Inspection·August 25, 2025

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and comfort, prevent infection to the extent possible ' and to prevent and assess for skin breakdown. Provide privacy by pulling privacy curtain or closing room door if a private room.Record review of the facility's policy on Promoting/Maintaining Resident Dignity, undated, read in part: It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, that maintains or enhances resident's quality of life by recognizing each resident's individuality. All staff members are involved in providing care to residents to promote and maintain resident dignity and respect resident rights. Maintain resident privacy. Random observations and/or verifications are conducted by the Director of Nursing Services (DNS), or designee, to ensure compliance with this policy. Event ID: Facility ID: 676332 If continuation sheet Page 2 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 5 of 33 residents (Resident #1, Resident #2, Resident #3, Resident #4, and Resident #6) reviewed for quality of care.The facility failed to perform weekly skin assessments on the residents for several weeks.This failure could place residents at risk for skin breakdown and/or wounds without receiving treatment or worsening of skin breakdown or wounds.Findings included:1. Record review of Resident #1's undated face sheet revealed she was a [AGE] year-old female admitted originally on 5/21/21, with the most recent admission being 7/25/25. She had diagnoses of type 2 diabetes mellitus (body does not produce insulin or resists it), stage 3 pressure ulcer (fat is visible, but not bone), cognitive communication deficit (difficulty in communication due to attention or memory), hemiplegia of left side (paralysis), contracture of right lower leg (shortening or tightening of muscles, tendons, or ligaments), contracture of left lower leg, and dementia (decline in mental ability affecting daily life).Record review Resident #1's Quarterly MDS assessment dated [DATE], revealed a BIMs score of 4 out of 15 which indicated severely impaired cognition. The resident had impairment on both sides of her upper and lower extremities and was dependent (helper does all of the effort) with all ADLs. The MDS revealed the resident had a Stage 3 pressure ulcer, and a Stage 4 (exposed bone, tendon or muscle) pressure ulcer. She also had 2 unstageable pressure injuries.Record review of Resident #1's care plan dated 5/22/21 revealed the following: *Focus: Resident had a Stage 3 pressure injury of the L Lateral Knee (outside of the knee) that was now a Stage 4 pressure injury after being readmitted from the hospital on 7/25/25 (Initiated: 9/5/24, Revised: 8/2/25). The goal was for the resident to remain free from further breakdown. An intervention was conducting weekly skin assessment per facility policy. *Focus: Resident had impaired physical mobility r/t decreased ROM to L hand (Initiated: 11/21/24). The goal was to reduce further contraction through next review. Interventions included monitoring R hand skin integrity, circulation, and motion. *Focus: Resident had a pressure ulcer/DTI to the L medial (inside) heel after readmission from the hospital on 7/25/25 (Initiated: 4/23/25, Revised: 8/2/25). The goal was to remain free from further breakdown through the review date. Interventions included skin assessment to be completed per facility policy and conduct a weekly skin inspection. *Focus: Resident had a pressure injury to the L plantar (bottom) foot (Initiated: 8/5/25). The goal was for her skin to remain intact through the review date. Interventions included conducting a weekly skin inspection and diabetic foot monitoring. *Focus: Resident had pressure injury to R Ischium (hip) on readmission 7/25/25 (Initiated: 7/25/25, Revised: 8/2/25). The goal was to show s/s of healing through the review date. Interventions included monitoring for tissue breakdown, monitoring for infection, and notifying MD if necessary. *Focus: Resident had pressure injury to R dorsal great toe (top of big toe) on readmission 7/25/25 (Initiated: 7/25/25, Revised: 8/2/25). The goal was to show s/s of healing through the review date. Interventions included monitoring for tissue breakdown and monitoring for infection.Record review of Resident #1's Physician Orders from 8/12/25, revealed an order from MD J for weekly head to toe skin assessments every night shift on Tuesdays, which was ordered on 7/25/25 to start on 7/29/25. Record review of Resident #1's medical records revealed an initial skin assessment was performed on re-admission 7/25/25 at 11:56am. Record review of Resident #1's assessments on 8/12/25, revealed the weekly wound reports were being performed.Record review of Resident #1's July 2025 MAR-TAR revealed LVN P initialed that she performed the skin assessment on 7/29/25. No weekly skin assessment for 7/29/25 was found in the resident's Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676332 If continuation sheet Page 3 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some chart.Record review of Resident #1's August 2025 MAR-TAR revealed LVN P initialed that she performed the skin assessment on 8/5/25. No weekly skin assessment for 8/5/25 was found in the resident's chart.In an observation and interview on 8/12/25 at 2:10pm, a skin assessment was performed on Resident #1 by LVN G and CNA I. No new skin issues were found. There were wounds on the resident's L thigh, L knee, R toe, and R hip. Per LVN G, the wounds were already being treated by wound care. The resident was not interviewable. 