Health inspection·November 12, 2025

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some identified; an unstageable pressure ulcer/injury to right heel. Note indicated wound measurements were 3cm X 2cm X 0.1cm and eschar was 100%. There was no documentation of physician notification.Record review of a physician's order summary report dated 11/12/25 for Resident #11 indicated the following physician orders: .consult Dr. [Wound physician name] for wound to r heel. dated 10/20/25 .wound location: right heel - skin prep daily unstageable PI to right heel. dated 10/20/25.wound location: right heel - clean wound with wound cleanser or NS, pat dry, apply medihoney and wrap with kerlix daily. dated 11/10/25. There was no order for wound care on 10/18/25 (the day wound was identified) There was no order for daily dressing changes dated 11/3/25 from surgeons' office visit.Record review of a Treatment Administration Record dated 10/1/25 to 10/31/25 for Resident #11 indicated she did not receive her wound care as ordered on 10/22/25 and 10/23/25.Record review of a Treatment Administration Record dated 11/1/25 to 11/30/25 for Resident #11 indicated she did not receive her wound care as ordered on 11/3/25, 11/7/25, and 11/8/25.Record review of a physician's office visit note dated 11/3/25 for Resident #11 indicated she had a physician visit on 11/3/25 to follow up with her foot surgeon. Note read: .Focused wound exam: Right lower extremity wound: surgical incision well healed however there is a full thickness, decubitus ulceration to the posterior heel with fluctuate eschar. Wound measurements were: 2.5cm X 1.1cm X 0.1cm. Excisional debridement was performed and post debridement measurements were 2.7cm X 1.2cm X 0.3cm. Documentation read: .Nature of tissues removed: devitalized tissue, fat necrosis, and slough.; wound care and dressing was applied and post-operative instructions read: .continue with daily dressing changes. 2. Record review of a facility face sheet dated 11/10/25 for Resident #12 indicated he was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including: pneumonia (an infection that inflames the air sacs in one or both lungs), urinary tract infection (a common infection that can affect any part of your urinary system, including the bladder, kidneys, and urethra), and acute kidney failure (a sudden loss of kidney function). Record review of a Medicare 5-day MDS assessment dated [DATE] for Resident #12 indicated a BIMS score of 15, which indicated he was cognitively intact. He was dependent or required maximal assistance with most/all ADLs. He was coded for 2 stage 4 pressure ulcers.Record review of a comprehensive care plan dated 10/23/25 for Resident #12 indicated he had stage 4 pressure ulcers/pressure injuries to right heel and left heel with an increased potential for pressure ulcer/pressure injury development and/or potential for worsening/additional pressure ulcer injury related to immobility. He had an intervention to complete a head-to-toe skin assessment on a weekly basis.Record review of a physician's order dated 10/19/25 for Resident #12 indicated he had the following order: .Clean with wound cleanser, pat dry, apply medihoney and cover with non-adherent dressing, wrap with gauze to secure. Change daily and prn soiled. Record review of a physician's order summary report dated 11/10/25 for Resident #12 indicated he had the following physician's orders: .wound location: left heel: clean wound daily w/NS or wound cleanser, apply ca alg (calcium alginate) w/silver and cover with dry dressing. Change daily and prn (as needed) if soiled, not intact. dated 10/22/25 .wound location: right heel: clean wound with wound cleanser or NS (normal saline), apply ca alg w/silver and cover with dry dressing, change daily and prn if soiled/not intact. dated 10/22/25. There were no physician orders for wound care between 10/15/25 through 10/19/25.Record review of a facility form titled Admission/re-admission Report Form dated 10/15/25 for Resident #12 read: .Wounds to bilateral heels. Right heel requires drsg (dressing) change. and was signed by LVN F. Record review of a nursing progress note clinical admission dated 10/15/25 at 3:21 pm for Resident #12 indicated he had unstageable pressure ulcers to both heels and was signed by LVN L. Note indicated resident physician was notified of admission, and triplicate forms were sent. No documentation of notification of wounds, or request for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 2 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some wound care orders. 3. Record review of a facility face sheet dated 11/10/25 for Resident #13 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: cerebral infarction (stroke), hypertension (high blood pressure), and hyperlipidemia (high cholesterol).Record review of a Quarterly MDS assessment dated [DATE] for Resident #13 indicated a BIMS score of 03, which indicated she had severely impaired cognition. She required maximum assistance with most/all ADLs. She was coded for 1 stage 4 pressure ulcer. Record review of a comprehensive care plan dated 10/29/25 for Resident #13 indicated she had a stage 4 pressure ulcer/pressure injury to her right lateral ankle with an increased potential for pressure ulcer/pressure injury development and/or potential for worsening/additional pressure ulcer/pressure injury related to immobility. She had interventions for complete head-to-toe skin assessments on a weekly basis, administer treatments as ordered, and low air loss mattress inflated at correct setting to maximize pressure relief. Record review of an electronic health record for Resident #13 on 11/10/25 indicated there were no skin assessments completed between the dates of 10/8/25 and 11/10/25.Record review of a wound care physician visit report dated 6/16/25 for Resident #13 indicated that Resident had a facility acquired stage 3 pressure ulcer to her right lateral ankle (the outer side of the right ankle) acquired on 6/2/25 and the wound measured 0.5cm X 0.5cm X 0.1cm with moderate serous exudate.Record review of a wound care physician visit report dated 10/20/25 for Resident #13 indicated that on 10/20/25 wound had progressed to a stage 4 pressure injury with measurements of 1cm X 0.8cm X 0cm with moderate serous exudate.During an observation and interview on 11/10/25 at 3:18 pm Resident #11 said she had been at the facility for approximately 6 weeks and was at home prior to being admitted to the facility. She said she had gone to the hospital with a broken foot and had a wound to her right heel. She said the wound to her heel had not been covered by a dressing in the last 3 days. She said prior to that they were putting a bandage on her heel and keeping it on for a week and it was supposed to be changed 3 times a week on Mondays, Wednesdays, and Fridays. She said she guessed the staff were just lazy. She said the wound had not been infected that she was aware of and had not said anything about wound care not being done as ordered. Resident #11 removed her sock from her right foot and showed this Surveyor her heel-area noted with slough present with a small amount of eschar in the wound bed. She said it had not been changed in 3 days. She said she was not refusing any care from the staff. She said it had been a while since she saw the wound care physician and the last time she saw him he did not look at her wound because it had a bandage on it. She said the wound did not hurt.During an interview on 11/10/25 at 10:12 am the ADON said if staff found new skin issues, they should be reporting to the nurse, and they let her (ADON) know as well. She said if the doctor did not give new orders, then staff would not write a progress note. She said nurses should have completed skin evaluations and assessments. She said there had been a huge problem with the nurses doing their assessments and evaluations. She said there was no one in the facility holding staff accountable to make sure things were done. She said they had even contacted staff to come in to complete their evaluations on their days off. She said the facility has had a problem for a long time with nurse administration not following through and not holding staff accountable for things that were not done. She said the facility did not have a treatment nurse and the nurses were responsible for completing the skin assessments and wound care in the facility. During a telephone interview on 11/11/2025 at 9:15 am the Wound Physician said he would visit the facility every 2 weeks and had been visiting the facility for the past 5 years. He said he only saw residents who had wounds, and his last visit was on 11/3/2025. He said usually a floor nurse would follow him. He said Resident #11 was last seen on 10/20/2025 and she had a wound to her right heel that was pressure ulcer-unstageable with dry eschar about the size of a quarter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 3 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Treatment orders were for skin prep and float heels. He said if a resident refused treatment, the nurses would document the refusal as he did not document anything on his notes. He said when he visited, he assessed the wounds, measured, debrided and provided recommendations. He said sometimes the wounds would deteriorate if the residents were noncompliant. He said he had not been notified within the past 2-3 months of any residents in the facility with a deterioration of wounds. He said the best person to talk to would be the nurses. He said he visited every other Monday and would be back in the facility on 11/17/2025.During a telephone interview on 11/11/2025 at 9:34 am LVN L said the facility did not have a treatment nurse in the facility, and the nurses were responsible for completing skin assessments daily and wound care. She said they have a schedule at the nurse's desk in a binder. She said with new admissions, she would assess the residents and conduct skin assessments. She said if a resident had a wound on admission, the nurse would measure the wounds, and when the wound care physician comes the wounds, he would also measure the wounds. She said she was not measuring the wounds daily nor weekly. She said if it looked like a wound was getting worse, she would measure it. She said the wound care was supposed to be done during the day, but sometimes wound care did not get done during the day shift and the night shift would sometimes complete the ones that she was not able to complete. She said if she noticed that a wound had worsened, she would notify the resident's primary medical doctor or the ADON because they do not have access to contact the wound physician. She said she had never seen him on her rotation. She said sometimes she was aware he had been there, and the residents would tell her if they had any new orders. She said she would then go and look to see if there were any new orders in the charting system. She said when a resident goes out to the hospital and then returns, the nurses were supposed to notify the Administrator, DON or ADON, medical doctor or family/RP of any new orders and changes in care. She said residents could be at risk of infection, and sepsis if they were not getting wound care as ordered or skin assessments are not done weekly.Record review of a facility policy titled Change in a Resident's Condition or Status dated March 2022 read: .Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition and/or status. This was determined to be an Immediate Jeopardy (IJ) on 11/11/2025 at 10:57 am. The facility's Administrator, DON, ADON, MDS, and Regional Director of Clinical Operations were notified. The Administrator was provided with the IJ template on 11/11/2025 at 11:04 am. The following Plan of Removal (POR) submitted by the facility was accepted on 11/12/2025 at 3:45 pm.PLAN OF REMOVALF580: Notification of ChangeName of facility: [name of facility]Date: November 11, 2025, 11:04 am.Immediate action: Immediately upon notification of the alleged deficient practice of notification of change the facility implemented the following measures: On 11/11/25 at 2:40 pm, The Corporate Director of Clinical Operations contacted the facility wound care consulting provider to ensure no information had been relayed to him regarding the residents currently under his care. Residents #11, #12, and #13 were discussed with the MDS Coordinator and the Assistant Director of Clinical Operations, no new orders were received. Regarding Resident #11: The consulting wound care physician was contacted by the Corporate Director of Clinical Operations on 11/12/25 at 11:15 am and was informed of the resident being seen by the surgeon who performed her original right metatarsal surgery and during the appointment, the right heel pressure injury was debrided, and the wound condition had deteriorated since his last observation. Also reviewed measurements of the wound, and the notes from the surgeon and the treatment (Santyl) ordered by the outside surgeon. Explained that we received this information this morning but there was an order from the attending physician for a different order (Medihoney). The consulting wound care physician stated to go with the order given by the attending physician and inquire which (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 4 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some consulting wound care physician the family and attending physician would like to use moving forward as they cannot both treat/bill for the resident. The resident representative was contacted by the Assistant Director of Nursing and informed of the debridement, deterioration of the wound, and inquired which consulting wound physician she would prefer to use for the pressure area to the left heel. The resident representative prefers to use the consulting wound care physician that comes to the facility. Regarding Resident #12: The wound care consulting physician was contacted by the Corporate Director of Clinical Operations on 11/12/25 at 11:15 am to inform of the most recent measurements and wound condition, no new orders were given. Regarding Resident #13: wound measurements and condition were compared to the most previous wound assessment with noted increase in size from previous observation. On 11/3/25 the wound measurements