yesterday (6/21/2025) and demanded CNA A be sent home. The DON stated she told LVN A she did not make those type of demands. Shortly after the call with LVN A, the DON stated she received a call from the ED and was informed LVN A was alleging abuse. She stated on Sunday (6/22/2025) LVN A reported abuse to the ED (abuse coordinator). The ED suspended LVN A and CNA A. The DON stated she spoke with CR#1 yesterday (6/23/2025) and he told her his weekend was good. The DON stated she asked CR#1 if anything happened this weekend he needed to talk about, and CR#1 told her no. The DON stated she did not asked CR#1 if CNA A was rough with him because he told her his weekend was good. The DON stated she did not speak with the FM's and did not file any report with the state. The DON stated she could not think of a negative outcome regarding this incident; however, she said after LVN A mentioned abuse it was a reportable incident. In an interview on 6/24/2025 at 6:52 PM, the ED stated on Saturday, 6/21/25, she received a phone call from CNA A, who stated CR#1 said he received a skin tear during a transfer with CNA A. She stated she spoke with RN A who stated the resident had an old bruise, which opened during a transfer to the bed by CNA's. She stated the RN told her WCN A was notified to look at the wound. The ED stated on Sunday, 6/22/25, around 2:30PM - 2:45PM, she received a call from LVN A claiming CNA A abused CR#1 yesterday (6/21/2025) afternoon. The ED stated she received information CR#1's FMs were visiting him. She stated she told the receptionist to go to CR#1's room and keep her on facetime so she could speak with the FM's. She stated she was informed by the FMs a CNA was rough with CR#1 yesterday (6/21/2025) and injured his arm while trying to put him in bed by herself. The ED stated during this time she directed RN A to bring in both CNAs (A & B) to identify which ones completed the transfer. She stated CR#1 identified CNA A as being rough with him and CNA B as being nice. The ED stated at this time the LVN and CNA A were suspended immediately and asked to leave the building. The ED stated LVN A told her she called and filed a police report and called in a report to the state survey agency. She stated FM B stated he called the police. The ED stated she reported the incident when she found out about it on Sunday, 6/22/2025. She stated the provider letter stated reports of abuse were to be reported within 2 hours. The negative outcome was other residents could be subjected to abuse because the alleged perpetrator could be providing care to other residents as well. She stated this was why she immediately suspended LVN A because (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 5 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few she had an obligation to report. The ED stated as soon as she became aware of the incident she called in a report to the state (Intake#1018590). Based on the initial interviews with staff involved she placed each on suspension, then terminated them. She stated it had only been 2 days since the incident and the provider investigation report has not been submitted to state. In a telephone interview on 7/1/2025 at 1:08 PM, SPO stated he received a call on 6/22/2025 regarding an abuse on an elderly resident. He stated he responded to the facility around 4:00 PM to take a report. Upon arrival, he met the family in the entrance area and walked to the resident room with them. He spoke with LVN A who stated a resident was abused by CNA A and she was working and had access to resident(s). He stated LVN A stated CNA A injured the resident's left arm. He stated he spoke with the resident who stated CNA A was rough with him by putting him in bed roughly. He stated he was unable to locate the CNA for an interview. He stated he spoke with CR#1's family who stated they didn't want to press charges; however, they wanted to wait to see what the facility's response would be. stated FMs A and B said if the facility did not address the issue, then they would press charges. He stated he took photos of the resident's left arm and entered them into evidence. Record review of the Facility's Abuse Protocol policy, dated April 2019, revealed the following:7. The following definitions are provided to assist our Facility's staff members in recognizing incidents of Patient Abuse:a. Abuse is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm or pain or mental anguish, or deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all Patient/Resident, irrespective of any physical or mentalcondition, cause physical harm, pain, or mental anguish. Willful as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.b. Taking or using photographs or recordings in any manner that would demean or humiliate a Patient. This includes using any type of equipment (e.g., cameras, smart phones, and other electronic devices) to take, keep or distribute photographs and recordings on social media.c. Misappropriation of Patient property means the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a Patient's belongings or money without the Patient's consent.d. Verbal abuse is defined as any use of oral, written or gestured language that includes disparaging and derogatory terms to Patient or their families, or within their hearing distance, to describe Patient, regardless of their age, ability tocomprehend, or disability.e. Sexual abuse is defined as, but is not limited to, sexual harassment, sexual coercion, or sexual assault, or any nonconsensual sexual contact of any type with the Patient.f. Physical abuse is defined as hitting, slapping, pinching, kicking, etc. It also includes controlling behavior through corporal punishment.g. Involuntary seclusion is defined as separation of a Patient from other Patient's or from his or her room against the Patient will, or the will of the Patient's legal guardian or representative. (Note: temporary monitored separation from other Patient's will not be considered involuntary seclusion and may be permitted when used as a therapeutic intervention to reduce agitation as determined by the Medical Director, and/or the Director of Nursing, and such action is consistent with the Patient's Care Plan).h. Mental abuse is defined as, but not limited to, humiliation, harassment, threats of punishment, or withholding of treatment or services. (Identifying)i. Adverse event is an untoward, undesirable, and usually unanticipated event that causes death or serious injury, or the risk thereof.j. Exploitation means taking advantage of a Patient for personal gain through the use of manipulation, intimidation, threats, or coercion.k. Mistreatment means inappropriate treatment or exploitation of a Patient.l. Neglect is the failure of the facility, it's employees or service providers to provide goods and services to a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 6 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Patient that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.m. Person-centered-care means to focus on the Patient as the locus of control and support the Patient in making their own choices and having control over the daily lives. 8. Any person observing an incident of Patient Abuse or suspecting Patient Abuse must immediately report such incidents to the Charge Nurse. The following information should be reported to the Charge Nurse:a. The name of the Patient involved;b. The date and time that the incident occurred;c. Where the incident took place;d. The name(s) of the person(s) committing the incident, if known;e. The name(s) of any witnesses to the incident;f. The type of abuse that was committed (i.e., verbal, physical,sexual, etc.); andg. Other information that may be requested by the Charge Nurse. 9. The Charge Nurse will immediately examine the Patient and notify the Abuse Prevention Coordinator upon receiving reports of mental, physical or sexual abuse. Findings of the examination will be recorded in the Patient's medical record. (Protection)This was determined to be an Immediate Jeopardy (IJ) was identified on 06/25/2025. The ED was notified and provided with the IJ template on 06/25/2025 at 5:27 p.m.The following Plan of Removal submitted by the facility was accepted on 6/26/2025at 8:18am:06/25/2025Plan of RemovalF600Facility Name and IDImpact Statement On 06/25/2025 the facility was cited for immediate jeopardy related to an incident on 06/21/2025. CR#1 reported to LVN A that CNA A was rough with him and injured his arm causing harm. CR#1 reported CNA A threatened him if he did not get to bed, she would leave him in the wheelchair until next shift and would not give him anything to eat. Staff failed to notify the abuse coordinator immediately leaving residents at risk for further abuse/neglect. Immediate Action: Please accept this as our Plan of Removal for the Immediate Jeopardy related to F600 Neglect Resident, CR #1, was assessed by licensed nurse and wound care nurse on 06/22/2025, treatment order in place for skin tear, CR #1 verbally denied pain no signs or symptoms noted. Social Worker completed psychosocial mental well-being evaluation on Resident, CR #1, on 06/24/2025, no negative findings. The Executive Director notified the Medical Director of Immediate Jeopardy on 06/25/2025 at 6:10 PM. The Facility held an Emergency QAPI Meeting. Director of Nursing, LVN A, RN A, and CNA A were terminated on 06/25/2025 for failure to immediately report abuse to the Abuse Coordinator. 1:1 education on Policy and Procedure Abuse and Neglect, including immediate reporting to Abuse Coordinator and timely reporting per HHSC guidelines were immediately provided to the Executive Director, ADON, Unit Manager by Senior Executive Director and Regional Director of Clinical Services. Completed on Date: 06/25/2025 Assessment - The Executive Director notified the facility Medical Director of the Immediate Jeopardy on 06/25/2025 5:31pm. -An emergency QAPI meeting was held on 06/25/2025 which was inclusive of a review of our policies/protocols Abuse and Neglect, they were found to be sufficient. Staff in- services, to include all facility employees, were started on Abuse and Neglect, including immediate notification to the Abuse Coordinator. Staff will not be allowed to start on the floor or give care until this training has been completed. All new facility staff will receive the in-services as part of the onboarding orientation process prior to working in the facility. All facility staff members completed a posttest after their education was completed to ensure staff were able to identify abuse and neglect, and proper reporting procedures.