Health inspection·November 9, 2023

F 0577 Record review of In-service of Survey binder dated 11/08/2023 noted the residents were in-serviced on the HHSC survey results binder location. Level of Harm - Potential for minimal harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 2 of 6 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 676436 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Thrive Rehabilitation of Pearland 3406 Business Center Drive Pearland, TX 77584 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that a resident who needed respiratory care was provided with such care, consistent with professional standards of practice for 1 (Resident #8) of 1 resident reviewed for respiratory care, in that: Residents Affected - Few The facility failed to set the oxygen flow rate at 2 liters of oxygen per minute as ordered on 10/24/2023for Resident #8. This deficient practice could place residents who used oxygen incorrect or inadequate respiratory support and could result in a decline in health. Findings included: Record review of Resident #8's Face Sheet (undated) revealed he was a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #8's diagnoses included hypertensive heart disease without heart failure (left changes in the heart as a result of chronic elevated blood pressure), atherosclerotic heart disease (buildup of plaque on the artery walls), atrial fibrillation (irregularly rapid heart rate). Record review of Resident #8's Comprehensive MDS assessment dated [DATE] revealed he was assessed as having a BIMS of 15 out of 15 indicting Resident #8 was intact cognitively. Section B indicted Resident #8 was able to understand others and able to make himself understood. Section O did not reveal: Oxygen in use while in the facility. During an observation on 11/08/2023 at 8:23AM revealed Resident #8 in bed with the head of his bed elevated. Resident #8 was awake alert and oriented. Resident #8 was wearing oxygen by nasal cannula. The oxygen concentrator was set at 4 liters per minute. During an observation on 11/08/2023 at 11:56 AM revealed Resident #8 in bed. Resident # 8 was wearing oxygen by nasal cannula. The oxygen concentrator was set at 4 liters per minute. During an observation on 11/08/2023 at 2:03 PM revealed Resident #8 with oxygen set at 4 liters per minute. Record review of Resident #8's Physician's Order Summary Report dated 11/09/2023 revealed Oxygen 2 liters per minute by nasal cannula (delivery of oxygen directly into the nose) as needed for shortness of breath. Order dated 10/24/2023. Record review of Resident #8's care plan dated 11/09/2023 revealed the following: Focus: The resident had oxygen therapy related to prn shortness of breath. Oxygen at 2 liters per minute by nasal cannula; Resident adjusted oxygen to higher levels. Goal: The resident will have no signs or symptoms of poor oxygen absorption through the review date. Interventions/Tasks: Resident educated on the consequences of increasing oxygen levels; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 3 of 6 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 676436 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Thrive Rehabilitation of Pearland 3406 Business Center Drive Pearland, TX 77584 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 The resident had, oxygen by nasal cannula at 2 liters PRN shortness of breath. Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 11/09/2023 beginning at 11:02 AM revealed Resident #8 in bed. Resident #8 was wearing oxygen set at 4 liters per minute. In an interview at this time Resident #8 stated he had not seen the nursing staff monitor his oxygen settings. Resident # 8 stated the nurses put the water bottle on the concentrator when it was needed. Resident #8 stated he did not see any nurses checking the oxygen rate daily. Resident #8 stated when he started on the oxygen it was at 2 liters. Resident #8 stated he liked the flow higher around 3 or 4 liters. During the interview the resident stated he adjusted the flow rate. Residents Affected - Few In an interview and record review on 11/09/2023 beginning at 11:18 AM LVN A stated Resident #8 was the only resident on oxygen. LVN A stated every time she went into the resident's room, she checked the oxygen concentrator to make sure it was running. LVN A stated she saw Resident #8's oxygen was set at 4 liters per minute. LVN A reviewed Resident #8's physician's order. LVN A stated the physician ordered the oxygen to be at 2 liters not 4 liters. LVN A stated she thought the order was for 4 liters. LVN A stated she had not checked the physician's order for the oxygen flow. LVN A stated the risk was oxygen toxicity (illness caused by a high partial pressure of oxygen during the oxygen therapy). LVN A stated to prevent an incorrect oxygen flow rate in the future she would monitor the physician's order and the oxygen concentrator more often in her shift. In an interview on 11/09/2023 at 11:32 AM the DON stated the staff notified her Resident #8 adjusted his oxygen flow rate. The DON stated she explained to Resident #8 the facility had to follow the physician's order for the oxygen to be at 2 liters per minute. The DON stated the nurses were responsible for monitoring the oxygen flow rate was set at the correct flow ordered by the physician. The DON stated she expected the nurses to monitor the oxygen flow every couple of hours during the day. The DON stated she expected the nurses to review the physician's orders daily for any changes. The DON stated the risk to the resident was high oxygen levels. To prevent the incorrect oxygen rated in the future she will reeducate the nurses on monitoring the physicians order and oxygen setting more often in the shift. In an interview on 11/09/2023 at 11:52 AM the Administrator stated the nurses were responsible for confirming the oxygen flow was correct as ordered by the physician. The Administrator stated the nurse was responsible for assessing the oxygen for proper function every time they go into the resident's room. The Administrator stated the risk was the resident could get too much oxygen. The Administrator stated she was writing a policy to monitor oxygen flow every 2 hours. The Administrator stated the staff was in serviced on the policy. In an interview on 11/09/2023 at 2:43 PM LVN A stated Resident #8's physician was notified the resident adjusted his oxygen to a higher oxygen flow rate. Record review of the facility's policy titled Oxygen administration, Nasal Cannula dated August 2017 read in part Policy: it is the policy of this facility to provide oxygen support when indicated via appropriate delivery device to achieve or maintain adequate oxygenation to the respiratory comprised resident . Important Points: 1. Oxygen is a drug and s such there must be a physician's order for its use FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 4 of 6 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 676436 