were 1.0 X 1.0 X 0.2 with 76-100% granulation and the measurements for 11/11/25 were 1.2 X 1.2 with 70% slough. The wound care consulting physician was notified by the MDS coordinator on 11/11/25 with no new orders received and he stated the wound was unavoidable related to residents' persistent position of right side lying. The resident representative was notified by the MDS Coordinator. On 11/11/25, the nursing administration team (Director of Nursing, Assistant Director of Nursing, and MDS Coordinator), with the assistance of the Corporate Director of Clinical Operations and the Assistant Director of Clinical Operations will compare all measurements and wound condition observations to the previous measurement/condition to ensure any area of deterioration/worsening are immediately reported to the Wound Care Physician and the resident's attending physician regarding wound care deterioration/worsening. On 11/11/25, all nurses present at the time of notification of the alleged deficient practice will be re-educated in the form of an in-service from the Assistant Director of Nursing regarding when to report skin issues to the provider vs. the wound care consulting physician, how to document physician communication regarding wound care and how to contact the wound care consulting physician. This in-service will continue until all nurses have been in-serviced and all nurses will receive re-education prior to beginning their next scheduled shift. Beginning 11/11/25 the Director of Nursing and the Facility Administrator will review the 24-hour report each day to ensure a progress note is written when the wound care physician visits each resident and when the wound care physician is contacted to update with changes in wound condition. All nurses on staff at the time of notification on 11/11/25 were provided with education by the administrative nursing team regarding the completion of the Skin Issues evaluation when a new wound is discovered or when a resident is admitted with a wound, to notify the Director of Nurses and Facility Administrator, to notify the attending physician and/or the consulting wound care physician to obtain treatment orders and begin treatment orders immediately upon receipt, to make a notation on the 24-hour report of the new wound and to inform the Certified Nurse Aides of the residents wound and any changes needed for the residents plan of care This in-service will continue until all nurses have been provided with education and no nurse will begin their next scheduled shift without receiving the education. On 11/11/25, the nurses present at the time of notification will be in-serviced by the administrative nursing team regarding admitting a resident with wounds, informing the physician of wound(s) discovered during the initial assessment, obtaining orders for treatment, ensuring orders for treatment are initiated immediately (not when electronic health record defaults to the next day), and inquiring about existing wound when receiving report from the discharging facility. This in-service will continue until all nurses are provided with the education and nurses will receive the education prior to beginning their next scheduled shift. On 11/11/25 all nurses present at the time of notification were provided with re-education regarding notification of the physician when there is a change in condition of a wound is noted. Nurses were reminded to document all physician (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 5 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some interaction in the electronic health record. This in-service will continue until all nurses are provided with the education and nurses will receive the education prior to beginning their next scheduled shift. The facility has begun the process of replacing the current consulting wound care physician with a wound care company that will be onsite weekly, physically examine and evaluate all residents with wounds, provide wound progress reports, training to staff, and work directly with facility management to ensure treatment and services are provided to prevent and heal pressure ulcers. The wound care company was contacted by the Corporate Director of Clinical Operations on 11/11/25, to inquire about projected start date of their services. The response from the wound care company is still pending. Another provider has been contacted and is willing to provide wound care consultant nurse practitioner service with the facility within the next 30 days. A determination of which company to be used will be made no later than 11/12/25 at 5:00 pm. Beginning 11/12/25 at 4:00 pm a daily stand-down meeting will be held by the Facility Administrator and Director of Nursing to ensure all assigned wound care tasks, documentation, recommendations, physician notifications, and physician orders are carried out appropriately. On 11/11/25 at 4:00 pm an impromptu QAPI meeting will be conducted with the Facility Medical Director, Facility Administrator, Director of Nursing, Assistant Director of Nursing, MDS Coordinator, Corporate Director of Clinical Operations and Assistant Director of Clinical Operations. Facilities Plan to Ensure Compliance QuicklyThe facility nursing administration staff (Director of Nursing, Assistant Director of Nursing, and MDS Nurse) with the assistance of the Director of Clinical Operations and the Assistant Director of Clinical Operations will ensure all residents have a current skin assessment completed and documented in the electronic health record and all residents with wounds will be evaluated immediately to ensure all appropriate interventions are in place and the attending physician and consulting wound care physician have been notified. This task will be completed no later than 11:00 pm on 11/11/25. The State Surveyors monitored the Plan of Removal as follows:Resident #11 - Progress note dated 11/10/25-MDS nurse notified primary physician, resident and RP of wound. RP notification verified by telephone interview 11/12/25 at 10:59 am.Resident #12 - Progress note dated 11/11/2025-RP was notified about wounds to feet. RP notification verified by telephone interview on 11/12/2025 at 11:12 am. Progress note dated 11/12/25 indicated physician notification was made by Corporate Director of Clinical Operations.Resident #13 - Progress note dated 11/11/25 - Physician and RP notified of wound by MDS nurse. RP notification was verified by telephone interview on 11/12/25 at 12:20 pm.Record review of progress note dated 11/12/25 for Resident #11 indicated current measurements had been taken and compared to previous, and notification made to wound care physician by Corporate Director of Clinical Operations. Record review of a progress note dated 11/11/25 for Resident #12 indicated current measurements had been taken and compared to previous, with an improvement in size, by MDS nurse.Record review of a progress note dated 11/11/25 for Resident #13 indicated current measurements had been taken and compared to previous, and notification made to wound care physician by MDS nurse.Record review of in-service dated 11/11/25 covered when to report skin issues to the provider vs. the wound care consulting physician, how to document physician communication regarding wound care and how to contact the wound care consulting physician. In-service also covered admitting a resident with wounds, informing the physician of wound(s) discovered during the initial assessment, obtaining orders for treatment, ensuring orders for treatment are initiated immediately (not when electronic health record defaults to the next day), and inquiring about existing wound when receiving report from the discharging facility, and notification of the physician when there is a change in condition of a wound noted. Nurses were reminded to document all physician interaction in the electronic health record. This in-service was signed by 10 nurses and the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 6 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete administrator.Record review of a checklist for daily tasks for morning meetings, stand down meetings, and weekly skin reports.Record review of email dated 11/11/25 with a wound consulting company from the facility.Checklist to be used during meetings verified.Record review of an impromptu QAPI dated 11/11/2025 indicated that the Medical Director, Administrator, DON and ADON were present to discuss immediate jeopardies relating to wound care and physician notification.Record review verified all 58 residents in facility had new skin assessment done 11/11/25 and 11/12/25.Interviews conducted on 11/12/25 from 11:00 am to 5:11 pm indicated DON, MDS, ADON, Administrator, LVN L, LVN F, and LVN Q were all able to verbalize the process of admitting a new resident with wounds, the process of identifying a new wound, completion of skin assessments, physician notification, notification of family, how to document resident refusals and provider notifications, where to find physician's/providers contact information, how and when to put orders into electronic health record, and how to complete the TAR. IDT Team members, which included DON, MDS, ADON, and Administrator, all verbalized their responsibilities related to providing oversight and monitoring reports during daily meetings. Interviews conducted included staff from both day and night shifts.The Administrator was informed that the Immediate Jeopardy was removed on 11/12/2025 at 6:34 pm however, the facility remained out of compliance at a scope of a pattern and a severity level of no actual harm that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 676439 If continuation sheet Page 7 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 interview and record review the facility failed to make sure a comprehensive care plan was prepared by an interdisciplinary team, that included but not limited to the participation of the resident and the resident representative for 1 of 10 residents (Resident #2) reviewed for care plans.The facility failed to ensure Resident #2, and her representative were invited and attended the resident care plan conferences.This failure could place residents at risk of not receiving the care and services to meet their needs.Findings include:Record review of an admission Record for Resident #2 dated 11/5/2025 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of major depressive disorder (persistent sadness or loss of interest in doing things), type 2 diabetes, and hypertensive heart disease with heart failure (high blood pressure that makes it difficult for the heart to pump blood through the body). Record review of a Significant Change MDS assessment dated [DATE] for Resident #2 indicated she did not have any impairment in thinking with a BIMS score of 15. She required set-up or clean-up assistance with eating and oral hygiene but was dependent on staff for toileting. Resident #2 was active in participating in the assessment and goal setting. Record review of a Quarterly IDT care plan conference summary dated 3/12/2025 for Resident #2 indicated she was in attendance in person, and her representative was in attendance via phone. All aspects of care were discussed including medications and her care plan. The conference summary was electronically signed by the MDS Coordinator.Record review of Resident #2's care plan conference summaries indicated there were not any other conferences since 3/12/2025.Record review of the care plan meetings scheduled from June 2025 to November 2025 for the facility indicated that Resident #2 was scheduled for a care plan meeting on 6/11/2025 but she was in the hospital. The care plan meeting was not rescheduled.During a phone interview on 11/3/2025 at 11:34 AM, the RP for Resident #2 said the last care plan meeting that they were invited to was in March 2025. She said she was not sure why the facility had not contacted her for one.During an interview on 11/10/2025 at 2:40 PM, the MDS Coordinator said she was responsible for conducting the care plan meetings. She said the facility had care plan meetings weekly and each resident in the facility would have a care plan meeting quarterly and as needed. She said Resident #2's last care plan meeting was 3/12/2025. She Resident #2 was scheduled for a care plan meeting in June 2025 but was in the hospital at that time. She said she was not sure why Resident #2 had not been scheduled for a care plan meeting. She said the care plan meetings were conducted with the residents/RP's to address any questions or concerns that they may have and also discuss their plan of care including code status and medications. She said the IDT team attended the care plan meetings which included the DOR, SW, DM, Activities and a CNA. She said if care plan meetings were not held then the facility would not know if the resident or representative had any concerns or questions. She said she did realize to put Resident #2 back on the monthly schedule for a care plan meeting after she went to the hospital in June 2025.During an interview on 11/12/2025 at 10:19 AM, the AD said she was part of the IDT team and they met once a week for care plan meetings. She said the MDS Coordinator was responsible for conducting and setting up the meetings. She said some residents attended the meetings and some families attended on the phone. She said she did not remember the last time they had a care plan meeting for Resident #2. She said during the meetings they discussed the residents medications, any changes, preferences or concerns they may have.During an interview on 11/12/2025 at 1:36 PM, the DOR said he had been employed at the facility for 1.5 years and he was a part of the IDT team. He said he attended the care plan meetings once a week and the MDS Coordinator was responsible for scheduling the meeting. He said sometimes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 8 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 residents attended the meeting and some family members would attend via phone conference. He said they discussed everything from their care, medications, likes and preferences and anything that came up such as complaints or concerns and they tried to correct the issues. He said it had been a while since Resident #2 had a care plan meeting and was unable to recall