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. A staff roster was utilized to ensure 100% of staff were in-serviced and tested. In-services were deemed to be effective by the in-services post test scores and verbalization of understanding by all facility staff. Who will be responsible: Executive DirectorThe in-services with all staff will be completed by 06/25/2025. All staff were in-serviced 06/25/2025. Facility leadership completed safe surveys on all current facility patients to ensure they were free from abuse and neglect, no negative (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 7 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete findings. Completed on Date 06/25/2025 Facility MonitoringResidents will continue to receive safe surveys daily for 7 days, including weekends by facility leadership Manager on Duty, and twice weekly for the next 4 weeks to ensure residents remain free from abuse and neglect. Facility leadership will continue with daily and PRN rounds to ascertain any signs and symptoms of abuse and neglect. Any negative findings will be immediately reported to the Abuse Coordinator. Beginning 06/25/2025 no staff will be allowed to work until the required in servicing has been completed. Who will be responsible: Facility Leadership Who will do monitoring: Executive Director Completed on date: 06/25/2025 Policy and Procedures Policy and procedures were reviewed by Senior Executive Director, Regional Director of Clinical Services, Executive Director. These policies include Abuse and Neglect. No policies needed any revisions.Interviews on 6/26/2025 from 2:45 PM - 8:45 PM, with multiple staff across multiple shifts. Interview conducted with the ED, ADON, RN B, RN C, RN D, RN E and RN F; LVN B, LVN C, and LVN E; CNA C, CNA D, CNA E, CNA F, CNA G and CNA H. All staff stated they were in-serviced and reviewed the facility's policy on abuse and neglect, and exploitation. According to the in-services completed, staff were given a posttest on identifying abuse and neglect, behaviors of residents who may exhibit signs of abuse, identifying any marks or bruises and neglect. The staff were expected to get a score of 90. All staff received a 90 or above on the post test. Each stated they have an obligation to reporting abuse immediately. Each were able to identify 3 types of abuse and neglect and the name of the abuse coordinator. Each staff member was able to tell where the abuse coordinator's information throughout the facility. The ED was informed the Immediate Jeopardy was removed on 6/26/2025 at 9:10 PM The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy and a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 676323 If continuation sheet Page 8 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to implement the abuse protocol that prohibit and prevent abuse, neglect, and exploitation of residents 1 (CR#1) of 9 residents reviewed for abuse. The facility failed to prevent abuse, report the abuse allegation immediately to the Abuse Coordinator, and failed to protect the residents as the alleged perpetrator was allowed to continue to work. CR#1 reported he was physically abused on his arm by CNA A on 6/21/2025 around 2:30pm, which was the time CNA A started her afternoon shift. An Immediate Jeopardy (IJ) situation was identified on 06/26/2025. While the IJ was removed on 6/27/2025., the facility remained out of compliance at a scope of pattern with the potential for more than minimal harm due to the facility's need to evaluate the effectiveness of the corrective systems. These failures placed residents at risk of physical harm, emotional distress, mental anguish and death from possible abuse and neglect.Findings Include: Record review of the facility's Abuse Protocol policy, dated April 2019, revealed the following:7. The following definitions are provided to assist our Facility's staff members in recognizing incidents of Patient Abuse:a. Abuse is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm or pain or mental anguish, or deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all Patient/Resident, irrespective of any physical or mental condition, cause physical harm, pain, or mental anguish. Willful as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.b. Taking or using photographs or recordings in any manner that would demean or humiliate a Patient. This includes using any type of equipment (e.g., cameras, smart phones, and other electronic devices) to take, keep or distribute photographs and recordings on social media.c. Misappropriation of Patient property means the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a Patient's belongings or money without the Patient's consent.d. Verbal abuse is defined as any use of oral, written or gestured language that includes disparaging and derogatory terms to Patient or their families, or within their hearing distance, to describe Patient, regardless of their age, ability to comprehend, or disability.e. Sexual abuse is defined as, but is not limited to, sexual harassment, sexual coercion, or sexual assault, or any nonconsensual sexual contact of any type with the Patient.f. Physical abuse is defined as hitting, slapping, pinching, kicking, etc. It also includes controlling behavior through corporal punishment.g. Involuntary seclusion is defined as separation of a Patient from other Patient's or from his or her room against the Patient will, or the will of the Patient's legal guardian or representative. (Note: temporary monitored separation from other Patient's will not be considered involuntary seclusion and may be permitted when used as a therapeutic intervention to reduce agitation as determined by the Medical Director, and/or the Director of Nursing, and such action is consistent with the Patient's Care Plan).h. Mental abuse is defined as, but not limited to, humiliation, harassment, threats of punishment, or withholding of treatment or services. (Identifying)i. Adverse event is an untoward, undesirable, and usually unanticipated event that causes death or serious injury, or the risk thereof.j. Exploitation means taking advantage of a Patient for personal gain through the use of manipulation, intimidation, threats, or coercion.k. Mistreatment means inappropriate treatment or exploitation of a Patient.l. Neglect is the failure of the facility, it's employees or service providers to provide goods and services to a Patient that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.m. Person-centered-care means to focus on the Patient as the locus of control and support the Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 9 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Patient in making their own choices and having control over the daily lives.8. Any person observing an incident of Patient Abuse or suspecting Patient Abuse must immediately report such incidents to the Charge Nurse. The following information should be reported to the Charge Nurse:a. The name of the Patient involved;b. The date and time that the incident occurred;c. Where the incident took place;d. The name(s) of the person(s) committing the incident, if known;e. The name(s) of any witnesses to the incident;f. The type of abuse that was committed (i.e., verbal, physical,sexual, etc.); andg. Other information that may be requested by the Charge Nurse.9. The Charge Nurse will immediately examine the Patient and notifythe Abuse Prevention Coordinator upon receiving reports of mental,physical or sexual abuse. Findings of the examination will berecorded in the Patient's medical record. (Protection)Record review of CR#1's undated face sheet reflected a [AGE] year-old male who was initially admitted to the facility on [DATE] and re-admitted on [DATE]. CR#1 had diagnoses which included toxic encephalopathy (a neurological disorder that occurs with brain is exposed to toxic substances, such as heavy metals or neurotoxic solvents over a period of time) and had a cystostomy catheter (tube inserted through the abdomen into the bladder).Record review of CR#1's Orders revealed, Wound Treatment-Xeroform (dressing) everyday shift cleanse wound to left hand with Normal Saline or skin cleanser. Pat dry. Apply Xeroform to wound. Cover with dry dressing. Start Date-06/22/2025. Record review of CR#1's care plan, dated 6/17/2025, revealed the following:Focus: [CR#1] has an ADL self-care performance deficit r/t. Date initiated 5/2/2025Goal: [CR#1] will maintain currently level of function in through the review date.Interventions: [CR#1] Transfer: Resident is totally dependent of staff for transferring. Date initiated: 5/27/2025Record review of WCD notes, dated 6/24/2025, revealed a skin tear wound of the left forearm. Wound size 2.2x1x0.3. Primary dressing Xeroform gauze apply once daily and as needed: if saturated, soiled, or dislodged. For 30 days. Record Review of the Nursing Board certificates received from ED for the current staff: DON, RN A, LVN A and CNA A. Each document contained a handwritten termination date and time on the upper righthand corner of each document. Record review of CR#1's admission MDS dated [DATE], revealed CR#1 has a BIMS Score of 12, which indicated moderate cognitive impairment. CR#1 used a wheelchair as a mobility device; required 2 or more helpers to complete to assist with transferring from wheelchair or bed.Record review of nursing notes, revealed there were no notes documented on 6/21/2025 regarding CR#1's injuries. Record review of TULIP did not reflect the facility reported the violation/incident to the Administrator, state agency and to all other required agencies within specified timeframes, regarding the abuse violation described on 6/21/2025.During an observation and interview on 6/24/25 at 9:15 AM, CR#1 was seated in his wheelchair at the entrance of his room and was observed with a bandage on his left forearm that had a small amount of blood on it. It had a written date of 6/24/2025. CR#1 was alert, orientated to person, place and event. CR#1 stated the injury occurred when CNA A tried putting him in bed by herself by pulling his arms to lift him out of the wheelchair. CR#1 stated he told CNA A he did not want to go to bed, but she insisted anyway and continued to pull on his arms. CR#1 stated CNA A told him she could put him in bed by herself and he told her it would take two people, but he was not ready to go to bed. He stated CNA A told him if she didn't put him in bed then he would be there all night even if he pooped on himself, and she would not bring him any food. He stated CNA A insisted on putting him in bed by herself and he told her he was unable to assist her due to how he was feeling. CR#1 stated during her pulling on his arms by herself, CNA A injured his left arm. CR#1 continued to tell CNA A not to pick him up by herself because it took two people. He stated she did not listen, but when she realized she couldn't she went and got CNA B. CR#1 stated he told LVN what occurred when she came to his room. He stated CNA A was rough with him.Record review of text received from LVN A (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 10 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some from her telephone reveals that the 911 call was made on 6/22/25 at 4:21pm. Record review of nursing notes, by WCN A, dated 6/22/25 at 6:38 PM, revealed Received report resident has skin tear to left hand. Assessment done verbally denied pain and discomfort. Physician informed, order in place. Wound care done at this time, tolerated well. Offloads reposition and safety noted. RP updated remain stable. Will continue plan of care. Record review of nursing notes, by RN A, dated 6/22/25 at 6:58 PM, for effective date 6/21/25 at 3:30 PM revealed the following note: Received report from the outgoing nurse that patient voiced concern regarding a CNA's approach during care. Patient reported that the assigned CNA was not gentle and continued to insist that he perform tasks independently, despite the patient stating he felt too weak and required two-person assistance. CNA reportedly attempted care initially alone, but eventually called for a second staff member to assist. During assessment, patient was noted with an existing bruise to the left upper arm that appeared to have reopened, resulting in a small amount of blood observed on the bedsheet. It remains unclear when the original injury occurred. Patient continued to express that the CNA was rough during care. Writer obtained statements from the involved CNA and requested the primary nurse to initiate an incident report for documentation and follow-up. Patient was repositioned and made comfortable in bed. The DON was notified of the incident and ongoing concerns. Will continue to monitor patient closely and follow up as needed. In a telephone interview on 6/24/2025 at 11:22 AM, LVN A stated she became aware of the incident by CR#1 on Saturday 6/21/2025 around 4:15PM-4:30PM while she was doing her rounds. She stated when she got to CR#1's room he was in bed which was unusual for him since he went to bed after dinner. LVN A went into the room, and she stated CR#1 looked as if he was crying. LVN A stated FM A informed her additional things that were going on like CR#1 had been treated mean and CR#1 stated CNA A hurt him. LVN A stated CR#1 told her CNA A told him if he didn't go to bed, she would let him sit in poop and would refuse to change him or feed him for the rest of the shift. LVN A stated CNA A attempted to transferred him from the wheelchair to the bed, which was an improper transfer as CR#1 was a 2 person assist. LVN A stated CR#1 told her CNA A tossed him in bed. After speaking with CR#1, LVN A stated she immediately notified RN A and told her to come to CR#1's room because he had a complaint and told her who the two CNA's (CNA A and CNA B) involved were. LVN A stated RN A arrived at CR#1's room, where he repeated what happened to him. RN A told LVN A to locate the WCN; however, she had gone home for the day, so LVN A stated she washed the wound and put a bandage on it until CR#1 could be seen Sunday 6/22/25 by WCN A. LVN A stated she telephoned the DON who told her she would call her back. LVN A stated the DON called back and only wanted to speak with RN A. LVN A stated during a telephone conversation between the DON and RN A she interrupted and told the DON and RN A that CNA A's actions were abuse and the abuse coordinator, ED needed to be called along with a report to the staff. She stated the DON said those words (Abuse) would result in severe consequences to her and never use that word in her facility again. LVN A stated the DON told her she didn't need to do anything as the situation would be handled. RN A told LVN A the situation was being taken care of and instructed her to leave for today (6/21/25) as her shift was ending; and return tomorrow (6/22/25) to complete documentation. LVN stated when she arrived for her shift the next day, 6/22/25, she viewed the nursing schedule and observed CNA A was scheduled to work and on 700 hall, which meant she would care for CR#1. LVN stated she called the DON and told her CNA A was scheduled to provide care to CR#1 when she abused him yesterday. LVN A stated she told the DON she was not going to work with CNA A and she was going to document in the nursing notes and file a police report. LVN A stated she requested the administrator's telephone number to report it and neither the DON nor RN A would provide it to her. She stated she obtained the ED's number from another staff member. LVN A stated FM A and FM B came to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 11 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some the facility to visit CR#1 and she was told by RN A she was not allowed to engage in the conversation with the family nor come into CR#1's room. LVN A stated on 6/22/25 she telephoned the ED and was informed she was suspended for not documenting timely, calling on 6/21/25 within 2 hours of being aware of the abuse and due to an immediate investigation. LVN A stated she tried to document in the nursing notes anyway, but her sign in and password were deactivated, which prompted her to call the police and make a report. In a telephone interview on 6/24/2025 at 1:54 PM, RN A stated on the afternoon of 6/21/2025, LVN A called her and said CR#1 had a complaint. She stated she arrived at CR#1's room and observed his left forearm with blood on it. RN A stated CR#1 told her his left arm was injured during a transfer with another nursing staff. CR#1 told her he told CNA A he was a 2-person assist because she attempted to transfer him alone. CNA A called another aide (CNA B) to the room, and both CNAs transferred him to the bed. She stated CR#1 had an old bruise on his arm and she believed it re-opened during the transfer and the bruise began to bleed, which explains the blood on his bed sheet. She stated it was a healing bruise that opened. RN A stated she required a statement from both CNA's due to the wound. RN A stated she told LVN A to call WCN A to look at CR#1's wound. RN A stated CR#1 never told her CNA A was rough with him and admitted during her interview with him she didn't ask. RN A stated LVN A told her CNA A did not handle CR#1 correctly, but admitted she never asked LVN A to clarify rough. RN A stated on 6/22/25, LVN A told her CNA A should not work the 700 hall with CR#1 because she didn't treat CR#1 right yesterday (6/21/2025) because she was rough. RN A stated CR#1 told her he told CNA A to get someone to assist. RN A stated she was informed the resident was transferred safely by the CNA's but could not recall how the resident should be transferred. RN A stated she met with CR#1's family on Sunday 6/22/25 with both CNA's, A and B. RN A stated CR#1 told his family, through speaking Spanish, that one CNA B was nice and CNA A wasn't nice. She stated she did not report the incident or what CR#1 stated to his family or to the abuse coordinator, administrator, even though she knew who the abuse coordinator was. RN A stated she reported it to the DON instead. In an interview on 6/24/2025 at 6:15 PM, the DON stated on Saturday evening 6/21/25, she received a call from LVN A regarding CNA A and had an issue with her. The DON stated she called the supervisor to find out what occurred. She stated CNA A reported she asked LVN A to assist her in transferring a resident to bed because he was a two person assist. The DON stated LVN A refused, and CNA A got CNA B to assist. The DON stated she called RN A to find out what was going on and RN A stated the resident had an old wound that was opened during the transfer. The DON initially stated she never received a call from LVN A on Sunday, 6/22/25; then stated LVN A telephoned her on Sunday, 6/22/2025 afternoon between 3:00PM - 3:30PM and told her she would not work with CNA A because she was rough to a resident when she attempted to transfer CR#1 to the bed alone on yesterday (6/21/2025) and demanded CNA A be sent home. The DON stated she told LVN A she did not make those type of demands. Shortly after the call with LVN A, the DON stated she received a call from the ED and was informed LVN A was alleging abuse. She stated on Sunday (6/22/2025) LVN A reported abuse to the ED (abuse coordinator). The ED suspended LVN A and CNA A. The DON stated she spoke with CR#1 yesterday (6/23/2025) and he told her his weekend was good. The DON stated she asked CR#1 if anything happened this weekend he needed to talk about, and CR#1 told her no. The DON stated she did not asked CR#1 if CNA A was rough with him because he told her his weekend was good. The DON stated she did not speak with the FM's and did not file any report with the state. The DON stated she could not think of a negative outcome regarding this incident; however, she said after LVN A mentioned abuse it was a reportable incident. In an interview on 6/24/2025 at 6:52 PM, the ED stated on Saturday, 6/21/25, she received a phone call from CNA A, who stated CR#1 said he received a skin tear during a transfer with CNA A. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 12 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some stated she spoke with RN A who stated the resident had an old bruise, which opened during a transfer to the bed by CNA's. She stated the RN told her WCN A was notified to look at the wound. The ED stated on Sunday, 6/22/25, around 2:30PM - 2:45PM, she received a call from LVN A claiming CNA A abused CR#1 yesterday (6/21/2025) afternoon. The ED stated she received information CR#1's FMs were visiting him. She stated she told the receptionist to go to CR#1's room and keep her on facetime so she could speak with the FM's. She stated she was informed by the FMs a CNA was rough with CR#1 yesterday (6/21/2025) and injured his arm while trying to put him in bed by herself. The ED stated during this time she directed RN A to bring in both CNAs (A & B) to identify which ones completed the transfer. She stated CR#1 identified CNA A as being rough with him and CNA B as being nice. The ED stated at this time the LVN and CNA A were suspended immediately and asked to leave the building. The ED stated LVN A told her she called and filed a police report and called in a report to the state survey agency. She stated FM B stated he called the police. The ED stated she reported the incident when she found out about it on Sunday, 6/22/2025. She stated the provider letter stated reports of abuse were to be reported within 2 hours. The negative outcome was other residents could be subjected to abuse because the alleged perpetrator could be providing care to other residents as well. She stated this was why she immediately suspended LVN A because she had an obligation to report.In a telephone interview on 7/1/2025 at 1:08 PM, SPO stated he received a call on 6/22/2025 regarding an abuse on an elderly resident. He stated he responded to the facility around 4:00 PM to