Inspection·June 26, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Observation and interview on 6/26/23 at 9:12a.m, revealed Resident #1 was observed lying in her bed. She stated, Can you help me get bariatric brief. The facility stopped ordering bariatric brief after they handed me 30-day discharge notice. She stated the facility had asked her family member to provide brief for the resident. She stated the family member sent a box this week, but it was not the correct size. She stated, I don't think it's fair for them to be asking my [family member] to provide briefs for me Residents Affected - Few In an interview on 6/26/23 at 10:24a.m., with CNA A, she stated Resident#1 was a total assist (hands-on activity where the person is incapable of participating in the activity and the provider must perform all services). Resident was incontinent of bowel and bladder. She stated Resident #1 required 3XL brief (white ones). She stated the facility had been out of the 3XL briefs for a while. She stated she could not recall the exact date. She stated she changed Resident#1 this morning and had to place two briefs on the resident so it would not leak. She stated the family member did bring the resident briefs, but they were not the correct size. Observation and interview on 6/26/23 at 10:26a.m., with CNA A of the supplies closet in Hall 500-600. Observation revealed there were no 3XL briefs. CNA A stated, we have been out of white briefs for a while. In an interview on 6/26/23 at 10:31a.m., with LVN BB, she stated she was not aware Resident #1 was out of briefs. She stated the facility had a contract with Resident#1's family member to purchase briefs for the resident. She stated she would call the resident's family member to bring some briefs. In a telephone interview on 6/26/23 at 10:47a.m., with Resident #1's family member, she stated the VP of Clinical Operations emailed her on May 17, 2023, requesting her to purchase briefs for Resident#1. She stated she replied in agreement to assist with purchasing the briefs because I didn't want them to treat [Resident #1] bad. She stated since that request, she had purchased and sent two big boxes with packets of briefs to the facility. She stated, Resident#1 was still residing in the facility and was under their care. I don't think that was fair for the facility to be asking family members to purchase supplies which was necessity for the resident. In an interview on 6/26/23 at 11:43a.m., with the BOM, she stated, Resident#1 was still in the facility and receiving services, food, care, activities even though she has not made any payments She stated the facility requested the family member to bring the briefs for the resident to help the facility and Resident. She stated the resident had briefs because the family member sent a box with uber . In an interview on 6/26/23 at 12:30p.m., with the Administrator, he stated the facility continued to provide everything, food and supplies to Resident#1. He stated, we asked family's help to provide brief. Told them here is what you owe us. We have done evidently everything to please her. In an interview on 6/26/23 at 12:38p.m., with the VP of Clinical Operations, she stated she was responsible for ordering supplies for the facility. She stated Resident#1 had not made payments. She stated she emailed Resident#1's family member to provide briefs for the resident to help the facility. She stated she was not aware that the family member did not deliver the briefs. At this time the Surveyor shared Resident#1's interview from earlier with the VP of Clinical Operations. The VP of Clinical Operation stated it was not brought to her attention that Resident #1 did not have briefs. She stated Central Supply made rounds and prepared a list for her to place an order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 2 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 6/26/23 at 1:08p.m., revealed LVN BB and CNA A provided incontinent care to Resident#1. Observation revealed Resident had two briefs on. LVN BB stated the draw sheet and the fitted sheet were wet and needed to be changed. LVN BB asked CNA A to bring the sheets to change resident's bed. In an interview on 6/26/23 at 1:57p.m., with Central Supply, she stated her responsibility was to make rounds and ask nurses and CNAs what supplies they needed. She stated she asked CNAs the brief sizes that needed to be ordered. Then, she would make a list and gave that list to the VP of Clinical Operations to place an order. She stated when the truck came, she would disperse supplies that staff needed. She stated the facility stopped ordering 3XL size briefs for Resident#1. She stated Resident#1 was the only one that required that size. She stated she was told by the VP of Clinical Operations that resident's family member was responsible for purchasing her briefs. In an interview on 6/26/23 at 4:52pm with the Administrator, VP of Clinical Operations and the BOM, the Surveyor explained while making her initial rounds during this visit Resident#1 requested the Surveyor to assist her get bariatric brief. The VP of Clinical Operations stated she was the interim DON and happened to be in the building when the Administrator asked if she could request the family member to assist financially. So, she sent an email on May 17, 2023 asking the family member to assist with purchasing briefs. I don't see anything wrong. It's a business. She has not made payments. Record review of facility's Resident Rights policy (Revised August 2009) read in part: 3.our facility will make every effort to assist each resident in exercising his/her rights to assure that the resident is always treated with respect, kindness, and dignity . