Health inspection·January 25, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #18's MDS Nursing Home Comprehensive, dated 01/23/2024, reflected he had a BIMS score of 0 indicating severe cognitive impairment. Resident #18's MDS did not provide a functional status in reference to his assistance with eating. Review of Resident #18's Care Plan indicated the last care conference date was 01/08/2024 and reflected Problem: Resident requires assistance with ADL's, Approach: Eating: TOTAL STAFF ASSIST X 1 ASSISTED DINING AREA with an edit date of 05/02/2021. Review of Resident #18's undated Orders reflected an open-ended ADL order on 12/05/2023 EATING with assist of one person (needs to be fed). Open ended ADL order on 12/05/2023 RISK: choking, swallowing, aspiration, weight loss, dehydration. Observation on 01/23/2024 at 1:19 PM revealed CNA I was seated between Resident #3 and Resident #18 at a table in the dining area of the facility between the 100 and 300 hallways. CNA I was seen providing feeding assistance to Resident #18 who was to her immediate left side. CNA I then turned to Resident #3 who was on her immediate right side and provided feeding assistance to her. CNA I continued to move back and forward between the residents until they completed their meals. CNA I was observed to be utilizing different utensils between the residents but did not wash or sanitize her hands as she switched back and forth between them. Observation on 01/24/2024 at 1:10 PM, CNA I was again seated between Resident #3 and Resident #18 at the same table in the dining area as observed on 01/23/2024. CNA I was seen providing feeding assistance to Resident #18, who was to her immediate left side. CNA I then turned to Resident #3 who was to her immediate right side and provided feeding assistance to her. CNA I was observed moving back and forth providing feeding assistance between Resident #3 and Resident #18. CNA I again utilized different utensils between the residents but did not wash or sanitize her hands as she switched back and forth between them. Interview on 01/24/2024 at 4:20 PM, notified the DRC of observation from dining hall the past two days of CNA I assisting two residents at the same time with their lunch. The DRC stated that limited staffing does not always allow them to provide one to one assistance with meals. Interview on 01/25/2024 at 1:12 PM, CNA I stated that they should only be providing feeding assistance for one resident at a time. CNA I stated that she was trained to assist one resident at a time but due to lack of staff she has provided assistance at the same time for Resident #3 and Resident #18 for approximately one year. CNA I stated that she made sure to only assist Resident #18 with her left hand and Resident #3 with her right hand. CNA I stated that she does not wash or sanitize her hands while moving back and forth between the two residents. CNA I stated that providing feeding assistance in this manner was a dignity issue for the residents and could pose an infection control risk . Interview on 01/25/2024 at 1:34 PM, ADON / LVN stated they do try to assist residents one to one, but due to staffing issues cannot always do so. The ADON / LVN stated that failure to provide one to one assistance could pose an issue with dignity and infection control depending on the situation. Interview on 01/25/2024 at 4:40 PM, the DON stated they would prefer that residents receive assistance with their meals on a one-to-one bases for dignity, but staffing does not always allow it. Review of facility's Nursing Policies and Procedures dated 06/20/2023 revealed, SUBJECT: MEAL (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few SERVICE IN THE DINING ROOM, PROCEDURES: 26. Sit, do not stand, when feeding or assisting the patient / resident with eating. Converse with the patients or residents rather than other staff. 31. Dining practices may be altered to meet federal, state, or local health department infection control guidelines during a disaster or pandemic. Review of facility's Nursing Policies and Procedures dated 05/05/2023 revealed, SUBJECT: ACTIVITIES OF DAILY LIVING, OPTIMAL FUNCTION; DEFINITION: Activities of daily living (ADLs), refer to task related to personal care including, grooming, dressing, oral hygiene, transfer, bed mobility, eating, bathing, and communication system. PROCDURES: 3. Facility staff develop and implement interventions in accordance with the resident's assessed needs, goals for care, preferences and recognized standards of practice that address the identified limitations in ability to perform ADLs. Review of facility's undated Resident Rights revealed that they utilize the Texas Department of Aging and Disability Services Statement of Resident Rights (Form FFTX033). You have a right to: 1. All care necessary for you to have the highest possible level of health; 2. safe, decent and clean conditions; 4. be treated with courtesy, consideration, and respect. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good grooming and personal hygiene for 3 (Resident #19, Resident #32, Resident #76) of 19 residents reviewed for ADL care. Residents Affected - Some The facility failed to provide fingernail care for Resident #19, Resident #32, and Resident #76. This failure could lead to a reduction in quality of life and could contribute to health-related issues from lack of hygiene. Findings included: Review of Resident #19's Face Sheet dated 1/25/24, reflected a 65 year of age male, who was admitted to the facility on [DATE]. Resident #19 was diagnosed with Cerebral Palsy (group of disorders that affect a person's ability to move and maintain balance and posture), Hemiplegia-right dominant side (paralysis that affects only one side of the body), Congestive Heart Failure (serious condition in which the heart doesn't pump blood as efficiently as it should), and Onychogryphosis (nail disorder resulting from slow nail plate growth). Review of Resident #19's MDS Optional State assessment dated [DATE], revealed that he had a BIMS score of 15 indicating cognition is intact. Review of Resident #19's Consolidated Care Plan indicated last care conference date of 11/29/2023 revealed that he requires assistance with ADL's r/t cerebral palsy, limited mobility, debility, which was last reviewed on 09/25/2023. Review of Resident #19's Orders dated 01/25/24 revealed a treatment order on 10/25/2023 for Nail Check to be completed once a day on Wednesday Second 07:00 PM - 07:00 AM. Review of Resident #19's Progress Notes dated 01/25/2024 from 11/02/2023 - 01/23/2024 reflected no documented attempts or refusals for nail care. Review of Resident #32's Face Sheet dated 1/25/24, reflected a 71 year of age female, who was admitted to the facility on [DATE]. Resident #32 was diagnosed with Parkinsonism (refers to brain conditions that cause slowed movements, rigidity (stiffness) and tremors), Neurocognitive Disorder with Lewy Bodies (type of progressive dementia that leads to a decline in thinking, reasoning, and independent function), and Contracture of Left and Right Hand (condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints). Review of Resident #32's MDS Optional State assessment dated [DATE], revealed that she had a BIMS score of 0 indicating severe cognitive impairment. MDS reflected that Resident #32 required extensive assistance with ADL's. Review of Resident #32's Care Plan indicated last care conference date of 11/15/2023 revealed Problem: Resident requires assistance with ADL's secondary to cognitive and physical decline with Goal: Will maintain a sense of dignity by being clean, dry, odor free and exhibit a well-groomed appearance over next 90 days which was edited on 01/22/2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 Review of Resident #32's Orders dated 01/25/24 revealed an open-ended treatment order on 07/09/2021 for Nail Check to be completed once a day on Monday Second 07:00 PM - 07:00 AM. Review of Resident #76's Face Sheet dated 1/25/24, reflected a 58 year of age male, who was admitted to the facility on [DATE]. Resident #76 was diagnosed with Quadriplegia (form of paralysis that affects all four limbs, plus the torso), Encephalopathy (damage or disease that affects the brain) and need for assistance with personal care. Review of Resident #76's MDS Optional State assessment dated [DATE], revealed that he had a BIMS score of 14 indicating cognition is intact. MDS reflected that Resident #76 required extensive assistance with ADL's. Review of Resident #76's Care Plan indicated last care conference date of 12/20/2023 revealed Problem: requires assistance with ADL's with Goal: Will maintain a sense of dignity by being clean, dry, odor free and well-groomed over next 90 days which was edited on 01/17/2024. Review of Resident #76's undated Orders revealed an open-ended treatment order on 12/05/2023 for Contractures in both arms (shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints). Resident #76 did not show to have any orders in reference to nail care. Observation on 01/24/2024 at 10:49 AM of Resident #32, who was in her room in bed. Resident #32 was observed to have long fingernails on her left and right hands with black and brown material under some. Resident #32 was observed to have contractors to both her left and right hand. Resident #32 was not interviewable but did allow her palms to be checked, which did not have any abrasions. Observation on 01/24/2024 at 11:01 AM, Resident #76 was seated in his wheelchair in a common area of the facility. Resident #76 was observed to have long fingernails on both his