Health inspection·November 16, 2023

F 0558 call light was underneath the bed on the floor. Resident #79 was sleeping. Level of Harm - Minimal harm or potential for actual harm Observation and interview on 11/14/23 at 3:15 PM revealed Resident #79 lying in his bed and his call light was underneath the bed on the floor. Resident #79 was sleeping. Residents Affected - Few Interview on 11/14/23 at 3:30 PM with CNA G revealed she was caring for Resident #79 and was last in his room around 2PM to change him. CNA G stated she placed the call light next to Resident #79. CNA G stated call lights were supposed to be within reach of the resident. CNA G went to Resident #79's room and observed the call light was underneath the bed on the floor. CNA G stated all staff were responsible, including her, to ensure a resident could reach their call light by placing it within their reach. CNA G stated the risk of not keeping the call light within reach could be a resident needing help and the call light was the only way to call for assistance . Interview on 11/14/23 at 3:35 PM with LVN K revealed she was the nurse assigned to Resident #79. She stated the last time she observed Resident #79 was around 2 PM when she provided him with his afternoon medications. She stated call lights should be within reach of the resident. She stated when she went to Resident #79 room she did not ensure if the call light was within reach. She stated there was not risk to Resident #79 because the resident was able to yell out for help. She stated call lights were needed for residents to call for assistance. Interview on 11/16/23 at 4:49 PM with the DON revealed her expectation was for call light to be within reach. She stated all staff were responsible for ensuring a resident's call light was within their reach. The DON said the purpose of having a call light within reach of the resident was so they could utilize it. A policy regarding Call light/Bells was requested; however, it was not provided upon exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 2 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 provide treatment and services to prevent complications of enteral feeding for one (Residents #15) of two resident reviewed for feeding tubes. 1. LVN E failed to check for residual of Resident #15's G-tube prior to medication administration. 2. The facility failed to ensure Resident #15's G-tube was flushed with 35 cc's water prior to and after medication administration per physician orders. 3. The facility failed to ensure Resident #15's G-tube was flushed with water between each medication administration. 4. The facility failed to ensure medication was dissolved completely prior to Resident #15's medication administration. These failures could place residents at risk of not receiving full dosage of medication, abdominal discomfort, medication incompatibility, tube obstruction, nausea, and risk of aspiration. Findings include: Record review of Resident #15's quarterly MDS assessment, dated 10/17/23, reflected a [AGE] year-old male with an admission date of 11/22/16. Resident #15 was unable to respond to the interview for mental status. Resident #15 was usually able to make himself understood and usually understood others. He had active diagnoses which included cerebral palsy (congenital disorder of movement, muscle tone, or posture) and received 51% or more of total calories through a feeding tube (a tube inserted through the abdomen that delivers nutrition directly to the stomach). Record review of Resident #15's Physician orders report, dated 10/15/23 to 11/15/23, reflected, .Flush G-tube with 35 ml of warm water before and after medication administration with a start date of 06/22/23. An observation on 11/15/23 at 08:20 AM of G-Tube medication administration for Resident #15 revealed LVN E prepared medication. LVN E poured 10cc of Carafate 1gm/per 10 ml (antacid), Linzess 290 mg (treats irritable bowel) 1 capsule, Pantoprazole 40 mg (proton pump inhibitor) granules, Zinc 50 mg (antioxidant) 1 tablet and MiraLAX 17 gm (laxative) 1 capful placed in cup with 8 oz. of water. LVN E opened the capsule and placed in a plastic cup and then crushed each tablet and placed each of them in separate cups and entered the resident's room. LVN E then filled a plastic cup with water from the bathroom sink and poured 5 cc of water into each medication cup. She then retrieved a 60-cc piston syringe and placed the feeding pump on hold. She disconnected the feeding tube from the G-tube and placed the piston syringe into the G-tube connector and poured 30 cc of water into the G-Tube without checking for residual. LVN E then administered each medication by gravity adding additional water into cups containing the zinc, pantoprazole and linzess which were not completely dissolved. LVN E did not flush with clear water between each medication. After the last medication administered. LVN E flushed the tube with 10 cc of water. She then reconnected the feeding tube and turned the pump back on. Removed gloves