Inspection·March 10, 2022

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On dates 02/26/2022, 02/27/2022, and 03/05/2022, the opportunities for provision of wound care were missed. In an interview with LVN G on 03/09/22 at 02:23 PM, she stated the Wound Care Nurse is the main nurse that provides wound care service in the facility but all other LVNs were responsible to provide wound care on their residents on the day the Wound Care Nurse was not on duty. She stated the risks for the resident skipping their wound care was the risk of infections and discomfort due to bandaging not being changed. In an interview with the Wound Care Nurse on 03/09/22 at 02:34 PM she stated Resident #62 received care for his right toe amputation and the wound care doctor saw him weekly as well. She said his wound care was ordered daily and PRN and she only works Monday through Friday. She stated, on the weekends, any nurse or charge nurse was qualified to do wound care and there was no excuse for the wound care not to be done on weekends. She stated she was not sure who worked on the weekend but sees some of the weekend days were missed. She stated there was little risk to the resident if his wound care was missed every two or three days because his wound currently had no odor, swelling, and because of the types of treatment ointments with dressing he was getting. She stated the facility's standard of care and frequency of care was higher than the average facility because they work with residents with the goal to get them physically well enough sooner to return to lesser care settings at home. In an interview with the DON on 03/09/22 at 03:20 PM, she stated she noticed Resident #62's wound care was not documented. She stated assigned LVN W, usually work worked night shifts to come in and do wound care on those weekends but she is not sure why she did not document the wound care. She said monitoring was being done and the issue likely occurred due to staffing issues, but they try their best to meet the mark. She stated the use of agency nurses also makes it necessary for her usual nursing staff to follow up on the resident's care to ensure the agency nurses are actually providing wound care. In a phone interview with LVN W on 03/09/22 at 03:35 PM she said she did not do any wound care on any of the assigned residents on 03/05/2022 because she was scheduled to start late and she was trying to figure out which residents needed wound care, on which part of their body and what tools were needed. She stated Saturday, 03/05/2022, was her trial day. Record review of the facility's policy on wound care, October 2010, revealed, the purpose of this procedure is to provide guidelines for the care of wounds to promote healing . Verify that there is a physician's order for this procedure . Review the resident's care plan to assess for any special needs of the resident . Record review of the facility's policy on care planning, dated September 2013, did not address implementation of resident care plans. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 2 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 appropriate treatment and services to prevent complications for 1 of 3 resident (Resident #33) reviewed for gastrostomy tube. -CNA P placed Resident # 33's bed in a flat position to provide incontinent care and adjusted Resident #33's feeding pump. This failure could affect residents with a gastrostomy tube by placing them at risk for aspiration. Findings include: Record review of the admission sheet for Resident # 33 revealed an [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included gastrostomy status, pneumonia, dysphagia, oropharyngeal phase and aphasia. Record Review of Resident #33's quarterly MDS assessment dated [DATE] revealed the BIMS score was blank indicating severely impaired cognitive skills. Staff assessment for mental status was conducted resident was unable to complete interview. Resident # 33 has short term memory problem, long term memory problem, and cognitive skills for daily decision making is severely impaired never/rarely made decision. Further review of the MDS revealed that she required total dependence from one-person physical assist for dressing, toilet use and personal hygiene. Resident was always incontinent of bowel and bladder. The resident was marked as having a feeding tube. Record review of Resident # 33's care plan initiated on 6/28/2020 revised on 11/18/2020 revealed the following care plan: Focus-Enteral feeding: Resident#33 has Inability to maintain adequate nutrition/ Potential for aspiration Related to Dx: Requires enteral feeding via PEG/GT Goal-Resident #33 will tolerate tube feeding without N/V, diarrhea, s/sx of aspiration, abdominal distention, dehydration daily x 90days. Interventions/Tasks: Check Resident#33 prior to each feeding. Enteral tube feeding as ordered per MD. Enteral Feed every shift Diabetisource ac 70 cc/20 hrs via continuous pump. Flush enteral tube with 30 ml water before and after medication administration and/or as ordered. Monitor enteral tube placement every shift. Monitor