right and left hands with black material under some. Resident #76 was also observed to have contractures to both his right and left hand. Observation and interview on 01/24/2024 at 12:00 PM, Resident #19 was observed in his motorized wheelchair. Resident #19 was observed to have long fingernails on both his left and right hand, which also displayed a brown tint and had a black substance under some. Resident #19 was observed to have limited use of his left and right hand, which were partially contracted. Resident #19 stated he did not want his fingernails as long as they were. Resident #19 stated, there is no point in telling staff he wanted his nails cut. Resident #19 stated that staff would not do anything and would say that they do not have time right now. Observation and interview on 01/25/2024 at 3:18 PM, Resident #76 was observed to still have long fingernails on both hands with debris present. Resident #76 stated that he did not want his fingernails as long as they were and last had them cut approximately one month ago. Resident #76 allowed his palms on both hands to be checked and did not have any abrasions. Interview on 01/25/2024 at 3:30 PM, CNA I stated that basic nail care could be performed by a Nurse or CNA. CNA I stated that if the resident is diabetic or required more than basic nail care she would notify a nurse. CNA I stated that all staff are supposed to pay attention to nail care but that the primary responsibility falls on staff that are providing the residents with their shower. CNA I stated that as a part of the shower process they are supposed to check for fingernail length and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 cleanliness. CNA I looked at the fingernails of Resident # 32 and stated that they were too long and needed to be cut. CNA I stated that long nails, especially in residents with contractures, could result in skin breakdown, which she checked Resident #32 for. CNA I looked at the fingernails of Resident #76 and stated they were too long given the contracted state of his hands. Resident #76 advised CNA I that he did not want his fingernails as long as there were. CNA I looked at the fingernails of Resident #19 and stated that his nails were too long given the contracted state of both hands. CNA I asked Resident #19 why he did not say anything, and he informed her that he told other staff, but they did nothing about it. Interview on 01/25/2024 at 3:38 PM, CNA J stated that nail care can be provided by CNAs, but they must notify a Nurse if they are a diabetic. CNA J stated that residents with long nails, especially those with contractures, could lead to skin breakdown, infection, and self-inflicted abrasions. CNA J looked at the fingernails or Resident #32 and stated they were not in line with her training and should be cut. CNA J looked at the fingernails of Resident #76 and stated they were not in line with her training and should be cut. CNA J looked at the fingernails of Resident #19 and stated they were not in line with her training and should be cut. Interview on 01/25/2024 at 3:46 PM, LVN D stated that nail care checks should be done by everyone but stated that nails are primarily checked during shower times, which are to occur three times a week. LVN D looked at the fingernails of Resident #32 and stated their length was unacceptable and needed to be cut to prevent skin breakdown. LVN D looked at the fingernails of Resident #19 and she stated they were too long unless he wanted them that length and appeared to have a fungal issue. Resident #19 informed LVN D that he wanted them cut and did not want them the length there were. LVN D looked at the fingernails of Resident #76 and stated they were too long unless he wanted them that length. Resident #76 told LVN D that he did not want them long and requested they be cut. LVN D stated that the hallway we currently were in was not her hallway and that she regularly checks her resident's fingernail lengths. Interview on 01/25/2024 at 4:40 PM, the DON stated that nail checks are to be performed by staff during shower time. The DON stated that failure to maintain nail care could result in presence of bacteria, which could become an infection issue. Interview on 01/25/2024 at 5:03 PM, the ADMINISTRATOR stated that ADL nail care should be conducted during resident showers. The ADMINISTRATOR stated that failure to trim fingernails could result in abrasions or possible infection depending on the circumstances. Review of facility's Nursing Policies and Procedures dated 05/05/2023 revealed, SUBJECT: ACTIVITIES OF DAILY LIVING, OPTIMAL FUNCTION; DEFINITION: Activities of daily living (ADLs), refer to task related to personal care including, grooming, dressing, oral hygiene, transfer, bed mobility, eating, bathing, and communication