Health inspection·December 18, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some new orders to deal with the resident's refusals of showers. LVN A stated there were no negative outcomes from the resident's refusals of showers and the resident did not reveal body odors. LVN A stated the CNAs [names not given] would inform him about the shower refusals. During a telephone interview on 12/18/25 at 10:25 AM CNA B stated Resident #1 had refused showers 1 or 2 times and she informed the charge nurse LVN A. CNA B stated she had been employed in the facility for 2 months. The CNA stated she documented refusals in the POC. CNA B stated she saw no skin breakdown or smelled odors when providing ADL care to the resident. During a telephone interview on 12/18/25 at 4:14 PM, the RP stated she visited the resident daily and would inquire about the need for Resident #1 to be showered. The RP stated she complained every day for 15 days and was given excuses or told the resident would be showered. The RP stated the resident was showered only on 12/3/25 and 12/4/25. During a telephone interview on 12/8/25 at 4:20 PM, Resident #1 stated he did not refuse showers and asked for a shower daily from the CNA [name not given] staff. Resident #1 stated the CNAs [names not given] would state he would be given a shower but did not return to give him a shower. Resident #1 stated the CNAs would make excuses why he missed or was not given a shower. The resident stated it was frustrating to get a shower, but showers were given on 12/3/25 and 12/4/25. 2.Observation and interview on 12/17/25 at 3:21 PM, Resident #4 was in bed watching TV; There were no injuries, skin tears or bruises present. W/C present. Disposition was one of neutrality. The resident was alert and oriented X3. The residents stated her showers day were M, W, and F. The resident stated, I have not had a shower in the past week.missed many days.they say (we will see about a shower) .my family has complained about showering. The Resident stated she was not sure about any skin breakdown due to lack of showers. The resident stated she gets angry when not showered. Record review of Resident #4's face sheet, dated 12/17/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #4 had diagnoses which included inflammation of the intestine, lack of coordination, and gait abnormality. The RP was listed as a family member. Record review of Resident #4's quarterly MDS, dated [DATE], reflected a BIMS score of 12, indicative of moderate impairment in cognition. The resident's ADLs for showers/bathing were documented as supervision with one staff assistance. B/B were listed as incontinent X1; and transfer and mobility X1. The resident's assistive device was a W/C. Record review of Resident #4's KARDEX (nurse form for listing of ADLs) dated 12/17/25 reflected one person assistance for bathing. Record review of Resident #4's Skin assessment dated [DATE] reflected her skin was intact. Record review of Resident #4's CP, undated, in the Goal of ADLs listed the resident could refuse showers as a personal preference. Record review of Resident #4's POC reflected her shower days were M, W, and F. Further review of documentation reflected:-12/1/25-refused-12/3/25-refused-12/5/25-refused-12/8/25-refused-12/10/25-received-12/15/25-refused-12/17/25Record review of Resident #4's nurse notes dated reflected there were no documentation of resident refusing showers from the period 12/1/25 to 12/9/25. Record review of Resident #4's Negotiated Risk Agreement dated 10/21/25 revealed: refusal of care and ADLs; and alternatives offered were bed bath, education, and showers. During an interview on 12/17/25 at 4:14 PM, the MDS Nurse stated the only place documented about shower refusals for Resident #4 was in the POC. The MDS Nurse stated there were no progress notes documenting shower refusals. The MDS Nurse stated that nursing staff needed to document shower refusals in the nurse notes, and she had no explanation for the missing documentation. During an interview on 12/18/25 at 8:27 AM, CNA C stated she provided services to Resident #4. CNA C stated ADLs included bathing/showering. CNA C stated the resident had refused showers in the past and she documented in the POC (Point of Care Portal). CNA C stated Resident #4 required one person assistance with bathing. CNA C stated part of showering was to do skin assessments and report to nursing any negative (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676372 If continuation sheet Page 2 of 7 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 676372 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Pines North Nursing and Rehabilitation Center 1301 Mallette Drive Victoria, TX 77904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some findings; and she never saw any negative findings. CNA C stated that her expectation was for the charge nurse to follow up and determine why the resident refused bathing/showers. CNA C stated if Resident #4 went without a shower for 2 weeks her expectation was to report to the nurse and the Administrator. During an interview on 12/18/25 at 8:53 AM, LVN D stated she had provided nursing care to Resident #1 and Resident #4. Regarding Resident #4, LVN D stated the resident had not refused to receive a shower. LVN D stated that no CNA had told her about Resident #4 or any