Health inspection·October 24, 2025

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident # 1 revealedno discharge order, discharge summary, or handwritten progress note from the physician to reflect the details of the discharge. During an interview with Resident # 1 on 10/8/2025 at 11:07a.m, she stated the facility coordinator promised her if she ever went to the Emergency Room, she would be allowed to return to the facility. Resident # 1 said: I found out later that; while I was at the hospital, they discharged me from the facility. One of the counselors from the hospital came to my hospital room to talk to me. The counselor said when she called the facility when I was getting close to discharge, the facility told the counselor, I was not allowed to come back. I called the facility to ask why I could not come back; I was told it was because I was refusing care and complaining too much. I anticipated returning to the facility, because they promised me at the beginning if I ever go to the ER, I would be able to come back. Resident # 1 stated she did not pack her belongings out of the room because she was not notified, she was not allowed to return. Resident # 1 stated her family member made a special trip to the facility to pack and remove her belongings from the facility.During an interview with the admission Coordinator on 10/08/2025 at 3:04 p.m., she stated the resident had called her from the hospital, and she told her she was not allowed to return to the facility due to aggressive behavior and she was non-compliant with treatment when she refused an enema ordered by the NP on the day she went to the ER. The coordinator stated, during the facility's morning meetings, they discussed residents' behaviors such as yelling at staff. The admission Coordinator stated Resident #1 yelled and screamed at the staff. The admission Coordinator said, Resident # 1's family member yelled and screamed at the front desk. The coordinator said, she called the resident at the hospital to let her know the facility was unable to accept her after her hospital discharge. During an interview with the DON on 10/09/2025 at 11:50 am, she stated Resident #1 was not allowed to return because of her family's aggressive behavior. The DON reviewed the facility's documentation and said there was no documentation of Resident #1's or her family's aggressive behavior. During an interview with the ADON on 10/09/2025 at 12:05 pm. she stated she heard of Resident # 1's family member's behavior but did not witness any. She heard the family member was demanding but she could not remember what resolutions were arrived at during the morning meetings. The ADON stated she did not know why Resident #1 was not allowed to return to the facility. During an interview with the Administrator on 10/09/2025 at 12:29 pm, the Administrator stated Resident #1 was not allowed to return because her family member was yelling at staff at the front desk on 07/28/2025. On 10/09/2025 at 12: 29 p.m., the Administrator said, Resident #1's family member said they were not returning to the facility. The Administrator stated she did not know if the resident went to the hospital with all her belongings. Record review of the transfer and discharge policy, dated December 2016, defined transfer as, moving the resident from the facility to another institutional setting, such as a hospital or another long-term care facility, or discharge with return anticipated. Discharge per facility record review was moving the resident to a non-institutional setting such as home, or discharge without expectation of return. The transfer and discharge process must provide sufficient preparation and orientation to residents to ensure a safe and orderly transfer or discharge from the facility.-Criteria for Transfer/DischargeThe facility does not transfer or discharge a resident, unless:-The transfer or discharge is necessary to meet the resident's welfare and the resident's welfare cannot be met in the facility.-Supporting information is documented in the resident's medical record. This includes documentation provided by the resident's physician.- The transfer or discharge is appropriate because the residents' health has improved sufficiently so the residents no longer need the services provided by the facility. Supporting information is documented in the resident's medical record. This includes documentation provided by the residents' physicians.- The safety of individuals in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 2 of 17 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 10/24/2025 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 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete facility is endangered. Supporting information is documented in the resident's medical record.-The health of individuals in the facility would otherwise be endangered.- Supporting information is documented in the resident's medical record.- The facility ceases operating.-Refusal of treatment would not constitute grounds for transfer.-A discharge order is obtained by nursing from the physician indicating where the resident is being discharged , why the resident is being discharged , and if the resident is to be discharged with or without medication.-Nursing notifies the business office of the transfer or discharge so that appropriate procedures can be implemented. Provide the information in wring and in a language and manner they understand.-Explain the residents' right to appeal the transfer/discharge.-Provide the name, address, and phone number of the state long term care ombudsman- Review the plan with the resident, and/or his or her family or responsible party, at least 24 hours before the resident's discharge from the facility.-The interdisciplinary team prepares the discharge summary-On the day of transfer or discharge, nursing prepares the resident-Provide notice, in writing, of the facility's bed-hold and readmission policies to the resident and an immediate family member, surrogate or representative.-Residents who were transferred for hospitalization or therapeutic leave, and whose absence exceeds the bed-hold period are permitted to return to the facility in the first available bed. The progress notes must include at least the following, as they may apply:-The reason(s) for the transfer or discharge.- That an appropriate notice of discharge was provided to the resident and/or representative.- That the residents and/or representative participated in a pre-discharge orientation program.-The date and time of the transfer or discharge. -The mode of transportation.- A summary of the resident's overall medical (including the condition of the skin), physical, and mental condition.- If medications are sent with the resident (list names, dosages, and amounts if medications are given to the resident).-Disposition of personal effects.