Health inspection·February 15, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 02/13/23 at 3:06 PM, the family member revealed Resident #3 had a pressure ulcer on her coccyx. The family member reported they had not seen her get a shower when they had been there, but there were 4 in her family that came up and sat with her. The family member said she would generally brush Resident #3's hair and had noticed it felt dirty, so they were wondering if Resident #3 had been getting bathed. They also stated they were going to call the other family members to ask if anyone had seen Resident #3 get bathed. The family member came by later that day and said they had reached 3 of the 4 other family members and none of them had ever seen Resident #3 get bathed. Review of Resident #3's EMR reflected no refusals of ADL care for January or February 2023. Review of Resident #3's bathing EMR documentation from 01/27/23 to 02/15/23 reflected Resident #3 received showers Tuesday, Thursday and Saturdays on the 6:00 AM to 2:00 PM shift, so Resident #3 should have received a total of eight showers. The EMR documentation reflected she received showers on the following days: -01/31/23 -02/07/23 -02/14/23 There was no documentation of showers given for Resident #3 on the following days and were marked NA for Not Applicable or left blank. -01/28/23 -02/04/23 -02/09/23 -02/11/23 Resident #12: Review of Resident #12's face sheet , dated 02/15/23, reflected a [AGE] year-old woman, admitted to the facility on [DATE] with diagnoses of dislocated left elbow joint, history of falling, morbid obesity, respiratory failure, muscle wasting and atrophy, cognitive communication deficit, degeneration of vertebral discs in her lower back, bipolar disease, depression, and end-stage renal disease. Review of Resident #12's admission MDS assessment, dated 01/31/23, reflected a BIMS of 12, indicating moderate cognitive impairment. Further review of the MDS reflected Resident #12 had no psychosis or behaviors (including refusal of care) during the past seven days. Resident #12 was always incontinent of bowel and bladder. Resident #12 only transferred once or twice, with the assistance of two people, and required extensive assistance of one person for dressing, and moving around in her bed, and extensive two-person assistance for toilet use, and personal hygiene. She was totally dependent, with one-person assistance for bathing. She required help from one person for part of her bathing activity. The assessment indicated Resident #12 answered that choosing between a tub bath, shower, bed bath, or sponge bath ranked as very important to her while in the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Review of Resident #12's care plan, dated 01/23/23, reflected she had limited mobility due to weakness, and had a goal of remaining free of complications related to immobility, including contractures, thrombus (blood clot) formation, skin breakdown, and fall related injury. I interventions included providing supportive care, assistance with mobility as needed, and documenting assistance as needed. Careplans did not reflect specific information about Resident #12's bathing, or any behaviors of refusing bathing. Residents Affected - Some Review of Resident #12's care plan, dated 02/07/23, reflected she had a behavior of removing her left arm splint, and telling staff therapy removed it. Review of Resident #12's care plans, current as of 02/14/23, reflected no refusals of bathing or other care, or specific information about Resident #12's bathing. Review of Resident #12's progress notes from 01/25/23 through 02/15/23 reflected mild cognitive impairment, with memory loss, and some confusion, occasional tearful and anxious behavior, and an unwanted behavior of removing her splint from her left arm, but no notes regarding bathing. Review on 02/14/23 of the ADL (Activities of Daily Living) task for bathing in Resident #12's EMR (Electronic Medical Record) reflected the resident's scheduled bath times were on Tuesdays, Thursdays, and Saturdays, during the 6:00 AM to 2:00 PM shift, so Resident #12 should have received a total of nine showers. The record reflected the following documentation on scheduled bath days: 01/26/23- received bathing 01/28/23- no documentation 01/31/23- no documentation 02/02/23- not applicable 02/04/23- not applicable 02/07/23- received bathing 02/09/23- not applicable 02/11/23- not applicable 02/14/23- resident not available Observation and interview on 02/13/23 at 11:17 AM, revealed Resident #12 was tearful, moaning, and was in pain. She stated she could not talk to the surveyor, but if her husband was there, he could talk, but he was dead. When asked if we could talk later in the day, when she felt better, Resident #12 shook her head to indicate she did not want to. On this observation, her hair appeared oily or wet, and sticking up from her head in some areas. Observation on 02/13/23 at 12:19 PM, of Resident #12 revealed her to be sleeping soundly, and her hair to appear the same as earlier observation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation and interview on 02/15/23 at 12:58 PM, revealed Resident #12 awake in bed, and agreeable to an interview, but confused, and giving delayed and irrelevant answers at times. She said she was waiting for a shower until she got to her next place and could not go into the shower because she would fall. She said the staff gave her 20 baths a day and wiped her in her bed, and that they used to spray her with the hose. When asked if anyone had washed her hair, she did not confirm or deny, but said she would like a shower, and for someone to wash her hair. Her hair appeared oily and mussed, the same as on earlier observations. Resident #24 Review of Resident #24's admission record dated 02/15/23 reflected an [AGE] year-old woman, admitted to the facility on [DATE] with diagnoses of acute respiratory failure, epilepsy and epileptic syndrome (types of seizures, age at which the seizures began, causes of the seizures), age-related physical debility, need for assistance with personal care, dependence on renal dialysis, atrial fibrillation (an irregular or rapid heart rate), multiple myeloma (a cancer of plasma cells), hypertensive heart disease, anemia (blood does not have enough healthy red blood cells), unspecified osteoarthritis, renal and perinephric abscess and acute kidney failure (a collection of pus that occurs due to a bacterial infection in the perinephric fat and fascia surrounding the kidney). Review of Resident #24's admission MDS assessment, dated 01/04/23, reflected a BIMS of 14, indicating she was cognitively intact. Further review of the MDS reflected Resident #24 had no psychosis or behaviors (including refusal of care) during the past seven days. Resident #24 required extensive assistance of one person for transfers, and toilet use. She also required limited assistance of one person for personal hygiene, dressing and that bathing had not occurred over the entire 7-day period. Review of Resident #24's care plan, dated 01/19/23, reflected she had an ADL Self-care Performance Deficit due to impaired balance. The goal included she will maintain the current level of function through the review date (04/19/23). Interventions included Bathing: check nail length and trim and clean on bath day, and as necessary. Report all changes to nurse. Provide sponge bath or shower as tolerated. The resident requires limited to extensive assist by 1 staff with showering as necessary. Review of Resident #24's EMR reflected no refusals of ADL care for January or February 2023. An observation and interview on 02/13/23 at 11:27 AM Resident #24 was up in a WC in her room, dressed and appeared well groomed. When asked about showers/baths she stated she had one shower since she had been there and had a bed bath yesterday (02/12/23). She stated when she would ask for one staff would say she could not have one today. She had been there since 12/29/22 and only had one shower. She said most of the time she had diarrhea and that lately it was watery diarrhea that hurt when she had it. Review of Resident #24's bathing EMR documentation from 12/29/22 to 02/15/23 reflected Resident #24 received showers/baths on the 6:00 AM to 2:00 PM shift (it did not specify any certain days, so it was undetermined exactly how many showers Resident #24 should have received, but approximately ten) and received a bath or shower on the following days: -01/24/23 -01/28/23 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 -02/14/23 Level of Harm - Minimal harm or potential for actual harm There was no documentation of showers given for Resident #24 on the following days and were marked with an X -01/01/23 through 01/12/23. The EMR further reflected she did not receive any assist due to being hospitalized from [DATE] through 01/19/23. Residents Affected - Some Per the EMR, there was no documentation of showers given for Resident #24 on the following days and were marked NA for Not Applicable, or left blank. -01/21/23 -01/26/23 -01/31/23 -02/02/23 -02/04/23 -02/07/23 -02/11/23 Resident #27: Review of Resident #27's face sheet dated 02/15/23 reflected an [AGE] year-old man, admitted to the facility on [DATE], with diagnoses of fractured vertebra, history of falling, muscle wasting and atrophy, leukemia, aphasia , heart failure, stroke, depression, and macular degeneration . Review of Resident #27's admission MDS assessment, dated 01/23/23, reflected a BIMS of 10, indicating moderately impaired cognition. Further review of the MDS reflected Resident #27 had no psychosis or behaviors (including refusal of care) during the past seven days. Resident #27 was frequently incontinent of bowel and bladder. Resident #27 required extensive assistance of one person for moving in bed, and using his wheelchair and the toilet, and for hygiene. He required extensive assistance from one person for transferring, and limited assistance of one person for dressing. Resident #27 did not bathe during the past seven days. The assessment indicated Resident #27 answered that choosing between a tub bath, shower, bed bath, or sponge bath ranked as very important to him while in the facility. Review of Resident #27's