Health inspection·August 19, 2025

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete already gone for the day. She said she had not heard back from anyone about her reported abuse allegation as of today, 08/19/25. During an interview on 08/19/25 at 8:14 a.m., Resident #1 said the care at the facility was not good. He said about 3 or 4 days ago (was not sure of the exact date), a nurse aide (said he did not know her name) hit him on the right side of his face in the eye. He said a nurse aide was changing him. He said the nurse aide turned him on his right side, and when she turned him, it caused him pain. He said the nurse aide had her hand on his left arm, and he told her he wanted her to lay him flat, and he tried to get her hand off him. He said that was when she hit him. He said he did not say anything to the nurse aide. He said she finished changing him and she left his room. He said he told his family member what happened, on a different day (he did not know what day). He said he did not tell anyone else. He said it made him mad when the nurse aide hit him. He said no staff had come to talk to him about the nurse aide hitting him. During a telephone interview on 08/19/25 at 9:56 a.m., Nurse A said on Saturday, 08/16/25, she was in the middle of taking care of a critical resident when Resident #1's family member came up to her and told her the CNAs were in the resident's room changing him and cleaning him up when one of the aides had hit him in the face. She said the resident's family member could not name the CNA, but the two CNAs in the room were, CNA A and CNA B. She said she asked CNA B if they had encountered anything in the room, and CNA B said Resident #1 told his family member that they had hit him in the face, but CNA B said she was by the bed with the other aide the whole time and it did not happen. She said CNA B told her they washed the resident's face with a washcloth. She said CNA B told her Resident #1 alleged she was the one who hit him in the face. She said after their conversation, she went into her critical resident's room to provide care. She said she sent out the critical resident to the hospital, stayed very late, forgot about the reported allegation of abuse from the resident's family member until this Investigator called her for this interview. She said she did not report the alleged abuse to anyone because she was juggling the allegation of abuse and the critical resident at the same time. She said when there was an alleged allegation of abuse, the Administrator, was to be called immediately. She said abuse should be reported immediately because there was alleged harm to the resident. She also said the resident would not trust staff, or could have sustained a serious injury, or their family would not trust staff. She said she did not ask Resident #1 anything about the alleged abuse because CNA A was still in the room picking up the linens off the floor. She said she received training on abuse, neglect, and exploitation. She said unfortunately she forgot to report the allegation of abuse and apologized for forgetting to report. During an interview on 08/19/25 at 12:25 p.m., the DON said when a nurse received an allegation of potential harm to a resident, they secured the resident, removed the potential harm, and notified the Administrator. He said they would notify the family/next of kin and the provider as well. He said he was not aware that Resident #1's family member reported an allegation of resident abuse to Nurse A this past Saturday, 08/16/25. He said failure to report abuse could cause a delay of treatment, if needed, and a delay of an investigation. During an interview on 08/19/25 at 1:19 p.m., the Administrator said she was not aware that Resident #1's family member reported an allegation of resident abuse to Nurse A on Saturday, 08/16/25. She said she was going to report it to the state today. She said staff members CNA A, CNA B, and Nurse A, had been suspended until the investigation was completed, and they would be in-servicing staff on Abuse/neglect and reporting. Event ID: Facility ID: 676333 If continuation sheet Page 2 of 5 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 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 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 - Minimal harm or potential for actual harm Residents Affected - Few 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 interview and record reviewed, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for 1 (Resident #1) of 4 residents reviewed for reporting of alleged allegations. - The facility failed to ensure Nurse A reported to the facility Administrator when Resident #1's family member's reported an alleged abuse allegation. Resident #1's family member reported to Nurse A on 08/16/25 that CNA A allegedly hit Resident #1 on his right eye, on an unknown date, when changing him. This failure could place residents at risk for not having incidents reported as required and continued abuse which could result in diminished quality of life. The findings included:Record review of Resident #1's admission Record, dated 08/19/25, revealed an [AGE] year-old male who was admitted to the facility on [DATE]. His diagnoses included infrarenal abdominal aortic aneurysm (a localized dilation of the abdominal aorta below the renal arteries), without rupture, unspecified mycosis (fungal infection), malignant neoplasm of prostate (prostate cancer), and major depressive disorder, recurrent, unspecified. Record review of Resident #1's MDS Assessment, dated 06/06/25, revealed a BIMS score of 12, indicating moderately impaired cognition. Further review revealed resident required 2 or more helpers to complete toileting. Record review of Resident #1's care plan report, undated, revealed the resident had an ADL self-care performance deficit r/t Alzheimer's and limited mobility. Interventions included assistance by (x1-2) staff for toileting. During a telephone interview on 08/19/25 at 7:39 a.m., Resident #1's family member said Resident #1 told her on Saturday, 08/16/25, that on an unknown date, CNA A had turned him to his side to change him and it caused pain. She said Resident #1 said he grabbed her hand, and she removed his hand and put it down and then hit him with her open palm on his right eye. Resident #1's family member said she reported the allegation of abuse to Nurse A later that afternoon, 08/16/25, between 3:30 p.m. and 4:00 p.m. She said Nurse A did not say what action she was going to take. She said Nurse A received a phone call during their conversation, answered the call, and then walked away. She said she did not see any marks or bruises on the Resident #1's face. She said she called the Administrator yesterday, 08/18/25, to make sure she was aware of the allegation of abuse, but said she was unable to reach her as she was already gone for the day. She said she had not heard back from anyone about her reported abuse allegation as of today, 08/19/25. During an interview on 08/19/25 at 8:14 a.m., Resident #1 said the care at the facility was not good. He said about 3 or 4 days ago (was not sure of the exact date), a nurse aide (said he did not know her name) hit him on the right side of his face in the eye. He said a nurse aide was changing him. He said the nurse aide turned him on his right side, and when she turned him, it caused him pain. He said the