Inspection·October 22, 2025

F 0689 Level of Harm - Actual harm Residents Affected - Few with no tremors or weakness. Patient had a mishap where she was reaching for food item while cup still in hand, and spill of hot liquid occurred with burn to thigh. Therapy services suggested. Record Review of Resident #1's Treatment Administration History from 10/01/2025 through 10/21/2025 reflected, Daily wound treatment: xeroform to burn with a dry dressing daily.start date of 10/13/25. Treatment was provided daily from 10/13/25 through 10/21/25. Record Review of the facility PIR initiated on 10/13/25 reflected, .CNA A was walking down the hall to fix herself a cup of tea, Resident #1 asked her what she had, and Resident #1 asked if she could have some. CNA A went to the kitchen and made Resident #1 a half of cup of tea and took it to her. She (Resident #1) was sitting in her wheelchair.Resident #1 spilled some of her hot tea on her leg but did not realize she had spilled it until hours later when being changed.She experienced no pain according to resident.Small blister to leg of Resident #1. Contacted MD and given order to treat with xeroform (petrolatum-based gauze dressing with antimicrobial properties). Wound care physician saw as well with no new orders. Keep clean and treat with xeroform daily.Provider response.Immediate treatment to the resident. In-service to all staff regarding hot beverages given to resident, therapy did assessment on all resident that drink hot beverages, all residents to be given hot beverage by staff, no resident self-serve, hot beverage mugs with lids ordered.Post action.Beverage cups with lids provided to residents, all residents to be served hot beverages, residents not allowed to self-serve, in-service to staff. In an interview with CNA A on 10/21/25 at 9:49 a.m. she stated on 10/13/25 around 8:50 a.m. she was walking down the hall from the skilled unit to the kitchen to make herself a cup of hot tea. She stated she had two tea bags with her. She stated Resident #1 was sitting in the hallway across from the living room area with the vending machines, when she stopped her and asked her what she was doing. She stated she told Resident #1 she was going to make her some tea and Resident #1 asked her if she would make her some tea as well. She stated she went into the kitchen area where the coffee maker was located and used the hot water dispenser from the coffee maker to make the tea. She stated she made her a cup of tea and filled the second cup half full for Resident #1. She stated she handed the cup of tea to Resident #1 who was still sitting in the hallway across from the vending machines. She told the resident the tea was hot, and to be careful. She stated she knew Resident #1 very well and stated she had taken care of her often since her admission to the facility. She stated the resident had always been independent with eating and drinking. She stated she was so upset when she heard Resident #1 had spilled the tea and burned herself. She stated she should have had the resident roll to one of the nearby tables and placed the tea on the table for her. She stated since the incident she had been in-serviced, and they were instructed to never obtain hot water from the coffee maker. She stated they now have carafe of hot water and hot coffee in each of the nutrition rooms that the kitchen staff prepare for the staff to be able to serve the residents from. She stated they had been instructed on temperature checking hot liquids with the thermometer provided in the nutrition room and it was not to exceed 150. She stated the facility had provided the residents who like to carry their coffee around with lidded cups. She stated any resident who traveled with hot coffee or tea had to have a lidded cup. She stated any resident who had tremors or weakness had to have a lidded cup and they were to sit the coffee or tea down on a table for the residents. In an interview and observation of Resident #1 on 10/21/25 at 9:05 a.m. she stated last Monday (10/13/25) she was headed to the snack machine to get her a snack when one of the CNAs walked by with something that smelled so good. She stated she asked her what it was, and she told her it was tea with cinnamon. She stated she asked her if she could have some. She stated the aide told her she would make her a cup and brought her a cup of tea. She stated she does not remember how full the cup was and stated she knew the tea was hot. She stated she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 2 of 8 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 10/22/2025 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 0689 Level of Harm - Actual harm Residents Affected - Few rolled herself to the vending machine while holding her cup of tea in her left hand. She stated she placed her money in the machine and when she bent forward to get her snack out of the vending machine, she accidently tipped the cup of tea in her lap. She stated it stung for a little bit when she first did it. She stated she went on about her day and went to her room for lunch and