Health inspection·October 5, 2025

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 6:07am when CR#1 was found in her bed non-responsive.Record Review of Facility's last vitals taken for CR#1 reflected:6/12/2025 Blood Sugar taken at 5:30pm_25 6/12/2025 Blood Pressure taken at 7:17pm 120/72 6/12/2025 Pulse taken at 5:30pm 59 bpm 6/13/2025 O2 stats taken at 1:02am 98.0% 6/12/2025 Temp taken at 7:10pm 97.8F Record Review of Nursing notes on 6/12/25 and 6/13/25 revealed no SBAR, Monitoring, assessing or follow-up notes by nursing. Record Review of the EMS run report dated 6/13/25 revealed, the FD responded to a call from the NF of an unconscious person. The report indicated the chief complaint was low BLG. EMS arrived to find the patient sitting up in bed, snoring. The patient was unresponsive with a GS of six. EMS assessed CR#1's vital signs which revealed, CR#1 was unresponsive at 5:56 AM with a blood pressure of 99/50, pulse 60 R, respiratory 14 R, oxygen 96%, blood sugar low did not register. The RN reported CR#1 was found with a low blood level of 21 and was administered glucagon and CR#1 did not respond, and 911 was called. The RN reported CR#1 had a hypoglycemic episode (low blood sugar) last night, was given glucagon, and treated with IV glucose by EMS and not transported to the ER. Record review of the Local Hospital B notes dated 6/13/25 revealed, CR#1 transferred to ER due to AMS and hypoglycemia. She was initially admitted to IMU (a step down or progressive care) and started on cefepime (treat bacteria) and Vanco (treat infection) but was transferred to ICU (highest level of care for critically ill patients) overnight due to worsening hypotension (low blood pressure) requiring vasopressors (used to treat dangerously low blood pressure). During a telephone interview on 10/1/25 at 2:10pm with LVN A she stated on 6/12/25, CNA A reported CR#1 was not looking well and didn't eat her lunch or dinner. LVN A stated on 6/12/25 at 5:30pm, she observed CR#1 to be lethargic at which time she began checking CR#1's vitals. She stated CR#1's blood sugar didn't register, which means the levels were low and the machine is unable to get a reading, and she administered glucagon (medicine that treat low blood sugar). CR#1's blood sugar was rechecked 10 minutes later the blood sugar registered at a 25. LVN A stated she called EMS on 6/12/25 and CR#1's representative, but not the doctor. LVN A stated she couldn't remember why she didn't call the doctor and knows she should have because of CR#1's change of condition. During an interview on 10/1/25 at 3:28pm the DON stated the two nurses should have called the doctor for an order to check the blood sugar continuously by the oncoming nurse (LVN B) (6p-6a), because she stated CR#1's blood sugar should have been checked every 20-30 minutes and follow-up documentation should have been completed on this. The DON stated waiting 13 hours to complete a round on CR#1 was unacceptable. The DON stated a failure to check blood sugar could result in a negative outcome, which could be coma, or death. During a telephone interview on 10/1/25 at 7:23pm with LVN B she stated on 6/13/25 at 6:07am she observed CR#1 foaming at the mouth. LVN B stated she was unable to arouse CR#1 so she began assessing her vitals. She stated CR#1's blood sugar was low, and LVN B administered glucagon, then called 911 (6/13/25). LVN B stated after 3 times and rechecking blood sugar levels she got a reading of 21. LVN B described CR#1 as being in an ICU state, where she was unable to respond to verbal commands. LVN B stated she made a nursing judgement to call 911 since she was informed by LVN A that on 6/12/25, EMS arrived at the facility earlier when called by LVN A but was advised by ADON that CR#1 was stable based on her blood sugar level, and there was no need to send CR#1 out to the hospital. LVN B stated in her professional opinion CR#1 should have been sent out earlier, via EMS. She stated CR#1's condition may have created a pancreas issue, fluid retention, and her kidneys were suffering. LVN B stated CR#1 was not eating or drinking fluids. LVN stated CR#1 was conscious when she left the facility. LVN B stated she did call CR#1's representative and the doctor but failed to complete documentation. LVN B stated she monitored CR#1 throughout the night, per orders, but did not note it in the nursing notes. During a follow-up telephone interview on 10/1/25 at 8:21pm with LVN A, she stated ADON was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 2 of 15 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 10/05/2025 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few present during the time EMS was tending to CR#1. She stated when CR#1's blood sugar registered the ADON informed them the resident was stable and there was no need to transport to the hospital at that time. During an interview on 10/2/25 at 11:00am the Hospital Medical Records Administrator stated CR#1 arrived at the ER on [DATE] a little after 6:00am transported by the local fire department and was admitted in the emergency room with a diagnosis of AMS and Hypoglycemia. During a telephone interview on 10/2/25 at 2:19pm CNA A stated he remembered CR#1 and working on 6/12/25. He stated during lunch he observed CR#1 had not eaten her lunch and reminded her that she needed to eat. CNA A stated after dinner he observed she hadn't eaten dinner and became concerned. He stated he again told CR#1 that she should eat, and she responded incoherently. CNA A stated he informed LVN A about CR#1 not eating her lunch and dinner meals and that she sounded incoherent, like babbling. CNA A stated LVN A rushed to CR#1's room and began her assessments and vitals. He stated then EMS arrived, which is when he left to tend to other residents before his shift ended at 6:00pm. During an Interview on 10/2/25 at 3:02pm the ADON stated she did not make the decision for EMS not to take CR#1 to the hospital on 6/12/25 at 5:30pm. ADON A stated she does not remember hearing CR#1 say she didn't want to go to the hospital, but if she did then she wouldn't be taken. The ADON stated the decision for EMS not taking CR#1 was between CR#1 and EMS. The ADON stated that she was informed after the fact that EMS was not going to transport CR#1 to the hospital. The ADON stated a change of condition could have been made, but she would have to see what the change of condition policy says. The ADON stated there should have been a follow-up with CR#1 after the initial event (6/12/25) and documented. The ADON stated she would have liked to have seen an Accu-Chek (device to check blood glucose/sugar levels) with a good number. She stated CR#1 crashed (a sudden change for the worse in CR#1's health) a little over 12 hours (between the time she was evaluated by LVN A and LVN B), but follow-up from the nurses may not have prevented it. The ADON stated a negative outcome could potentially result in death. During a telephone interview on 10/2/25 at 3:50pm with the MD, she stated any calls after 6:00pm are forwarded to the on-call answering services; however, if she