Health inspection·January 29, 2026

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete breathing. She stated Resident #1's son was on the phone talking to Resident #1 when she removed the phone from Resident #1 chest and placed it on the bedside table, within reach of Resident #1. She stated Resident #1 was able to reach the cell phone from where she was lying in bed. ADON A stated the bedside rolling table was not located on the right side of the bed and was not toward the middle of the bed, instead it was directly beside Resident #1, at the head of the bed. ADON A stated it was Resident #1's right to have her cell phone when her son was on the phone speaking to Resident #1. She stated Resident #1 was not able to hold the cell phone with her hand. ADON A stated Resident #1's hands were shaking, and she was not capable of holding a cell phone. ADON A stated she was expected to follow resident rights and had been in-service on resident rights. She stated she did not recall the time or date of the in-service. ADON A stated she did not have anything else to say about the cell phone, that was all she knew to report about the situation of the phone. In an interview on 01/16/2026 at 4:00 pm, the Director of Nurses stated anytime a Resident was on their personal cell phone with a family member, and they find comfort having their family member on the cell phone when they are in distress or not in distress it was against resident rights for a staff to remove the cell phone from the resident. She stated ADON A was not to remove the cell phone from Resident #1 and place it where Resident #1 could not reach it. The Director of Nurses stated a resident had a right to speak to their family anytime they choose, and to have their cell phone within reach. She stated all staff had been in-service on resident rights. She stated she had not interviewed ADON A about the incident with Resident #1, and the facility was going to conduct a full investigation of what occurred with Resident #1 on 01/13/2026. In an interview on 01/16/2026 at 4:35 pm, the Administrator stated all residents had a right to have access to using phone to contact family. She stated if a resident had a personal cell phone and a family member was on the phone with the resident, it did not matter what the situation was, the staff was not to take the cell phone away from a resident while family was on the phone. The Administrator stated if a resident had a cell phone, and not using it, the staff was not to place a resident's cell phone outside of the reach of the resident. She stated a resident's personal cell phone was expected to be within reach of the resident at all times, especially when the resident's family was talking to the resident on the phone. She stated that was against the resident's rights. The Administrator stated all staff had been in-serviced on resident rights, and she did not recall the date or time of the in-service. She stated the facility was completing an investigation of what occurred with Resident #1 on 01/13/2026. The Administrator stated she would be conducting further investigation about the situation with the cell phone incident that occurred on 01/13/2026. Record review of the facility's policy on Resident Rights, dated 2009, reflected Employees shall treat all residents with kindness, respect, and dignity. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident to use a telephone in privacy. Residents are entitled to exercise their rights and privileges to the fullest extent possible. Our facility will make every effort to assist each resident in exercising his/her rights to assure that the resident is always treated with respect, kindness, and dignity. Event ID: Facility ID: 676437 If continuation sheet Page 2 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure a comprehensive care plan was reviewed and revised by theinterdisciplinary team after each assessment for 1 of 5 (Resident #2) reviewed for care plans. The facility failed to ensure Resident #2's care plan was revised to reflect Resident #2 was on Enhanced Barrier Precautions . This failure could place residents at risk of not receiving appropriate care to meet their needs. Findings included: Review of Resident #2's Face sheet, dated 01/14/2026, reflected a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of sepsis, unspecified organism (a serious medical conditions characterized by the body's extreme response to an infection, where the specific organism causing the infection is not identified. It can lead to organ failure), perforation of intestine ( a hole or tear in the intestinal wall, allowing digestive contents like food, bacteria, bile, and acid to leak into the abdominal cavity, causing severe infection and potentially life-threatening sepsis), colostomy status (a surgically created opening in the abdominal wall that connects the colon to the outside of the body, allowing waste to bypass a damaged or diseased part of the lower bowel), and malignant neoplasm of rectum (cancer forming in the tissues of the rectum). Review of Resident #2's MDS Assessment, dated 01/01/2026, reflected Resident #2 had a BIMS score of 13 indicated his cognition was intact. Resident #2 had a colostomy. He had diagnosis of septicemia (body's extreme response to an infection that enters the bloodstream) and sepsis. Review of Resident #2's Comprehensive Care Plan, revised on 01/07/2026, reflected Resident #2 had an ostomy secondary to bowel perforation. He was at risk for complications including but not limited to stoma, irritation and bleeding. Interventions: Colostomy care every shift as needed. Monitor for signs of infections such as edema, redness, increased pain around the stoma area. There was not a care plan for Resident #2 to be on enhance barrier precautions. Interview on 01/16/2026 at 4:00 pm, the Director of Nurses stated Resident #2's care plan should have been revised on 01/07/2026. She stated either the ADON or DON was responsible for updating care plans. The Director of Nurses stated they hired an MDS