an aide came in to help her put on some dry pants. She stated when they removed her pants her leg was red with a few little blisters, but by the next day it had blistered up and filled up with fluid. She stated the area was still puffed up, but not as much. She stated it did not hurt. She stated the staff immediately put a bandage on it and had been treating the area every day. She stated some doctor came by and looked at the area one day last week, but stated she was not sure what day that was. She stated she had not had any pain from the burn, just had generalized pain in her back and legs. In an interview with CNA G on 10/21/25 at 12:04 p.m. she stated she was the CNA assigned to Resident #1 on 10/13/25. She had gotten the resident up that morning and as usual the resident was out of her room wandering about the facility in her wheelchair. She stated the Nurse had told her the resident needed her pants changed, stating they were wet. She stated she went to the resident's room around 12:45 p.m. to change her and when she pulled the residents' pants off she noticed the reddened, blistered area on her left thigh. The resident told her she had spilled hot tea on herself. She stated she had no idea who had made her hot tea. She stated she notified the nurse immediately about the spot on the resident's leg. She stated Resident #1 was independent with eating and drinking and always ate in her room. She stated she went to the snack machine daily and would get herself a coke and chips. She stated they did receive In-service and were told they were not to prepare hot beverage that the kitchen had to make it. She stated they were also in-serviced on temperature checking any food or drink they were asked to reheat for a resident and stated they had the temperatures posted in the nutrition room and had a thermometer they were to use. She stated they also were provided with lidded cups for the residents. In an interview with LVN B on 10/21/25 at 12:20 p.m. she stated the day of the incident with Resident #1 she was in the hallway performing her blood sugar checks, when the resident rolled past her in the hall around 11:30 a.m. She stated the resident told her she had a spill and was headed to her room to get changed and get ready for lunch. She stated she never said anything about spilling hot tea or indicated she was in pain. She stated she did not have a cup in her hand at that time. She stated the resident always ate all of her meals in her room but stated after her meals she wheeled about throughout the facility and frequently went to the vending machine for cokes and chips. She stated the CNA alerted her about the red spot on her leg and she went to assess it. She stated she alerted ADON A and she came and assessed it as well. She stated this was when the resident told them she had spilled hot tea on herself. She stated since the incident they implemented several changes. She stated they were screening any resident who had tremors, vision impairments, behaviors and weakness to determine who needed to have lidded cups for hot beverages and supervision. She stated nursing staff had to serve the residents their beverages and residents cannot self-serve coffee in the dining room. She stated the kitchen brings fresh coffee and hot water three times a day to the nourishment room, and only the staff have access to those rooms. She stated they were discouraged from reheating any coffee, instead pour fresh. For reheating food, they have a thermometer to be able to check the temperature. She stated the food temperature was not to exceed 160 degrees and any resident who had been deemed independent and wanted to carry their hot beverage with them had to be in a lidded cup or travel mug with a lid. In an observation on 10/21/25 at 9:15 a.m. LVN E prepared wound care supplies for Resident #1's wound care. LVN E performed hand hygiene, put on gown and gloves and entered Resident #1's room to provide wound care. LVN E assisted the resident to a standing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 3 of 8 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 10/22/2025 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 0689 Level of Harm - Actual harm Residents Affected - Few position to pull down her pants, revealing a dressing on the upper portion of her left thigh right below her brief line. LVN E removed the old dressing revealing a fluid filled blister approximately the size of a half dollar on her left upper thigh. There was no redness noted surrounding the blister. LVN E performed hand hygiene, put on clean gloves and cleaned the blister with wound cleanser and applied xeroform gauze and covered with dry dressing. The resident did not express any pain or show signs of pain during the procedure. In an interview with LVN E on 10/21/25 at 9:25 a.m. she stated she was not working on the day of the incident with Resident #1. She stated Resident #1 was independent with eating and drinking and always ate her meals in her room. She stated she wheels herself in her wheelchair throughout the facility most of the day and returns