system. PROCDURES: 3. Facility staff develop and implement interventions in accordance with the resident's assessed needs, goals for care, preferences and recognized standards of practice that address the identified limitations in ability to perform ADLs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who was fed by enteral means received the appropriate treatment and services to prevent complications from enteral feeding for 1 (Resident #58) of 4 residents reviewed for enteral feeding. The facility failed to ensure that the head of Resident #58's bed was at an angle of at least 30 degrees and not more than 45 degrees while actively receiving enteral gastric tube feeding. This failure could affect residents in the facility receiving enteral feeding by placing them at risk of complications such as aspiration pneumonia. Findings Included: Review of Resident #58's Face Sheet dated 01/24/2024, reflected a 59 year of age male, who was admitted to the facility on [DATE]. Resident #58 was diagnosed with Parkinsonism (brain conditions that cause slowed movements, rigidity (stiffness) and tremors), Dementia (loss of cognitive functioning - thinking, remembering, and reasoning that interferes with a person's ADL), Acute Respiratory Disease (life-threatening lung injury that allows fluid to leak into the lungs), and Gastro-Esophageal Reflux Disease (condition in which the stomach contents leak backward from the stomach into the food pipe). Review of Resident #58's MDS Optional State assessment dated [DATE], revealed that he had a BIMS score of 0 indicating severe cognitive impairment. MDS revealed that Resident #58 requires extensive assistance with ADL's and receiving nutrition by way of feeding tube - nasogastric or abdominal. Review of Resident #58's Consolidated Care Plan indicated last care conference date of 09/27/2023 revealed Problem, Category: Nutritional Status, at risk for malnutrition and dehydration related to enteral feedings secondary to: Parkinson's disease; Dementia in other diseases classified elsewhere, unspecified severity, with other behavior disturbance. (Edited 1/15/2024) Goal: Maintain weight with no significant changes through next review. Will tolerate tube feeding as ordered as evidence by no nausea, vomiting, diarrhea, placement checks, residual checks, and weight stability. (Edited 1/15/2024) Approach: Provide tube feeding & water flush as ordered: [ENTERAL FORMULA] 1.2 @ 70 cc /hr x 22 hours; Water flushes 200 cc's TID. (Edited 1/15/204) Review of Resident #58's undated Orders revealed an Enteral order on 11/08/2023 Continuous Enteral Feeding: Formula [ENTERAL FORMULA] 1.2 70 ML/HR x 22 hours. Special Instructions: Date, and label tubing with each change. Every Shift First, Second. Open ended Enteral order on 10/05/2023 Enteral Feeding: Tube site care: Clean around PEG stoma & change drain sponge daily. Special Instructions: Turn off between hours of 0300-0500 for 2-hour break from continuous feeding. Once A Day 07:00 AM - 07:00 PM. Open ended Enteral order on 10/02/2023 Enteral Feeding: Elevate HOB 30 - 45 degrees during feeding Once A Day 07:00 PM - 07:00 AM. Observation and interview on 01/25/2024 at 8:29 AM, Resident #58 observed in bed receiving enteral feeding via G-Tube with the head of the bed elevated between 30 and 45 degrees. Resident #58 was observed to be positioned lower in the bed on this date and appeared to have a body position of less than 30 degrees. LVN B entered the room of Resident #58 and stated that he was pulling on his G-Tube (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and had pulled it out some. LVN B stated that she checked the area and reinserted the G-Tube to the correct position. Resident #58 was observed to be grabbing in the area of his G-Tube and LVN B continued to redirect his hand. Interview on 01/25/2024 at 8:45 AM, RN Surveyor questioned LVN B about her observation and actions in reference to Resident #58's G-Tube this date. LVN B stated that when she came into the room of Resident #58 she observed that he was almost flat while receiving enteral feeding. LVN B stated that she immediately raised the head of the bed to at least 30 degrees. LVN B stated that failure to raise the head of Resident #58's bed at an angle of at least 30 degrees while receiving enteral feeding could result in aspiration (accidentally inhaling food or liquid through the vocal cords and into the airway). LVN B stated that Resident #58's current lower body position in the bed likely was not at 30 degrees or more and had additional staff coming to assist her to move him up in the bed. LVN B stated that Resident #58 had been resistant to care at times this date. Interview on 01/25/2024 at 8:55 AM, CNA G stated that she had been at work this date since 6:00 AM working in Resident #58's