Health inspection·December 10, 2025

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that the staff that cared for Resident #3 on 11/30/2025 were agency staff. The Administrator stated he contacted the agency but never received a response. The Administrator stated he tried to contact CNA B who was responsible for Resident #3's care but was unsuccessful. He did instruct the DON to ensure CNA B did not return the facility. The Administrator stated he did not contact the nurse that was on shift or the aide that changed Resident #3. The Administrator acknowledged that to find out how Resident #3 presented the aide who changed her should have been contacted. The Administrator stated that he and the DON conducted the investigation, because he allowed the DON to deal with the clinical staff. Record review of an email from Resident #3 family member to the Administrator dated 12/02/2025 sent at 8:32am revealed on 11/30/2025 at 11:45 a.m. Resident #3's family member walked into Resident #3's room and Resident #3 was soaked with feces and urine, and sheets were dirty. Resident #3's family member informed RN A that Resident #3 needed to be changed and asked RN A who was the aide assigned to Resident #3 and RN A found the aide asleep in her car. The aide that day was agency, this was unacceptable and negligent. During an interview on 12/10/2025 at 3:03 p.m., the DON revealed that she learned about the allegation of neglect from the Administrator who received an email from Resident #3's Resident Representative on 12/02/2025 after morning meeting. The DON stated her role in the investigation was to assign staff to complete Resident #3's skin assessment, get the agency contact information to the Administrator, and to contact the RN A and the CNA B that worked that day to gather facts, but was unsuccessful in contacting RN A and CNA B. The DON stated that she also instructed the facility staffing coordinator to place the aide on do not return. The DON stated that she did not contact the aide who changed the resident. During an interview on 12/10/2025 at 3:40p.m., RN A revealed that she was the agency nurse assigned to hall 100 on 11/30/2025. RN A stated that right before lunchtime a family member came to her and stated that their mother needed to be changed and asked who the aide for the room was. RN A stated that she did not see the aide assigned to that room on the hall but was able to get another aide to change Resident #3. RN A stated she went outside as she was informed there was someone sleeping in a car, but RN A stated she did not find anyone asleep in a car outside. RN A stated she did not know who the aide was who changed Resident #3 as she had not worked with her before and could not recall her name. RN A stated that the family member did not approach her in a way that she thought the family member implied Resident #3 was neglected, but in a manner, she thought Resident #3 was dirty and requested Resident #3 be changed. RN A stated she never went into the room so she could not provide a description of how Resident #3 looked. RN A stated that she called the staffing coordinator to locate the assigned aide and was informed she was on break. During an interview on 12/10/2025 at 3:52 p.m., the Staffing Coordinator revealed that on 11/30/2025 RN A contacted her to locate CNA B because she did not see her on the hall and was not informed, she left her assignment. The staffing coordinator stated she was able to reach CNA B and was informed she was on her lunch break. The staffing coordinator stated that on 12/02/2025 the DON informed her to place CNA B on do not return. The staffing coordinator stated that on 12/02/2025 she placed CNA B on do not return. The staffing coordinator stated that once the flag is placed the individual will no longer see available shift assignments for the facility. This was verified by observation of shiftkey (platform that connected facilities with independent licensed professionals) that showed the facility had CNA B flagged as do not return. During an interview on 12/10/2025 at 4:10 p.m., CNA B stated that she had picked up a shift on 11/30/2025 and was the assigned aide for Resident #3. CNA B stated that upon arrival she conducted rounds and was waiting for another aide as they had a call in, so she checked and changed approximately 13 residents. CNA B stated that she checked Resident #3 when she started her rounds and she was dry at about 7 a.m. Then checked again around 9:25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676326 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676326 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewood Rehabilitation and Care Center 1101 Windbell Dr Mesquite, TX 75149 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete a.m. and changed her. CNA B stated that Resident #3 received tube feedings and that can cause residents to urinate a lot and have loose stools. CNA B stated that after the other aide arrived, she took her break at 11:30 a.m. CNA B stated she did not know the other aides' name because they were all agency staff. CNA B stated that as she returned from her break there was an aide in Resident #3's room with family members; she entered the room and asked the aide if she needed any assistance, the aide responded no. CNA B said stepped out and started preparing for lunch. CNA B stated she had not been contacted by the facility, and this was the first time hearing there was an issue. Attempted to contact the other assigned aide, left a voicemail, but no returned call was received prior to exit. Record review of facility accident/incident reporting - patient/resident undated, reflected the following: Procedures:2. Witnesses of facility accident or incident provide immediate assistance and report objectiveinformation to the supervisor. Record review of facility abuse, neglect, exploitation or mistreatment policy undated, reflected the following:Component VI: Investigation:1. The facility maintains that all allegations of abuse, neglect, and misappropriation of property are thoroughly investigated, and appropriate actions are taken. 4. Investigations prompt, comprehensive and responsive to the situation and contain founded conclusions. 5. The investigation may include but not limited to the following:5e. written summaries of interviews with individuals having first-hand knowledge of the incident. Employees/witnesses will be interviewed by designated facility staff and the interviewer will record all witness accounts in a document, written, dated and signed by the interviewer. 7.Guidelines for investigation:7g. Interview individuals having firsthand knowledge of the incident and write summaries of the interviews. Event ID: Facility ID: 676326 If continuation sheet Page 3 of 3