wasn't on call she would have gotten the message anyway. The MD stated she was not notified on 6/12/2025 nor 6/13/2025 of CR#1's condition. The MD stated blood sugar numbers under 40 are not good numbers and this was a critical event, and a doctor should have been notified immediately. The MD stated since nursing staff didn't send CR#1 out to the hospital, CR#1 should've been monitored every 20 minutes by finger stick to get a more recent reading and to determine if the blood sugar is rising to an acceptable range within 2 to 4 hours at the most. She stated CR#1's eating and fluid intake should have been monitored as well. During the 2 to 4 hour monitoring range, if blood sugar levels were not within range during this period, then EMS should have been called based on resident's medical history and condition. The MD stated blood sugar ranges of 21 & 25 are not acceptable numbers and a resident is still not cognitive to make decisions. The MD stated that there should have been more details documented in nursing notes of how the resident was doing based on nurse monitoring. The MD stated the resident was taking medication for diabetes and glucagon not being monitored could have had a dangerous effect. Record review of the Change of Condition policy reflected:PROCEDURE:1. Acute medical changes or any sudden or serious change in condition manifestedby a marked change in physical, mental and psychosocial status:a Licensed Nurse will notify the physician,b If unable to contact attending physician or alternate physician, notify the Medical Director,Notify and inform legal surrogate for any change of condition.2. Using the Interact Tool SBAR - notify physician for all signs and symptomsmanifested by the patient. The form will be used to initiate change of conditiondocumentation for any decline or improvement.3. Follow notification guideline for physicians using Interact Tool Change of Condition File Cards4. Except (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 3 of 15 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 10/05/2025 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few in medical emergencies, notifications will be made within twenty-four (24) hours of a change occurring in the resident's medical/mental condition or status. 5. Regardless of the resident's current mental or physical condition, the Nursing Supervisor/Charge Nurse will inform the resident of any changes in his/her medical care or nursing treatments. An Immediate Jeopardy (IJ) was identified on 10/03/2025 The IJ template was provided to the facility (administrator) on 10/3/25at12:26pm While the IJ was removed on 10/04/2025, the facility remained out of compliance at a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy and a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems. Review of the facility's Plan of Removal reflected:[Facility name] October 3, 2025 F580 Notification of Changes The facility failed to consult with resident's physician when there was a significant change in the resident's physical, mental or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications). The following are the Immediate Plan for Removal for F580 Notification of Changes Version 2 1. Corrective and appropriate actions to be implemented for the affected residents identified in the deficiencies. 2. Immediate Action: On 6/13/25 CR#1 has been discharged to [the hospital] via 911. 3. Immediate Action: LPN A no longer works at the facility since _7/15/25__. 4. Immediate Action: LPN B no longer works at the facility since __8/20/25_____. CNA-A was provided 1:1 in-service on 10/3/2025 on reporting changes and any meal intake less than 75% to license nurse to offer supplement or other substitute meal available. 5. Immediate Action: Inservice training was provided by DON/designee with all CNAs on ensuring that any changes in meal intake less than 75% and also changes in condition observed are reported to license nurse assigned. Training initiated on 10/3/2025 with _8_ total CNA's attending and targeted completion date of _10/4/25_. 6. Immediate Action: Inservice training was provided by DON/designee initiated on 10/3/2025 with all LNs. Staff will not be allowed to provide direct care until training has been completed. Training initiated on 10/3/2025 with _6_ total LN's attending and targeted completion date of __10/3/25_ with the following education: a. Completing change of condition evaluation for residents b. Notifying physicians for any change of conditions c. Notifying the party responsible for change of conditions. 2. Governing Body - QAPI committee a. Immediate Action: During the ad hoc QAPI Committee meeting on 10/3/2025, a root cause analysis (RCA) revealed multiple system-level factors that contributed to the poor medical event follow up which includes handoff communication issue, monitoring follow up, training and possible competency gaps and timely physician notification. The RCA identified the root cause as the proper communication and handoff follow up for identified care issues and physician notification for changes of conditions for any medical events. b. The NHA will oversee corrective actions initiated on 10/3/2025 and monthly thereafter during QAPI meetings which are based on the results of the RCA and plan of corrections for the findings during the survey. Any corrective actions not meeting the 100% compliance benchmark, as determined by medical records audits, medication administration pass audit will be reviewed and revised with the QAPI Committee for revision, further evaluation, and recommendations, with a designated person IDT member assigned to each corrective action. c. Any new issues found during medical record audits and medication pass administration audit will be presented to the QAPI team members for immediate action. The DON will monitor the immediate actions for implementation of monitoring/audit needs at least monthly for the next 3 months or until compliance is 100% or is achieved. 3. Specific staff involved in implementing the corrective actions.a. Team Members: Medical Director, Nursing Home Administrator (NHA), Director of Nurses (DON), Assistant Director of Nurses (ADON). Each member will perform:i. Medical Director: Through the QAPI committee, the Medical Director will monitor the system, recommend changes, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 4 of 15 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 10/05/2025 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few oversee corrective action plans. This role includes identifying and implementing medical interventions to reduce medical events.ii. NHA: The NHA will oversee all corrective actions initiated on 9/9/2025 and continue monthly reviews during QAPI meetings.iii. DON: The DON will oversee the investigation, reporting, and resolution of medication administration errors, ensuring patient safety and regulatory compliance. The DON will implement corrective actions, conduct audits, monitor staff adherence to policies, and collaborate with the ADON to provide ongoing training, reinforcing best practices in