take a report. Upon arrival, he met the family in the entrance area and walked to the resident room with them. He spoke with LVN A who stated a resident was abused by CNA A and she was working and had access to resident(s). He stated LVN A stated CNA A injured the resident's left arm. He stated he spoke with the resident who stated CNA A was rough with him by putting him in bed roughly. He stated he was unable to locate the CNA for an interview. He stated he spoke with CR#1's family who stated they didn't want to press charges; however, they wanted to wait to see what the facility's response would be. stated FMs A and B said if the facility did not address the issue, then they would press charges. He stated he took photos of the resident's left arm and entered them into evidence. This was determined to be an Immediate Jeopardy (IJ) was identified on 06/26/2025. The ED was notified and provided with the IJ template on 6/26/2025 at 12:10pm. The following Plan of Removal submitted by the facility was accepted on 6/27/2025 at 2:53pm. 06/27/25Plan of RemovalF607Facility Name and ID:Impact StatementOn 06/27/2025 the facility was cited for immediate jeopardy related to incident on 06/21/2025. Staff failed to notify the Abuse Coordinator of allegation of physical abuse, notify HHSC within 2 hours and initiating an investigation after CR#1 reported to LVN A he was abused and threatened by CNA A during a transfer from his wheelchair to his bed. Staff failed to notify the abuse coordinator immediately leaving residents at risk for further abuse/neglect.Immediate Action:Please accept this as our Plan of Removal for the Immediate Jeopardy related to F607 Implement Abuse Policies. The Executive Director notified the Medical Director of Immediate Jeopardy on 6/27/25 at 1:00pm. The Facility held an Emergency QAPI Meeting. The Director of Nursing, LVN A, RN A, and CNA A were terminated on 6/25/2025 for failure to immediately report abuse to the Abuse Coordinator.1:1 education on Policy and Procedure Abuse and Neglect, including immediate reporting to Coordinator and immediately reporting per HHSC guidelines was immediately provided Executive Director, ADON, Unit Manager by Senior Executive Director. Completion on Date: 06/27/2025AssessmentAn emergency QAPI meeting was held on 06/25/2025 which was inclusive of a review of our policies/protocols Abuse and Neglect, they were found to be sufficient.Staff in- services, to include all facility employees, were started on Abuse and Neglect, including immediate notification to the Abuse Coordinator. Staff will not be allowed to start on the floor or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 13 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete give care until this training has been completed.All new facility staff will receive the in-services as part of the onboarding orientation process prior to working in the facility.All facility staff members completed a posttest after their education was completed to ensure staff were able to identify abuse and neglect, and proper reporting procedures.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. A staff roster was utilized to ensure 100% of staff were in-serviced and tested.In-services were deemed to be effective by the in-services post test scores and verbalization of understanding by all facility staff. Who will be responsible: Executive Director The in-services with all staff will be completed by 06/25/2025. All staff were in-serviced 06/25/2025. Facility leadership completed safe surveys on all current facility patients to ensure they were free from abuse and neglect, no negative findings.Completion Date 06/25/2025Facility MonitoringResidents will continue to receive safe surveys daily for 7 days, including weekends by facility leadership Manager on Duty, and twice weekly for the next 4 weeks to ensure residents remain free from abuse and neglect. Facility leadership will continue with daily and PRN rounds to ascertain any signs and symptoms of abuse and neglect. Any negative findings will be immediately reported to the Abuse Coordinator. Beginning 06/25/2025 no staff will be allowed to work until the required in servicing has been completed.Who will be responsible: Facility Leadership Who will do monitoring: Executive Director Completed on date: 06/27/2025 Policy and Procedures Policy and procedures were reviewed by Senior Executive Director, Regional Director of Clinical Services, Executive Director. These policies include Abuse and Neglect. No policies needed any revisions.Interviews on 6/26/2025 & 6/27/2025 from 2:45 PM - 5:20 PM, with multiple staff across multiple shifts. Interview conducted with the ED, ADON, RN B, RN C, RN D, RN E and RN F; LVN B, LVN C, and LVN E; CNA C, CNA D, CNA E, CNA F, CNA G and CNA H. All staff stated they were in-serviced and reviewed the facility's policy on abuse and neglect, and exploitation. According to the in-services completed, staff were given a posttest on identifying abuse and neglect, behaviors of residents who may exhibit signs of abuse, identifying any marks or bruises and neglect. The staff were expected to get a score of 90%. Record Review revealed all staff received a 90% or above on the post test. Each stated they have an obligation to reporting abuse immediately. Each were able to identify 3 types of abuse and neglect and the name of the abuse coordinator. Each staff member was able to tell where the abuse coordinator's information throughout the facility. The ED, ADON and LVN D were in-serviced 1:1 by the SED on Policy and Procedure Abuse and Neglect, including immediate reporting to Abuse Coordinator per HHSC guidelines. The ED was informed the Immediate Jeopardy was removed on 6/27/2025 at 6:00 PM The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 676323 If continuation sheet Page 14 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to report an alleged violation involving abuse or resulting in serious bodily injury immediately, but not later than 2 hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury to the administrator of the facility and to other officials including to the State Survey Agency in accordance with State law through established procedures; that 1(CR#1) of 9 residents had been abused by CNA A, which resulted in injury.The facility staff failed to immediately report abuse to the Abuse Coordinator, the State Survey Agency and Law Enforcement. An Immediate Jeopardy (IJ) situation was identified on 06/26/2025. While the IJ was removed on 6/27/2025., the facility remained out of compliance at a scope of pattern with the potential for more than minimal harm due to the facility's need to evaluate the effectiveness of the corrective systems. This failure could place residents at risk of continued abuse. Findings include:Record review of CR#1's undated face sheet reflected a [AGE] year-old male who was initially admitted to the facility on [DATE] and re-admitted on [DATE]. CR#1 had diagnoses which included toxic encephalopathy (a neurological disorder that occurs with brain is exposed to toxic substances, such as heavy metals or neurotoxic solvents over a period of time) and had a cystostomy catheter (tube inserted through the abdomen into the bladder).Record review of CR#1's Orders revealed, Wound Treatment-Xeroform (dressing) everyday shift cleanse wound to left hand with Normal Saline or skin cleanser. Pat dry. Apply Xeroform to wound. Cover with dry dressing. Start Date-06/22/2025. Record review of CR#1's care plan, dated 6/17/2025, revealed the following:Focus: [CR#1] has an ADL self-care performance deficit r/t. Date initiated 5/2/2025Goal: [CR#1] will maintain currently level of function in through the review date.Interventions: [CR#1] Transfer: Resident is totally dependent of staff for transferring. Date initiated: 5/27/2025Record review of WCD notes, dated 6/24/2025, revealed a skin tear wound of the left forearm. Wound size 2.2x1x0.3. Primary dressing Xeroform gauze apply once daily and as needed: if saturated, soiled, or dislodged. For 30 days. Record Review of the Nursing Board certificates received from ED for the current staff: DON, RN A, LVN A and CNA A. Each document contained a handwritten termination date and time on the upper righthand corner of each document.Record review of CR#1's admission MDS dated [DATE], revealed CR#1 has a BIMS Score of 12, which indicated moderate cognitive impairment. CR#1 used a wheelchair as a mobility device; required 2 or more helpers to complete to assist with transferring from wheelchair or bed.Record review of nursing notes, revealed there were no notes documented on 6/21/2025 regarding CR#1's injuries. During an observation and interview on 6/24/25 at 9:15 AM, CR#1 was seated in his wheelchair at the entrance of his room and was observed with a bandage on his left forearm that had a small amount of blood on it. It had a written date of 6/24/2025. CR#1 was alert, orientated to person, place and event. CR#1 stated the injury occurred when CNA A tried putting him in bed by herself by pulling his arms to lift him out of the wheelchair. CR#1 stated he told CNA A he did not want to go to bed, but she insisted anyway and continued to pull on his arms. CR#1 stated CNA A told him she could put him in bed by herself and he told her it would take two people, but he was not ready to go to bed. He stated CNA A told him if she didn't put him in bed then he would be there all night even if he pooped on himself, and she would not bring him any food. He stated CNA A insisted on putting him in bed by herself and he told her he was unable to assist her due to how he was feeling. CR#1 stated during her pulling on his arms by herself, CNA A injured his left arm. CR#1 continued to tell CNA A not to pick him up by herself because it took two people. He stated she did not listen, but when she realized she couldn't she went and got CNA B. CR#1 stated he told LVN what occurred (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 15 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some when she came to his room. He stated CNA A was rough with him.Record review of text received from LVN A from her telephone reveals that the 911 call was made on 6/22/25 at 4:21pm. Record review of nursing notes, by WCN A, dated 6/22/25 at 6:38 PM, revealed Received report resident has skin tear to left hand. Assessment done verbally denied pain and discomfort. Physician informed, order in place. Wound care done at this time, tolerated well. Offloads reposition and safety noted. RP updated remain stable. Will continue plan of care. Record review of nursing notes, by RN A, dated 6/22/25 at 6:58 PM, for effective date 6/21/25 at 3:30 PM revealed the following note: Received report from the outgoing nurse that patient voiced concern regarding a CNA's approach during care. Patient reported that