2. Record review of Resident #2's undated face sheet revealed he was a [AGE] year-old male admitted on [DATE] with diagnoses of ESBL (type of multi-drug resistant organism) resistance, prediabetes, paraplegia (paralysis of lower extremities), cognitive communication deficit (difficulty in communication due to attention or memory), bipolar (mood swings ranging from depressive lows to manic highs), and depression.Record review of Resident #2's admission MDS assessment dated [DATE] revealed a BIMs score of 15 out of 15 which indicated normal cognition. The resident had impairment on both sides of his upper and lower extremities and was dependent with almost all ADLs. The resident had a foley catheter (tube into bladder to drain urine) and was incontinent of bowel. The MDS revealed the resident had no unhealed pressure ulcers/injuries.Record review of Resident #2's care plan dated 6/25/25 revealed a Focus: Resident had a Stage 3 pressure injury that he was admitted with, to his sacrum (tailbone) (Initiated: 6/25/25, Revised: 6/29/25). The goal was for the resident to remain free from further breakdown through the review date. An intervention was to conduct weekly skin inspections.Record review of Resident #2's medical records revealed an initial skin assessment that was performed on 6/25/25 at 3:48pm. Further review revealed no additional skin assessments.Record review of Resident #2's Physician Orders from 8/12/25, revealed no orders for weekly skin assessments.In an observation on 8/12/25 at 1:25pm, a skin assessment was performed on Resident #2 by LVN D and LVN G. No skin issues were found, and the sacrum pressure ulcer was gone. The resident was not interviewable. 3. Record review of Resident #3's undated face sheet revealed she was a [AGE] year old female admitted on [DATE] with diagnoses of hemiplegia and hemiparesis (paralysis and weakness) on the right side after a stroke, type 2 diabetes mellitus (body does not produce insulin or resists it), functional quadriplegia (paralysis of upper and lower extremities), epilepsy (seizures), and muscle wasting/atrophy to the right and left lower leg.Record review of Resident #3's Quarterly MDS assessment dated [DATE] revealed a BIMs score of 15 out of 15 which indicated normal cognition. The MDS revealed she had impairment on both sides of her upper and lower extremities, and she was dependent on staff for all ADLs. The resident was incontinent of bowel and bladder. The MDS revealed the resident had 1 unstageable pressure injury and was receiving care.Record review of Resident #3's care plan dated 2/19/25 revealed a Focus: Resident had a Stage 1 (redness with no open areas) pressure ulcer to the R medial (inside) foot (Initiated: 4/24/25). The goal was for the resident's skin to remain intact through the review date. Interventions included conducting weekly skin inspections, notifying the MD if symptoms worsen, and skin assessments to be completed per facility policy.Record review of Resident #3's Physician Orders from 8/12/25, revealed an order from MD M for weekly head to toe skin assessments every Tuesday evening, ordered on 2/19/25 to start on 2/25/25.Record review of Resident #3's assessments revealed the last weekly skin assessment was performed on 7/22/25 at 8:09pm.Record review of Resident #3's July 2025 MAR-TAR revealed LVN G initialed she performed the weekly skin assessment on 7/29/25. No weekly skin assessment was found in the resident's chart for 7/29/25. Record review of Resident #3's August 2025 MAR-TAR revealed a blank spot for the weekly skin assessment on 8/5/25.In an interview on 8/12/25 at 4:00pm, the ADM said she ensured LVN G performed a skin assessment on Resident #3 and there were no skin issues found. 4. Record review of Resident #4's undated face sheet revealed he was an [AGE] year-old male originally admitted on [DATE], with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676332 If continuation sheet Page 4 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some most recent admission being 2/11/25. He had diagnoses of atrial fibrillation (irregular heartbeat), type 2 diabetes, COPD (lung diseases that cause airflow blockage and breathing problems), heart failure (heart does not pump blood effectively), cerebral infarction (stroke), and pneumonia (infection in the lungs).Record review of Resident #4's Quarterly MDS assessment dated [DATE] revealed a BIMs score was unable to be performed. The resident had impairment on both sides of his upper and lower extremities and was dependent for all ADLs. The resident was incontinent of bowel and bladder but had no pressure injuries. She did have some MASD (skin breakdown from moisture).Record review of Resident #4's care plan