when her last care plan meeting was held. He said the residents had a care plan meeting about every couple of months. He said having the meetings was a benefit and the facility would not know what was going on with the entire team if they did not have the meetings.During an interview on 11/12/2025 at 3:19 PM, the DM said she had been employed at the facility since March 2025 and was part of the IDT team. She said the facility had care plan meeting every week and the residents received notification from the MDS Coordinator about the meeting once a week and sometimes the families would attend over the phone. She said that day (11/12/2025) they had a meeting with Resident #2 and her RP's. She said they had one meeting with her a while ago and residents should have one quarterly. She said they missed one of Resident #2's meetings because she was in the hospital. She said during the meetings they discussed their care, medications, treatments, and care in the facility. She said each person on the IDT team would discuss their care and any changes and if the resident was satisfied with their care. She said if they were not having care plan meetings residents would not get the care they needed or would not know what was going on or any changes.During an interview on 11/12/2025 at 5:24 PM, the Administrator said residents should have a care plan meeting at least quarterly. She said every Wednesday the facility had care plan meetings and she would attend sometimes. She said they discussed the residents plan of care, risks, code status, dietary, updates, therapy services, and medications. She said she was not aware that Resident #2's last care plan meeting was conducted in March 2025. She said residents/families may not be informed on what was going on with them or not getting things addressed. She said she planned to make sure the MDS Coordinator was following the calendar to ensure residents were having care plan meetings quarterly and as needed. She said the MDS Coordinator was responsible for conducting the care plan meetings and they were based off the MDS assessments.Record review of a facility policy titled Care Plans, Comprehensive Person-Centered revised December 2016 indicated, .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. 1. The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident. 3. The IDT includes: 3. the resident and the resident's legal representative (to the extent practicable). Event ID: Facility ID: 676439 If continuation sheet Page 9 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that residents received care and services in accordance with professional standards of practice for 4 of 11 residents (Resident #1, # 7, #14, and #15) reviewed for quality of care.1.The facility failed to ensure RN A assessed, provided care, conducted and documented a neuro assessment, and notify the physician and family when Resident #1 fell and hit her head on 10/30/2025. 2. The facility failed to ensure a head-to-toe skin assessment was completed by a nurse after CNA G identified possible ant bites to Resident #15 on 10/9/25, and Residents #7 and #14 on 10/10/25.These failures could place residents at risk for not receiving appropriate care and treatment and or decline in their health.The findings included: 1.Record review of an admission Record for Resident #1 dated 11/5/2025 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of dementia (loss of thinking, remembering, and reasoning skills), age related osteoporosis (brittle bones due to age), hypertension (high blood pressure), and atrial fibrillation (irregular heart rhythm). Record review of a Quarterly MDS Assessment for Resident #1 dated 10/8/2025 indicated she had severe impairment in thinking with a BIMS score of 3. She required partial/moderate assistance with sitting to standing. She required the use of a manual wheelchair for mobility. She had two falls since admission/entry without injury. Record review of a care plan for Resident #1 revised on 10/29/2025 indicated she had an actual fall. Interventions included: immediately after fall, assess resident for injury, obtain vital signs and initiate neuro checks. If unwitnessed or head involved, continue neuro checks and vital signs every 15 min x 1 hr., every 30 min x2 hr., every hr. x2 hrs. and every shift x72 hrs.Record review of a 24-hour report for Resident #1 dated 10/30/2025 indicated, knocked head on chair and has skin tear to mid forearm-small dressing in place.Record review of a 24-hour report for Resident #1 dated 10/31/2025 indicated, fall 10/30/2025 day shift, needs incident report and needs to notify family. Orders to send to ER.Record review of a progress note for Resident #1 dated 10/31/2025 at 5:37 AM by LVN N indicated, This nurse was asked by hall one aides if I was made aware of a fall resident had from morning shift. There is no incident report or note placed in chart.Record review of a progress note for Resident #1 dated 10/31/2025 at 2:04 PM by LVN L indicated, Resident had a fall on previous day shift large abrasion on forehead, increased lethargy around breakfast, with c/o of dizziness, neuros in place at this time, called [EMS] for transport to ER for a CT of the head per Physician's orders. RP notified.Record review of a facility in-service signed and dated 10/31/2025 indicated 59 staff were trained on timely response, notification, and documentation of resident events. 2. Record review of a facility face sheet dated 11/10/25 for Resident #15 indicated he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including: epilepsy (seizure disorder) and dysphagia (difficulty swallowing). Record review of a Quarterly MDS assessment dated [DATE] for Resident #15 indicated he was unable to complete a BIMS assessment due to being rarely/never understood and he had moderately impaired cognition. He was dependent with most/all ADLs. Record review of a comprehensive care plan dated 2/3/25 for Resident #15 indicated he had the potential for an alteration in skin integrity and had an intervention for LVNs and RNs that read: .Inspect skin from head to toe no less than one time per week and document/measure all abnormal findings.Record review of a facility form titled Skin Monitoring: Comprehensive C.N.A. Shower Review dated 10/9/25 and signed by CNA G for Resident #15 indicated CNA G identified bites to Resident #15's abdomen around his belly button. Bottom of form read .Turn into DON after skin issues have been addressed. Shower sheet had not been signed off on by a nurse.Record review of an electronic health record for Resident #15 on 11/10/25 indicated there was no skin assessment Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 10 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Actual harm Residents Affected - Some completed by a nurse on 10/9/25 for Resident #15 and no nursing progress note dated 10/9/25 indicating Resident #15 had been assessed by a nurse for bites. There were no weekly skin assessments documented between 9/25/25 and 10/23/25.3. Record review of a facility face sheet dated 11/10/25 for Resident #7 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including acute and chronic respiratory failure with hypoxia (when the body does not get enough oxygen, leading to a condition known as hypoxia), type 2 diabetes (uncontrolled blood sugar), and dementia (a disease that affects memory, thinking, and the ability to perform daily activities). Record review of a Quarterly MDS assessment dated [DATE] for Resident #7 indicated a BIMS score of 15, indicating her cognition was intact. She required minimal assistance/was independent with most ADLs. Record review of a comprehensive care plan dated 6/15/22 for Resident #7 indicated she had the potential for alteration in skin integrity and had an intervention for LVNs and RNs that read: .Inspect skin from head to toe no less than one time per week and document/measure all abnormal findings.Record review of a facility form titled Skin Monitoring: Comprehensive C.N.A. Shower Review dated 10/10/25 and signed by CNA G for Resident #7 indicated CNA G identified multiple ant bites to Resident #7's shoulders, right arm, chest, and abdomen. Bottom of form read .Turn into DON after skin issues have been addressed. Shower sheet had not been signed off on by a nurse.Record review of an electronic health record for Resident #7 on 11/10/25 indicated there was no skin assessment completed by a nurse on 10/10/25 for Resident #7 and no nursing progress note dated 10/10/25 indicating Resident #7 had been assessed by a nurse for ant bites. There were no weekly skin assessments documented between the dates of 10/19/25 and 11/2/25.4. Record review of a facility face sheet dated 11/10/25 for Resident #14 indicated he was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including: chronic obstructive pulmonary disease (a group of lung diseases that includes emphysema and chronic bronchitis. It is characterized by obstructed airflow from the lungs, making it difficult to breathe), urinary tract infection (a common infection that can affect any part of your urinary system, including the bladder, kidneys, and urethra), and Alzheimer's disease (the most common cause of dementia - a disease that affects memory, thinking, and the ability to perform daily activities). Record review of a Comprehensive MDS assessment dated [DATE] for Resident #14 indicated a BIMS score of 11, which indicated he had moderate cognitive impairment. He required moderate assistance with most ADLs.Record review of a comprehensive care plan dated 9/12/25 for Resident #14 indicated he had the potential for an alteration in skin integrity and had an intervention for LVNs and RNs that read: .Inspect skin from head to toe no less than one time per week and document/measure all abnormal findings.Record review of a facility form titled Skin Monitoring: Comprehensive C.N.A. Shower Review dated 10/10/25 and signed by CNA G for Resident #14 indicated CNA G identified eight visible bites to Resident #14's neck, back, and right leg. Bottom of form read .Turn into DON after skin issues have been addressed. Shower sheet had not been signed off on by a nurse.Record review of an electronic health record for Resident #14 on 11/10/25 indicated there was no skin assessment completed by a nurse on 10/10/25 for Resident #14 and no nursing progress note dated 10/10/25 indicating Resident #14 had been assessed by a nurse for ant bites. There were no weekly skin assessments documented between the dates of 9/24/25 and 10/15/25.During an observation and interview on 11/4/2025 at 9:10 AM, LVN Q was on hall 100 administering medications. She said she was working as the medication aide that day. She said the facility had two medication aides during the day, and one at night that stayed until 11 pm. She said she had been employed at the facility since April 2025. She said the facility did not have a treatment nurse, but did have a wound care physician that visited weekly. She said the nurses were responsible for completing the skin assessments weekly and as needed. During an interview on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 11 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Actual harm Residents Affected - Some 11/5/2025 at 8:32 AM, LVN L said she worked on Halloween 10/31/2025. She said she was informed during report from the night nurse on 10/30/2025 that Resident #1 had a fall on Thursday 10/30/2025 during the day shift and that they needed to do an incident report and documentation. She said at breakfast on 10/31/2025, Resident #1 was groggy (sleepy) and had a huge abrasion to her forehead. She said the DON was informed and she notified the doctor and sent a picture to him, and she needed to send Resident #1 to the ER. She said she received orders and the doctor asked if it was such a bad fall, why was Resident #1 not sent out the day of the fall. She said she started neuros and checked Resident #1's blood pressure which was elevated along with her pupils being sluggish. She said she notified Resident #1's RP and the resident did not leave the facility until around 1 pm because EMS did not have any emergent vehicles for transport. She said she contacted another EMS for transport. She said RN A was the nurse who worked the day before (10/30/2025). She said she told the DON that Resident #1 was not acting like herself. She said when a resident had a fall, the nurse was supposed to assess them to see if they were safe to get up, obtain vitals and neuros, if necessary, and notify the doctor and family. She said if a resident hit their head, they normally would send the residents out for evaluation at the ER. She said residents could be at risk for injuries that might be untreated like death or brain bleeds if they were not assessed properly and timely. She said she had been trained on notifying the family and doctor, was told to not allow the nurse aides to get a resident off the floor until the nurse completed an assessment. She said proper notification would be needed and neuros needed to be started if a resident hit their head or it was an unwitnessed fall. She said nursing staff should complete a progress note and a fall risk management (incident report). During a phone interview on 11/5/2025 at 9:01 AM, RN A said she had been employed at the facility for 6 months and worked 6 am-6 pm and would work other shits at times. She said the last day she worked was on Thursday 10/30/2025. She said she was suspended pending an investigation with Resident #1. She said on 10/30/2025 at around 5 pm, she was at the nurse's desk, and the Activity Director informed her another resident having chest pain, and the resident was not assigned to her, but she was the only nurse around at that time. She said at the same time, CNA B told her that Resident #1 had a cut on her head and informed her it was ok,so they put a bandage on it until she could check Resident #1 and Resident #1 was in bed. She said when she went into the room to assess Resident #1, who was in bed, and Resident #1 said she was not sure how she injured herself. She said CNA B and CNA C were the nurse aides assigned to the hall where Resident #1 resided. She said both CNA B and CNA C told her they found Resident #1 on the floor. She said she thought Resident #1 tried to self-transfer and must have fallen. She said she checked Resident #1 from head to toe, and Resident #1 had an abrasion to her head, she conducted neuros and her vital signs were fine. She said Resident #1 told her she did not fall, but the resident had dementia. She said around 5:10 pm was the first time she saw Resident #1 and she checked neuros, and all the information was written down in her spiral because it was almost time for her to get off at 6 pm. She said she made herself a note to complete an incident report. She said she removed the steri strips from Resident #1's forehead and cleaned her head that had dried blood that measured 1 cm x 0.5 cm skin tear and placed a bandage on her head. She said the resident did not have any protrusions (sticking out) or a hematoma (a collection of blood outside of a blood vessel). She said Resident #1 was fine, and she gave report to the night shift nurse and informed her that Resident #1 had a skin tear on her forehead, and the oncoming nurse needed to complete an incident report. She said she did not document it on the 24-hour report, but had the information in her spiral book. She said she asked the Administrator if she could come in to work on 10/31/2025 to complete paperwork and was contacted before noon on 10/31/2025 to inform her that she was suspended. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 12 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Actual harm Residents Affected - Some She said she started neuros on Resident #1, but did not document it in the facility paperwork. She said she left work without her work being completed and did not document what she had done. She said Resident #1 could have had a head bleed and the nurses would have been at fault because documentation was not done and not followed through. She said the facility documented the neuro assessment on paper neuros, and she RN A did not complete one. She said she sent documentation to the Administrator to show that she started neuros, but did not send it to the night shift nurse.During an interview on 11/5/2025 at 10:03 AM, CNA C said she had been employed at the facility since October 2025 and worked 6 am-6 pm and usually worked on hall 100 where Resident #1 resided. She said Resident #1 slouches down in her wheelchair sometimes and the staff have to pull her up but has never fallen out. She said on 10/31/2025 around 1 pm or 2 pm after lunch, CNA B pushed Resident #1 back to her room after lunch and was about to start a round with performing incontinent care. She said CNA B left Resident #1 in her room and gathered supplies. She said another resident called out down the hall and she went to see what happened with that resident. When CNA B entered Resident #1's room, the resident was on the floor and she heard her say oh no, she's on the floor. She said she ran to the room of Resident #1 and Resident 1#'s wheelchair was locked sitting by the bed, and when she fell, she either hit the chair or the trashcan, and she was bleeding from the middle of her forehead and asked Resident #1 who said she hit the chair. She said she was lying on the left side and was in between the trash can and the chair. She said they both (CNA B and CNA C) went and told RN A who was at the nurse station and were told she was handling another resident who was having chest pain. She said RN A told them to pick Resident #1 up and put her to bed, and she would check on her in a little bit. She said she asked RN A what to do about Resident #1's bleeding head, and RN A told her she would be there in a minute. She said she told CNA B that RN A told her to pick Resident #1 up and put her to bed, so they put her back to bed, covered her up and about an 1 and a half hour passed and RN A still had not entered the room to check on Resident #1. She said Resident #1's head was still bleeding, and RN A had not come back fast enough. She said she performed incontinent care for three residents and RN A still had not entered the room. She said the DON and ADON were both at work on 10/31/2025 and she did not want to go above RN A to report anything. She said she told RN A a second time that Resident #1's head was still bleeding and told RN A that she was going to get some supplies to cover Resident #1's head. CNA C said she entered the room, cleaned the wound, and placed steri strips on the open area that was about a nickel size. She said she looked down the hall and RN A was still at the nurse's desk and the resident she helped was gone to the ER. She said she never saw RN A go in the room to check on Resident #1. She said later she saw Resident #1 had a bandage that was on her forehead that was not completely attached around 5:30 pm. She said RN A later told her that the resident did not have a fall. She said they got off at 6 pm and told the night shift nurse aides that Resident #1 had a fall and the nurse (RN A) did not do anything about it, and she was complaining about being dizzy and her head was hurting. She said Resident #1 was not given any medication for her head, which she was aware. She said she worked the next day 10/31/2025, and someone was asking about what happened to Resident 1's head. She said the Administrator was made aware that Resident #1 had a fall on 10/30/2025, and she had to write a witness statement. She said if a resident was found on the floor, they were to notify the nurse, whoever was in charge, not move them, and wait for the nurse to evaluate the resident and check them. She said on Friday 10/31/2025, LVN L assessed Resident #1 on the day shift.During an interview on 11/5/2025 at 10:43 AM, CNA B said she had been employed at the facility since August 2025 and worked the day shift from 6 am-6 pm. She said Resident #1 was on the hall she was assigned that day 10/30/2025. She said she worked on 10/30/2025 and Resident #1 was fine that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 13 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Actual harm Residents Affected - Some day, after lunch she was in her room ready to lie down and stepped out to get linens. She said she heard a loud bump, thought it was Resident #1, so she ran into her room and she was on the floor and it was sometime after lunch around 1:30 PM or so. She said there was a chair that was parallel to her bed, and she fell out of her wheelchair, and it looked like she hit the chair. She said she and CNA C entered the room, she told CNA C to get RN A, and CNA C came back and told her to put Resident #1 back to bed. She said they put her in bed knowing that they should not have, and thought RN A was coming and asked CNA C if she told RN A Resident #1 was bleeding from her head. She said it was a cut to her forehead. She said after they put Resident #1 in bed, they tried to clean her head, changed her, told RN A twice. She said the second time RN A was informed was after the dinner trays had been passed out (around 5 pm), RN A entered the room with her and that's when RN A assessed Resident #1. She said RN A took Resident #1's vital signs and provided treatment for her forehead. She said CNA C reported the fall to the night shift nurse aides. She said Resident #1 was her normal self and not complaining of any dizziness or headaches at that time. She said the Administrator contacted her on 10/31/2025 and asked about the incident. She said she was told to not move a resident, and they could not pick a resident off the floor until they had been assessed. She said she did not know that before and thought that the nurse should have come in to assess the resident immediately. She said they had an in-service on falls, who to report to, and not to pick them up until the nurse assessed the resident. During an observation and interview on 11/5/2025 at 12:37 PM, Resident #1 was in her room sitting up in bed awake eating her lunch. Resident #1 had a scab noted to her forehead with a wheelchair in her room with her bed in a low position. Resident #1 was alert to person with confusion noted.During a phone interview on 11/6/2025 at 9:27 AM, the Physician said he visited the facility once a week on Tuesdays and more often if needed. He said Resident #1 was one of his residents who had some intermittent times around September 2025 with her dementia getting worse. He said she had a history of falls; repeated falls most of the time when she tried to transfer herself. He said he was notified about a fall the morning after (10/31/2025) the nurse was still concerned that Resident #1 was dizzy and was asked by the facility about sending Resident #1 to the ER. He said the facility notified him about falls, and he would have told them to continue to monitor Resident #1 and let him know if anything was abnormal. He said they told him that Resident #1 possibly hit her head, and she had an abrasion. He said they sent him a photo image and reported Resident #1 complained of dizziness. He said Resident #1 was not taking any blood thinners which would increase her risk of bleeding. He said Resident #1 was sent to the ER for evaluation, but did not sustain any fractures; only a laceration to her forehead from the fall. During an observation and interview on 11/6/2025 at 11:42 AM, Resident #7 was in her room sitting on her rollator walker by the window. She was alert to person, place, and time. She said there had been a problem with ants in her room for a long time. She said she had some bites on her back not long ago from ants a few weeks ago. She said the ants were in her bed and everyone in the facility was aware. She said pest control came to the facility and treated her room. She said she had not seen any more since then. She said they treated her for the ant bites, and she was not allergic.During an observation and interview on 11/6/2025 at 11:55 AM, Resident #15 was sitting in a wheelchair in the dining room alert to person only. When asked if he had been bitten by ants, he said he had been in his bedroom on his body. He said he saw them in his room all the time.During an observation and interview on 11/6/2025 at 11:57 AM, Resident #14 was sitting on his walker in the dining room. He was alert to person, place, time, and situation. He said he had been at the facility since December 2024. He said he had ants in his room not long ago and was bitten by them in his bed. He said he had not seen any since then. He said the facility treated his ant (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 14 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Actual harm Residents Affected - Some bites, he was not allergic to the ants, and he did not like being bitten.During an interview on 11/10/2025 at 9:33 AM, CNA G said she was one of the shower techs for the facility and she worked Monday-Friday giving showers for the residents in the facility. She observed the shower sheets for Resident #7, #14 and #15 from October 2025. She said she signed the sheets and notified the ADON and the nurse for the residents and just verbalized what she observed on those days with the ant bites. She said either the ADON, or the nurse would go and check the resident's skin to see if it needed any medications or not. She said she saw the staff go into the room, but was not sure what they did. She said she did not see any ants in Resident #7's room. She said Resident #14 had ant bites and she reported them to the nurse. She said she saw someone from pest control came out to the facility and treat the rooms. She said she had not seen any more residents with ant bites since October 2025. During an interview on 11/10/2025 at 10:12 AM, the ADON said if staff found new skin issues, they should report them to the nurse, and they notified her as well. She said the staff were also to notify the physician and if the physician did not give orders, then staff would not write a progress note. She said nurses should have completed skin evaluations and assessments, and there was a huge problem with the nurse not doing those evaluations. She said the nurses were responsible for conducting skin evaluations weekly and as needed. She said there was no one in the facility to hold staff accountable to make sure things were being done. She said they had contacted staff, before, to come into the facility to complete their evaluations on their days off. She said the facility had a problem for a long time with nurse administration not following through and not holding staff accountable for things that were not done. During an interview on 11/12/25 at 12:40 pm, LVN Q said she had been working at the facility since April 2025 as a charge nurse. She said skin assessments were to be completed at least weekly on all residents, and were the responsibility of the charge nurse. She said if a CNA reported any skin issues to the charge nurse, the charge nurse should immediately do a thorough assessment and document any findings. She said if any issues were identified during this assessment, the physician should be notified for any new orders, along with the DON, Administrator, and Responsible Party or family member. She said if this was not done appropriately, further skin breakdown could occur.During an interview on 11/12/2025 at 5:24 PM, the Administrator said if a resident had a fall, the staff should notify the nurse and should evaluate the resident. She said the nurse should start a risk management assessment, check vital signs, and initiate neuros. She said all unwitnessed falls have a protocol in place to start neuros, notify RPs, the physician, and facility management. She said residents could be at risk of an adverse event. She said at no time should a resident be picked up off the floor without an assessment. She said RN A was terminated. She said skin assessments were the responsibility of the nurses and should be conducted weekly. She said if staff observed any skin issues, they were to report immediately to the charge nurse and then the charge nurse was to complete a head-to-toe assessment to determine best course of action and notify the physician and RPs. Record review of a termination form for RN A signed and dated 11/8/2025 by the Administrator indicated she was terminated for failing to properly assess, evaluate, or treat timely to a resident that had a fall with injury. Record review of the facility's policy titled Assessing Falls and Their Causes revised March 2018 indicated, .The purposes of this procedure are to provide guidelines for assessing a resident after a fall and to assist staff in identifying causes of the fall. After a fall: 1. If a resident has just fallen, or is found on the floor without a witness to the event, evaluate for possible injuries to the head, neck, spine, and extremities. 