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 3 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to send a copy of the notice of transfer or discharge and the reasons for the transfer or discharge in writing to the Office of the State Long-Term Care Ombudsman, the location to which the resident is transferred or discharged ; the name, address (mailing and email) and telephone number of the Office of the State Long Term Care Ombudsman for 1 (Resident #1) of 2 residents reviewed for discharge. -The facility gave Resident #1 a 30-day written notice which failed to include the location to which the resident would be transferred. -The facility failed to send a copy of 30-day written notice to the Ombudsman as soon as practicable for Resident #1. These failures could place residents at risk of being discharged and not having access to available advocacy services, discharge/transfer options, and the appeal processes. Findings included: Record review of Resident #1's, undated, face sheet revealed a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included acute respiratory failure with hypoxia (a condition where there's not enough oxygen or too much carbon dioxide in your body), morbid (severe) obesity due to excess calories (a chronic disease in which a person has a body mass index (BMI) of 40) and acute kidney failure (is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days). Record review of Resident #1's Medicare-5 days MDS assessment dated [DATE] revealed her BIMS score was 15 out of 15, which indicated the resident was cognitively intact. Resident #1 required total dependence from one person physical assist from staff with bed mobility, transfer and toilet use. Record review of Resident #1's Care plan initiated on 3/13/23 and revised 6/26/23 revealed the following: Focus: (Resident#1) family wishes for her to return home. Goal: Their desire to discharge to their home will be honored through next review Target date: 08/01/2023. Intervention/Tasks: Assist with arranging outside services (home health) as ordered. Prior to discharge educate the family about treatments and medications in terms they can understand. Record review of Resident#1's 30-day written notice undated read in part: .Notice: 30-day discharge Dear (Resident #1), pursuant to Federal and State regulations, this Notice is being provided as formal notification that you are being transferred or discharged from [Facility name] for the following reason(s) that are marked: Your bill for services at the facility has not been paid after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 4 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few reasonable and appropriate notice to pay (Medicare or Medicaid) your stay at this facility . The letter was signed by Resident #1 and the Administrator dated 4/27/23. The notice mentioned 3 different locations to which the resident could be transferred. Record review of Resident#1's nurse notes/progress notes for the month of June 2023 provided by the VP of Clinical Operations revealed there were no notes regarding discharge planning/care plan meeting held with the interdisciplinary team, Resident #1, or the Responsible party after the 30-day discharge was given to the Resident. Record review of the email dated 5/17/23 between the VP of Clinical Operations and Resident#1's family member received from the family member read in part: .If there was a certain question or certain questions that should be asked to the facilities, recommendations are absolutely accepted. The accusations are absolutely unwarranted as we all navigate the unfamiliar process. Lastly, If there are any facilities that you've worked with that accept Medicaid pending, please advise. When researching the facilities, this information is oftentimes not clearly noted . In an interview on 6/26/23 at 9:12a.m. Resident #1 stated she was given a 30-day notice to leave the facility. She stated she required extensive assistance from staff with bathing, dressing and changing briefs. She stated she was glad the ombudsman came to find out about the discharge notice and was assisting her with fair hearing. She stated the Administrator handed her the discharge notice and asked her to sign the letter. She said the facility had not discussed having a discharge planning meeting with her or her family member. She stated her family member was assisting her with filling out the Medicaid application. She said the facility did not offer to help with filling out the Medicaid application. She said the facility wanted to send her to a personal care home. The facility set up the transport without her approval. She stated she refused to go to the personal care home when the transport arrived. She stated, I did not feel it was a safe place for me to go. They wanted me out of here. In a telephone interview on 6/26/22 at 11:21 a.m., the Ombudsman stated the facility had issued Resident #1 a 30-day discharge notice on 4/27/23. He stated he filed a complaint on behalf of Resident#1. The reason was for non-payment. He stated there was no IDT care plan meeting for the discharge after the notice was issued. There were 3 different facilities listed on the discharge notice. He stated, the Administrator was making threats of putting the resident in a cab to send her home. He stated the facility was not contracted with a social worker. The facility failed to send the discharge letter for Resident #1 to the Ombudsman Office. He stated the facility violated the following, .F623 of the SOM clearly stated Notice before discharge 483.15c5 Contents of the notice. The written notice specified in paragraph (c) (3)of this section must including the following. The location to which the resident