Health inspection·May 18, 2023

F 0635 sitting on her bedside table. Resident #70 was wearing her life vest device. Level of Harm - Minimal harm or potential for actual harm During an interview on 05/16/2023 at 10:56 a.m., LVN K said she was aware Resident #70 wore a life vest. LVN K said she had asked nursing management (DON, unit manager) about obtaining a physician's order for the life vest in the morning meeting. LVN K said she had not notified the physician for an order for the life vest. Residents Affected - Few During an interview on 05/18/2023 at 12:12 p.m., LVN G (unit manager) said the admitting nurse would obtain the physician's order for the life vest. LVN G said the unit manager was responsible for reviewing the new admissions to ensure the care needs were met. LVN G said not having an order for the life vest could be dangerous. LVN G (unit manager) said the admitting nurse no longer worked at the facility. During an interview on 05/18/2023 at 12:41 p.m., the DON said she expected the admitting nurse to obtain the order for any device. The DON said the unit manager reviews the chart after admission. The DON said the life vest was also a cardiac defibrillator. During an interview on 05/18/2023 at 1:03 p.m., the Administrator said the physician's orders should be reconciled and reviewed upon admission by the nurse managers. The Administrator said she would expect monitoring devices to have physician's orders. The Administrator said not having physician orders could cause a failure in the resident needs. The Administrator said Resident #70's life vest was a lifesaving monitoring device. A policy for the use of the life vest was requested but not provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 2 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan to meet resident's medical, nursing, mental and psychosocial need identified in the comprehensive assessment for 2 of 3 residents reviewed for care plans. (Resident #70 and Resident #39) 1.The facility failed to schedule Resident #70 a cardiology appointment according to her discharge orders. 2.The facility failed to ensure Resident 39's care plan was updated to include psychotic medication of lorazepam (anxiety medication). These failure could place the residents at increased risk of not having their needs met and a decreased quality of life. Findings included: 1.Record review of Resident #70's face sheet dated 05/18/2023 indicated she was a [AGE] year-old female who initially admitted on [DATE] and readmitted on [DATE] with the diagnoses of heart attack, diabetes, and heart failure. Record review of Resident #70's hospital discharge orders and instructions dated 04/19/2023 indicated to schedule an appointment with the cardiologist as soon as possible for a visit in 2 weeks. Record review of Resident #70's consolidated physician's orders dated 05/18/2023 did not reveal a physician ordered follow up appointment with the cardiologist. Record review of Resident #70's electronic medical record on 05/18/2023 revealed the MDS assessment was not completed. Record review of Resident #70's baseline care plan dated 04/27/2023 failed to address any cardiology appointments. Record review of Resident #70's progress notes from 04/19/2023 until 05/10/2023 failed to reveal a cardiologist appointment was scheduled. The progress notes failed to reveal any attempts to schedule the cardiologist appointments. During an interview on 05/17/2023 at 2:19 p.m., the cardiologist's receptionist said Resident #70's appointment was scheduled today for 06/19/2023 at 3:30 p.m. During an interview on 05/18/2023 at 12:12 p.m., LVN G (unit manager) said nurses schedule the appointments for the new admission, readmissions, or return appointments. LVN G said each station had a scheduling book to write the appointments down. LVN G said Resident #70's cardiology appointment was important and could be dangerous if not completed. LVN G was unsure why the cardiology appointment was not scheduled. During an interview on 05/18/2023 at 12:38 p.m., the DON said typically the admitting nurse sets (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 3 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the appointments. The DON said the unit manager was responsible for follow up to ensure the appointment was scheduled. The DON said not having the cardiology follow up appointment could cause an adverse effect on treatment. The DON failed to indicate how the scheduling of the appointment was missed. The DON said the admitting nurse no longer worked at the facility. During an interview on 05/18/2023 at 1:00 p.m., the Administrator said the nurses book the appointments, and then they were discussed in the morning meetings. The Administrator said depending on the appointment the resident could be at risk. An appointment scheduling policy was requested but not provided. 2.Record review of a face sheet dated 05/18/23 revealed Resident #39 was a [AGE] year-old male admitted on [DATE] with diagnoses including anxiety, seizures, and chronic respiratory failure (condition that occurs when the lungs cannot get enough oxygen into the blood or eliminate enough carbon dioxide from the body). Record review of Resident #39's quarterly MDS assessment, dated 04/19/23, indicated Resident #39 was usually understood and usually understood others. The MDS indicated Resident #39 cognition was severely impaired (BIMS score was 06). The MDS indicated Resident #39 required total assist with bathing and extensive assist with transfers, bed mobility, dressing, personal hygiene, toilet use, and eating. The MDS indicated Resident #39 received antipsychotic medication 5 days during the look back period. Record review of Resident #39's physician orders dated 04/23/23 indicated Lorazepam (anxiety medication) 1MG. Give 1 tablet every 4 hours as needed for anxiety. Record review of Resident #39's physician orders dated 05/11/23 indicated Lorazepam (anxiety medication) 1MG. Give 1 tablet daily for anxiety. Record review of Resident #39's comprehensive care plan dated 01/12/23 did not indicate anything about Lorazepam for anxiety started on 04/23/23. The care plan indicated Resident #39 received Risperdal for psychotropic medication but this medication was discontinued on 04/18/23. During an interview on 05/17/23 at 12:04 p.m., LVN Q said Resident #39 received a new order for Lorazepam sometime last month. She said Resident #39 was taking Lorazepam for anxiety. During an interview on 05/18/23 at 11:37 a.m., the MDS nurse said she was responsible to update the care plans with the MDS assessments. She said the unit managers and DON were responsible to update the acute care plans. The MDS nurse said they discuss all new orders and changes in the morning meeting. She said sometimes the staff will tell her about a new order and she would update the care plan. The MDS nurse said she was unaware of Resident #39's Lorazepam order starting. The MDS nurse said the DON was the overseer of care plans. She said the failure to update a care plan could lead to staff not being aware of current care and interventions. During an observation and interview on 05/18/23 at 11:42 a.m., The unit manager LVN G said anyone can update the care plan but the MDS nurse and unit managers were who usually updated the care plans. The unit manager LVN G said everyone worked together and went over residents in morning meeting and stand down meetings in the evening. The unit manager LVN G looked at Resident #39's care plan and did not see Lorazepam care planned. She indicated Risperdal was still on Resident #39's care plan. She looked in PCC (Point click care-the facilities computer system) and said the order was written (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 4 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 04/23/23 before she started working on 05/01/23 so she was unaware why Lorazepam had not been added to the care plan. The unit manager LVN G said care plans were done to correlate with the residents needs and how to take care of them. During an interview on 05/18/23 at 11:50 a.m., the DON said all nurses could update a care plan. She said the MDS nurse was responsible for making sure all care plans were updated and she was the overseer. The DON said she was unsure why Resident #39's care plan had not been updated for Lorazepam. The DON said it was important to update a care plan because it reflected residents' care and needs. During an interview on 05/18/23 at 12:16 p.m., the interim administrator said the MDS nurse updates the quarterly and significant change in condition care plans, and the other updates were done by the unit managers and DON. She said they reviewed new orders or changes in the morning meeting and updated care plans. The interim administrator said it was important to have care plans because it talked about the care the residents should be receiving. Record review of facility policy titled, Care Planning, dated 09/13, indicated, Our facilities care planning interdisciplinary team is responsible for the development of an individual care plan for each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 5 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to review and revise the person-centered care plan to reflect the current condition for 1 of 7 (Resident #39) residents reviewed for care plan revisions. The facility failed to ensure Resident 39's care plan to discontinued psychotic medication of Risperdal (mood disorder medication). This deficient practice could affect residents by placing them at risk of not receiving appropriate interventions to meet their current needs. Findings included: Record review of a face sheet dated 05/18/23 revealed Resident #39 was a [AGE] year-old male admitted on [DATE] with diagnoses including anxiety, seizures, and chronic respiratory failure (condition that occurs when the lungs cannot get enough oxygen into the blood or eliminate enough carbon dioxide from the body). Record review of Resident #39's quarterly MDS assessment, dated 04/19/23, indicated Resident #39 was usually understood and usually understood others. The MDS indicated Resident #39 cognition was severely impaired (BIMS score was 06). The MDS indicated Resident #39 required total assist with bathing and extensive assist with transfers, bed mobility, dressing, personal hygiene, toilet