Health inspection·July 2, 2025

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some disposed of at the end of each shift. RN E stated that she did not know why the Vital Sign Sheet for 06/30/25 for the 6a-6p shift was not properly disposed in a secured area. RN E stated that the risk of the facility's Vital Signs Sheet being left in an occupied resident's room was that it violated HIPAA because the sheet contained residents confidential information regarding their health. RN E stated that every 3 months, she had taken In-Service Trainings on HIPAA via the computer. In an interview with LVN D on 07/01/25 at 3:12 PM, LVN D stated that she had been employed at the facility for 1 1/2 year. She stated that she worked the 6a-6p shift with CNA C on 06/30/25 and both were assigned to Resident #1's room. LVN D stated that she was unaware that the Vital Signs Sheet for 06/30/25 for the 6a-6p shift was on the dresser in Resident #1's room. LVN D stated that the CNAs would record the vital signs for the residents they were assigned to during their shift. LVN D stated that CNA C had left the Vital Signs Sheet in Resident #1's room accidently. She stated that normally, the CNA would record the vital signs for the residents on the Vital Signs Sheet and at the end of the shift, the CNA would provide the document to the Nurse on duty, who would shred the document at the end of the shift. LVN D stated that she could not remember if CNA C handed her the Vital Signs Sheet on 06/30/25 at the end of her shift. LVN D stated the information on the Vital Sign Sheet was confidential and because it was not shredded and disposed of, there was the risk that the information on it could cause can be used against the potentially affected residents she privacy for all residents under her care. In an interview with the DON on 07/02/25 at 1:17 PM, the DON stated she had been employed at the facility for 9 years. The DON stated that she was unaware that the Vital Signs Sheet for 06/30/25 for the 6a-6p shift was located on the dresser in Resident #1's room by the Surveyor. The DON stated that the Vital Signs Sheet was used in-house by staff to record the vital signs of the residents. The DON stated that the CNAs were assigned with the task of completing the Vital Signs Sheet for the residents they were assigned to every shift. The DON stated that at the end of each shift, the CNAs were to give the Vital Signs Sheet to their Nurse for review. The DON stated after the Nurse reviewed the Vital Signs Sheet, which included residents vital signs such as temperatures, blood pressure and respiratory/oxygen levels, the form is then to be shredded at the end of the shift in the designated shredding container confidential storage container located in the hallway at the facility. The DON stated it was her expectation that residents' health information was to be kept private to prevent HIPAA violations. The DON stated that CNA C and LVN D, should have ensured that the facility's Vital Signs Sheet was not visible to Resident #1 or any other persons. She said the health information of a resident should be protected and could not be shared without the permission of the resident or the resident's responsible party. She said all employees were expected to provide full privacy and confidentiality of information for all residents. The DON stated that she would collaborate with the ADON's about the issue of resident rights, confidentiality, and HIPAA. The DON stated she would immediately start an In-service Training with all staff about privacy, confidentiality of the residents' information such as personal and medical information and HIPAA. The DON stated that there were not any potential risks or harm to any residents associated with the Vital Sign Sheets document for 06-30-25 being observed on 07-01-25 in Resident #1's room. The DON stated the facility did not have a policy related to HIPAA policies, procedures, and guidelines. She stated that the facility follows the HIPAA Guidelines in relation to the Health Insurance Portability and Accountability Act of 1966. In a telephone interview with the CNA C on 07/02/25 at 1:33 PM, stated that she had been employed at the facility since February 2025. She stated that she worked the 6a-6p shift with LVN D on 06/30/25, and both were assigned to Resident #1's room. CNA C stated that the Vital Signs Sheet was used by CNAs at the facility to record residents vital signs such as blood pressures, temperatures, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676410 If continuation sheet Page 2 of 5 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 676410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pure Health Transitional Care at Texas Health Pres 8200 Walnut Hill Lane Main 5 Dallas, TX 75231 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete respirations, oxygen levels, heart rates and weights. She reported that the Vital Signs Sheet was also used to record residents' weights, but the weights were recorded on Sundays, and according to the residents' doctors' orders. CNA C stated that she was unaware on 07/01/25 at 9:48 AM, the Surveyor observed the Vital Signs Sheet for 06/30/25 for the 6a-6p shift on the dresser in Resident #1's room. CNA C stated at the end of each shift, she would give the Vital Signs Sheet to the Nurse on duty. CNA C stated that the Vital Signs Sheet was shredded by the Nurse each day. CNA C stated that she did not leave the Vital Signs Sheets in Resident #1's room and gave it to LVN D on her 6a-6p shift on 06/25/25. She said the information on the facility's Vital Sheets Sheet was confidential and should not be seen by unauthorized individuals because it contained several residents personal and confidential information. She said the risks of residents' confidential information on the Vital Signs Sheet being available to unauthorized persons in Resident #1's room might cause a resident to feel embarrassed that others would know they had hypertension or other health issues, which violated the HIPAA guidelines. CNA C stated that she attended trainings on HIPAA during her New Hire Orientation in February 2025. An observation on 07/02/25 at 1:45 PM, revealed a shredding container and confidential storage container on the hallway located near the Administrator's Office. Record review of the Staff Schedule for 06/30/25 revealed CNA C and LVN D were assigned the 6a-6p shift on Resident #1's hallway. Record review of the facility's In-service Training records from 03/01/25 to 06/30/25, revealed there were no In-Service Trainings conducted with staff relating to residents' privacy and /or residents' rights, or HIPAA during this period. Record review of the facility's section of the General New Hire Classroom Training, reflected