and performed hand hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 3 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 In an interview with LVN E on 11/15/23 at 8:20 a.m., she stated she was supposed to check residual before administering medications. She stated she thought the procedure for flushing was 30 cc before and 10 cc after. She stated she did not look at the order which indicated 35 cc before and after. She stated she thought she had flushed with 10 cc of water after each medication. She stated failing to flush could cause problems with the tube clogging and interaction with medications. Residents Affected - Few In an interview with the DON on 11/15/23 at 10:10 AM, the DON stated staff were to always check residual prior to giving medication through the g-tube. She stated they were to follow the doctors' orders on the amount of fluid to flush before and after medications and they were to always flush between medications and were supposed to use warm water and to ensure each medication was dissolved prior to administering to prevent clogging the tube and ensure all medication was administered. She stated failing to follow the correct procedure placed the resident at risk of aspiration, vomiting and not incompatibility between medications. Record review of LVN E's competency check, completed on 09/07/23, for gastrostomy tube management, tube flushing and irrigation and medication administration via enteral tube reflected she was competent in the procedure. Record review of the facility's Nursing Policy and Procedures titled, Enteral Feeding- Administering Medications, dated May 2023, reflected, .The licensed nurse will administer medications prescribed by the physician to be given by enteral tube, using the appropriate method according to recognized standards of practice. The licensed nurse will verify correct tube placement on those devices that are not inserted directly into the gut, per current clinical standards of practice .Cross reference .Lippincott Nursing Procedures 9th Ed., Enteral Tube Drug Instillation, .Before administration check the patency and position of the tube and assess the patients GI status .Medications administered enterally must be given in liquid form to avoid enteral tube obstruction .Aspirate tube contents .Notify the practitioner if tube placement is in doubt .After verifying proper tube placement, flush the tube with at least 15 ml of purified water .administer the medication .Flush the enteral tube with at least 15 ml of purified water .Repeat the procedure with the next medication .Flush the enteral tube one final time with at least 15 ml of purified water FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 4 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 needed respiratory care were provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one of three residents (Resident #285) reviewed for respiratory care. Residents Affected - Few The facility failed to ensure the supplemental O2 was provided at the physician ordered liter amount for Resident #285. This failure could place residents at risk of receiving an incorrect amount of oxygen and the risk of oxygen toxicity. Findings include: Record review of Resident #285's admission assessment, dated 11/09/23, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #285 was cognitive. Her diagnoses included acute on chronic diastolic congestive heart failure (decreased blood flow), dysphagia, pain, cough, chronic hepatic failure without coma (liver failure), end stage liver disease (liver failure), chronic respiratory failure with hypoxia (low blood oxygen levels), and chronic obstructive pulmonary disease. Record of Resident #285's physician orders oxygen flow sheet for November 2023 reflected the resident admit date was 11/09/2023 and reflected oxygen at 3 l/m via nasal cannula every shift. Record review of Resident #285's Care Plan, dated 11/09/23, reflected, At risk for activity intolerance related to imbalance between supply oxygenation needs. Approach dated 11/9/2023, Monitor activity tolerance and document and increase in intolerance of complaints of fatigue and/or weakness. Record review of Resident #285's TAR, dated 11/16/2023, reflected, . Oxygen at 3 l/m via nasal cannula start date 11/10/2023 . An observation and interview on 11/16/23 at 9:13 a.m. and 11/16/23 at 1:12 p.m. revealed Resident #285 had oxygen via nasal cannula in place and the oxygen flow rate was set to deliver 4 liters per minute via an oxygen concentrator. Resident #285 stated her oxygen flow rate received was 3 liters, resident denied any breathing complications. Interview with LVN B on 11/16/23 at 1:12 p.m. revealed Resident #285's order was 3 liters per minute via an oxygen concentrator. LVN B stated she didn't usually work Resident #285's hall. She also revealed she worked PRN ; however, she was the nurse assigned to Resident #285. She stated providing the inappropriate amounts of oxygen could make the resident lose the ability to breathe by causing them to retain too much carbon dioxide . Interview with ADON G on 11/16/23 at 01:05 p.m. revealed Resident #285's order was 3 liters per minute via an oxygen concentrator. ADON G stated she believed the resident's oxygen was changed from 3 l/m to 4 l/m on the previous night shift. ADON G stated it was the nurse on duty responsibility to ensure the residents oxygen rate are set correctly. ADON G revealed with the oxygen set at the incorrect amount of 4 l/m could cause a resident to lose the ability to breathe on their own . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 5 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview with the DON on 11/16/23 at 1:36 p.m. revealed doctors' orders should be followed. Staff would get a PRN order to adjust 02 based on 02 saturation due to plurX drain . DON stated it was the charge nurse on duty responsibility to ensure the residents oxygen rate are set correctly and should be checked during every shift. Record review of the facility's policy, Respiratory Treatment, Care and Services Program revised May 2023, reflected, .Depending on the type of respiratory services received, licensed independent practitioner orders and the individualized plan of care, documentation includes the following, as appropriate and necessary .Documentation includes new orders received, implemented interventions, response to treatment Event ID: Facility ID: 676394 If continuation sheet Page 6 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for two of eight residents (Resident #2 and Resident # 51) reviewed for medication storage. The facility failed to ensure Resident #2, and Resident #51 did not have unsecured medication in their rooms on 11/14/23. This deficient practice could place residents at risk of not being monitored for their medications, adverse reactions, and drug diversion. Findings include: 1. Record review of Resident #2's, undated, face sheet reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #2 had diagnoses which included Rash and other nonspecific skin eruption, history of urinary tract infections and atherosclerotic heart disease (damage or disease in the hearts major blood vessels). Record review of Resident #2s quarterly MDS assessment, dated 10/27/23, reflected she had a BIMS of 15, which indicated she was cognitively intact and was dependent on staff for personal hygiene. Record review of Resident #2s Care Plan, last revised on 10/30/23, did not reflect Resident #2 could self-administer her medications or keep medications in her room. Record review of Resident #2's Physician order report for 11/01/23-11/14/23, did not reflect an order for Hydrocortisone 1% cream (steroid used to treat rashes) or any order which indicated the resident could have medications at beside. An observation and interview on 11/14/23 at 10:25 AM with Resident #2 revealed she had a rash to her right arm and upper chest. She stated the staff gave her Benadryl (antihistamine) but she stated it still itched. She stated someone brought her some cream to put on it and pointed to a box of Hydrocortisone 1% cream on her over the bed table. She stated she could not remember who brought it to her, but they brought last night (11/13/23). In an interview with LVN D on 11/14/23 at 12:10 PM, she stated Resident #2 developed a rash last week and the doctor had ordered Benadryl. She stated she was unaware the resident had Hydrocortisone cream at her bedside, and it would require an order and the nurses would be responsible for putting it on the resident. She stated there was nothing mentioned in the 24-hour report about any order for hydrocortisone cream. LVN D stated she passed medications and had not noticed the box of hydrocortisone cream in the resident's room. In an interview and observation made with ADON A on 11/14/23 at 12:15 PM in Resident #2's room revealed the Hydrocortisone cream remained on the residents over the bed table. ADON A assessed the resident's rash on her arms and chest and told her she would call the doctor and get something else (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 7 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 - Few ordered. ADON A asked the resident if she remembered who brought her the cream and she stated one of the nurses' but could not remember who. ADON A informed the resident they were not allowed to keep medication in the resident's room and removed the medications from the room. 2. Record review of Resident #51's, undated, face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #51 had diagnoses which included hypertension, atrial fibrillation (irregular, rapid heartbeat) and acute respiratory infection. Record review of Resident #51s quarterly MDS assessment, dated 10/13/23, reflected she had a BIMS of 15, which indicated she was cognitively intact and was dependent on staff for personal hygiene. Record review of Resident #51's Care Plan, last revised on 11/07/23, did not reflect Resident #51 could self-administer her medications and keep medications in her room. Record review of Resident #51's