use, and eating. The MDS indicated Resident #39 received antipsychotic medication 5 days during the look back period. Record review of Resident #39's physician orders dated 05/01/23 through 05/31/23 did not indicated Risperdal (mood disorder medication). Record review of Resident #39's comprehensive care plan dated 01/12/23 did not indicate anything about Lorazepam for anxiety started on 04/23/23. The care plan indicated Resident #39 received Risperdal for psychotropic medication but this medication was discontinued on 04/18/23. During an interview on 05/17/23 at 12:04 p.m., LVN Q said Resident #39 Risperdal was discontinued sometime last month and he received a new order for Lorazepam. During an interview on 05/18/23 at 11:37 a.m., the MDS nurse said she was responsible to update the care plans with the MDS assessments. She said the unit managers and DON were responsible to update the acute care plans. The MDS nurse said they discuss all new orders and changes in the morning meeting. She said sometimes the staff will tell her about a new order and she would update the care plan. The MDS nurse said she was unaware of Resident #39's Risperdal stopping. The MDS nurse said the DON was the overseer of care plans. She said the failure to update a care plan could lead to staff not being aware of current care and interventions. During an observation and interview on 05/18/23 at 11:42 a.m., The unit manager LVN G said anyone can update the care plan but the MDS nurse and unit managers were who usually updated the care plans. The unit manager LVN G said everyone worked together and went over residents in morning meeting and stand down meetings in the evening. The unit manager LVN G looked at Resident #39's care plan and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 6 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few indicated Risperdal was still on his care plan. She looked in PCC (Point click care-the facilities computer system) and said the order was written to be discontinued 04/18/23 before she started working on 05/01/23 so she was unaware why the care plan had not been updated to discontinue Risperdal. The unit manager LVN G said care plans were done to correlate with the residents needs and how to take care of them. During an interview on 05/18/23 at 11:50 a.m., the DON said all nurses could update a care plan. She said the MDS nurse was responsible for making sure all care plans were updated and she was the overseer. The DON said she was unsure why Resident #39's care plan had not been updated for discontinued Risperdal. The DON said it was important to update a care plan because it reflected residents' care and needs. During an interview on 05/18/23 at 12:16 p.m., the interim administrator said the MDS nurse updates the quarterly and significant change in condition care plans, and the other updates were done by the unit managers and DON. She said they reviewed new orders or changes in the morning meeting and updated care plans. The interim administrator said it was important to have care plans because it talked about the care the residents should be receiving. During an interview on 05/18/23 at 12:20 p.m., the interim administrator said she was not able to find a policy on revision of care plans, but she gave a policy on care planning. Record review of facility policy titled, Care Planning, dated 09/13, indicated, Our facilities care planning interdisciplinary team is responsible for the development of an individual care plan for each resident. The resident or the resident's family and or representative to participate in the development of and revision to the resident's care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 7 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure necessary services to maintain grooming and personal hygiene were provided for 1 of 6 residents reviewed for ADLs. (Resident #1) Residents Affected - Few The facility failed to ensure Resident #1 was routinely showered. This failure could place residents at risk of not receiving services/care, decreased quality of life, and decreased self-esteem. Findings included: Record review of Resident #1's face sheet dated 05/18/23, indicated he was a [AGE] year-old male who initially admitted to the facility on [DATE] with diagnoses which included chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs), paranoid schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly), dementia (memory loss) without behaviors, and essential hypertension (high blood pressure). Record review of Resident #1's admission MDS assessment dated [DATE], indicated he was able to make himself understood and could understand others. Resident #1 had a BIMS score of 5, which indicated his cognition was severely impaired. The MDS did not indicate Resident #1 had behaviors or refused care. The MDS indicated under bathing, activity itself did not occur. Resident #1 required limited assistance with bed mobility, transfers, locomotion, and toileting. Record review of Resident #1's comprehensive care plan dated 04/16/23 and revised on 04/16/23, indicated he exhibited ADL self-care performance deficit and required assistance due to cognitive deficit secondary to dementia. The care plan interventions included to provide assistance with eating, dressing, toileting and grooming as needed and bath per schedule. During an observation on 05/15/23 at 11:32 AM, Resident #1 was sitting up in his wheelchair in the lobby he was not interviewable and he had 0.5 inch fingernails. Record review of Resident #1's bathing report dated 4/1/23-5/16/23, indicated he received a bed bath on 4/8/23 and 5/5/23. Resident #1 refused his bath on 4/4/23 and 4/8/23. No further baths or refusals were documented. Record review of the facility's shower schedule for 500/600 hall, indicated Resident #1 was scheduled to receive a shower on Tuesday, Thursday, and Saturday on the 6p-6a shift. Record review of Resident #1's MAR for April 2023, indicated Resident #1 did not exhibit any behaviors all month. Record review of Resident #1's progress notes dated 04/18/23- 05/18/23 did not indicate Resident #1 refused any of his showers. Record review of Resident #1 MAR for May 2023 indicated Resident #1 had not exhibited behaviors between 05/01/23- 05/18/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 8 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 05/16/23 at 03:23 PM, CNA T said she worked the 400-600 halls. CNA T said the showers were provided according to the shower schedule. CNA T said the showers given were reflected on the point of care. CNA T said if no was documented then it meant that the resident did not receive a shower or bath. CNA T said she was unaware of any residents refusing their showers. CNA T said she would notify the nurse if a resident refused their shower or bath. CNA T said Resident #70's shower was scheduled for 6p-6a shift. During an interview on 05/16/23 at 03:32 PM, LVN C said if a resident refused a shower or bath the aide notified her. LVN C said she then would ask the resident why and document in the chart. LVN C said some residents refuse their showers at times but not on a routine basis. LVN C said was she not aware Resident #70 refused his showers. During an interview on 05/18/23 at 12:09 PM, Unit Manger G said she expected showers/baths to be done as per the schedule or as needed if a resident asks for one. Unit Manager G said the charge nurse was responsible for ensuring the baths/showers were completed as per the schedule. Unit Manager G said by not receiving their scheduled showers/baths the residents were at risk for infection or wounds. During an interview on 05/18/23 at 12:25 PM, the DON said she expected the shower/bath schedule to be followed at the best of their ability of what the resident would want or allow. The DON said the showers were documented in the POC. DON said the charge nurses were responsible for ensuring the showers/baths were received daily. The DON said by not completing the showers as scheduled the residents were at risk for skin breakdown a dignity issue for not being clean. During an interview on 05/18/23 at 12:46 PM, the Interim Administrator said she expected the residents to receive their shower according to the schedule and as needed. The Interim Administrator said if a resident refused their shower, it was the responsibility of the CNA to notify the charge nurse. The Interim Administrator said if the nurse was not capable of encouraging the resident to receive their shower, then she expected the social worker to be involved. The Interim Administrator said the nurses and aides should document the resident refusal. The Interim Administrator said No marked on the POC indicated it did not happen. The Interim Administrator said by not receiving their showers as scheduled the resident was at risk for skin integrity issues and infection. The Interim Administrator said the unit managers and the DON were responsible for ensuring the showers were completed. Record review of the facility's policy Shower/Tub Bath revised October 2010, indicated .The purpose of this procedure are to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin . The following information should be recorded on the resident's ADL record and/or in the resident's medical record. 1. The date and time the shower/bath was performed. 2. The name and title of the individual(s) who assisted the resident with the shower/tub bath .5. If the resident refused the shower/tub bath the reason(s) why and the intervention taken. 6. The signature and title of the person recording the data. Notify the supervisor if the resident refuses the shower/tub bath. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 9 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure the activities program was directed by a qualified professional who was a qualified therapeutic recreation specialist or an activities professional who completed a training course approved by the State for 1 of 1 facility reviewed for Activity Director qualifications. Residents Affected - Some The facility did not ensure the Activity Director was qualified to serve as the director of the activities program. This failure could place residents at risk of not receiving a program of activities that met their assessed activity needs. Findings include: Record review of an, undated, Personnel File Review Sheet indicated the Activity Director was hired on 6/17/19. Record review of the Activity Director's payroll change notice, with an effective date of 10/24/22, indicated employee has been promoted from CNA to activity director. Record review of the N.A.P.T National Activity Professional Training Course enrollment form dated 05/16/23 indicated the Activity Director was enrolled in the course. During an interview on 05/17/23 at 2:28 PM, the Interim Administrator said the Activity Director was not certified and according to the regulations she knew she was supposed to be. The Interim Administrator said the previous administrator should have enrolled her, but he was terminated and the ball was dropped. The Interim Administrator said the Activity Director had been in the position since she started in the facility in January 2023 and thought she was already certified. During an interview on 05/18/23 at 11:27 AM, the Activity Director said she had been the activity director since the end of October 2022. The Activity Director said she was overseen by the Administrator. The Activity Director said she was under the impression she had a couple of months to become certified. The Activity Director said it was important to be certified because it was a state requirement. During an interview on 05/18/23 at 12:25 PM, the DON said she was not over the activity department. The DON said the Activity Director reported to the Administrator. The DON said if it was a state or federal requirement then she expected the Activity Director to be certified. During an interview on 05/18/23 at 12:55 PM, the Interim Administrator said she expected the Activity Director to provide joyful activities to the residents and be certified. The Interim Administrator said it was her responsibility to ensure the activity director was certified. The Interim Administrator said no one was overseeing the activity director. The Interim Administrator said by the Activity Director not being certified she could fail to meet the resident needs or requirements. Record review of the facility's job description for Activity Director indicated . The primary purpose of our job description is to plan, organize, develop, and direct the overall operation of the Activity Department in accordance with current federal, state, and local standards, guidelines, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 10 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0680 Level of Harm - Minimal harm or potential for actual harm regulations, our established policies and procedures, and as may be directed by the Administrator and/or Activity Consultant, to assure that an on-going program of activities is designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental and psychosocial well-being of each resident Experience .Must have completed a training course approved by the this state Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 11 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that a resident who needed respiratory care was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents goals and preferences for 2 of 7 residents (Residents #37 and #56) reviewed for respiratory care. Residents Affected - Few 1. The facility failed to ensure Resident #37 had a clean oxygen concentrator filter in place. 2. The facility failed to properly store the HHN tubing for Resident # 56. These failures could place residents at risk for respiratory infections and exacerbation of respiratory disease. Findings Include: 1. Record review of Resident #37's face sheet indicated a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included kidney disease (damage to kidney causing loss of function), high blood pressure, anemia (blood disorder), and generalized weakness. Record review of Resident #37's admission MDS, dated [DATE], indicated she had a BIMS score of 10, which indicated she had moderately impaired cognition. The MDS indicated the resident required extensive assistance from 1 person for bed mobility, transfers, dressing, toileting, person hygiene, and total assistance from 1 person for bathing. The resident used oxygen while a resident. Record review of Resident #37's order summary report, dated 05/18/23, indicated she had an order for O2: (oxygen) at 3 L/minute via Nasal cannula continuously every shift that started 04/24/23 and an order O2: Clean filter on concentrator Q week on Sunday on the night shift. Record review of Resident #37's care plan, dated 03/15/23 and revised on 04/16/23, indicated she had a focus of oxygen therapy with the goal of no signs and symptoms of poor oxygen absorption. During an observation on 05/15/23 at 09:58 AM, Resident #37 was sitting in her wheelchair. She had her oxygen on her via nasal cannula with the setting on 3L/Minute. The nasal cannula tubing was dated 5/14/23 and the filter on the left side of the concentrator was dirty with gray matter covering it. During an observation on 05/17/23 at 09:08 AM, Resident #37 was sitting in her recliner with oxygen on via nasal cannula and set on 3L/minute. The oxygen concentrator filter continued to have gray colored matter covering it. During an observation and interview on 05/18/23 at 12:25 PM, CNA P was in the room with Resident #37. She was shown the filter on the left side of the oxygen concentrator. CNA P said she did not touch anything with residents' oxygen, but she was responsible for ensuring she had it on. Resident #37 asked what we were looking at? The surveyor told showed Resident #37 her dirty oxygen filter and asked her if she knew what that meant. Resident #37 said she assumed she was breathing dirty air and she did not like that. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 12 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0695 Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 05/18/23 at 12:27 PM, LVN O was shown the oxygen concentrator filter and LVN O said the filter was dirty. LVN O said the oxygen concentrator filters should be cleaned and changed out on the night shift weekly by the 10:00 PM - 6:00 AM charge nurse. She said this failure could cause problems with Resident #37's concentrator not filtering air as it was supposed to, and it could cause Resident #37 problems with her intake of oxygen and could cause breathing difficulties. Residents Affected - Few During a phone interview on 05/18/23 at 2:03 PM LVN S ,that was the nurse responsible for cleaning the filter, did not answer. During an interview on 05/18/23 at 2:13 PM, the Interim Administrator said she expected the oxygen concentrator filters to be removed and cleaned weekly and as needed. She said it was the 10:00 PM -6:00 AM charge nurses' responsibility to ensure oxygen filters were clean when they changed out the oxygen tubing. The Interim Administrator said the failure could lead to Resident #37 having respiratory concerns. During an interview on 05/18/23 at 2:25 PM, the Corporate Nurse said it was protocol for the 10:00 PM 6:00 AM charge nurse to change out the oxygen tubing and clean the oxygen concentrator filters weekly. She said any nurse could complete the task. The Corporate Nurse said failure of not cleaning the oxygen concentrator filters increased risk for respiratory infections. 2. Record review of Resident #56's face sheet, dated 05/18/23, revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included heart failure (develops when your heart does not pump enough blood for your body's needs), high blood pressure, obesity (overweight), and asthma (a disease that affects your lungs). Record review of Resident #56's quarterly MDS assessment, dated 03/10/23, indicated Resident #56 was understood and understood others. Resident #56's cognition was moderately impaired with a BIMS score of 11. Resident #56 required extensive assist with transfers, bed mobility, limited assist with bathing and supervision with dressing, personal hygiene, toilet use, and eating. Record review of Resident #56's comprehensive care plan, dated 02/22/22, indicated she had asthma. The interventions were to identify asthma triggers and strategies for prevention, give medications as ordered and observe for any signs or symptoms impending asthma attack. Record review of Resident #56's physician orders, dated 05/12/23, indicated Albuterol Sulfate Inhalation Nebulization Solution 2.5MG/0.5ML. Give 1 applicator via nebulizer every 6 hours as needed for shortness of breath. During an observation on 05/15/23 at 9:40 a.m., Resident #56 was sitting up in her wheelchair in her room. HHN tubing on the bedside table was not bagged. Resident #56 said she used the HHN last night (05/14/23). During an observation on 05/16/23 at 9:35 a.m., Resident #56 was in her bathroom. HHN was on the bedside table and was not in a bag. During an observation on 05/17/23 at 10:18 a.m., Resident #56 was in her bed with her eyes closed. HHN remained on the bedside table and was not bagged. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 13 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation and interview on 05/18/23 at 8:33 a.m., LVN Q stated the HHN was not bagged and said it needed to be bagged to prevent cross contamination. LVN Q said she was unsure why the HHN was not bagged but said all nurses were responsible to ensure the HHN was bagged when not in use. During an interview on 05/18/23 08:36 a.m., LVN C said all tubing should be dated and bagged to prevent infection. During an interview on 05/18/23 at 11:50 a.m., the DON said night shifts were responsible to change out tubing weekly and place in a bag and the day nurses were supposed to ensure they were labeled and bagged. The DON said herself and unit managers were the overseers. The DON said she expected HHN's to be labeled dated and in bags for infection precaution. During an interview on 05/18/23 at 12:16 p.m., the Interim Administrator said HHN were something the residents would put in their mouths, so she expected them to be in bags. She said the charge nurses should ensure HHN's were bagged and nurse managers were to follow up. The interim administrator said they should be stored in a bag when not in use for infection control issues. During an interview and record review on 05/18/23 at 12:20 p.m., the Interim Administrator said she was not able to find a policy on HHN, but she gave a policy on oxygen administration, but it did not contain any information related to HHN. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 14 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on interview and record review the facility failed to ensure nurse aides were able to demonstrate competency in skills and necessary techniques to care for resident's needs, as identified through resident assessments and described in the plan of care for 1 of 4 CNAs (CNA L) reviewed for nurse aide competencies. The facility failed to ensure CNA L was proficient with hand hygiene and glove changes with incontinent care skills. This failure could place residents at an increased and unnecessary risk of exposure to staff who lack the appropriate skill competencies to provide incontinent care that was capable of minimizing urinary tract infections. Findings include: During an observation and interview on 05/17/2023 at 2:45 p.m., CNA L entered Resident #136's room and washed her hands. CNA L set up a towel on the bedside table and placed wipes and the brief on top of the towel. CNA L opened a trash bag and placed it at the foot of Resident #136's bed. CNA L cleansed Resident #136 peri-area using two wipes downward. The second wipe downward there was feces on the wipe. CNA L then cleansed the catheter tubing away from Resident #136 twice using separate wipes. CNA L then removed her gloves and performed hand hygiene. CNA L then applied new gloves, assisted Resident #136 to roll over and she cleansed her buttock area. CNA L then obtained the brief from the overbed table and applied Resident #136's brief. CNA L then assisted Resident #136 with repositioning, she pulled Resident #136's blouse down, pulled Resident #136's blankets up and then she removed the dirty gloves and applied hand gel. During the interview with CNA L, she said she should have removed her gloves and applied hand gel prior to touching Resident #136's shirt and blanket. CNA L said she had not been evaluated on incontinent care skills since hired in December 2022. CNA L said she forgot to change her gloves and perform hand hygiene. CNA L said not removing dirty gloves and using hand sanitizer could cause an infection by spreading germs. During an interview on 05/17/2023 at 2:56 p.m., CNA L said she should have changed her gloves and performed hand hygiene during incontinent care. CNA L said she was a newly certified CNA, and she denied having had skills check off upon hire. During an interview on 05/18/2023 at 11:08 a.m., LVN M said she was unable to find CNA L's skills check off done upon hire. LVN M said she was responsible for the skills check offs as the infection preventionist. During an interview on 05/18/2023 at 12:12 p.m., LVN G (unit manager) said competencies were done upon hire, annually, and as needed for the nursing staff. LVN G said the unit managers were responsible for checking off the nursing staff. LVN G said a new position of learning coordinator would be responsible for CNAs and MAs skills check offs. During an interview on 05/18/2023 at 12:41 p.m., the DON said she believed all the competencies were completed. The DON said the responsibility was a collaborative effort with nursing. The DON said the new position of the talent coordinator would be responsible for the skill check offs upon hire and annually going forward. The DON said without the skills check offs the employee may not know how (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 15 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0726 to perform their job duties. Level of Harm - Minimal harm or potential for actual harm During an interview on 05/18/2023 at 1:04 p.m., the Administrator said skill competencies were completed upon hire and annually. The Administrator said the Director of Nurses was responsible. The Administrator said without skill competencies an employee may provide care improperly. A skills competency policy was requested but not provided. Residents Affected - Few Record review of CNA L's work details report, dated 05/18/2023, indicated her hire date was 01/23/2023. Record review of CNA L's On Shift (work schedule) indicated she was scheduled on 05/08/2023, 05/09/2023 (300, 201-203), 05/12/2023, 05/13/2023, 05/14/2023, 05/15/2023 (400 hall), and 05/16/2023 (400 hall). Record review of the CMS-672, dated 05/15/2023, indicated the facility had 50 residents occasionally or frequently incontinent of bladder, and 45 occasionally or frequently incontinent of bowel. Record review of a CNA Proficiency Evaluation form, dated 05/18/2023, indicated CNA L was evaluated by LVN M on 05/18/2023 in the areas of blood pressure, daily catheter care, measuring output, linen handling, handwashing, personal care grooming, nail care, perineal care, gait belt transfer, and Heimlich maneuver. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 16 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Record review of Resident #23's face sheet, dated 05/18/2023, indicated a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #23 had diagnoses which included respiratory failure (a serious condition that makes it hard to breathe on your own), heart failure, and anemia (blood without enough healthy red blood cells). Residents Affected - Some Record review of Resident #23's admission MDS, dated [DATE], indicated he was understood, and he understands. The MDS indicated he had moderately impaired cognition. Resident #23 did not require assistance feeding himself his meals only setting up his tray. Record review of Resident #23's comprehensive care plan, dated 04/24/2023 and revised on 05/15/2023, indicated he was at risk for weight fluctuations due to changes in his appetite, difficulty adjusting to the new environment, and recent hospitalization. Resident #23's goal was to maintain an adequate nutritional status. Resident #23's interventions included to provide the prescribed diet and observe closely during meals times. Record review of Resident #23's consolidated physician's orders, dated 05/18/2023, indicated he received a 2-gram sodium diet regular texture and regular consistency. The order also indicated he received double portion of eggs for breakfast and a large portion entrée at dinner. During an interview on 05/15/23 at 09:21 a.m., Resident #23 said the food was terrible and it was served to him cold. 5. Record review of Resident #76's face sheet, dated 05/18/2023, indicated a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #73 had diagnoses which included a fractured leg, anxiety (uneasy and overwhelming feeling to every day happenings), a urinary tract infection (infection of the bladder and or kidneys). Record review of Resident #76's admission MDS, dated [DATE], indicated she understands and was understood by others. Resident #76 had moderate cognitive impairment. Resident #76 was able to feed herself but required tray set help. Record review of Resident #76's consolidated physician's orders dated May 2023 indicated she received a regular diet, regular texture, and regular consistency. Record review of Resident #76's comprehensive care plan, dated 05/10/2023, indicated she had the potential for weight loss due to a decreased appetite. Resident #76's goal was to maintain her weight. The interventions for Resident #76 included to provide and serve diet as ordered, and if meals were refused to provide extra nourishment. During an interview on 05/15/2023 at 9:07 a.m., Resident #76 said the food was not edible. Resident #76 said the food was served cold and without any flavor. Record review of a grievance, dated 04/11/23, indicated the resident council complained about cold food, and sandwich variety. Resolution included the DM and Activities Director meeting with the resident council, the Administrator and resident ambassadors making daily rounds and addressing concerns. The grievance was resolved and on-going monitoring was required. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 17 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of a grievance, dated 04/12/23, indicated a resident complained the breakfast is always cold. The DM followed up with the resident for the next three meals after the complaint and indicated each meal was great and hot. Resident ambassadors indicated resident voiced zero concerns and said dinner and breakfast have [improved]. Record review of a grievance, dated 04/16/23, indicated a resident complained about receiving the wrong meal, then the resident received a cold grilled cheese sandwich over 30 minutes later. The DM followed up next meal service to make sure food was hot. Record review of the facility's Food: Quality and Palatability policy, dated 05/2014 and revised 09/2017, stated: Policy Statement Food will be prepared by methods that conserve nutritive value, flavor and appearance. Food will be palatable, attractive and served at a safe and appetizing temperature . .Procedures . .4. The Cook(s) prepare food in accordance with the recipes, and season for region and/or ethnic preferences, as appropriate. Cook(s) use proper cooking techniques to ensure color and flavor retention. Record review of the facility's Meal Distribution policy, dated 05/2014 and revised 09/2017, stated: Policy Statement Meals are transported to the dining locations in a manner that ensures proper temperature maintenance, protects against contamination, and are delivered in a timely and accurate manner. Procedures 1. All meals will be assembled in accordance with the individualized diet order, plan of care, and preferences. 2. All food items will be transported promptly for appropriate temperature maintenance. 3. All food that are transported to dining areas that are not adjacent to the kitchen will be covered. 4. The nursing staff will be responsible for verifying meal accuracy and the timely delivery of meals to residents/patients Record review of Resident #37's face sheet indicated a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #37 had diagnoses which included kidney disease (damage to the kidneys causing loss of function), high blood pressure, anemia (blood condition), and generalized weakness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 18 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #37's admission MDS, dated [DATE], indicated she had a BIMS score of 10, which indicated she had moderately impaired cognition. The resident required supervision with eating, extensive assistance from 1 person for bed mobility, transfers, dressing, toileting, person hygiene, and total assistance from 1 person for bathing. Record review of Resident #37's care plan, dated 03/15/23 and revised on 4/15/23, indicated she was at risk for weight fluctuations and was on a renal regular diet. During an interview on 05/15/23 at 09:58 AM, Resident #37 said she ate meals in her room and the food was not good. She said she was limited because of her diet, but it was normally not hot and did not have a good taste. 