to her room for meals. She stated since the incident they had received in-service which required the staff to pour coffee or hot water from the carafe provided from the kitchen. She stated the carafes were stored in the nutrition rooms and only the staff had keys to the nutrition rooms. She stated they were also instructed that any resident who traveled with their hot beverage had to have a lidded cup. She stated if food or beverages were reheated in the microwave they had to check the temperature prior to giving it to the resident. She stated hot coffee was not served if it was over 150 degrees. In an observation and interview with CNA A of the nutrition room on the skilled unit side of the facility on 10/21/25 at 9:55 a.m., two carafes were revealed. One was labeled coffee the other was labeled hot water. CNA A retrieved the thermometer, wiped it with an alcohol wipe and tested the carafe with coffee which registered 139 degrees. She wiped the thermometer with another alcohol wipe and tested the carafe with hot water which registered 150 degrees. She stated they do not reheat coffee for residents but instead get them a fresh cup of coffee. She stated the kitchen replenished the coffee carafes three times a day or when they run out they will go to the kitchen to have them fill the carafes. In an interview and observation with the Dietary Manager on 10/21/25 at 10:05 a.m. the kitchen area was revealed to be divided. The entrance contains a commercial coffee urn. Observation of the twin coffee brewing system revealed between the two coffee tanks was a hot water dispenser. The coffee brewing system had 3 settings, high, medium and low. The system was set on medium. Interview with the Dietary manager revealed this had been the setting the machine had been set on upon its installation, which was a top setting of about 175 degrees, which was needed to brew coffee. She stated the kitchen staff had always filled the coffee carafes for serving on the halls and the dining room for the residents. She stated they had very few residents who drank hot tea, but if they requested the kitchen staff would make it, and temperature check before giving it to the staff. She stated she had been here 10 years, and they had never had a Hot-beverage incident. She stated since the incident the nursing staff had assessed all of the residents who had dementia, tremors, behaviors, poor vision and poor hand control and they were provided with a list of those residents. She stated those residents had to have a lidded coffee mug for hot beverages. She stated she went one step further and for all the hall trays they all had lidded coffee mugs. She stated they only use open coffee cups in the dining room under supervision and if the resident had been deemed safe with hot beverages. She stated they also had stopped setting the coffee carafes out for the residents to self-serve. She stated staff had to serve the residents. She stated her staff temperature check the coffee carafes before putting out for service. She stated carafes will cool off about 10 degrees. She stated they brew coffee at least three times a day. She stated the first pot was brewed at about 5:30 a.m. for breakfast so by the time they start plating for breakfast the coffee has cooled. In observation of the long-term care unit's nutrition room with ADON C on 10/21/25 at 11:10 a.m. revealed signs posted for the correct serving temperature for any food and drink to be reheated in the microwave. Temperatures for food were not to exceed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 4 of 8 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 10/22/2025 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 0689 Level of Harm - Actual harm Residents Affected - Few 160 degrees and drinks 150 degrees. ADON C wiped the thermometer with an alcohol wipe, poured a cup of coffee and tested the temperature. The coffee registered 130 degrees. She stated they had sent for a carafe of hot water and stated the kitchen would replenish the carafes around lunchtime. Observation of the long-term care dining room on 10/21/25 at 11:15 a.m. revealed CNA F serving drinks to the resident prior to lunch service. Two residents were observed with lidded coffee mugs. CNA F went into the kitchen serving area to refill one of the residents' coffee mugs from a coffee carafe. ADON A temperature checked the carafe, and it registered 130 degrees. Hall carts for hall 100 and Hall 200 were also being loaded. The coffee carafes were filled. Temperature checks completed by ADON A on hall cart 200 registered 143.8 degrees. Hall 100 registered 141 degrees. In an interview with CNA F on 10/21/25 at 11:25 a.m. she stated they had all been in-serviced about the new process for serving hot beverages. She stated they were not allowed to make any resident a hot beverage, but instead the kitchen had to make it to make sure it was the correct temperature. She stated they had also moved the coffee carafes out of the dining room, and they had to serve the residents their coffee. She stated they had been instructed to have any