medication management.iv. ADON: This role will include educating staff and plays a critical role in addressing medical events intervention by providing targeted training and education to licensed nursing staff, ensuring compliance with facility policies and regulatory standards. The role includes conducting in-service sessions on proper medication administration, change of condition, overseeing competency evaluations, and implementing corrective action plans to prevent future errors while promoting a culture of accountability and continuous improvement.4. Identification of other residents who may need to be included (who may have been affected by the deficient practice: a. All residents with diagnosis of diabetes were identified to be at risk for the identified deficient practice. On 10/3/2025, a random audit of all in-house patients was completed by DON/designee and found a total of _26_ residents to have Diabetes.i. A random audit of lunch administered on 10/3/2025 for all 78 residents completed by ADON or designee showed that there was no other resident affected by any meal intakes less than 75% that were reported to licensed nurses and documented by CNAs.ii A random audit by DON or designee of all 26 residents with diabetes and blood sugar checks showed zero affected resident with blood sugar results of less than 70 for completed fingerstick done prior to lunch.5. Systemic Changes and Measures: 1. System Change: Training in change of condition monitoring and reporting will be included for new hires and will be reviewed yearly by ADON during the annual performance review. The annual training calendar will include change of condition monitoring for its annual in-service for LNs beginning the month of October-2025.b. System Change: Training in meal intake monitoring and reporting will be included for new hires and will be reviewed yearly by ADON during the annual performance review. The annual training calendar will include meal % monitoring its annual in-service for CNAs beginning the month of October-2025.c. System Change: Starting 10/4/25, the MDS Nurse will conduct audits of blood sugar monitoring using BS audit tool to determine if notification of physician and patient representative occurred and change of condition was initiated. Audits will be conducted daily for three (3) days, then weekly for two (2) weeks, and monthly thereafter. The MDS Nurse will submit the findings of the audits to the DON for review, analysis, and implementation of necessary corrective actions to improve medication administration practices and ensure regulatory compliance. Issues found by the DON will refer to the QAPI Committee for further review and revision of action plan and/or to determine any further training needs for staff involved d. System Change: Starting 10/4/25, the MDS Nurse will conduct audits of meal intake and LN notification using meal intake report from EHR. Audits will be conducted daily for three (3) days, then weekly for two (2) weeks, and monthly thereafter. The MDS Nurse will submit the findings of the audits to the DON for review, analysis, and implementation of necessary corrective actions to improve medication administration practices and ensure regulatory compliance. Issues found by the DON will refer to the QAPI Committee for further review and revision of action plan and/or determining any further training needs for staff involved.e. System Change: Starting 10/4/25, the MDS Nurse will conduct change of condition audit using a COC audit tool. Audits will be conducted daily for three (3) days, then weekly for two (2) weeks, and monthly thereafter. The MDS Nurse will review and submit the findings of the audits to the DON for review, analysis, and implementation of necessary corrective actions to improve medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 5 of 15 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 10/05/2025 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few administration practices and ensure regulatory compliance. Issues found by the DON will refer to the QAPI Committee for further review and revision of action plan and/or to determine any further training needs for staff involved 6. Training and Education Started on 10/3/2025 by DON and/or Designee. a. Immediate Action: CNA-A was provided 1:1 in-service on 10/3/2025 on reporting changes and any meal intake less than 75% to license nurse to offer supplement or other substitute meal available. b. Immediate Action: Inservice training was provided by DON/designee with all CNAs on ensuring that any changes in meal intake less than 75% and also changes in condition observed are reported to license nurse assigned. Training initiated on 10/3/2025 with _8_ total CNA's attending and targeted completion date of _10/4/25__.7. Immediate Action: Inservice training was provided by DON/designee initiated on 10/3/2025 with all LNs. Training initiated on 10/3/2025 with _6_ total LN's attending and targeted completion date of _10/3/25_ with the following education: a. Completing change of condition evaluation for residents b. Notifying physicians for any change of conditions c. Notifying the party responsible for change of conditions. Please review the following POR.Sincerely,[name], Monitoring On 10/4/2025 at 10:50pm the Administrator was informed the IJ was removed. During a telephone interview on 10/5/25 at 5:00PM with the MDS Nurse it was revealed that on 10/4/25, the MDS Nurse conducted audits of blood sugar monitoring using a blood sugar audit tool, which will alert nursing staff for out-of-range blood sugars. This is a change in the system that was implemented after the IJ. At this time management roles are currently being expanded where there may be another ADON; however, until one is hired, he will be responsible for the audits, to determine if notification of physician and patient representative occurred and change of condition was initiated. The MDS stated he found that notifications were initiated. The MDS stated this process will be the same using the change of condition audits. The MDS stated the process he will use to ensure the audits are completed is conduct audits multiple times daily for the next 3 days, then weekly for the next 2 weeks and then monthly thereafter. The MDS Nurse will submit the findings of the audits to the DON for review, analysis, and implementation of necessary corrective actions to improve medication administration practices and ensure regulatory compliance. Any issue found by the DON will be referred to the QAPI Committee for further review and revision of action plan and/or to determine any further training needs for staff involved. The MDS stated implementation will be discussed in the morning clinical meetings. This will be daily. Whoever takes over this responsibility will be informed this information is to be shared with the staff in the morning clinical meetings. The MDS Nurse stated experience has shown that there needs to be a system created from management at the top and comes down to the doctor. He stated the facility's main goal is to ensure residents are safe and being