hallway. CNA G stated that she had not entered Resident 58's room on this date and stated that LVN B had been providing care for him. In an interview and observation on 01/25/2024 at 9:05 AM, the DON was notified of interviews and observations from this date in reference to Resident #58's G-Tube care and enteral feeding. The DON stated that she would look into the G-Tube feeding and position but did not feel comfortable stating what could have happened to Resident #58 due to uncertainty about the details of the situation. Resident #58 was now positioned farther up in his bed and was at an overall angle of greater than 30 degrees. Resident #58's tube feeding formula and tubing was dated 01/25/2024. On 01/25/24 at 10:54 AM, Surveyor attempted to interview LVN C, who worked over night in the hallway of Resident #58 but was unable to speak with her. Interview on 01/25/2024 at 10:56 AM, CNA H stated that she did work last night with LVN C and provided care for Resident #58. CNA H stated that she checked on Resident #58 at least four times throughout the night and changed his briefs on three separate occasions. CNA H stated that each time that Resident #58 was changed she received assistance in doing so. CNA H stated that Resident #58's tube feeding is stopped / paused while they lower the angle of his bed to allow for his brief change. CNA H stated that the head of Resident #58's bed must be elevated during eternal feeding to prevent him from choking. CNA H stated that they did a change of Resident #58's bed sheets during the night and repositioned him farther up in the bed one time because he had slid down. CNA H stated that she knows she elevated the head of Resident #58's bed every time she lowered it during the night shift. CNA H stated that she was unsure if another staff member possibly lowed Resident #58's bed but stated that last night was different because they had to get another resident prepared for a morning appointment. Interview on 01/25/2024 at 12:06 PM, the DRC stated that LVN C did a respiratory assessment of Resident #58 and found no adverse effects. The DRC stated that they were going to contact Resident #58's Hospice provider and Doctor. The DRC stated that all staff including CNA's receive training in reference to residents with enteral tube feedings as a part of ADL care. The DRC stated that all resident with enteral tube feeding should be at an angle of 30 to 45 degrees while receiving nourishment. In an interview and observation on 01/25/2024 at 12:13 PM, Resident #58 displayed no signs of distress or labored breathing. HOSPICE RN arrived in the room of Resident #58 and stated that she had not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few been notified by the facility yet and was there for a routine visit. HOSPICE RN stated she checked on Resident #58 at least once a week and provided him with care for approximately one year. HOSPICE RN was advised of LVN C's observation of Resident #58 on this date. HOSPICE RN stated Resident #58 should never be at an angle of less than 30 degrees while receiving eternal feeding and she would prefer he be closer to 45 degrees. HOSPICE RN stated providing enteral feeding while positioned at an angle of less than 30 degrees could result in aspiration, drop in O2, and a drop in BP. HOSPICE RN stated Resident #58 does have issues of agitation and anxiety and has been known to pull at his G-Tube. HOSPICE RN stated she does not want a belt to secure the G-Tube of Resident #58 because it would increase his anxiety. HOSPICE RN stated they have been able to maintain Resident #58's safe G-Tube placement through monitoring and medication. HOSPICE RN stated during her visits with Resident #58 at the facility she has not seen the head of his bed at less than 30 degrees. HOSPICE RN stated she would conduct a full assessment of Resident #58. In a follow-up interview on 01/25/2024 at 12:30 PM, LVN C was asked for further details in reference to her observation and actions when she entered the room of Resident #58 this morning. LVN C stated when she entered the room of Resident #58 she estimated his bed was between 7 and 10 degrees . LVN C stated that Resident #58 was actively receiving eternal feeding via his G-Tube when she first observed him. LVN C stated she observed Resident #58 pulling at his G-Tube and redirected him and ensured proper placement. LVN C stated she did a full respiratory assessment of Resident #58 and found no labored breathing, was not choking, no fluid sounds, O2 level was 96, BP was 118 / 60, and his heart rate was 78. LVN C stated she also again ensured proper placement of the G-Tube and secured it with a dated bandage. In a follow-up interview on 01/25/2024 at 1:28 PM, HOSPICE RN stated she completed a full assessment of Resident #58. HOSPICE RN