Health inspection·January 31, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm During an interview on 1/31/24 at 8:45 AM, the previous Interim DON said she was not part of the investigation of CNA A, and it was handled by the ADM who was also the abuse coordinator at the facility. The previous Interim DON said all staff were in-serviced on abuse, neglect, and misappropriation of property, during the new hire orientation, annually, and as needed. The previous Interim DON said she expected staff to follow the facility's abuse policy. Residents Affected - Few During an interview on 1/31/24 at 11:55 AM, the ADM said he was the Abuse Coordinator. The ADM said when he received the report of CNA A calling Resident #5 a B word, he followed the facility's abuse policy and suspended CNA A during the investigation which led to CNA A's termination for verbal abuse. Record review of Resident #5's undated resident statement included in the 12/6/23 PIR, revealed Resident #5 said she had been verbally abused by CNA A. Record review of CNA B's undated witness statement included in the 12/6/23 PIR, revealed while she was providing care to Resident #5, Resident #5 told her, CNA A had called her the B word. CNA B said she reported the incident immediately to the unit manager and the ADM. Record review of the facility's PIR dated 12/6/23 and signed by the ADM on 12/13/23 revealed an employee had reported CNA A had called Resident #5 a B word. CNA A was suspended during the investigation and then was terminated for verbal abuse. The PIR revealed staff were in-serviced regarding abuse, neglect, and misappropriation. Record review of the facility's abuse policy, titled Abuse Prevention Program, dated revised 1/9/23 revealed . residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation . includes but not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 2 of 14 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 01/31/2024 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure the right to be free from misappropriation of resident property for 2 of 24 residents reviewed for misappropriation of resident property. (Resident #3 and Resident #4) Residents Affected - Few The facility failed to prevent CNA E from stealing a $25.00 gift card and some change from Resident #3. The facility failed to prevent misappropriation of property when CNA A took Resident #4's box of sodas. These failures could place residents at risk for decreased quality of life, misappropriation of property, and dignity. Findings included: 1. Record review of face sheet dated 01/29/24 indicated Resident #3 was [AGE] years old and was admitted to the facility on [DATE] with diagnoses of respiratory failure, chronic obstructive pulmonary disease (a chronic lung disease), depressive episodes and anxiety. The face sheet indicated Resident #3 was discharged on 08/13/23. Record review of an admission MDS assessment dated [DATE] indicated Resident #3 was understood and understood others. The MDS indicated a BIMS of 13 which indicated no cognitive impairment. Record review of a care plan last revised on 7/11/23 for Resident #3 had an ADL self-care performance deficit and had depression. Record review of a Provider Investigation Report dated 06/28/23 indicated an incident on 06/22/23 at 10:30 a.m. The report indicated the perpetrator was CNA E. The description of the allegation was Resident #3 stated that her card was stolen from her purse. The investigations findings were confirmed. A post-investigation note indicated, Credit card is still missing at this time. Resident has been educated of opening a trust fund. (CNA E) is currently terminated. Record review of CNA E's employee file revealed a Payroll Change Notice dated 06/26/23. The notice indicated CNA E was terminated for misappropriation of resident's property and insubordination. The notice was signed by the Administrator. Record review of a Report of Certified Nursing Assistant Misconduct dated 06/28/23 indicated, The Administrator .was reported from (Resident #3) that her credit card was missing from her night stand. Being said, she identified (CNA E) due to when leaving her room her blinds were open as well as her door .when (Resident #3) returned from the vending machine her door was closed as well as the blinds. Amongst entering her room she caught (CNA E) by surprise and then identified her credit card was missing. Ultimately, this led to grounds to termination as well as becoming a reportable incident to the state . Record review of a facility Record of In-Service dated 05/22/23 titled Abuse Prevention Protocol Misappropriation of funds indicated, .Misappropriation of resident property means the deliberate (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 3 of 14 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 01/31/2024 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent . There was no sign in sheet attached to the in-service. Record review of a facility Record of In-Service dated 06/08/23 indicated, .Misappropriation of resident property is defined as the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent . There was no sign in sheet attached to the in-service. During an interview on 01/29/2024 at 2:05 p.m., CNA E said she had worked at the facility for 2 years and had been a good hardworking employee prior to being terminated. She said she was blamed for stealing a gift card by a new resident. She said the resident had dementia. She said she never went in the resident's room. She said she never saw a gift card. She said the Administrator even told her he had no proof that she took the card. She said there was another