- The signature of the person recording the data in the medical record Event ID: Facility ID: 676436 If continuation sheet Page 3 of 17 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 10/24/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to develop a person-centered care plan to meet practicable physical needs for 1 (Resident #2) reviewed for care plans. Based on record reviews and interviews facility failed to develop or implement a care plan with goals or interventions related to use of adaptive devices for Resident # 2. On 10/23/2025 at 05:05 p.m., an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 10/24/2025, the facility remained out of compliance at a severity level of isolation with potential for more than minimal harm due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. This failure could place Residents at risk of not receiving necessary care and services for not having their individual medical, physical, psychological and/or emotional needs met. Findings included: Record review of Resident # 2's face sheet dated 08/18/2025, revealed an [AGE] year-old male admitted on [DATE] following a joint replacement surgery on 06/25/2025. His diagnoses included: joint replacement surgery, type 2 diabetes(high levels of sugar in the blood stream), hypertension (high blood pressure), parathyroid( overactive thyroid glands), hyperlipidemia ( high levels of fat in the blood stream), dementia, depression, degenerative disease of nervous system, epilepsy (repeated seizures caused by damaged brain cells), Transient-Cerebral Ischemic Attack (brief blockage of blood flow to the brain), generalized muscle weakness, acute kidney failure, dysphagia (difficulty swallowing), tremors, lack of coordination, cognitive communication deficit (communication challenge caused by problem with thinking abilities like attention, memory, and executive function rather than a language or speech problem), fracture of left femur(fracture of the hip bone), closed fracture with routine healing (a non-surgical procedure used to align and immobilize broken bones without the need for surgery. Resident # 2 was initially admitted on [DATE]. Record review of Resident # 2's MDS dated [DATE], cognition section C0400 was coded 1 which indicates able to recall after cueing. Cognition section C0500 was coded 06, which indicated severe cognitive impairment. Record review of Resident # 2's care plan dated 08/15/2025 revealed Resident # 2 had a fracture with goal to remain free of complication related to hip fracture, such as contracture formation, embolism (obstruction of an artery, typically by a clot of blood or an air bubble) and immobilization. Resident # 2 had ADL self-care performance deficit with the following intervention: needs transfer with two people assisting from bed to chair or vice versa.Record review of Resident # 2's hospital discharged paperwork, dated 06/25/2025 revealed, gait assistance, needs two person assist with a gait belt, maximal assistance. Scooting: needs two total assistance (sitting and supine scooting). Sit to supine: total assistance. Needs two. Precautions: fall precautions, posterior hip precautions. Abdominal pillow in the lower extremity while in bed, as well as hip abduction pillow. Pillow for hip replacement surgery for leg support and prevention of dislocation. Record review of facility's New admission Report Sheet, dated 06/25/2025, did not reveal any special equipment or type of assistance needed during transfer for Resident # 2.Record review of Resident # 2's admission report dated 06/25/2025, revealed no special equipment, amount or type of mobility assistance for transfer. Record review of Resident # 2's baseline care plan, dated 06/25/2025, revealed no special or adaptive devices such as a hip abduction pillow, wedge or cushion to be used. Resident # 2's care plan indicated he had a fracture with goal to remain free of complications related to hip fracture, such as contracture formation, embolism (obstruction of an artery, typically by a clot of blood or an air bubble) and immobilization. Resident # 2's care plan for ADL self-care deficit with the following intervention: transfer with two people assisting from bed to chair and vice versa. Record review of Resident # 2's Physician orders revealed no special adaptive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 4 of 17 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 10/24/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few devices like a hip abduction pillow, wedge or cushion to be used for proper body alignment. Record review, of Resident # 2's electronic health revealed no use of special or adaptive devices. Further review revealed no precautions or interventions related Resident # 2's hip or transferring assistance.Record review of video placed by family member in Resident # 2's room, dated 07/07/2025, at 3:20 p.m. revealed CNA C transferred Resident # 2 without a second person assist. In the video, CNA C said, I am going to transfer you by myself. The video revealed CNA C transferred Resident # 2 from a wheelchair to his bed without using a gait belt. CNA C left the cushion in between Resident # 2's legs. CNA C removed the cushion from between his legs as he was sitting up in bed with pillows behind him. CNA C proceeded to remove his pants; CNA C, pushed on the left side of his legs on knees. Resident # 2 said whoa whoa. CNA C said, I am just taking your pants off and then pushed on his right side of his legs on knees to lower his pants. CNA C then put the cushion back between his legs. Record review of hospital care team progress notes revealed: on 07/09/2025 at 1:45 p.m., radiographs for orders placed on 07/09/2025 for bilateral (both) hips shows dislocation of the right total hip arthroplasty (a surgical procedure that involves creating, repairing, or replacing a damaged or diseased joint with an artificial joint called a prosthesis). There is a left hip hemiarthroplasty (a surgical procedure that replaces only half of a damaged joint, most commonly the hip with a prosthetic) without acute changes. The care team advised Resident # 2 be taken to the ED for attempt to close the reduction with possibility of OR if unable to reduce in the ED. Record review of facility's Post-Surgical Orthopedic Care, dated 08/2025 on section Mobility and Rehabilitation, revealed: re-enforce hip / knee/shoulder precautions to prevent dislocation or injury. Further documentation revealed that: Record all assessments, interventions, resident responses, and communications with the physician / family. Update the care plan and interdisciplinary notes routinely to reflect progress or new problems. During an interview with the MDS Coordinator on 10/08/2025 at 2:32 p.m., he stated Resident 2 #'s care plan did not change because the facility does not change care plans when residents return from hospitalization. He said the only update would be medication changes. He said there were no changes made to Resident # 2's care plan. During an interview with CNA D on 10/22/2025 at 10:45 am, she said Resident # 2 was a two person assist. She said Resident # 2 could get hurt or being dropped if an inappropriate transfer was performed. CNA D said staff used a cushion between Resident # 2's legs to prevent stiffness. CNA D said the nurse and therapy staff educated her on how to use the leg separator. CNA D said, the cushion stays on Resident # 2 during transfer and is taken off when he is in bed. She said the wedges are used when Resident # 2 is in bed. She said, when patient care is provided to Resident # 2, all the pillows and wedges are removed to enable Resident # 2 to lie on his back. During an interview with CNA E, he said he checks the electronic medical records every morning to know how to transfer a Resident. He said, Resident 2 required 2 people during transfer. CNA E said, if he had to transfer Resident # 2, he would request assistance. He said, if Resident # 2 was in bed, the wedge and cushion was placed between his legs, a wedge behind his back, a pillow to support his head. CNA E said during patient care for Resident # 2, the assistive devices were removed. CNA E said if a Resident # was transferred inappropriately, it could result to death or get further injured. During an interview with the Occupational Therapy Assistant and Physical Therapy Assistant on 10/22/2025 at 12:48 pm, they both stated any adaptive devices would have an order which is written in the Resident's electronic health records and should be reflected in the care plan. The PTA said, supervising OT and PT would update with electronic records with the appropriate adaptive devices, which is determined on a case basis. PT A and OTA said, the adaptive device should be in place while the Resident is in bed and while sitting, and this order would be specified by a physician. PTA said, based (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 5 of 17 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 10/24/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few on his professional opinion, the device should be removed before transfer and put it back once Resident is