dated 8/8/24 revealed a Focus: Resident had physical functioning deficit r/t self-care impairment (Initiated: 10/20/24). The goal was that the resident would maintain current level of functioning. The interventions included inspecting the skin and report any redness, rashes, or open areas.Record review of Resident #4's Physician Orders from 8/12/25, revealed an order from MD J for weekly head to toe skin assessments to be done every Tuesday evening, ordered on 2/11/25 to start on 2/13/25.Record review of Resident #4's assessments revealed the last weekly skin assessment was performed on 7/31/25 at 9:29pm.Record review of Resident #4's August 2025 MAR-TAR revealed LVN G initialed she performed the weekly skin assessment on 8/7/25. No weekly skin assessment was found in the resident's chart for 8/7/25.In an interview on 8/12/25 at 4:00pm, the ADM said she ensured LVN G performed a skin assessment on Resident #4 and the only skin issue that was reported to her was redness to his groin. 5. Record review of Resident #6's undated face sheet revealed she was a [AGE] year-old female originally admitted on [DATE], with the most recent admission being 6/2/25. She had diagnoses of respiratory failure (not enough oxygen in the blood), type 2 diabetes (body does not produce insulin or resists it), atrial fibrillation (irregular heartbeat), congestive heart failure (heart is not able to pump the fluid out of the body), and hypertensive heart/chronic kidney disease with heart failure (high blood pressure that caused kidneys/heart to fail).Record review of Resident #6's Significant Change MDS assessment dated [DATE] revealed a BIMs score was unable to be performed. The resident had impairment on both sides of her upper and lower extremities and was substantial/max assist with ADLs. The MDS revealed the resident was incontinent of bowel and bladder and she had a Stage 2 (shallow open ulcer or open/ruptured blister) pressure injury and was receiving care.Record review of Resident #6's care plan dated 1/14/21 revealed a Focus: Resident #6 had potential for pressure ulcer development r/t immobility (Initiated: 4/14/21, Revised: 6/3/21). The goal was to have intact skin through the review date. The interventions included following the facility's policies/protocols for the prevention of skin breakdown.Record review of Resident #6's Physician Orders from 8/12/25, revealed an order from MD M for weekly skin assessments every Tuesday evening, ordered on 5/24/25 to start on 5/27/25.Record review of Resident #6's weekly skin assessments revealed the last weekly skin assessment was performed on 7/22/25 at 7:58pm.Record review of Resident #6's assessments revealed weekly wound assessments were performed until 8/1/25, when her pressure ulcer healed.Record review of Resident #6's July 2025 MAR-TAR revealed LVN G initialed she performed the weekly skin assessment on 7/29/25. No weekly skin assessment was found in the resident's chart for 7/29/25.Record review of Resident #6's August 2025 MAR-TAR revealed a blank spot on 8/5/25 for the weekly skin assessment.In an observation on 8/12/25 at 1:36pm, a skin assessment was performed on Resident #6 by LVN G and CNA T. Redness was found to her L lateral foot, R underarm, and R buttock, but no open areas.In an interview on 8/12/25 at 9:59am, LVN D said the floor nurse performed the weekly skin assessment according to the schedule they had posted at the nursing station. She said if the resident was being treated by wound care, then the wound care nurse would do the weekly skin assessment. She said if a weekly skin assessment was not performed, they could miss skin issues.In an interview on 8/12/25 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676332 If continuation sheet Page 5 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 10:50am, LVN G said she was the Wound Care Nurse. She said the weekly skin assessment should still be performed by the floor nurse, even if they had wounds. She said she filled out the Weekly Wound Review and it was based off the measurements the Wound Care MD gave her.In an interview on 8/12/25 at 11:41am, the ADM said a skin assessment was performed at every admission and was documented under the Admission/Baseline Care Plan. She said then weekly, a head-to-toe skin assessment was performed by one of the 3 different shifts, according to the schedule at the nursing station. The ADM said the Weekly Wound Review should be done along with the Weekly Skin assessment. The ADM said the nurses were trained on performing skin assessments and knew the schedule on when to perform them. She said she did not know why the nurses were not doing the skin assessments and had not heard anything from them about the assessments not being done.In an interview on 8/12/25 at 3:15pm, the ADM said she investigated the reason for the skin assessments not being done and Resident #2's weekly skin assessments were never triggered in the EMR. She said she would call the company to see what was going on. The ADM said even though it did not trigger in the system, the nurses should have known to do the assessment, even if they had to do it on