Health inspection·October 12, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 10/4/23 at 9:07 a.m. the Transportation Aide said Resident #2 had on a hospital gown and a black sweater, and she put a blanket over her knees. She said Resident #2 had on one none slip sock and soft cast boot on the other foot. The Transportation aide said there was no family in the ER when she left Resident #2. During an interview on 10/4/23 at 11:01 a.m. the Administrator said Resident #2's family came by his office on yesterday and voiced concerns. He said the family was upset because they had dropped the resident off at the hospital and left her unsupervised. He said he did investigate their concerns. He said the Transportation Aide did check Resident #2 into the hospital and the family was notified. He said Resident #2 had no cognitive impairment and they could leave her at the hospital without supervision. The NP said the family indicated when Resident #2's sodium is low, the resident is confused. She said people with low sodium could become confused. During an interview, and observation on 10/4/23 at 12:30 p.m. of Resident #2 and her family members in the hospital. Resident #2 was lying in a hospital bed with an IV infusing. She had a plate of food in front of her, but she was not eating. She was confused. When Resident #2 was asked questions she would tell long unrelated stories, and it was hard to get her back to the conversation at hand. Resident #2 said she was embarrassed to be sent to the hospital with only a brief and a hospital gown. She said the staff in the ER asked why she was brought to the hospital with only a gown which made her feel bad. She said one of the nurses told her she was going to find something to cover her with because her brief was showing from the back of the chair. The family member said a nurse at the hospital (Hospital RN) called her to say they did not know how the resident got there, why she was there, and she was only wearing a hospital gown and a brief. The family member said not only did they just drop Resident #2 off, but they did not make sure she was dressed and presentable. They said the facility sent the family member to the hospital in a diaper and a gown. The family member said Resident #2 was very particular about how she looked in public. The family member said there was no reason to send her out looking like that, because she had clothes in her closet. During an interview on 10/4/23 at 1:15 p.m. the Hospital RN said she was the admitting nurse for Resident #2. She said the resident was left in the ER with a hospital gown and brief and she was confused. During an interview and observation with on 10/5/23 at 7:10 a.m. CNA V said she was not the one that got the Resident #2 up to go to the hospital. She said she was off the last two days. She said Resident #2 had clothes to put on and observation of the closet showed pants and shirts. CNA V said that Resident #2 usually got dressed daily. She said Resident #2 was a two person assist with transfers, and she was non weight bearing. During an interview with on 10/5/23 at 7:20 p.m. CNA W said therapy usually got Resident #2 up, but she always wanted to get dressed. She said Resident #2 was usually oriented with no cognitive impairment, but she was a little confused on Sunday, the last day she worked with her. She said Resident #2 was talking about a lot of different things, telling long stories unrelated to anything, and not answering questions appropriately. During an interview with on 10/5/23 at 7:25 a.m. LVN F said Resident #2 was oriented times 4, but because of the low sodium she was a little confused. She said the staff took the resident to her appointment but there were two people, and they were not supposed to leave her alone. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 2 of 24 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 10/12/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to immediately consult with the resident physician when there was a significant change in the resident physical condition for 1 of 6 residents reviewed for change in condition. (Resident #1) The facility failed to notify the physician when Resident #1 experienced nausea and vomiting for 3 days after receiving new medications. Resident #1 was prescribed 5 different medications on 9/27/23 and 4 of them had side effects of nausea and vomiting. Resident #1 received the medications on 9/27/23. She vomited on 9/28/23, 9/29/23 and 9/30/23 and nurses noted in the clinical record no adverse reactions to medications. On 10/1/23 Resident #1 was sent to the ER with decreased blood pressure, decreased heart rate, and oxygen levels. On arrival to the hospital, she was found to have a low body temperature and sepsis. On 10/1/23 Resident #1 was sent to the ER with decreased blood pressure, decreased heart rate, and oxygen levels. On arrival to the hospital, she was found to have a low body temperature and sepsis. An immediate Jeopardy (IJ) situation was identified on 10/11/23 at 1:45 p.m. The IJ template was provided to the facility on [DATE] at 4:00 p.m. While the IJ was removed on 10/12/23 at 6:40 p.m. the facility remained out of compliance at actual harm with a scope of pattern due to the facilities need to evaluate the effectiveness of the corrective systems. This deficient practice could place residents at risk of not having their physician consulted on changes in condition requiring medical intervention. caused harm and could have resulted in the death of the resident. Finding included: Record review of Resident #1's face sheet indicated she was a [AGE] year-old female admitted to the facility on [DATE]. Some of her diagnoses were chronic respiratory failure, asthma, obesity, bronchitis, unspecified dementia, high blood pressure, rheumatoid arthritis, and gout( form of arthritis characterized by severe pain) of the right knee. Record review of a quarterly MDS dated [DATE] indicated Resident #1 had moderate cognitive impairment, and she required extensive assistance of two people with all ADLs. She required one-person extensive assist with dressing and supervision for eating. Record review of Resident #1's care plan dated 4/16/23 indicated a Focused Area of a potential for respiratory distress related to Asthma. One of the interventions was to observe for signs of respiratory distress, rapid breathing, cyanosis (bluish discoloration of skin resulting from inadequate oxygenation of the blood), shortness of breath, nasal flaring, retractions, and wheezing. Record review of Resident #1's computerized physician's orders indicated and order for BIPAP (a machine that helps breathing) to be placed at night and removed in the mornings. Ondansetron (Zofran) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 3 of 24 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 10/12/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some HCL 4m as needed for nausea and vomiting. Budesonide Inhalation suspension 0.5 mg inhale orally every 12 PRN. Record review of Resident #1's nursing note dated 9/27/23 at 5:42 p.m. indicated the resident retuned from a doctor's appointment with new orders for 5 new medications. Signed by LVN K. Record review indicated Resident#1 was given new order on 9/27/23 by a Rheumatoid Arthritis Doctor for the following medications:. Sulfasalazine 500 mg QD- side effects feeling sick nausea, vomiting, stomach pain. Neurontin 600 mg QD- side effects felling sick nausea and or vomiting. Prednisone 5mg bid - side effects decrease in the amount of urine, fast, slow, pounding, or irregular heartbeat, or pulse, rattling breathing. Tramadol HCL 50 mg every 6 hours-routine- side effect fatigue or drowsiness, loss of appetite, nausea, and vomiting. Allopurinol 100 mg QD- the most common side effect upset stomach, nausea, diarrhea, or drowsiness. Record review of Resident #1's September 2023 MAR indicated on 9/27/23 Neurontin 600 mg at 5 p.m. ( initial dose) was administered by MA M. Record review of Resident #1's nursing notes dated 9/28/23 at 12:42 a.m . indicated at 9:00 p.m. the resident stated that she went to the doctor today and got some new medications. Medication education was given related to Tramadol, 50mg for pain every 6 hours. Neurontin 600 mg two times a day, uric Acid, and Alopurinol 100 mg the resident received education on these medications. Signed by RN J. Record review of a nursing note dated 9/28/23 at 11:33 a.m. indicated the resident was give Ondansetron for nausea. At 2:00 p.m. the medication was noted to be effective. Signed by LVN K. Record review of nursing note dated 9/28/23 at 6:00 p.m. indicated the resident had no adverse effects to new medications and would continue to monitor. At 9:01 p.m. the resident was given Ondansetron for nausea. At 10:18 p.m. it was noted to be effective. Signed by LVN K. Record review of Resident #1's nursing notes dated 9/28/23 at 9:45 p.m. indicated Ondansetron (Zofran) was given for nausea. At 10:18 p.m. it was effective. At 11:35 a.m. the resident vomited Signed by RN J. Record review of nursing note dated 9/28/23 at 11:35 p.m. indicated at 9:30 p.m. rResident #1 vomited undigested food particle. O2 stat 97 percent with oxygen infusing at 2.5 liters per minute . HR 60, 18 respiration, temperature 97.4 and BP 110/77, Zofran given for nausea and vomiting. The Resident requested to leave the CPAP for now. Head of bed elevated. Will continue to monitor. Written by RN J. Record review of Resident #1's September 2023 MAR indicated: on 9/28/23 Neurontin 600 mg at 9:00 a.m. and 5 p.m. was given by MA I. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 4 of 24 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 10/12/2023 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 0580 Allopurinol 100 mg was given at 9:00 a.m. ( initial dose) by MA M. Level of Harm - Immediate jeopardy to resident health or safety Sulfasalazine 500 mg was given at 9:00 a.m. ( initial dose) by MA M. Residents Affected - Some Tramadol 50mg was given at 3:00 a.m. by RN J ( initial dose) -Tramadol 50 mg was given at 9:00 a.m. and 3:00 p.m. by MA I , and Tramadol 50 mg given at 9:00 p.m. by RN J. Prednisone 5mg was given at bedtime ( initial dose) was given by RN J. Record review of the Facility 24-hour report for Resident #1 on the night of 9/28/23 through 9/29/23 indicated on the 6p to 6 a shift indicated at 9:30 p.m. Resident #1 complained of nausea and vomited one time. Record review of nursing notes dated 9/29/23 at 4:32 a.m. indicated Resident #1 was asleep with the head of bed elevated and oxygen infusing at the prescribed rate. No adverse reactions noted to the new medications. Push or encourage fluids was done. Written by RN J. Record review of nursing notes dated 9/29/23 at 5:19 p.m. no adverse reaction noted to new medications give food with meds. Written by LVN E. Record review of Resident #1's September 2023 MAR indicated on 9/29/23 MA X administered Neurontin 600 mg at 9:00 a.m. and 5 p.m. Allopurinol 100 mg was given at 9:00 a.m. by MA X Sulfasalazine 500 mg was given at 9:00 a.m. by MA X On 9/29/23 Prednisone 5mg was given in the morning and bedtime by MA X. On 9/29/23 Tramadol 50mg was given at 3:00 a.m. by RN J -Tramadol 50 mg given at 9:00 a.m. and 3:00 p.m. by MA X, and Tramadol 50 mg for 9:00 p.m. was not administered; the MAR was blank with no reason documented for not administered. Record review of nursing notes dated 9/30/23 at 8:59 a.m. indicated day three of new medication no adverse reactions noted. Written by LVN E. Record review of nursing notes dated 9/30/23 at 7:05 p.m. Ondansetron gives for nausea at 10: 16 pm effective. Written by LVN C. Record review of Resident #1's September 2023 MAR indicated on 9/30/23 MA X administered Neurontin 600 mg at 9:00 a.m. and 5 p.m. Sulfasalazine 500 mg was given at 9:00 a.m. by MA X Allopurinol 100 mg was given at 9:00 a.m. by MA X Prednisone 5mg was given in the morning and bedtime by MA X. On 9/30/23 Tramadol 50 mg. At 3:00 a.m. the Tramadol was not administered; the MAR was blank with no reason documented for not administered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 5 of 24 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 10/12/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Tramadol 50 mg given at 9:00 a.m. and 3:00 p.m. by MA X, and Tramadol 50 mg . At 9:00 p.m. Tramadol was not administered; the MAR was blank with no reason documented for not administered. Record review of the Facility 24-hour report for Resident #1 on the night of 9/30/23 through 10/1/23 indicated on the 6p to 6 a shift the Tramadol was held due to nausea and possible reaction to the drug. There was no vomiting after 8 p.m. the resident was non-compliant with cpap, or oxygen pulled both off o2 stats remained in the upper 90 checked every hour and oxygen replaced . Record review of nurses note dated 10/1/23 at 8:45 a.m. Resident #1's family member stated the resident is not right. This nurse assessed the resident and bp was 118/72 pulse 60, respirations 18, the resident is a bit lethargic but is talking, notified the DON, instructed to send to the hospital. The resident vomited before this shift. Written by LVN E. Record Review of a nursing note dated 10/1/23 at 9:36 a.m. indicated at this time nurse was asked by LVN E to assist with patients' assessment. Upon entering the room this nurse met by family member and was brought up to date on the situation with Resident #1. When this nurse observed the patient lying on her back in bed with the head of the bed raised at 45 degrees angle, the resident appearance prompted the nurse to ask LVN E to call 911. The nurse continued with the patient's assessment pulse )O2 reading 54 percent on 2 LPM with heart rate 52. The nurse asked family member if patient had a diagnosis of COPD (constriction of air way and difficulty breathing), and she said no raised O2 to 4 liters. Blood pressure was manually taken and was 118/72 . uUpon palpating pulse, it was noted to be light and thready (difficult to feel. The Resident's lower legs were noted to be discolored with yellow splotches and cold to touch, no pulse noted to feet, popliteal ( back of the knee) pulse and the feet was the same. Light and thready. At this time EMS times 2 attendants arrived. [NAME] by LVN F Record review of nursing noted dated 10/1/23 at 7:45 p.m. indicate a late entry for 9/30/23 at 9:40 p.m. Resident #1 vomited two times and Zofran administered the resident was monitored the rest of the night with now as non-compliant with nasal cannula and the cpap r eplaced both several times oxygen stats remained over 90 precent q hour all night. Written by LVN C Record review of Resident #1's an EMS report indicated they received a call at 8:36 a.m. They arrived at the facility at 8:44 a.m. The patient was lying on her back on the bed awake and alert. She was found to be pale and cool to the touch. The patient responded to all questions appropriately but would occasionally fall asleep intermittently. She stated she felt fine and had no complains but felt tired. The nurse stated that the patient was acting lethargic (sleepy and drowsy), and she felt she was having difficulty breathing. Upon assessment the patient was found to be breathing normally but was found to have symptomatic bradycardia ( low heart rate less than 60 beats per minute). The patients' radial pulses and blood pressure was palpated ( by touch) at 70 pulses. The patient was symptomatic but was also awake and alert with no complaints. She was moved to the cot and transported to the hospital. The patient was given IV with atropine ( medication used to reduce low heart rate) 1mg after a dose of atropine the patient's heart rate increase to 55 and the blood pressure increased. The patient continuously reassessed and remained stable. Upon arrival to the hospital the patient was moved to a bed and left with the ER staff the transfer of care was at 9:20 a.m. Record review of the hospital ED Physician Documentation dated 10/1/23 indicated Resident #1 had arrived at 9:12 a.m. at 9:57 a.m. she had shortness of breath. EMS was called to the nursing home for shortness of breath. When they arrived, they found the patient did not seem to have a lot of shortness of breath. However, her vital signs found she had a heart rate in the high 20s and low 30s and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 6 of 24 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 10/12/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some was sinus on the monitor . The patients initial blood pressure was 70/40. They gave the patient 2 doses of atropine end route. When she arrived at the ER her heartrate was in the 50s and was junctional rhythm . Her blood pressure though head had decreased, and her initial blood pressures were 50s over 30s. tThe patient was still awake and alert, talking and said she felt fine. Record Review of a Critical Care Hospital and Physical dated 10/1/23 indicated. On presentation to the hospital, she was severely bradycardia with heart rate of 29. She was hypotensive ( low blood pressure), and hypothermia ( low body temperature) with a temperature of 94 degrees. She had been started on dopamine. She still required additional Levophed ( used to treat low BP) to the dopamine because of hypotension. She was given Maxipine ( used to treat infections) in the ER for probable sepsis. Her urine output was extremely poor with Foley placed in the ER. The impression was Sepsis ( harmful microorganisms in the blood), Anemia, Bradycardia , and acute urinary tract infection. The plan was to gently warm the patient while treating for sepsis with antibiotic and IV fluids. The patient will be intubated (insertion of a tube down the mouth or nose into the windpipe to open airways) and mechanically ventilated. The patient is unstable and was critically ill with life in imminent threat . Record review of a Grievance Complaint Report dated 10/1/23 indicated the Family member of Resident # 1 made a report to the Administrator and the DON that indicated the LVN E did not send Resident #1 to the Hospital in a timely manner. The actions taken was a one-on-one meeting with the charge nurse. Record review of Resident #1's nursing notes dated 10/2/23 at 8:05 a.m. indicated the nurse called the hospital for an update on the resident condition. The nurse was informed the resident was intubated in ICU with no date of discharge at this time. [NAME] by LVN K During an interview on 10/3/23 at 9:59 a.m. the DON said they had received a complaint from the family member of Resident #1. She said the family member complained that it took LVN E too long to send Resident #1 to the hospital on [DATE]. The DON said Resident #1's blood pressure was normal, but her oxygen level was low. They had sent her to the hospital, they knew she was in ICU because the family member said as much, but they did not know the status of Resident #1. The DON said she did an in service with LVN E and investigated the allegations but did not have hospital records. During an interview on 10/3/23 at 10:45 a.m. Resident #3 ( roommate to Resident #1) said the staff were all saying they thought Resident was sick because of her new medications. Resident #3 said on Saturday, 9/30/23 Resident #1 was real quite all day. She said on Saturday after the family member left Resident #1 started throwing up and when they got her cleaned up and she would throwed up again. Resident #3 said when they were all in the room the CNA A told the LVN C Resident #1 needed to go to the hospital. Resident said over in the night Resident #1 was talking out of her head to someone named sis and that was unusual. During an interview on 10/3/23 at 10:50 CNA H said she worked from 6 a to 12 p.m. on Saturday 9/30/23 . She said while she was at work Resident#1 did not throw up that day, but she had thrown up the night before because her sheets, blanket, and gown had vomit on them. She had cleaned her up and told LVN E. CNA H said Resident #1 said she was not feeling well and had thrown up. She said on Sunday 10/1/23 she arrived at work at 6:00 a.m. and saw LVN E come out of Resident #1's room about 6:30 a.m. She said when she went in the room about 7:20 a.m. or so the family member was in the room. The resident had thrown up and they started to clean her up. CNA H said the family member went and got LVN E to take Resident #1's blood pressure and the nurse could not. She fumbled around for about an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 7 of 24 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 10/12/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some hour and the family member just wanted Resident #1 sent to the hospital. The aide said she told LVN E Resident #1 needed to go to the hospital because she was not herself. She said the LVN E acted like she did not want to send the Resident to the hospital . CNA H said LVN