resident who had behaviors, tremors, weaknesses, or poor vision had to have a lidded cup and be supervised. She stated they were to place the coffee on the table away from the edge of the table for any resident they served a hot beverage too. She stated for residents who like to wheel around or want to take their coffee with them they had to place it in a lidded cup. She stated a lot of those residents have their own lidded coffee mugs. In an interview with ADON A on 10/21/25 at 11:30 a.m. she stated the day of incident with Resident #1 she was alerted by LVN B about the burn to the resident's leg. She stated she went to assess the area and stated it was slightly red with some small, raised blisters. She stated the resident told her she had spilled her hot tea on herself. She stated they first thought she had just gotten the hot tea but later found out it was much earlier in the day, and she had not said anything to anyone. She stated she immediately called the doctor and received treatment orders, notified the family and notified the DON. She stated they started reviewing the incident and immediately stopped the staff from preparing any hot beverages for a resident. She stated they started in-servicing right away. She stated therapy evaluated the at-risk residents to determine who was safe with hot beverages. She stated they had always had coffee carafes in the nutrition room for the residents use, but now the rooms were locked, and the staff had to serve the residents and ensure the temperature was checked. She stated they also posted the safe temperatures for reheating food or drinks. She stated food did not exceed 160 degrees and hot beverage 150 degrees. She stated any resident who was alert and wanted to take their coffee with them had to have a lidded cup or travel mug with a lid. She stated they had several residents who liked to take their coffee with them as they went around the facility. In an interview with the Maintenance Director on 10/21/25 at 11:40 a.m. he stated the facility's commercial coffee maker had always been set on its lowest setting that will effectively brew coffee. He stated the water tank only keeps water warm so when they start brewing it does not have to heat cold water. He stated the water will heat up during the brewing process. He stated the hottest temperature test he had found was when the water was going into the brewing basket and it registered at 175 degrees. He stated they had always had it set to the midpoint and never to the high point. He stated he tested the hot water holding tank the day of the incident it was testing at 135 degrees when he tested it. He stated the temperature will fluctuate when the machine starts to brew coffee but will then decrease after the brewing process was complete. He stated it depended on the timing of when you get hot water out of it and on what the temperature will be. A second observation on 10/22/25 at 8:35 a.m. of the coffee brewing system with the Dietary manager revealed the right coffee pot had been brewed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 5 of 8 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 10/22/2025 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 0689 Level of Harm - Actual harm Residents Affected - Few approximately 15 minutes earlier. The Dietary manger drew up a cup of coffee directly from the brew station and the temperature check registered 150.9 degrees. The left coffee pot was brewed approximately an hour ago and the temperature check registered 149 degrees. A cup of hot water was poured from the holding tank, and it registered 135.5 degrees. The Dietary manager stated this was the range of temperatures they were getting each time they tempt the coffee and water. She stated their policy was coffee was to be consumed at temperatures between 155 to 175 degrees. She stated powdered creamer will not dissolve in coffee below 150 degrees. In an interview with Occupational Therapist D on 10/22/25 at 11:15 a.m. she stated she had provided therapy to Resident #1 several times since her admission to the facility. She stated she never had any issues with upper or lower range of motion and had always been independent for eating and drinking. She stated her main issues were poor core strength and balance when standing or ambulating. She stated it was simply a fluke accident. She stated she re-screened her after the incident and there were no changes from her previous base line. She stated the facility had them screen all residents with dementia, ataxia (lack of muscle control and balance) tremors, rheumatoid arthritis (causes inflammation and damage to the joints) and decrease range of motion for hot liquid safety. She stated any of those residents would require a lidded cup and supervision while drinking. She stated any resident who wanted to travel with their hot beverage would also need a lidded cup. In an interview with the DON on 10/22/25 at 12:05 p.m she stated CNA A was given a verbal warning for getting hot tea for a resident without checking the temperature. She stated secondly, she should had