safely in bed. The device is used as a precaution to prevent the hip from rotating. PTA/OTA said, if the wedge was removed, a pillow needed to be put in place. The PTA said, there could be a risk of dislocation due to the hip moving inward or rotating without a device or pillow in place during transfers or patient care. During an interview with CNA F on 10/22/2025 at 2:40 p.m., she said the nurse would update her on the Residents' care. She said she would also ask family members if there had been any changes with the Resident. CNA F said, she remembered Resident # 2 had a catheter but did not remember any type of cushion. During an interview with the MDS Coordinator, he said the IDT team had the ability to revise the care plans. He said he was not sure if Resident # 2 was admitted to the facility with assistive devices. The MDS Coordinated said; we used the hospital clinicals, and what the therapy identifies for the resident. He said, the baseline care plan was created within the first forty-eight hours. The Therapy team evaluates the Resident within forty-eight to seventy-two hours. They have all the information on the Net health. During an interview with the DON on 10/22/2025 at 2:55 p.m., she said the WCN, SW, CN and the therapy team reviewed the plan of care from the hospital clinicals, physician orders and skin assessment to determine interventions. The DON said the MDS Coordinator created the care plans. She said the transfer training was based on one -two-person transfer or a Hoyer lift. The DON said, if a wedge or pillow was used for a Resident, the nurses would demonstrate to the CNAs on how to use the device. She said, there is ongoing training on the use of transfer devices. She said after a care plan is completed, any special equipment or devices are added in the resident's electronic health records for certified nurse aids to review for care needs. The DON said physician orders would indicate if special equipment needed to be removed or added at a certain time during Resident's care. The DON said, I don't think he's used a hip abduction pillow since he's been here. Not aware of any special equipment after he was admitted to the facility. Resident # 2 was a two person assist. On 07/09/2025, the orthopedic team admitted him to the hospital for hip surgery. Resident # 2 returned to the facility on 8/8/2025. On 8/9/25 x-ray revealed a right hip dislocation (right hip displacement). Change of condition was documented on 8/9/25. Yes, an inappropriate transfer could result in a possible hip dislocation. During an interview with the Administrator on 10/23/25 at 10:38 a.m., she said she was not aware of care plans not being updated. She said we could have done better. She said updating the care plan is a team effort, by different disciplines. She said adjustments are made during morning meetings. The Administrator said the CNAs get a report at the beginning of their shift, they have access to the Kardex, she did not believe the CNAs had access to the care plan. The Administrator said Resident # 2 did not get the attention needed. She said there is an outside company that is currently auditing the care plans. The Administrator said she was not aware of the inappropriate transfer. There were issues with CNA C. Families would complain every other week. CNA C was told to stay away from Resident # 2's room. The Administrator said, before Resident # 2 returned to the facility, CNA C went into his room and made his bed, she made a comment, I don't care if there was a camera in the room. The Administrator said the Therapy team is responsible for transfer and position trainings. The Administrator said her expectation of staff as far as transferring residents, staff should follow the plan of care, if they don't know, they should find out. If they are in doubt, they should ask for help. She said staff can get information on care/services for the Residents from the morning report or the Kardex. During an interview on 10/24/2025 at 4:32 p.m., Nurse A said pain assessment/monitoring was when the patient was complaining of pain. She said an order for pain monitoring was an assessment of acute or chronic pain based on resident's health report. She said she would ask residents on a scale 1 to 10 and note any facial (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 6 of 17 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 10/24/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few expression or behavior and check vitals. She said they were to complete an assessment every day according to a physician order. She said the assessment was regarding any surgeries and all the components of the body. She said for Resident # 2 she would check for pain in hip. She said she was not sure if she completed an assessment for Resident # 2 on 07/07/2025 or 07/08/2025. She said she may have completed pain monitoring on a pain assessment tool sheet. She said the risk of not completing or documenting a pain assessment could aggravate other causes and triggers for the resident. This nurse did not answer the question; if she assessed or administered pain medication. A record review of the facility's Residents' right policy dated November 2017, revealed: facility behaviors designed to support and encourage resident participation and goals as documented in the resident assessment and care plan are not interference or coercion. Review of the facility patient safety lifting and transfer policy, dated July 2016 revealed that: It is the responsibility of the facility that all resident/patient transfer/lifting is done safely and appropriately to protect the employees and residents/patients from injury. The purpose of this policy is to remove as many opportunities for caregivers to incur injuries to themselves as well as the residents/patients when transferring, ambulating or lifting residents/patients. All employees will be instructed in and expected to use the proper body mechanics and the use of the available mechanical lift equipment when lifting or transferring residents/patients. Failure to follow the guidelines established by this policy could result in disciplinary action up to and including termination. The Charge Nurse should be consulted when any change in a resident's/patient's mobility/transfer/lift status is indicated. The Charge Nurse is responsible for updating and communicating the changing lift needs of each resident/patient. Valuable assessment input will be necessary from CNAs, licensed professionals, including Physical and Occupational Therapists.Communication Vehicle for Patient Needs to Caregiver: Immediate communication to the caregiver regarding the patient's transfer/mobility needs is essential in ensuring our patients are properly handled without injury to the patient or employee. Gait Belts - It is the policy of this center that residents/patients assessed are moved with a gait belt to minimize the possibility of skin tears, dislocations or falls. The proper use of a gait belt reduces unexpected falls, soften falls when gently eased to the floor with this equipment and consequently, there is less possibility of injury to the caregiver as well. Utilize the proper transfer/lift procedure for each resident/patient. Rehab will help to evaluate incidents involving the transfer of residents/patients Review of the facility's CNA's job description revealed responsibilities and accountabilities as follows: Provides patient care in a manner conducive to safety and comfort. Patient care includes, but is not limited to:-Assist patients with ambulation and transfers.