Physician order report for 11/01/23-11/14/23 did not reflect an order for sore throat spray or antifungal powder or any order indicating resident could have medications at beside. Record review of Resident #51's inactive physician orders reflected an order on 09/19/23 for Sore Throat (phenol) (numbing agent) over the counter aerosol spray 1.4% 1 spray every 2 hours as needed. The order was discontinued on 09/25/23. An observation and interview with Resident #51 on 11/14/23 at 9:05 AM revealed Resident #51 was in her bed with both arms elevated on pillows. A bottle of sore throat spray with a date of 09/19/23 written on the label in black marker and a bottle of antifungal powder were on top of her bedside chest of drawers. Resident #51 stated she had a sore throat several weeks ago, but not now. She stated she did not have skin issues she aware of. She stated she was not sure who brought it to her room or how long it had been in her room. In an interview with LVN D on 11/14/23 at 12:12 PM, she stated she was not aware Resident #51 had sore throat spray or antifungal powder in her room and stated it would require an order and the nurses would be responsible for administering the throat spay and applying the antifungal powder. LVN D stated she had passed medications and had not noticed the throat spray or the antifungal powder in the resident's room. In an interview and observation made with ADON A on 11/14/23 at 12:20 PM in Resident #51's room revealed the sore throat spray and antifungal powder remained on top of the chest of drawers by the resident's bed. ADON A asked the resident if she remembered who brought her the spray and powder and she stated she could not remember. ADON A informed the resident they were not allowed to keep medication in the resident's room and removed the medications from the room. In an interview with the DON on 11/16/23 at 12:00 p.m., she stated it was the expectation all medications or treatments provided to any resident had to have an order and those medications and treatments were secured on the locked medication carts or treatment carts. She stated for a resident to keep medications at the bedside required an assessment to determine if they understood the use and frequency of the medication and it required a physician order for them to be able self-administer. She stated the risk of medications in the room were not knowing what residents were taking, interactions with other medications and or ineffective treatments. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 8 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 Record review of the facility's policy Medication Storage, dated April 2022, reflected .In accordance with State and Federal laws, the facility will store all drugs and biologicals in locked compartments under proper temperature . The medication and biological supply is only accessible to licensed nursing personnel, pharmacy personnel or authorized staff members Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 9 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0790 Provide routine and 24-hour emergency dental care for each resident. 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 assist residents in obtaining routine and 24-hour emergency dental care for one of 24 residents (Residents #26) reviewed for dental services. Residents Affected - Few The facility failed to assist in providing dental services for Resident #26. This failure could place residents at risk of oral complications, dental pain, and diminished quality of life. Findings include: Record review of Resident #26's face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #26 had diagnoses which included Pruritus (an uncomfortable, irritating sensation), acute respiratory infection, cerebral infarction (result of disrupted blood flow to the brain), unspecified pain, need for assistance with personal care. Record review of Resident #26's MDS, dated [DATE], reflected a BIMS score of 14, which indicated she was cognitively intact. Her Functional Status indicated she required limited assistance with one person for eating, set up assistance for dental hygiene, and substantial/maximal assistance with personal hygiene. Record review of Resident #26 progress note, dated 06/05/23 at 1:00 PM, written by the Social Worker reflected Resident emergency contact/friend, stopped to visit with the Social Worker. The Social Worker reviewed Resident #26 was seen by dental x2 in January and referral was submitted again on 5/24/23 to the Dental Provider. Record review of Resident #26 progress note, dated 08/08/23 at 12:31 PM, written by LVN C reflected the resident complained of mouth pain and all over pain, medication given and resident tolerating well at this time. Record review of Resident #26 progress note, dated 11/15/23 at 2:26 PM, written by the Social Worker Assistant reflected the Social Worker Assistant spoke with the Dental Provider about Resident #26's dental concerns. The Dental Provider would put her on the list for tomorrow (11/16/23) to