nurse, however, she would begin working next week. She stated if a Resident had an order for enhanced barrier precautions, the nurse reviewing the physician order could have added it to the care plan. The Director of Nurses stated all information about a resident was to be care planned, including enhanced barrier precautions. She stated the interdisciplinary team, and all staff was to follow what was documented on the plan of care for each resident, and if enhanced barrier precautions was not on the care plan, there was a possibility if a nurse reviewed the care plan, the nurse may not know how to use PPE prior to entering the resident's room, if the enhanced barrier precaution sign fell off the door of the resident's room. Interview on 01/16/2026 at 4:35 pm, the Administrator stated she expected any time there was a change of condition or change of treatment, it was to be immediately added to the resident's care plan. She stated if a resident had a new order for enhanced barrier precautions, she expected the nurse, DON, or the Interim nurse completing care plans, to implement this on the resident's care plan. She stated if enhanced barrier precautions were not on a resident's care plan, there was the potential for a nurse, or any staff who may review the care plan, not realize to follow the facility's enhanced barrier precautions protocols. She stated if a staff did not follow enhance barrier precautions, there was a possibility bacteria could be spread to another resident. She stated ultimately, the Director of Nurses was responsible for ensuring the care plans were completed and revised until the new MDS nurse began working next week. She did not recall the exact hire date for the new MDS nurse. Record review of the facility's policy on Comprehensive Care plan, dated December 2015, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 3 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete reflected A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Assessments of residents are ongoing, and care plans are revised as information about the residents and the residents' conditions change.The Interdisciplinary Team must review and update the care plan:1. When there has been a significant change in the resident's condition.2. When the desired outcome is not met;3. When the resident has been readmitted to the facility from a hospital stay; and4. At least quarterly, in conjunction with the required quarterly MDS assessment. Event ID: Facility ID: 676437 If continuation sheet Page 4 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 interview, observation, and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person -centered care plan, and the residents' choice for one (Resident #1) of 5 residents reviewed for quality of care.The facility failed to promptly identify and intervene for an acute change in Resident #1's condition related to congestive heart failure (CHF), resulting in the family calling 911 to transport the resident to the hospital. The resident was admitted to the hospital with respiratory distress and pulmonary edema.An Immediate Jeopardy (IJ) was identified on 01/28/2026. The IJ template was provided to the facility on [DATE] at 12:16 PM. While the IJ was removed on 01/29/2026, the facility remained out of compliance at a scope of isolated and a severity level of no actual harm due to staff needing more time to monitor the plan of removal for effectiveness.This failure placed residents at risk for not being provided the care and treatment required to meet their needs.Findings included: Review of Resident #1's face sheet, dated 01/14/2026, reflected an [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses: generalized anxiety disorder ( a chronic mental health condition marked by excessive, persistent, and uncomfortable worry about everyday things like health, work, and family that's hard to control and interfere with daily life), unspecified diastolic congestive heart failure (heart's main pumping chamber is stiff and cannot relax or fill properly with blood between beats, causing fluid backup (congestion), essential hypertension ( high blood pressure with no single identifiable cause), paroxysmal atrial fibrillation ( a type of irregular heartbeat where episodes start and stop suddenly, usually resolving on their own or with treatment within seven days, often ending within minutes to hours), nonrheumatic aortic valve stenosis ( the heart's aortic valve narrows, most commonly age-related or a congenital defect, restricting blood flow from the heart to the body and forcing the heart to work harder, potentially leading to heart failure), end stage of renal disease ( your kidneys have failed and can no longer effectively filter waste from your blood, requiring dialysis or a kidney transplant for survival, as kidneys lose their ability to function, leading to waste buildup and serious body-wide problems). Review of Resident #1's Medicare MDS Assessment, dated 11/18/2025, reflected Resident #1 had a BIMS score of 15 which indicated her cognition was intact. She required assistance with dressing, personal hygiene, bed mobility, transfers, and bathing. She did not have any shortness of breath or difficulty with breathing . Review of Resident #1's Comprehensive Care Plan, dated 01/08/2026 reflected: Resident #1 had altered cardiovascular status related to congestive heart failure . Interventions: Give oxygen as ordered by the physician. Assess fingers and toes for warmth and color. Resident #1 had the potential for signs and symptoms and complication related to hypertension. Intervention: Avoid taking blood pressure reading after physical or emotional distress. Document and report to the MD as needed any signs or symptoms of malignant hypertension: headache, difficulty breathing, seizure activity, irritability, lethargic, confusion and/or visual problems. Give medications as ordered. Resident #1 needed hemodialysis ( a life-sustaining medical treatment for kidney failure that uses a machine with an artificial kidney to filter waste