2. Obtain and record vitals as soon as it is safe to do so. If the fall is unwitnessed (resident found in floor) or the fall is witnessed and the resident was known to hit their head, neuro vital signs will be initiated and carried out per (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 15 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Actual harm guidelines. 3. If there is evidence of injury, provide appropriate first aid and/or obtain medical treatment immediately. 5. Notify the resident's attending physician and family in an appropriate time frame. Reporting: 1. Notify the following individuals when a resident falls: a. The resident's family; b. The Attending physician; The Director of Nursing Services; and d. The Nursing Supervisor on duty. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 16 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure the necessary treatment and services, in accordance with comprehensive assessment and professional standards of practice, to prevent development of pressure injuries was provided for 4 of 4 Residents (Resident's #11, #12, #13, and #16) reviewed for pressure injuries.1. The facility failed to complete weekly skin assessments after 10/18/25 for Resident #11 who admitted on [DATE] after ORIF (Open Reduction Internal Fixation) for fracture to right foot. She was admitted with no pressure ulcers and developed an unstageable pressure injury to Right heel on 10/18/25.The facility failed to obtain and implement wound care orders for Resident #11 for 2 days after identifying unstageable pressure injury to right heel on 10/18/25. The facility failed to implement dietary recommendations from 10/28/25 from the dietician for Resident #11. The facility failed to perform wound care treatments for 5 days in October and November 2025 for Resident #11.2. The facility failed to obtain and implement wound care orders for Resident #12 until 10/19/25 after admission on [DATE]. Resident was admitted with bilateral stage 4 pressure injuries to heels.The facility failed to complete head to toe skin assessment for Resident #12 on 10/25/25.The facility failed to perform wound care as ordered for Resident #12 for 3 days in October and November 2025.3. The facility failed to prevent deterioration of an existing pressure wound for Resident #13 when on 10/20/25 an existing stage 3 pressure wound progressed to a stage 4 pressure injury and increased in size. The facility failed to perform wound care as ordered for Resident #13 for 10 days in October and November 2025. The facility failed to complete weekly skin assessments after 10/8/25 for Resident #13.The facility failed to implement intervention of low air loss mattress from care plan dated 10/29/25 for Resident #13. 4. The facility failed to perform wound care as ordered for Resident #16 for 10 days for October 2025.The facility failed to complete weekly skin assessments for Resident #16 after 10/5/25.An Immediate Jeopardy (IJ) was identified on 11/11/25 at 10:57 am. The IJ template was provided to the facility on [DATE] at 11:04 am. While the IJ was removed on 11/12/25 at 6:34 pm, the facility remained out of compliance at a scope of pattern and a severity level of no actual harm due to the facility's need to monitor and evaluate the effectiveness of the plan of removal and corrective actions.These failures could place residents at risk for developing pressure injuries, decreased quality of life, infections, and death.Findings included:1. Record review of a facility face sheet dated 11/10/25 for Resident #11 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: pneumonia (an infection that inflames the air sacs in one or both lungs), dementia (a disease that affects memory, thinking, and the ability to perform daily activities), and nondisplaced fracture of first metatarsal bone (fracture of the big toe), right foot. Record review of a Medicare 5-day MDS assessment dated [DATE] for Resident #11 indicated a BIMS score of 15 indicating she was cognitively intact. She required moderate to maximum assistance with most ADLs. She was not coded for pressure ulcers.Record review of a nursing progress note type Clinical Admission dated 9/2/25 at 1:00 pm and signed by RN A for Resident #11 indicated she had a surgical wound to right dorsal 1st metatarsal phalangeal joint (the joint where the first metatarsal bone meets the proximal phalanx of the big toe), an abrasion to left medial calf (the back of the lower leg), and bruising to right dorsum right hand (the back or posterior surface of the right hand), and there was no documentation of a pressure injury to her right heel.Record review of a comprehensive care plan dated 9/9/25 for Resident #11 indicated she had potential for alteration in skin integrity due to impaired mobility and had an intervention to inspect skin from head to toe no less than once per week and document/measure all abnormal findings. She also had an intervention to inform physician, family, Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 17 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some dietician, and director of nursing of any new skin breakdown.Record review of an electronic health record for Resident #11 on 11/10/25 indicated there were no skin assessments completed between the dates of 9/2/25 and 9/15/25 and no skin assessments documented between the dates of 10/18/25 to 11/10/25.Record review of a nursing progress note dated 10/18/25 at 8:12 pm and signed by RN K for Resident #11 indicated a new skin issue was identified; an unstageable pressure ulcer/injury to right heel. Note indicated wound measurements were 3cm X 2cm X 0.1cm and eschar was 100%. There was no documentation of physician notification.Record review of a Nutrition/Dietary Note dated 10/28/25 for Resident #11 read .Recommendation: 1. Vitamin C 500mg po (by mouth) daily. 2. Zinc sulfate 220mg daily po x 14 days 3. mvi/min (multivitamin with minerals) po daily 4. house supplement 60ml BID.Record review of a physician's order summary report dated 11/12/25 for Resident #11 indicated the following physician orders: .consult Dr. [Wound physician name] for wound to r heel. dated 10/20/25 .wound location: right heel - skin prep daily unstageable PI to right heel. dated 10/20/25.wound location: right heel - clean wound with wound cleanser or NS, pat dry, apply medihoney and wrap with kerlix daily. dated 11/10/25. There was no order for wound care on 10/18/25 (the day wound was identified) There was no order for daily dressing changes dated 11/3/25 from surgeons' office visit. There was no order for Vitamin C, Zinc Sulfate, Multivitamin with minerals, or house supplement.Record review of a visit note dated 11/3/25 for Resident #11 indicated she had a physician visit on 11/3/25 to follow up with her foot surgeon. Note read: .Focused wound exam: Right lower extremity wound: surgical incision well healed however there is a full thickness, decubitus ulceration to the posterior heel with fluctuate eschar. Wound measurements were: 2.5cm X 1.1cm X 0.1cm. Excisional debridement was performed and post debridement measurements were 2.7cm X 1.2cm X 0.3cm. Documentation read: .Nature of tissues removed: devitalized tissue, fat necrosis, and slough.; wound care and dressing was applied and post-operative instructions read: .continue with daily dressing changes. Record review of a Treatment Administration Record dated 10/1/25 to 10/31/25 for Resident #11 indicated she did not receive her wound care as ordered on 10/22/25 and 10/23/25. There was no documentation of resident refusal of treatments.Record review of a Treatment Administration Record dated 11/1/25 to 11/30/25 for Resident #11 indicated she did not receive her wound care as ordered on 11/3/25, 11/7/25, and 11/8/25. There was no documentation of resident refusal of treatments. 2. Record review of a facility face sheet dated 11/10/25 for Resident #12 indicated he was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including: pneumonia (an infection that inflames the air sacs in one or both lungs), urinary tract infection (a common infection that can affect any part of your urinary system, including the bladder, kidneys, and urethra), and acute kidney failure (a sudden loss of kidney function). Record review of a Medicare 5-day MDS assessment dated [DATE] for Resident #12 indicated a BIMS score of 15, which indicated he was cognitively intact. He was dependent or required maximal assistance with most/all ADLs. He was coded for 2 stage 4 pressure ulcers.Record review of a comprehensive care plan dated 10/23/25 for Resident #12 indicated he had stage 4 pressure ulcers/pressure injuries to right heel and left heel with an increased potential for pressure ulcer/pressure injury development and/or potential for worsening/additional pressure ulcer injury related to immobility. He had an intervention to complete a head-to-toe skin assessment on a weekly basis.Record review of a physician's order dated 10/19/25 for Resident #12 indicated he had the following order: .Clean with wound cleanser, pat dry, apply medihoney and cover with non-adherent dressing, wrap with gauze to secure. Change daily and prn soiled. Record review of a physician's order summary report dated 11/10/25 for Resident #12 indicated he had the following physician's orders: .wound location: left heel: clean wound daily w/NS or wound cleanser, apply ca alg (calcium alginate) w/silver and cover with dry (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 18 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some dressing. Change daily and prn (as needed) if soiled, not intact. dated 10/22/25 .wound location: right heel: clean wound with wound cleanser or NS (normal saline), apply ca alg w/silver and cover with dry dressing, change daily and prn if soiled/not intact. dated 10/22/25. There were no physician orders for wound care between 10/15/25 through 10/19/25.Record review of a facility form titled Admission/re-admission Report Form dated 10/15/25 for Resident #12 read: .Wounds to bilateral heels. Right heel requires drsg (dressing) change. and was signed by LVN F. Record review of a nursing progress note clinical admission dated 10/15/25 at 3:21 pm for Resident #12 indicated he had unstageable pressure ulcers to both heels and was signed by LVN L. Note indicated resident physician was notified of admission, and triplicate forms were sent. No documentation of notification of wounds, or request for wound care orders. Record review of an electronic health record for Resident #12 on 11/10/25 indicated there were no skin assessments completed between the dates of 10/18/25 and 11/6/25 and no physician's order for skin assessments.Record review of a Treatment Administration Record dated 10/1/25 through 10/31/25 for Resident #12 indicated he did not receive treatments to heels as ordered on 10/23/25 and 10/27/25.Record review of a Treatment Administration Record dated 11/2/25 through 11/30/25 for Resident #12 indicated he did not receive treatments to heels as ordered on 11/7/253. Record review of a facility face sheet dated 11/10/25 for Resident #13 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: cerebral infarction (stroke), hypertension (high blood pressure), and hyperlipidemia (high cholesterol).Record review of a Quarterly MDS assessment dated [DATE] for Resident #13 indicated a BIMS score of 03, which indicated she had severely impaired cognition. She required maximum assistance with most/all ADLs. She was coded for 1 stage 4 pressure ulcer. Record review of a comprehensive care plan dated 10/29/25 for Resident #13 indicated she had a stage 4 pressure ulcer/pressure injury to her right lateral ankle with an increased potential for pressure ulcer/pressure injury development and/or potential for worsening/additional pressure ulcer/pressure injury related to immobility. She had interventions for complete head-to-toe skin assessments on a weekly basis, administer treatments as ordered, and low air loss mattress inflated at correct setting to maximize pressure relief. Record review of an electronic health record for Resident #13 on 11/10/25 indicated there were no skin assessments completed between the dates of 10/8/25 and 11/10/25 and no physician's order for skin assessments.Record review of a Treatment Administration Record dated 10/1/25 to 10/31/25 for Resident #13 indicated she did not receive ordered treatments on 10/6/25, 10/8/25, 10/13/25, 10/22/25, 10/23/25, 10/27/25, and 10/28/25. There was no documentation of resident refusal of treatments. She had the following wound care order dated 5/22/25 and discontinued on 10/20/25: .Apply skin prep to right outer ankle once daily one time a day until redness resolved. and the following order dated 10/20/25: .Wound Location: right lateral ankle: clean wound to right ankle daily w wound cleanser or NS, apply ca alg and dry dressing. change daily or pm if soiled, not intact.Record review of a Treatment Administration Record dated 11/1/25 to 11/30/25 for Resident #13 indicated she did not receive ordered treatments on 11/3/25, 11/4/25, and 11/7/25. There was no documentation of resident refusal of treatments. She had the following order dated 10/20/25: .Wound Location: right lateral ankle: clean wound to right ankle daily w wound cleanser or NS, apply ca alg and dry dressing. change daily or pm if soiled, not intact.Record review of a wound care physician visit report dated 6/16/25 for Resident #13 indicated that Resident had a facility acquired stage 3 pressure ulcer to her right lateral ankle (the outer side of the right ankle) acquired on 6/2/25 and the wound measured 0.5cm X 0.5cm X 0.1cm with moderate serous exudate.Record review of a wound care physician visit report dated 10/20/25 for Resident #13 indicated that on 10/20/25 wound had progressed to a stage 4 pressure injury with measurements of 1cm X 0.8cm X 0cm with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 19 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some moderate serous exudate.4. Record review