never hand the resident hot tea while in her wheelchair and should have taken it to her room for her or placed it on a nearby table. She stated Resident #1 was independent with eating and drinking. She stated the CNA was simply providing the resident with what she asked for but stated should have thought it through. She stated it was a pure and simple accident. She stated the resident never alerted them until hours later she had spilled hot tea on her. She stated they did have the wound care physician evaluate her and he would continue to see her until the area was healed. She stated all the staff were told to immediately stop preparing any hot beverage for residents and only have the kitchen staff prepare it. She stated they told the staff they were to serve the residents coffee or obtain hot water from the carafes the kitchen staff provided, because they had been temperature checked for safety. She stated they had placed thermometer and safe temperature notices in the nourishment rooms in case the staff were reheating food and drinks, and they had all been in-serviced on checking temperatures and knowing the appropriate temperature for food and coffee. She stated the Dietary Manager had conducted in-service and training with all the dietary staff. She stated they also screened and updated resident's care plan for resident who required a lidded cup for hot beverages. She stated they met with all of the alert residents and informed them going forward the staff would have to serve them coffee instead of them having access to the coffee carafes. She stated any alert resident who wanted to go around the facility with their coffee also had to have it in a lidded cup or lidded travel mug. She stated several of the residents had their own coffee mugs with lids. In an interview with the Administrator on 10/22/25 at 07:55 p.m. He stated the incident with Resident #1 was the result of CNA A preparing her a cup of tea and not knowing how hot it was. He stated they immediately stopped all the nursing staff from preparing any hot beverage for a resident, and instead were instructed to request if from dietary, so they can properly test the temperature. He stated the coffee was checked by kitchen staff every time they put it into the carafes and was to be within the proper temperature range and staff were to ensure when poured it did not exceed 150. He stated staff were instructed to lock the nourishment rooms because they were expected to serve the residents anytime they requested coffee. He stated they had also implemented lidded (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 6 of 8 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 10/22/2025 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 0689 Level of Harm - Actual harm Residents Affected - Few cups for all of the residents that ate on the hall and any resident who wanted to move about the facility with their coffee had to have it in a lidded cup. He stated in the 10 years he had been here this was the first and only hot liquid burn they had. He stated it was just an unfortunate accident, but stated he felt with all the measures they had put in place it should never happen again. He stated they had an Ad-hoc QA meeting with the Medical director on 10/14/25 and reviewed their mitigation plan. He stated they covered every possible scenario and had put measure in place to ensure all staff were aware of safe temperatures and safe interventions to prevent future accidents. Record review of the facility's Nutrition Policies and Procedures Guidelines to Reduce The Risk of Burns From Hot Beverages revised August 2020, reflected, Precautions shall be implemented to limit the risk of burns from hot beverage (coffee, tea, etc.,) .Hot beverages should be consumed at temperatures between 155 degrees Fahrenheit and 175 degrees Fahrenheit. Palatability is affected by temperature and varies from person to person.Pots or urns containing hot liquids should not be left unattended. Facility staff should pour all hot beverages. Locations where hot beverages may be prepared and/or reheated such as employee break rooms or nourishment rooms should be safeguarded. Patients or residents should not carry hot beverages without a lid while walking or moving in a wheelchair.When serving hot beverages to patients or residents: Transfer the beverage from its brewing urn to a serving container. Beverages served directly from the brewing urn will be hotter. Do not overfill cups. Explain to the patient/resident that a hot beverage is being served. Place cup away from the edge of the table and within patient's/resident's field of vision and reach of dominant hand. Remove lids to allow beverage to cool faster.When serving hot beverage to patients or resident with behaviors or medical conditions that put them at risk for spills.Evaluate the patient's/resident's ability to manage hot beverages independently. Provide assistance and/or supervision as needed. Consider providing a lid for the coffee cup or a travel mug. Allow hot beverage to coo before serving. Ensure all appropriate staff is aware of those residents need supervision. Patients/resident who may be at greater risk may include, but are not limited to, those with: Tremors, Poor hand Control, Visual Impairments, Behavioral issues. The facility implemented the following Mitigation plan on 10/14/25-1. Hot beverage injury has been thoroughly investigated by facility administration. 