for abdominal distention, regurgitation, nausea, cramps, diarrhea. Record review of Resident #33's Physician orders dated 01/11/2022 revealed an order for enteral feeding every shift Diabetisource ac 70 cc/20 hrs via continuous pump. Record review of Resident #33's Physician orders dated 01/11/2022 revealed an order for enteral feeding every shift H20 flushes 45 cc/q 1 hrs via continuous pump. Observation and attempted interview on 03/09/2022 at 9:16a.m., with Resident #33, revealed Resident was resting on her bed. Resident was alert and well groomed. The resident mumbled for 5 minutes while being interviewed and could not make self-understood and did not respond appropriately to asked questions about her stay at the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 3 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 Observation of Resident # 33 on 03/09/2022 at 9:21a.m., revealed CNA P entered the room and informed Resident #33 of incontinent care to be performed. CNA P set Resident # 33's enteral feeding pump from run to hold then lowered Resident # 33's head of bed down to a flat position. CNA P provided incontinent care, laying resident in a flat position. After care was completed, CNA P changed the setting of Resident #33's enteral feeding pump to run to resume Resident #33's feeding. Residents Affected - Few In an interview on 03/09/2022 at 9:38a.m., with CNA P, she said she was not trained to set enteral feeding pumps. CNA P said she saw how the nurses did it, so she learned from them. She said, I probably should have asked a nurse to hold the feeding as it's not in my scope of practice. She said the feeding was supposed to be on hold while providing incontinent care to prevent the resident's risk of choking. In an interview on 03/09/2022 at 9:51a.m., LVN I, said she administered Resident #33's morning meds at 9:00 a.m., and did not put the feeding pump on hold. She said she was not aware CNAs were providing care to the resident. She said CNA's were not allowed to touch the enteral feeding pumps because they were not licensed, and they were supposed to get a nurse to put the feeding pump on hold and let the nurse know when they were finished providing care so the nurse could re-start the feeding. She said if CNA's put the pump on hold residents could possibly not get their feedings and it was risk for aspiration. In an interview on 03/09/2022 at 10:47a.m., the DON, said only nurses were allowed to manipulate the enteral feeding pumps. The DON said CNA's were not trained or competent to manipulate enteral feeding pumps. The DON said it was not in CNAs scope of practice. The DON said the CNA should have asked the nurse to place Resident # 33's enteral feeding on hold or off as it placed the resident at risk for aspiration. Record review of facility's Administration Medications through an Enteral Tube policy (revised November 2018) read in part: .Purpose: The purpose of this procedure is to provide guidelines for the safe administration of medication through an enteral tube . Record review of facility's Enteral Nutrition policy (Revised November 2018) read in part: .Policy Statement: Adequate nutritional support through enteral nutrition is provided to residents as ordered. 16. Risk of aspiration is assessed by the nurse and provider and addressed in the individual care plan . Record review of facility's Job Description: Certified Nursing Assistant prepared by/Date: Human Resources (2-2019) read in part: .General Purpose: The primary purpose of your job position is to provide each of your assigned residents with routine daily nursing care and services in accordance with the resident's assessment and care plan, and as may be directed by your supervisor. Essential Duties: Perform only those nursing care procedures that you have been trained to do . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 4 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of 1 of 4 residents (39) reviewed for pharmacy services. - LVN O failed to administer medication to Resident #39 correctly by crushing Protonix DR granules, a medication for acid reflux/heart burn that should not be crushed. This failure could place residents receiving medications via feeding tube at risk for inadequate therapeutic outcomes. Findings Include: Record review of Resident #39's face sheet dated 03/09/22 revealed an [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included: pressure ulcers, dysphagia (difficulty swallowing), cognitive communication deficit, muscle weakness, anemia, depression, epilepsy, GERD and an esophageal obstruction . Record review of Resident #39 's care plan revised 03/08/22 revealed, Focus- feeding tube, resident has a feeding tube to meet my nutrition needs and is at risk for complications. Goals- resident will have nutritional need met through feeding tube and will not have any complications with feeding tube through next review. Interventions- tube feeding and flushes as ordered. Record review of Resident #39's admission MDS dated [DATE] revealed, severely impaired cognition as indicated by a BIMS score