products, excess fluids, and toxins from the blood, mimicking healthy kidney function) related to renal failure. Interventions: Report significant changes in pulse, respirations and blood pressure immediately. Resident #1 was on diuretic therapy. Interventions: Administer medications as ordered. Resident #1 had CHF ( congestive heart failure- ( a long-term condition where the heart muscle weakens and cannot pump enough blood to meet the body's needs.) and is on dialysis. Resident #1 uses anti-depressant medication. Interventions: Monitor for side effects such Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 5 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 - Few as agitation, emotional blunting (a mental state characterized by a significant reduction in the intensity of emotions, leading to feelings of numbness, detachment, or indifference to both positive and negative events), dry mouth , and restlessness. Review of Resident #1's Late Entry Nurses Notes, dated 01/13/2026 at 7:30 AM reflected new order for Oxygen. Primary Care Provider feedback responded family called 911. Primary Care Physician approved for transferring resident to emergency room. Review of Resident #1's Nurses Notes, dated 01/13/2026 at 8:16 a.m. reflected ADON A entered Resident #1's room approximately at 7:45 a.m. Resident #1 was sitting upright in bed on 2 L/min oxygen via nasal cannula. SpO2 94%, Respirations 20. Room Temperature was 74 degrees Fahrenheit. Resident #1's family member was on phone and repeatedly instructed staff to call 911. Attempted to reposition Resident #1; Resident #1 refused. Breathing treatment was offered and declined. When asked what exacerbated or relieved symptoms, Resident #1 declined to answer and did not engage with staff (ADON A) Resident #1 closed eyes and vocalized softly. When family member asked if Resident #1 was okay, Resident #1 responded clearly and without difficulty stating No, I just need you to do something or come here to help. Resident #1 looked at this nurse (ADON A) and stated 911. Resident #1 remained upright in bed. Resident #1 was offered breathing treatment and refused. Resident #1 was restless. Signed by ADON A. Review of Resident #1's Physician Orders, dated12/01/2025, reflected Resident #1 was on medication for depression. O2 at 2L/minute via PRN as needed for shortness of breath. Review of O2 Sats Summary dated 01/13/2026 at 7:35 am reflected Resident O2 SATS was 92 percent at room air. Resident #1's O2 Sats from 10/16/2025 to 01/13/2026 averaged between 91 percent to 98 percent at room air. Observation of video in Resident #1's room revealed on 01/13/2026 at 7:26 AM Resident #1 asked LVN B for oxygen. LVN B stated, You are right. You may need oxygen. Your face looks flushed . LVN B obtained vital signs, blood pressure and O2 saturation, and stated her O2 Sat was 92 percent. Resident #1 continued to ask for oxygen. The television was on in the room, and there were times when the television was loud, and it was difficult to hear all the conversation. Resident #1 began to become very anxious. She had grimacing facial expression and began to breathe heavier ( her chest was moving faster). Resident #1 continued to ask for oxygen. LVN B stated to Resident #1, do you want another nurse to take care of you. Resident #1's tone of voice changed to a crying sound, and she was having difficulty with talking and held her chest. She kept repeating I need oxygen. LVN B collected her medical devices, and exited the room at 7:31 a.m. Observation of video of Resident #1 in her room on 1/13/2026 at 7:33 a.m. revealed Resident #1 was talking on her phone, and it was difficult to understand what she was saying due to the television being loud and she having difficulty talking. Resident #1 continued to breathe heavier, and her chest was moving faster when she would speak. Observation of video of Resident #1 in her room on 01/13/2026 at 7:37 a.m. revealed LVN B returned to the room with oxygen and stated your O2 Sat is 97 percent. LVN B placed oxygen on Resident #1 at 7:39 a.m. and exited the room at 7:40 a.m. Observation of video of Resident #1 in her room on 01/13/2026 at 7:40 a.m. revealed Resident #1 was moaning and making crying sounds. She had her personal phone on her chest. ADON A entered Resident #1's room at 7:41 a.m. Resident #1 was crying and stated she could not breathe. ADON stated, You can't breathe? You are on oxygen Is the O2 not helping you ? Resident stated, call 911. ADON stated you want to call 911. Resident #1 stated she couldn't breathe. ADON A stated she needed to assess her. ADON A did not assess Resident #1, and asked Resident #1 why are you not talking to me? You are talking to your family member. Resident #1 became more frustrated and anxious. Her chest was moving faster and she could barely speak. ADON A asked, what can we do to help you right now. Resident #1 did not respond to the question. ADON A stated, you are talking to your [family member] and won't talk to me. Resident #1 stated I can't breathe. ADON A asked Resident #1 if she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 6 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 - Few wanted a breathing treatment. Resident #1 did not respond. ADON did not check her O2 sats, blood pressure, oxygen tank, or tubing. She exited the room at 7:44 a.m. ADON A re-entered Resident #1's room at 7:51 a.m. and she checked the temperature of the room. ADON A stated you need to speak to me. you are talking to your [family member] on the phone but won't speak to me. Resident #1 stated call 911 I can't breathe. ADON A removed Resident #1's phone from her chest and placed it on the rolling table, where Resident #1 was unable to reach the phone. ADON A stated your O2 Sats is 94. ADON A did not check her O2 Sats. EMS entered Resident #1's room at 7:52 a.m. Resident #1 was attempting to reach her cell phone and was stating to the EMS her [family member] was on the phone. She was unable to reach her cell phone to give it to the EMS. EMS picked up the phone and