taken care of. The person-centered care is very important, and it is what drives excellent customer service. During an interview on 10/5/25 at 5:50PM with ADON who stated the DON conducted random audits of change of condition. She stated she is aware of the policy for quality of care and change of condition. The ADON stated she is aware of completing audits and ensuring the SBAR and all people are notified, provided in -services and required to follow up on issues and ensure that the documentation is completed properly. She stated she felt like the nurses did what they needed to do during CR#1's event. She stated the whole event taught her that there needs to be a follow up note/chart.During an interview on 10/5/25 at 6:15PM the DON stated she took the initiative to ensure all the change of conditions were completed. She stated she has learned that the nurses need to make sure that they are following through with all their charting. She stated she is committed to doing random audits to ensure proper documentation has been completed. She stated in-service training will be ongoing in all areas, especially areas of change of condition. She stated the CNAs complete their charting on the ADL platform and she will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 6 of 15 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 10/05/2025 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete monitoring their documentation as well.During an interview on 10/5/25 at 7:00PM the Admin stated it requires accountability in all areas from staff. She stated she is a RN herself and able to read charts, diagnosis, protocols for change of conditions and assessments. She stated this IJ has taught her that there needs to be an accountability system in place to ensure resident safety and maintain that person-centered care. She stated the process that is in place for the change of condition, reporting, dietary intake monitoring will be continued on a daily basis. An Immediate Jeopardy (IJ) was identified on 10/03/2025 The IJ template was provided to the facility (Administrator) on 10/3/25 at 12:26pm While the IJ was removed on 10/04/2025, the facility remained out of compliance at a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy and a scope of Isolated due to the facility's need to evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 676436 If continuation sheet Page 7 of 15 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 10/05/2025 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 (CR#1) of 7 residents reviewed for quality of care. The facility failed to send CR#1 to the hospital when her blood sugar was extremely low, despite EMS being called before and arriving 13 hours before her eventual transport to the local hospital. The facility failed to monitor CR#1's blood sugar for approximately 13 hours after it was documented as critically low. This lapse led to a second hypoglycemic episode during which CR#1 was found unresponsive and required emergency medical care. An Immediate Jeopardy (IJ) was identified on 10/03/2025 The IJ template was provided to the facility (administrator) on 10/3/25at12:26pm While the IJ was removed on 10/04/2025, the facility remained out of compliance at a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems. These failures could place residents at risk for possible serious injuries, harm and death. Findings Include: Record review of CR#1's face sheet dated 6/10/2025 reflected a [AGE] year-old female, with an original admission date of 10/1/2003 with diagnoses of ESRD (Kidney failure), hypertension (high blood pressure), diabetes mellitus without complications (type 2) and UTI (bladder infection). Record review of CR#1's MDS dated [DATE], revealed CR#1's cognitive skills were severely impaired, and she was dependent on staff for all her needs; there was no BIMS score listed. Record review of CR#1's orders dated 6/13/2025 revealed, CR#1 was prescribed Glipizide (5mg) for diabetes mellitus without complications. Blood glucose greater than 100 on 6/11/25 and D/C on 6/13/25 at 6:42am; Gabapentin (100MG) (1 tablet by mouth 3 times a day) for diabetes mellitus without complications on 6/11/25 and D/C on 6/16/25.Record review of CR #1's baseline care plan dated 6/10/25, revealed hypoglycemic medications. Record Review of nursing notes dated 6/12/25 at 5:30pm written by LVN A revealed, pt found lethargic during rounds, vitals assessed blood sugar monitor read low, bp 128/57, spo2 94, r 18, temp 97.5, glucagon (medicine that treats low blood sugar) administered x 1, rechecked 10 min later blood sugar 25, ems called, pt stabilized and remains on unit. rp notified. will continue to monitor. Record Review of nursing notes dated 6/13/25 at 6:07am written by LVN B revealed, Patient found lethargic, unable to arouse, vitals assessed blood sugar monitor read low, bp 120/50, spo2 91, r 10, temp 97.5, P 65 , glucagon administered x1, 911 was called, Rales to Bilateral lungs (crackling sound in both lungs), recheck sugar 3x and got a reading of 21, EMS, unable to rouse patient, patient was routed to Local hospital. Record Review of Facility's last vitals taken for CR#1 reflected:6/12/2025 Blood Sugar taken at 5:30pm_25 6/12/2025 Blood Pressure taken at 7:17pm 120/72 6/12/2025 Pulse taken at 5:30pm 59 bpm 6/13/2025 O2 stats taken at 1:02am 98.0% 6/12/2025 Temp taken at 7:10pm 97.8F Record Review of Nursing notes on 6/12/25 and 6/13/25 revealed no SBAR, Monitoring, assessing or follow-up notes by nursing. Record Review of the EMS run report dated 6/13/25 revealed, the FD responded to a call from the NF of an unconscious person. The report indicated the chief complaint was low BLG. EMS arrived to find the patient sitting up in bed, snoring. The patient was unresponsive with a GS of six. EMS assessed CR#1's vital signs which revealed, CR#1 was unresponsive at 5:56 AM with a blood pressure of 99/50, pulse 60 R, respiratory 14 R, oxygen 96%, blood sugar low did not register. The RN reported CR#1 was found with a low blood level of 21 and was administered glucagon and CR#1 did not respond, and 911 was called. The RN reported CR#1 had a hypoglycemic episode (low blood sugar) last night, was given glucagon, and treated with IV glucose by EMS and not transported to the ER. Record review of the Local Hospital B notes dated 6/13/25 Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 8 of 15 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 10/05/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some revealed, CR#1 transferred to ER due to AMS and hypoglycemia. She was initially admitted to IMU (a step down or progressive care) and started on cefepime (treat bacteria) and Vanco (treat infection) but was transferred to ICU (highest level of care for critically ill patients) overnight due to worsening hypotension (low blood pressure) requiring vasopressors (used to treat dangerously low blood pressure). Record review of facility Diabetic Management Policy dated January 2021 revealed the following: HYPOGLYCEMIA PROTOCOLMild reactions: For a mild reaction when the resident is