E finally went and got LVN F and LVN A left the room. She said EMS arrived a few minutes later and Resident #1 was taken to the hospital. During an interview on 10/3/23 at 11:03 a.m. CNA G said she worked the weekend and Resident #1 was sick on Saturday. She said the resident was not really a complainer, she was just not herself and she would not eat. CNA G said she told LVN E on Saturday, 9/30/23 several times Resident #1 was not feeling well and not eating. She said she arrived to work at 6:00 on 10/1/23. She said Resident #1 refused her breakfast and was groggy. She said LVN E knew she was not feeling well the last few days. CNA G said around 7:20 a.m. the family member came and told us she had thrown up on 9/29/23 at night. We ( me and CNA H) told LVN E-to send Resident #1 out, but it was not until about 9:00 a.m. when Resident #1 was sent to the hospital. She said LVN E did not want to send Resident #1 out and the family member said she needed to go to the hospital several times. During an interview on 10/3/23 at 11:14 a.m. LVN F said she worked Sunday 10/1/23 at the other nurse's station. She said on 10/1/23 she saw a patient she never met before. She said LVN E came and got her to assist with the assessment of Resident #1 and to help her make the decision whether to send the resident to the hospital or not. LVN F said LVN E could not find a pulse Ox . LVN F said she had her own. She said LVN E was not familiar with central supply closet where they kept the little crash cart that had everything, such as blood pressure cup and pulse Ox. LVN F sad LVN E had already came and gotten another nurse's manual blood pressure cup from the other nurse's station. LVN F said what she saw when she entered Resident #1's room was an African American female whose skin was grayish. She said the moment she walked into the room told LVN E to call 911. LVN F said Resident #1's lower legs to knees were cold and she looked almost white, her 02-level was 54 percent on 2 liters of oxygen, and heart rate 52. She said she asked the family member to turn the oxygen up to 4 liters, because she was on that side of the bed and she watched where she put the level. LVN F said her check of Resident #1's blood pressure was 118/72 and the 72 was very light., her pulse was weak and thready. She said Resident #1 opened her eyes and winked at her but never spoke a word. LVN F said she counted 12 respirations a minute. She said she was told LVN E had come to get her once and the family member had come to get her, but she was in a room. She said she the aides had told her they had told LVN E to send Resident #1 to the hospital the day before. LVN F said shortly after they left with Resident #1 the family member called and said they had put Resident #1 in ICU. She said when LVN E came and got her, she left the room to call 911, she never came back. She said EMS took Resident #1's blood sugars and they were 132. During an interview on 10/3/23 at 11: 20 a.m. the family member of Resident #1 said they had come to the facility on Saturday evening and the resident was drowsy and not eating. She had thrown up her food. She said she had already thrown up because there was vomit in the trash can. The family member said Resident#1's gown and everything had vomit on it. She said prior to leaving she asked the nurse LVN C not to give her the night dose of tramadol because she was so sleepy. The family member said on Sunday morning she had come early because she wanted to see how Resident #1 was doing. The family member said arrived about 7:30 a.m. Resident #1 was so sleepy she could hardly talk. The family member said she went and got LVN E to take her blood pressure and LVN E could not find a blood pressure cup that worked the battery was low or something. The family member said after about 30 minutes LVN E went and got a manual blood pressure cup. The family member said when LVN E took Resident #1's blood pressure the family member said they did not believe LVN E knew what she was doing the blood pressure was 117/72. The family member asked for an oxygen status, and for a second (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 8 of 24 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 10/12/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some opinion or to just send Resident #1 to the hospital. The family member said after about 30 more minutes LVN F accompanied LVN E in the room. The family member said LVN F took one look at the Resident #1 and told to LVN E to send her to the hospital. The family member said LVN E left the room, and she did not come back that she remembered. The family member said Resident #1's feet were cold and when she got to the hospital, they had to warm her body up because she was cold. The family member said LVN F was able to take Resident #1's oxygen status and it was low. The family member said when the resident arrived at the hospital her oxygen level was 52 and her bp was 88/53. The family member said at when the nursing home took it manually it was 117/72 and they did not do it right. The family member said the aides said they had told LVN E, the resident did not look good and needed to go to the hospital, but she would not listen. The family member said at the hospital they put the catheter in Resident #1 and got no urine output. The family member said when Resident #1 arrived at the hospital they said she was septic, the had to put some type of warming blanket on her, and they had intubated the resident and put her in ICU, she was not doing well at the current time. During an interview on 10/3/23 at 11:40 a.m. the DON said the family member was upset because she felt the resident was not sent to the hospital timely. She said LVN E called her to say Resident #1's O2 stat was low, and she was kind of lethargic. She said told her the family wanted Resident #1 sent to the hospital, and she had told her if the family wanted her sent out then send her out. The DON said she called LVN E to check on Resident #1 and did a follow up to make sure the resident had gotten to the hospital. She said someone said something about the resident had thrown up, during morning meeting on Friday, 9/29/23, but she was not aware Resident #1 continued vomiting. During an interview on 10/3/23 at 12:35 p.m. the NP said on 9/29/23 she was informed Resident#1 had thrown up on Friday during morning meeting. She said she worked at the facility Monday through Friday and if there were any issues the staff notified her. If she had questions or concerns, she would notify the physician. She said she was only informed that one time Resident #1 had vomited. She said she was not informed the resident continued to throw up the next two days. She said Resident #1 went to a Rheumatoid doctor on 9/27/23 and came back with prescriptions for 5 different medications. She said she told the nursing staff to make sure Resident #1 ate before giving her the medications and no one informed her she continued to throw up. The NP said the resident continued vomiting could have been due to the new medications. She said if she had been informed the resident was throwing up for 3 days, she would have requested labs, pushed fluids, and looked at some other interventions for the resident. If she continued to vomit, she would have sent her to the hospital for an evaluation. During an interview on 10/3/23 at 1:05 p.m . the DON said that she would look for the one on one in service she had conducted with LVN E. She then said she had conducted the interview over the phone and did not have it written down at the current time. During an interview on 10/4/23 at 9:25 a.m. LVN E said she had worked at the facility for 4 days and on Sunday 10/1/23, it was her third time working with Resident #1. She said she did not remember the aides telling her anything about Resident #1 being sick and not eating. She said she had not consulted with the physician or the NP during the weekend . She said after she sent Resident #1 to the hospital, she had sent the NP a text. She said when she came in and the nurse on the night shift said Resident #1 had vomited. She went to the room to check the roommates blood sugars. She walked over to Residen#1's side of the room and touched her hand, and the resident was doing fine, she did not note anything out of the ordinary. She said around 7:30 a.m. or so the resident's family member came and asked her to check Resident #1's blood pressure. She said the batteries were down in the one she had, and she could not find another one. She had gone to the nurse's station on the other hall and gotten one a manual BP cup from a coworker. She said Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 9 of 24 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 10/12/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some #1's BP was 117/70. Pulse 60 and R 18. The family member told her she wanted someone else to do it. She went and got the nurse from across the way. She said that nurse had a pulse Ox, and she could not find one. She said the residents O2 stat was 50 and she left to call 911. She said she did call the DON first and then 911. She said the resident temp was 97 . She said her feet were cold she had stayed in the room probably 20 minutes with the family member and Resident #1. During an observation and interview on 10/4/23 at 1:00 p.m. at the hospital with Resident #1 and the ICU nurse. Resident #1 was observed in the ICU in a hospital bed. She was laying on her back with monitors hooked up and IVs flowing. She was awake and fidgety. She shook her head yes when asked if she had been sick a few days prior to coming to the nursing home. The only other communication was she whispered her name. The ICU RN said her intubation was removed yesterday. He said she appeared to have decreased memory and more confusion. Observation of Resident #1 wanted the nurse to open the suction tubing for her to suction her throat, several times she kept repeating open. She was coughing up mucus and wanted to continue to use the tube. The RN explained to her several times she was clear and did not need the tube. Resident #1 did calm down a appeared to rest. The nurse said they did not have any discharge plans for the resident at this time. During a telephone interview on 10/5/23 at 3:20 a.m. LVN C said she worked Saturday, 9/30/23 night going into Sunday, 10/1/23 morning. She said on the Saturday evening about 8 p.m. the family member came and told