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Thrive Rehabilitation of Pearland 3406 Business Center Drive Pearland, TX 77584 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 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to inform the resident or his or her representative they are not required to enter into a binding arbitration agreement as a condition of admission, or as a condition to continue to receive care at the facility; and failed to inform the resident or representative they have the right to rescind or terminate the agreement within 30 calendar days of signing. Residents Affected - Many Failure statement: The facility's arbitration agreement did not contain a statement to inform the resident or representative they have the right to rescind or terminate the agreement within 30 calendar days of signing, or that residents were not required to enter into a binding arbitration agreement as a condition of admission This failure in the arbitration agreement could place the residents and their representatives at risk of being uninformed about their rights regarding binding arbitration and less able to defend their rights related to disputes, controversy or claims arising out of or related to the services provided by the nursing facility. The findings included: Record review of the facility's admission packet title admission agreement packet adopted undated had no information about an arbitration agreement. Record review of the facility's arbitration agreement, undated titled The Resorts Arbitration Agreement did not explicitly state the agreement was optional or that residents or responsible parties had the option to rescind the agreement. Record review of the Resident Rights policy dated [DATE] had no mention of the arbitration agreement. Interview on 11/08/2023 at 10:30 AM with the Administrator said all residents signed an arbitration agreement. Interview on 11/09/2023 at 11:19 AM with the Business Office Manager. She said the Admissions Director oversaw the arbitration agreements. Interview on 11/09/2023 at 11:23 AM with the Admissions Director She said she had been with the company since [DATE]. She said her role at the facility was to verify insurance, get the admission packet, got their room ready, made sure it was suitable, and cleaned for them, she placed their name on door, and if the residents or family had not signed admission packet then she had them sign it. She said she worked 8 AM- 5 PM, Monday- Friday. She said she was responsible for the arbitration agreements. She said it was a part of the admission packet and if someone had issues with the facility, they were asked to come to her fist before getting legal involved. She said technically a resident could not involve legal due to the arbitration agreements. She said a resident had never refused to sign the arbitration agreement. She said she had not been told it was required, but it was a part of the admissions packet, and they were supposed to sign the arbitration agreement along with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 5 of 6 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 676436 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Thrive Rehabilitation of Pearland 3406 Business Center Drive Pearland, TX 77584 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 0847 Level of Harm - Potential for minimal harm Residents Affected - Many admissions packet. She said she did not know if residents were allowed to change their minds about signing the arbitration agreement. She said the policy for the arbitration agreement was it should be signed along with the admissions packet. She said it was a part of the consent to treatment. She said, that was how she was told how to do it. She said normally the arbitration was emailed, but sometimes it was printed and as soon as the resident arrived, they were given the arbitration ration to sign. She said she had never been in-serviced or trained on arbitration agreements. She said the Regional Director of Business Development was responsible for ensuring she followed policy or protocol. She said she did not know the risk to res if the policy procedure was not followed. She said the failure occurred because she was unaware the arbitration agreement was optional or that residents and responsible parties could rescind the agreement. Attempted interview on 11/09/2023 at 11:52 AM with the Regional Director of Business. The call did not go through, and this surveyor could not leave a voicemail. Interview on 11/09/2023 at 11:55 AM with the Administrator. She said she had worked at the facility since JUN 28, 2023. She said her role at the facility was as the Administrator and typically worked 8 AM- 6 PM, 630 PM Monday- Friday. She said she worked weekends too. She said she routinely ensured residents had good quality care, their concerns were addressed, and her team were doing their job and following the resident's Plan of Care. She said if a resident refused to sign the arbitration agreement, she did not think the facility could force them to sign the arbitration. She said she did not know what would happen if a resident or responsible party refused to sign the arbitration agreement. She said she thought it might say on the arbitration agreement that it was optional for residents to sign. She said the arbitration agreement had been revised last month. The Administrator reviewed the arbitration agreement during the interview and said the arbitration did not have an out or it was optional. She said her boss through text said residents could change their mind. She reviewed her emails and said on [DATE]th, 2023, the arbitration was revised, and that res are supposed to sign it upon admission. She was asked for a copy of that email, and she said it was just an informative email where she told her staff that the arbitration agreement needed to be signed along with the admission packet. She said she was responsible for admissions and handled the arbitration and the arbitration agreement was a part of the Admissions packet. She said the new arbitration agreement form came out recently and there was no training. She said she was responsible for everything at the facility and for ensuring staff followed protocol and policy. She said it was important the arbitration agreement was within regulation because it saved court costs for the facility, and it was for the protection of the resident, and they needed to be informed of all the processes. She said the worst thing that can happen to the resident when proper protocols were not practiced was depended on what it was, and it could affect the resident's ability to have proper legal guidance. She could not say why the failure occurred. She said she did not know that residents had the option to rescind the arbitration agreement or that residents were not required to sign the arbitration agreement. The facility did not have a policy regarding arbitration agreements. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 6 of 6