CNA that did steal from residents. She said nothing ever happened to that CNA. She said she did provide care for Resident #3. She said she only passed her meal trays. She said she never even assisted Resident #3 with a shower. During an interview on 1/30/2024 at 10:15 a.m., a family member said Resident #3 had told them she had been out of her room. The family member said when Resident #3 was out of her room, she always left her door open. She said on the day of the incident Resident #3 returned to her room, her door was closed, and the blinds were closed. The family member said Resident #3 told her the aide was in her room and was acting funny. The family member said the aide stole some change and a bank card. She said Resident #3 was able to positively identify the aide and the aide was fired. During an interview on 1/30/2024 at 12:40 p.m., Resident #3 said while she was at the facility, she had a credit card gift card worth $25.00 and some change stolen by an aide. She said she had left her room to go to therapy. She said she always left her door open to her room and her blinds had been open. She said when she returned to her room the door was closed and CNA E was inside her room. She said she knew the aide was CNA E. She said she asked CNA E, What the hell are you doing in here?. She said the aide left out of the room in a hurry. She said she immediately checked her wallet and the $25.00 credit card gift card, and some change was missing. She said she reported this immediately to staff. She said the Administrator came to talk to her. She said she chose not to file a police report. She said she did not feel they would do anything over $25.00 and some change. During an interview on 1/31/2024 at 11:18 a.m., the DON said when staff were hired they receive training on abuse, neglect, misappropriation of property and exploitation. She said this was probably one of the most repeated in-services. She said staff receive a ton of trainings on the topic. She said they have zero tolerance for stealing. She said any staff caught stealing would be terminated. She said she was not employed at the facility at the time of the incident concerning Resident #3. During an interview on 1/31/2024 at 10:57 a.m., the Administrator said he did not condone any staff members taking any items from residents. He said Resident #3 was able to positively identify the aide that was in her room. He said the aide was terminated and a referral was submitted to the nurse aide registry. He said if her were a resident he would not appreciate a staff member stealing his personal items. He said items being stolen could affect a resident emotionally. 2. Record review of Resident #4's face sheet, dated 1/29/24, revealed Resident #4 was a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including kidney failure, diabetes (high blood sugar), chronic obstructive pulmonary disease (constriction of the airways resulting in difficulty or discomfort in breathing), dementia (persistent and progressive impairment of memory (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 4 of 14 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 01/31/2024 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 0602 and thinking), hypertension (high blood pressure), heart failure, and muscle weakness. Level of Harm - Minimal harm or potential for actual harm Record review Resident #4's quarterly MDS assessment, dated 10/28/23, revealed Resident #4 was usually understood and usually had the ability to understand others. Resident #4 had a BIMS of 5, which indicated the resident was severely cognitively impaired. Residents Affected - Few Record review of Resident #4's undated care plan revealed Resident #4 had impaired cognitive function/impaired thought processes related to dementia diagnosis. During an interview on 1/29/24 at 3:35 PM, Resident #4 said his RP would bring him sodas to keep in his personal refrigerator. He said he did not remember a staff member taking his sodas. During an interview on 1/30/24 at 9:11 AM, Resident #4's RP said he was notified by the ADM about the sodas seen by a staff member being taken by another staff member. Resident #4's RP said he had brought Resident #4 a 12 pack of sodas the previous day and the facility told him they were missing. During an interview on 1/30/24 at 11:15 AM, CNA C said she had worked at the facility for almost a year. CNA C said she was in the hallway helping pick up resident meal trays and as she went down the hallway, she noticed a box of sodas on top of the rolling meal tray cart. CNA C said she thought it was just an empty box and CNA A was going to throw it away and didn't really think anything about it at that time. CNA C said she didn't know the box of sodas were Resident #4's until CNA B told her later that day. CNA C said CNA B said she had seen CNA A with a box of sodas and CNA A had taken the sodas to her car. CNA C said CNA B said she knew the sodas were Resident #4's due to Resident #4's RP had just brought them to Resident #4. CNA C said CNA B said she had already reported it to ADM that day. Attempted to call CNA B on 1/30/24 at 11:02 AM and at 2:05 PM and again on 1/31/24 at 10:30 AM, but there was no answer and was unable to leave a voicemail due to the mailbox was full. During an interview on 1/30/24 at 2:09 PM, LVN F said CNA B reported observing CNA A walk out of Resident #4's room with a box of sodas while they were picking up the meal trays. LVN F said CNA B and CNA C reported to her seeing CNA A take the box of sodas to her car. LVN F said she immediately reported the incident to the ADM. Attempted to call CNA A on 1/30/24 at 2:20 