be seen. Resident #26's records and treatment plan would be provided after visit. The Social Worker Assistant would continue to follow. Record review of Resident #26's care plan, revised 11/15/23, reflected no indication of oral/dental health problems or concerns. Interview and observation on 11/14/23 at 11:50 AM, Resident #26 stated she took lots of medication (indicating she could not be specific with the name of medications or what they were for) in the morning and right before bed. Resident #26 stated she often had pain which included mouth pain, she felt like she had exposed nerves and needed to see the dentist to have her teeth pulled. Resident #26 stated she hardly had any teeth left (Resident #26 opened her mouth to reveal more than half of her teeth missing from both top and bottom), Resident #26 stated she thought she was going to have the remainder of her teeth pulled but no one seems to remember. Resident #26 stated it had been at least 3-4 months since last discussed to have them removed, Resident #26 stated she kept asking about it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 10 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0790 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few but the response she was given was we just don't know anything . Resident #26 stated she was not sure if it had something to do with an insurance denial or what but would really like to move forward with having her teeth extracted as planned. Resident #26 stated she was able to get pain medication if needed, however had not seen the dental provider in a while or have not been updated on the extraction date. Resident #26 stated she would like to have dentures after her teeth were extracted. Resident #26 stated she did not get assistance or daily reminders to complete oral hygiene. Resident #26 stated she spoke with her case manager, social worker, and the nurse concerning her dental concerns. Interview on 11/15/23 at 12:36 PM with the Social Worker revealed she was alerted of dental concerns either by the facility staff or residents themselves. The Social Worker stated the facility procedure was then to have both the resident or responsible party and the physician to sign consent forms which were faxed to the Dental Provider for routine visits. The Social Worker stated in case of emergency the facility could fill out an emergency form and fax to the Dental Provider for expedited visits or would send residents to an outside provider for services. The Social Worker stated a while back, earlier this year, she received a concern from Resident #26's case worker that she had not brushed her teeth since admission and had not received any dental services. The Social Worker stated she discovered a referral was done two days prior to the grievance. The Social Worker stated she had not followed up with Resident #26 to see if she required any additional dental services, she assumed everything was addressed with Resident #26's dental concerns . The Social Worker stated there were just too many residents and appointments, so she does not follow up on every appointments. The Social Worker stated she was not told of any additional dental services required by Resident #26, case manager or facility staff since the original grievance. Interview on 11/15/23 at 12:48 PM, the Social Worker stated the Dental Provider would have had to get with the business office about moving forward with any additional services Resident #26 would have needed after the dental visit. The Social Worker stated Resident #26 would need to be up to date on her annual income before any additional dental services would need to be completed, once the business office approved the service, then Social Services was notified to schedule a referral or a visit. Interview on 11/15/23 at 3:30 PM with the Business Office Manager revealed she did receive requests for future dental plans for residents who would be on the next visit from the Dental Provider. The Business Office Manager stated Resident #26 was consistently on the list from the Dental Provider, however, since her annual income was not correct Resident #26 could not be approved for further dental services. The Business Office Manager stated she submitted documentation to correct the issue; however, it had not been corrected. The Business Office Manager stated she had not discussed this issue with anyone, and she had not done anything to get Resident #26 the recommended services from Dental Provider . Business Office Manager stated it was hard getting ahold of anyone with the state to have them fix the issue. The Business Office Manager revealed she could have spoken with the Administrator and could have figured out a way to resolve the issue, however there was a third party that completes the process for corrections and uploading to the portal for the facility. The Business Office Manager stated by not reaching out to anyone about the discrepancy caused Resident #26 to have continued dental concerns. The Business Office Manager stated