care plan, dated 01/16/23 reflected he had an ADL Self-care Performance Deficit due to vertebra fracture. The careplan goal was to improve his current level of function in ADLs. Interventions included the resident was totally dependent on one staff to provide a shower on shower days three times a week, and as necessary. Resident #27's careplans did not reflect any behaviors of refusing bathing. Review of Resident #12's progress notes from 01/16/23 through 02/13/23 reflected various levels of confusion, high fall risk and actual falls, and reflected no pattern of refusals of bathing. Review on 02/13/23 of the ADL task for bathing in Resident #27's EMR reflected the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm scheduled bath times were on Mondays, Wednesdays, and Fridays during the 2:00 PM - 10:00 PM shift, during which period Resident #27 should have received thirteen baths. The record reflected the following documentation on scheduled bath days: 01/16- no documentation Residents Affected - Some 01/18- no documentation 01/20- no documentation 01/23- no documentation 01/25- no documentation 01/27- received bathing 01/30- received bathing 02/01- not applicable 02/03- received bathing 02/06- received bathing 02/08- resident refused bathing 02/10- received bathing 02/13- not applicable An interview and observation on 02/13/23 at 3:35 PM, revealed Resident #27 was up in a chair, and his wife sitting next to him. Resident #27 nodded sometimes to answer questions but was unable to have a conversation with the surveyor. He appeared clean, and fully dressed. Resident #27's wife said that since the resident admitted on the 16th, she had been there nearly 24/7. She said that when they arrived, there was no orientation about the rules, and nobody told her about the bath schedule, so she did not know when he was eligible to take a bath, and did not know to ask, because the staff were always changing. She said he had been in the facility approximately 14 days with no bathing, and she finally spoke with the DON about it, and he was then provided a bed bath. She said after that, he went a long time again without a bath, and she appealed to one of the CNAs who took good care of him, even though it was not her shift and she bathed him on her shift. Resident #38 Review of Resident #38's admission record, dated 02/15/23, reflected a [AGE] year-old man, admitted to the facility on [DATE] with diagnoses of wedge compression fracture (small breaks or cracks in the vertebrae) of the 3rd lumbar vertebra, history of falling, muscle wasting and atrophy (waste away), other symbolic dysfunction (social impairment), cognitive communication deficit, hypertensive heart disease, benign prostatic hyperplasia (age-associated prostate gland enlargement that can cause urination difficulty), retention of urine, calculus of kidney and cerebral infarction (stroke (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 occurring as a disrupted blood flow to the brain). Level of Harm - Minimal harm or potential for actual harm Review of Resident #38's admission MDS assessment, dated 01/17/23, reflected a BIMS of 10, indicating moderate cognitive impairment. Further review of the MDS reflected Resident #38 had no psychosis or behaviors (including refusal of care) during the past seven days. Resident #38 required total extensive assistance of one person for transfers, dressing, toilet use, and personal hygiene. It further reflected that bathing did not occur the entire 7-day period. Residents Affected - Some Review of Resident #38's care plan, dated 01/11/23, reflected he had a self-care deficit performance related to pain and compression fracture. The goals included he will improve the current level of function in ADLS through the review date (04/24/23). Resident will be able to perform ADLS with supervision. Interventions included Bathing: check nail length and trim and clean on bath day, and as necessary. Report all changes to nurse. Review of Resident #38's care plans, current as of 02/15/23, reflected no refusals of care, or other behavioral issues. Observation on 02/13/23 01:54 PM, revealed Resident #38 up in a WC, in his room, dressed and appeared well groomed, and had a family member visiting. An interview on 02/13/23 at 1:54 PM with Resident #38's family member revealed no one had helped him or even suggested to brush his teeth and she had only realized it the previous day so they had helped him. They further revealed he had been there 2 months and had only one shower since he was there. They said he was treated with respect, no roughness or meanness, just not much help. Review of the undated bathing schedule reflected Resident #38 was scheduled to be bathed on Mondays, Wednesdays, and Fridays, on the 6:00 AM to 2:00 PM shift. Review of Resident #38's bathing EMR documentation from 01/11/23 - 02/15/23, during which time Resident #38 should have received an estimated 15 baths, reflected: -Resident #38 received bed baths or showers on 01/11/23, 01/13/23 and 01/16/23. There was no documentation of showers given for Resident #38 on the following days and were marked