PM but the number was not a working number, and the facility did not have an alternate phone number for her. During an interview on 1/31/24 at 8:45 AM, the previous Interim DON said she was not part of the investigation of CNA A, and it was handled by the ADM who was also the abuse coordinator at the facility. The previous Interim DON said all staff were in-serviced on abuse, neglect, and misappropriation of property, during the new hire orientation, annually, and as needed. The previous Interim DON said she expected staff to follow the facility's abuse policy. During an interview on 1/31/24 at 11:55 AM, the ADM said he was the Abuse Coordinator. The ADM said when he received the report of CNA A taking Resident #4's sodas, he followed the facility's abuse policy and suspended CNA A during the investigation which led to CNA A's termination for misappropriation of resident property. Record review of CNA B's undated witness statement included in the 12/6/23 PIR, revealed while she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 5 of 14 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 01/31/2024 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was in the hallway, she saw CNA A walking down the hallway with a soda box that was known to be Resident #4's, on top of a cart. Record review of LVN F's undated witness statement included in the 12/6/23 PIR, revealed LVN F was notified of CNA A removing an opened case of sodas belonging to Resident #4. LVN F said CNA B and CNA C reported seeing CNA A taking the case of sodas to her car. Record review of the PIR, dated 12/6/23, indicated CNA B and CNA C had witnessed CNA A with a box of sodas belonging to Resident #4. The PIR revealed the sodas had been taken off the property. CNA A was suspended during the investigation and then terminated for misappropriation of resident property. The PIR revealed staff were in-serviced regarding abuse, neglect, and misappropriation. Review of an Abuse Prevention Program facility policy dated 1/9/23 indicated, .Our residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation .Our Center will not condone any form of resident abuse or neglect . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 6 of 14 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 01/31/2024 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview, and record review, the facility failed to implement its written polices, and procedures that prohibit abuse, neglect, and exploitation for 2 of 6 staff (RN H and CNA J) reviewed for neglect and abuse policies. Residents Affected - Few The facility failed to conduct a criminal background check on RN H and CNA J in 2023. This failure could put residents at risk of receiving services from employees with a history of misconduct and/or were ineligible to provide services in this setting. Finding included: 01/29/2024 10:00 a.m. the employee files for RN H and CNA J were requested. Record review on 01/29/2024 at 3:30 p.m. of personnel files revealed the following staff did not have criminal background checks prior to or during employment: RN H and CNA J. During an interview on 01/31/2024 at 11:52 a.m., Human Resources (HR) stated she was responsible for completing all pre-employment checks. She stated she completed criminal background checks, checked employee misconduct registry, checked past employment references among other things. HR stated it was mandatory to conduct criminal background checks prior to employment and annually by the state. HR stated the reason screenings were conducted were to ensure staff were eligible to safely work with the residents and to ensure the residents were not being abused or neglected by the staff. HR stated not keeping up with the annual mandatory screenings could be a risk to the residents leaving them open to abuse or neglect. HR stated she was not employed with the company when RN H and CNA J were hired and she could not locate any part of CNA J's file, it had disappeared. HR stated the blank criminal background request located in RN H's employee file suggested the background was never ran and HR was unable to locate the criminal background check for either RN H or CNA J even after contacting their corporate office for support. During an interview on 1/31/2024 12:20 p.m., the Administrator stated it was part of the facility's abuse policy to perform pre-employment criminal background checks on all employees to keep the resident's safe from individuals who a history of misconduct or crimes against the elderly. The Administrator stated it was the responsibility of HR to ensure these backgrounds were done prior to employment. The Administrator stated he was ultimately responsible to ensure HR had completed these tasks. He stated it was important to protect all the residents from anyone who had the potential to inflict harm, neglect, or misappropriation of the resident's property. Record review on 1/31/2024 at 2:00 p.m., the criminal history investigation form for RN H was signed by RN H on 08/16/2023 giving the facility permission to run the background. No criminal history background was located for RN H. Record review on 01/31/2024 at 2:00 p.m. revealed no employee file was located for CNA J prior to exit. No criminal background check was located for CNA J prior to exit. Record review on 1/31/2024 at 2:15 p.m. of the facility Abuse Prevention Program dated 01/09/2023 revealed Our center conducts employment background screenings, reference checks, and criminal conviction investigation checks on direct access employees. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 7 of 14 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 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to develop, and implement a comprehensive care plan to meet the medical, nursing, mental and psychosocial needs for 1 of 24 residents reviewed for care plans (Resident #6). The facility failed to implement 2-person assistance during transfers for Resident #6. This failure could place residents at an increased risk of injury during transfers, a decline in physical or functional well-being and care needs not being met. Findings included: 1. Record review of Resident #6's face sheet dated 1/29/24 indicated Resident #6 was a [AGE] year-old male and admitted on [DATE] and readmitted on [DATE] with diagnoses including sepsis (life threatening infection), brain bleed, difficulty swallowing following cerebral infarction (disruption of blood flow to the brain and parts of the brain die), high blood pressure, weakness, unsteadiness of feet, abnormalities of gait and mobility, lack of coordination, pain, and needs assistance with personal care. Record review of Resident #6's re-admission MDS assessment dated [DATE] indicated Resident #6 was usually understood and usually had the ability to understand others. The MDS indicated Resident #6 had a BIMS score of 04 which indicated he was severely cognitively impaired. Resident #6 and impairment to one side to both upper and lower extremities. Resident #6 required substantial/maximal assistance for sit to stand, chair/bed-to-chair transfers, and most ADLs. The MDS indicated Resident #6 had one fall in past 2-6 months without injury. Record review of Resident #6's care plan with a last reviewed date of 1/27/24 indicated Resident #6 had an ADL self-care performance deficit and he required 2 staff participation with transfers. Resident #6 was at risk for falls related to impaired balance. Record review of Resident #6's 10/28/23 Fall Investigation Worksheet indicated CNA D assisted Resident #6 to the floor as a result of resident's legs buckling under him during a transfer in the bathroom after a shower. Record review of Resident #6's 12/9/23 Fall Investigation Worksheet indicated CNA D lowered Resident #6 to the floor when shower chair rolled away from the resident while transferring. Record review of Resident #6's progress notes dated 12/9/23 revealed the CNA came to get the LVN L and said the resident was sitting on the floor. Upon LVN L entering the room, the resident was sitting on his bottom with his legs out in front of him on the floor and the shower chair was behind the resident with the wheels locked. LVN L assessed Resident #6 and no injuries were noted. LVN L educated CNA on using 2 people to transfer resident off shower chair. During an observation and interview on 1/29/24 beginning at 3:55 PM, Resident #6 was observed in his wheelchair in his room with his RP in the room also. Resident #6 said he could not use his right arm or leg and was difficult to speak. Resident #6 had difficulty speaking and his RP spoke for him. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 8 of 14 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 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Resident #6's RP said CNA D had dropped him or almost dropped him on multiple occasions while doing 1 person transfers. Resident #6's RP said Resident #6's right side of his body does not work. Resident #6's RP said Resident #6 had always been a 2 person assist during transfers and did not understand why he was not still a 2 person assist during transfers. Resident #6's RP said CNA D was a small lady and was not strong enough to transfer Resident #6 by herself safely and could end up injuring one or both of them. Residents Affected - Few During an interview on 1/29/24 at 4:20 PM, LVN L said about a month ago, CNA D came and got her and reported Resident #6 was in the floor because she had to lower him to the floor when his leg gave out while attempting to transfer him to the shower chair without assistance. LVN L said she assessed Resident #6, and he did not appear to have any injuries, then she assisted CNA D to pick Resident #6 up and onto the shower chair. LVN L said she educated CNA D to use 2 people when transferring Resident #6 due to his right sided weakness for his safety. During an interview on 1/30/24 at 3:21 PM, CNA D said she provided care for Resident #6, such as getting him dressed, up from bed and transferred to his wheelchair, and bathed him on one of the two days that she worked during the week. CNA D said she transferred him from his bed to his wheelchair with just herself but would sometimes get assistance to transfer him to his wheelchair, potty chair, or shower chair when she felt he would not be able to transfer. When asked how CNA D determined whether he would be able to transfer, CNA D said she would try to transfer him by herself first and if he could not stand, she would get some help. CNA D said he had had several almost falls, where his leg gave out and she had to ease him onto the floor and then reported to the nurse. CNA D said the last time his leg gave out was about 2 months ago and she was transferring him from his wheelchair to the shower chair by herself and his leg gave out and she had to ease Resident #6 to the floor. CNA D said she usually got help with his transfers now. During an interview on 1/31/24 at 11:00 AM, the DON said in reviewing Resident #6's chart, he required 2-person assistance during transfers from his bed to his wheelchair, wheelchair to bed, wheelchair to potty chair or shower chair and back to his wheelchair. The DON said she expected staff to follow the care plan. The DON said if the care plan was not being