the assigned CNA was not gentle and continued to insist that he perform tasks independently, despite the patient stating he felt too weak and required two-person assistance. CNA reportedly attempted care initially alone, but eventually called for a second staff member to assist. During assessment, patient was noted with an existing bruise to the left upper arm that appeared to have reopened, resulting in a small amount of blood observed on the bedsheet. It remains unclear when the original injury occurred. Patient continued to express that the CNA was rough during care. Writer obtained statements from the involved CNA and requested the primary nurse to initiate an incident report for documentation and follow-up. Patient was repositioned and made comfortable in bed. The DON was notified of the incident and ongoing concerns. Will continue to monitor patient closely and follow up as needed.In a telephone interview on 6/24/2025 at 11:22 AM, LVN A stated she became aware of the incident by CR#1 on Saturday 6/21/2025 around 4:15PM-4:30PM while she was doing her rounds. She stated when she got to CR#1's room he was in bed which was unusual for him since he went to bed after dinner. LVN A went into the room, and she stated CR#1 looked as if he was crying. LVN A stated FM A informed her additional things that were going on like CR#1 had been treated mean and CR#1 stated CNA A hurt him. LVN A stated CR#1 told her CNA A told him if he didn't go to bed, she would let him sit in poop and would refuse to change him or feed him for the rest of the shift. LVN A stated CNA A attempted to transferred him from the wheelchair to the bed, which was an improper transfer as CR#1 was a 2 person assist. LVN A stated CR#1 told her CNA A tossed him in bed. After speaking with CR#1, LVN A stated she immediately notified RN A and told her to come to CR#1's room because he had a complaint and told her who the two CNA's (CNA A and CNA B) involved were. LVN A stated RN A arrived at CR#1's room, where he repeated what happened to him. RN A told LVN A to locate the WCN; however, she had gone home for the day, so LVN A stated she washed the wound and put a bandage on it until CR#1 could be seen Sunday 6/22/25 by WCN A. LVN A stated she telephoned the DON who told her she would call her back. LVN A stated the DON called back and only wanted to speak with RN A. LVN A stated during a telephone conversation between the DON and RN A she interrupted and told the DON and RN A that CNA A's actions were abuse and the abuse coordinator, ED needed to be called along with a report to the staff. She stated the DON said those words (Abuse) would result in severe consequences to her and never use that word in her facility again. LVN A stated the DON told her she didn't need to do anything as the situation would be handled. RN A told LVN A the situation was being taken care of and instructed her to leave for today (6/21/25) as her shift was ending; and return tomorrow (6/22/25) to complete documentation. LVN stated when she arrived for her shift the next day, 6/22/25, she viewed the nursing schedule and observed CNA A was scheduled to work and on 700 hall, which meant she would care for CR#1. LVN stated she called the DON and told her CNA A was scheduled to provide care to CR#1 when she abused him yesterday. LVN A stated she told the DON she was not going to work with CNA A and she was going to document in the nursing notes and file a police report. LVN A stated she requested the administrator's telephone number to report it and neither the DON nor RN A would provide it to her. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 16 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some She stated she obtained the ED's number from another staff member. LVN A stated FM A and FM B came to the facility to visit CR#1 and she was told by RN A she was not allowed to engage in the conversation with the family nor come into CR#1's room. LVN A stated on 6/22/25 she telephoned the ED and was informed she was suspended for not documenting timely, calling on 6/21/25 within 2 hours of being aware of the abuse and due to an immediate investigation. LVN A stated she tried to document in the nursing notes anyway, but her sign in and password were deactivated, which prompted her to call the police and make a report. In a telephone interview on 6/24/2025 at 1:54 PM, RN A stated on the afternoon of 6/21/2025, LVN A called her and said CR#1 had a complaint. She stated she arrived at CR#1's room and observed his left forearm with blood on it. RN A stated CR#1 told her his left arm was injured during a transfer with another nursing staff. CR#1 told her he told CNA A he was a 2-person assist because she attempted to transfer him alone. CNA A called another aide (CNA B) to the room, and both CNAs transferred him to the bed. She stated CR#1 had an old bruise on his arm and she believed it re-opened during the transfer and the bruise began to bleed, which explains the blood on his bed sheet. She stated it was a healing bruise that opened. RN A stated she required a statement from both CNA's due to the wound. RN A stated she told LVN A to call WCN A to look at CR#1's wound. RN A stated CR#1 never told her CNA A was rough with him and admitted during her interview with him she didn't ask. RN A stated LVN A told her CNA A did not handle CR#1 correctly, but admitted she never asked LVN A to clarify rough. RN A stated on 6/22/25, LVN A told her CNA A should not work the 700 hall with CR#1 because she didn't treat CR#1 right yesterday (6/21/2025) because she was rough. RN A stated CR#1 told her he told CNA A to get someone to assist. RN A stated she was informed the resident was transferred safely by the CNA's but could not recall how the resident should be transferred. RN A stated she met with CR#1's family on Sunday 6/22/25 with both CNA's, A and B. RN A stated CR#1 told his family, through speaking Spanish, that one CNA B was nice and CNA A wasn't nice. She stated she did not report the incident or what CR#1 stated to his family or to the abuse coordinator, administrator, even though she knew who the abuse coordinator was. RN A stated she reported it to the DON instead. In a telephone interview on 6/24/2025 at 6:00pm with WCN A, she stated she was called to CR#1's room to look at his arm on Sunday 6/22/25 because the wound occurred on (Saturday), 6/21/2025. She stated CR#1's wound was covered on Sunday when she observed it. The WCN stated CR#1 told her staff gave him a skin tear and did not mention a name. When asked if she had attempted to probe the resident for more information, she stated, I was there to do my job, so I didn't ask any further question. WCN A stated she was aware she was a mandatory reporter and did not report the incident to the abuse coordinator. In an interview on 6/24/2025 at 6:15 PM, the DON stated on Saturday evening 6/21/25, she received a call from LVN A regarding CNA A and had an issue with her. The DON stated she called the supervisor to find out what occurred. She stated CNA A reported she asked LVN A to assist her in transferring a resident to bed because he was a two person assist. The DON stated LVN A refused, and CNA A got CNA B to assist. The DON stated she called RN A to find out what was going on and RN A stated the resident had an old wound that was opened during the transfer. The DON initially stated she never received a call from LVN A on Sunday, 6/22/25; then stated LVN A telephoned her on Sunday, 6/22/2025 afternoon between 3:00PM - 3:30PM and told her she would not work with CNA A because she was rough to a resident when she attempted to transfer CR#1 to the bed alone on yesterday (6/21/2025) and demanded CNA A be sent home. The DON stated she told LVN A she did not make those type of demands. Shortly after the call with LVN A, the DON stated she received a call from the ED and was informed LVN A was alleging abuse. She stated on Sunday (6/22/2025) LVN A reported abuse to the ED (abuse coordinator). The ED suspended LVN A and CNA A. The DON stated she spoke with CR#1 yesterday (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 17 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some (6/23/2025) and he told her his weekend was good. The DON stated she asked CR#1 if anything happened this weekend he needed to talk about, and CR#1 told her no. The DON stated she did not asked CR#1 if CNA A was rough with him because he told her his weekend was good. The DON stated she did not speak with the FM's and did not file any report with the state. The DON stated she could not think of a negative outcome regarding this incident; however, she said after LVN A mentioned abuse it was a reportable incident. In an interview on 6/24/2025 at 6:52 PM, the ED stated on Saturday, 6/21/25, she received a phone call from CNA A, who stated CR#1 said he received a skin tear during a transfer with CNA A. She stated she spoke with RN A who stated the resident had an old bruise, which opened during a transfer to the bed by CNA's. She stated the RN told her WCN A was notified to look at the wound. The ED stated on Sunday, 6/22/25, around 2:30PM - 2:45PM, she received a call from LVN A claiming CNA A abused CR#1 yesterday (6/21/2025) afternoon. The ED stated she received information CR#1's FMs were visiting him. She stated she told the receptionist to go to CR#1's room and keep her on facetime so she could speak with the FM's. She stated she was informed by the FMs a CNA was rough with CR#1 yesterday (6/21/2025) and injured his arm while trying to put him in bed by herself. The ED stated during this time she directed RN A to bring in both CNAs (A & B) to identify which ones completed the transfer. She stated CR#1 identified CNA A as being rough with him and CNA B as being nice. The ED stated at this time the LVN and CNA A were suspended immediately and asked to leave the building. The ED stated LVN A told her she called and filed a police report and called in a report to the state survey agency. She stated FM B stated he called the police. The ED stated she reported the incident when she found out about it on Sunday, 6/22/2025. She stated the provider letter stated reports of abuse were to be reported within 2 hours. The negative outcome was other residents could be subjected to abuse because the alleged perpetrator could be providing care to other residents as well. She stated this was why she immediately suspended LVN A because she had an obligation to report. The ED stated as soon as she became aware of the incident she called in a report to the state (Intake#1018590). Based on the initial interviews with staff involved she placed each on suspension, then terminated them. She stated it had only been 2 days since the incident and the provider investigation report has not been submitted to state. In a telephone interview on 7/1/2025 at 1:08 PM, SPO stated he received a call on 6/22/2025 regarding an abuse on an elderly resident. He stated he responded to the facility around 4:00 PM to take a report. Upon arrival, he met the family in the entrance area and walked to the resident room with them. He spoke with LVN A who stated a resident was abused by CNA A and she was working and had access to resident(s). He stated LVN A stated CNA A injured the resident's left arm. He stated he spoke with the resident who stated CNA A was rough with him by putting him in bed roughly. He stated he was unable to locate the CNA for an interview. He stated he spoke with CR#1's family who stated they didn't want to press charges; however, they wanted to wait to see what the facility's response would be. stated FMs A and B said if the facility did not address the issue, then they would press charges. He stated he took photos of the resident's left arm and entered them into evidence. Record review of the facility's abuse Policy revealed the following:8. Any person observing an incident of Patient Abuse or suspecting Patient Abuse must immediately report such incidents to the Charge Nurse. The following information should be reported to the Charge Nurse: a. The name of the Patient involved; b. The date and time that the incident occurred; c. Where the incident took place; d. The name(s) of the person(s) committing the incident, if known; e. The name(s) of any witnesses to the incident; f. The type of abuse that was committed (i.e., verbal, physical, sexual, etc.); and g. Other information that may be requested by the Charge Nurse. 