asked if Resident #1 was complaining of shortness of breath. EMS stated to family member via cell phone, we are checking her on our monitor. Does she have any other issues other than Congestive Heart Failure? . EMS stated Her O2 Sat is 79 %. I can understand why she was having shortness of breath. EMS explained to the family member on the phone and to Resident #1 they would be transferring her to the hospital and asked their hospital preference. Observation and interview on 01/14/2026 at 5:40 PM of five residents' ( Resident # 3, Resident #4, Resident #5, Resident #6 and Resident #7) oxygen tanks in their rooms revealed there were no concerns with oxygen tanks. Residents did not have any concerns of receiving oxygen or having issues with their oxygen tanks. Record review of Resident #1's hospital records reflected Resident #1 arrived at the ER on [DATE] at 8:15 a.m. [Resident #1] had history of CKD, CAD, presents the emergency department with respiratory distress, [Resident #1] gets hemodialysis Tuesday, Thursday and Saturday. She woke up this morning having respiratory distress she tried to have the nursing facility call EMS to bring her to the hospital and the facility declined. Resident #1 called her [family member] and he called EMS to bring [Resident #1] to the emergency department at that point EMS reports that she was on 2 L nasal cannula and oxygen saturations were in the 70's. [Resident #1] placed on CPAP with improvement. [Resident #1] did not have any other complaints at this time. Resident #1 was admitted to the hospital for respiratory distress in setting of volume overload. Resident #1's chest radiographs revealed findings consistent with volume overload with trace right pleural effusion ( an early or mild buildup of excess fluid throughout the body that has resulted in a tiny, minimal amount of fluid collecting in the membrane space surrounding the right lung). Resident #1 was admitted to the hospital. In an attempted interview on 1/14/2026 at 11:05 AM attempted to contact Resident #1 via phone but was unable to leave a message. Resident #1 was in the hospital. In an interview on 01/14/2026 at 12:01 p.m., ADON A stated she entered Resident #1's room approximately 7:45 a.m. on 01/13/ 2026, upon request of LVN B. She stated Resident #1 was sitting upright in the bed and she was on 2 liter(s per minute) of oxygen. She stated Resident #1 was upset and she could not understand what Resident #1 was saying to her. ADON A stated Resident #1 did state she was having shortness of breath. ADON A stated she complained about that a lot. She stated she began to assess her. ADON A stated she checked her O2 sats, blood pressure, oxygen tank, and the room temperature. ADON A stated she was only in Resident #1's room one time. She stated Resident #1 would say she was having difficulty with breathing, and her family member was on Resident #1's cell phone. She stated her oxygen saturation was 94 percent . She stated she used the pulse oximeter three times when she checked Resident #1's O2 sats and it was 94 percent each time. ADON A stated she checked the oxygen tubing in Resident #1's nose to ensure it was secure. ADON A stated Resident #1 became more frustrated and anxious with the questions she was asking about what she could do to help her. ADON A stated Resident #1 stated 911. ADON A stated she removed the cell phone from Resident #1's chest and placed it on the bedside table right beside her bed where she could reach it. ADON A stated Resident #1's family (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 7 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 - Few member was on the phone when she removed it from Resident #1's chest. She stated she did not speak to the family member. ADON A stated EMS entered the room and took over with assessing Resident #1. ADON A stated if a Resident asked for 911 to be called, the facility staff was expected to call 911. She stated she did not call 911 or anyone about Resident #1's complaints of having shortness of breath.ADON A did not respond why she did not call 911. ADON A did not reply why she did not call 911. She stated she did not call the physician or report the resident's complaint of having difficulty with breathing and wanting to go to hospital to anyone. ADON A stated she had been in-serviced on resident rights and change of condition, and she was expected to contact the physician and to call 911 if a resident requested to go to the hospital. She stated LVN B called 911 and that was when EMS came to the facility to transport Resident #1 to the hospital. She stated the family did not call 911, and the facility staff called 911. In an interview on 01/14/2026 at 3:03 p.m., LVN B stated she entered Resident #1's room at approximately 7:15 a.m. after it was reported to her that Resident #1 was complaining of having shortness of breath. LVN B stated Resident #1 did request oxygen several times during the assessment. She stated the oxygen tank in Resident #1 was not working. LVN B stated Resident #1 became frustrated and anxious when she was assessing Resident #1. She stated Resident #1 continued to ask for oxygen. She stated she felt she was frustrating Resident #1 and was making Resident #1 worse due to her color becoming flushed and her becoming upset due to wanting oxygen. LVN B stated she did not call 911 or the physician. She stated she did not think it was necessary to contact the physician or call 911 until she finished her assessment. LVN B stated she re- entered Resident #1's room approximately 10 minutes later with an oxygen tank and placed the oxygen on Resident #1. She stated when she checked Resident #1's O2 sat, it was 94 percent at room air. LVN B stated after she placed the oxygen on Resident #1, she exited the room and asked ADON A to assess Resident #1. LVN B stated she asked Resident #1 if she wanted another nurse to give her care and she became upset after this question was asked of her. LVN B did not respond to why Resident #1 became upset after this question was asked. She