of 03 out of 15, total dependence on all ADLs and always incontinent of both bladder and bowel. Record review of Resident #39's Physician's Order dated 02/22/22 revealed, Protonix Tablet Delayed Release 40 mg give 1 tablet via g-tube one time a day for GERD. Record review of Resident #39's Physician's Order dated 02/23/22 revealed, enteral feed order- flush tube with 30 mL before and after medication administration and 5-10 mL between each medication every shift. An observation and interview on 03/09/22 at 08:17 AM revealed, LVN O preparing medication for administration via G-tube for Resident #39. She retrieved a packet of Protonix 40 mg DR for suspension, a medication that should not be crushed, and 14 other solid and liquid medications and poured them into individual medication cups. At 08:23 AM she placed each solid form (tablets and granules) in individual pill crush bags and crushed the medications and returned them to their individual medication cups. LVN O said she crushed the Protonix Granules because it sometimes clogs the G-tube during medication administration. At 08:37 AM she entered into the resident's room, suspended the medications in 5-10 mL of water and administered them to Resident #39 after checking for placement and completing a 30 mL flush. LVN O flushed with 10 mL of water between each of the medications and then performed a 30 mL flush after medication administration. In an interview on 03/09/21 at 10:35 AM, the DON said that Protonix DR for suspension granules (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 5 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few should not be crushed because it alters the rate of release into the body. She said crushing medication that should not be crushed impacts the efficacy of the medication and places residents at risk of insufficient therapy. In an observation and interview on 03/09/1 at 10:42 AM, LVN O said she did not realize that she could not crush Resident #39's Protonix 40 mg DR granules for suspension. She said DR/ER and enteric coated medications should not be crushed because their formulation is supposed to release the medication into the body over a prolonged period and crushing the medication would change this periodic release. She looked at the packet of the Protonix and said since it said DR (delayed release) she should not have crushed the medication and she would contact Resident #39's doctor to inform them of the medication error and awaiting further instructions. She said that by crushing the Protonix she changed the release pattern which placed Resident #39 at risk of insufficient therapy. Record review of the facility policy titled Crushing Medications revised 04/18 revealed, 2- The nursing staff and/or consultant pharmacist shall notify any attending physician who gives and order to crush a drug that the manufacturer states should not be crushed (for example, long-acting or enteric coated medication). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 6 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 - Many 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. Based on observation, interview, and record review the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, included the appropriate accessory and cautionary instructions, the expiration date when applicable and stored all drugs and biologicals in locked compartments and under proper temperature controls, and permitted only authorized personnel to have access to the keys for 4 out of 4 medication carts (West Back Nursing Cart, [NAME] Medication Aide Cart, East Nursing Cart and East Medication Aide Cart) and 1 out of 1 Medication Rooms (West Medication Room) reviewed for medication storage. - The facility failed to ensure that the [NAME] Back Nursing Cart and East Medication Aide Cart did not contain medication stored outside of specified manufacturer temperature ranges. - The facility failed to ensure that the [NAME] Medication Aide Cart and the East Nursing Cart did not contain open multi-dose containers without open dates. - The facility failed to ensure that the [NAME] Medication Room did not contain expired IV medication. Findings Include West Medication Aide Cart. In an observation and interview on 03/09/22 at 10:00 AM, inventory of the [NAME] Medication Aide Cart with the Medaide revealed: - An open bottle of liquid protein with manufacturer instructions of 3-month shelf life from date opened with no open date. The Medaide said when a multidose container of liquid protein was opened it should be labeled with the open date. She said that the opened date was used to track the expiration date since the opened bottle should not be used more than 3 months after opening. She said that nursing staff are expected to check their nursing carts every shift as used for inappropriately labeled and expired medications. The Medaide said since the liquid protein did not have an open date its expiration date could not be established. She said when medication expires it loses efficacy so the liquid protein could not be used and it must discarded in the drug disposal