stated that she did not find any adverse effects from Resident #58 receiving enteral feeding while not being elevated at 30 degrees or greater. HOSPICE RN documented from her assessment of Resident #58 that his temperature was 97.7, Pulse 65 regular, respirations 18, BP 127 / 82, oxygen of 99% on room air, regular heart rhythm, active bowel sounds, breath sounds clear in all lobes. HOSPICE RN stated that Resident #58 had no needs after her assessment. Interview on 01/25/2024 at 3:46 PM, LVN D stated all residents receiving eternal tube feeding should be positioned between 30 and 45 degrees when receiving nutrients to prevent aspiration. In a follow-up interview on 01/25/2024 at 4:40 PM, the DON stated if a resident was provided eternal tube feeding while not at an angle between 30 and 45 degrees it could lead to aspiration. In a follow-up interview on 01/25/2024 at 4:55 PM, the DRC stated if a resident was provided eternal tube feeding while not at an angle of at least 30 degrees it could lead cause aspiration and possibly lead to Pneumonia (infection that inflames the air sacs in one or both lungs). Interview on 01/25/2024 at 5:03 PM, the ADM stated residents actively receiving eternal tube feeding should have their head elevated to prevent aspiration. Review of the facility's Nursing Policies and Procedures dated 05/05/2023, SUBJECT: ENTERAL AND PARENTERAL FEEDINGS, POLICY: Nutritionally complete enteral (tube) or parenteral feedings may be indicated for patients / residents who are unable to obtain adequate nutritional intake orally and whose clinical condition demonstrates that enteral / parenteral feedings are unavoidable. Review of facility's Nursing Policies and Procedures dated 05/05/2023, SUBJECT: ENTERAL GASTROSTOMY (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete AND JEJUNOSTOMY TUBE FEEDING AND CARE, POLICY: The qualified licensed nursing staff will monitor the patient / resident being enterally fed daily and document according to facility practice guidelines. CROSS REFERENCE: Lippincott Nursing Procedures 9th Ed. Review of Lippincott Nursing Procedures, MANAGING ENTERAL TUBE FEEDING PROBLEMS, COMPLICATIONS Aspiration of gastric secretions, NURSING INTERVENTIONS Elevate the head of the bed a minimum of 30 degrees, unless contraindicated. Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to ensure that drugs and biologicals used in the facility were stored properly for 1 (Hall 100-300) of 2 medication storage rooms and 1 (Rehabilitation Nurse's cart) of 3 medication carts reviewed for drug storage. The medication storage room for Halls 100-300 had one expired medication, one expired oral supplement and one expired topical paste used for ostomy (opening from inside the body to outside) care. The Rehabilitation Nurse's cart had one expired oral medication dated 2017. This failure placed residents at risk of receiving expired oral medications and supplements which could lead to reduced potency and adverse medication effects. Findings included: Observation and interview on 01/24/2024 at 7:32 AM in the medication storage room for 100-300 Halls revealed a bottle of Vitamin C 500 mg with an expiration date of 06/2021, a bottle of Clinical Nutrition Cranberry + Dietary Supplement expiration date 12/2023 and Ostomy care paste with an expiration date of 9/15/2023. Observation and interview on 01/24/2024 at 8:03 AM in the Rehabilitation Nurse's cart revealed a bottle of Vitamin D 3 1000 IU with an expiration dated of 2017. The ADON/LVN stated the expired medication would not have the same potency or desired effect if given to a resident. In an interview on 01/25/2024 at 4:43 PM the DON stated they try to have medication technicians and nurses clean out the carts for expired medications. She stated they have a new employee hired for that purpose who had not yet been trained to do that task. She further stated she and the Nurse Manager are ultimately responsible for medication storage. In an interview on 01/25/2024 at 4:55 PM the DRC stated medication aides, or a central supply person should remove expired medications. She stated the potential risk of giving expired medications to a resident was it would not have the desired effects and wouldn't work as intended. In an interview on 01/25/2024 at 5:00 PM the ADM stated she had been in that position for two weeks. She stated her expectation was for the nurses and medication aides to check the carts and medication storage rooms for expired medications on arrival to their shift and to check for expired medications at least weekly. She further stated the expired medications could have an adverse effect. Record review of a facility Policy and Procedure revised 04/01/2022 and titled Medication Storage reflected Medications and biologicals are stored safely, securely, and