awake but signs or symptoms of low blood sugar or has a blood sugar level less than 70 mg/dl: Rule of 15 Give 1/2 cup of juice (apple or orange juice [for Renal patients, avoid orange juice Give a 15 gram dose of glucose gel (read labels) or glucose tablets. Brands vary. Wait 15 minutes and recheck the blood sugar. If the resident continues to have low blood sugar or has a blood sugar level below 70 mg/dl. Repeat the treatment. Recheck the blood sugar in 15 minutes and prepare to treat for a serious reaction if the resident does not recover. Moderate reactions: For a moderate reaction where the resident blood sugar is less than 45 mg/dL, but if they are awake, give 30 gm of carbohydrate orally by using two of the items listed above and continue the Rule of 15. Prepare glucagon if the individual does not recover immediately. Severe reactions: For a severe reaction where the resident cannot drink or swallow, isunconscious, or is having seizures: Administer 1 mg of glucagon intramuscularly. Position the resident on their side in case of vomiting. The CR#1 should awaken within minutes. If not, administer an additional dose of 1 mg glucagon intramuscularly and call for emergency assistance. Some facilities can provide intravenous dextrose 50% which should provide recovery. Once fully awake and not vomiting, the resident should eat. The following alert strategy could be considered: Call provider immediately in cases of low blood glucose levels (<70 mg/dL [3.9 mmol/L]). Call provider as soon as possible when glucose values are 70 100 mg/dL (3.9 5.6 mmol/L) (regimen may need to be adjusted), Record review of Quality of Life - Homelike Environment policy dated April 2018 revealed the following:PURPOSE: 1. Staff shall provide person-centered care that emphasizes the resident comfort, independence and personal needs and preferences. During a telephone interview on 10/1/25 at 2:10pm with LVN A she stated on 6/12/25, CNA A reported CR#1 was not looking well and didn't eat her lunch or dinner. LVN A stated on 6/12/25 at 5:30pm, she observed CR#1 to be lethargic at which time she began checking CR#1's vitals. She stated CR#1's blood sugar didn't register, which means the levels were low and the machine is unable to get a reading, and she administered glucagon (medicine that treat low blood sugar). CR#1's blood sugar was rechecked 10 minutes later the blood sugar registered at a 25. LVN A stated she called EMS on 6/12/25 and CR#1's representative, but not the doctor. LVN A stated she couldn't remember why she didn't call the doctor and knows she should have because of CR#1's change of condition. During an interview on 10/1/25 at 3:28pm the DON stated the two nurses should have called the doctor for an order to check the blood sugar continuously by the oncoming nurse (LVN B) (6p-6a), because she stated CR#1's blood sugar should have been checked every 20-30 minutes and follow-up documentation should have been completed on this. The DON stated waiting 13 hours to complete a round on CR#1 was unacceptable. The DON stated a failure to check blood sugar could result in a negative outcome, which could be coma, or death.During a telephone interview on 10/1/25 at 7:23pm with LVN B she stated on 6/13/25 at 6:07am she observed CR#1 foaming at the mouth. LVN B stated she was unable to arouse CR#1 so she began assessing her vitals. She stated CR#1's blood sugar was low, and LVN B administered glucagon, then called 911 (6/13/25). LVN B stated after 3 times and rechecking blood sugar levels she got a reading of 21. LVN B described CR#1 as being in an ICU state, where she was unable to respond to verbal commands. LVN B stated she made a nursing judgement to call 911 since she was informed by LVN A that on 6/12/25, EMS arrived at the facility earlier when called by LVN A (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 9 of 15 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 10/05/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some but was advised by ADON that CR#1 was stable based on her blood sugar level, and there was no need to send CR#1 out to the hospital. LVN B stated in her professional opinion CR#1 should have been sent out earlier, via EMS. She stated CR#1's condition may have created a pancreas issue, fluid retention, and her kidneys were suffering. LVN B stated CR#1 was not eating or drinking fluids. LVN stated CR#1 was conscious when she left the facility. LVN B stated she did call CR#1's representative and the doctor but failed to complete documentation. LVN B stated she monitored CR#1 throughout the night, per orders, but did not note it in the nursing notes.During a follow-up telephone interview on 10/1/25 at 8:21pm with LVN A, she stated ADON was present on 6/12/25, during the first time EMS was tending to CR#1. She stated when CR#1's blood sugar registered to 21 at which time, the ADON informed EMS the resident was stable and there was no need to transport to the hospital at that time. LVN A stated she completed her documentation and shift change with LVN B, then left the facility because her shift was over at 6pm, During an interview on 10/2/25 at 11:00am the Hospital Medical Records Administrator stated CR#1 arrived at the ER on [DATE] a little after 6:00am transported by the local fire department and was admitted in the emergency room with a diagnosis of AMS and Hypoglycemia. During a telephone interview on 10/2/25 at 2:19pm CNA A stated he remembered CR#1 and working on 6/12/25. He stated during lunch he observed CR#1 had not eaten her lunch and reminded her that she needed to eat. CNA A stated after dinner he observed she hadn't eaten dinner and became concerned. He stated he again told CR#1 that she should eat, and she responded incoherently. CNA A stated he informed LVN A about CR#1 not eating her lunch and dinner meals and that she sounded incoherent, like babbling. CNA A stated LVN A rushed to CR#1's room and began her assessments and vitals. He stated then EMS arrived, which is when he left to tend to other residents before his shift ended at 6:00pm. During an Interview on 10/2/25 at 3:02pm the ADON stated she did not make the decision for EMS not to take CR#1 to the hospital on 6/12/25 at 5:30pm. ADON A stated she does not remember hearing CR#1 say she didn't want to go to the hospital, but if she did then she wouldn't be taken. The ADON stated the decision for EMS not taking CR#1 was between CR#1 and EMS. The ADON stated that she was informed after the fact that EMS was not going to transport CR#1 to the hospital. The ADON stated a change of condition could have been made, but she would have to see what the change of condition policy says. The ADON stated there should have been a follow-up with CR#1 after the initial event (6/12/25) and documented. The ADON stated she would have liked to have seen an Accu-Chek (device to check blood glucose/sugar levels) with a good number. She stated CR#1 crashed (a sudden change for the worse in CR#1's health) a little over 12 hours (between the time she was evaluated by LVN A and LVN B), but follow-up from the nurses may not have prevented