bin located in the medication room. West Back Nursing Cart In an observation and interview on 03/09/22 at 10:05 AM, inventory of the [NAME] Back Nursing Cart with LVN I revealed: - An open bottle of Acidophilus, a probiotic, at room temperature in the drawer with manufacturer instructions of Refrigerate After Opening. LVN I said she did not know the probiotic had to be refrigerated. She said nursing staff are expected to check their nursing carts every shift as the medications are used and since the probiotic was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 7 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 at room temperature it should be discarded in the drug disposal bin located in the medication room. LVN I said that when medications that should be stored in the refrigerator were left at room temperature it can deteriorate and loose efficacy so it should not be used. West Medication Room Residents Affected - Many In an observation and interview on 03/09/22 at 10:10 AM, inventory of the [NAME] Medication Room with LVN I revealed: - 2 50 ml IV bags of Furosemide, a diuretic, 80mg prepared on 02/22/22 at 05:15 PM with pharmacy instructions of expires 24 hours from preparation in the refrigerator. - 2 100 ml IV bags of Levofloxacin 750mg, an antibiotic, with expiration dates of 03/08/22 in the refrigerator. LVN I said all nursing staff should check the medication rooms for expired medications daily, she said the residents had discharged or moved to the other unit so there was no risk of administering the expired IVs. She said since the IVs were expired, they could not be used and must be placed in the drug disposal bin for destruction . LVN I said that expired IVs can have a loss in efficacy placing residents at risk for decreased therapeutic effects. East Nursing Cart In an observation on 03/09/22 at 10:15 AM, inventory of the East Nursing Cart with LVN O revealed: - An open bottle of liquid protein with manufacturer instructions of 3-month shelf life from date opened with no open date. East Medication Aide Cart In an observation on 03/09/22 at 10:25 AM, inventory of the East Medication Aide Cart with LVN O revealed: - 2 open bottles of Acidophilus, a probiotic, at room temperature in the drawer with manufacturer instructions of Refrigerate After Opening. In an interview on 03/09/22 at 10:25 AM, LVN O said that nursing staff should check their carts for inappropriately labeled, expired and medications stored outside of their specified temperatures on every shift as the cart is used. She said that all multidose containers should be labeled when open in other to track their expiration date and since the bottle of liquid protein had no expiration date it must be discarded in the drug disposable bin. LVN O said she did not know the bottles of acidophilus required refrigeration and when medication expires or is stored at the wrong temperature they can lose its efficacy resulting in a loss of therapeutic effect if given to residents. In an interview on 03/09/22 at 10:35 AM, the DON said that nursing staff are expected to check their carts for expired, inappropriately labeled and medication stored at the wrong temperature on each shift, while the ADON is responsible for checking the medication room daily. She said that all medications should be stored at manufacturer specified temperature ranges and by leaving the acidophilus at room temperature the medication can deteriorate. The DON said all multidose containers should be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 8 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 labeled with a date when opened in order to track the expiration date and once expired the medication should be discarded promptly. She said medication stored outside of specified manufacturer temperatures, inappropriately labeled and expired medications should be discarded in the drug disposal bin located in the medication room since they can deteriorate and/or lose efficacy placing residents at risk for uncertain therapeutic outcomes if used. Residents Affected - Many Record review of the facility policy titled Storage of Medications revised 11/20 revealed, 1- drugs and biologicals used in the facility are stored in locked compartments under proper temperature, light, and humidity controls. 4 . Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. 7- medications requiring refrigeration are stored in a refrigerator located in the drug room at the nurses' station or other secured location. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 9 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure food was stored in accordance to professional standards for foodservice safety for 3 of 3 main storage areas (dry storage, walk-in cooler and the walk-in freezer), in that: - Boxes of food items were observed on the floor in the walk-in cooler, freezer and dry good storage. This failure could affect all residents who eat meals served by the dietary department and place them at risk for potential food-borne illness. Findings included: During observations of the kitchen and an interview with the Dietary Manager on 03/08/2022 at 8:50AM, an opened box of kosher salt was observed sitting in an opened resealable bag. The Dietary Manager stated that the bag should have been resealed; in the walk-in cooler, a box of potatoes and a box of chicken was observed sitting on the floor; in the walk-in freezer, a box of [NAME] tots, a box of lemon merengue and 4 boxes of frozen vegetables were observed resting on the floor; in dry good storage, a box of rolled oats and a box of canned cheddar sauces. The Dietary Manager stated that he received a delivery of food around 8AM this morning and they were wheeled in and dropped off by the delivery men. He said he usually tried to put them away as soon as possible or at least by the end of the day but he knew they were supposed to rest at least 6 inches off the ground and or on the shelfs before storing them away. He stated the consequences of having food on the floor was attraction of rodents and pests. Record review of the facility's policy on Food Receiving and Storage, dated October 2017, stated, .food in designated dry storage areas shall be kept off the floor (at least 18 inches) . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 10 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 involving 2 of 2 staff (Wound Care Nurse and CNA P) and 2 of 4 residents (Resident #31and #33) reviewed for infection control. Residents Affected - Some -The facility failed to ensure the Wound Care Nurse followed infection control techniques while performing wound care for Resident #31 by crossing from a dirty part of the procedure to the clean part. -CNA P failed to perform hand hygiene and contaminated clean items while providing care for Resident #33. These failures could place residents at risk of cross contamination, infection and hospitalization. Findings include: Resident #31 Record review of the admission sheet for Resident # 31 revealed an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included pressure ulcer of right heal, unstageable, non-pressure chronic ulcer of other part of right lower leg with other specified severity, bipolar disorder, and displaced fracture of greater trochanter of right femur, subsequent encounter for closed fracture with routine healing. Record Review of Resident #31's quarterly MDS assessment dated [DATE] revealed the BIMS score was 07 out of 15 indicating severely impaired cognitively. Further review of Section M1040. Other Ulcers, Wounds and Skin Problems was coded Resident having Diabetic foot ulcer. Record review of Resident #31's Physician orders dated 3/8/22 revealed an order for L-heel/dm: clean with ns, pat dry, paint with betadine, apply collagen and cover with dry dressing qd and prn until resolved. Everyday shift and as needed. Record review of Resident # 31's care plan initiated on 10/08/2021 and revised on 01/20/2022 revealed the following care plan: Focus- Resident #31 has diabetic ulcer of the l heel r/t Diabetes Goal-The resident will have no complications related to ulcer through review date. Interventions/Tasks- Monitor pressure areas for color, sensation, temperature. Monitor/document wound: Size, Depth, Margins: periwound skin, sinuses, undermining, exudates, edema, granulation, infection, necrosis, eschar, gangrene, Document progress in wound healing on an ongoing basis. Notify MD as indicated. Redness and swelling, Red lines coming from the wound, Excessive pain, Fever. Weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue and exudate and any other notable changes or observations. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 11 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 Observation and interview on 03/09/2022 at 9:52a.m., revealed Resident #31 was resting on her bed. She was alert and well groomed. Observation of wound care for Resident #31 on 03/09/2022 at 9:55a.m., revealed the Wound Care Nurse performed hand hygiene, applied clean gloves to remove the soiled dressing from the left heel pressure injury, dated 03/08/22. The Wound Care Nurse threw the soiled dressing into the biohazard bag taped to the resident's foot of the bed. Observed an open area of approximately 0.9 centimeters in diameter on the left heel. Without removing the soiled gloves and sanitizing her hands, the Wound Care Nurse cleansed the wounds with normal saline x2, patted dry with a clean dry gauze, applied the betadine, collagen and covered it with clean dry dressing on the left heel. The Wound Care Nurse without changing gloves, placed a clean pair of socks on the resident and covered the resident. In an interview on 03/09/2022 at 10:09a.m., with the Wound Care Nurse, she said she should have changed her gloves after removing the soiled dressing as it posed a risk for infection control. She said the DON periodically checked on her. She said she received training on infection control this week either Monday (3/7/22) or Tuesday (3/8/22). In an interview on 03/09/2022 at 10:47a.m., with the DON, this state surveyor shared her wound care observation from earlier. The DON said she would correct the Wound Care Nurse as