NA for Not Applicable or left blank. -01/18/23 -01/20/23 -01/23/23 -01/25/23 -01/27/23 -01/30/23 -02/01/23 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 -02/03/23 Level of Harm - Minimal harm or potential for actual harm -02/06/23 -02/08/23 Residents Affected - Some -02/10/23 -02/13/23 -02/15/23 Resident #40: Review of Resident #40's face sheet, dated 02/15/23, reflected a [AGE] year-old female, admitted on [DATE] with diagnoses of stroke, diabetes, muscle wasting and atrophy, heart disease, and osteoarthritis. Review of Resident #40's admission MDS assessment, dated 02/01/23, reflected a BIMS score of 13, indicating intact cognition. The assessment reflected no behaviors, or indicators of psychosis. Resident #40 required extensive one-person with bed mobility, dressing, and toilet use. She required extensive two-person assistance with hygiene, and total assistance of one person for bathing. Resident #40 was frequently incontinent of bladder, and always incontinent of bowel. The assessment indicated Resident #40 answered that choosing between a tub bath, shower, bed bath, or sponge bath ranked as very important to her while in the facility. Review of Resident #40's care plan, revised 01/25/23, reflected she had an ADL self-care performance deficit related to right sided weakness from a stroke, with a goal of improving her current level of function in ADLs. The interventions included the resident was totally dependent on staff for staff to provide showers three times a week, and as needed. Careplan documentation reflected no refusals of bathing. Review on 02/13/23 of the ADL task for bathing in Resident #40's EMR reflected the resident's scheduled bath times were on Tuesdays, Thursdays, and Saturdays, during the 6:00 AM to 2:00 PM shift. During the period reviewed, Resident #40 should have received eight baths. The record reflected the following documentation on scheduled bath days: 01/26- no documentation 01/28- received bathing 01/31- no documentation 02/02- not applicable 02/04- no documentation 02/07- not applicable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 02/09- not applicable Level of Harm - Minimal harm or potential for actual harm 02/11- received bathing Residents Affected - Some Review of Resident #40's progress notes from 01/25/23 through 02/14/23 reflected the resident was normally alert and oriented 2-3 with some confusion, and isolation precautions for a urinary tract infection. The notes did not reflect any refusals of bathing or other care. Review of Resident #47's face sheet, dated 01/26/23, reflected a [AGE] year-old man, admitted on [DATE], and discharged to his home on [DATE], with a primary diagnosis of a broken femur. Review of a facility Grievance Resolution Form, dated 01/26/23, reflected a grievance form for Resident #47. He had a concern that he had not received a shower during his stay and wanted to get one prior to his discharge. The resolution was the resident received a shower on 01/27/23. Review of the ADL bathing documentation of Resident #47 for the period of his stay reflected no bathing documentation for the entirety of his stay. An interview and observation on 02/13/23 at 2:00 PM revealed Resident #40 was on isolation precautions for a urinary tract infection, and she stayed in bed. She said she was not feeling very good that day, and her memory was not very good, and the surveyor should speak with her daughter about details, because she could not remember dates. She said she got a bath when she first arrived, then she did not get one for a while, because of the ice storm (referring to a weather event occurring the week of 01/30/23 through 02/03/23) causing staffing problems. She said they told her it would get better after the storm, and it was some better than it was at first, but she felt she only got about one bed bath a week. She said if the staff offered baths, she accepted most times. She said it depended on which staff was working, whether she got a bath, or had to wait to get changed. She said her daughter complaint to the Administrator and it did get some better after that, but she still did not think she was getting three baths per week. An interview on 02/13/23 at 2:23 PM with the family member of Resident #40 revealed the family's main concern regarding bathing was that the resident was in the facility for at least four days before she received a bath. She said it was not explained to the resident, or to the family, that there was a bath schedule, until another relative contacted the Administrator, and complained that the resident was being neglected. She was not sure if the resident was currently getting baths on schedule. In a confidential group interview on 02/14/23 at 12:03 PM, one resident stated she did not ask to get bathing for approximately three weeks after she was admitted , and nobody offered, so she did not get any. She said she did not know to ask for one, and was not aware that there was a schedule. She said she did not blame the staff, because they were so busy, and there were real sick people there, and she felt staff had to prioritize them. She said they gave her a bath during the week of this interview, and It makes you feel so much better to be clean. I even washed my hair! Another resident stated when she was admitted , she was not offered a shower for several days (she did not know how long), and not informed of the process or schedule for getting one. When she felt she needed one badly enough, she decided to ask for one. She said it was at night, and the staff member turned the water on for her, and left her alone to shower herself, but the floor was flooded, and she was scared about falling. She said she very quickly showered herself, and turned the water off, and did not ask again. She said she had received showers since, and a staff member stayed with her, but at first she was on her own. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An interview on 02/15/23 at 1:11 PM with the DON revealed the facility did not have a policy on ADLs, but she provided the bathing procedures. She said they had realized they had a problem with the documentation on bathing, and all of the missing dates were related to agency staff. They provided the logins for them, and oriented them all, and she even told her staff to remind them to do ADLs, but with agency staff, they had a lot of problems with accountability, and they worked hard to get agency staff out of the building. They had a lot of new staff at the time of this interview, after trying to get rid of agency staff for over a year, finally sometime during the week of 02/05/23-02/11/23 they had eliminated agency staff use. She said sometime during January was the worst time they had with the agency staff, and documentation. The DON stated she did speak to Resident #27s wife about procedures at the facility after he admitted , but his wife came to her later, and did not remember having that conversation. She said his wife had talked to her about many concerns but had never mentioned any concerns regarding his ADL care. She said she thought it was in early January when she noticed a change for the worse in agency documentation and expressed her significant frustration about being cited for this issue when she thought they had already fixed the problem. She stressed how difficult it had been to deal with agency staff and said that she could not intervene with problems when she was not told about them, and she had not been made aware that residents were having problems with bathing by any of them. She said they had gone through the QAPI (Quality Assurance and Performance Improvement) process, and were still looking at it, but she felt agency staff was the problem and they had fixed that. She said Resident #12 did not want to get up at all, and the staff bathed her, but she presented a very short time window for any care, because she would be fine at first, then start screaming and want them to stop. She said because they did short-term only, they had a very high turnover, and the type of residents they had at one time might be drastically different from what they had the next month. An interview on 02/15/23 at 1:58 PM with CNA A revealed she only had worked in the facility for a few days, and there was a paper at the nurses' station with the resident shower schedule on it, which had the shift, and the room number, so they would know what day and shift a resident was scheduled for bathing. She said she did not think the residents seemed like they were lacking bathing, except Resident #12, who had an odor sometimes, and refused her bathing. She said she documented the bathing task in the EMR, where it had the bath days for that resident. She said if nobody documented on a bath day, it would turn red. She said the only times she used not applicable was when the bath task was red, but their bath was scheduled on a different day. She said it was important to bathe residents to keep their skin healthy. An interview on 02/15/23 at 2:14 PM with CNA B revealed she had worked in the facility for a few months. She said she knew when residents were supposed to be bathed by what room they were in, and the bath schedule was also in PCC, where she documented how much help a resident needed, and how many people they needed, and if they refused. She said Resident #12 did not like baths, but she did what she could with her. She said usually when she was asked if she was ready for a bath, she would cry, and say she was too tired, and it was too cold. She said she would tell the nurse, and try again twice, before she documented the refusal. She said she had to catch the resident in a really good mood to even provide any care for her, and it was even difficult to do her incontinent care. She said she had given Resident #40 bed baths twice, and she was cooperative, but she had not worked with Resident #27. She said bathing was important because not doing it could cause bed sores, and emotional distress, and it was also neglect. She was not aware of problems with bathing, and if she was, she would tell the Administrator. An interview on 02/15/23 at 2:35 PM with CNA C revealed that when asked about each resident surveyors found with bathing problems, she said