-Positions patients in correct body alignment in and out of bed. This was determined to be an IJ, on 10/23/2025 at 05:05 p.m. The Administrator was notified. The Investigator/Surveyor provided the IJ template to the Administrator on10/23/2025 at 05:05 p.m. The POR summitted by the Administrator was accepted on 10/24/2025 at 10:30 am. The POR revealed: Immediate Jeopardy, POR, 10/24/2025 at 10:30 a.m. The facility failed to ensure all residents received adequate supervision and assistive devices to prevent accidents. The facility failed to ensure proper transfer of Resident #2's who required a two person assistance during transfers. CNAC transferred Resident #2, from his wheelchair to his bed, by one person assist. On 7/7/25 CNA C inappropriately transferred Resident #2 from his wheelchair to his bed, instead of doing a 2-person assist transfer. On 7/9/25 x-rays confirmed Resident #2, who had a recent hip replacement, had a right hip dislocation. Corrective and appropriate actions to be implemented for the affected residents identified in the deficiencies.- Resident # 2 was discharged on 7/9/25. Resident # 2 was readmitted on [DATE] and discharged on 8/9/25. - Resident # 2 was re-admitted to facility on 8/15/25. The IDT reviewed current (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 7 of 17 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 10/24/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Resident 2's condition regarding medical condition and transfer need. The MDS Coordinator updated the plan of care on 10/23/25 to include and show any current need for special or adaptive devices like a Hip Abduction Pillow, wedge or cushion to be used. MD orders were reviewed by DON/designee on 10/23/25 and orders were updated and reviewed.-Immediate Action: DON provided 1:1 in-service with MDS coordinator on completion of personalized baseline care plans and comprehensive care plans on 10/23/25.During the ad hoc QAPI Committee meeting on 10/23/25 with Medical Director, DON and DSD and IP, the deficient practice was discussed the alleged deficient practice and plan of removal. -The Administrator will oversee corrective actions initiated on 10/23/25 and monthly thereafter during QAPI meetings and plan of corrections for the findings during survey. Any corrective actions not meeting the 100% compliance benchmark, as determined by medical records audits, will be reviewed and revised monthly with the QAPI Committee for revision, further evaluation, and recommendations, with a designated IDT member assigned to each corrective action. DON will monitor the immediate actions for implementation of monitoring/audit need at least monthly for the next three months or until compliance is one hundred percent or is achieved.-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 related to post surgical orthopedic care.-Administrator: The Administrator will oversee all corrective actions initiated on 10/23/2025 and continue monthly reviews during QAPI meetings.-Director of Nurses (DON): The DON or designee will regularly review orthopedic patients, assess intervention effectiveness, and adjust care plans as needed.- Director of Staff Development (DSD): This role involves educating staff on care planning and documentation. Responsibilities include training new hires on resident safety, conducting competency assessments, emphasizing risk assessment, and ensuring accurate documentation related to post surgical orthopedic care. All residents who post-surgical orthopedic care were identified as affected by the deficient practice. A total of twelve Residents were identified by the DON/Designee as receiving post-surgical orthopedic care on 10/23/25. MD orders were updated on 10/23/25 for affected residents to include devices used by DON/Designee, including EMR patient banner update to include special instructions for devices and one -two-person assistance.An admission audit will be conducted by MDS or designee for all residents who are post-surgical every Monday-Friday to determine whether residents' MD orders a care plan for one-two person assist and any devices are included. Immediately following completion of audits, any findings will be referred to DON for further review and recommendations. admission nurses, RN supervisor/designee will complete reviews on weekends and holidays. Beginning 10/23/25, all residents care plans will be updated in coordination with the rehab evaluations by the Rehabilitation Department to determine the appropriateness and safety of one-two-person assist and any needed devices for post orthopedic patients as needed. Immediately following completion of audits, the DON or designee will follow up and coordinate with MDS Coordinator any need for updates and revisions to the care plan. The MDS Coordinator/ Designee will ensure that this information is accurately entered into the special Instructions individual patient profile banner in EMR and/or patient Kardex making it readily visible for all nursing staff to see and review prior to performing any ADL performed. In-service training was conducted by DON or and/or DSD regarding one-two person assistance and transfers for post-surgical orthopedic care initiated on 10/23/2025 for nursing staff and will be completed on 10/26/2025.Staff who were not trained /in-serviced were not allowed to provide direct care until training has been completed. In-service training was conducted by DON and or designee for admission nurses to include personalized baseline care plans for one-two person assist and devices beginning 10/23/25 and completed on 10/24/25. Any staff that have not been trained yet will not be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 8 of 17 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 10/24/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete allowed to provide direct care until training has been completed Inservice training was conducted by DON and/or DSD regarding policy on post-surgical orthopedic care initiated on 10/23/2025 for nursing staff and will be completed on 10/26/2025. Any staff that have not been trained yet will not be allowed to provide direct care until training has been completed. Training in care planning and one-two person transfers will be included for new hires and will be reviewed yearly by DSD/ and DON during the annual performance review. The annual training calendar for licensed nurses and CNAs will include providing care planning and patient transfer competencies as part of its annual in-service for licensed nurses beginning the month of October 2025. Monitoring of the plan for removal included: Following acceptance of the facility's plan of removal, the facility was monitored from 10/24/2025 from 10:30 am to 10/24/2025 at 5:39 pm., to remove the IJ which will continue until every staff is trained by: Record review of facility ongoing training and policies updates for nurses and certified nursing assistants. Resident # 2's care plan was updated to reflect adaptive devices. CNAs, master competency worksheet updated to reflect training on transfer, gait, one-two person assist and Hoyer lift (a medical device used to assist individuals with limited mobility in transferring between surfaces such as beds, chairs, or wheelchairs) during new employee orientation. An ongoing training rosters for gait belt, Hoyer lift, and one-two person transfer were presented with staff signatures. Staff who were not working on 10/22/2025 to 10/24/2025 would be trained upon their return to work. Observation of CNA H and CNA I on 10/24/2025 at 2:03 pm, revealed they successfully completed a gait belt transfer from wheelchair to bed and vice versa. Observation and examination on 10/24/2025 at 11:48 a.m., revealed all mechanical lift devices were functioning properly, including charging locations on the halls. A total of fifteen direct care staff were trained. Interviews were conducted with CNAs , therapists, and nurses on 10/24/2025 at 12:119 p.m., to 10/24/2025 at 4:35 p.m., CNA B, CNA G, CNA H, CNA I, CNA J, RN B, RN C, LVN A, LVN B, LVN C, revealed they were reeducated on the use of mechanical lift, gait belt, one-two persons transfer, reviewing the Kardex prior to Resident transfer.Administrator was informed that the IJ was removed on 10/24/2025 at 05:39 p.m. The facility remained out of compliance at a severity of removed. The facility remained out of compliance potential for more than minimal harm that is immediate