stated Resident #1's family member called 911 for EMS to come to the facility and Resident #1 was transferred to the emergency room and was admitted to the hospital with shortness of breath and respiratory distress. LVN B stated if a resident requested for 911 to be called, and complained of shortness of breath, the facility was expected to call 911, the physician, and the family. She stated Resident #1's family member was on the phone when she was in the room. LVN B stated she did not have anything else to report about the situation with Resident #1. In an interview on 01/14/2026 at 4:00 p.m., the Director of Nurses stated anytime a resident was complaining about shortness of breath and requested for the nurse to call 911, her expectation was for the nurse to call 911 immediately. She stated Resident #1 did have a history of having shortness of breath and had heart conditions. Director of Nurses stated Resident #1 was placed on oxygen prior to EMS entering the facility. She stated that occurred on 01/13/2026 approximately 7:30 a.m. The Director of Nurses stated ADON A was in the room with Resident #1. She stated they were investigating exactly what occurred with Resident #1 on 01/13/2026. She stated ADON A needed to call 911 when the resident first stated she had shortness of breath and wanted 911 to be called instead of the family having to call 911. She stated it was the facility's responsibility to ensure the resident's wishes were honored and not neglect what Resident #1 was requesting. The Director of Nurses stated she would need to review the hospital records to determine Resident #1's condition when she arrived at the hospital to determine if it was an emergency for Resident #1 to be admitted to the hospital. She stated she would need to investigate more into the situation with Resident #1 before answering any further questions. Review of the facility's Change in a Resident's Condition or Status, dated 2016 , reflected Our facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 8 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 - Few shall promptly notify the resident , his or her Attending Physician, and representative (sponsor) of changes in the resident's medical, mental condition and /or status (e.g. changes in level of care, billing/payments, resident rights etc.) or need to transfer the resident to the hospital/treatment center . The Director of Nurses was notified on 01/28/2026 at 12:16 pm that an Immediate Jeopardy had been identified due to the above failures and an IJ template was provided. The following POR was accepted on 01/28/2026 at 9:30 pm. Letter of Credible AllegationFor Removal of Immediate Jeopardy Attention Sir or Madam On 1/28/2026 an abbreviated survey was initiated at facility. On 1/28/2026 the surveyor provided an Immediate Jeopardy (IJ) Template notification that the Regulatory Services has determined that the condition at the facility constitutes an immediate jeopardy to resident health and safety. Submission of the Letter of Credible Allegation does not constitute an admission or agreement of the facts alleged or the conclusion set for in the verbal and written notice of immediate jeopardy and/ or any subsequent Statement of Deficiencies. The immediate jeopardy allegations are as follows: F684 Quality of Care The facility failed to ensure Resident #1 received treatment and care in accordance with professional standards of practice. Resident #1 remains in the hospital and does not expect to return to the facility related to new health concern with heart as stated by the family member. Actions for Resident Involved Resident #1 was discharged to the hospital on [DATE]. Investigation completed on 01/14/2026, ADON A received disciplinary action and one on one re-education. Identification of Others On 1/28/2026 an Inservice was initiated with the licensed nurses, nurses' aides, and medication aides, regarding honoring resident wishes when requesting 911 to be called, comprehension will be verified by posttest after in servicing completed. Director of Nurses was in serviced on honoring residents wishes when requesting 911 to be called by Clinical Service Director with a post test. Start date was 01/28/2026 and completion date was 01/28/2026. The Director of Nurses and/ or designee was responsible for these in-services. On 1/28/2026 interview able residents will be interviewed to ensure staff are honoring their wishes. Any identified concerns will be addressed immediately . Non-interview able residents will be observed to ensure no change in condition is present. It will be documented on life satisfaction survey forms and reviewed by the administrator and any concerns will be addressed immediately. The start date was 01/28/2026 and completion date was 01/28/2026. The administrator and/ or designee was responsible for interviewing the residents. System Monitoring The Director of Nurses or designee will continue with in servicing newly hired staff including PRN staff and agency( if utilized), regarding honoring residents' wishes when wanting 911 called during the orientation process.The department heads will conduct rounds ( documented on life satisfaction survey forms) on their assigned rooms daily to interview able residents to ensure staff are honoring their wishes to include if requesting to call 911. Non-interview able residents will be observed to ensure no change in condition was present. It will determine all the documented-on life satisfaction survey forms and reviewed by the administrator and any concerns will be addressed immediately. Quality Assurance An impromptu Quality Assurance and Performance Improvement review of the plan of removal was completed on 1/28/2026 with the Medical Director. The Medical Director has reviewed and agrees with this plan. We respectfully submit this action plan for the removal of Immediate Jeopardy. The Surveyor monitored the POR ( Plan of Removal) on 01/29/2026 as follows: In an interview and observation on 01/29/2026 at 9:50 am Resident #3 stated she is on oxygen, and the