it was her responsibility to speak up for Resident #26 to complete her dental services. Interview on 11/15/23 at 3:39 PM with the Social Worker revealed Social Services never received recommendations from the Dental Provider for Resident #26, therefore it was unknown that she required additional services. The Social Worker stated there was a problem with Resident #26's annual income (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 11 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0790 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few so nothing more was done after the last visit. The Social Worker stated Resident #26 would be seen tomorrow on an emergency visit while the Dental Provider would be in the facility. Interview on 11/16/23 at 11:04 AM with Social Worker revealed she received a document from the Dental Provider today (11/16/23) after she called to request information. The Social Worker stated her expectation was if there was a follow up to address pain or discomfort with a resident; that was something that should have been communicated to her directly with a phone call and email to ensure she received proper information. The Social Worker stated if then there was an issue with the resident's annual income or financials, she would have taken the issue to the Administrator to make a judgment call whether to set up payment with the sprinter or use an outside dental provider. The Social Worker stated risk to the resident caused a prolonged issue of pain and not getting timely services. The Social Worker stated she hated Resident #26 had to wait this long to be seen. The Social Worker stated she was responsible for ensuring residents were seen in a timely manner by all facility providers. Interview on 11/16/23 at 2:20 PM with the DON revealed she understood Resident #26's dental recommendations were not received to Social Services until they were requested. The DON stated, we are responsible for each resident and if there is a situation where they are having pain, issues or concerns we need to act to get them what they need. The DON stated it was her expectation if there was a problem with getting a resident seen by a provider, that issue should have been taken to the Administrator to have him address the issue. The DON stated it should not have taken this long to have Resident #26 seen by the Dental Provider. The DON stated Resident #26 was placed on an emergency visit to be seen today (11/16/23). The DON stated the facility should not have held off residents to receive services or appointments due to a financial issue, this caused Resident #26 to have continued issues with her teeth. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 12 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0880 Provide and implement an infection prevention and control program. 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 maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for three of six residents (Resident #39, Resident # 33, Resident # 385 and Resident # 336) and eight of 13 rooms (Rooms #201, #202, #203, #204, #205, #207, #208 and #209) reviewed for infection control. Residents Affected - Some 1. LVN C failed to perform hand hygiene after completion of insulin injection on Resident # 39. 2. LVN D failed to clean Resident #33's administration site with an alcohol wipe prior to giving her an insulin injection. 3. CNA J failed to use hand hygiene while passing lunch trays on the 200 hall, Rooms #201, #202, #203, #204, #205, #207, #208 and #209. 4. MA F failed to sanitize the blood pressure cuff between uses on Resident # 385 and Resident # 336. Theses failure could place residents at risk for infection and cross contamination. Findings include: 1. Record review of Resident #39's undated face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #39 had a diagnosis which included type 2 diabetes mellitus. Observation during medication pass on 11/14/23 at 10:37 AM revealed LVN C placed numerous plastic cups on a tray with alcohol wipes, lancets, a whole bottle of test strips, gloves, glucometer, and Residents #39's Novolog insulin (in a vial) and her Lantus insulin Pen -both in plastic bag on a tray. LVN C entered Resident #39's room and placed the tray of supplies on the resident's bedside table. LVN C washed her hands and put on gloves and performed a fingerstick blood sugar check. LVN C removed her soiled gloves and placed them on tray beside the insulins and the bottle of test strips and left the room to go to the medication cart outside of the door without performing hand hygiene. LVN C determined the amount of Insulin the resident required returned to the room and washed her hands and re-gloved. LVN C removed the box of Novolog insulin out of plastic bag and drew up 4 units and administered insulin to the resident. LVN C removed her gloves and placed them on the tray and without performing hand hygiene placed the insulin back in the plastic bag and placed the dirty glucometer on the tray next to the bottle of test strips. LVN C