of an admission Record for Resident #16 indicated she was admitted to the facility on [DATE] and was readmitted to the facility on [DATE] with type 2 diabetes (uncontrolled blood sugar) and hemiplegia following cerebral infarction affecting left non-dominant side (left sided weakness or paralysis following a stroke). She was discharged to the hospital on [DATE] following a fall. Record review of a Medicare/5 Day MDS assessment for Resident #16 indicated she had severe impairment in thinking with a BIMS score of 6. She had an unhealed pressure ulcer/injury that was classified as an unstageable wound due to coverage of the wound bed by slough and/or eschar.Record review of a care plan for Resident #16 dated 7/24/2025 indicated she had a pressure ulcer/injury to sacrum with an increased potential for worsening/additional pressure ulcers. Interventions included to evaluate/record/monitor healing, measure at least once a week, report declines to the MD. Record review of a skin assessment for Resident #16 dated 10/4/2025 indicated she had a wound to her coccyx that was a stage 3 wound that measured 8 cm x 4 cm x 4 cm with tunneling at 10 o'clock at 0.5 cm with 80% granulation.Record review of skin assessments for Resident #16 indicated there were not any other skin assessments by the facility after 10/5/2025.Record review of a wound physician note for Resident #16 dated 10/6/2025 indicated she had a stage 4 sacral pressure ulcer that measured 6 x 5 x 2 with undermining starting at 10 o'clock and ending at 3 o'clock at 3 cm deep. Record review of a wound physician note for Resident #16 dated 10/20/2025 indicated she had a stage 4 sacral pressure ulcer that measured 5.5 x 4.5 x 1.6 after he debrided the wound. Record review of active physician orders for Resident #16 dated 11/17/2025 indicated she had wound care orders for an unstageable sacral wound that started on 9/3/25 to be performed daily and prn. Record review of the TAR for Resident #16 dated 10/1/2025-10/31/2025 indicated she had 10 days without documentation on the TAR for wound care to an unstageable sacral wound that were blank that included: 10/3/2025, 10/6/2025, 10/8/2025, 10/13/2025, 10/15/2025, 10/18/2025, 10/22/2025, 10/23/2025, 10/26/2025, and 10/27/2025. There was no documentation that Resident #16 refused treatment for her wound.During an observation on 11/10/2025 at 9:51 am Resident #13 was observed not to have a low air loss mattress on her bed.During an observation and interview on 11/10/25 at 3:18 pm Resident #11 said she had been at the facility for approximately 6 weeks and was at home prior to being admitted to the facility. She said she had gone to the hospital with a broken foot and had a wound to her right heel. She said the wound to her heel had not been covered by a dressing in the last 3 days. She said prior to that they were putting a bandage on her heel and keeping it on for a week and it was supposed to be changed 3 times a week on Mondays, Wednesdays, and Fridays. She said she guessed the staff were just lazy. She said the wound had not been infected that she was aware of and had not said anything about wound care not being done as ordered. Resident #11 removed her sock from her right foot and showed this Surveyor her heel-area noted with slough present with a small amount of eschar in the wound bed. She said it had not been changed in 3 days. She said she was not refusing any care from the staff. She said it had been a while since she saw the wound care physician and the last time she saw him he did not look at her wound because it had a bandage on it. She said the wound did not hurt.During an observation and interview on 11/10/25 at 3:42 pm the MDS Coordinator said she performed wound care to Resident #11 earlier today (11/10/25). She said she put skin prep on her heel that had an unstageable wound that was scabbed over and was dry. She went to the room to observe the wound and asked the resident if she could look at her foot, the resident said she could, she removed her sock and observed the heel. She said the wound had drainage but had a scab earlier that was black that must have fallen off. She said she applied skin prep earlier and now the wound has slough. She said she would contact the wound physician. She said the resident's sock was wet with drainage.During an interview on 11/10/25 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 20 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 10:12 am the ADON said if staff found new skin issues, they should be reporting to the nurse, and they let her (ADON) know as well. She said if the doctor did not give new orders, then staff would not write a progress note. She said nurses should have completed skin evaluations and assessments. She said there had been a huge problem with the nurses not doing their assessments and evaluations. She said there was no one in the facility holding staff accountable to make sure things were done. She said they had even contacted staff to come in to complete their evaluations on their days off. She said the facility has had a problem for a long time with nurse administration not following through and not holding staff accountable for things that were not done. She said the facility did not have a treatment nurse and the nurses were responsible for completing the skin assessments and wound care in the facility. During a telephone interview on 11/11/2025 at 9:15 am the Wound Physician said he would visit the facility every 2 weeks and had been visiting the facility for the past 5 years. He said he only saw residents who had wounds, and his last visit was on 11/3/2025. He said usually a floor nurse would follow him. He said Resident #11 was last seen on 10/20/2025 and she had a wound to her right heel that was pressure ulcer-unstageable with dry eschar about the size of a quarter. Treatment orders were for skin prep and float heels. He said if a resident refused treatment, the nurses would document the refusal as he did not document anything on his notes. He said when he visited, he assessed the wounds, measured, debrided and provided recommendations. He said sometimes the wounds would deteriorate if the residents were noncompliant. He said he had not been notified within the past 2-3 months of any residents in the facility with a deterioration of wounds. He said if he was notified, the facility would notify the residents primary physician who would assess. He said the best person to talk to would be the nurses. He said he visited every other Monday and would be back in the facility on 11/17/2025.During a telephone interview on 11/11/2025 at 9:34 am LVN L said the facility did not have a treatment nurse in the facility, and the nurses were responsible for completing skin assessments daily and wound care. She said they have a schedule at the nurse's desk in a binder. She said with new admissions, she would assess the residents and conduct skin assessments. She said if a resident had a wound on admission, the nurse would measure the wounds, and when the wound care physician comes the wounds, he would also measure the wounds. She said she was not measuring the wounds daily nor weekly. She said if it looked like a wound was getting worse, she would measure it. She said the wound care was supposed to be done during the day, but sometimes wound care did not get done during the day shift and the night shift would sometimes complete the ones that she was not able to complete. She said if she noticed that a wound had worsened, she would notify the resident's primary medical doctor or the ADON because they do not have access to contact the wound physician. She said she had never seen him on her rotation. She said sometimes she was aware he had been there, and the residents would tell her if they had any new orders. She said she would then go and look to see if there were any new orders in the charting system. She said when a resident goes out to the hospital and then returns, the nurses were supposed to notify the Administrator, DON or ADON, medical doctor or family/RP of any new orders and changes in care. She said residents could be at risk of infection, and sepsis if they are not getting wound care as ordered or skin assessments are not done weekly.Record review of a facility policy titled Pressure Injury Risk Assessment dated March 2020 read: .Notify attending MD if new skin alteration noted. Record review of a facility policy titled Prevention of Pressure Injuries dated April 2020 read: .Evaluate, report, and document potential changes in the skin. This was determined to be an Immediate Jeopardy (IJ) on 11/11/2025 at 10:57 am. The facility's Administrator, DON, ADON, MDS, and Regional Director of Clinical Operations were notified. The Administrator was provided with the IJ template on 11/11/2025 at 11:04 am. The following Plan of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 21 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Removal (POR) submitted by the facility was accepted on 11/12/2025 at 1:25 pm.PLAN OF REMOVALF686: Treatment/Services to Prevent/Heal Pressure UlcersName of facility: [name of facility]Date: November 11, 2025, 11:04 am.Immediate action: Immediately upon notification of the alleged deficient practice of treatment/services to prevent/heal pressure ulcers, the facility implemented the following measures: Resident #11 was not in the facility at the time of the wound care physician's visit on 11/3/25 as she was out at a doctor's appointment. On 10/20/25 the right heel wound measured 2.0 X 2.5 X 0.0 and on 11/11/25 the wound measured 1.9 X 2.7 X 0.0. The dietary recommendation written on 10/28/25 for Vitamin C 500mg QD, Zinc 220mg QD X 14 days, Multiple vitamins with supplement 1 QD and house 2.0 supplement 60cc QID was approved 11/4/25 with orders written 11/11/25. The consulting wound care physician was contacted by the Corporate Director of Clinical Operations on 11/12/25 at 11:15 am and was informed of the resident being seen by the surgeon who performed her original right metatarsal surgery and during the appointment, the right heel pressure injury was debrided and the wound condition had deteriorated since his last observation. Also reviewed measurements of the wound, and the notes from the surgeon and the treatment (Santyl) ordered by the outside surgeon. Explained that we received this information this morning but there was an order from the attending physician for a different order (Medihoney). The consulting wound care physician stated to go with the order given by the attending physician and inquire which consulting wound care physician the family and attending physician would like to use moving forward as they cannot both treat/bill for the resident. The resident representative was contacted by the Assistant Director of Nursing and informed of the debridement, deterioration of the wound, and inquired which consulting wound physician she would prefer to use for the pressure area to the left heel. The resident representative prefers to use the consulting wound care physician that comes to the facility. Resident #11 is scheduled to be seen by the wound care physician on 11/17/25. Resident #12's left heel wound measurement on 11/03/25 was 3.0 X 3.0 and the measurements on 11/11/25 were 1.1 X 1.2 X 0.1 and the right heel measured 2.5 X 2.0 X 0.3 on 11/03/25 then on 11/11/25 the wound measured 0.9 X 0.4 X 0.1 showing a significant improvement and the orders remained unchanged since 10/23/25. The wound care consulting physician was contacted by the Corporate Director of Clinical Operations on 11/12/25 at 11:15 am to inform of the most recent measurements and wound condition, no new orders were given. The resident representative was notified of the current wound condition by the MDS Coordinator on 11/11/25. The admitting nurse was provided with individual education regarding ensuring residents admitting with a wound have orders for treatment, notifying the physician to obtain orders for treatment and immediately rendering treatment upon admission. Resident #13's wound measurements and condition were compared to the most previous wound assessment with noted increase in size from previous observation. On 11/3/25 the wound measurements were 1.0 X 1.0 X 0.2 with 76-100% granulation and the measurements for 11/11/25 were 1.2 X 1.2 with 70% slough. The wound care consulting physician was notified by the MDS coordinator on 11/11/25 with no new orders received and he stated the wound was unavoidable related to residents' persistent position of right side lying. The resident representative was notified by the MDS Coordinator. Resident #16 was not in the facility at the time of notification. All nursing staff present at the time of notation were provided with an in-service prepared by the Corporate Director of Clinical Operations and given by the administrative nursing staff on how to document when a resident is not available for a visit by a consulting provider. This in-service will be initiated 11/11/25 and will continue until all nurses have been provided with the necessary education. The facility MDS coordinator evaluated all current wounds, measured wounds, and documented the condition of all wounds in the Skin Issue evaluation of the electronic health record on 11/11/25. On 11/11/25, the nursing administration team (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 22 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some (Director of Nursing, Assistant Director of Nursing, and MDS Coordinator), with the assistance of the Assistant Corporate Director of Clinical Operations will compare all measurements and wound condition observations to the previous measurement/condition to ensure any area of deterioration/worsening are immediately reported to the Wound Care Physician and the resident's attending physician regarding wound care deterioration/worsening. This process will be completed on 11/11/25. On 11/11/25, all nurses present at the time of notification of the alleged deficient practice will be re-educated in the form of an in-service from the Assistant Director of Nursing regarding completion of weekly skin assessments. This in-service will include how to complete the assessment, what to look for, when to complete the assessment, what to document on the skin assessment, when to report skin issues to