it. The ADON stated a negative outcome could potentially result in death. During a telephone interview on 10/2/25 at 3:50pm with the MD, she stated any calls after 6:00pm are forwarded to the on-call answering services; however, if she wasn't on call she would have gotten the message anyway. The MD stated she was not notified on 6/12/2025 nor 6/13/2025 of CR#1's condition. The MD stated blood sugar numbers under 40 are not good numbers and this was a critical event, and a doctor should have been notified immediately. The MD stated since nursing staff didn't send CR#1 out to the hospital, CR#1 should've been monitored every 20 minutes by finger stick to get a more recent reading and to determine if the blood sugar is rising to an acceptable range within 2 to 4 hours at the most. She stated CR#1's eating and fluid intake should have been monitored as well. During the 2 to 4 hour monitoring range, if blood sugar levels were not within range during this period, then EMS should have been called based on resident's medical history and condition. The MD stated blood sugar ranges of 21 & 25 are not acceptable numbers and a resident is still not cognitive to make decisions. The MD stated that there should have been more details documented in nursing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 10 of 15 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 10/05/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some notes of how the resident was doing based on nurse monitoring. The MD stated the resident was taking medication for diabetes and glucagon not being monitored could have had a dangerous effect. Record review of the Change of Condition policy reflected:PROCEDURE:1. Acute medical changes or any sudden or serious change in condition manifestedby a marked change in physical, mental and psychosocial status:a Licensed Nurse will notify the physician,b If unable to contact attending physician or alternate physician, notify the Medical Director,Notify and inform legal surrogate for any change of condition.2. Using the Interact Tool SBAR - notify physician for all signs and symptomsmanifested by the patient. The form will be used to initiate change of conditiondocumentation for any decline or improvement. An Immediate Jeopardy (IJ) was identified on 10/03/2025 The IJ template was provided to the facility (administrator) on 10/3/25at12:26pm While the IJ was removed on 10/04/2025, the facility remained out of compliance at a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems. Review of the facility's Plan of Removal reflected:[Facility name]October 3, 2025 F684 The facility failed to ensure CR#1 received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan. The facility failed to seek medical Guidance from CR # 1's physician or sent her out to emergency care when she experienced a change of condition related to hypoglycemia. Facility nurse failed to follow monitor CR #1's blood sugar for approximate 13 hours after it was noted to be critically low. This resulted in a second occurrence of hypoglycemia and CR #1 was noted to be unresponsive and required emergency medical care. The following are the Immediate Plan for Removal for F684 Free Quality of Care Version 4. Corrective and appropriate actions to be implemented for the affected residents identified in the deficiencies. 1. Immediate Action: On 6/13/25 CR#1 has been discharged to [the hospital] via 911. 2. Immediate Action: LPN A no longer works at the facility since _7/15/25__. 3. Immediate Action: LPN B no longer works at the facility since __8/20/25_____. 4. Immediate Action: CNA-A was provided 1:1 in-service on 10/3/2025 on reporting changes and any meal intake less than 75% to license nurse to offer supplement or other substitute meal available. 5. Immediate Action: Inservice training was provided by DON/designee with all CNAs on ensuring that any changes in meal intake less than 75% and also changes in condition observed are reported to license nurse assigned. Training initiated on 10/3/2025 with _8_ total CNA's attending and targeted completion date of _10/4/25_. 6. Immediate Action: Inservice training was provided by DON/designee initiated on 10/3/2025 with all LNs. Staff will not be allowed to provide direct care until training has been completed. Training initiated on 10/3/2025 with _6_ total LN's attending and targeted completion date of __10/3/25_ with the following education: a. Completing change of condition evaluation for residents b. Notifying physicians for any change of conditions c. Notifying the party responsible for change of conditions. d. Review of hypo/hyperglycemic protocols, monitoring blood sugar according to the protocol/MD order including discussion signs and symptoms of hyper/hypoglycemia that requires physician intervention and notification. 2. Governing Body QAPI committee a. Immediate Action: During the ad hoc QAPI Committee meeting on 10/3/2025, a root cause analysis (RCA) revealed multiple system-level factors that contributed to the poor medical event follow up which includes handoff communication issue, monitoring follow up, training and possible competency gaps and timely physician notification. The RCA identified the root cause as the proper communication and handoff follow up for identified care issues and physician notification for changes of conditions for any medical events. b. The NHA will oversee corrective actions initiated on 10/3/2025 and monthly thereafter during QAPI meetings which are based on the results of the RCA and plan of corrections for the findings during the survey. Any corrective actions (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 11 of 15 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 10/05/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some not meeting the 100% compliance benchmark, as determined by medical records audits, medication administration pass audit will be reviewed and revised with the QAPI Committee for revision, further evaluation, and recommendations, with a designated person IDT member assigned to each corrective action. c. Any new issues found during medical record audits and medication pass administration audit will be presented to the QAPI team members for immediate action. The DON will monitor the immediate actions for implementation of monitoring/audit needs at least monthly for the next 3 months or until compliance is 100% or is achieved.3. Specific staff involved in implementing the corrective actions.a. Team Members: Medical Director, Nursing Home Administrator (NHA), Director of Nurses (DON), Assistant Director of Nurses (ADON). Each member will perform:i. Medical Director: Through the QAPI committee, the Medical Director will monitor the system, recommend changes, and oversee corrective action plans. This role includes identifying and implementing medical interventions to reduce medical events.ii. NHA: The NHA will oversee all corrective actions initiated on 9/9/2025 and continue monthly reviews during QAPI meetings.iii. DON: The DON will oversee the investigation, reporting, and resolution of medication administration