resident missing or refusing a shower. LVN D stated the expectation for residents missing showers was to explore with the resident the cause of the refusal and if needed to notify the family and physician for guidance. LVN D stated that if a pattern of missed showers was present the nurse was required to document it in the nurse's notes. During an interview on 12/18/25 at 9:18 AM, CNA E stated she had provided showers to Resident #4. CNA E stated Resident #4 had complained to her about two weeks ago that she had not been showered for an extended period. The CNA E stated she told the charge nurse [name not given] about the comment made by Resident #4 of missing showers. CNA E stated she expected the charge nurse to do something or relay the message of the resident alleging missing showers to nurse management or the Administrator. CNA E stated she was not aware of Resident #4 having any negative outcomes or psychosocial harm from missing showers/bathing. CNA E stated she had no explanation for nursing staff not giving Resident #4 showers on scheduled shower days. During a telephone interview on 12/18/25 at 9:46 AM, Resident #4's MD stated he had not been informed about any resident missing showers. The MD stated bathing/showers were to be given at least every third day. The MD stated showers were important for hygiene and bodily function. The MD stated if a resident went without showers for an extended period he should be notified for him to speak to the resident and issue any new orders. During an interview on 12/18/25 at 9:51 AM, the wound nurse, LVN F stated had provided nursing care to Resident #1. LVN F stated that nursing care included assessments, skin assessments, vitals, monitoring, and medications. LVN F stated skin assessments for the past 90 days to include on 12/10/25 had shown Resident #4'skin was intact. LVN F stated if a resident had missed showers for a week or more, the nursing staff should contact the MD, RP and speak to the resident to ascertain the reason for refusals and missed showers. LVN F stated, the charge nurse was responsible for checking the POC to ensure showers were done for residents. During an interview on 12/18/25 at 10:34 AM, the acting DON (Regional Compliance Nurse) stated she had not worked with Resident #1 or Resident #4 but had been a former DON in the facility. The DON stated that if a resident by nursing practice had a history of refusing showers/ bathing interventions included a CP meeting, notification to family, and re-education of the resident; and ensuring the CP and documentation were current. The DON stated for Resident #1 the POC had to be documented for missing showers or showers not given; and she could not explain the missing documentation. The DON stated the POC had to reflect ADLs given or refused. During an interview on 12/18/25 at 11:40 AM, the Administrator stated she had no knowledge of complaints involving ADLs in showers/bathing until the appearance of the surveyor on 12/17/25. The Administrator stated she received communications from corporate on 12/3/25 [16 days from admissions of Resident #1] call that a family member alleged Resident #1 was not getting showers. The Administrator stated she did an internal investigation and the outcome revealed that the resident had a shower on 12/3/25 and the resident was discharged [DATE]. The Administrator stated the communications from the corporate HQs were not treated as a grievance and no further action was taken. The Administrator stated that she was leaving her position effective 12/19/25. The Administrator stated she was not aware of Resident #4 expressing that she missed showers. The Administrator stated she expected nursing management to keep her informed when there was a negative outcome in showers or clinical documentation. The Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676372 If continuation sheet Page 3 of 7 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 676372 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Pines North Nursing and Rehabilitation Center 1301 Mallette Drive Victoria, TX 77904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm stated she was not aware of documentation errors or lack of documentation involving Resident #1 or Resident #4, but she was aware as the Administrator for the accuracy of clinical records. Record review of facility's Bath, Tub/Shower policy undated read: .The resident will experience improved comfort and cleanliness by bathing. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676372 If continuation sheet Page 4 of 7 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 676372 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Pines North Nursing and Rehabilitation Center 1301 Mallette Drive Victoria, TX 77904 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain medical records that were complete and accurately documented for 2 of 4 (Residents #1 and #4) residents reviewed for accuracy of clinical records. There were no Nurse Notes in the EMR documenting that Resident #1's and Resident #4's missed or refused showers/bathing. This failure could result in inadequate care due to incomplete and inaccurate medical records. The findings include: 1.Record review of Resident #1's face sheet, dated 12/27/25, reflected a [AGE] year-old male who was admitted to the facility on [DATE] and