followed then she needed to provide education to the staff. The DON said the [NAME] was the part of the chart that was triggered during development or updating the care plans that the CNAs should be looking at for guidance of the resident's care. The DON said Resident #6's [NAME] said he was a 2 person transfer and CNA D should be utilizing the [NAME]. The DON said if CNA D was not following the [NAME] then it was a training issue with CNA D. The DON said if CNA D was not using 2 persons during Resident #6's transfers, it could cause an increased risk of injury to the resident and the employee. The DON said they wanted both to be safe during transfers. The DON said staff needed to follow the Care Plan/[NAME] as the recipe for the resident's care. During an interview on 1/31/24 at 11:25 AM, the ADM said he would expect the care plans to be followed and updated as needed to provide appropriate care for the residents. Record review of the facility's policy titled Care Plans, Comprehensive Person-Centered, dated revised December 2016, revealed . a comprehensive, person-centered care plan that included measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident . each resident's comprehensive person-centered care plan would be consistent with the resident's rights to participate in the development and implementation of the plan of care, including the right to . receive the services . in the plan of care . the comprehensive person-centered care plan would . describe the services that were to be furnished to attain or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 9 of 14 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 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treviso Transitional Care 1154 East Hawkins Parkway Longview, TX 75605 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm maintain the resident's highest practicable physical, mental, and psychosocial well-being . aid in preventing or reducing decline in the resident's functional status and/or functional levels . care plan interventions were chosen only after careful data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 10 of 14 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 01/31/2024 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on, interview, and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate administering of all drugs and biologicals, to meet the needs of 2 of 6 residents reviewed for pharmacy services. (Resident # 1 and Resident #2) 1. The facility failed to administer 14 of 30 scheduled doses of the medication glipizide (used of treatment of diabetes mellitus type 2) 2.5 mg once daily before breakfast and omeprazole 20mg once daily before breakfast (used to treat GERD) timely for Resident #1 in January 2024. 2. The facility failed to administer 6 out of 21 doses of Synthroid (used to treat thyroid hormone imbalance) 100 micrograms daily in July 2023 for Resident #2. These failures could place residents at risk for inaccurate drug administration resulting in a decline in health and decreased quality of life or death. Findings included: 1.Record review of the face sheet dated 01/29/2024 indicated Resident #1 was an [AGE] year-old female admitted on [DATE] with diagnoses of diabetes mellitus type 2, GERD (gastroesophageal reflux disease), and gout (buildup of uric acid in joints that can be painful). Record review of an MDS assessment dated [DATE] indicated Resident #1 had moderately impaired cognition with a BIMS (brief interview for mental status) score of 10 out of 15. Resident #1 required extensive assistance of 2 staff members for bed mobility and transfer and supervision of one staff for eating. Record review of a care plan reviewed on 04/10/2023 indicated Resident #1 was at risk for discomfort related to GERD with the intervention of administer medication as ordered. Record review of the physician order summary dated January 2024 indicated Resident #1 was to receive glipizide 2.5 mg daily before breakfast for diabetes ordered on 07/15/2023. Record review of the physician order summary dated January 2024 indicated Resident #1 was to receive omeprazole 20mg once daily before breakfast for GERD ordered on 10/02/2023. During a record review of the MAR January 2024 for Resident #1 indicated she had not received ordered glipizide or omeprazole before breakfast on 01/03, 01/04, 01/08, 01/09, 01/12, 01/13, 01/14, 01/17, 01/18, 01/22, 01/23, 01/26, 01/27, and 01/28/2024. The MAR for January 2024 for Resident #1 indicated glipizide and omeprazole were scheduled for 6:30 a.m. During an interview on 01/29/2024 at 3:00 p.m., CMA K stated the glipizide and omeprazole for Resident #1 were both due to be administered on 6:30 a.m., the nurse would be responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 11 of 14 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 01/31/2024 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some administering the medication. CMA K stated if she noticed the medication had not been signed out when she passed morning medications that are due between 7:00 a.m. and 11:00 a.m., she would administer the glipizide and omeprazole when she got to Resident #1. CMA K was not aware of the importance of administering glipizide and omeprazole before meals. 