errors, ensuring patient safety and regulatory compliance. The DON will implement corrective actions, conduct audits, monitor staff adherence to policies, and collaborate with the ADON to provide ongoing training, reinforcing best practices in medication management.iv. ADON: This role will include educating staff and plays a critical role in addressing medical events intervention by providing targeted training and education to licensed nursing staff, ensuring compliance with facility policies and regulatory standards. The role includes conducting in-service sessions on proper medication administration, change of condition, overseeing competency evaluations, and implementing corrective action plans to prevent future errors while promoting a culture of accountability and continuous improvement.4. Identification of other residents who may need to be included (who may have been affected by the deficient practice: a. All residents with diagnosis of diabetes were identified to be at risk for the identified deficient practice. On 10/3/2025, a random audit of all in-house patients was completed by DON/designee and found a total of _26_ residents to have Diabetes.i. A random audit of lunch administered on 10/3/2025 for all 78 residents completed by ADON or designee showed that there was no other resident affected by any meal intakes less than 75% that were reported to licensed nurses and documented by CNAs.ii A random audit by DON or designee of all 26 residents with diabetes and blood sugar checks showed zero affected resident with blood sugar results of less than 70 for completed fingerstick done prior to lunch.5. Systemic Changes and Measures:a. System Change: Training in change of condition monitoring and reporting will be included for new hires and will be reviewed yearly by ADON during the annual performance review. The annual training calendar will include change of condition monitoring for its annual in-service for LNs beginning the month of October-2025. b. System Change: Training in meal intake monitoring and reporting will be included for new hires and will be reviewed yearly by ADON during the annual performance review. The annual training calendar will include meal % monitoring its annual in-service for CNAs beginning the month of October-2025.c. System Change: Starting 10/4/25, the MDS Nurse will conduct audits of blood sugar monitoring using BS audit tool to determine if notification of physician and patient representative occurred and change of condition was initiated. Audits will be conducted daily for three (3) days, then weekly for two (2) weeks, and monthly thereafter. The MDS Nurse will submit the findings of the audits to the DON for review, analysis, and implementation of necessary corrective actions to improve medication administration practices and ensure regulatory compliance. Issues found by the DON will refer to the QAPI Committee for further review and revision of action plan and/or to determine any further training needs for staff involved d. System Change: Starting 10/4/25, the MDS Nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 12 of 15 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 10/05/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some will conduct audits of meal intake and LN notification using meal intake report from EHR. Audits will be conducted daily for three (3) days, then weekly for two (2) weeks, and monthly thereafter. The MDS Nurse will submit the findings of the audits to the DON for review, analysis, and implementation of necessary corrective actions to improve medication administration practices and ensure regulatory compliance. Issues found by the DON will refer to the QAPI Committee for further review and revision of action plan and/or determining any further training needs for staff involved.e. System Change: Starting 10/4/25, the MDS Nurse will conduct change of condition audit using a COC audit tool. Audits will be conducted daily for three (3) days, then weekly for two (2) weeks, and monthly thereafter. The MDS Nurse will review and submit the findings of the audits to the DON for review, analysis, and implementation of necessary corrective actions to improve medication administration practices and ensure regulatory compliance. Issues found by the DON will refer to the QAPI Committee for further review and revision of action plan and/or to determine any further training needs for staff involved f. System Change: Starting 10/4/25, the ADON/designee will conduct a random audit of residents with change of condition to determine that monitor occurred for 72 hours following an identified change of condition. Any findings will be reviewed with the DON for review, analysis and implementation of necessary corrective actions. g. System Change: Starting 10/4/25, weekly for 2 weeks and monthly thereafter for 3 months, a random verification of licensed nurses' knowledge and training will be conducted by ADON/designee using a mock hypo/hyperglycemia drill to test responses of nurses based on physician's order and/or diabetic protocol ordered. Any findings will be reviewed with the DON for review, analysis and implementation of necessary corrective actions.6. Training and Education Started on 10/3/2025 by DON and/or Designee. a. Immediate Action: CNA-A was provided 1:1 in-service on 10/3/2025 on reporting changes and any meal intake less than 75% to license nurse to offer supplement or other substitute meal available. b. Immediate Action: Inservice training was provided by DON/designee with all CNAs on ensuring that any changes in meal intake less than 75% and also changes in condition observed are reported to license nurse assigned. Training initiated on 10/3/2025 with _8_ total CNA's attending and targeted completion date of _10/4/25__.c. Immediate Action: Inservice training was provided by DON/designee initiated on 10/3/2025 with all LNs. Training initiated on 10/3/2025 with _6_ total LN's attending and targeted completion date of _10/3/25_ with the following education: a. Completing change of condition evaluation for residents b. Notifying physicians for any change of conditions c. Notifying the party responsible for change of conditions. d. Review of hypo/hyperglycemic protocols, monitoring blood sugar according to the protocol/MD order including discussion signs and symptoms of hyper/hypoglycemia that requires physician intervention and notification.Please review the following POR.Sincerely,[name], Record Review of facility monitoring plan, confirmed the facility implemented their plan of removal and monitoring began on 10/4/2025. The following was confirmed: LVN A no longer employedLVN B no longer employedCNA A in-serviced 1:1In-services for CNAsIn-services for LVNsAudit that identified 26 residents with diabetesLunch audit on 10/3The audit of the 26 residents with diabetesThe blood sugar audit toolThe meal intake formThe change of condition audit tool During an interview on 10/4/25 at 4:46pm with RN A she stated she received in-service yesterday and today. She stated the dietary intake guide monitors the nutrition intake