discharged home on [DATE]. Resident #1 had diagnoses which included: HTN (hypertension), kidney disease, a UTI (urinary tract infection at admissions), and a history of stroke. The RP was listed as: a family member. Record review of Resident #1's admissions MDS, dated [DATE], reflected a BIMS score of 15, indicative of no impairment in cognition. The ADLs for: B/B were incontinent for some episodes Transfer and Mobility was set up. ROM: was left side impairment. Toileting was assisted by one staff member. Resident's assistive device was walker. Record review of Resident #1's Care Plan, undated, revealed, the goals and interventions included: ADLs: showers X1. G Interventions included-self-determination, participation during care, and staff to give explanation. CP also reflected that residents were resistive to care related to adjustment to NF, anxiety, and refusals of baths. Record review of Resident #1's Customer Service assessment, dated 12/3/25 and authored by corporate staff, revealed: the family (RP) expressed concern that the resident was not showered, and the family member stated the resident refused showers at time. Resident was showered on 12/3/25. Record review of Resident #1's POC for showers/bathing revealed: the scheduled days were Tuesday, Thursday, and Saturday. Further review of the POC revealed, in reference to showers/bathing:-11/18/25-not documented-11/20/25-not documented-11/22/25-not documented-11/25/25-refused-11/27/25-refused-11/29/25-not documented-12/2/25-received-12/4/25-received Record review of Resident #1's Nurse Notes from 11/17/25 to 12/4/25 revealed no nurse documentation of resident refusing or missing showers. During an interview on 12/17/25 at 4:39 PM, the MDS Nurse stated she had no explanation for nurse notes not containing any documentation involving Resident #1 refusing or missing showers. The MDS Nurse stated the DON or Administrator was responsible for the accuracy of the clinical record. During a telephone interview on 12/18/25 at 10:25 AM CNA B stated Resident #1 had refused showers 1 or 2 times and she informed the charge nurse, LVN A. CNA B stated she documented refusals in the POC. During a telephone interview on 12/18/25 at 4:14 PM, the RP stated she visited the resident daily and would inquire about the need for Resident #1 to be showered. The RP stated she complained every day for 15 days and was given excuses or told the resident would be showered. The RP stated the resident was showered only on 12/3 and 12/4/25. During a telephone interview on 12/8/25 at 4:20 PM, Resident #1 stated he did not refuse showers and asked for a shower daily from the CNA [name not given] staff. Resident #1 stated the CNAs [names not given] would state he would be given a shower but did not return to give him a shower. Resident #1 stated the CNAs would make excuses why he missed or was not given a shower. The resident stated it was frustrating to get a shower, but showers were given on 12/3/25 and 12/4/25. 2.Observation and interview on 12/17/25 at 3:21 PM, Resident #4 was in bed watching TV; There were no injuries, skin tears or bruises present. W/C present. Disposition was one of neutrality. The resident was alert and oriented X3. The residents stated her showers day were M, W, and F. The resident stated, I have not had a shower in the past week.missed many days.they say (we will see about a shower) .my family has complained about showering. The Resident stated she was not sure about any skin breakdown due to lack of showers. The resident stated she gets angry (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676372 If continuation sheet Page 5 of 7 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 676372 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Pines North Nursing and Rehabilitation Center 1301 Mallette Drive Victoria, TX 77904 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some when not showered. Record review of Resident #4 's face sheet, dated 12/17/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #4 had diagnoses which included inflammation of the intestine, lack of coordination, and gait abnormality. The RP was listed as a family member. Record review of Resident #4's quarterly MDS, dated [DATE], reflected a BIMS score of 12, indicative of moderate impairment in cognition. The resident's ADLs for showers/bathing were documented as supervision with one staff assistance. B/B was listed as incontinent X1; transfer and mobility X1. Resident's assistive device was a W/C. Record review of Resident #4's KARDEX (nurse form for listing of ADLs) dated 12/17/25 reflected one person assistance for bathing. Record review of Resident #4's POC reflected her shower days were M, W, and F. Further review of documentation reflected:-12/1/25-refused-12/3/25-refused-12/5/25-refused-12/8/25-refused-12/10/25-received-12/15/25-refused-12/17/25Record review of Resident #4's nurse notes reflected no entries made about the resident refusing showers/bathing for 9 days from 12/1/25 to 12/20/25 and for another 7 days from 12/10/25 to 12/17/25. Record review of Resident #4's Negotiated Risk Agreement dated 10/21/25 revealed: refusal of care and ADLs; and alternatives offered were bed bath, education, and showers. During an interview on 12/17/25 at 4:14 PM, the MDS Nurse stated the only place documented about shower refusals for