staff checks her oxygen several times a day. She stated she does not have any issues with her care at the facility, and she feels safe and confident in the abilities of the nursing staff to give her the care she needs. There were no concerns with her oxygen. In an interview on 01/29/2026 at 10:05 am Resident #4 stated anytime she needed help someone always came to her room and assisted her. She complained about her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 9 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 - Few back hurting and had reported this concern to MA D. She stated her back pain was chronic and anytime she asked for pain medication if it was time for her to have it the nurse always brought the pain medication to her room. She stated she felt safe at the facility and did not worry about not receiving good care from the nurses. In an interview on 01/29/2026 at 10:12 am ADON B stated she did give Resident #4 her pain medication for her back. In an interview on 01/29/2026 at 10:15 am Resident #4 verified she did receive her pain medication. In an interview on 01/29/2026 at 10:24 am Resident #5 stated anytime she asked for a nurse for medicine or for any help the nurse came to her room within a reasonable time. She stated she never had to wait very long to speak to a nurse. Resident #5 stated she felt safe at the facility and the care she received. She stated she did not have any concerns about her care or the nurses giving care to her. In an interview and observation on 01/29/2026 at 10:30 am Resident #6 stated he was on oxygen continuously. He stated the nurses checked his oxygen every day. He stated he has never had any issues with his oxygen. Resident #6 stated he had confidence in the staff to give him the care he needed, and he felt safe in the facility. Did not observe any issues with Resident #6's oxygen. In an interview and observation on 01/29/2026 at 10:40 am Resident #7 stated she loved the nurses at the facility. She stated when she asked for assistance with anything a nurse would come in and check on her. She stated a nurse checked her oxygen every day and she did not have any issues with not receiving her oxygen. Resident #7 stated she felt safe at the facility and felt safe receiving the needs she required to get the care the doctor wanted her to have while living at this facility. There were no concerns with her oxygen. In an interview and observation on 01/29/2026 at 10:47 am Resident #8 stated she received oxygen at night, and she did not have any issues of not receiving her oxygen on time. She stated the nurses were very good to assist her with oxygen and anything else she may need. Resident #8's oxygen was in her room. She stated she had only been at the facility a few weeks and she felt comfortable and safe with the care she has received from nursing staff and from all the staff. Did not observe any concerns with her oxygen. In an interview on 01/29/2026 at 12:00 pm MA F ( 6 am to 6 pm) stated she had been in serviced on resident rights and change of condition. She stated she received in-service on 1/28/2026. She stated anytime a resident requested to go to the hospital she was expected to immediately report it to the nurse. She stated it was a resident right to request for 911 to be called. MA F stated anytime a resident was having a change of condition such as physical, behaviors, or mentally, she would report the change to the nurse. She stated she did take a quiz on resident rights and change of condition. She stated she learned the resident had a right to call 911 on their personal cell phone and the staff was not to interfere with resident's request to go to the hospital. MA F stated if a resident had a cell phone it was not to be taken away from resident and placed in an area where the resident was unable to reach the phone. She stated the resident had a right for privacy when speaking to their family. She stated if staff removed the cell phone away from a resident while their family was on the phone and placed it where resident was unable to speak to their family , she would consider this resident neglect and she would report it immediately. She stated the Administrator was the abuse/ neglect coordinator. In an interview on 01/29/2026 at 12:10 pm ADON E ( 6 am to 6 pm ) stated she was in serviced on 01/28/2026 on resident rights and change of condition of a resident. She stated after she received in-service she was given a written quiz on resident rights and change of condition. She stated anytime a resident requests for 911 to be called due to any type of physical concern, she would call 911 and would assess the resident until EMS came to the facility. She stated it was a resident right for 911 to be called for health reasons such as difficulty of breathing. She stated if a resident was complaining of having shortness of breath and asked for 911 to be contacted she would contact 911 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 10 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 - Few immediately. ADON E stated she would call the physician and responsible party. She stated it was resident rights for 911 to be contacted upon their request when the resident was having a change of condition in their physical condition, behaviors, and mental status. She stated residents had a right to voice their opinion about their care. ADON E stated anytime a resident is requesting oxygen related to shortness of breath the nurse is expected to check physician orders to ensure the resident has orders for oxygen and provide the oxygen for resident after assessing the resident. She stated if the resident repeats to call 911 this is her resident right for 911 to be called and nurse is expected to call 911 and the physician. ADON E stated a resident's cell phone was never to be taken away from the resident especially if the family was on the phone speaking to resident. She stated this was a resident right to speak to family in private and to have the phone where the resident had access to the cell phone. She