nurse aide had her hand on his left arm, and he told her he wanted her to lay him flat, and he tried to get her hand off him. He said that was when she hit him. He said he did not say anything to the nurse aide. He said she finished changing him and she left his room. He said he told his family member what happened, on a different day (he did not know what day). He said he did not tell anyone else. He said it made him mad when the nurse aide hit him. He said no staff had come to talk to him about the nurse aide hitting him. During a telephone interview on 08/19/25 at 9:56 a.m., Nurse A said on Saturday, 08/16/25, she was in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 3 of 5 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 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 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 - Minimal harm or potential for actual harm Residents Affected - Few middle of taking care of a critical resident when Resident #1's family member came up to her and told her the CNAs were in the resident's room changing him and cleaning him up when one of the aides had hit him in the face. She said the resident's family member could not name the CNA, but the two CNAs in the room were, CNA A and CNA B. She said she asked CNA B if they had encountered anything in the room, and CNA B said Resident #1 told his family member that they had hit him in the face, but CNA B said she was by the bed with the other aide the whole time and it did not happen. She said CNA B told her they washed the resident's face with a washcloth. She said CNA B told her Resident #1 alleged she was the one who hit him in the face. She said after their conversation, she went into her critical resident's room to provide care. She said she sent out the critical resident to the hospital, stayed very late, forgot about the reported allegation of abuse from the resident's family member until this Investigator called her for an interview. She said she did not report the alleged abuse to anyone because she was juggling the allegation of abuse and the critical resident at the same time. She said when there was an alleged allegation of abuse, the Administrator, was to be called immediately. She said abuse should be reported immediately because there was alleged harm to the resident. She also said the resident would not trust staff, or could have sustained a serious injury, or their family would not trust staff. She said she went back and looked at the resident. She said the resident reported pain to his paralyzed left side, pointed to his arm/shoulder and leg, and requested a pain pill. She said she looked at his face, did not see any bruising or marks, and the resident said they just turned him. She said she gave him Tylenol 3 and then went to her critical care resident. She said she did not ask him anything about the alleged abuse because CNA A was still in the room picking up the linens off the floor. She said she received training on abuse, neglect, and exploitation. She said unfortunately she forgot to report the allegation of abuse and apologized for forgetting to report. During a telephone interview on 08/19/25 at 10:34 a.m., CNA A said she worked Saturday, 08/16/25. She said she worked the 2:00 p.m. to 10:00 p.m. shift. She said between 5:30 p.m. and 6:00 p.m. t Resident #1, the resident's family member, and she were in Resident #1's room. She said Resident #1's family member asked her if she could change the resident's gown and get him cleaned up. She said after Resident #1's family member asked her, she left the room and approximately 20 minutes later Resident #1's family member left the facility. She said she changed the resident after his family member left the facility. She said the family member did not mention any alleged allegations of abuse. She said she had never hit Resident #1. During an interview on 08/19/25 at 12:25 p.m., the DON said when a nurse received an allegation of potential harm to a resident, they secured the resident, remove the potential harm, and notified the Administrator. He said they would notify the family/next of kin and the provider as well. He said he was not aware that Resident #1's family member reported an allegation of resident abuse to Nurse A this past Saturday, 08/16/25. He said failure to report abuse could cause a delay of treatment, if needed, and a delay of an investigation. He said there were no reports from any staff regarding an allegation of abuse to Resident #1. During a telephone interview on 08/19/25 at 12:42 p.m., the Weekend Supervisor said he worked this past Saturday, 08/16/25 and did not receive any reports/notifications from staff, visitors, and/or family members of resident abuse. During a telephone interview on 08/19/25 at 1:06 p.m., CNA B said she worked the 2:00 p.m. to 10:00 p.m. shift on Saturday, 08/16/25. She said she was not assigned to Resident #1 but assisted CNA A with wiping him down with soap and water, changing his brief and clothes, and bed sheets because his family member complained that he smelled bad. She said she did not think she was alone in the room with the resident's family member and the resident at any point. She said when they were all in the room (Resident #1, the resident's family member, CNA A, and her) the resident at first (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676333 If continuation sheet Page 4 of 5 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 676333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Crossing Nursing and Rehabilitation Cente 10800 Flora Mae Meadows Rd Houston, TX 77089 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete said she hit him in the eye but then told his family member CNA A hit him, as she was walking out of his room. She said CNA A was walking out behind her. She said CNA A and she walked out of the resident's room, went to the nurse's station, and told Nurse A that Resident #1 was claiming she hit him in the eye and then changed his story and said CNA A hit him in the eye. She said she did not recall what Nurse A said but she said they laughed about it and then went their different ways. She said she had never hit Resident #1. During an interview on 08/19/25 at 1:19 p.m., the Administrator said she was not aware that Resident #1's family member reported an allegation of resident abuse to Nurse A on Saturday, 08/16/25. She said she was going to report it to the state today. She said staff members CNA A, CNA B, and Nurse A, had been suspended until the investigation was completed, and they would be in-servicing staff on Abuse/neglect and reporting. Record review of the facility's Abuse, Neglect and Exploitation policy, date implemented 7/11/25, reveled in part .It is the policy of this facility to provide protections for the health and welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse.Abuse.it includes physical abuse.Alleged Violation is a situation or occurrence that is observed or reported by.resident, relative.but has not yet been investigated.V. A. An immediate investigation is warranted when.reports of abuse.occur.VII. A.1. Reporting of all alleged violations to the Administrator, state agency.within specified timeframes: a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause that allegation involve abuse or result in serious bodily injury, or. Event ID: Facility ID: 676333 If continuation sheet Page 5 of 5