9. The Charge Nurse will immediately examine the Patient and notify the Abuse Prevention Coordinator upon receiving (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 18 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some reports of mental, physical or sexual abuse. Findings of the examination will be recorded in the Patient's medical record. (Protection) This was determined to be an Immediate Jeopardy (IJ) was identified on 06/26/2025. The ED was notified and provided with the IJ template on 6/26/2025 at 12:10pm. The following Plan of Removal submitted by the facility was accepted on 6/27/2025 at 2:53pm. 06/27/25 Plan of Removal

F609 Facility Name and ID: Impact Statement On 06/27/2025 the facility was cited for immediate jeopardy related to an incident on 06/21/2025 the facility staff failed to report abuse immediately, but no later than 2 hours to the Administrator, State Survey Agency, and Law Enforcement. The facility failed to report abuse immediately, but no later than 2 hours to the Administrator, State Survey Agency, and Law Enforcement. Immediate Action:Please accept this as our Plan of Removal for the Immediate Jeopardy related to F609 Reporting of Alleged Allegation. The Executive Director notified the Medical Director of Immediate Jeopardy on 6/27/25 at 1:00pm. The facility held an Emergency QAPI Meeting. Director of Nursing, LVN A, RN A, and CNA A were terminated on 6/25/2025 for failure to immediately report abuse to the Abuse Coordinator. 1:1 education on Policy and Procedure Abuse and Neglect, including immediate reporting to Abuse Coordinator and timely reporting per HHSC guidelines was immediately provided Executive Director, ADON, Unit Manager by Senior Executive Director. Completion Date: 06/27/2025 AssessmentAn emergency QAPI meeting was held on 06/27/2025 which was inclusive of a review of our policies/protocols Abuse and Neglect, they were found to be sufficient. Staff in- services, to include all facility employees, were started on Abuse and Neglect, including immediate notification to the Abuse Coordinator. Staff will not be allowed to start on the floor or give care until this training has been completed. All new facility staff will receive the in-services as part of the onboarding orientation process prior to working in the facility. All facility staff members completed a posttest after their education was completed to ensure staff were able to identify abuse and neglect, and proper reporting procedures. 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. A staff roster was utilized to ensure 100% of staff were in-serviced and tested. In-services were deemed to be effective by the in-services post test scores and verbalization of understanding by all facility staff. Who will be responsible: Executive Director The in-services with all staff will be completed by 06/25/2025. All staff were in-serviced 06/25/2025. Facility leadership completed safe surveys on all current facility patients to ensure they were free from abuse and neglect, no negative findings. Completion Date 06/25/2025 Facility Monitoring Residents will continue to receive safe surveys daily for 7 days, including weekends by facility leadership Manager on Duty, and twice weekly for the next 4 weeks to ensure residents remain free from abuse and neglect. Facility leadership will continue with daily and PRN rounds to ascertain any signs and symptoms of abuse and neglect. Any negative findings will be immediately reported to the Abuse Coordinator. Beginning 06/25/2025 no staff will be allowed to work until the required in servicing has been completed. Who will be responsible: Facility Leadership Who will do monitoring: Executive Director Completed on date: 06/27/2025 Policy and Procedures Policy and procedures were reviewed by Senior Executive Director, Regional Director of Clinical Services, Executive Director. These policies include Abuse and Neglect. No policies needed any revisions.Interviews on 6/26/2025 & 6/27/2025 from 2:45 PM - 5:20 PM, with multiple staff across multiple shifts. Interview conducted with the ED, ADON, RN B, RN C, RN D, RN E and RN F; LVN B, LVN C, and LVN E; CNA C, CNA D, CNA E, CNA F, CNA G and CNA H. All staff stated they were in-serviced and reviewed the facility's policy on abuse and neglect, and exploitation. According to the in-services completed, staff were given a posttest on identifying abuse and neglect, behaviors of residents who may exhibit signs of abuse, identifying any marks or bruises and neglect. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 19 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete The staff were expected to get a score of 90%. Record Review revealed all staff received a 90% or above on the post test. Each stated they have an obligation to reporting abuse immediately. Each were able to identify 3 types of abuse and neglect and the name of the abuse coordinator. Each staff member was able to tell where the abuse coordinator's information throughout the facility. The ED, ADON and LVN D were in-serviced 1:1 by the SED on Policy and Procedure Abuse and Neglect, including immediate reporting to Abuse Coordinator per HHSC guidelines. The ED was informed the Immediate Jeopardy was removed on 6/27/2025 at 6:00 PM The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 676323 If continuation sheet Page 20 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 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 0610 Respond appropriately to all alleged violations. 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 have evidence that all alleged violations of abuse were thoroughly investigated, to prevent further potential abuse or mistreatment while the investigation was in progress, and report the result of all investigations to other officials in accordance with State law, including to the State Survey Agency within 5 working days of the incident for 1 (CR#1) of 9 residents reviewed for abuse.The facility failed to ensure resident(s) was/were free from physical/mental abuse and neglect when CR#1 reported he was abused by CNA A and received an injury. The facility staff failed to immediately report the incident to the Abuse Coordinator (ED), suspend staff, and being an investigation of the incident promptly.The facility failed to prevent CNA A from having access to CR#1 and other residents after an allegation of abuse was reported.An Immediate Jeopardy (IJ) situation was identified on 06/26/2025. While the IJ was removed on 6/27/2025., the facility remained out of compliance at a scope of pattern with the potential for more than minimal harm due to the facility's need to evaluate the effectiveness of the corrective systems. These failures placed resident(s) involved in abuse incidents at risk of continued abuse, mistreatment, further injury, pain and physical and emotional distress contributing to further serious injuries. The findings include:Record review of CR#1's undated face sheet reflected a [AGE] year-old male who was initially admitted to the facility on [DATE] and re-admitted on [DATE]. CR#1 had diagnoses which included toxic encephalopathy (a neurological disorder that occurs with brain is exposed to toxic substances, such as heavy metals or neurotoxic solvents over a period of time) and had a cystostomy catheter (tube inserted through the abdomen into the bladder).Record review of CR#1's Orders revealed, Wound Treatment-Xeroform (dressing) everyday shift cleanse wound to left hand with Normal Saline or skin cleanser. Pat dry. Apply Xeroform to wound. Cover with dry dressing. Start Date-06/22/2025.Record review of CR#1's care plan, dated 6/17/2025, revealed the following:Focus: [CR#1] has an ADL self-care performance deficit r/t. Date initiated 5/2/2025Goal: [CR#1] will maintain currently level of function in through the review date.Interventions: [CR#1] Transfer: Resident is totally dependent of staff for transferring. Date initiated: 5/27/2025Record review of WCD notes, dated 6/24/2025, revealed a skin tear wound of the left forearm. Wound size 2.2x1x0.3. Primary dressing Xeroform gauze apply once daily and as needed: if saturated, soiled, or dislodged. For 30 days.Record Review of the Nursing Board certificates received from ED for the current staff: DON, RN A, LVN A and CNA A. Each document contained a handwritten termination date and time on the upper righthand corner of each document.Record review of CR#1's admission MDS dated [DATE], revealed CR#1 has a BIMS Score of 12, which indicated moderate cognitive impairment. CR#1 used a wheelchair as a mobility device; required 2 or more helpers to complete to assist with transferring from wheelchair or bed. Record review of nursing notes, revealed there were no notes documented on 6/21/2025 regarding CR#1's injuries. During an observation and interview on 6/24/25 at 9:15 AM, CR#1 was seated in his wheelchair at the entrance of his room and was observed with a bandage on his left forearm that had a small amount of blood on it. It had a written date of 6/24/2025. CR#1 was alert, orientated to person, place and event. CR#1 stated the injury occurred when CNA A tried putting him in bed by herself by pulling his arms to lift him out of the wheelchair. CR#1 stated he told CNA A