Resident #4 was in the POC. The MDS Nurse stated there were no progress notes documenting shower refusals. The MDS Nurse stated that nursing staff needed to document shower refusals in the nurse notes, and she had no explanation for the missing documentation. During an interview on 12/18/25 at 8:27 AM, CNA C stated she provided services to Resident #4. CNA C stated ADLs included bathing/showering. CNA C stated the resident had refused showers in the past and she documented in the POC (Point of Care Portal). CNA C stated Resident #4 required one assistance with bathing. CNA C stated part of showering was to do skin assessments and report to nursing any negative findings; and she never saw any negative findings. CNA C stated that her expectation was for the charge nurse to follow up and determine why the resident refused bathing/showers. CNA C stated if a Resident #4 went without a shower for 2 weeks her expectation was to report to the charge nurse and the Administrator. During an interview on 12/18/25 at 8:53 AM, LVN D stated she had provided nursing care to Resident #1 and Resident #4. Regarding Resident #4, LVN stated the resident had not refused to receive a shower. LVN D stated that no CNA had told her about Resident #4 or any resident missing or refusing a shower. LVN D stated the expectation for residents missing showers was to explore with the resident the cause of the refusal and if needed to notify the family and physician for guidance. LVN D stated that if a pattern of missed showers was present the nurse was required to document it in the nurse's notes. During an interview on 12/18/25 at 9:18 AM, CNA E stated she had provided showering to Resident #4. CNA E stated Resident #4 had complained to her about two weeks ago that she had not been showered for a long period of time. The CNA E stated she told the charge nurse [name not given] about the comment made by Resident #4 of missing showers. CNA E stated she expected the charge nurse to do something or relay the message of the resident alleging missing showers to nurse management or the Administrator. CNA E stated she was not aware of Resident #4 having any negative outcomes or psychosocial harm from missing showers/bathing. CNA E stated she had no explanation for nursing staff not giving Resident #4 showers on scheduled shower days. During an interview on 12/18/25 at 9:51 AM, the wound nurse, LVN F stated she had provided nursing care to Resident #1. Nursing care included: assessments, skin assessments, vitals, monitoring, and medications. LVN F stated if Resident #4 refused or missed showers for over a week nurse management needed to be informed and the RP. LVN F stated, the charge nurse was responsible for checking the POC to ensure showers were done for residents. LVN F stated she had no explanation for no nursing notes in the EMR for Resident #1 and Resident #4 missing or not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676372 If continuation sheet Page 6 of 7 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 676372 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Pines North Nursing and Rehabilitation Center 1301 Mallette Drive Victoria, TX 77904 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete given showers. During an interview on 12/18/25 at 10:34 AM, the acting DON (Regional Compliance Nurse) stated she had not worked with Resident #1 or Resident #4 but had been a former DON in the facility. The DON stated that if a resident by nursing practice had a history of refusing showers/ bathing interventions included: documentation as a nurse note in the nurse note section of the EMR. The DON stated for Resident #1 the POC had to be documented for missing showers or showers not given; and she could not explain the missing documentation. The DON stated the POC as well as nurse notes had to reflect ADLs given or refused for an extended period During an interview on 12/18/25 at 11:40 AM, the Administrator stated she had no knowledge of complaints involving ADLs in showers/bathing until the appearance of the surveyor on 12/17/25. The Administrator stated she received communications from corporate on 12/3/25 [16 days from admissions of Resident #1] call that a family member alleged Resident #1 was not getting showers. The Administrator stated she did an internal investigation and the outcome revealed that the resident had a shower on 12/3/25 and the resident was discharged [DATE]. The Administrator stated the communications from the corporate HQs were not treated as a grievance and no further action was taken. The Administrator stated that she was leaving her position effective 12/19/25. The Administrator stated she was not aware of Resident #4 expressing that she missed showers. The Administrator stated she expected nursing management to keep her informed when there was a negative outcome in showers or clinical documentation. The Administrator stated she was not aware of documentation errors or lack of documentation involving Resident #1 or Resident #4, but she was aware as the Administrator for the accuracy of clinical records. Record review of facility's Documentation policy undated revealed .The facility will maintain complete and accurate documentation for each resident on all appropriate clinical record sheets. Event ID: Facility ID: 676372 If continuation sheet Page 7 of 7