is transferred or discharged . The 30-day discharge notice had 3 different facilities names and address listed. Which facility was the resident going to . He stated the facility wanted to send Resident #1 to a personal care home. He stated that would be an unsafe discharge because the resident required total assistance even with transfer from bed to wheelchair. He stated, clearly the facility is in violation for the above mentioned regulations. Record review and interview on 6/26/23 at 11:43a.m., with the Business Office Manager, she stated the 30-day discharge notice was issued to Resident #1 for nonpayment. She said it was a generic notice that came from corporate. She said, all I do is add the resident's name and address if the letter needed to be mailed. Print the letter and give it to the Administrator. The Administrator needed to give the letter to the resident. She stated she was not involved in the discharge planning. The BOM reviewed Resident#1's 30-discharge notice with the Surveyor. The BOM said, 3 facilities mentioned on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 5 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the letter came from corporate. I am assuming they are Medicaid pending facilities. When asked which facility was the resident transferring to after her 30 days were over. The BOM stated, her [family member] needs to tell us. In a telephone interview on 6/26/23 at 2:08p.m., with Resident#1's family member, she said she received a call from someone at the facility saying, [Resident #1's] coverage for Medicare is ending. You can apply for Medicaid. She said there was no communication on discharge planning. The facility management kept saying you need to find a place for [Resident #1] to go. She said there was no clear instructions given by the facility. She said she was searching for nursing facilities online and calling those facilities if they were accepting new residents. She said she gave a list of facilities to the BOM that were accepting new residents. She stated the BOM then guided her that she also needed to ask if those facilities were accepting residents with Medicaid pending. She said [facility name] did not assist at all with the discharge planning. She said the facility did not have a social worker. A community SW got involved. She said the facility wanted to send the resident to a personal care home to get rid of her. She said she came to find out about the Ombudsman and asked for his assistance with the appeal process while she applied for resident's Medicaid application. In an interview on 6/26/23 at 2:34p.m., with the Administrator and the VP of Clinical Operations, the VP of Clinical Operations stated it was not a safe discharge for Resident #1 to go home. She stated with the help of a community social worker the facility found a personal care home. She stated at first the resident agreed to go to the personal care home. The facility set up the transportation for transfer. When the transportation came with the stretcher to pick up the resident for transfer, Resident#1 stated, don't touch me. Therefore, the facility had to give the 30-day notice to the resident. Record review and interview on 6/26/23 at 3:40p.m., the Surveyor reviewed Resident#1's 30-day discharge notice with the Administrator and the VP of clinical operations. The Administrator said, 3 facilities listed on the letter was letting the resident know here are some choices. Can't say whether or not they will accept. They are just options; we were trying to help. The Administrator said the facility had not made contact with the 3 facilities mentioned in the letter. The VP of clinical operations said there was no documentation an IDT care plan meeting/discharge planning was held after the notice was given on 4/27/23 because we are waiting on the [family member] to give the name of a facility to transfer the resident. At this time policies on Transfer or Discharge Notice were requested. No policies on Transfer or Discharge Notice were provided on exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 6 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to conduct a comprehensive and accurate assessment within 14 days after admission for 2 of 4 residents (Resident #1 and #2) reviewed for assessments. -The facility failed to ensure admission MDS Assessments for Residents #1 and #2 were completed within 14 days after admission. This failure could place residents at risk for improper or incorrect care and services necessary for their physical, mental, and psychosocial well-being. Findings included: Resident#1 Record review of Resident #1's, undated, face sheet revealed a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included acute respiratory failure with hypoxia (a condition where there's not enough oxygen or too much carbon dioxide in your body), morbid (severe) obesity due to excess calories (a chronic disease in which a person has a body mass index (BMI) of 40) and acute kidney failure (is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days). Record review of Resident #1's electronic medical record revealed as of 06/26/2023 no admission assessment MDS had been completed. Further review of Resident #1's electronic medical record revealed an alert in red under the MDS tab, ARD: 3/27/2023 , 91 days overdue. Resident#2 Record review of Resident #2's, undated, face sheet revealed a [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included type 2 diabetes mellitus (is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel), anemia (a condition in which the body does not have enough healthy red blood cells) and hypertension (A condition in which the force of the blood against the artery walls is too