treat due to the facility's need to evaluate the effectiveness of the corrective systems that were put in place. Event ID: Facility ID: 676436 If continuation sheet Page 9 of 17 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 10/24/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** The facility failed to provide adequate supervision to prevent accidents for 1 (Resident # 2) of 1 resident reviewed for accident and supervision. Based on record reviews and interviews, the facility failed to ensure adequate supervision when CNA C transferred Resident # 2 alone using a stand and pivot method instead of a two-person transfer. The facility failed to ensure CNA C improperly transferred Resident # 2 by performing a two person transfer alone using a stand and pivot method on 07/07/2025 at 15:20 p.m. On 10/23/2025 at 05:05 p.m., an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 10/24/2025, the facility remained out of compliance at a severity level of isolation with potential for more than minimal harm due to the facility continuing to monitor the implementation and effectiveness of their plan of Removal. This failure could place residents at risk for experiencing pain, injuries, bruises, dislocation and fracture from possible accidents which could result in a diminished quality of life and hospitalization. Findings included: Record review of Resident # 2's face sheet dated 08/18/2025, revealed an [AGE] year-old male admitted on [DATE] following a joint replacement surgery on 06/25/2025. His diagnoses included: joint replacement surgery, type 2 diabetes(high levels of sugar in the blood stream), hypertension (high blood pressure), parathyroid( overactive thyroid glands), hyperlipidemia ( high levels of fat in the blood stream), dementia, depression, degenerative disease of nervous system, epilepsy (repeated seizures caused by damaged brain cells), Transient-Cerebral Ischemic Attack (brief blockage of blood flow to the brain), generalized muscle weakness, acute kidney failure, dysphagia (difficulty swallowing), tremors, lack of coordination, cognitive communication deficit (communication challenge caused by problem with thinking abilities like attention, memory, and executive function rather than a language or speech problem), fracture of left femur(fracture of the hip bone), closed fracture with routine healing (a non-surgical procedure used to align and immobilize broken bones without the need for surgery. Resident # 2 was initially admitted on [DATE]. Record review of Resident # 2's MDS dated [DATE], cognition section C0400 was coded 1 which indicated able to recall after cueing. Cognition section C0500 was coded 06, which indicated severe cognitive impairment.Record review of Resident # 2's care plan dated 08/15/2025 revealed Resident # 2 had a fracture with a goal to remain free of complications related to hip fracture, such as contracture formation, embolism (obstruction of an artery, typically by a clot of blood or an air bubble) and immobilization. Resident # 2 had ADL self-care performance deficit with the following intervention: needs transfer with two people assisting from bed to chair or vice versa. Record review of video placed by family member in Resident # 2's room, dated 07/07/2025, at 3:20 p.m. revealed CNA C transferred Resident # 2 without a second person assist. In the video, CNA C said, I am going to transfer you by myself. The video revealed CNA C transferred Resident # 2 from a wheelchair to his bed without using a gait belt. CNA C left the cushion in between Resident # 2's legs. CNA C removed the cushion from between his legs as he was sitting up in bed with pillows behind him. CNA C proceeded to remove his pants; CNA C, pushed on the left side of his legs on knees. Resident # 2 said whoa whoa. CNA C said, I am just taking your pants off and then pushed on his right side of his legs on knees to lower his pants. CNA C then put the cushion back between his legs. Record review of hospital care team progress notes revealed: on 07/09/2025 at 1:45 p.m., radiographs for orders placed on 07/09/2025 for bilateral (both) hips shows dislocation of the right total hip arthroplasty (a surgical procedure that involves creating, repairing, or replacing a damaged or diseased joint with an artificial joint called a prosthesis). There is a left hip hemiarthroplasty (a surgical procedure that replaces only half of a damaged joint, most commonly the hip with a prosthetic) without acute (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 10 of 17 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 10/24/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few changes. The care team advised Resident # 2 be taken to the ED for attempt to close the reduction with possibility of OR if unable to reduce in the ED. During an interview with CNA A, on 10/08/2025 at 2:19 pm, she said if a resident required two staff members during transfer and only one staff member was used, the resident might fall. During an interview with the MDS Coordinator on 10/08/2025 at 2:32 p.m., he stated Resident 2 #'s care plan did not change because the facility does not change care plans when residents return from hospitalization. He said the only update would be medication changes. He said there were no changes made to Resident # 2's care plan. During an interview with the DON, on 10/08/2025 at3:18 pm, she stated an inappropriate transfer might result to an injury, or death. During an interview with CNA B on 10/08/2025 at 4:20 pm, she stated that Resident # 2 required two staff during transfer. She said if one staff member attempted to transfer Resident # 2, he might be injured and that might lead to a change in condition. During an interview with RN A on 10/08/2025 at 5:11 p.m., she stated Resident # 2 required two staff during transfer. She said an inappropriate transfer could result in a fall, and Resident # 2 was a fall risk as indicated on his care plan. During an interview with the Administrator, on 10/09/2025 at 12:29 p.m., she stated an inappropriate transfer could cause injury to the Resident and staff member. During an interview with CNA C, on 10/09/2025 at 2:09 pm, she stated that her transfer on 07/07/2025 was a good transfer. She said that was not the first time she was transferring Resident # 2 without a second person, because he was a tiny man. CNA C said after the video review, the facility therapist conducted an in-service with all certified nurse assistants using a gait belt to demonstrate a safe transfer. During an interview with CNA D on 10/22/2025 at 10:45 a.m., CNA D said she only worked with Resident #2 a few times. She said she helped his aide, CNA C. CNA D said Resident #2 would whisper, but he did not really talk, he mumbled. She said he never complained of pain when she assisted him. CNA D said she could tell if Resident #2 was in pain because he would pull back or grimace (twisted expression on a person's face, typically expressing disgust, or pain. She said Resident #2 was a two person assist. She said the risk when a resident was not transferred appropriately, the resident could get hurt or staff could accidentally drop the resident. CNA D said Resident #2 used a cushion between his legs, she said the cushion helped to keep his legs open, to prevent stiffness. CNA D said therapy and the nurses taught her how to use the leg separator and how to put it on. She said the cushion stayed on the resident as they were getting transferred and it was taken off when they were in bed. CNA D said the wedges were used when Resident #2 was lying in bed. She said when patient care was provided for Resident #2 all the pillows and wedges were removed so that Resident #2 can lie on his back. She said Resident #2 could not be turned. During an interview on 10/22/2025 at 11:42 am, said every morning he would check the Kardex which showed him the seizure risk, how you bath the Resident, and how to transfer a resident. He said Resident #2 required a 2-person assist. He said when he had