2. Record review of the face sheet dated 01/29/2024 indicated Resident #2 was a [AGE] year-old female admitted on [DATE] with diagnoses of hypothyroidism (condition in which the thyroid gland doesn't produce enough thyroid hormone), post laminectomy syndrome (a condition characterized by chronic back or neck pain following surgery), and hypertension. Record review of an MDS assessment dated [DATE] indicated Resident #2 had moderately impaired cognition with a BIMS (brief interview for mental status) score of 11 out of 15. Resident #2 required limited assistance with ADLs. Record review of the physician order summary dated July 2023 indicated Resident #2 was to receive Synthroid 100 micrograms daily in the morning ordered 07/07/2023. During a record review of the MAR July 2023 for Resident #2 indicated she had not received ordered Synthroid on 07/11, 07/12, 07/15, 07/16, 07/17, 07/26/2023. During an interview on 01/30/2024 at 3:00 p.m., the DON said it was important for the residents to receive diabetic medications such as glipizide before meals as ordered. The DON stated omeprazole worked better to control GERD if given before meals. The DON stated Synthroid was another medication it was important to administer before breakfast. The DON stated it was the nurse's responsibility to pass these medications because the medication aides did not come in until 8:00 a.m. The DON was unaware the medications were missed and stated there was no monitoring in place to ensure medications were not missed. During an interview on 01/30/2024 at 4:45 p.m., the Administrator said his expectation was for his staff to follow policy and procedures to prevent medication issues such as missed and late medication. Record review of the facility's policy titled Medication Administration dated 08/2020 indicated Medications should be administered as order to promote therapeutic effect of medication and prevent complications that can arise from taking multiple medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 12 of 14 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 01/31/2024 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 0836 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards. Based on interview and record review, the facility failed to operate and provide services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in such a facility for 1 or 6 employees (RN H) personnel files reviewed. -The facility failed to notify the Texas Board of Nursing as noted under employment requirements of the court order from the Texas Board of Nursing signed on 05/04/2016 of the employment of RN H. in August 2023. -The facility failed to submit a criminal background check for RN H prior to employment in August 2023. These failures placed the residents at risk of abuse, neglect, and exploitation. Findings included: Record review of the personnel file for RN H revealed a RN license through the state of Texas with court ordered stipulations related to charges involving misuse of narcotic medication signed 05/04/2016. Record review of the personnel file for RN H revealed she was hired on 08/16/2023. The file did not contain a notification of employment form required by the court order issued by Texas Board of Nursing as a stipulation of employment noted to RN H's license. No copy of the stipulations were noted in the RN's employee file. Record review of employee time sheets for RN H revealed her first day worked at the facility was 08/22/2023 with a termination date of 10/31/2023. Record review of the personnel file for RN H revealed no criminal background check prior to or during employment. Record review of the court order dated 05/04/2016, section Employment Requirements, revealed . B. Notification of Employment Forms: Respondent shall cause each present employer in nursing to submit the Board's Notification of Employment form to the Board's office within ten (10) days of receipt of this order. Respondent shall cause each future employer to submit the Board's Notification of Employment form to the Board's office within 5 (5) employment days of employment as a nurse. During an interview on 01/29/2024 at 12:43 p.m. with HR, she said it was the responsibility of the HR personnel to print and present any stipulations employees had on professional license to the DON and Administrator prior to the individual working at the facility. HR stated she did not work at the facility when RN J was hired and was unaware why there was no copy of her stipulations in her employee file or a notification form to the Board of Nursing. HR stated it was the facility's policy to keep the court order with stipulations and the notification form in the personnel file. During an interview on 01/30/2024 at 2:30 p.m., the Administrator stated he was unaware RN J had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 13 of 14 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 01/31/2024 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 0836 Level of Harm - Minimal harm or potential for actual harm stipulations and he could not recall if the facility notified the Board of Nursing about her employment at the facility or if RN J was supervised by another RN during the time she worked at the facility. The Administrator stated it was implemented as part of the hiring process that all court orders and stipulations be printed and added to the personnel file and be brought to the administrator and DON's attention before they are allowed to work the floor. The Administrator stated this was implemented around August or September of 2023. Residents Affected - Some Attempted interviews of RN H were made on 01/29/2024 at 10:00 a.m., 01/30/2024 at 2:15 p.m., and 01/31/2024 at 8:15 a.m. No working phone number was located for RN H. Record review of facility policy from Employee Handbook dated 12/2011, read in part . All potential employees will be subject to a criminal background check. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676368 If continuation sheet Page 14 of 14