paper.In an interview on 8/12/25 at 4:47pm, the ADM said after investigation of the other resident's skin assessments not being done, she thinks they were overlooked. She said the ADON normally would follow up on skin assessments to ensure they got done and she had not had an ADON in a few weeks. She said she also was in between DONs so everyone was stretched thin. She said if skin assessments were not done, they could miss skin issues and residents could get wounds.Record review of the facility's policy and procedure on Skin Assessment, undated, read in part: It is our policy to perform a full body skin assessment as part of our systematic approach to pressure injury prevention and management.A full body, or head to toe, skin assessment will be conducted by a licensed or registered nurse upon admission/re-admission, daily for three days, and weekly thereafter. The assessment may also be performed after a change of condition or after any newly identified pressure injury.Document if resident refused assessment and why. Event ID: Facility ID: 676332 If continuation sheet Page 6 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that residents received care, consistent with professional standards of care to prevent the development of pressure ulcers for 1 of 7 (Resident #7) residents reviewed for pressure ulcers. - The facility failed to prevent Resident #7 from acquiring DTIs to both of her heels and from the L heel progressing into an unstageable PU, when she was admitted with only redness to both heels. Resident #7 required hospitalization for the treatment of the injuries to her heels.An Immediate Jeopardy (IJ) was identified on 8/21/2025. The IJ template was provided to the facility on 8/21/2025 at 12:55pm. While the IJ was removed on 8/22/2025 at 4:00pm, the facility remained out of compliance at a severity of actual harm that is not immediate jeopardy with a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems.This failure could place residents at risk for pain, infection, and hospitalization.Findings include:Record review of Resident #7's undated face sheet revealed she was an [AGE] year-old female admitted on [DATE] with diagnoses of type 2 diabetes (body does not make insulin or resists it), retention of urine, osteoarthritis (joint disease where cartilage breaks down), neuropathy (nerve pain), and difficulty walking.Record review of Resident #7's admission MDS assessment dated [DATE] revealed a BIMs score of 15 out of 15 which indicated normal cognition. She had an impairment on both sides of her upper and lower extremities. The resident was partial/moderate (helper does less than half the effort) assistance with ADLs. She had an indwelling catheter and was incontinent of bowel. The MDS revealed the resident had no pressure injuries on admission.Record review of Resident #7's admission and Baseline Care plan dated 6/30/25 revealed the resident had redness to her right and left heel on admission, with no DTIs or open wounds to her heels. Resident #7 admitted with a wound to the sacrum but there was no evidence of it worsening.Record review of Resident #7's care plan dated 6/30/25 revealed a Focus: Resident #7 admitted with DTI of the L heel (Initiated 6/30/25, Revised 7/30/25). The goal was to remain free from further breakdown through the next review. Interventions included floating the heels, heel boots, weekly skin inspection, and treatments as ordered. Focus: Resident #7 admitted with DTI of the R heel (Initiated: 6/30/25, Revised: 7/30/25). The goal was to remain free from further breakdown through the next review. Interventions included weekly skin inspections, float the heels, heel boots, and treatments as ordered.Record review of Resident #7's previous hospital's Initial admission Physical assessment dated [DATE] at 10:19pm, revealed redness to the sacrum (tailbone), but no wounds and no mention of redness or any concerns to the heels.Record review of Resident #7's previous hospital's Wound Care Consult dated 6/24/25 at 12:42pm, revealed she had .sacral blanchable [turns white] redness over intact skin.Bilateral lower extremities with edema [swelling].no open wounds. Bilateral feet had palpable [able to feel] pulses. No other alterations to skin integrity noted.Record review of Resident #7's previous hospital's Shift Physical assessment dated [DATE] at 9:00am, revealed her exception to a normal skin assessment was having swollen bilateral legs. There was no mention of any other skin issues.Record review of Resident #7's Progress Note dated 7/1/25 at 1:14pm by LVN W, revealed the resident had pressure ulcers on her sacrum and Wound Care was consulted. Nothing was noted about the heels having wounds.Record review of Resident #7's Physician Orders revealed the following orders from MD M:- Consult Wound Care. Ordered on 7/1/25.- Wound Care: Cleanse R Heel with NS, Pat dry, Apply skin prep to wound and LOA, QD. Ordered on 7/9/25 at 6:00am.- Wound Care: Cleanse L Heel with NS, Pat dry, Apply skin prep to wound and LOA, QD. Ordered on 7/10/25 at 6:00am.- Use Heel Lift to float heels at all times while in bed, every shift. Ordered 7/10/25 at 2:00pm.