to transfer Resident #2, he would get one other person to help. CNA E said if a male staff member was assisting him, he would grab the top part of his body, and the other person would grab the bottom half of his body. CNA E said when Resident # 2 was in bed, the wedge cushion was placed in between his legs. He said during patient care, his leg boots, cushions and pillows were taken off. CNA E said during patient care, Resident #2 was expected to stay on his back. He said the risk for inappropriate transfers, could be death, or the resident can get injured even more. Review of the facility patient safety lifting and transfer policy dated July 2016 revealed that: It is the responsibility of the facility that all resident/patient transfer/lifting is done safely and appropriately to protect the employees and residents/patients from injury. The purpose of this policy is to remove as many opportunities for caregivers to incur injuries to themselves as well as the residents/patients when transferring, ambulating or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 11 of 17 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 10/24/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few lifting residents/patients. All employees will be instructed in and expected to use the proper body mechanics and the use of the available mechanical lift equipment when lifting or transferring residents/patients. Failure to follow the guidelines established by this policy could result in disciplinary action up to and including termination. The Charge Nurse should be consulted when any change in a resident's/patient's mobility/transfer/lift status is indicated. The Charge Nurse is responsible for updating and communicating the changing lift needs of each resident/patient. Valuable assessment input will be necessary from CNAs, licensed professionals, including Physical and Occupational Therapists.Communication Vehicle for Patient Needs to Caregiver: Immediate communication to the caregiver regarding the patient's transfer/mobility needs is essential in ensuring our patients are properly handled without injury to the patient or employee.Gait Belts - It is the policy of this center that residents/patients assessed are moved with a gait belt to minimize the possibility of skin tears, dislocations or falls. The proper use of a gait belt reduces unexpected falls, soften falls when gently eased to the floor with this equipment and consequently, there is less possibility of injury to the caregiver as well. Utilize the proper transfer/lift procedure for each resident/patient. Rehab will help to evaluate incidents involving the transfer of residents/patients Review of the facility's CNA's job description revealed responsibilities and accountabilities as follows: Provides patient care in a manner conducive to safety and comfort. Patient care includes, but is notlimited to: -Assist patients with ambulation and transfers.- Positions patients in correct body alignment in and out of bed.On 10/23/2025 at 5:05 p.m., the Administrator was notified of an Immediate Jeopardy (IJ). The Investigator/Surveyor provided the IT template to the Administrator on 10/23/2025 at 05:05 p.m. The POR summitted by the Administrator was accepted on 10/24/2025 at 10:30 am. The POR revealed: The following Plan of Removal submitted by the facility was accepted on 10/24/2025 at 10:30 p.m. N4030, Free of Accident Hazards. Supervision/Devices The facility failed to ensure all residents received adequate supervision and assistance devices to prevent accidents. The facility failed to ensure proper transfer of Resident #2's which required a two-person as/sist and instead transferred Resident #2, from his wheelchair to his bed, by 1-person assist. On 7/7/25 CNA C inappropriately transferred Resident #2 from his wheelchair to his bed, instead of doing a two person assist transfer. On 7/9/25 x-rays confirmed Resident #2, who had a recent hip replacement, had a right hip dislocation. Corrective and appropriate actions to be implemented for the affected residents identified in the deficiencies.- Resident # 2 was discharged on 7/9/25. Resident 2 was readmitted on [DATE] and discharged on 8/9/25. - Resident # 2 was re-admitted to facility on 8/15/25. The IDT reviewed current Resident 2's condition regarding medical condition and transfer need. The MDS Coordinator updated the plan of care on 10/23/25 to include and show any current need for special or adaptive devices like a Hip Abduction Pillow, wedge or cushion to be used. MD orders were reviewed by DON/designee on 10/23/25 and orders were updated and reviewed.Immediate Action: During the ad hoc QAPI Committee meeting on 10/23/25 with Medical Director, DON and DSD and IP, the deficient practice was discussed with the alleged deficient practice and plan of removal.-The Administrator will oversee corrective actions initiated on 10/23/25 and monthly thereafter during QAPI meetings and plan of corrections for the findings during survey. Any corrective actions not meeting the 100% compliance benchmark, as determined by medical records audits, will be reviewed and revised monthly with the QAPI Committee for revision, further evaluation, and recommendations, with a designated IDT member assigned to each corrective action. DON will monitor the immediate actions for implementation of monitoring/audit need at least monthly for the next three months or until compliance is one hundred percent or is achieved.Specific staff involved in implementing the corrective actions. Team Members: Medical Director, Executive Director, DON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 12 of 17 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 10/24/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few or designee. Each member will perform:-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 related to post surgical orthopedic care.-Administrator: The Administrator will oversee all corrective actions initiated on 10/23/2025 and continue monthly reviews during QAPI meetings.-Director of Nurses (DON): The DON or designee will regularly review orthopedic patients, assess intervention effectiveness, and adjust care plans as needed.-Director of Staff Development (DSD): This role involves educating staff on care planning and documentation. Responsibilities include training new hires on resident safety, conducting competency assessments, emphasizing risk assessment, and ensuring accurate documentation related to post surgical orthopedic care. Identification of other residents who may need to be included (who may have been affected by the deficient practice:All residents who post-surgical orthopedic care were identified as affected by the deficient practice. A total of twelve residents were identified by the DON/Designee as receiving post-surgical orthopedic care on 10/23/25. MD orders were updated on 10/23/25 for affected residents to include devices used by DON/Designee, including EMR patient banner update to include special instructions for devices and one-to-two-person assistance.System Change: An admission audit will be conducted by MRD or designee for all residents who were post-surgical every Monday through Friday to determine whether residents' MD orders care plan to reflect one -two-person assistance and any devices were included. Any findings will be referred to DON for further review and recommendations. admission nurses, RN supervisor/designee will complete reviews on weekends and holidays. Beginning 10/23/25, all residents care plans will be updated in coordination with the rehabilitation evaluations by the Rehabilitation Department to determine the appropriateness and safety of 1-2-person assist and any needed devices for post orthopedic patients as needed. Immediately following completion of audits, the DON or designee will follow up and coordinate with MDS Coordinator any need for updates and revisions to the care plan. The MDS Coordinator/ Designee will ensure that this information is accurately entered