high). Record review of Resident #2's electronic medical record revealed as of 06/26/2023 no admission assessment MDS had been completed. In a telephone interview on 06/26/23 at 3:57 p.m., with the MDS Nurse, she said she helped part time at this facility because the facility did not have a full time MDS nurse. She said she reviewed Resident #1 and Resident #2's records today and noticed they were missing the admission MDS assessments. She said the time frame for an admission MDS to be completed was 14 days from admission. She said Resident #1 and Resident #2 were admitted in March 2023. She said in March 2023 the facility had an MDS nurse and that MDS nurse should have completed the assessments. She said, I didn't go back and check the previous MDS nurse's work. Now that it has been brought to my attention, I will look at all the residents MDS. She said not completing an MDS assessment in a timely manner could affect a resident's care plan and receiving services needed . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 7 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 06/26/23 at 4:46p.m., with the VP of clinical operations, she said the DON was on leave and she was the interim. Surveyor asked when the admission MDS was completed and who was responsible for checking the accuracy and submission of MDS. The VP of clinical operations said, this would be a question for the Administrator. I don't know their procedure. I could be wrong. In an interview on 06/26/23 at 4:52p.m., with the Administrator, BOM, and the VP of Clinical operations. when asked how often the MDS assessments were completed and the importance for completing and submitting the assessments timely. The BOM said I don't know. The Administrator said, I don't know when the MDS were submitted. I am not sure what could happen if MDS assessments were not completed in a timely manner. This is a nursing task. The VP of Clinical Operations said the Administrator was not a nurse. The VP of Clinical Operations said, I don't know. Will find out. The Administrator asked this Surveyor, Can you tell us what's the importance of MDS and when its submitted?. The VP of clinical Operations said, we have a MDS nurse we can call her and find out. At this time the Surveyor asked VP of clinical operations if she would like to call the MDS nurse to provide them with clarity. The VP of Clinical Operations said, we will call her later. Go on. Record review of the mds-3.0-rai-manual-v1.17.1_October_2019 revealed in part: .The admission assessment is a comprehensive assessment for a new resident and, under some circumstances, a returning resident that must be completed by the end of day 14, counting the date of admission to the nursing home as day 1 if: -this is the resident' s first time in this facility, OR -the resident has been admitted to this facility and was discharged return not anticipated, OR -the resident has been admitted to this facility and was discharged return anticipated and did not return within 30 days of discharge . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 8 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment for 2 of 4 residents (Resident #1 and #2) reviewed for care plan revisions, in that: -Resident #1's comprehensive care plan did not address the resident's code status, allergies, antidepressants, anticoagulant therapy, antihypertensive medications, oxygen therapy, falls, bowel and bladder incontinence, pain, diuretic therapy, yeast infection and ADLs . -Resident #2's comprehensive care plan did not address the resident's code status, antidepressants, antihypertensive medications, and ADLs. These deficient practice could place residents at risk of receiving inappropriate care. Findings included: Resident#1 Record review of Resident #1's, undated, face sheet revealed a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included acute respiratory failure with hypoxia (a condition where there's not enough oxygen or too much carbon dioxide in your body), morbid (severe) obesity due to excess calories (a chronic disease in which a person has a body mass index (BMI) of 40) and acute kidney failure (is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days). Record review of Resident#1's Care plan initiated 3/14/2023 revealed the following read in part: .Focus: Alteration in skin integrity. Goal: Wounds will not develop a secondary infection. Target Date: 07/19/2023. Intervention/Tasks: Monitor skin and report red/discolored or broken skin. Notify physician PRN. Skin assessment as per protocol. Treatments as ordered . Further review of care plan did not address resident's code status, allergies, antidepressants, anticoagulant therapy, antihypertensive medications, oxygen therapy, falls, bowel and bladder incontinence, pain, diuretic therapy, yeast infection and ADLs. Record review of Resident#1's consolidated physician orders dated 3/14/23 revealed the following: -Apixaban Oral Tablet 5 MG (Apixaban) Give 1 tablet by mouth two times a day related to OTHER PULMONARY EMBOLISM WITHOUT ACUTE CORPULMONALE Monitor for abnormal bruising/bleeding and notify MD/NP if occurs -acetaZOLAMIDE Oral Tablet 250 MG (Acetazolamide) Give 1 tablet by mouth two times a day related to UNSPECIFIED COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE -Amiodarone HCl Oral Tablet 200 MG (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 9 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 (Amiodarone HCl)Give 1 tablet by mouth two times a day for Arrhythmias related to UNSPECIFIED COMBINED SYSTOLIC (CONGESTIVE)AND DIASTOLIC (CONGESTIVE) HEART FAILURE HOLD FOR HR <60 -Sertraline HCl Oral Tablet 50 MG Residents Affected - Some (Sertraline HCl) Give 1 tablet by