- May send to [hospital] for eval and tx, one time. Ordered on 8/3/25 at 8:30pm.Record review of Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676332 If continuation sheet Page 7 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Resident #7's Weekly Head to Toe Skin Check dated 7/7/25 at 12:34pm by LVN C, revealed L heel with no description and no mention of the R heel. Under the weekly heel check questions LVN C answered the L heel was not boggy (mushy), not discolored, did not have an open area, and did not have a blister.Record review of Resident #7's Wound Care Note dated 7/8/25 at 4:39pm from MD O, revealed the resident had a R heel deep tissue injury that was 3cm x 4cm x 0cm. She also had a L heel deep tissue injury that was 3cm x 3.5cm x 0cm.Record review of Resident #7's Weekly Head to Toe Skin Check dated 7/14/25 at 12:38pm by LVN C, revealed R heel DTI and no mention of the L heel. Under the weekly heel check questions LVN C answered the L heel was not boggy, it was discolored, did not have an open area, and did not have a blister.Record review of Resident #7's Wound Care Note dated 7/15/25 at 9:11pm from MD O, revealed the R heel DTI was 3.2cm x 3.5cm x 0cm. The L heel DTI was 4cm x 4.5cm x 0cm.Record review of Resident #7's Weekly Head to Toe Skin Check dated 7/21/25 at 12:38pm by LVN C, revealed R heel DTI and no mention of the L heel. Under the weekly heel check questions LVN C answered the L heel was not boggy, it was discolored, did not have an open area, and did not have a blister.Record review of Resident #7's Wound Care Note dated 7/24/25 at 6:45pm from MD O, revealed the R heel DTI was 3cm x 3.5cm x 0cm. The L heel DTI was 4cm x 4.5cm x 0cm.Record review of Resident #7's Weekly Head to Toe Skin Check dated 7/29/25 at 7:11am by LVN D, revealed R heel pressure and no mention of the L heel. Under the weekly heel check questions LVN D answered the L heel was not boggy, it was discolored, did not have an open area, and did not have a blister.Record review of Resident #7's Wound Care Note dated 8/1/25 at 8:59pm from MD O, revealed the R heel DTI was 3cm x 3.4cm x 0cm. The L heel DTI was 3.5cm x 4.5cm x 0cm.Record review of Resident #7's hospital Wound Care Consult, dated 8/4/25 at 10:49am from MD Q, revealed the resident had a DTI of the R heel and an unstageable L heel ulcer.In an observation and interview on 8/7/25 at 10:55am with Resident #7, she was admitted to the hospital and lying on her left side in bed. She had pressure relieving boots (foam boots for pressure) on both of her feet. She said she did not like the nursing facility she came from because they did not change her frequently but was unable to answer any other questions due to having severe pain in her bottom from her pressure ulcer.In a telephone interview on 8/7/25 at 3:25pm, Resident #7's family member said the resident's mom admitted to the nursing facility with a very small sacrum wound, but nothing on her heels. She said the resident was always calling her and telling her she had to go potty in her diaper because she could not wait anymore for someone to come help her.In a telephone interview on 8/8/25 at 3:28pm, Resident #7's other family member, said the resident would always complain about hitting the call bell and no one would come to help her so she would have to go in her diaper because she could not hold it anymore. She also said every time she went to the facility the resident was on her back in bed. She never saw Resident #7 on her side. The family member said she spoke to the Director of Rehab about the issues many times and nothing got done. She spoke to the Director of Rehab because that was the only phone number she had for Leadership Personnel.Record review of Resident #7's hospital Wound Care Consult dated 8/9/25 at 6:30pm from MD Q, revealed the resident had a DTI of the R heel and an unstageable L heel ulcer.During an attempted telephone interview on 8/12/25 at 9:13am, a message was left for LVN C.During an attempted telephone interview on 8/12/25 at 10:18am, a message was left for LVN W.In an interview on 8/12/25 at 10:50am, LVN G said the weekly head to toe assessment should still be completed by the floor nurse, even if the wound assessment was performed. She said the admitting nurse measured the wounds, consulted the Wound MD, and treated the wounds by getting orders from the doctor.In an interview on 8/12/25 at 11:41am, the ADM said a skin assessment was performed at every admission and documented under the Admission/Baseline Care Plan. She said the weekly head to toe assessments were performed on a schedule by the 3 different (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676332 If continuation sheet Page 8 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some shifts. The ADM said the head to toe skin assessment should still be completed along with the Wound Assessment. She said the admitting nurse would identify any wounds and stage them, but not measure them, and then notify the MD to get orders. She said the Wound Care MD would measure the wounds and document the measurements.In an interview on 8/21/25 at 12:53 pm, the ADM said