2. Record review of Resident #42's face sheet, dated 05/18/23, indicated a [AGE] year-old female who initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #42 had diagnoses which included enterocolitis (inflammation of the intestines) due to clostridium difficile (bacteria that causes infection in the large intestine), chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs), end stage renal disease (kidneys cease functioning on a permanent basis) and heart failure (heart does not pump well as it should). Record review of Resident #42's 5-day Medicare Part A stay MDS assessment, dated 04/30/23, indicated she was able to make herself understood and could understand others. Resident #42 had a BIMS score of 11, which indicated her cognition was moderately impaired. Resident #42 required extensive assistance with bed mobility and toileting. Resident #42 required limited assistance with transfers, locomotion, dressing and personal hygiene and was independent with eating. The MDS did not indicate a weight loss or weight gain for Resident #42 in the last 6 months. The MDS indicated the resident was receiving a therapeutic diet. Record review of Resident #42's comprehensive care plan, dated 04/30/23 and revised on 05/15/23, indicated she was at risk for weight fluctuations due to carbohydrate-controlled diet, changes in appetite, difficulty adjusting to new environment and recent hospitalizations. The care plan interventions included to provide prescribed diet and observe closely during mealtimes. Record review of Resident #42's order summary report, dated 05/18/23, indicated she had an order for renal diet. During an interview on 05/15/23 at 08:56 AM, Resident #42 said the meals she received were not good. During an interview on 05/15/23 at 12:56 PM, Resident #42 said her lunch meal was received cold. Based on observation, interview and record review the facility failed to provide residents with food and drink that was palatable, attractive, and at a safe and appetizing temperature for five of six residents (Residents #29, #23, #37, #42 and #76) reviewed for palatable food. The facility failed to provide palatable food served at an appetizing temperature or taste to Resident #29, Resident #23, Resident #37, Resident #42, and Resident #76, who complained the food was served cold and did not taste good. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 19 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some This failure could place residents at risk of decreased food intake, weight loss, altered nutritional status, and a diminished quality of life. Findings included: 1. Record Review of Resident #29's face sheet, dated 05/16/23, indicated a [AGE] year-old female who was admitted to the facility on [DATE]. She had diagnoses which included acute kidney failure (a condition that occurs when your kidneys suddenly become unable to filter waste products from your blood), cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it. A lack of adequate blood supply to brain cells deprives them of oxygen and vital nutrients which can cause parts of the brain to die off), chronic obstructive pulmonary disease (a group of diseases that cause airflow blockage and breathing related problems), vitamin D deficiency (occurs when there is not enough vitamin D in the body. This can lead to a loss of bone density), muscle wasting and atrophy (the wasting or thinning of muscle mass), end stage renal disease (a condition that occurs when the kidneys are no longer able to work as they should to meet the body's needs), and chronic diastolic heart failure (occurs when the heart muscle does not pump blood as well as it should). Record review of Resident #29's quarterly MDS, dated [DATE], indicated she was able to make herself understood and she was able to understand others. She had a BIMS score of 10, which indicated moderate cognitive impairment. She did not exhibit behaviors of rejection of care or wandering. She required extensive assistance to total dependence on all ADLs except for eating which she required supervision assistance. Record review of Resident #29's physician's orders, dated 05/16/23, indicated she had an order for a 2 gram sodium diet, with regular texture and regular consistency. The order start date was 03/07/23. Record review of Resident #29's care plan, initiated on 12/17/20, and revised on 01/09/23, indicated a focus of resident was at risk of weight fluctuations due to changes in appetite. The goal was resident would maintain adequate nutritional status as evidenced by maintaining weight within baseline, no signs and symptoms of malnutrition, and consuming at least 70% of meals served daily. Interventions included monitor weights as per facility protocol, provide and serve supplements as ordered, provide prescribed diet and observe closely during mealtimes, and report to doctor signs and symptoms of malnutrition: emaciation, muscle wasting, and significant weight loss. Record review of the facility's dietary menu indicated for lunch on Tuesday 05/16/22 the meal included: *Hawaiian Baked Ham *Salisbury Steak - [NAME] Gravy *Buttered Grean Peas *Capri Vegetable Blend (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 20 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0804 *Baked Sweet Potatoes Level of Harm - Minimal harm or potential for actual harm *Parmesan Noodles *Dinner Roll/Bread Residents Affected - Some -Margarine *Summer Fresh Fruit Cup During an observation on 05/16/23 at 12:58 PM, the test tray left the kitchen on hall 100 cart. All other halls and dining rooms had been served. The test tray was last to be delivered to the State Surveyors after resident trays. During an observation on 05/16/23 at 01:08 PM, the Dietary Manager sampled the test tray with the State Surveyors. The ham with pineapple was cold. The roll was cold and hard. The sweet peas had no flavor and tasted like they were not finished cooking. The sweet potato was cold. During an interview on 05/15/23 at 10:08 AM, Resident #29 said the food was always cold and she did not like it. During an interview on 05/16/23 at 01:11 PM, the Dietary Manager said he agreed with the State Surveyors that the ham was cold, the peas did not have enough flavor, and they were not done cooking. During an interview on 05/16/23 at 02:18 PM, the Corporate Dietary District Manager said they had difficulty with the food because they did not have a plate warmer in the facility. During an interview on 05/16/23 at 02:20 PM, the Dietary Manager said the peas were not cooked thoroughly and they were not seasoned. During an interview on 05/16/23 at 03:28 PM, Resident #29 said her lunch that day was cold and she did not eat it. She said the pork chop, sweet peas, and sweet potato were all cold. She complained about it and sent it back to the kitchen. She asked for an alternate meal and she received a ham and cheese sandwich that she said she was able to eat. She said she had to ask for an alternative because she did not like the food. She said this happened about every other day. She said she complained to staff but it had not changed. During an interview on 05/17/23 at 08:46 AM, Resident #29 said her breakfast this morning was cold. She said she had eggs, pancakes, and bacon and it was all cold. She said she had one of the aides reheat it this morning. She said she could not remember who the aide was. She said after it was reheated, she did not like it so she asked for some cereal. During an interview on 05/17/23 at 08:50 AM, CNA A said the food was not always as hot as some of the residents would like. She said she occasionally had to reheat some of the resident's food. She said occasionally some residents would refuse the meals because they were cold. During an interview on 05/17/23 at 02:00 PM, the Dietary Manager said he had complaints of the temperature of the food before. He said it was cold before because the staff took too long to pass the trays. He said he was not sure why the food on the previous day was cold. He said the meal was a hard (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 21 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some one to keep warm. He said the ham was hard to keep warm and they did not have a plate warmer. He said he tried before to get the facility to purchase a plate warmer but he had not heard back. He said his boss was going to check with the dietary services corporate to see if they could purchase one. During an interview on 05/17/23 at 02:10 PM, CNA B said she worked PRN at the facility. She said she heard complaints about the food at least every other day. She said she had to reheat resident meals at least every other day. She said it was not always the same residents who complained about the food being cold. She said she complained to the kitchen but it had not changed. During an interview on 05/18/23 at 11:09 AM, the DON said she saw several grievances about the food and heard several complaints. They in serviced the kitchen staff and complained to the dietary corporate and talked to the dietician. They talked to the resident council. She said the Administrator was taking care of the concerns. She said she was not responsible for the food. The kitchen staff were responsible for ensuring the food was palatable and at a safe and appetizing temperature. She said the risk to the residents could be weight loss and decreased meal intake. She said she had not talked with the kitchen about getting a plate warmer. During an interview on 05/18/23 at 11:13 AM, the Corporate Clinical Services Director said she heard about food complaints about preferences on the 17th. She said the facility had some grievances before about the food that they were working on. She said the Administrator reviewed the kitchen and interviewed the residents. She said they did rounds and asked the residents about food. She said the Administrator would do a root cause assessment to see what was causing the problems in the kitchen. She said they wanted to get a plate warmer but they had trouble obtaining one due to backordered appliances. During an interview on 05/18/23 at 11:16 AM, the Interim Administrator said the residents were satisfied. She said she had some food complaints in April and she had the Dietary Manager follow up with the affected residents. She said the kitchen staff and ultimately the Administrator were responsible for ensuring the food was palatable and at a safe and appetizing temperature. She said the risk was the residents could skip meals and suffer weight loss. She said they offered alternative meals and they asked the dietician to see the residents if they lose weight. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 22 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Record review of Resident #70's face sheet, dated 05/18/2023, indicated a [AGE] year-old female who initially admitted to the facility on [DATE] and readmitted on [DATE] with the diagnoses which included heart attack (blockage of blood flow to the heart), diabetes (too much sugar in the blood), and heart failure (heart fails to pump adequately). Residents Affected - Some Record review of Resident #70's electronic medical record revealed the MDS assessment was not completed. Record review of Resident #70's baseline care plan, dated 04/27/2023, revealed the care plan failed to address her needs with personal hygiene, and bathing. Record review of Resident #70's comprehensive care plan, dated 04/29/2023 and revised on 05/10/2023, indicated she had an ADL self-care deficit. Resident #70's goal was to maintain her current level of function with the interventions of requiring one person to assist with bathing and dressing. During an observation on 05/15/2023 at 9:51 a.m., CNA N was providing Resident #70 a bed bath, and a pile of dirty linen was on the floor at the foot of Resident #70's bed. During an interview on 05/17/2023 at 11:21 a.m., CNA N said the linen had just fallen from Resident #70's bed when the State Surveyor entered the room. CNA N said having dirty linen should not be on the floor. CNA N said the dirty linen on the floor could cause urine and feces to be taken to other resident rooms. CNA N said she had been in-serviced on infection control and linen handling. During an interview on 05/18/2023 at 11:56 a.m., LVN Q said she was responsible for Resident #70's care. LVN Q said dirty linen was not to be directly on the floor. LVN Q said the dirty linen should be bagged due to infection control prevention efforts of preventing the spreading of infections. During an interview on 05/18/2023 at 12:04 p.m., LVN G said dirty linen should never be on the floor. LVN G said the dirty linen should be bagged due to cross contamination and prevention of the spread of germs. LVN G said all nurses and CNAs should know this practice. During an interview on 05/18/2023 at 12:33 p.m., the DON said she audited by making frequent rounds, and she had never seen dirty linen on the floor. The DON said placing dirty linen on the floor was an infection control concern by the spreading of germs from room to room. The DON said everyone was responsible. During an interview on 05/18/2023 at 1:04 p.m., the Interim Administrator said dirty linen should not be on the floor. The Interim Administrator said the linen should be placed in a bag as it was pulled from use. The Interim Administrator said this was an infection control issue and could cause the spread of germs. The Interim Administrator said the DON and unit manager were responsible for monitoring by walking rounds auditing for linen on the floor and check offs. 3. Record review of Resident #136's face sheet, dated 05/18/2023, indicated an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included a blood clot in the lungs, malnutrition (inadequate caloric intake), and a urinary tract infection (infection of the bladder or kidneys). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 23 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0880 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #136's baseline care plan, dated 05/13/2023, indicated she was incontinent and required briefs. Record review of Resident #136's electronic medical record indicated her admission MDS, or the comprehensive care plan was not completed. Residents Affected - Some During an observation and interview on 05/17/2023 at 2:45 p.m., CNA L entered Resident #136's room and washed her hands. CNA L set up a towel on the bedside table and placed wipes and the brief on top of the towel. CNA L opened a trash bag and placed it at the foot of Resident #136's bed. CNA L cleansed Resident #136 peri-area using two wipes downward. The second wipe downward there was feces on the wipe. CNA L then cleansed the catheter tubing away from Resident #136 twice using separate wipes. CNA L then removed her gloves and performed hand hygiene. CNA L then applied new gloves, assisted Resident #136 to roll over and she cleansed her buttock area. CNA L then obtained the brief from the overbed table and applied Resident #136's brief. CNA L then assisted Resident #136 with repositioning, she pulled Resident #136's blouse down, pulled Resident #136's blankets up and then she removed the dirty gloves and applied hand gel. During the interview with CNA L, she said she should have removed her gloves and applied hand gel prior to touching Resident #136's shirt and blanket. CNA L said she had not been evaluated on incontinent care skills since hired in December 2022. CNA L said she forgot to change her gloves and perform hand hygiene. CNA L said not removing dirty gloves and using hand sanitizer could cause an infection by spreading germs. During an interview on 05/18/2023 at 12:09 p.m., LVN G said gloves should be changed any time there was soiling. LVN G said changing soiled gloves decreased the risk of infection. LVN G said the CNAs knew to change gloves when they were soiled. During an interview on 05/18/2023 at 12:33 p.m., the DON said nursing staff should do hand hygiene between clean and dirty. The DON said she expected the nursing staff to follow the infection control policy, change according to their skills check off upon hire, and how they were taught in their nurse aide program. During an interview on 05/18/2023 at 1:04 p.m., the Interim Administrator said staff should wash hands prior to putting on gloves. The Interim Administrator said staff should wash their hands or use hand hygiene gel after the removal of gloves. The Interim Administrator said by not removing the gloves or using hand hygiene, infections could spread. The Interim Administrator said hand hygiene was monitored by rounds and skills check offs. The Interim Administrator said the DON and unit manager were responsible. 4. Record review of Resident #45's face sheet, dated 05/18/23, indicated a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included stroke (brain damage), spinal stenosis (occurs when the spine narrows and create pressure on the spinal cord and nerve roots), Hypertension (high blood pressure), depression (persistent sadness) and anemia (lacking red blood cells). Record review of Resident #45's admission MDS, dated [DATE], indicated she was understood and understood others. Resident #45 had moderate cognitive impairment indicated with a BIMS of 09 and required extensive assistance for ADLs. Record review of Resident #45's comprehensive care plan, dated 04/14/23, indicated she had mixed incontinence related to cognitive deficit and impaired mobility. Resident #45's intervention was to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 24 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some check for incontinence during rounds and notify the doctor of any signs or symptoms of urinary tract infection. During an observation on 05/15/23 at 9:30 a.m., CNA N was providing Resident #45's incontinent care. She provided privacy and explained what she was going to do. CNA N wiped the front, of the peri area changed her gloves without performing hand hygiene, wiped the buttock(backside), and changed her gloves without performing hand hygiene, and applied the resident's brief. During an interview on 05/16/23 at 2:48 p.m., CNA N said she thought she sanitized between glove changes. CNA N said she was supposed to sanitize between gloves changes to prevent cross contamination. 5. Record review of Resident #35's face sheet, dated 05/18/23, indicated a [AGE] year-old female initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included stoke (occurs when blood flow to the brain is blocked), seizures (a sudden, uncontrolled burst of electrical activity in the brain), high blood pressure and peripheral vascular disease (a slow and progressive circulation disorder of the blood vessels). Record review of Resident #35's quarterly MDS assessment, dated 03/29/23, indicated she was rarely understood and usually understood others. Resident #35 was severely impaired on daily decision making. Resident #35 required total assistance with transfers, extensive assistance with bed mobility, dressing, personal hygiene, toilet use, and eating. Record review of Resident #35's comprehensive care plan, dated 09/26/19, indicated she had ADL self-care performance deficit related to hemiplegia (paralysis of one side of the body) and inability to control bowel and bladder. The interventions were to assist Resident #35 with incontinent care as needed and monitor her skin for any redness or changes in skin and report to the nurse and/or doctor. During an observation on 05/15/23 at 12:17p.m., CNA R was providing incontinent care for Resident #35. CNA R explained what she was going to do, wiped the front of the peri area, changed her gloves without performing hand hygiene, wiped the buttock (backside), changed her gloves without performing hand hygiene, and applied cream to the buttocks and used the same dirty gloves to position the bed in lowest position with the hand control and pulled up the covers. During an interview on 05/17/23 at 9:43 a.m., CNA R said she did not sanitize her hands in between glove changes. CNA R said she did not sanitize her hands because she did not have any hand sanitizer with her. CNA R