in a resident and anything less than 70% is to be reported immediately to the charge nurse. She stated the SBAR is the most important thing to communicate to physicians during the Change of Condition (sudden changes, vitals, etc. and anything unusual). Any change of condition should be reported to the doctor, resident rep, and DON. She stated during 9:15am staff morning 24-hour report, all resident information is reported. She stated when a resident is hypoglycemic the resident will not be alert, will be sweating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 13 of 15 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 10/05/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some and unable to arouse. RN A stated there were three required steps before calling the doctor when a resident has a change of condition. Those requirements are perform a head to toe assessment, obtain vital signs (including any relevant measurements like O2 saturation, glucose, and pain score), and clarify doctor orders, check code status. She stated the two signs of a glucose emergency are hypoglycemia or hyperglycemia (high blood sugar). She stated the protocol for hypoglycemic is to complete head to toe assessment, give juice honey, administer glucagon and recheck every 15 minutes and call 911 if the blood sugar is under 70. Call the MD, RP; and the protocol for hyperglycemic is to ensure residents have lot of fluids, administer insulin, look for consciousness, complete head to toe assessments, notify the MD, RP. During a telephone interview on 10/4/25 at 5:00pm CNA B stated she received in-service training yesterday and today on changes in conditions, dietary intake monitoring and reporting to the nurse in charge. She stated an example of a change in condition is anything unusual with a resident, which is the change in eating, and sleeping patterns. She stated a dietary intake guide is a monitoring tool of how much a resident has eaten. She stated anything below 70% is reported to the charge nurse.During an interview on 10/4/25 at 5:26pm with CNA C she stated today is day two for in-service training on change of condition, reporting, vitals, physical and mental changes, and dietary intake. She stated that a resident who arrived coherent, and is now confused, is considered to have a change in condition. She stated a dietary intake guide is a monitoring form that tells nursing staff when a resident has eaten and how much. She stated anything under 70% - 75% the charge nurse should be notified due to factors of underlying conditions and conditions worsening for the resident. During an interview on 10/4/25 at 5:38pm with CNA D she stated she was in-serviced yesterday on change of condition for residents and their food intake. She stated changes in condition are considered abnormal. One of the changes would be if a resident is not eating, eating less than usual, their vital signs and if their behavior has changed. She stated the dietary intake guide shows the percentage of food residents have eaten. She stated if food intake is 70% or lower it should be reported to the charge nurse because something could be wrong.During a telephone interview on 10/4/25 at 6:00pm LVN C stated she was in-serviced on change in condition, and proper documentation. She stated an example is a resident may have diarrhea or 3 or more stools in a day. It is a concern and should be reported as a change in condition. She stated a dietary intake guide is a measurement of resident meal intake and must be reported if it is below 70% by the CNA. She stated as a charge nurse she reports changes in condition to the DON, MD, and RP. She stated it is important to report changes because the changes could be severe and detrimental to the resident up to death if not addressed. There could be early signs that could lead to more serious conditions and reporting could reduce the risk. The two signs of a glucose emergency are hypoglycemia and hyperglycemia. She stated the protocol for hypoglycemic is to complete head to toe assessment, give juice honey, glucagon and recheck every 15 minutes and call 911 if the blood sugar is under 70. Call the MD, RP; and the protocol for hyperglycemic is to ensure residents have lot of fluids, administer insulin, look for consciousness, complete head to toe assessments, notify the MD, RP. During a telephone interview on 10/4/25 at 6:15pm RN B stated she was in-serviced on change in condition, and proper documentation. She stated an example is a resident may have diarrhea or 3 or more stools in a day. It is a concern and should be reported as a change in condition. She stated a dietary intake guide is a measurement of resident meal intake and must be reported if it is below 70% by the CNA. She stated as a charge nurse she reports changes in condition to the DON, MD, and RP. She stated it is important to report changes because the changes could be severe and detrimental to the resident up to death if not addressed. There could be early signs that could lead to more serious conditions and reporting could reduce the risk. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 14 of 15 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 10/05/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete two signs of a glucose emergency are hypoglycemia and hyperglycemia. She stated the protocol for hypoglycemic is to complete head to toe assessment, give juice honey, glucagon and recheck every 15 minutes and call 911 if the blood sugar is under 70. Call the MD, RP; and the protocol for hyperglycemic is to ensure residents have lot of fluids, administer insulin, look for consciousness, complete head to toe assessments, notify the MD, RP. During a telephone interview on 10/4/25 at 6:25pm CNA E stated she was in serviced this morning on changes in condition and reporting to charge nurse. She stated that a change in condition regarding a resident is a sign or symptom that is a new onset out of the norm. She stated like if a resident stopped talking all of a sudden. It should be reported to the charge nurse. She stated a dietary intake guide measures the amount of food residents have eaten and gives a percentage that requires you to report to the charge nurse. It should be reported to the charge nurse if the food intake is below 70%. During a telephone interview on 10/4/25 at 6:40pm RN C stated she received in-service yesterday on changes in condition, which was on signs and symptoms and a new onset of behaviors not in the resident's norm. It's out of character. Also, the importance of documentation, and reporting to the MD, DON, and Resident Representative. An example of a change is a resident not eating or drinking like they did in the past. The dietary intake guide should be used to measure resident meal intake and if the resident intake is below a 70% the CNA must report to the charge nurse who will report to the doctor after a head-to-toe assessment, then to the resident rep. The changes could be severe and detrimental to the resident up to death if not Event ID: Facility ID: 676436 If continuation sheet Page 15 of 15