the facility was treating Resident #7's heels and there was no way to avoid the PUs. She said sometimes residents got facility acquired PUs and there was nothing the facility could do.In a telephone interview on 8/21/25 at 2:53pm, NP B said she performed her own skin assessment at admission, but she did not remember if the resident had heel DTIs or not, even though nothing was mentioned in her H&P. She said interventions that would prevent heel wounds would be offloading, pressure relieving boots, heel protectors, and nutritional support. She said she did not know if Resident #7's heels got better or worse because she defers all wounds to the Wound Care MD.In a telephone interview on 8/21/25 at 2:57 pm, MD O said if the staff were using heel cushions, offloading, and repositioning for Resident #7, the heels would have gotten better and not opened into ulcers. She said if the DTIs to her heels opened into an ulcer, it would have been because the pressure was not relieved to her heels. She also said if a resident came to the facility with no wounds, and precautions were put in place to prevent PUs, there would be no reason why a resident would get a pressure ulcer.Record review of the facility's policy and procedure on Pressure Injury Prevention and Management, undated, read in part: This facility is committed to the prevention of avoidable pressure injuries, unless clinically unavoidable, and to provide treatment services to heal the pressure ulcer/injury, prevent infection and the development of additional pressure ulcers/injuries.The facility shall establish and utilize a systematic approach for pressure injury prevention and management, including prompt assessment and treatment; intervening to stabilize, reduce or remove underlying risk factors; monitoring the impact of the interventions; and modifying the interventions as appropriate.Licensed nurses will conduct a full body skin assessment on all residents upon admission/re-admission, weekly, and after any newly identified pressure injury. Findings will be documented in the medical record.Nursing assistants will inspect skin during bath and will report any concerns to the resident's nurse immediately after the task. Evidence-based interventions for prevention will be implemented for all residents who are assessed at risk or who have a pressure injury present. Basic or routine care interventions could include but are not limited to: Redistribute pressure (such as repositioning, protecting and/or offloading heels, etc.); Minimize exposure to moisture and keep skin clean, especially of fecal contamination; Provide appropriate, pressure-redistributing, support surfaces; Provide non-irritating surfaces; and Maintain or improve nutrition and hydration status, where feasible. The RN Unit Manager, or designee, will review all relevant documentation regarding skin assessments, pressure injury risks, progression towards healing, and compliance at least weekly, and document a summary of findings in the medical record.This was determined to be an Immediate Jeopardy (IJ) on 8/21/25 at 12:55pm. The ADM and the DON were notified on 8/21/25 at 12:55pm. The ADM was provided with the IJ template on 8/21/25 at 12:55pm.The following Plan of Removal submitted by the facility was accepted on 8/22/25 at 1:02pm.The plan of removal reflected the following:Name of Facility: [Name of facility]Date: 8/22/2025F686 - Treatment/Services to Prevent Pressure Ulcers1. Corrective Action Taken for the Resident(s) Found to Have Been AffectedResident #7 was admitted on [DATE] with redness to both heels and subsequently developed bilateral deep tissue injuries, progressing to an unstageable ulcer on the left heel The facility failed to prevent Resident #7 from acquiring DTIs to both heels and from the L heel progressing into an unstageable PU, when she was admitted with only redness to both heels.2. Corrective Action Taken for Residents Having the Potential to Be AffectedOn 8/21/25, immediately upon identification of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676332 If continuation sheet Page 9 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Immediate Jeopardy, licensed nurses conducted full head-to-toe skin assessments on all residents in the facility completed on 08/21/25. Two new residents were identified with new pressure areas, one new pressure injury to left medial foot and one new pressure injury to sacrum. Repositioning interventions are in place on each newly identified residents care plan and Kardex, both newly identified residents can reposition self. All Resident's Pressure Injury Risk Assessments were completed on 8/21/2025 by DON/Designee. All findings were documented and reviewed by the Director of Nursing, and physician orders were obtained for any new or existing areas of skin alteration. Preventive interventions, including heel elevation, use of heel boots, and use of pressure-relieving mattresses or cushions, were verified to be in place for all residents identified at risk completed on 8/21/2025 by DON/Designee. Kardex and Care plans were reviewed and updated to reflect individualized risk factors and interventions