they were not on her hall. She said the EMR told her when a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm resident needed bathed, and she bathed them in the shower in her room, or a bed bath, depending on what the resident needed and wanted. She said if they refused, she told the nurse, made three attempts, and documented the refusal. She said she had not noticed residents looking like they had not been bathed, and if she did, she would bathe them if it was her resident, or notify their nurse and CNA. CNA C said she only used not applicable when it was not the resident bath day. Residents Affected - Some An interview on 02/15/23 at 2:44 PM with CNA D revealed she did work with Resident #38, and he refused on the day of the interview, and on 02/20/23, saying he did not care if he was dirty or not, and she could not make a resident care. She said she documented bathing in PCC, and never used not applicable for bathing. She said she only used it for things like if a resident did not walk at all, and they did not walk in their room or on the unit, the part of the documentation about walking would be not applicable. She said she had not noticed residents being dirty, and some residents would forget if they had a bath. CNA D said not bathing residents would be considered neglect, and if she found residents were not getting bathed, she would inform the DON. An interview on 02/15/23 at 6:51 PM with the DON revealed one day Resident #40's family member visited the facility and said Resident #40 was not showered. She spoke with CNA E, who said she gave her a shower, and had even had a conversation with the resident about it, got the things she needed set up, and gave her a bed bath. CNA E said she did not understand why anyone was saying Resident #40 didn't get a bath. The DON said she could not recall some of the details, but she knew the family member who had complained to the Administrator apologized for it, and that Resident #40 did get a shower. An interview on 02/15/2023 at 7:03 PM with the Administrator revealed he heard about the complaint about bathing from a family member of Resident #40. The family member emailed him about it, and he reached out and asked for more information, because the initial email did not identify which patient wash having the problem. He said the family member, who turned out to be Resident #40's secondary emergency contact, identified Resident #40. He spoke with that family member, and another family member who was the primary emergency contact, and they both repeated what the email said initially, that the resident had not been bathed on 01/28/23. The family member who was the primary contact said she felt it was neglect, so he reported the allegation to HHSC (Health and Human Services.) He went to Resident #40, and asked her specific questions about bathing, and other ADLs, and she only had a complaint about long call light wait times. They in-serviced the staff on her concern and contacted the family member who was her primary emergency contact, and told her about the conversation with Resident #40, and what they had done to address the concern, and she said she was satisfied with that. When talking to the family members, he learned another family member had been visiting, and when CNA E went into the room to shower the resident, that family member took leave, to protect Resident #40's privacy, and did not stay to see that the resident was bathed. When the secondary contact family member visited Resident #40 on 01/29/23, Resident #40 told her she did not get a shower the day before, and that the aide had only left the shower things there and did not bathe her. The aide confirmed the bathing did occur and she had documented it. At Resident #40's careplan meeting, both of her emergency contact family members went to the nurses station, and repeated the same complaint, but after Resident #40 told them she had been bathed, they came out and apologized. Review of a facility Quality Improvement Plan reflected a goal of removing all agency staff by 02/01/23, due to problems which included lack of documentation, and lack of ADL care (brushing hair and teeth, and showers/baths. The goal was modified, extending the date to 02/06/23, after which date no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 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 676407 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Purehealth Transitional Care at Thr Arlington 800 W. Randol Mill Road, 6th Floor Arlington, TX 76012 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 agency staff scheduled to work in the building for the remainder of the month were cancelled. Level of Harm - Minimal harm or potential for actual harm Review of in-service education documentation, dated 01/10/23, reflected the DON provided an in-service to CNAs on showers, checking the EMR assignment for showers due, and completing the ADL documentation. Residents Affected - Some Review of in-service education documentation, dated 01/23/23, reflected[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676407 If continuation sheet Page 12 of 12