her Resident #1 was nauseated, she gave her some Zofran and she threw that up. She gave her another one and put that one under her tongue and the resident went to sleep. She said she checked on her all through the night and kept putting the oxygen on her. She said about 3:00 a.m. the resident said she wanted to get up, but she did not. She said on Sunday morning she went in to check on her and she was fine she said she gave her a routine breathing treatment, she did not have any breathing issues and her O2 stat was never under 90. Said the aides did tell her she was none responsive around 5:30 a.m., but when they went in to check on about 5:45 a.m. she was talking. She said she took her O2 stats at that time but did not write them down. She told the oncoming nurse to check on her because she was not feeling well and to keep check on her O2 status. She said the resident's status had changed since they put her on the new medications. She had held the tramadol because she was so sleepy. She had put on the MAR refused because there were only so many choices. She said she had put that information on the 24-hour report. During a telephone interview on 10/5/23 at 3:26 a.m. with CNA A said she worked at the facility for about a month. On Friday night Resident#1 complained of being nauseous. She said when she came in Saturday at 6:00 p.m. about two hours into the shift she said Resident #1 was nauseated and she threw up several times. The last time she saw her was about 5:30 a.m. on 10/1/23 when she and CNA B went in to change her. CNA A said Resident #1 was not coherent. She said they tried to wake her up and could not. She said they told LVN C about the Resident #1's condition. CNA A said Resident #1 had her oxygen on at that time, and the oxygen was on around 3:00 a.m. when they had gone into the room. During a telephone interview on 10/5/23 at 3:29 a.m. CNA B said he worked at the facility for 7 years. He said on Friday night the Resident #1 was fine but complained of being nauseated. He said Resident #1 was a two person assist and most of the time when CNA A went into the room, he was with her. He said Resident #1 was sick all-night Saturday, 9/30/23 they told the nurse several times. He said about 5:30 a.m. when then did the last round Resident #1 seemed dead. They could not get her to open her eyes, they changed her and told the nurse. She had her oxygen on at that time. During an interview on 10/5/23 at 5:53 a.m. CNA A said they had informed LVN C several times on Saturday night Resident #1was sick. She said she never saw her go into her room. She said Resident #1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 10 of 24 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 10/12/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some was wet each time they went into change her and she had her oxygen on. She said what they did to Resident #1 was not right. They knew she was sick all weekend and did nothing. A statement written by CNA A dated 10/5/23 indicated on Friday 9/29/23 Resident #1 was responsive and said she was nauseated. On Saturday, 9/30/23 Resident #1 was responsive at 6:00 p.m. and complaining about being nauseated. She started throwing up around 8-8:30 p.m. as the night progressed, she started to get worse. She said we, ( Me and CNA B) told LVN C she needed to go to the hospital. CNA A said LVN C said she was going to give her some more anti-nausea pills. She said around 5:30 a.m. Resident #1 was incoherent and they ( she and CNA B) could not wake her up. She said they told LVN C. She said LVN C went to check on Resident #1 one time when she was throwing up and did not go back to check on her during the night. During an interview on 10/5/23 at 5:57 a.m. CNA B said when they went in to change Resident #1 her brief was wet. He said she was different and sick for the last couple of nights. He said they all thought it was because of the new medications they had given her because she was not like that before. He said they told LVN A several times that night and that morning the resident was sick. He said at 5:30 a.m. they told LVN C, Resident #1 was not responsive. He said he never saw her move to go toward her room. During an interview on 10/5/23 at 6:10 a.m. LVN C said she had held Residents #1'sTramadol on the night of 10/1/23 because she was throwing up and she felt it had something to do with the medications. She had not called the physician with any of her concerns. During an interview on 10/5/23 at 7:00 a.m. LVN E said on 10/1/23 when the night nurse ( LVN C) left, she told her Resident #1 had been throwing up. She said LVN E said she had looked in on Resident #1 and she was okay. She said she did not give her any medications that morning before she left for the hospital, the medication aide gave the medications. The medication aide did not arrive until 8:00 a.m. LVN E said Resident #1 could have been having a reaction to the medications. She said the nurses were the ones that wrote the notes in the chart about no adverse reactions to the medications. She thought it was somewhere on the nurse MAR that they put that information. During an interview with on 10/5/23 at 8:30 a.m. MA I said she did not write anything in the cart about adverse reactions to medications, that was the nurses that did that . She said Resident #1 had some new medications and she gave them as prescribed. She said Resident #1 always took her medication without any problems. MA I said she did not know anything about Resident #1 being sick. During an interview on 10/11/23 at 2:55 p.m. the DON said it was the facility policy that nurses give the initial dose of new medications to residents. She said after that the MAs give the medication, but the nurses are to check for adverse reactions to the medications. She said it was her policy that the nurses notify her of any change in condition before they send someone out to the hospital. She said if the family request the nurses send them out and call her after. She said she had a procedure written down that she gave to nurses on hire. During an interview on 10/11/23[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 11 of 24 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 10/12/2023 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident received the treatment and care in accordance with professional standards of practice for 1 of 5 residents reviewed for quality of care.(Resident #1), in that: Residents Affected - Some The facility failed to ensure Resident #1 was not having adverse reactions to new medication. Resident #1 was prescribed 5 different medications on 9/27/23 and 4 of them had side effects of nausea and vomiting. Resident #1 received the medications on 9/27/23. She vomited on 9/28/23, 9/29/23 and 9/30/23 and nurses noted in the clinical record no adverse reactions to medications. They failed to assess Resident #1 and notify the physician when she experienced adverse reaction to new medications. On 10/1/23 Resident #1 was sent to the ER with decreased blood pressure, decreased heart rate, and oxygen levels. On arrival to the hospital, she was found to have a low body temperature and sepsis. An immediate Jeopardy (IJ) situation was identified on 10/11/23 at 1:45 p.m. The IJ template was provided to the facility on [DATE] at 4:00 p.m. While the IJ was removed on 10/12/23 at 6:40 p.m., the facility remained out of compliance at actual harm with a scope of pattern due to the facilities need to evaluate the effectiveness of the corrective systems. This deficient practice could place residents at risk of not receiving care and services to meet their needs caused harm and could have resulted in the death of the resident. Finding included: Record review of Resident #1's face sheet indicated she was a [AGE] year-old female admitted to the facility on [DATE]. Some of her diagnoses were chronic respiratory failure, asthma, obesity, bronchitis, unspecified dementia, high blood pressure, rheumatoid arthritis, and gout( form of arthritis characterized by severe pain) of the right knee. Record review of a quarterly MDS dated [DATE] indicated Resident #1 had moderate cognitive impairment, and she required extensive assistance of two people with all ADLs. She required one-person extensive assist with dressing and supervision for eating. Record review of Resident #1's care plan dated 4/16/23 indicated a Focused Area of a potential for respiratory distress related to Asthma. One of the interventions was to observe for signs of respiratory distress, rapid breathing, cyanosis(bluish discoloration of skin resulting from inadequate oxygenation of the blood), shortness of breath, nasal flaring, retractions, and wheezing. Record review of Resident #1's computerized physician's orders indicated and order for BIPAP (a machine that helps breathing) to be placed at night and removed in the mornings. Ondansetron(Zofran) HCL 4m as needed for nausea and vomiting. Budesonide Inhalation suspension 0.5 mg inhale orally every 12 PRN. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 12 of 24 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 10/12/2023 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 0684 Record review of Resident #1's nursing note dated 9/27/23 at 5:42 p.m. indicated the resident retuned from a doctor's appointment with new orders for 5 new medications. Signed by LVN K. Level of Harm - Immediate jeopardy to resident health or safety Record review indicated Resident#1 was given new order on 9/27/23 by a Rheumatoid Arthritis Doctor for the following medications. Residents Affected - Some Sulfasalazine 500 mg QD- side effects feeling sick nausea, vomiting, stomach pain. Neurontin 600 mg QD- side effects felling sick nausea and or vomiting. Prednisone 5mg bid- side effects decrease in the amount of urine, fast, slow, pounding, or irregular heartbeat, or pulse, rattling breathing. Tramadol HCL 50 mg every 6 hours-routine- side effect fatigue or drowsiness, loss of appetite, nausea, and vomiting. Allopurinol 100 mg QD- the most common side effect upset stomach, nausea, diarrhea, or drowsiness. Record review of Resident #1's September 2023 MAR indicated on 9/27/23 Neurontin 600 mg at 5 p.m. ( initial dose) was administered by MA M. Record review of Resident #1's nursing notes dated 9/28/23 at 12:42 a.m. indicated at 9:00 p.m. the resident stated that she went to the doctor today and got some new medications. Medication education was given related to Tramadol, 50mg for pain every 6 hours. Neurontin 600 mg two times a day, uric Acid, and Alopurinol 100 mg the resident received education on these medications. Signed by RN J. Record review of a nursing note dated 9/28/23 at 11:33 a.m. indicated the resident was give Ondansetron for nausea. At 2:00 p.m. the medication was noted to be effective. Signed by LVN K. Record review of nursing note dated 9/28/23 at 6:00 p.m. indicated the resident had no adverse effects to new medications and would continue to monitor. At 9:01 p.m. the resident was given Ondansetron for nausea. At 10:18 p.m. it was noted to be effective. Signed by LVN K. Record review of Resident #1's nursing notes dated 9/28/23 at 9:45 p.m. indicated Ondansetron (Zofran) was given for nausea. At 10:18 p.m. it was effective. At 11:35 a.m. the resident vomited Signed by RN J. Record review of nursing note dated 9/28/23 at 11:35 p.m. indicated at 9:30 p.m. resident #1 vomited undigested food particle. O2 stat 97 percent with oxygen infusing at 2.5 liters per minute. HR 60, 18 respiration, temperature 97.4 and BP 110/77 Zofran given for nausea and vomiting. The Resident requested to leave the CPAP for now. Head of bed elevated. Will continue to monitor. Written by RN J. Record review of Resident #1's September 2023 MAR indicated: on 9/28/23 Neurontin 600 mg at 9:00 a.m. and 5 p.m. was given by MA I. Allopurinol 100 mg was given at 9:00 a.m. ( initial dose) by MA M. Sulfasalazine 500 mg was given at 9:00 a.m. ( initial dose) by MA M. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 13 of 24 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 10/12/2023 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 0684 Prednisone 5mg was given at bedtime ( initial dose) was given by RN J. Level of Harm - Immediate jeopardy to resident health or safety Tramadol 50mg was given at 3:00 a.m. by RN J ( initial dose) -Tramadol 50 mg was given at 9:00 a.m. and 3:00 p.m. by MA I , and Tramadol 50 mg given at 9:00 p.m. by RN J. Residents Affected - Some Record review of the Facility 24-hour report for Resident #1 on the night of 9/28/23 through 9/29/23 indicated on the 6p to 6 a shift indicated at 9:30 p.m. Resident #1 complained of nausea and vomited one time. Record review of nursing notes dated 9/29/23 at 4:32 a.m. indicated Resident #1 was asleep with the head of bed elevated and oxygen infusing at the prescribed rate. No adverse reactions noted to the new medications. Push or encourage fluids was done. Written by RN J. Record review of nursing notes dated 9/29/23 at 5:19 p.m. no adverse reaction noted to new medications give food with meds. Written by LVN E. Record review of Resident #1's September 2023 MAR indicated on 9/29/23 MA X administered Neurontin 600 mg at 9:00 a.m. and 5 p.m. Allopurinol 100 mg was given at 9:00 a.m. by MA X Sulfasalazine 500 mg was given at 9:00 a.m. by MA X On 9/29/23 Prednisone 5mg was given in the morning and bedtime by MA X. On 9/29/23 Tramadol 50mg was given at 3:00 a.m. by RN J -Tramadol 50 mg given at 9:00 a.m. and 3:00 p.m. by MA X, and Tramadol 50 mg for 9:00 p.m. was not administered the MAR was blank with no reason documented for not being administered. Record review of nursing notes dated 9/30/23 at 8:59 a.m. indicated day thee of new medication no adverse reactions noted. Written by LVN E. Record review of nursing notes dated 9/30/23 at 7:05 p.m. Ondansetron [NAME] for nausea at 10: 16 pm effective. Written by LVN C. Record review of Resident #1's September 2023 MAR indicated on 9/30/23 MA X administered Neurontin 600 mg at 9:00 a.m. and 5 p.m. Sulfasalazine 500 mg was given at 9:00 a.m. by MA X Allopurinol 100 mg was given at 9:00 a.m. by MA X Prednisone 5mg was given in the morning and bedtime by MA X. On 9/30/23 Tramadol 50 mg. At 3:00 a.m. the Tramadol was not administered; the MAR was blank with no reason documented for not being administered. Tramadol 50 mg given at 9:00 a.m. and 3:00 p.m. by MA X, and Tramadol 50 mg . At 9:00 p.m. Tramadol was not administered the MAR was blank with no reason documented for not being administered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 14 of 24 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 10/12/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of the Facility 24-hour report for Resident #1 on the night of 9/30/23 through 10/1/23 indicated on the 6p to 6 a shift the Tramadol was held due to nausea and possible reaction to the drug . There was no vomiting after 8 p.m. the resident was non-compliant with cpap, or oxygen pulled both off o2 stats remained in the upper 90 checked every hour and oxygen replaced. Record review of nurses note dated 10/1/23 at 8:45 a.m. Resident #1's family member stated the resident is not right. This nurse assessed the resident and bp 118/72 pulse 60, respirations 18, the resident is a bit lethargic but is talking, notified the DON, instructed to send to the hospital. The resident vomited before this shift. Written by LVN E. Record Review of a nursing note dated 10/1/23 at 9:36 a.m. (late entry) indicated at this time nurse was asked by LVN E to assist with patients' assessment. Upon entering the room this nurse met by family member and was brought up to date on the situation with Resident #1. When this nurse observed the patient lying on her back in bed with the head of the bed raised at 45 degrees angle, the resident appearance prompted the nurse to ask LVN E to call 911. The nurse continued with the patient's assessment pulse )O2 reading 54 percent on 2 LPM with heart rate 52. The nurse asked family member if patient had a diagnosis of COPD (constriction of air way and difficulty breathing), and she said no raised O2 to 4 liters. Blood pressure was manually taken and was 118/72 . uUpon palpating pulse, it was noted to be light and thready (difficult to feel. The Resident's lower legs were noted to be discolored with yellow splotches and cold to touch, no pulse noted to feet, popliteal ( back of the knee) pulse and the feet was the same. Light and thready. At this time EMS times 2 attendants arrived. [NAME] by LVN F Record review of nursing noted dated 10/1/23 at 7:45 p.m. indicate a late entry for 9/30/23 at 9:40 p.m. Resident #1 vomited two times and Zofran administered the resident was monitored the rest of the night as non compliant with nasal cannula and the cpap CPAP replaced both several times oxygen stats remained over 90 precent q hour all night. Written by LVN C Record review of Resident #1's an EMS report indicated they received a call at 8:36 a.m . They arrived at the facility at 8:44 a.m. The patient was lying on her back on the bed awake and alert. She was found to be pale and cool to the touch. The patient responded to all questions appropriately but would occasionally fall asleep intermittently. She stated she felt fine and had no complains but felt tired. The nurse stated that the patient was acting lethargic (sleepy and drowsy), and she felt she was having difficulty breathing. Upon assessment the patient was found to be breathing normally but was found to have symptomatic bradycardia ( low heart rate less than 60 beats per minute). The patients' radial pulses and blood pressure was palpated ( by touch) at 70 pulses. The patient was symptomatic but was also awake and alert with no complaints. She was moved to the cot and transported to the hospital. The patient was given IV with atropine( medication used to reduce low heart rate) 1mg after a dose of atropine the patient's heart rate increase to 55 and the blood pressure increased. The patient continuously reassessed and remained stable. Upon arrival to the hospital the patient was moved to a bed and left with the ER staff the transfer of care was at 9:20 a.m. Record review of the hospital ED Physician Documentation dated 10/1/23 indicated Resident #1 had arrived at 9:12 a.m. at 9:57 a.m. she had shortness of breath. EMS was called to the nursing home for shortness of breath. When they arrived, they found the patient did not seem to have a lot of shortness of breath. However, her vital signs found she had a heart rate in the high 20s and low 30s and was sinus on the monitor. The patients initial blood pressure was 70/40. They gave the patient 2 doses of atropine end route. When she arrived at the ER her heartrate was in the 50s and was junctional rhythm . Her blood pressure though head decreased, and her initial blood pressures were 50s over 30s. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 15 of 24 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 10/12/2023 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 0684 the patient was still awake and alert, talking and said she felt fine. Level of Harm - Immediate jeopardy to resident health or safety Record Review of a Critical Care Hospital and Physical dated 10/1/23 indicated. On presentation to the hospital, she was severely bradycardia with heart rate of 29. She was hypotensive ( low blood pressure), and hypothermia( low body temperature) with a temperature of 94 degrees. She had been started on dopamine. She still required additional Levophed( used to treat low BP) to the dopamine because of hypotension. She was given Maxipine ( used to treat infections) in the ER for probable sepsis. Her urine output was extremely poor with Foley placed in the ER. The impression was Sepsis( harmful microorganisms in the blood), Anemia, Bradycardia , and acute urinary tract infection. The plan was to gently warm the patient while treating for sepsis with antibiotic and IV fluids. The patient will be intubated(insertion of a tube down the mouth or nose into the windpipe to open airways) and mechanically ventilated. The patient is unstable and was critically ill with life in imminent threat . Residents Affected - Some Record review of a Grievance Complaint Report dated 10/1/23 indicated the Family member of Resident # 1 made a report to the Administrator and the DON that indicated the LVN E did not send Resident #1 to the Hospital in a timely manner. The actions taken was a one-on-one meeting with the charge nurse. Record review of Resident #1's nursing notes dated 10/2/23 at 8:05 a.m. indicated the nurse called the hospital for an update on the resident condition. The nurse was informed the resident was intubated in ICU with no date of discharge at this time. [NAME] by LVN K. During an interview on 10/3/23 at 9:59 a.m. the DON said they had received a complaint from the family