completed on 8/21/2025 by DON/Designee. In-servicing conducted by DON on 08/21/2025 with all full-time licensed staff included review of Kardex for current interventions in place for residents.3. Measures and Systemic Changes Put into PlaceOn 8/21/25, the Director of Nursing and wound nurse re-educated all fulltime/scheduled nursing staff, including registered nurses, licensed vocational nurses, and certified nursing assistants, on pressure ulcer prevention, early identification of skin changes, proper use of preventive devices, and documentation requirements. In-Servicing completed on 08/21/2025. Nursing staff will be in-serviced prior to start of their next scheduled shift, In-servicing will remain on-going for all new hires/PRN prior to the start of their assigned shift. AD HOC QAPI held with IDT Team and Medical Director, Skin assessment and wound management policies were reviewed and updated to include a comprehensive skin assessment conducted by the Wound Care Nurse on the day after admission or readmission to ensure assessments were completed accurately, completed on 08/22/2025. On 08/21/2025 daily meeting board was updated to include an admission tab ensuring all new admissions will receive a complete skin assessment upon admission, will be reviewed daily Monday thru Friday by DON/Designee and preventive interventions will be initiated and documented immediately. The Director of Nursing and Assistant Director of Nursing/Wound Care Nurse will ensure care plans are updated within 24 hours of any identified skin change or physician order. 4. Monitoring to Ensure Ongoing ComplianceBeginning 8/21/25, the Director of Nursing or Designee will perform audit of completed skin assessments of 5 residents daily for five days Monday through Friday, then two times weekly for four weeks, then weekly for two months, then random audit congoing to ensure continued compliance to confirm preventive interventions are in place, to ensure no residents are developing new pressure ulcers, and ensure that completed skin assessments were performed correctly. In addition, the Director of Nursing/Designee will perform direct observation of nursing staff to ensure heel elevation, turning/repositioning and use of pressure relief devices are consistently completed. Any noncompliance identified during audit will require immediate re-education, by DON/designee, with the Licensed Nurse who completed the skin assessment. Audit results are reported to the QAPI committee monthly, and corrective actions are initiated immediately if deficiencies are identified. Any staff found to be non-compliant with pressure ulcer prevention protocols will receive immediate re-education and disciplinary action if necessary. Compliance will be further validated by corporate clinical support during monthly monitoring visits. Starting 08/22/2025 and continuing forward, per updated Skin Assessment policy, the Wound Care Nurse will perform daily audits Monday-Friday of new admissions and re-admissions to ensure skin assessments were completed and correct. Any variance found will result in immediate re-education of Nursing Staff. Starting 08/22/2025, Certified Nursing Assistants will complete shower sheets on scheduled shower days which will be verified by Licensed Nurses and then turned into Wound Care Nurse for review and follow up as needed. The DON/Designee will review (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676332 If continuation sheet Page 10 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some these logs daily during daily clinical meetings Monday through Friday to ensure timely follow up and accuracy. Completion Date - 08/22/2025From 8/22/25-8/23/25 a monitoring visit was conducted to ensure the facility was following its POR. The visits revealed:Record review revealed the skin assessments performed on 8/21/25 by the DON, found 2 residents with new pressure ulcers. Resident #8 was found to have an unstageable PU to her L inner foot and Resident #9 was found to have a PU to her sacrum. The facility notified the MDs for both residents and received orders.Record review of Resident #8's chart revealed the Head-to-Toe assessment performed on 8/22/25 that found the new PU, along with the Wound Assessment also performed on 8/22/25. Record review revealed MD orders for the PU found to the L inner foot, entered on 8/22/25. Record review also revealed the Care Plan was updated with the PU.Record review of Resident #9's chart revealed the Head-to-Toe assessment performed on 8/22/25 that found the new PU, along with the Wound Assessment also performed on 8/22/25. Record review revealed the MD orders for the PU found to the sacrum, entered on 8/22/25. Record review also revealed the Care Plan was updated with the PU.In an observation on 8/22/25 at 3:26pm, Resident #8 was asleep on her left side in bed. Her legs were under the covers, so it was undetermined if she had any heel protectors on.In an observation and interview on 8/22/25 at 3:30pm, Resident #9 was sitting up in bed with her heels elevated. She said the staff did find a new wound to her bottom, but it was not bothering her. She said they