her actions create a risk for infection control and cross contamination. She said the Wound Care Nurse should have changed her gloves prior to moving from a dirty to a clean site. She said staff were in serviced weekly on infection control/hand hygiene. She said she spot checked the wound care nurse monthly and wound care doctor made rounds with wound care nurse weekly. Resident #33 Record review of the admission sheet for Resident # 33 revealed an [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE]. Her diagnoses included gastrostomy status, pneumonia, dysphagia, oropharyngeal phase and aphasia. Record Review of Resident #33's quarterly MDS assessment dated [DATE] revealed the BIMS score was blank indicating severely impaired cognitive skills. Staff assessment for mental status was conducted resident was unable to complete interview. Resident # 33 has short term memory problem, long term memory problem, and cognitive skills for daily decision making is severely impaired never/rarely made decision. Further review of the MDS revealed that she required total dependence from two persons physical assist for dressing, toilet use and personal hygiene. Resident was always incontinent of bowel and bladder. The resident was marked as having a feeding tube. Record review of Resident # 33's care plan initiated on 6/28/2020 revised on 11/18/2020 revealed the following care plan: Focus- Resident # 33 has an ADL self-care performance deficit r/t generalized weakness and impaired mobility Goal: Resident # 33 will improve current level of function through the review date. Interventions: Bathing/Showering: Assist x 2, INCONTINENT CARE Assist X 2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 12 of 13 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 676435 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Houston Transitional Care 8550 Jason Street Houston, TX 77074 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 Observation on 03/09/2022 at 9:21a.m., revealed CNA P and CNA L provided incontinent care to Resident #33. CNA P removed Resident #33's brief and tucked it under the resident's buttocks. CNA L assisted Resident #33 turn onto her right side to clean her buttocks. Resident had a bowel movement. CNA P cleaned the resident and removed the soiled brief, draw sheet and the fitted sheet. CNA P then searched the resident's dresser for a fitted sheet with the same dirty gloves. CNA P said she was unable to find the fitted sheet but found a draw sheet. With the same soiled gloves she placed the clean draw sheet on the resident's bed. In an interview on 03/09/2022 at 9:38a.m., with CNA P, she said she should have changed her gloves, washed her hands or used hand sanitize since the resident had a bowel movement. She said the resident's sheets were soiled so they hurried up and stiped her bed. She said they did not have a fitted sheet, so she searched for the fitted sheet in the resident's dresser. She said the failure placed the resident at risk for infections and cross contamination. She said she was in-serviced on infection control/hand hygiene 2 months ago. In an interview on 03/09/2022 at 10:47a.m., with the DON, she said the CNA should have either washed or sanitized her hands after touching a dirty area prior to moving to a clean area when performing incontinent care. She said CNA P brought to her attention and shared her observation. She said she told CNA P to remove all the clothing from the resident's dresser as all were contaminated. She said these failures were risk for infection control. Record review of facility's Wound Care policy (Revised October 2010) read in part: .Purpose: The purpose of this procedure is to provide guidelines for the care of wounds to promote healing. Steps in the Procedure: 4. Put on exam glove. Loosen tape and remove dressing. 5. Pull glove over dressing and discard into appropriate receptacle. Wash and dry your hands thoroughly. 6. Put on gloves . Record review of Wound Care Competency Checklist-Direct Care provider (not dated) read in part: .Diabetic Foot Ulcers (DFU) Ulcer treatment: Cleanses DFU as per hospital/facility policy. Applies/changes dressings as ordered per hospital/facility policy . Record review of facility's Handwashing/Hand Hygiene policy (Revised August 2019) read in part: .7. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for following situations: g. Before handling clean or soiled dressing, gauze pads, etc.; h. Before moving from a contaminated body site to a clean body site during resident care; 9. The use of gloves does not replace hand washing/hand hygiene. Integration of gloves use along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infections . Record review of facility's Infection Control policy (Revised October 2018) read in part: .This facility's infection control policies and practices are intended to facilitate maintaining a safe, sanitary and comfortable environment and to help prevent and manage transmission of diseases and infection . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676435 If continuation sheet Page 13 of 13