member of Resident #1. She said the family member complained that it took LVN E too long to send Resident #1 to the hospital on [DATE]. The DON said Resident #1's blood pressure was normal, but her oxygen level was low. They had sent her to the hospital, they knew she was in ICU because the family member said as much, but they did not know the status of Resident #1. The DON said she did an in service with LVN E and investigated the allegations but did not have hospital records. During an interview on 10/3/23 at 10:45 a.m. Resident #3 ( roommate to Resident #1) said the staff were all saying they thought Resident was sick because of her new medications. Resident #3 said on Saturday, 9/30/23 Resident #1 was real quite all day. She said on Saturday after the family member left Resident #1 started throwing up and when they got her cleaned up and she would throwed up again. Resident #3 said when they were all in the room the CNA A told the LVN C Resident #1 needed to go to the hospital. Resident said over in the night Resident #1 was talking out of her head to someone named sis and that was unusual. During an interview on 10/3/23 at 10:50 CNA H said worked from 6 a to 12 p.m. on Saturday 9/30/23 . She said while she was at work Resident#1 did not throw up that day, but she had thrown up the night before because her sheets, blanket, and gown had vomit on them. She had cleaned her up and told LVN E. CNA H said Resident #1 said she was not feeling well and had thrown up. She said on Sunday 10/1/23 she arrived at work at 6:00 a.m. and saw LVN E come out of Resident #1's room about 6:30 a.m. She said when she went in the room about 7:20 a.m. or so the family member was in the room. The resident had thrown up and they started to clean her up. CNA H said the family member went and got LVN E to take Resident #1's blood pressure and the nurse could not. She fumbled around for about an hour and the family member just wanted Resident #1 sent to the hospital. The aide said she told LVN E Resident #1 needed to go to the hospital because she was not herself. She said the LVN E acted like she did not want to send the Resident to the hospital . CNA H said LVN E finally went and got LVN F and LVN A left the room. She said EMS arrived a few minutes later and Resident #1 was taken to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 16 of 24 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 10/12/2023 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 0684 hospital. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 10/3/23 at 11:03 a.m. CNA G said she worked the weekend and Resident #1 was sick on Saturday. She said the resident was not really a complainer, she was just not herself and she would not eat. CNA G said she told LVN E on Saturday, 9/30/23 several times Resident #1 was not feeling well and not eating. She said she arrived to work at 6:00 on 10/1/23. She said Resident #1 refused her breakfast and was groggy. She said LVN E knew she was not feeling well the last few days. CNA G said around 7:20 a.m. the family member came, and told us she had thrown up on 9/29/23 at night. We ( me and CNA H) told LVN E-to send Resident #1 out, but it was not until about 9:00 a.m. when Resident #1 was sent to the hospital. She said LVN E did not want to send Resident #1 out and family member said she needed to go to the hospital several times. Residents Affected - Some During an interview on 10/3/23 at 11:14 a.m. LVN F said she worked Sunday 10/1/23 at the other nurse's station. She said on 10/1/23 she saw a patient she never met before. She said LVN E came and got her to assist with the assessment of Resident #1 and to help her make the decision whether to send the resident to the hospital or not. LVN F said LVN E could not find a pulse Ox . LVN F said she had her own. She said LVN E was not familiar with central supply closet where they kept the little crash cart that had everything, such as blood pressure cup and pulse Ox. LVN F sad LVN E had already came and gotten another nurse's manual blood pressure cup from the other nurse's station. LVN F said what she saw when she entered Resident #1's room was an African American female whose skin was grayish. She said the moment she walked into the room told LVN E to call 911. LVN F said Resident #1's lower legs to knees were cold and she looked almost white, her 02-level was 54 percent on 2 liters of oxygen, and heart rate 52. She said she asked the family member to turn the oxygen up to 4 liters, because she was on that side of the bed and she watched where she put the level. LVN F said her check of Resident #1's blood pressure was 118/72 and the 72 was very light., her pulse was weak and thready. She said Resident #1 opened eyes and winked at her but never spoke a word. LVN F said she counted 12 respirations a minute. She said she was told LVN E had come to get her once and the family member had come to get her, but she was in a room. She said she the aides had told her they had told LVN E to send Resident #1 to the hospital the day before. LVN F said shortly after they left with Resident #1 the family member called and said they had put Resident #1 in ICU. She said when LVN E came and got her, she left the room to call 911, she never came back. She said EMS took Resident #1's blood sugars and they were 132. During an interview on 10/3/23 at 11: 20 a.m. the family member of Resident #1 said they had come to the facility on Saturday evening and the resident was drowsy and not eating. She had thrown up her food. She said she had already thrown up because there was vomit in the trash can. The family member said Resident#1's gown and everything had vomit on it. She said prior to leaving she asked the nurse LVN C not to give her the night dose of tramadol because she was so sleepy. The family member said on Sunday morning she had come early because she wanted to see how Resident #1 was doing. The family member said arrived about 7:30 a.m. Resident #1 was so sleepy she could hardly talk. The family member said she went and got LVN E to take her blood pressure and LVN E could not find a blood pressure cup that worked the battery was low or something. The family member said after about 30 minutes LVN E went and got a manual blood pressure cup. The family member said when LVN E took Resident #1's blood pressure the family member said they did not believe LVN E knew what she was doing the blood pressure was 117/72. The family member asked for an oxygen status, and for a second opinion or to just send Resident #1 to the hospital. The family member said after about 30 more minutes LVN F accompanied LVN E in the room. The family member said LVN F took one look at the Resident #1 and told to LVN E to send her to the hospital. The family member said LVN E left the room, and she did not come back that she remembered. The family member said Resident #1's feet were cold and when she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 17 of 24 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 10/12/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some got to the hospital, they had to warm her body up because she was cold. The family member said LVN F was able to take Resident #1's oxygen status and it was low. The family member said when the resident arrived at the hospital her oxygen level was 52 and her bp 88/53. The family member said at the nursing home took it manually it was 117/72 and they did not do it right. The family member said the aides said they had told LVN E, the resident did not look good and needed to go to the hospital, but she would not listen. The family member said at the hospital they put the catheter in Resident #1 and got no urine output. The family member said when Resident #1 arrived at the hospital they said she was septic, the had to put some type of warming blanket on her, and they had intubated the resident and put her in ICU, she was not doing well at the current time. During an interview on 10/3/23 at 11:40 a.m. the DON said the family member was upset because she felt the resident was not sent to the hospital timely. She said LVN E called her to say Resident #1's O2 stat was low, and she was kind of lethargic. She said told her the family wanted Resident #1 sent to the hospital, and she had told her if the family wanted her sent out then send her out. The DON said she called LVN E to check on Resident #1 and did a follow up to make sure the resident had gotten to the hospital. She said someone said something about the resident had thrown up, during morning meeting on Friday, 9/29/23, but she was not aware Resident #1 continued vomiting. During an interview on 10/3/23 at 12:35 p.m. NP said on 9/29/23 she was informed Resident#1 had thrown up on Friday during morning meeting. She said she worked at the facility Monday through Friday and if there were any issues the staff notified her. If she had questions or concerns, she would notify the physician. She said she was only informed that one time Resident #1 had vomited. She said she was not informed the resident continued to throw up the next two days. She said Resident #1 went to a Rheumatoid doctor on 9/27/23 and came back with prescriptions for 5 different medications. She said she told the nursing staff to make sure Resident #1 ate before giving her the medications and no one informed her she continued to throw up. The NP said the resident continued vomiting could have been due to the new medications. She said if she had been informed the resident was throwing up for 3 days, she would have requested labs, pushed fluids, and looked at some other interventions for the resident. If she continued to vomit, she would have sent her to the hospital for an evaluation. During an interview on 10/3/23 at 1:05 p.m. the DON said that she would look for the one on one in service she had conducted with LVN E. She then said she had conducted the interview over the phone and did not have it written down at the current time. During an interview on 10/4/23 at 9:25 a.m. LVN E said she had worked at the facility for 4 days and on Sunday 10/1/23, it was her third time working with Resident #1. She said she did not remember the aides telling her anything about Resident #1 being sick and not eating. She said she had not consulted with the physician or the NP during the weekend. She said after she sent Resident #1 to the hospital, she had sent the NP a text. She said when she came in and the nurse on the