he did not want to go to bed, but she insisted anyway and continued to pull on his arms. CR#1 stated CNA A told him she could put him in bed by herself and he told her it would take two people, but he was not ready to go to bed. He stated CNA A told him if she didn't put him in bed then he would be there all night even if he pooped on himself, and she would not bring him any food. He stated CNA A insisted on putting him in bed by herself and he told her he was unable to assist her due to how he was Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 21 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some feeling. CR#1 stated during her pulling on his arms by herself, CNA A injured his left arm. CR#1 continued to tell CNA A not to pick him up by herself because it took two people. He stated she did not listen, but when she realized she couldn't she went and got CNA B. CR#1 stated he told LVN what occurred when she came to his room. He stated CNA A was rough with him.Record review of text received from LVN A from her telephone reveals that the 911 call was made on 6/22/25 at 4:21pm.Record review of nursing notes, by WCN A, dated 6/22/25 at 6:38 PM, revealed Received report resident has skin tear to left hand. Assessment done verbally denied pain and discomfort. Physician informed, order in place. Wound care done at this time, tolerated well. Offloads reposition and safety noted. RP updated remain stable. Will continue plan of care.Record review of nursing notes, by RN A, dated 6/22/25 at 6:58 PM, for effective date 6/21/25 at 3:30 PM revealed the following note: Received report from the outgoing nurse that patient voiced concern regarding a CNA's approach during care. Patient reported that the assigned CNA was not gentle and continued to insist that he perform tasks independently, despite the patient stating he felt too weak and required two-person assistance. CNA reportedly attempted care initially alone, but eventually called for a second staff member to assist. During assessment, patient was noted with an existing bruise to the left upper arm that appeared to have reopened, resulting in a small amount of blood observed on the bedsheet. It remains unclear when the original injury occurred. Patient continued to express that the CNA was rough during care. Writer obtained statements from the involved CNA and requested the primary nurse to initiate an incident report for documentation and follow-up. Patient was repositioned and made comfortable in bed. The DON was notified of the incident and ongoing concerns. Will continue to monitor patient closely and follow up as needed.In a telephone interview on 6/24/2025 at 11:22 AM, LVN A stated she became aware of the incident by CR#1 on Saturday 6/21/2025 around 4:15PM-4:30PM while she was doing her rounds. She stated when she got to CR#1's room he was in bed which was unusual for him since he went to bed after dinner. LVN A went into the room, and she stated CR#1 looked as if he was crying. LVN A stated FM A informed her additional things that were going on like CR#1 had been treated mean and CR#1 stated CNA A hurt him. LVN A stated CR#1 told her CNA A told him if he didn't go to bed, she would let him sit in poop and would refuse to change him or feed him for the rest of the shift. LVN A stated CNA A attempted to transferred him from the wheelchair to the bed, which was an improper transfer as CR#1 was a 2 person assist. LVN A stated CR#1 told her CNA A tossed him in bed. After speaking with CR#1, LVN A stated she immediately notified RN A and told her to come to CR#1's room because he had a complaint and told her who the two CNA's (CNA A and CNA B) involved were. LVN A stated RN A arrived at CR#1's room, where he repeated what happened to him. RN A told LVN A to locate the WCN; however, she had gone home for the day, so LVN A stated she washed the wound and put a bandage on it until CR#1 could be seen Sunday 6/22/25 by WCN A. LVN A stated she telephoned the DON who told her she would call her back. LVN A stated the DON called back and only wanted to speak with RN A. LVN A stated during a telephone conversation between the DON and RN A she interrupted and told the DON and RN A that CNA A's actions were abuse and the abuse coordinator, ED needed to be called along with a report to the staff. She stated the DON said those words (Abuse) would result in severe consequences to her and never use that word in her facility again. LVN A stated the DON told her she didn't need to do anything as the situation would be handled. RN A told LVN A the situation was being taken care of and instructed her to leave for today (6/21/25) as her shift was ending; and return tomorrow (6/22/25) to complete documentation. LVN stated when she arrived for her shift the next day, 6/22/25, she viewed the nursing schedule and observed CNA A was scheduled to work and on 700 hall, which meant she would care for CR#1. LVN stated she called the DON and told her CNA A was scheduled to provide care to CR#1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 22 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some when she abused him yesterday. LVN A stated she told the DON she was not going to work with CNA A and she was going to document in the nursing notes and file a police report. LVN A stated she requested the administrator's telephone number to report it and neither the DON nor RN A would provide it to her. She stated she obtained the ED's number from another staff member. LVN A stated FM A and FM B came to the facility to visit CR#1 and she was told by RN A she was not allowed to engage in the conversation with the family nor come into CR#1's room. LVN A stated on 6/22/25 she telephoned the ED and was informed she was suspended for not documenting timely, calling on 6/21/25 within 2 hours of being aware of the abuse and due to an immediate investigation. LVN A stated she tried to document in the nursing notes anyway, but her sign in and password were deactivated, which prompted her to call the police and make a report. In a telephone interview on 6/24/2025 at 1:54 PM, RN A stated on the afternoon of 6/21/2025, LVN A called her and said CR#1 had a complaint. She stated she arrived at CR#1's room and observed his left forearm with blood on it. RN A stated CR#1 told her his left arm was injured during a transfer with another nursing staff. CR#1 told her he told CNA A he was a 2-person assist because she attempted to transfer him alone. CNA A called another aide (CNA B) to the room, and both CNAs transferred him to the bed. She stated CR#1 had an old bruise on his arm and she believed it re-opened during the transfer and the bruise began to bleed, which explains the blood on his bed sheet. She stated it was a healing bruise that opened. RN A stated she required a statement from both CNA's due to the wound. RN A stated she told LVN A to call WCN A to look at CR#1's wound. RN A stated CR#1 never told her CNA A was rough with him and admitted during her interview with him she didn't ask. RN A stated LVN A told her CNA A did not handle CR#1 correctly, but admitted she never asked LVN A to clarify rough. RN A stated on 6/22/25, LVN A told her CNA A should not work the 700 hall with CR#1 because she didn't treat CR#1 right yesterday (6/21/2025) because she was rough. RN A stated CR#1 told her he told CNA A to get someone to assist. RN A stated she was informed the resident was transferred safely by the CNA's but could not recall how the resident should be transferred. RN A stated she met with CR#1's family on Sunday 6/22/25 with both CNA's, A and B. RN A stated CR#1 told his family, through speaking Spanish, that one CNA B was nice and CNA A wasn't nice. She stated she did not report the incident or what CR#1 stated to his family or to the abuse coordinator, administrator, even though she knew who the abuse coordinator was. RN A stated she reported it to the DON instead.In a telephone interview on 6/24/2025 at 6:00pm with WCN A, she stated she was called to CR#1's room to look at his arm on Sunday 6/22/25 because the wound occurred on (Saturday), 6/21/2025. She stated CR#1's wound was covered on Sunday when she observed it. The WCN stated CR#1 told her staff gave him a skin tear and did not mention a name. When asked if she had attempted to probe the resident for more information, she stated, I was there to do my job, so I didn't ask any further question. WCN A stated she was aware she was a mandatory reporter and did not report the incident to the abuse coordinator.In an interview on 6/24/2025 at 6:15 PM, the DON stated on Saturday evening 6/21/25, she received a call from LVN A regarding CNA A and had an issue with her. The DON stated she called the supervisor to find out what occurred. She stated CNA A reported she asked LVN A to assist her in transferring a resident to bed because he was a two person assist. The DON stated LVN A refused, and CNA A got CNA B to assist. The DON stated she called RN A to find out what was going on and RN A stated the resident had an old wound that was opened during the transfer. The DON initially stated she never received a call from LVN A on Sunday, 6/22/25; then stated LVN A telephoned her on Sunday, 6/22/2025 afternoon between 3:00PM - 3:30PM and told her she would not work with CNA A because she was rough to a resident when she attempted to transfer CR#1 to the bed alone on yesterday (6/21/2025) and demanded CNA A be sent home. The DON stated she told LVN A she did not make those type of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 23 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some demands. Shortly after the call with LVN A, the DON stated she received a call from the ED and was informed LVN A was alleging abuse. She stated on Sunday (6/22/2025) LVN A reported abuse to the ED (abuse coordinator). The ED suspended LVN A and CNA A. The DON stated she spoke with CR#1 yesterday (6/23/2025) and he told her his weekend was good. The DON stated she asked CR#1 if anything happened this weekend he needed to talk about, and CR#1 told her no. The DON stated she did not asked CR#1 if CNA A was rough with him because he told her his weekend was good. The DON stated she did not speak with the FM's and did not file any report with the state. The DON stated she could not think of a negative outcome regarding this incident; however, she said after LVN A mentioned abuse it was a reportable incident.In an interview on 6/24/2025 at 6:52 PM, the ED stated on Saturday, 6/21/25, she received a phone call from CNA A, who stated CR#1 said he received a skin tear during a transfer with CNA A. She stated she spoke with RN A who stated the resident had an old bruise, which opened during a transfer to the bed by CNA's. She stated the RN told her WCN A was notified to look at the wound. The ED stated on Sunday, 6/22/25, around 2:30PM - 2:45PM, she received a call from LVN A claiming CNA A abused CR#1 yesterday (6/21/2025) afternoon. The ED stated she received information CR#1's FMs were visiting him. She stated she told the receptionist to go to CR#1's room and keep her on facetime so she could speak with the FM's. She stated she was informed by the FMs a CNA was rough with CR#1 yesterday (6/21/2025) and injured his arm while trying to put him in bed by herself. The ED stated during this time she directed RN A to bring in both CNAs (A & B) to identify which ones completed the transfer. She stated CR#1 identified CNA A as being rough with him and CNA B as being nice. The ED stated at this time the LVN and CNA A were suspended immediately and asked to leave the building. The ED stated LVN A told her she called and filed a police report and called in a report to the state survey agency. She stated FM B stated he called the police. The ED stated she reported the incident when she found out about it on Sunday, 6/22/2025. She stated the provider letter stated reports of abuse were to be reported within 2 hours. The negative outcome was other residents could be subjected to abuse because the alleged perpetrator could be providing care to other residents as well. She stated this was why she immediately suspended LVN A because she had an obligation to report. The ED stated as soon as she became aware of the incident she called in a report to the state (Intake#1018590). Based on the initial interviews with staff involved she placed each on suspension, then terminated them. She stated it had only been 2 days since the incident and the provider investigation report has not been submitted to state. In a telephone interview on 7/1/2025 at 1:08 PM, SPO stated he received a call on 6/22/2025 regarding an abuse on an elderly resident. He stated he responded to the facility around 4:00 PM to take a report. Upon arrival, he met the family in the entrance area and walked to the resident room with them. He spoke with LVN A who stated a resident was abused by CNA A and she was working and had access to resident(s). He stated LVN A stated CNA A injured the resident's left arm. He stated he spoke with the resident who stated CNA A was rough with him by putting him in bed roughly. He stated he was unable to locate the CNA for an interview. He stated he spoke with CR#1's family who stated they didn't want to press charges; however, they wanted to wait to see what the facility's response would be. stated FMs A and B said if the facility did not address the issue, then they would press charges. He stated he took photos of the resident's left arm and entered them into evidence. Record Review of the facility's Abuse Protocol policy, dated April 2019, revealed the following: 8. Any person observing an incident of Patient Abuse or suspecting Patient Abuse must immediately report such incidents to the Charge Nurse. The following information should be reported to the Charge Nurse: a. The name of the Patient involved; b. The date and time that the incident occurred; c. Where the incident took place; d. The name(s) of the person(s) committing the incident, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 24 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some if known; e. The name(s) of any witnesses to the incident; f. The type of abuse that was committed (i.e., verbal, physical, sexual, etc.); and g. Other information that may be requested by the Charge Nurse. 9. The Charge Nurse will immediately examine the Patient and notify the Abuse Prevention Coordinator upon receiving reports of mental, physical or sexual abuse. 10. The Abuse Prevention Coordinator will: a. Immediately (within 2 hours) report to The Department of Aging and Disability Services (DADS) and other appropriate authorities incidents of Patient Abuse as required under applicable regulations and regulatory guidance. Report events that cause reasonable suspicion of serious bodily injury immediately (within 2 hours) after forming the suspicion to The Department of Aging and Disability Services (DADS) and other appropriate authorities as required under applicable regulations and regulatory guidance. b. Immediately (within 24 hours) suspend the employee for an abuse allegation until an investigation is completed. c. Conduct and document on a Patient Abuse Investigation (see Form 3-5) a thorough investigation of each incident of Patient Abuse, neglect, exploitation or mistreatment to include: observations, interviews and reviews of all Patient's involved interviews of all witnesses, including Patients, staff and family members notifying physicians notifying families and responsible parties of the involved Patient's recording all relevant physical findings. d. Complete an appropriate assessment of all Patient's involved e. Take all steps necessary to protect the Facility's Patients from further incidents of Patient Abuse, neglect, exploitation or mistreatment while the investigation is in progress. f. Provide a copy of each Patient Abuse Investigation to the Director of Operations, Regional Director of Operations, and the Regional Director of Clinical Services. g. Be responsible for carrying out any interventions or follow-up steps subsequent to the investigation of any abuse or alleged abuse, neglect, exploitation or mistreatment. (Investigation) This was determined to be an Immediate Jeopardy (IJ) was identified on 06/26/2025. The ED was notified and provided with the IJ template on 6/26/2025 at 12:10pm.The following Plan of Removal submitted by the facility was accepted on 6/27/2025 at 2:53pm. 06/27/25Plan of RemovalF610Facility Name and ID #: Impact StatementOn 06/27/2025 the facility was cited for immediate jeopardy related to incident on 06/21/2025. LVN A reported to RN and DON regarding resident abuse by CNA A placing residents at risk of continuous abuse due to the facility not following their abuse policy. The facility was not able to immediately investigate and take action placing the resident in further harm. The facility failed to immediately investigate, suspend suspected staff, and protect CR #1 after the report of abuse by CNA A. Immediate Action:Please accept this as our Plan of Removal for the Immediate Jeopardy related to F610 Failure to Investigate. The Executive Director notified the Medical Director of Immediate Jeopardy on 6/27/25 at 1:00pm. Facility held an Emergency QAPI Meeting. Director of Nursing, LVN A, RN A, and CNA A were terminated on 6/25/2025 for failure to immediately report abuse to the Abuse Coordinator. 1:1 education on Policy and Procedure Abuse and Neglect, including immediate reporting to Abuse Coordinator, immediately investigate allegations of abuse and neglect, and timely reporting per HHSC guidelines was immediately provided Executive Director, ADON, Unit Manager by Senior Executive Director.Completion Date: 06/27/2025 AssessmentAn emergency QAPI meeting was held on 06/27/2025 which was inclusive of a review of our policies/protocols Abuse and Neglect, they were found to be sufficient.Staff in- services, to include all facility employees, were started on Abuse and Neglect, including immediate notification to the Abuse Coordinator. Staff will not be allowed to start on the floor or give care until this training has been completed.All new facility staff will receive the in-services as part of the onboarding orientation process prior to working in the facility.All facility staff members completed a posttest after their education was completed to ensure staff were able to identify abuse and neglect, and proper reporting procedures.If the employee did not pass the test (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676323 If continuation sheet Page 25 of 26 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 676323 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Crescent 11353 Sugar Park Lane Sugar Land, TX 77478 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete with at least 90% correctly answered the staff member was re-educated and re-tested until at least 90% pass rate was met.A staff roster was utilized to ensure 100% of staff were in-serviced and tested.In-services were deemed to be effective by the in-services post test scores and verbalization of understanding by all facility staff.Who will be responsible: Executive DirectorThe in-services with all staff will be completed by 06/25/2025. All staff were in-serviced 06/25/2025.Facility leadership completed safe surveys on all current facility patients to ensure they were free from abuse and neglect, no negative findings.Completion Date 06/25/2025 Facility Monitoring Residents will continue to receive safe surveys daily for 7 days, including weekends by facility leadership Manager on Duty, and twice weekly for the next 4 weeks to ensure residents remain free from abuse and neglect. Facility leadership will continue with daily and PRN rounds to ascertain any signs and symptoms of abuse and neglect. Any negative findings will be immediately reported to the Abuse Coordinator. Beginning 06/25/2025 no staff will be allowed to work until the required in servicing has been completed. Who will be responsible: Facility Leadership Who will do monitoring: Executive Director Completed on date: 06/27/2025 Policy and Procedures Policy and procedures were reviewed by Senior Executive Director, Regional Director of Clinical Services, Executive Director. These policies include Abuse and Neglect. No policies needed any revisions. Interviews on 6/26/2025 & 6/27/2025 from 2:45 PM - 5:20 PM, with multiple staff across multiple shifts. Interview conducted with the ED, ADON, RN B, RN C, RN D, RN E and RN F; LVN B, LVN C, and LVN E; CNA C, CNA D, CNA E, CNA F, CNA G and CNA H. All staff stated they were in-serviced and reviewed the facility's policy on abuse and neglect, and exploitation. According to the in-services completed, staff were given a posttest on identifying abuse and neglect, behaviors of residents who may exhibit signs of abuse, identifying any marks or bruises and neglect. The staff were expected to get a score of 90%. Record Review revealed all staff received a 90% or above on the post test. Each stated they have an obligation to reporting abuse immediately. Each were able to identify 3 types of abuse and neglect and the name of the abuse coordinator. Each staff member was able to tell where the abuse coordinator's information throughout the facility. The ED, ADON and LVN D were in-serviced 1:1 by the SED on Policy and Procedure Abuse and Neglect, including immediate reporting to Abuse Coordinator per HHSC guidelines. The ED was informed the Immediate Jeopardy was removed on 6/27/2025 at 6:00 PM The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy and a scope of Pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 676323 If continuation sheet Page 26 of 26