said she knew she was supposed to sanitize her hands between clean and dirty but she did not. CNA R said failure to sanitize her hands could lead to cross contamination. During an interview on 05/18/23 at10:28 a.m., charge nurse LVN C said she expected the CNAs to introduce themselves, wash their hands and apply gloves, clean front of peri area, remove gloves, wash hands, apply new gloves, wash the buttock, remove gloves, wash hands, apply new gloves and then assist with clothes and bed covering. She said when all tasks were completed staff should remove gloves and wash hands. LVN C said this should be done to prevent cross contamination. During an interview on 05/18/23 at 11:50 a.m., the DON said CNAs should preform incontinent care the way they were trained in school. The DON said the CNAs were checked off on competencies and she was the overseer. The DON said CNAs should perform hand hygiene in between glove changes to prevent infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 25 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 05/18/23 at 12:16 p.m., the Interim Administrator said she expected staff to wash their hands between glove changes to prevent infection. She said the DON and unit managers were the overseers of nursing staff. Record review of competencies skills for incontinent care and hand hygiene revealed CMA N had been checked off on 12/13/22. Record review of competencies skills for incontinent care and hygiene revealed CMA R had been checked off on 12/13/22. Record review of Policies and Practices-Infection Control, dated August 2007, indicated the facility's infection control policies were intended to facilitate maintaining a safe, sanitary, and comfortable environment and to help prevent and manage transmission of disease and infections. Record review of a Perineal Care policy, dated October 2010, indicated the purposes of this procedure were to provided cleanliness and comfort to the resident, to prevent infections and skin irritation and to observe the resident's skin condition. Based on observation, interview and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 5 of 5 residents (Residents #35, #42, #45, #70 and #136) reviewed for infection control practices. The facility failed to ensure the proper disinfectant cleaner was used to clean Resident #42's isolation room with clostridium difficile (bacteria that causes infection in the large intestine). CNA N failed to handle Resident #70's dirty linen properly. CNA L failed to remove her dirty gloves and perform hand hygiene during Resident #136 incontinent care. The facility failed to ensure CNA N and CNA R performed hand hygiene while providing incontinent care for Resident #45 and Resident #35. These failures could place residents and staff at risk for cross contamination and the spread of infection. Finding include: 1. Record review of Resident #42's face sheet, dated 05/18/23, indicated a [AGE] year-old female who initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included enterocolitis (inflammation of the intestines) due to clostridium difficile (bacteria that causes infection in the large intestine), chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs), end stage renal disease (kidneys cease functioning on a permanent basis) and heart failure (heart does not pump well as it should). Record review of Resident #42's 5-day Medicare Part A stay MDS assessment, dated 04/30/23, indicated she was able to make herself understood and could understand others. Resident #42 had a BIMS score of 11, which indicated her cognition was moderately impaired. Resident #42 required extensive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 26 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some assistance with bed mobility and toileting. Resident #42 required limited assistance with transfers, locomotion, dressing and personal hygiene and was independent on eating. Resident #42 was frequently incontinent of bowel. Record review of Resident #42's comprehensive care plan, dated 05/11/23 and revised on 05/15/23, indicated she had clostridium difficile due to a positive toxin lab result. The care plan interventions included to administer vancomycin as ordered, contact isolation precautions, and disinfect all equipment used before it left the room. Record review of Resident #42's order summary report, dated 05/18/23, indicated the following order: *Contact isolation precautions for clostridium difficile every shift with a start date of 05/11/23. During an interview on 05/17/23 at 09:17 AM, Housekeeping District Manager D said when they came up to a room that was on isolation, they would ask the nurse why that resident required to be on isolation so they could ensure they used the correct disinfectant to clean the room. During an interview and observation on 05/17/23 at 10:14 AM, Housekeeping District Manager D said they used Oxivir TB, perdiem (general purpose cleaner and hydrogen peroxide) and peridox multi-surface cleaner when disinfecting the isolation rooms which included the room with clostridium difficile infection. The disinfecting bottles labels did not indicate it killed the clostridium difficile organism. During an interview on 05/17/23 at 02:24 PM, the Housekeeping Supervisor and Housekeeping District Manager F said they were uncertain as to why the oxivir tb epa registration number (70627-56) was not indicating it killed the clostridium difficile bacteria. During an interview on 05/18/23 at 09:52 AM, an agent for the Oxivir TB distributor said the Oxivir TB disinfecting cleaner did not kill the clostridium difficile bacteria. During an interview on 05/18/23 at 11:40 AM, Housekeeping District Manager F said they had been using the Oxivir TB as the disinfecting cleaner for the rooms on isolation which included the room with the clostridium difficile infection. The Housekeeping District Manager said they carried a card on their badge that indicated what disinfectant to use. The Housekeeping District Manager said by not using the correct disinfectant the bacteria could spread and the resident could become ill. Housekeeping District Manager F said it was the Housekeeping Supervisors and her responsibility to ensure the correct disinfectant was being used when cleaning the isolation rooms. During an interview on 05/18/23 at 12:09 PM, Unit Manager G said she expected the proper cleaning solution to be used when disinfecting the isolation rooms. Unit Manager G said by not using the correct disinfectant the infection could spread therefore leading to an outbreak of infections. Unit Manager G said the housekeeping staff were responsible for ensuring the proper disinfectant cleaner was being used. During an interview on 05/18/23 at 12:25 PM, the DON said she expected the housekeeping personnel to use the correct disinfectant when cleaning rooms in isolation. The DON said by not using the correct disinfectant the infection could spread from one room to the next. The DON said the Housekeeping Supervisor and the corporate person were responsible for ensuring the correct disinfectant cleaners (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 27 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0880 were being used. Level of Harm - Minimal harm or potential for actual harm During an interview on 05/18/23 at 12:46 PM, the Interim Administrator said she expected the proper chemical be used to clean the isolation rooms. The Interim Administrator said by not using the proper chemical it could cause the infection to spread. The Interim Administrator said it was the Housekeeping Supervisor and herself responsibility to ensure the proper chemicals were being used to clean the isolation rooms. Residents Affected - Some Record review of the sites following were accessed on 05/17/23 at 3:30 PM, and did not indicate the Oxivir TB disinfectant cleaner was used to kill the clostridium difficile bacteria. * List K: Antimicrobial Products Registered with EPA for Claims Against Clostridium difficile Spores | US EPA * US EPA, Pesticide Product Label, OXIVIR TB,03/10/2022 *Labels for OXIVIR TB (70627-56) | US EPA Record review of the facility's policy titled Cleaning and Disinfection of Environmental Surfaces, revised in June 2009, indicated .Environmental surfaces will be cleaned and disinfected according to current CDC recommendations for disinfection of healthcare facilities and the OSHA Bloodborne Pathogens Standards .19. in units with high rate of endemic Clostridium Difficile infection or in an outbreak setting, dilute solutions of 5.25%- 6.15% sodium hypochlorite (e.g., 1:10 dilution of household bleach) will be used for routine environmental disinfectant. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 28 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition for 2 of 6 residents (Resident #56 and Resident #78) reviewed for safe functional equipment. Residents Affected - Few 1. The facility failed to ensure Resident #56 had a functioning wheelchair brake. 2. The facility failed to ensure Resident #78's wheelchair seat was not torn. These failures could place residents at risk for skin issues, discomfort, and falls. Findings include: 1. Record review of Resident #56's face sheet, dated 05/18/23, revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included heart failure (develops when your heart does not pump enough blood for your body's needs), high blood pressure, obesity(overweight), and asthma (a disease that affects your lungs). Record review of Resident #56's quarterly MDS assessment, dated 03/10/23, indicated the resident was understood and understood others. Resident #56's cognition was moderately impaired indicated with a BIMS score of 11. Resident #56 required extensive assist with transfers, bed mobility, limited assist with bathing and supervision with dressing, personal hygiene, toilet use, and eating. Record review of Resident #56's comprehensive care plan, dated 02/22/22, indicated she had an ADL self-care performance deficit and was at risk to fall related to impaired balance. The interventions were to assist Resident #56 with transfers, educate her about safety reminders and what to do if a fall occurred, and keep furniture in locked position. During an observation and interview on 05/15/23 at 9:11 a.m., Resident #56 was sitting in her wheelchair. She said she had issues with her wheelchair brakes. Resident #56 stood up and when she sat back down her wheelchair rolled. Resident #56 demonstrated how to lock the brakes, but brakes would not lock. Resident #56 said she told staff (unknown who and when) about her brakes. She said she remembered a time when the maintenance man fixed them but they were broken again. During an interview on 05/15/23 at 3:35 p.m., the Interim Administrator said Resident #56 was measured for a new wheelchair and they were in the process of getting her a new wheelchair. She said they did replace Resident #56 with another wheelchair due to the wheelchair brakes not locking after survey intervention. 