properly following manufacturers recommendations or those of the supplier. Outdated, contaminated, or deteriorated medications are immediately removed from stock, disposed of according to procedures for medication destruction, and reordered from the pharmacy if replacements are needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food under sanitary conditions in the facility's only kitchen reviewed for sanitation. Residents Affected - Many The facility failed to discard of food products that were past the use by date or in accordance with facility policy in the double door refrigerator, walk-in refrigerator, walk-in freezer, and dry storage area. The facility failed to label and date food products in the walk-in freezer and walk-in refrigerator. The facility failed to close food product bags in the walk-in freezer to prevent exposure to air. The facility failed to prevent mold growth on bottled products in the walk-in refrigerator. The facility failed to clean the industrial can opener. The facility failed to remove dented cans from the dry storage area to prevent service to residents. These failures could place residents at risk of cross contamination, loss of nutritional value, weight loss, and foodborne illness. Findings included: Observation on 01/23/2024 at 9:05 AM of the facility's only walk in freezer revealed an open bag of chicken strips that were not labeled or dated and exposed to air, a box of chicken nuggets that were exposed to air, an open box of carrot slices that were exposed to air, a sealed bag of tater tots that were not dated, a sealed bag of popcorn shrimp that were not labeled or dated, and a sealable plastic bag of pork chops dated 11/27/23 that had visible freezer burn. Observation on 01/23/2024 at 9:10 AM of the facility's only walk in refrigerator revealed a one-gallon container of cole slaw dressing dated 12/6/23 with an expiration date of 1/12/24, a one-gallon container of mayonnaise dated 8/30 with a best by date of 12/21/23 and visible mold growth on the lid and container, a one-gallon container of sweet pickle relish dated 6/7 with no best by date and visible mold growth near the lid, a four pound four ounce container of picante sauce with no date and visible mold growth around the lid, a one gallon container of yellow salad mustard dated 6/7 with no best by date and dried mustard and visible mold growth on the container, 2 five pound containers of sour cream dated 10/18/23 with a use by date of 11/25/23, plastic sealable bag containing sliced turkey breast with a use by date of 1/10/24, a plastic sealable bag containing sliced turkey breast dated 1/9 and use by date of 1/20/24. Observation on 01/23/2024 at 9:37 AM of a container of peaches out on a table in the kitchen. The container was dated 1/9/24 and showed a use by date of 1/13/24. Observation on 01/23/2024 at 9:38 AM of the facility's double door refrigerator revealed a one gallon container of ranch dressing that had no date or use by date on it, 4 plastic containers of tea (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many that was not labeled or dated , 1 plastic container of labeled tea dated 1/19/24 and a use by date of 1/22/24, 46 ounce container of prune juice dated 12/13 with a use by date of 12/21/23, 4 individually bagged peanut butter and jelly sandwiches dated 1/8/24 and use by date of 1/21/24, and an individually bagged sliced turkey breast sandwich dated 1/18 with a use by date of 1/21/24. Observation on 01/23/2024 at 9:45 AM of the facility's dry storage area revealed 4 forty-six ounce containers of prune juice dated 6/7/23 with a use by date of 12/21/23, 4 forty six ounce containers of cranberry cocktail juice dated 5/23/23 with a use by date of 12/21/23, box dated 9/15/23 with 23 twelve ounce cans of evaporated milk that all had a best by date of 1/19/24, two 6.61 pound cans of mandarin oranges dated 1/3/24 with dents in them near the top seal, and a metal rack with four shelves labeled 1/17/24 with a use by date of 1/20/24 that contained 2 packages of hot dog buns, 10 packages of hamburger buns, and one and half loaves of bread. Observation on 01/23/2024 at 10:02 AM of the facility's only industrial can opener revealed dried and moist substances around and behind the cutting blade. Interview on 01/23/2024 at 10:05 AM, the RDC stated the industrial can opener should be cleaned after every use and failure to do so could lead to cross contamination and food borne illness. The RDC stated that all food in the freezer should be labeled when received and opened. The RDC stated all bags containing food products in the freezer should have been sealed to prevent exposure to air and that failure to do so could result in loss of nutritional value and taste. The RDC stated failure by staff to remove food products