2. Treatment was ordered and implemented3. An updated list of Residents who drink coffee/hot liquids was proved to Dietary Department for reference. List will be updated weekly. 4. Resident that consumes hot beverages while mobile throughout the facility have the potential to be affected by this alleged deficient practice.5. Skin audits of residents that consume hot liquids from dispenser were completed by the Licensed Nurses: no other concerns were identified.6. Facility will have additional cups with lids on hand for residents who are identified as at risk for hot spills.7. A Therapy referral was initiated for the affected Resident for adaptive equipment and management of eating/drinking ADLs.8. A Therapy referral will be initiated for any resident that may be at risk for hot beverage spills. 9. CSD provided education to Administrator, DON and Dietary Manager on appropriate notification if there is a hot liquids injury identified. Also, procedures for proper temping of hot liquids and keeping hot liquids in a secured locations available to resident with assistance from staff. 10. Licensed nurses and certified nursing assistants and Dietary Manager and dietary staff were re-educated regarding serving hot liquids for those residents that normally use the carafes to obtain hot liquids in cups with lids and stored in nourishment room where they must get assistance from staff t pour hot liquids. 11. This re-education will be completed by 10/14/25. Any Staff member not receiving this re-education by this date will receive prior to next scheduled shift. This will be provided for agency staff and new hire orientation. 12. The Administrator or Designee will validate that residents who desire hot liquids and are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676394 If continuation sheet Page 7 of 8 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 10/22/2025 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 0689 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete mobile through the facility have hot liquids in a cup with a lid and hot liquids is available in nourishment room with assistance from staff for 5 days and then weekly for 3 months and re-evaluate for further supervision if needed. 13. Ad-hoc QA with Medical Director, Administrator, and DON was conducted on 10/14/25. Record review of in-services dated 10/14/25 reflected the Administrator, DON, ADON C and the Dietary Manager were in-serviced by the Clinical Service Director on the facility's Nutrition Polices to reduce the risk of Burns from hot beverages. Record review of in-services dated 10/14/25 reflected the Nursing staff were in-serviced by the DON on the facility's Nutrition Polices to reduce the risk of Burns from hot beverages. Record review of in-services dated 10/14/25 reflected the Dietary staff were in-serviced by the Dietary Manger on the facility's Nutrition Polices to reduce the risk of Burns from hot beverages. Record review of the Coffee Temperature log, for October 2025 reflected Temperatures were taken at breakfast, lunch, and dinner. Temperatures were within the facility guidelines for transfer to serving pots. Record review of the facility's Quality Assurance meeting minutes reflected an AD Hoc meeting was held with the Medical Director, Administrator, DON, Dietary Manager, and ADON's on 10/14/25 about the mitigation plan for hot beverages. Record review of the resident roster list provided to the dietary department on 10/14/25 and 10/21/25 indicated which residents were high risk travelers for hot beverages and residents who had vision, tremors, poor hand control and behaviors. Record review of CNA A personnel file reflected she received a verbal warning and education from the DON on 10/14/25 to always have dietary prepare hot beverages for residents, ensure the beverages were placed safely on a table to prevent the potential for a spill. In interviews covering all three shifts (6 AM- 2PM, 2 PM-10 PM, and 10 PM- 6 AM), revealed they had been in-serviced that all hot beverages had to be prepared by the kitchen staff. Hot beverage was to be served by the staff from carafes provided by dietary. All hot beverages were stored in the nutrition room under lock and key and only staff could pour hot liquids for residents. Staff were in serviced on ensuring mobile residents who were independent with food and drink had a travel mug with a lid in use with hot beverages. Staff were taught any resident with vision impairment, tremors, weakness, or behaviors required a lidded cup and supervision while consuming. Staff were also trained on appropriate temperature for reheating of food and coffee. Food 160 degrees and Coffee 150 d Event ID: Facility ID: 676394 If continuation sheet Page 8 of 8