returned to the medication cart with tray of supplies, put on gloves, and pulled out a germicidal disinfectant wipe and wiped down the glucometer and placed it back in the top drawer of the medications cart without letting it dry. LVN C then removed her gloves and placed the vial of test strips without sanitizing them, the remaining alcohol wipes, lancets, and the packages of insulin and placed them back in the medications cart. In an interview with LVN C on 11/14/23 at 10:55 AM, she stated she used the various cups to keep everything separate. She stated she was supposed to sanitize her hands before and after each procedure and she did not realize she had not sanitized her hands before she had touched the computer and placed the vial of insulin back in its plastic bag. She stated she should have only taken the supplies (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 13 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0880 needed into the room to prevent the risk of cross contamination. Level of Harm - Minimal harm or potential for actual harm Record review of LVN C's competency checks, dated 09/04/23, reflected she was competent in administering subcutaneous injections, blood glucose monitoring and hand washing. Residents Affected - Some 2. Record review of Resident #33's, undated, face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #33 had diagnoses which included type 2 diabetes mellitus. Observation during a medication pass on 11/14/23 at 11:00 AM revealed LVN D entered Resident #33's room to obtain a fingerstick blood sugar. After checking the resident's blood sugars LVN D removed her gloves performed hand hygiene and checked the computer to determine the amount of insulin required. LVN D primed the insulin pen and dialed in 5 units. LNV D then administered the insulin in the resident's abdomen without first cleaning the site with alcohol disinfectant. In an interview with LVN D on 11/14/23 at 11:10 AM, she stated she was supposed to clean the site with alcohol before administering the insulin. She stated failing to do this posed the risk of introducing germs into the resident. She stated she could not believe she forgot. She stated she just got nervous. In an interview with the DON on 11/14/23 at 11:15 AM, she stated staff were not following the facility procedure if they were carrying in multiple supplies to check a resident's blood sugars. She stated they were only to carry in the necessary supplies needed to check a blood sugar, then perform hand hygiene and retrieve the required insulin and perform hand hygiene before and after giving the insulin. She stated any injection required the nurse to clean the site with alcohol before giving the injection to prevent the introduction of germs into the resident. She stated that was nerves on the nurse's part. She stated failure to follow the correct procedures placed residents at risk of blood borne pathogens as well as infections and cross contamination. Record review of LVN D's competency checks, dated 09/01/23, reflected she was competent in administering subcutaneous injections. Record review of the facility's Staff Education/Orientation Policies and Procedure titled, Infection, subcutaneous, dated July 2013, reflected, .select site for administration .Cleanse site using circular motion from center outward about 2 inches and allow to dry 3. Observation on 11/14/23 at 11:45 AM at 12:08 PM revealed CNA J on hall 200, with the food cart that was pushed to the floor (hall 200). CNA J approached the food cart and proceeded down the hall (200). CNA J did not use hand hygiene prior to touching the food cart, prior to touching food trays, or while passing out lunch trays to residents on 200 Hall. CNA J approached the food cart on the hall and proceeded to remove the food tray for rooms beginning at #201 - #213, helping to set up trays for eating and assisting residents to sit up in bed. Interview on 11/14/23 at 1:00 PM with CNA J revealed she was working through agency at the facility. CNA J stated she had not received infection control or hand hygiene in-services. CNA J stated she was aware of using proper hand hygiene, she used hand hygiene before and after entering resident rooms and during before and after resident care. Observation on 11/15/23 at 11:45 AM at 12:08 PM revealed CNA I and CNA J on hall 200, the food cart (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 14 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some was pushed to the floor (hall 200) by kitchen staff. CNA J approached the food cart and proceeded to pass out trays down the hall (200). CNA J did not use hand hygiene prior to touching the food cart, prior to touching food trays, or while passing out lunch trays to residents on 200 Hall. CNA J continued to assist on hall 200, passing lunch trays, without using proper hand hygiene. Interview on 11/15/23 at 1:05 PM with CNA I revealed she was working through an agency at the facility. CNA I state she completed training on infection control and use of proper