night shift said Resident #1 had vomited. She went to the room to check the roommates blood sugars. She walked over to Residen#1's side of the room and touched her hand, and the resident was doing fine, she did not note anything out of the ordinary. She said around 7:30 a.m. or so the resident's family member came and asked her to check Resident #1's blood pressure. She said the batteries were down in the one she had, and she could not find another one. She had gone to the nurse's station on the other hall and gotten one a manual BP cup from a coworker. She said Resident #1's BP was 117/70. Pulse 60 and R 18. The family member told her she wanted someone else to do it. She went and got the nurse from across the way. She said that nurse had a pulse Ox, and she could not find one. She said the residents O2 stat was 50 and she left to call 911. She said she did call the DON first and then 911. She said the resident temp was 97 . She said her feet were cold she had stayed in the room (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 18 of 24 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 10/12/2023 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 0684 probably 20 minutes with the family member and Resident #1. Level of Harm - Immediate jeopardy to resident health or safety During an observation and interview on 10/4/23 at 1:00 p.m. at the hospital with Resident #1 and the ICU nurse. Resident #1 was observed in the ICU in a hospital bed. She was laying on her back with monitors hooked up and IVs flowing. She was awake and fidgety. She shook her head yes when asked if she had been sick a few days prior to coming to the nursing home . The only other communication was she whispered her name. The ICU RN said her intubation was removed yesterday. He said she appeared to have decreased memory and more confusion. Observation of Resident #1 wanted the nurse to open the suction tubing for her to suction her throat, several times she kept repeating open. She was coughing up mucus and wanted to continue to use the tube. The RN explained to her several times she was clear and did not need the tube. Resident #1 did calm down a appeared to rest. The nurse said they did not have any discharge plans for the resident at this time. Residents Affected - Some During a telephone interview on 10/5/23 at 3:20 a.m. LVN C said she worked Saturday, 9/30/23 night going into Sunday, 10/1/23 morning. She said on the Saturday evening about 8 p.m. the family member came and told her Resident #1 was nauseated, she gave her some Zofran and she threw that up. She gave her another one and put that one under her tongue and the resident went to sleep. She said she checked on her all through the night and kept putting the oxygen on her. She said about 3:00 a.m. the resident said she wanted to get up, but she did not. She said on Sunday morning she went in to check on her and she was fine she said she gave her a routine breathing treatment, she did not have any breathing issues and her O2 stat was never under 90. Said the aides did tell her she was none responsive around 5:30 a.m., but when they went in to check on about 5:45 a.m. she was talking. She said she took her O2 stats at that time but did not write them down. She told the oncoming nurse to check on her because she was not feeling well and to keep check on her O2 status. She said the resident's status had changed since they put her on the new medications. She had held the tramadol because she was so sleepy. She had put on the MAR refused because there were only so many choices. She said she had put that information on the 24-hour report. During a telephone interview on 10/5/23 at 3:26 a.m. with CNA A said she worked at the facility for about a month. On Friday night Resident#1 complained of being nauseous. She said when she came in Saturday at 6:00 p.m. about two hours into the shift she said Resident #1 was nauseated and she threw up several times. The last time she saw her was about 5:30 a.m. on 10/1/23 when she and CNA B went in to change her. CNA A said Resident #1 was not coherent. She said they tried to wake her up and could not. She said they told LVN C about the Resident #1's condition. CNA A said Resident #1 had her oxygen on at that time, and the oxygen was on around 3:00 a.m. when the had gone into the room. During a telephone interview on 10/5/23 at 3:29 a.m. CNA B said he worked at the facility for 7 years. He said on Friday night the Resident #1 was fine but complained of being nauseated. He said Resident #1 was a two person assist and most of the time when CNA A went into the room, he was with her. He said Resident #1 was sick all-night Saturday, 9/30/23 they told the nurse several times. He said about 5:30 a.m. when then did the last round Resident #1 seemed dead. They could not get her to open her eyes, they changed her and told the nurse. She had her oxygen on at that time. During an interview on 10/5/23 at 5:53 a.m. CNA A said they had informed LVN C several times on Saturday night Resident #1was sick. She said she never saw her go into her room. She said Resident #1 was wet each time they went into change her and she had her oxygen on. She said what they did to Resident #1 was not right. They knew she was sick all weekend and did nothing. A statement written by CNA A dated 10/5/23 indicated on Friday 9/29/23 Resident #1 was responsive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 19 of 24 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 10/12/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some and said she was nauseated. On Saturday, 9/30/23 Resident #1 was responsive at 6:00 p.m. and complaining about being nauseated. She started throwing up around 8-8:30 p.m. as the night progressed, she started to get worse. She said we, ( Me and CNA B) told LVN C she needed to go to the hospital. CNA A said LVN C said she was going to give her some more anti-nausea pills. She said around 5:30 a.m. Resident #1 was incoherent and they ( she and CNA B) could not wake her up. She said they told LVN C. she said LVN C went to check on Resident #1 one time when she was throwing up and did not go back to check on her during the night. During an interview on 10/5/23 at 5:57 a.m. CNA B said when they went in to change Resident #1 her brief was wet. He said she was different and sick for the last couple of nights. He said they all thought it was because of the new medications they had given her because she was not like that before. He said they told LVN A several times that night and that morning the resident was sick. He said at 5:30 a.m. they told LVN C, Resident #1 was not responsive. He said he never saw her move to go toward her room. During an interview on 10/5/23 at 6:10 a.m. LVN C said she had held Residents #1'sTramadol on the night of 10/1/23 because she was throwing up and she felt it had something to do with the medications. She had not called the physician with any of her concerns. During an interview on 10/5/23 at 7:00 a.m. LVN E said on 10/1/23 when the night nurse ( LVN C) left, she told her Resident #1 had been throwing up. She said LVN E said she had looked in on Resident #1 and she was okay. She said she did not give her any medications that morning before she left for the hospital, the medication aide gave the medications. The medication aide did not arrive until 8:00 a.m. LVN E said Resident #1 could have been having a reaction to the medications. She said the nurses were the ones that wrote the notes in the chart about no adverse reactions to the medications. She thought it was somewhere on the nurse MAR that they put that information. During an interview with on 10/5/23 at 8:30 a.m. MA I said she did not write anything in the cart about adverse reactions to medications, that was the nurses that did that. She said Resident #1 had some new medications and she gave them as prescribed. She said Resident #1 always took her medication without any problems. MA I said she did not know anything about Resident #1 being sick. During an interview on 10/11/23 at 2:55 p.m. the DON said it was the facility policy that nurses give the initial dose of new medications to residents. She said after that the MAs give the medication, but the nurses are to check for adverse reactions to the medications. She said it was her policy that the nurses notify her of any change in condition before they send someone out to the hospital. She said if the family request the nurses send them out and call her after. She said she had a procedure written down that she gave to nurses on hire. During an interview on 10/11/23 the Medical Director of the facility said he could not talk to me about patient information. He was not familiar with Resident #1 right off hand, or why she was taken to the hospital. He said did not FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 20 of 24 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 10/12/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure each resident received adequate supervision for 1 of 5 residents reviewed for supervision. (Resident #2) The facility did not supervise Resident #2 when staff dropped her off at a local emergency room alone and confused. This failure could place residents at risk of injury or harm. Findings included: Record review of Resident #2's face sheet indicated she was a [AGE] year-old female admitted to the facility on [DATE]. Some of her diagnoses were fracture of the left ankle, diabetes, anxiety disorder, bipolar disorder, depressive disorder, mild cognitive impairment. The face sheet listed the contacts. Record Review of an admission MDS dated [DATE] indicated Resident #2 did not have any cognitive impairment. The resident's functional status was she required limited assistance of one person for transfers. She required extensive assist of two people for toilet use and extensive assistance of one person for personal hygiene. Record review of Resident #2's care plan dated 9/19/23 indicated she had a Focus Area of a fracture to the left ankle. One of the interventions was to wear a soft cast. Record review of Resident #2's nursing notes dated 10/3/23 at 9:30 a.m. indicated Resident #2 was sent to the hospital for an IV to be places so she could receive Sodium Chloride to improve sodium levels. She was transported by the community transportation bus by way of wheelchair. Resident #2 did not complain of pain, her vitals were within normal limits, and she was alert and