stated the department heads have assigned residents they make satisfaction rounds and beginning yesterday ( 01/28/2026) began asking about their care and their resident rights. If a resident was not interview able they made observations of the residents to determine if the resident was in any type of distress such as grimacing expression , moaning, or change in complexion. In an interview on 01/29/2026 at 12:30 pm LVN G ( 6 pm to 6 am) stated he was in-serviced on resident rights and change of condition on 01/28/2026. He stated when a resident is in physical distress and asking for 911 to be called the nurse was expected to honor resident rights and contact 911. LVN G stated it was resident rights to be transferred to the hospital upon resident request. He stated a resident has the right to be treated with dignity and respect. LVN G stated anytime a resident had a cell phone it was their resident right to have the cell phone within reach of the resident. LVN stated if a resident was speaking to a family member on the cell phone the resident had a right for privacy, and the cell phone was not to be taken away from the resident and placed where the resident was unable to reach the phone. He stated he did receive a quiz after the in-service on resident rights and change of condition. He stated the quiz was about giving examples of resident rights and what to do observe if a resident had a change of condition such as physical, mental , behaviors, etc. He stated anytime he suspected a resident being neglected he would report it immediately to the Administrator who was the abuse coordinator. In an interview on 01/29/2026 at 1:10 pm CNA H (6 am to 6 pm) stated if a resident was not at their baseline mentally, physically or with their behaviors she would immediately report it to the nurse. She stated she had been in-serviced on resident rights and change of condition. She stated she did take a quiz after she was in-serviced. CNA H stated she learned if a resident complains a lot about the same thing do not ignore their complaints and always report any health complaints to the nurse. She stated anytime a resident stated they wanted 911 to be called she was to report this immediately to the nurse. CNA H stated it was resident neglect to take a cell phone away from a resident while family was on the phone and place the phone where the resident was not able to reach the phone. She stated it was also considered against resident rights. CNA H stated she received in-service on 1/28/2026. She stated she learned the resident had a right to call 911. She stated anytime there was any changes with a resident, and a resident was not at their baseline to report it immediately to the nurse. She stated if she noticed anything unusual with oxygen she would report this immediately to the nurse, such as the concentrator not working properly or there was no air coming out of the tubing. She stated anytime there was anything unusual with the resident no matter what it was to always report to the nurse. In an interview on 01/29/2026 at 3:00 pm the Director of Nurses stated she was in-serviced on quality of care, change of condition, respecting resident wishes and when a resident wants to go to the hospital. She stated residents are to be treated respectfully and explain the care to the resident and report any type of concern of the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 11 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete immediately to the nurse and if the nurse is the one observing the concern, the nurse was to immediately call the physician or 911 according to the circumstance of the resident. She stated quality of care meets professional standards and supports residents' highest level of well-being. The Director of Nurses stated when a resident had a change of condition this was when a new physical, mental or emotional change occurred, or an existing concern deteriorated. She stated the staff was expected to recognize the change, call the physician, report to the nurse, or call 911. She stated the resident was to be monitored until EMS came to the facility. The Director of Nurses stated delaying reporting can cause serious harm or delay calling 911. She stated if a resident refused care the nurse was to document it in the nurses notes.In an interview on 01/29/2026 at 3:30 pm the Administrator stated all staff except for 8 had been in-serviced on change of condition, resident rights and quality of care. She stated the 8 staff would not be eligible to work until they receive in-service. The Administrator stated ADON A was suspended on 01/28/2026. She stated they had a QAPI meeting and reviewed the POR and the concern with Quality of Care. The Administrator stated they had already began monitoring process such as the department heads make rounds on the residents they are assigned to and ensure there is no new or past issues with the residents. She stated in-services would be ongoing and anyone new would receive the in-service on resident rights, quality of care and change in condition prior to working at the facility. She stated the facility was continuing with their investigation of the situation with Resident #1. She stated the facility staff would randomly be monitored by the Director of Nurses or designee of their overall care for the r[TRUNCATED] Event ID: Facility ID: 676437 If continuation sheet Page 12 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to establish and maintain an infection control program designed to provide safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infection for 1 of 4 residents ( Resident #2) reviewed for infection control. 