into the special Instructions individual patient profile banner in EMR and/or patient Kardex making it readily visible for all nursing staff to see and review prior to performing any ADL performed.Training and Education Started on 10/23/25 by Director of Staff Director and/or Designee.Immediate Action: In-service training was conducted by DON or and/or MRD regarding one-two person assistance and transfers for post-surgical orthopedic care initiated on 10/23/2025 for nursing staff and will be completed on 10/26/2025. Any staff that have not been trained yet will not be allowed to provide direct care until training has been completed. Immediate Action: In-service training was conducted by DON and or designee for admission nurses to include personalized baseline care plans for one -two-person assistance and devices beginning 10/23/25 and completed on 10/24/25. Any staff that have not been trained yet will not be allowed to provide direct care until training has been completed Immediate Action: Inservice training was conducted by DON and/or DSD regarding policy on post-surgical orthopedic care initiated on 10/23/2025 for nursing staff and will be completed on 10/26/2025. Any staff that have not been trained yet will not be allowed to provide direct care until training has been completed. Training in care planning and one-two person transfers will be included for new hires and will be reviewed yearly by DSD/ and DON during the annual performance review. The annual training calendar for licensed nurses and CNAs will include providing care planning and patient transfer competencies as part of its annual in-service for licensed nurses beginning the month of October 2025. Monitoring of the plan of removal included: Following acceptance of the facility's plan of removal, the facility was monitored from 10/24/2025 from 10:30 a.m., to 10/24/2025 at 5:39 pm., to remove the IT by: Record review of facility ongoing training and policies updates for nurses (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 13 of 17 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 10/24/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and certified nursing assistants. Resident # 2's care plan was updated to reflect adaptive devices. CNAs, master competency worksheet updated to reflect training on transfer, gait, one or two persons assist and Hoyer lift during new employee orientation. An ongoing training rosters for gait belt, Hoyer lift, and one -two persons transfer were presented with staff signatures. This will continue until every staff is trained. Staff who were not working on 10/22/2025 to 10/24/2025 would be trained upon their return to work. Observation of CNA H and CNA I on 10/24/2025 at 2:03 p.m., revealed they successfully completed a gait belt transfer from wheelchair to bed and vice versa. Observation and examination on 10/24/2025 at 11:48 am, revealed all mechanical lift devices were functioning properly, including charging locations on the halls. Interviews were conducted with CNAs , therapists, and nurses on 10/24/2025 at 12:119 p.m., to 10/24/2025 at 4:35 p.m., CNA B, CNA G, CNA H, CNA I, CNA J, RN B, RN C, LVN A, LVN B, LVN C, revealed they were reeducated on the use of mechanical lift, gait belt, one -two persons transfer, reviewing the Kardex prior to Resident transfer. While the training was ongoing, a total of fifteen direct-care staff were in-serviced on proper transfer with the right equipment.Administrator was informed that the IJ was removed on 10/24/2025 at 05:39 p.m. The facility remained out of compliance at a severity of isolation with potential for more than minimal harm due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. Event ID: Facility ID: 676436 If continuation sheet Page 14 of 17 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 10/24/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** The facility staff failed to ensure residents received treatment and care in accordance with professional standards of practice in performing physician ordered daily pain monitoring for 1 of 3 residents (Resident # 2) reviewed for pain assessment. Based on record reviews and interviews the facility failed to ensure Resident # 2 was assessed for pain according to physician's orders on 07/07/2025 and 07/08/2025.This failure could place, dependent residents at risk of experiencing pain, injuries, bruises, and fractures from possible accidents which could result in a diminished quality of life and hospitalizationFindings include: Record review of Resident # 2's face sheet dated 08/18/2025, revealed an [AGE] year-old male admitted on [DATE] following a joint replacement surgery on 06/25/2025. His diagnoses included: joint replacement surgery, type 2 diabetes(high levels of sugar in the blood stream), hypertension (high blood pressure), parathyroid( overactive thyroid glands), hyperlipidemia ( high levels of fat in the blood stream), dementia, depression, degenerative disease of nervous system, epilepsy (repeated seizures caused by damaged brain cells), Transient-Cerebral Ischemic Attack (brief blockage of blood flow to the brain), generalized muscle weakness, acute kidney failure, dysphagia (difficulty swallowing), tremors, lack of coordination, cognitive communication deficit, fracture of left femur(fracture of the hip bone), closed fracture with routine healing(a non-surgical procedure used to align and immobilize broken bones without the need for surgery.Record review of Resident # 2's MDS dated [DATE], cognition section C0400 was coded 1 which indicated able to recall after cueing. Cognition section C0500 was coded 06, which indicated severe cognitive impairment. Record review of Resident # 2's care plan dated 08/15/2025 revealed Resident # 2 had a fracture with a goal to remain free of complications related to hip fracture, such as contracture formation, embolism (obstruction of an artery, typically by a clot of blood or an air bubble) and immobilization. Resident # 2 had ADL self-care performance deficit with the following intervention: needs transfer with two people assisting from bed to chair or vice versa. Record review of Resident # 2 Physician Orders dated 6/25/2025 revealed Pain Monitoring using verbal/nonverbal 0 -10 scale. Frequency: every shift everyday. Start Date:6/25/2025 End Date: indefinite (Discontinued 7/14/2025).Record review of facility Physician progress notes dated 7/2/2025 revealed Assessment/Plan: 85 you male, with deficits in mobility, endurance and ADLs secondary to left hip FX , S/P repair. Pain due to fracture, neuropathy. New Problem: Impact on therapy causing imbalance, instability, decreased strength. Workup: Continue with PT/OT. Emphasis on AD training, static and dynamic balance training, functional activity tolerance, sensorimotor skills, increase body awareness, improve range of motion, strengthening, endurance training and neuromuscular training and control. Record review of Resident # 2's MAR, dated 07/ 2025 revealed Acetaminophen two tablet by mouth every six hours as needed for Headache: Pain. Tramadol HCl Give one tablet by mouth every 6 hours as needed for pain did not reveal pain level documented in MAR. Further review of progress notes, assessments, or vitals did not reveal notes for Pain Monitoring or Pain Level for dates 7/7/2025 - 7/8/2025. Record review of video placed by family member in Resident # 2's room, dated 07/07/2025, at 3:20 p.m. revealed CNA C transferred Resident # 2 without a second person assist. In the video, CNA C said, I am going to transfer you by myself. The video revealed CNA C transferred Resident # 2 from a wheelchair to his bed without using a gait belt. CNA C left the cushion in between Resident # 2's legs. CNA C removed the cushion from between his legs as he was sitting up in bed with pillows behind him. CNA C proceeded to remove his pants; CNA C, pushed on the left side of his legs on knees. Resident # 2 said whoa whoa. CNA C said, I am just taking your pants off and then pushed on his right