section, Compliance & State Regulated Trainings, with a subsection Training for Essentials of HIPAA, which included a 7-hour Training for staff. Record review of the facility's policy, Electronic Messaging and Internet Usage, dated October 2021, reflected no information regarding securing confidential and clinical records for residents that were available on paper. Record review of the CMS website revealed, The Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes national standards to protect individuals' medical records and other personal health information. The HIPAA Privacy Rule also gives individuals rights over their health information, like getting a copy of their records and seeking correction. The Rule applies to 3 types of HIPAA covered entities, like health plans, health care clearinghouses, and health care providers that conduct certain health care transactions electronically to safeguard protected health information (PHI) entrusted to them. On 07/03/25 at 1:21 PM and 3:21 PM, emails were sent to the Administrator and DON requesting the facility's Resident Rights Policy and there were no replies. Event ID: Facility ID: 676410 If continuation sheet Page 3 of 5 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 676410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pure Health Transitional Care at Texas Health Pres 8200 Walnut Hill Lane Main 5 Dallas, TX 75231 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 establish and 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 2 of 6 residents (Resident #4 &#18) reviewed for infection control. Residents Affected - Few 1, LVN A failed to wear the appropriate PPE while providing wound care to Resident #18. 2. CNA B failed to wear the appropriate PPE while providing transfer to Resident #4. This failure could place residents at risk of being infected by staff in contact with other residents with infections. Findings included: Review of Resident #18's face sheet dated 07/02/25 revealed she was a [AGE] year-old female, she was originally admitted on [DATE] and re-admitted on [DATE]. Admitting diagnoses included, pneumonia, Type 2 diabetes, asthma, muscle weakness, chronic kidney disease, heart failure and need for assistance for personal care. Review of Resident #18's care plan initiated on 07/18/24 reflected, the resident the resident had stage 4 pressure ulcer of sacrum or potential for pressure ulcer development. Review of Resident #18's orders summary dated 06/19/25 for the month of July reflected, an order to clean stage IV pressure injury to (sacrum)with normal saline, cover the wound bed with moist hydrofera blue and border foam dressing every day shift for pressure injury. Another order dated 6/18/25 reflected an order of a urinary catheter - [16] F [10 ml] bulb. Review of Resident #4's face sheet dated 07/02/25 revealed she was a [AGE] year-old female, she was admitted on [DATE]. Admitting diagnoses included, anxiety, seizures, anemia, arthritis, muscle weakness and need for assistance for personal care. Review of Resident #4's care plan initiated 06/11/25 reflected, the resident was on intravenous medications. Review of Resident #4's order summary dated 06/23/25 for the month of July reflected, right lateral thigh to clean with normal saline apply a dry dressing. Monitor for signs or symptoms of infection. Resident #4 was on intravenous medications. Observation on 07/01/25 at 09:53 AM revealed LVN A completing wound care to Resident #18. LVN A was providing care without the appropriate PPE for the residents who had wound and foley catheter. In an interview on 07/01/25 at 10:15 AM with LVN A she stated she was not aware the resident was on enhanced barrier precaution until she was asked about the resident being on enhanced barrier precaution. LVN A stated there was supposed to be a sign on the door indicating the resident was on enhanced barrier precaution because she had a foley catheter and a wound. LVN A stated she was supposed to use the gown and gloves when providing care to the resident. LVN A stated she was supposed to use (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676410 If continuation sheet Page 4 of 5 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 676410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pure Health Transitional Care at Texas Health Pres 8200 Walnut Hill Lane Main 5 Dallas, TX 75231 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 - Few gown and gloves to prevent cross contamination, and she stated she had completed in-service on infection control training a few weeks on enhanced barrier precaution. Observation on 07/02/25 at 10:40 AM revealed CNA B transferring Resident #4 from the wheelchair to bed. The posting on the door indicated the resident was enhanced barrier precaution. During the transfer CNA B had only gloves on. Resident #4 was observed with an intravenous line to the left upper arm. In an interview on 07/02/25 at 10:48 AM with CNA B, she stated she was supposed to use a gown as it indicated on the door, while she was transferring the resident from the chair to bed. She stated she was supposed to use the gown and gloves because the resident had an intravenous line. CNA B stated she was supposed to use the appropriate PPE to prevent cross contamination. CNA B stated she had been in-serviced on infection control and use of PPE last week, could not remember the specific day. In an interview on 07/02/25 at 12:44 PM with the DON she stated there were resident who were on EBPs in the facility. The DON stated the staff were expected to put on the appropriate PPEs while providing care to the residents who were on EBPs. The list the DON expected to put on while proving care to the residents on EBPs were the gowns and gloves. The DON stated if there was a posting on the door and if the residents had wounds, foley catheter, and intravenous line, the staff were expected to have a gown and gloves on while providing care to the resident. PPE use on residents on EBPs was required to prevent cross contamination. The staff had been in-serviced on infection control and the use of PPE. Record review of the facility policy dated August 2022 and titled Enhanced Barrier Precaution reflected, Enhanced Barrier Precaution (EBP) are utilized to prevent the spread of multi-drug resistant organisms (MDROs) to residents. 2. EBPs employ targeted gown and gloves use during high contact resident care activities when contact precautions do not otherwise apply. 3. Examples of high contact resident care activities requiring the use of gown and gloves for EBPs include. c. Transferring. h. Wound care (any skin openings requiring a dressing). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676410 If continuation sheet Page 5 of 5