oriented times 4. Signed by LVN D. Record review of Resident #2's hospital records dated 10/3/23 indicted she was presented to the ER with altered mental status. Her sodium was 121 ( normal range 135-145.) The ED Physician Documentation indicated at about 11:35 a.m. the patient appeared in the lobby wearing a hospital gown and was intermittently confused. It was unknown where she came from, but she stated she came from a facility in the city. She believed she had a sodium problem. She did not know what day it was, or the time. She knew she was in a hospital. She was pleasant and cooperative. She had a cast on her foot. She stated she broke it a while back and was in rehab. Attempts would be made to get information form from the family. The family was contacted. During a record review and interview on 10/4/23 at 12:15 p.m. at the receptionist at the hospital looked in her computer system and said someone had partially filled out an information sheet on Resident #2. She said the ER had a sheet that was required for all admissions to the ER. She said the sheet had Resident #2's name, social security number, date of birth , a note that said call LVN D, a telephone number, and the form listed the reason for the visit as IV. There was no more information. A blank ER form was reviewed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 21 of 24 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 10/12/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm During an interview on 10/4/23 at 8:15 a.m . the DON said they sent Resident #2 out to have an IV placed, due to low sodium and it was not an emergency. The DON said the NP had talked to the family the night before about sending her to the ER because they could not get an IV started on Resident #2. She said LVN D sent Resident #2 to the hospital. The DON said they were going to use the community transportation bus, but something went wrong so the facility staff transported her. Residents Affected - Few During an interview on 10/4/23 at 9:05 a.m. LVN D said they had gotten Resident #2 ready to be transported by the community transportation bus and were told they could not transport to the emergency room. She said she had written the note earlier on about Resident #2 being transported by the community bus and did not go back and write another note. She said no one told her Resident #2 was confused and she seemed fine to her. She said she called the primary family member about 10:30 a.m. ( an hour after the note at 9:30 a.m.) to see if she could take Resident #2 to the ER. She said the family member said they were 2 hours away and could not take her. She said Resident #2 left the facility about 12:00 p.m. LVN D said she did not call that family member back; she called another family member ( not listed on the face sheet) that lived in town . She did not actually talk to that family member; she left a message. She said she thought the family was supposed to meet the Resident #2 at the hospital . She said she asked Resident #2 for the family members number that lived in town, and she gave it to her. She said the hospital called and asked why Resident #2 was sent to the hospital. Said the hospital staff wanted to know why no one was there with her. She said she could not call the Family member that lived in town back because she had written the number on the face sheet and no longer had it. She said Resident #2 was not scheduled to be taken by the facility transport, the Transportation Aide had two people to take to appointments. She said the Transportation Aide agreed to drop the Resident #2 off at the hospital. She said she had sent her paperwork, a face sheet and order summary, with and Resident#2 and Transportation Aide to the hospital. During an interview on 10/4/23 at 9:07 a.m. the Transportation Aide said she checked Resident #2 into the hospital, she was told she could stay by herself . The Transportation Aide said she said there was no family in the ER when she left Resident #2. She said when she arrived at the ER, she filled out the requireds sheet, put LVN D's telephone number on the sheet and left. She said they asked her to transport the Resident #2, but she could only drop her off because she had two prior appointments. During an interview on 10/4/23 at 11:01 a.m. the Administrator said Resident #2's family came by his office on yesterday and voiced concerns. He said the family was upset because they had dropped the resident off at the hospital and left her unsupervised. He said he did look into her concerns. The Administrator said the Transportation Aide did check Resident #2 into the hospital and the family was notified. He said Resident #2 had no cognitive impairment and they could leave her at the hospital without supervision. During an interview on 10/4/23 at 11:35 a.m. the NP said she had spoken to Resident #2's family member the on the night of 10/2/23. She said she told the family they were going to send Resident #2 to the hospital because they were unable to get a vein to start an IV. She said she explained to Resident#2 and the family member it was not an emergency so they could wait until the next morning. She said she told the nurse they needed to call the family before transport. She said that morning she stopped by the nurse's station. Resident #2 was sitting there in a wheelchair. The NP said they were about to transport Resident #2 to the ER, and she asked LVN D if she had called the family. She said LVN D said she had called the family. The NP said the family indicated when Resident #2's sodium low the resident is confused. She said people with low sodium become confused. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 22 of 24 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 10/12/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview, and observation on 10/4/23 at 12:30 p.m. of Resident #2 and her family members in the hospital. Resident #2 was lying in a hospital bed with an IV infusing. She had a plate of food in front of her, but she was not eating. She was confused. When Resident #2 was asked questions she would tell long unrelated stories, and it was hard to get her back to the conversation at hand. The family member said a nurse (Hospital RN) at the hospital (Hospital RN) called to say they did not know how the resident got there, why she was there, and she was only wearing a hospital gown and a brief. The family member said not only did they just drop Resident #2 off, but they did not make sure she was dressed and presentable. The family member said there was no reason to send her out looking like that she had clothes in her closet. Resident #2 said she did not remember her arrival at the hospital very well. She said she remembered they had stuck her multiple times the night before and could not find a vein, but the guy in the ER had found a vein on the first try. The family member said the facility staff had called her earlier on 10/3/23 to see if she could take Resident#2 to the hospital. The family member said they were on their way to the facility when the Hospital RN called to say Resident #2 was at the hospital. The family member said the hospital staff did not know why Resident #2 was there. The family member said the NP promised her the night before and LVN D promised her on 10/3/23 they would let her know when Resident #2 was going to the hospital so they could meet her there. The family member said no one called her to say they were sending Resident #2 to the hospital. The family member said she knew they had called the other family member that lived close to the facility and left a message. However, that family member was on a plane at the time. The family member said they received a voice mail from the hospital at 12:50 p.m. Review of the voice revealed it said this is ( Name) Hospital RN at the hospital I think we have your family member here at the hospital. Please give me a call and number. The family member said when she arrived her family member was in a hospital gown, and a brief, and she was confused. During an interview on 10/4/23 at 1:15 p.m. the Hospital RN said she was the admitting nurse for Resident #2. She said the resident was left in the ER with a hospital gown and brief and she was confused. She said Resident #2 had a face sheet with family listed. The Hospital RN said she did not remember if there was a handwritten number or not. She said all the paperwork said was she needed an IV. She had called the facility and spoke to LVN D, who said Resident #2 needed an IV because her sodium was low. She had called two different family members and one called her back and said she was on her way. During an interview and observation with on 10/5/23 at 7:10 a.m. CNA V said Resident #2 usually got dressed daily. She said Resident #2 was a two person assist with transfers, and she was non weight bearing. During an interview with on 10/5/23 at 7:20 p.m. CNA W said therapy usually got Resident #2 up, but she always wanted to get dressed. She said Resident #2 was usually oriented with no cognitive impairment, but she was a little confused on Sunday, the last day she worked with her. She said Resident #2 was talking off the about a lot of different things, telling long stories unrelated to anything, and not answering questions appropriately. During an interview with on 10/5/23 at 7:25 a.m. LVN F said Resident #2 was oriented times 4, but because of the low sodium she was a little confused. She said the staff took the resident to her appointment but there were two people, and they were not supposed to leave her alone. Record review of the facility policy on Transportation, Diagnostic Services policy revised December 2008. Indicated: The facility will assist residents in arranging transportation to and from diagnostic appointments when necessary. Should it become necessary to transport a resident to a diagnostic, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 23 of 24 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 10/12/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm service outside the facility the Social services designee or the charge nurse shall notify the resident representative and inform them of the appointment. A member of the nursing staff or social services will accompany the resident to the diagnostic center with the residents family is not available if the resident had cognitive impairment. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 24 of 24