that were past their best by dates could result in residents becoming sick due to food borne illnesses. The RDC stated products from dented cans should never been served to residents due to uncertainty if air was allowed into the product which could result in food borne illnesses. The RDC stated the containers in the walk-in refrigerator were not properly dated because they had no year listed and further advised that they should have been removed immediately if any mold growth was observed. Interview on 01/24/2024 at 3:45 PM, the DOC stated she had been in the facility since September of 2023. The DOC stated all products should have receive date, open date, and expiration / best by dates if opened. The DOC stated the dates should always include the month, day, and year because failure to list all three could lead to uncertainty. The DOC stated cooked foods that are refrigerated should be dated to expire three days after date in. The DOC stated the can opener should be cleaned after every use or daily at a minimum. The DOC stated failure to properly seal bags of food products in the freezer could lead to freezer burn and loss of nutritional value. The DOC stated that service of out-of-date food products could lead to food borne illness and weight loss due to issues of palatability. The DOC stated dates of products should be checked daily and all expired / out of date products should be discarded. The DOC stated she was made aware of the condiment containers and showed a picture that the RDC captured of them. The DOC stated it was primarily her responsibility to check them, but she could not see the condiments very well due to their height on the shelf and her being short. The DOC stated the mold growth on the containers likely resulted from the refrigerator getting above a minimum temperature of 41 degrees Fahrenheit approximately three weeks ago. The DOC stated all items except for the containers of condiments were discarded due to the elevated temperature in the refrigerator before repair. The DOC stated products from dented cans were not to be served to residents because it could result in food borne illnesses. Interview on 01/25/2024 at 5:03 PM, the ADM stated she had been advised of the kitchen observations, which she stated could result in food borne illnesses. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 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 676382 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Falcon Ridge Rehabilitation 149 Klattenhoff Lane Hutto, TX 78634 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 0812 Level of Harm - Minimal harm or potential for actual harm Review of in-service summary and attendance dated 10-18-23 revealed, Subject: Labeling & FIFO (first in first out) conducted by the DOC revealed, 5 DATES NEEDED WHEN LABELING *Received date *Open date *Expiration / use by * Pull Date, ALWAYS REMEMBER FIFO METHOD, rotate the oldest item to the front and newest to the back. All Labeling and item names should be visible at all times. In-service was attended by seven culinary staff members including the DOC. Residents Affected - Many Review of the facility's Nutrition Policies and Procedures dated 06/20/2023, SUBJECT: FOOD SAFETY IN RECEIVING AND STORAGE, POLICY: Food will be received and stored by methods to minimize contamination and bacterial growth. PROCEDURES: Receiving Guidelines 5. Inspect food when it is delivered to the facility and prior to storage for signs of contamination. Food packages shall be in good condition to protect the integrity of the contents so that the food is not exposed to adulteration or potential contaminants. Refrigerated Storage Guidelines 12. Refrigerated, ready to eat Time/Temperature Control for Safety FOODS (TCS) are properly covered, labeled, dated with a use-by date, and refrigerated immediately. [NAME] them clearly to indicate the date by which the food shall be consumed or discarded. The day of preparation or day original container is opened shall be considered day 1. Follow USDA guidelines for food storage. 13. In the case of commercially processed food, the date marked by the facility may not exceed a manufacturer's use-by date. 14. Refrigerated condiments and salad dressings are properly covered, labeled, and clearly marked to indicate a use by date two months from the date opened. SUBJECT: SAFE FOOD HANDLING, POLICY: Food acquisition, storage, and distribution will comply with accepted food handling practices. Proper food handling is essential in preventing foodborne illness. Review of Infection Prevention and Control Policies and Procedures dated May 15, 2023, did not reveal any documentation that directly related to food borne illness. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676382 If continuation sheet Page 14 of 14