1. The facility failed, on 01/14/2026, to ensure RN C sanitized her hands prior to donning gloves while providing colostomy care to Resident #2.2. The facility failed, on 01/14/2026, to ensure RN C wore PPE (gown) while providing high contact resident care ( colostomy care) to Resident #2. These failures could place residents at risk for infection and hospitalization.Findings include: Review of Resident #2's Face sheet, dated 01/14/2026, reflected a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of sepsis, unspecified organism (a serious medical conditions characterized by the body's extreme response to an infection, where the specific organism causing the infection is not identified. It can lead to organ failure), perforation of intestine ( a hole or tear in the intestinal wall, allowing digestive contents like food, bacteria, bile, and acid to leak into the abdominal cavity, causing severe infection and potentially life-threatening sepsis), colostomy status (a surgically created opening in the abdominal wall that connects the colon to the outside of the body, allowing waste to bypass a damaged or diseased part of the lower bowel), and malignant neoplasm of rectum (cancer forming in the tissues of the rectum). Review of Resident #2's MDS Assessment, dated 01/01/2026, reflected Resident #2 had a BIMS score of 13 indicated his cognition was intact. Resident #2 had a colostomy. He had diagnoses of septicemia (body's extreme response to an infection that enters the bloodstream) and sepsis. Review of Resident #2's Comprehensive Care Plan, revised on 01/07/2026, reflected Resident #2 had an ostomy secondary to bowel perforation. He was at risk for complications including but not limited to stoma (surgically created opening in the abdomen that allows bodily waste, such as urine or feces, to exit the body into a collection pouch, irritation and bleeding. Interventions: Colostomy care every shift as needed. Monitor for signs of infections such as edema, redness, increased pain around the stoma area. There was not a care plan for Resident #2 to be on enhance barrier precautions. Review of Resident #2's Physician Orders, revised on 01/07/2026, reflected enhanced barrier precautions related to colostomy/[NAME] drain (a surgical device with a tube and squeezable bulb that creates suction to remove excess blood and fluid from a surgical site, preventing infection and promoting healing). Observation on 01/16/2026 at 11:20 am, RN C was standing at the medication cart and was preparing the colostomy bag. She touched the scissors and the left side of her shirt. RN C did not wash her hands and touched the wafer of the colostomy (the skin barrier which is the sticky adhesive base that seals around the stoma to protect the skin from output and hold the pouch in place.) RN C exited the medication cart and walked down the hall to Resident #2's room. On the wall beside Resident #2's room (he did not have a roommate) was an enhance barrier precaution sign. RN C entered Resident #2' room without sanitizing hands, or donning gown. She donned gloves on her hands once she entered Resident #2's room but did not wash her hands. She touched the fourchettes of the gloves with her contaminated fingers and hands. RN C proceeded to change the colostomy and put in a new colostomy bag. In an interview on 01/16/2026 at 11:45 pm, RN C stated she did not sanitize her hands after she used the scissors at the medication cart, and she did touch the left side of her shirt. She stated she was expected to sanitize her hands prior to donning gloves. She stated the gloves were considered contaminated due to touching the outside of the gloves with her contaminated fingers and hands. RN C stated she did not have an excuse or reason she did not don a gown prior to entering Resident #2 room. She stated Resident #2 was on enhance Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676437 If continuation sheet Page 13 of 14 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 676437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accel at College Station 1500 Medical Avenue College Station, TX 77845 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete barrier precautions, and without wearing appropriate PPE, she could spread germs into the area when she removed the colostomy. She stated there was a possibility that bacteria may transfer to her clothes, and she may spread bacteria to other residents. RN C stated the enhanced barrier precaution sign was on the wall beside Resident #2's door. She stated a container was beside his door with gowns, gloves, and all the PPE items she needed to wear when she entered Resident #2's room and prior to changing his colostomy bag. She stated she had been in-service on enhanced barrier precautions, hand hygiene, and infection control. RN C stated she did not recall the date she received the in-services. In an interview on 01/16/2026 at 4:00 pm, the Director of Nurses stated all staff was expected to wear PPE (gown and gloves) when entering a resident room on enhanced barrier precaution. She stated RN C did not follow the facility's protocol for infection control. The Director of Nurses stated there was a potential RN C to spread bacteria from Resident # 2 to another resident when she did not don a gown. She stated RN C had been in-serviced on infection control, enhanced barriers precautions, and hand hygiene. She stated RN C was to wash or sanitize her hands anytime she touched anything considered contaminated. The Director of Nurses stated scissors and clothes were considered contaminated. Record review of the facility's policy on Personal Protective Equipment- using gowns, dated 2010, reflected to guide the use of gowns. To prevent the spread of infections. To prevent soiling of clothing with infections materials. To prevent splashing or spilling blood or body fluids onto clothing or exposed skin. Record review of the facility's policy on Handwashing /Hand Hygiene, dated August 2015, reflected This facility considers hand hygiene the primary means to prevent the spread of infections. Use alcohol-based hand rub containing at least 62 percent alcohol; or alternatively soap (antimicrobial or non- antimicrobial) and water for the following situations: before and after contact with residents. Before performing any non-surgical invasive procedures. Before donning sterile gloves. Event ID: Facility ID: 676437 If continuation sheet Page 14 of 14