hand hygiene. CNA I stated she was aware to use proper hand hygiene before and after entering resident rooms, before, after and sometimes during resident care. CNA I stated the facility continually expressed the importance of hand hygiene. CNA I stated it was important to use proper hand hygiene to prevent the spread of infection. Interview on 11/15/23 at 1:15 PM with CNA J revealed she was not using proper hand hygiene to pass out lunch trays. CNA J stated she knew to use hand hygiene while passing out trays, however, she was just trying to get the food trays passed out before they got cold. CNA J stated not using proper hand hygiene could spread infection and cause residents to become sick. Interview on 11/16/23 at 2:04 PM with LVN E revealed it was her expectation that staff were using proper hand hygiene, at all times. LVN E stated she was not aware CNA I was not using proper hand hygiene while passing food trays. LVN E stated she expected staff to use hand hygiene while passing food trays, before and after entering resident rooms and during resident care. LVN E stated not doing so put residents and staff at risk of spreading possible infection from one resident to another. Interview on 11/16/23 at 2:20 PM with the DON revealed all staff were to use proper hand hygiene while working. The DON stated there were several in-services completed on Infection Control and Hand Hygiene. The DON stated the last In-service was done about 2 weeks ago. The DON stated CNA J was reminded recently to ensure she was using proper hand hygiene while the state surveyors were in the facility. The DON stated it was her expectation for staff to use hand hygiene before and after entering resident rooms to prevent spread of disease and infection. The DON stated ultimately, she was responsible for ensuring staff followed facility protocols, however each staff was responsible to ensure they used proper hand hygiene at all times. Record review of the facility's policy titled, Hand Hygiene/ handwashing, dated May 2023, reflected, Hand hygiene/hand washing is done before patient/resident contact .Before taking part in a medical or surgical procedure .After contact with soiled or contaminated articles, such as articles that are contaminated with body fluids .After contact with a contaminated object or source where there is a concentration of microorganisms .After removal of medical/surgical or utility gloves 4. Record review of Resident #385's, undated, face sheet reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #38 had diagnoses which included hypertension ( high blood pressure) and urinary tract infection. Record review of Resident # 336's, undated, face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #336 had diagnoses which included heart failure and urinary tract infection. Observation during medication pass on 11/15/23 at 09:00 AM revealed MA F entered Resident #385's room to obtain her blood pressure. After performing the blood pressure reading MA F returned to the medication cart and obtained the resident's morning medications and administered them. MA F returned (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 15 of 16 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 676394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Place Rehabilitation Suites 5600 Woodlands Trail Denison, TX 75020 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to the cart and walked across the hall with the un-sanitized blood pressure cuff to take Resident # 336's blood pressure. After several attempts to get a reading, MA F went to the cart and retrieved a wrist blood cuff and obtained the resident's blood pressure. In an interview with MA F on 11/15/23 at 9:20 AM, she stated she was supposed to clean the blood pressure cuff with a germicidal wipe after each use. She stated she was trying to get Resident #336's medication to her before she went to therapy. She stated she knew she was supposed to clean all the equipment between residents to prevent the spread of infection. In an interview with the DON on 11/15/23 at 10:10 AM, she stated the staff were required to clean the equipment used after each use before using it another resident. She stated failure to do this could potentially spread germs. Record review of the facility's policy titled, Cleaning, disinfecting and sterilizing patient/resident care equipment. Dated May 2023 reflected, Equipment will be maintained and kept sanitized or disinfected in accord with acceptable polices .non-critical items are those that come in contact with intact skin but not mucous membranes. Such items include .blood pressure cuffs . Routine cleaning and disinfection of resident care equipment that is shared among residents will be completed. The items require cleaning followed by eighter low or intermediate level disinfection following manufacturer's instructions. Disinfection should be completed by an EPA-registered disinfectant labeled for use in healthcare settings . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 16 of 16