2.Record review of Resident #78's face sheet, dated 05/18/23, indicated a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included Chronic respiratory failure (a condition that occurs when the lungs cannot get enough oxygen into the blood or eliminate enough carbon dioxide from the body), diabetes (diseases that result in too much sugar in the blood), anxiety (feelings of nervousness, panic or fear) and tracheostomy status (a hole that surgeons make through the front of the neck and into the windpipe [trachea]. A tracheostomy tube was placed into the hole (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 29 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0908 to keep it open for breathing). Level of Harm - Minimal harm or potential for actual harm Record review of Resident #78's admission MDS assessment, dated 03/15/23, indicated she was understood and understood others. Resident #78 was moderately impaired with a BIMS score of 11. Resident #78 required extensive assist with bathing, limited assistance with transfers, bed mobility, dressing, personal hygiene, toilet use, and supervision with eating. Residents Affected - Few Record review of Resident #78's comprehensive care plan, dated 04/16/23, indicated she had ADL self-care performance deficit related to shortness of breath and was at risk to fall related to unsteady gait. The interventions were to assist Resident #78 with transfers, anticipate needs, educate her about safety reminders and what to do if a fall occurred, and maintain a clear pathway, free of obstacles. During an observation and interview on 05/15/23 at 9:01 a.m., Resident #78 was sitting on her bed. Resident #78's wheelchair was sitting beside the bed with the front part of seat torn and one screw was visible. Resident #78 said she used her wheelchair for mobility. During an observation and interview on 05/18/23 at 8:14 a.m., Resident #78 was sitting on the side of her bed. Resident #78's wheelchair was sitting beside her bed with the front part of the seat torn and one screw visible. Resident #78 said she was aware the wheelchair seat was torn and had tried to tell staff (unknown who and when) before but they did not hear her. During an observation and interview on 05/18/23 at 8:35 a.m., LVN C stated Resident #78's wheelchair seat was torn with a visible screw. LVN C said she was not aware Resident #78's wheelchair seat was torn. LVN C said the visible screw could cause injury and the torn wheelchair seat could cause a fall. LVN C gave Resident #78 a new wheelchair. During an interview on 05/18/23 at 10:33 a.m., CNA H said she worked hall 600 and 300. CNA H said she was unaware of Resident #56's brakes not locking properly or Resident #78's wheelchair seat being broken. She said if she was aware she would have reported it to maintenance. During an interview on 05/18/23 at 11:21p.m., the Maintenance Supervisor said he was aware of Residents #56's wheelchair brakes not locking about a month ago and he fixed them. He said he was not aware of any other brake issues until Monday 05/15/23 when he replaced her wheelchair. The Maintenance Supervisor said he was not aware of Resident #78's torn wheelchair until 05/18/23 when he replaced it. He said he did not have a system in place for checking equipment. The Maintenance Supervisor said the facility used TELS (building management platform) to complete work orders but sometimes staff would tell him and he would fix whatever they reported. He said the harm of wheelchairs not locking could lead to falls and wheelchair seats torn could cause injuries by pinching skin. During an interview on 05/18/23 at 11:50 a.m., the DON said staff were supposed to use TELS for any equipment issues. She said the Maintenance Supervisor was responsible for all equipment and the Administrator was the overseer. The DON said faulty equipment could cause injuries. During an interview on 05/18/23 at 12:16 p.m., the Interim Administrator said if any equipment needed to be repaired, staff was to utilize TELS. She said if staff was aware of any broken equipment, they were supposed to remove the equipment to prevent others from using it. The Interim Administrator said the Maintenance Supervisor was the overseer of equipment. She said any faulty equipment could place residents at risk for injury. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 30 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0908 Level of Harm - Minimal harm or potential for actual harm During an interview on 05/18/23 at 2:33 p.m., the Social Worker said she was Resident #78's ambassador (a facility designated person who visits certain residents daily to check on them). She said she was not aware of Resident #78's wheelchair seat being torn. She said she looked to see if the room was tidy, items labeled and bagged and to see how the resident was doing. The Social Worker said she would start looking at equipment because faulty equipment could cause injuries. Residents Affected - Few Record review of TELS from 02/15/23 through 05/15/23 did not reveal any work orders requested for Resident #56 or Resident #78. Record review of the facility policy Maintenance Service, dated December 2009, indicated, Maintenance service shall be provided to all areas of the building, grounds, and equipment. #1 the maintenance department was responsible for maintaining the buildings, ground, and equipment in a safe and operable manner always. #3 the maintenance director was responsible for developing and maintaining a schedule of maintenance service to assure that the building, ground, and equipment were maintained in a safe and operable manner #8 the maintenance director was responsible for maintaining the following records and or: K. Inspection of the building, L. work order request, M. maintenance schedule, #10 maintenance personnel shall follow established safety regulations to ensure the safety and well-being of all concerned. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 31 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0940 Develop, implement, and/or maintain an effective training program for all new and existing staff members. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to develop, implement, and maintain an effective training program for all existing staff, consistent with their expected roles for 3 of 21 employees (Activity Director, Maintenance Supervisor and the Housekeeping Supervisor) reviewed for required trainings. Residents Affected - Some The facility failed to ensure the Activity Director, Maintenance Supervisor and the Housekeeping Supervisor received restraint and HIV training annually. This failure could place residents at risk for inappropriate restraints and exposure to HIV. Findings include: Record review of an undated personnel file review sheet indicated hiring dates for the following staff members: *Activity Director was hired on 06/17/19 *Maintenance Supervisor was hired on 12/20/21 *Housekeeping Supervisor was hired on 03/4/19 Record review of the facility's in-service titled, annual required training on bloodborne pathogens, HIV, elopement management, compliance in ethics and restraints, dated 12/1/22, indicated the Activity Director, Maintenance Supervisor and the Housekeeping Supervisor did not sign the in-service. During an interview on 05/18/23 at 12:09 PM, Unit Manager G said she expected all staff to have the required trainings. Unit Manager G said by not having the annual required training on HIV and restraints, the staff would not have the proper education to properly care for the residents. Unit Manager G said the learning coordinator was responsible for ensuring the required trainings were completed. During an interview on 05/18/23 at 12:29 PM, the DON said she expected the staff to have the required HIV and restraint training. The DON said it was a collaborative effort to have all the trainings completed. The DON said she delegated the task of providing the in-services to the unit managers, but she was responsible for coordinating the in-services. The DON said she did not know why the in-services were not signed by the Activity Director, Maintenance Supervisor, or the Housekeeping Supervisor. The DON said by not having the proper training the residents were at risk for not receiving the care they need. During an interview on 05/18/23 at 12:52 PM, the Interim Administrator said she expected the staff to receive HIV and restraint training upon hire and annually. The Interim Administrator said by not having the proper training the staff would not be able to properly care for those residents. The Interim Administrator said the DON and herself were responsible for ensuring the required trainings were completed. Record review of the facility's policy Staff Development Program, revised August 2010, indicated . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 32 of 33 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 676368 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 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 0940 Level of Harm - Minimal harm or potential for actual harm All personnel must participate in initial orientation and regularly scheduled in-service training classes .The primary purpose of our facility's in-service training program is to provide our employees with an in-depth review of our established operational policies and procedures, their positions, methods and procedures to follow in implementing assigned duties, and to provide up-to-date information that will assist in providing quality care .10. The following in-service training classes are mandatory .b. AIDS .j. restraints Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 33 of 33