put new interventions in place like turning and putting her feet up.In an interview on 8/23/25 at 2:37pm, LVN D said she worked the 6am-2pm shift. She said she recently had in-services on wound care and ensuring it was done, assessing for PUs and how to assess for PUs, reporting to the MD and to the Wound MD if any skin issue were found, ensuring accurate skin assessments were done, and ensuring shower sheets were verified by the nurse and then turned over to the Wound Care Nurse if a skin issue was found. She also said the admission assessments were performed by the floor nurse and then the Wound Care Nurse performed them after.In an interview on 8/23/25 at 2:40pm, LVN G, also the Wound Care Nurse, said she worked the 2pm-10pm shift. She said she had in-services on skin assessments, PUs, documenting wounds, and calling the MD for orders. She said there were also in-services on the risk factors for PUs, and interventions for PUs. She said the admission/readmission skin assessment was done by the floor nurse and then re-assessed by the Wound Nurse. She also said if the CNA found skin issues during a shower, the shower sheet was filled out and then given to the nurse then the Wound Nurse.In an interview on 8/23/25 at 2:43pm, CNA I said she worked the 6am-6pm shift. She said she received in-services on ways to prevent PUs like repositioning and floating the heels. She said she also received in-services on ensuring the skin was checked and filling out shower sheets and giving them to the nurse if there were any skin concerns found.In an interview on 8/23/25 at 2:45pm, CNA T said she worked the 6am-6pm shift. She said she received in-services on skin assessments, giving shower sheets to the nurse or Wound Care Nurse if any skin issues were found, and interventions to prevent PUs like floating the heels, and repositioning.In a telephone interview on 8/23/25 at 3:21pm, CNA S said she worked the 6pm-6am shift. She said she received in services on PUs and how to look for them and what to do if she found any on a resident. She said she also received in-services on interventions to prevent PUs like turning, repositioning, and floating heels. She said she was also trained on filling out shower sheets if a skin concern was found and giving them to the supervisor.In a telephone interview on 8/23/25 at 3:50pm, LVN P said she worked the 10pm-6am shift. She said she had in-services on skin assessments, how to do them, what to look for, and that the Treatment Nurse would do the Admission/readmission assessments. She said they also received in-services on interventions to prevent PUs like turning, repositioning, and floating the heels. Also, she had in-services on the CNAs filling out the shower sheets and if they found any skin concerns, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676332 If continuation sheet Page 11 of 12 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 676332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Suites Pasadena 4900 East Sam Houston Parkway South Pasadena, TX 77505 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete they needed to give the sheets to the nurse and then the nurse gave them to the Treatment Nurse.Record reviews performed by the Surveyor on 8/23/25:- Braden Scales (determines risk for skin breakdown) for all residents were completed on 8/21/25 and revealed 17 at risk, 4 at moderate risk, 2 at high risk, and 12 with no risk.- A list of residents whose Kardex and Care Plan had been reviewed by the DON on 8/21/25.In-services given by the DON on 8/21/25 to the CNAs and Licensed Nurses on Early Identification of PUs with 24 staff signatures.- In-services given by the DON on 8/21/25 top the Nursing Staff on PU Prevention, Skin Audits, and ANE with 23 signatures.- In-services given by the DON on 8/21/25 to the Treatment Nurse, RNs, and LVNs on PU Prevention with 20 signatures.- Ad Hoc QAPI Meeting from 8/21/25-8/22/25 revealed MD M, the Medical Director, the ADM, the SW, the BOM, the HR Director, the Maintenance Director, the AD, the DM, and the Admissions Director were in attendance.- A sheet that said Admissions on the top and had a column starred that said, Skin Issues: Identified on Admission, Assessment with Notification and New Order for Treatment as Applicable. There was another column starred that said, If Skin Issue Identified, Accuracy of Classification/Stage of Wound Confirmed. The log did not have anyone on it yet.- The Skin Assessment Audits log had 3 residents that had been audited on 8/22/25 and were found to have preventative measures in place, the skin assessment was complete and accurate, and no corrective actions needed to be taken.- The Wound Care Nurse Admission/readmission Audits log was blank and did not have anyone on it yet. An Immediate Jeopardy (IJ) was identified on 8/22/2025. The IJ template was provided to the facility on 8/22/2025 at 12:55pm. While the IJ was removed on 8/23/2025 at 4:00pm, the facility remained out of compliance at a severity of actual harm that is not immediate jeopardy with a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 676332 If continuation sheet Page 12 of 12