side of his legs on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 15 of 17 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 10/24/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few knees to lower his pants. CNA C then put the cushion back between his legs. Further review of the video did not reveal CNA C assessing Resident # 2 for pain using verbal or non-verbal scale. Further review did not reveal CNA C informing a facility nurse to assess Resident # 2 for pain. During an interview on 10/22/2025 at 10:45 a.m., CNA D said she worked with Resident # 2 sometimes, when she helped his aide, CNA C. CNA D said Resident # 2 could not verbalize pain and he could only whisper certain words. CNA D said, she could tell if Resident # 2 was in pain because of his facial grimaces. CNAF said if any nonverbal resident was in pain, he or she would make facial grimaces. During an interview 10/22/2025 at 2:41 p.m., CNA F said Resident # 2 was moved from 100 hall to 600 hall. CNAF said when she provided care to Resident # 2, she had to be careful during repositioning. She said Resident # 2 could verbalize his pain. CNA F said she could not recall Resident # 2 exhibiting any signs of pain when she took care of him. During an interview on 10/23/205 at 10:38 a.m., the Administrator said, the CNA's get a report at the beginning of the shift and through electronic record on how to care for Resident # 2 which included transfer needs and other concerns. She said prior to investigation, she was not aware Resident # 2 had a dislocation of the right hip. She said she was aware of a communication issue with CNA C insisting on completing tasks without assistance. She said CNA C was no longer employed at the facility. She said she was not aware Resident #2 had pain or injury.During an interview on 10/23/2025 at 3:25 p.m., Nurse A said, she remembered Resident # 2. She said Resident #2, was first admitted to her hallway. She said Resident# 2 had a small blister on his leg because of the stocking (ted hose), which was discontinued. She said there was swelling of the right foot. She said the ankle x-ray result was negative with no displacement of the ankle. She said the plan was to elevate the right leg during the day shift. She said Resident # 2's family member was concerned about Resident # 2 being roughly transferred. She said Resident # 2 always complained of pain when staff had to put on the stocking and he would say ow ow ow, and they would have to come back later to apply the stocking before it was discontinued. She said she was not aware of the dislocation of hip or fracture of hip and did not hear anything about it. During an interview on 10/24/2025 at 2:13 p.m., CNA G said the nurses completed pain assessments for the Residents and the CNAs would ask questions like are you in pain or look to see if there were facial signs when touching body parts and report to the nurse. She said CNA's document the pain assessment completed in charting sheet a written in the online system's progress notes. During an interview on 10/24/2025 at 2:19 p.m., the ADON said on admission they asked the new guest if they had any pain. She said based on the resident's diagnoses, history and physical they are assessed for pain in areas of concern for each pain assessment/ monitoring. She said once the facility received reports or orders from the hospital, or PCP, the Resident would have medications available like narcotics. She said an order for pain assessment could be for medication and physician assessment. She said she would check Resident # 2's leg when there was an ankle complaint due to his history of hip replacement surgery and would ask who transferred and order x ray of whole leg. She said if bruising was noticed, they were to check for swelling in feet or pain when touched and if Resident # 2's body was touching anything that hit that area. She said pain monitoring was two hours every shift and the family was notified. The ADON stated skin observations was completed every hour or two hours. During an interview on 10/24/2025 at 3:22 p.m., Nurse B said in the facility electronic records portal, pain assessments were in Vitals. He said when completing the pain monitoring order in the system he would click on the medication order under the Residents name in the MAR then click nonverbal and completed. He said he had to ask the patient if he/she was in pain and looked for non-verbal cues and would ask before point to the non-verbal cues' images. Nurse B said, if Resident # 2 was given medication it was also entered and would complete a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676436 If continuation sheet Page 16 of 17 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 10/24/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete follow up for effectiveness of the medication and call the doctor. He said Resident # 2 was monitored every shift for pain assessment. He said on 07/07/2025 and 07/08/2025 pain monitoring was not recorded. He said the pain assessment task would be located in the MAR and would not be cleared up until completed. During an interview on 10/24/2025 at 4:32 p.m., Nurse 1 said pain assessment/monitoring was when the patient was complaining of pain. She said an order for pain monitoring was an assessment of acute or chronic pain based on resident's health report. She said she would ask residents on a scale 1 to 10 and note any facial expression or behavior and check vitals. She said they were to complete an assessment every day according to a physician order. She said the assessment was regarding any surgeries and all the components of the body. She said for Resident # 2 she would check for pain in hip. She said she was not sure if she completed an assessment for Resident # 2 on 07/07/2025 or 07/08/2025. She said she may have completed pain monitoring on a pain assessment tool sheet. She said the risk of not completing or documenting a pain assessment could aggravate other causes and triggers for the resident. During an interview on 10/24/2025 at 4:38 p.m., Nurse C said there was an order on every shift for assessing pain and there was an option for 0 - 10, and documentation was located on the TAR. Nurse C said if the resident's pain was level 0 that was to be entered. She said if the resident was alert you took whatever the resident told you or observed if the resident was making an expression or holding on to the body part and make a note. She said some residents did not tell you when they were in pain and would say they are not in pain. She said an assessment was to reposition residents that cannot move themselves and to view any skin breakdowns document in progress notes. She said she cannot remember and if Resident # 2 had pain medications or complained of pain. She said if pain assessment was not completed it could be a risk, this could intervene with therapy which was why Resident # 2 was admitted to the facility.Record review of the facility's pain screening and assessment policy dated 11/2024 revealed:-It is the policy of the facility to screen and assess each resident for pain.-Every shift, a pain score will be documented for each Resident.-Nursing will document a comprehensive pain assessment for Residents with a positive pain score. -Reassessments will occur at specific intervals following the initiation of a pain treatment plan.-Reassessment will minimally include pain location, intensity, side effects, functional status and adherence or substance abuse concerns.-Pain treatment effectiveness/outcomes and resulting revisions in the pain treatment plan will be documented in the medical records.-Anytime routine vitals are taken, the 0-10 pain intensity rating scale must be included as the 5th vital sign.-The screening of cognitively impaired residents may also required the observation of behavioral factors that signal pain or discomfort.-When possible, the [NAME] Faces pain rating scale may be used. Event ID: Facility ID: 676436 If continuation sheet Page 17 of 17