mouth one time a day related to MAJOR DEPRESSIVE DISORDER, RECURRENT,UNSPECIFIED -Vitamin C Oral Tablet 500 MG (Ascorbic Acid) Give 1 tablet by mouth one time a day for wound healing -Zinc Sulfate Oral Tablet 220 (50 Zn) MG (Zinc Sulfate) Give 1 tablet by mouth one time a day for supplement -Potassium Chloride ER Oral Tablet Extended Release 20 MEQ (Potassium Chloride) Give 1 tablet by mouth one time a day for low potassium to be given with lasix -Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 25 MG (Metoprolol Succinate) Give 100 mg by mouth one time a day related to ESSENTIAL (PRIMARY) HYPERTENSION Hold for SBP<110 or HR <60 -Nystatin Powder (Nystatin (Bulk)) Apply to Groin topically one time a day for yeast infection -Furosemide Oral Tablet 20 MG (Furosemide) Give 1 tablet by mouth one time a day for Congestive Heart Failure -Flonase Allergy Relief Nasal Suspension 50 MCG/ACT (Fluticasone Propionate (Nasal))1 spray in both nostrils at bedtime for Allergy Relief -Famotidine Oral Tablet 20 MG (Famotidine) Give 1 tablet by mouth one time a day for acid reflux -Cetirizine HCl Oral Tablet 10 MG (Cetirizine HCl) Give 1 tablet by mouth one time a day for allergies -02: 3LPM via NC continuous- Monitor 02 Sats q shift. -Apply Bipap every night at bedtime for breathing support and remove per schedule. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 10 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 Resident#2 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #2's, undated, face sheet revealed a [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included type 2 diabetes mellitus (is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel), anemia (a condition in which the body does not have enough healthy red blood cells) and hypertension (A condition in which the force of the blood against the artery walls is too high). Residents Affected - Some Record review of Resident #2's Care plan initiated 3/24/2023 revealed Resident was care planned for only one care area, which read in part: .Focus: At risk for cerebrovascular complications. Goal: Will not develop complications. Target Date: 07/19/2023. Interventions: Observe for weakness, headache . Resident #2's care plan did not address code status, antidepressants, antihypertensive medications, or ADLs Record review of Resident#2's consolidated physician orders dated 3/24/23 revealed the following: -Atenolol Oral Tablet 100 MG (Atenolol) Give 1 tablet by mouth one time a day for HTN HOLD FOR SBP <110 AND HR <60 -NIFEdipine ER Oral Tablet Extended Release 24 Hour 60 MG (Nifedipine) Give 1 tablet by mouth one time a day for HTN HOLD FOR SBP <110 -Pantoprazole Sodium Oral Tablet Delayed Release 40 MG (Pantoprazole Sodium) Give 1 tablet by mouth one time a day for GERD -PROzac Oral Capsule 40 MG (Fluoxetine HCl) Give 1 capsule by mouth one time a day for CVA, depression In an interview on 6/26/23 at 11:10a.m., with LVN BB, she said the DON was responsible for updating resident's care plans. She said the DON was not in the facility today. In a telephone interview on 06/26/23 at 3:57 p.m., with the MDS Nurse, she said the care plan was completed within 7 days after the comprehensive MDS assessment was completed. She said care plans were important for informing the team about the resident's needs and how the resident was to be cared for. She said the MDS nurse was responsible for the comprehensive care plans that correlated with the admission MDS assessments. She said she was reviewing the care plans today to ensure all areas were addressed when she realized that Resident #1's didn't really have a care plan. She said Resident#1 had a set of care plans from back in 2019 when the resident was first admitted to the facility. The MDS nurse said, so I re-activated that cancelled care plan today. Resident cannot be in the facility without a care plan. She said the previous MDS Nurse initiated Resident #1 and Resident #2's care plans. But, they were not completed because both residents did not have the admission MDS. She said the MDS triggered certain categories that were incorporated into the Resident's care plan. She said the importance for incorporating the triggers from the MDS was so that they could meet the resident's needs and deliver the appropriate treatment to residents. In an interview on 06/26/23 at 4:52p.m., with the Administrator, BOM, and the VP of Clinical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 11 of 12 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 676384 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Sugar Land, LLC 1803 Wescott Avenue Sugar Land, TX 77479 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 - Some operations, the Administrator was asked who was responsible for updating the care plans. The Administrator said the IDT consisted of the DON, ADON, Director of rehabilitation, MDS nurse, social service, Dietary manager and BOM were involve with care plan . He said, it's done initially. Then, the Receptionist would set up a care plan meeting. The VP of Clinical operations said base line care plan was completed on admission and the comprehensive care plan kicks in day 15. The BOM said the facility did not have a MDS nurse. The new MDS nurse started working 4 to 6 weeks ago. Record review of facility's Care planning-Interdisciplinary Team policy (Revised February 2014) read in part: .Our facility's Care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident. Policy Interpretation and Implementation: 1. A comprehensive care plan for each resident is developed within seven (7) days of complication of the resident assessment (MDS ) . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676384 If continuation sheet Page 12 of 12