the provider vs. the wound care consulting physician, how to document physician communication regarding wound care. This in-service will continue until all nurses have been in-serviced and all nurses will receive re-education prior to beginning their next scheduled shift. Nurses will be provided with notification of consequences for failure to complete scheduled skin assessments during their shift. Beginning 11/11/25 Completion of skin assessments will be monitored Monday through Friday by the Director of Nursing and by the designated Weekend Nursing Supervisor on Saturday and Sunday. A complete head to toe skin inspection was completed by the Director of Nursing, Assistant Director of Nursing, MDS Coordinator and Assistant Corporate Director of Clinical Operations on all residents on 11/10/25 to ensure any existing area of pressure injury is identified and treatment is initiated immediately; no new areas were identified. On 11/11/25, the nurses present at the time of notification will be in-serviced by the administrative nursing team regarding admitting a resident with wounds, informing the physician of wound(s) discovered during the initial assessment, obtaining orders for treatment, ensuring orders for treatment are initiated immediately (not when electronic health record defaults to the next day), and inquiring about existing wound when receiving report from the discharging facility. This in-service will continue until all nurses are provided with the education and nurses will receive the education prior to beginning their next scheduled shift. The Director of Nursing, Assistant Director of Nursing, MDS Coordinator and Facility Administrator will be provided with re-education on 11/11/25 by the Corporate Director of Clinical Operations and/or designee regarding the process for reviewing the missing documentation report for the Treatment Administration Record from the electronic health record. This in-service will include what action to take if documentation is missing. Beginning 11/12/25 every morning during the morning clinical meeting on Monday through Friday the missing documentation report for Treatment Administration Records will be reviewed by the Director of Nursing to ensure no treatment was missed or documentation was not completed. The Facility Administrator will ensure this task is completed each day. On 11/11/25 the Facility Administrator, Director of Nursing, Assistant Director of Nursing, and MDS Coordinator (administrative nursing team) were re-educated by the Director of Clinical Operations and the Assistant Director of Clinical Operations regarding daily review of admission records, admission order reconciliation, review of 24/72 hour report, and reviewing the missing order documentation report each morning during the morning meeting process. The Facility Administrator will be responsible for ensuring the daily review of the missed documentation report, admission record review, admission order reconciliation, and review of the 24/72-hour report. In the absence of the Facility Administrator the Director of Nursing will be responsible. The facility has begun the process of replacing the current consulting wound care physician with a wound care company that will be onsite weekly, physically examine and evaluate all residents with wounds, provide wound progress reports, training to staff, and work directly with facility management to ensure treatment and services are provided to prevent and heal pressure ulcers. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 23 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete wound care company was contacted by the Corporate Director of Clinical Operations on 11/11/25, to inquire about projected start date of their services. The response from the wound care company is still pending. Another provider has been contacted and is willing to provide wound care consultant nurse practitioner service with the facility within the next 30 days. A determination of which company to be used will be made no later than 11/12/25 at 5:00 pm. The Facility Administrator and Administrative Nursing Team will be reviewing the nursing schedule to ensure one designated nurse is scheduled to review wounds, complete measurements, evaluate wound condition and prepare the weekly skin report at least once per week beginning 11/12/25. The weekly skin report will be reviewed by the Administrative Nursing Team and the Facility Administrator to ensure all interventions are present including supplements/vitamins as recommended by the registered dietician, support surfaces are appropriate for the residents and treatments are evaluated for effectiveness. The weekly skin report review meeting will begin 11/11/25 and will occur on Tuesday of each week. Beginning 11/12/25 at 6:00 pm, the Assistant Director of Nursing will divide daily treatments/wound care between the day shift and night shift to allow floor nurses more time to complete the treatment/skin assessment processes. Beginning 11/11/25 at 5:00 pm a daily stand-down meeting will be held by the Facility Administrator and Director of Nursing to ensure all assigned wound care tasks, documentation, recommendations, physician notifications, and physician orders are carried out appropriately. On 11/11/25 at 8:00 pm an impromptu Event ID: Facility ID: 676439 If continuation sheet Page 24 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services to ensure the accurate administration of medications for 1 (Resident #2) of 16 residents reviewed for pharmacy services. The facility failed to administer ordered medications for Resident #2 on 9/3/25, 9/6/25, 9/9/25, 9/17/25, 9/30/25, 10/6/25, 10/7/25, 10/13/25, 10/14/25, 10/29/25, 10/30/25, and 11/1/25. This failure could place the residents at risk of a decline in health, and decreased quality of life.Findings included:Record review of a facility face sheet dated 11/5/25 for Resident #2 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: acute and chronic respiratory failure with hypoxia (a condition where you don't have enough oxygen or too much carbon dioxide in your body), type 2 diabetes (uncontrolled blood sugar), and hypothyroidism (Underactive thyroid - a condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowdown in metabolism).Record review of a Comprehensive MDS assessment dated [DATE] for Resident #2 indicated a BIMS score of 15, indicating her cognition was intact. She required maximal assistance with most ADLs. Record review of a Comprehensive Care Plan dated 7/10/25 for Resident #2 indicated she had hypothyroidism, was on medication related to restless leg syndrome, was on routine pain medication therapy related to Chronic Pain/Fibromyalgia and neuropathy, and was on anti-anxiety medications related to anxiety disorder. An intervention was to give medications as ordered.Record review of a physician's order summary report dated 11/5/25 for Resident #2 indicated she had the following physician's orders: Ativan Oral Tablet 0.5mg (Lorazepam) Give 0.5 mg by mouth at bedtime related to anxiety disorder - dated 9/5/25. Atorvastatin Calcium Oral Tablet 80 mg (Atorvastatin Calcium) Give 1 tablet by mouth at bedtime related to hyperlipidemia - dated 6/24/25. Calcium Carbonate Tablet Chewable 500 mg Give 2 tablet by mouth four times a day related to Gastro-esophageal reflux disease - dated 6/24/25. Cyclosporine Emulsion 0.05% Instill 1 drop in both eyes four times a day for dry eyes due to inflammation related to dry eye syndrome of unspecified lacrimal gland - dated 6/24/25. Duloxetine HCL (Hydrochloride) Capsule Delayed Release Particles 60 mg Give 1 capsule by mouth two times a day for depression related to Major Depressive Disorder, recurrent, unspecified - dated 6/24/25. Levothyroxine Sodium Oral Tablet 50 mcg (Levothyroxine Sodium) Give 1 tablet by mouth one time a day related to hypothyroidism - dated 6/24/25. Lyrica Oral Capsule 100 mg (Pregabalin) Give 1 capsule by mouth three times a day related to hereditary and idiopathic neuropathy, unspecified; and other chronic pain - dated 8/24/25. Ramelteon Tablet 8 mg Give 1 tablet by mouth at bedtime for insomnia - dated 7/3/25. Ropinirole HCL Oral tablet 1 mg (Ropinirole Hydrochloride) Give 2 mg by mouth at bedtime related to restless legs syndrome - dated 6/24/25. Tizanidine HCL Oral tablet 2 mg (Tizanidine HCL) Give 1 tablet by mouth every 8 hours related to other chronic pain - dated 6/24/25. Topiramate Oral tablet 100 mg (Topiramate) Give 1 tablet by mouth two times a day related to migraine, unspecified, not intractable, without status migrainosus - dated 6/24/25.Record review of Medication Administration Record dated 9/1/25 through 9/30/25 for Resident #2 indicated the MAR had blanks on: 9/3/25 at 5:00 am for Levothyroxine, Calcium Carbonate, and Cyclosporine drops 9/3/25 at 5:00 pm for Tizanidine, Calcium Carbonate, and Cyclosporine drops 9/6/25 at 5:00 am for Levothyroxine, Calcium Carbonate, and Cyclosporine drops 9/9/25 at 5:00 pm for Tizanidine, Calcium Carbonate, and Cyclosporine drops 9/17/25 at 5:00 am for Levothyroxine 9/30/25 at 5:00 am for Levothyroxine, Calcium Carbonate, and Cyclosporine drops 9/30/25 at 4:00 pm for Lyrica 9/30/25 at 5:00 pm for Tizanidine 9/30/25 at 9:00 pm for Ativan 9/30/25 at 11:00 pm for LyricaRecord review of Medication Administration Record dated 10/1/25 through 10/31/25 for Resident #2 indicated the MAR had blanks on: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 25 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 10/6/25 at 9:00 pm for Ativan, Atorvastatin, Toprol, Rameltron, Ropinerole, Duloxetine, Entresto, and Topiramate 10/7/25 at 5:00 am for Levothyroxine, Calcium Carbonate, Cyclosporine drops 10/13/25 at 11:00 pm for Lyrica, Calcium Carbonate 10/14/25 at 1:00 am for Tizanidine 10/14/25 at 5:00 am for Levothyroxine, Calcium Carbonate, Cyclosporine drops 10/29/25 at 5:00 pm for Tizanidine, Calcium Carbonate, Cyclosporine drops 10/30/25 at 5:00 pm for Tizanidine, Calcium Carbonate, Cyclosporine dropsRecord review of Medication Administration Record dated 11/1/25 through 11/5/25 for Resident #2 indicated the MAR had blanks on: 11/1/25 at 5:00 pm for Tizanidine, Calcium Carbonate, and Cyclosporine dropsDuring an interview on 11/12/25 at 10:10 am, Resident #2 said when she did not get her medications as she was supposed to, it increased her pain levels. She said she was unsure of exactly which medications she was not receiving, but she just knew she was not always getting them. She said she wanted to get better so she could see her niece again, who lived out of state. During an interview on 11/6/25 at 10:30 am, LVN E said she was the charge nurse for Resident #2, but said she could not recall any missed medications for Resident #2. She said any time she held a medication or did not give it for any reason, she would write a progress note and there should be some kind of indication on the MAR of a reason why it was not given. She said if the MAR had a blank in it, that it looked like the medication was not given. She said the charge nurses were responsible for ensuring the medication aides gave resident's medications. She said if residents did not get their medications appropriately and as ordered, the medications could be ineffective or not maintain therapeutic levels.During an interview on 11/6/25 at 10:50 am, CMA O said she cared for Resident #2. She said she could not remember any specific times Resident #2 did not receive her medications. She said anytime she did not give a medication for any reason, she would still initial off the MAR and input the vital signs, if applicable, and would then notifoy the nurse the reason the medication was not given. She said there should be no blanks on the MARs, as it would appear the medication was not given. She said she would always make a progress note indicating the reason the medication was held or not given (if it was refused or held due to parameters).During an interview on 11/10/2025 at 10:12 am ADON said there was a huge problem with the nurses doing their assigned tasks. She said there was no one in the facility holding staff accountable to make sure things were done. She said they had even contacted staff to come in to complete their documentation on their days off. She said the facility has had a problem for a long time with nurse administration not following through and not holding staff accountable for things that are not done. She said she was unaware of any specific medications missed for Resident #2. She said, however, she knew things were being missed. During an interview on 11/12/2025 at 4:38 pm, MDS said going forward, she would be responsible, along with the other administrative nurses to monitor the missed medications report daily. She said residents could have adverse events if they did not get their medications as ordered.During an interview on 11/12/2025 at 4:54 pm, ADON said going forward, during the morning meeting, she and the other administrative nurses would be reviewing the missed medications report to ensure medications were given appropriately. She said if a resident did not get their medications as ordered, they could suffer a health decline or complications. During an interview on 11/12/2025 at 5:11 pm, the Administrator said she was unaware specifically of any missed medications for Resident #2, but said she expected her staff to administer medications as ordered. She said going forward, she would be monitoring the missed medications report daily in the morning meeting. She said residents could be at risk of a decline in health status or medications not being effective if they are not administered as ordered. Record review of the facility's policy titled Administering Medications dated April 2019 read: .Medications are administered in a safe and timely manner, and as prescribed. and .If a drug is withheld, refused, or given at a time other than the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 26 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 scheduled time, the individual administering the medication shall indicate the refusal in the electronic health record MAR. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 27 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure residents were free of any significant medication errors for 2 of 11 residents reviewed for medications. (Resident #4 and Resident #2)1.The facility failed to administer Metoprolol (a medication to treat high blood pressure) and Entresto (a medication to treat high blood pressure and treat heart failure) to Resident #2 on 10/6/25 at 9:00 pm as ordered.2. The facility failed to ensure Entresto 24/26 mg 1 tablet by mouth twice a day was ordered for Resident #4 when she was admitted to the facility from the hospital on 9/18/2025. 3. The facility failed to ensure Resident #4 received Eliquis (a medication used to treat and prevent blood clots) 5 mg 1 tablet by mouth twice a day as ordered by missing 8 doses in October 2025 and she was hospitalized from [DATE] to 10/28/2025 and diagnosed with atrial fibrillation with RVR (rapid ventricular response-rapid heart rate), acute on chronic systolic and diastolic heart failure along with a small pulmonary embolus in the right middle lobe of the lung (blood clot in the lung).On 11/5/2025 at 2:10 PM, an Immediate Jeopardy (IJ) was identified. While the Immediate Jeopardy was removed on 11/6/2025 at 4:15 PM, the facility remained out of compliance at a scope of pattern and a severity level of no actual harm that was not Immediate Jeopardy due to the facility continuing to monitor the implementation and the effectiveness of their Plan of Removal.These deficient practices could place residents at risk of physical complications, hospitalization, and death. Findings included:1.Record review of a facility face sheet dated 11/5/25 for Resident #2 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: acute and chronic respiratory failure with hypoxia (a condition where you don't have enough oxygen or too much carbon dioxide in your body), type 2 diabetes (uncontrolled blood sugar), and hypothyroidism (Underactive thyroid - a condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowdown in metabolism).Record review of a Comprehensive MDS assessment dated [DATE] for Resident #2 indicated a BIMS score of 15, indicating her cognition was intact. She required maximal assistance with most ADLs. Record review of a Comprehensive Care Plan dated 7/10/25 for Resident #2 indicated she had hypertension (high blood pressure) and cardiomyopathy (a disease of the heart muscle). She had interventions to give medications as ordered.Record review of a physician's order summary report dated 11/5/25 for Resident #2 indicated she had the following physician's orders: Metoprolol Succinate ER (Extended Release) Oral tablet extended release 24-hour 25 mg (Metoprolol Succinate) Give 1 tablet by mouth one time a day related to hypertensive heart disease with heart failure; hold for heart rate less than 60, systolic blood pressure less than 100, or diastolic blood pressure less than 60 - dated 6/24/25. Entresto (Sacubitril-Valsartan) Oral tablet 49-51 mg Give 1 tablet by mouth two times a day related to other cardiomyopathies, hold if systolic blood pressure less than 100 or pulse less than 55 - dated 9/10/25.2. Record review of an admission Record for Resident #4 dated 11/4/2025 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of acute on chronic diastolic heart failure (a sudden, life threatening condition in which your heart is unable to pump effectively), atrial flutter (a heart rhythm disorder), and hypertension (high blood pressure). She was discharged from the facility to the hospital on [DATE].Record review of an admission MDS Assessment for Resident #4 dated 9/25/2025 indicated she had moderate impairment in thinking with a BIMS score of 12. During the 7-day look back period, she took an anticoagulant. Record review of a care plan for Resident #4 dated 9/26/2025 indicated she was on anticoagulant therapy Eliquis related to atrial flutter. Interventions included to administer anticoagulant medications as ordered by the physician. Record review of hospital discharge records for Resident #4 dated 9/18/2025 indicated a medication list that included Entresto 24/26 Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 28 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some mg 1 tablet by mouth two times a day. Eliquis 5 mg 1 tablet by mouth two times a day.Record review of a progress note by the NP for Resident #4 dated 9/30/2025 indicated her medication list consisted of Entresto 24/26 mg 1 tablet by mouth twice a day and Eliquis 5 mg 1 tablet by mouth twice a day.Record review of a progress note by the Medical Director for Resident #4 dated 10/2/2025 indicated she was on Entresto for hypertensive heart and chronic kidney disease with heart failure. Currently on Entresto 24/26 mg twice a day.Record review of a progress note by the NP for Resident #4 dated 10/7/2025 indicated the resident reported she was not always receiving her medications consistently; some days she only received one dose at night. Record review of a progress note by the NP for Resident #4 dated 10/14/2025 indicated she spoke to the cardiologist for Resident #4 to discuss Entresto and the cardiologist said there was no added benefit to taking it.Record review of a progress note for Resident #4 dated 10/26/2025 at 3 pm by RN A indicated, .res co[complained of] epigastric pain and RP is at bs[bedside], res has exertional sob but speaking full sentences, skin w/d 2 pitting edema (swelling in the legs/feet) noted. RP and resident request to go to hospital.Record review of hospital discharge summary for Resident #4 dated 10/29/2025 indicated she admitted to the hospital on [DATE] with chief complaints of shortness of breath and lower extremity edema. She was found to be in atrial fibrillation with RVR and was also found to have a small pulmonary embolus in the right middle lobe (blood clot in the lung). Record review of active physician orders for Resident #4 dated 11/4/2025 indicated an order for Eliquis 5 mg 1 tablet by mouth two times a day with a start date of 9/19/2025. There was no order for Entresto.Record review of a MAR for Resident #4 dated 10/1/2025 to 10/31/2025 indicated there were blanks on the MAR without any documentation noted for the following dates and time: 10/3/2025 at 5 pm, 10/4/2025 at 5 am, 10/6/2025 at 5 pm, 10/11/2025 at 5 am, 10/12/2025 at 5 am, 10/15/2025 at 5 am, 10/27/2025 at 9 pm, 10/28/2025 at 9 pm.During an observation and interview on 11/4/2025 at 9:10 AM, LVN Q was on hall 100 administering medications. She said there were two medication aides during the day shift, and one scheduled at night that stayed until 11 pm. She said she had been employed at the facility since April 2025. She said Resident #4 had shortness of breath on yesterday (11/3/2025), her vital signs were elevated, and she talked to the NP who told her to send Resident #4 out. She said Resident #4 had a pulmonary embolism before this hospital stay. She said she took care of Resident #4 at times and the resident wanted to choose what medications to take. She said Resident #4 was very difficult but alert and oriented to person, place, and time.During an interview on 11/4/2025 at 9:46 AM, the NP said the facility notified her about Resident #4 when she went to the hospital yesterday (11/3/2025) for shortness of breath, and prior to that hospital stay, had been diagnosed with a pulmonary embolism. She said Resident #4 was not compliant with taking Eliquis as ordered. She said Resident #4 may have had some form of dementia as she would argue with the staff. She said she told the RP that the staff could not force Resident #4 to take her medications. She said the facility kept her updated on changes in resident conditions. She said the RP for Resident #4 had her personal cell phone and would call when she had questions or concerns.During an interview on 11/4/2025 at 1:15 PM, the ADON said the admission nurse LVN L would have been the nurse responsible for ensuring the discharge medications from the hospital were entered for Resident #4 when she admitted to the facility in September. She said the charge nurses were responsible for entering and verifying medication orders. She said if a resident refused medications, there should be documentation in the MAR or on a progress note about the refusal. She said the MAR should have a (2) to signify the resident refused and if there was a blank, then it was not charted and they would not know if the medication was given or not. She said the facility was not aware that Resident #4 should have been ordered Entresto from the hospital discharge medication list in September 2025. She said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 29 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some she was not sure why it was overlooked.During an interview on 11/4/2025 at 2:04 PM, LVN F said the charge nurses were responsible for entering medication orders for a new admission from the hospital. She said residents could be at risk for medication errors or be given the wrong dose or medication, if medications were not entered correctly. She said Resident #4 was difficult at first as she often refused care and liked things done the way she wanted them done. She said if a resident refused medications or care, the charge nurse would try to talk to them and try to change their minds, and if they still refused, they would go to the DON, the Administrator, and notify the NP and family. She said on the MAR, if the resident refused medications, they were supposed to enter a code to show the refusal. She said nurses were responsible for administering medications like Entresto and Eliquis and not the medication aides.During an observation on 11/4/2025 at 2:43 PM, the nurse medication cart for the hall where Resident #4 resided with the LVN F present revealed Resident #4's medications were still in the cart, but there were no Entresto for her.During an interview on 11/4/2025 at 2:44 PM, MA R said Resident #4 refused medications at times from certain people. She said they were to document the refusal in the MAR and notify the charge nurse about the refusal. She said Resident #4 was difficult to care for. During a phone interview on 11/4/2025 at 3:38 PM, RN K said she had been employed at the facility since July 2025, working nights from 6 pm-6 am, and was assigned the hall where Resident #4 resided. She said Resident #4 was alert to herself and had problems with her memory and often did not remember what she did or did not do. She said Resident #4 would often report she had pain in her chest and went to the hospital with atrial fibrillation and recently had a pulmonary embolism. She said lot of the times Resident #4 was anxious and they would send her out to the ER when she wanted to go the hospital. She said Resident #4 was noncompliant with care and refused to take her medications with certain staff, but would usually take them with her. She said Resident #4 would still look at her cup and count everything to make sure what she was taking but would not remember what she did or not take. She said she tried to reassure Resident #4 that she took certain medications at different times of the day. She said if a resident refused to take their medications, she would try to talk to them. She said two times Resident #4 gave her an attitude, she allowed her to calm down, and went back and tried again and she was ok with taking her medications. She said if a resident refused medications, they were to document the refusal, and there was a place in the MAR to document the refusal. She said Eliquis would be administered by the nurse and not the medication aide. She said she was not sure why there would be any blanks on Resident #4's MAR but sometimes she would get behind on charting and would have to go back and make it up because she was busy taking care of other residents. She said she gave medications when they were due to be given. She said she was instructed that if something was not documented, then it was not done.During an interview on 11/4/2025 at 4:30 PM, LVN F said on 10/3/2025, she worked, and that evening prior to her getting off at 6 pm, RN K came in early, and she took the laptop as she finished her rounds a little after 5 pm. She said she and RN K did a narcotic count in the medication cart and she left the facility. She said RN K told her she would finish what she had left to complete that included administering medications. She said the MARs should not have blanks and something should be documented to indicate if the resident took the medication or if it was refused. She said if a medication was refused, there should have been documentation of the refusal. She said on 10/3/2025 she left her shift before 6 pm and RN K said she would take care of things she had left, including giving Resident #4 her Eliquis that was due at 5 pm.During a phone interview on 11/4/2025 at 6:23 pm, the NP said the cardiologist and the RP of Resident #4 did not want her to take the Entresto that was ordered on admission to the facility. She said she saw Entresto on her list of medications and she contacted the cardiologist on 10/14/2025 and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 30 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some was told they did not think Entresto would benefit her one way or another. She said the hospital had it on her discharge medication list, but the RP did not want the resident to take it. She said she was told by staff that Resident #4 would sometimes refuse medications at times. She said if the resident refused, then the staff needed to document the refusal and indicate that they did not give the resident the medication. She said the Eliquis was ordered for atrial fibrillation. She said on 10/26/2025-10/28/2025, Resident #4 was sent to the hospital and diagnosed with an embolism. She said the resident would sometimes not remember she was given medications and would say she had not received any. During a phone interview on 11/5/2025 at 8:32 AM, LVN L said she had been employed at the facility since July 2025 and worked day shift from 6 am-6 pm. She said she took care of Resident #4, who was stubborn at times and would refuse to take her medications. She said Resident #4 liked things her way and wanted to be in charge, and if they let her be in charge she would be compliant. She said Resident #4 refused care a lot including medications, but if they talked to her, she would allow certain people to administer them. She said if a resident refused, they were supposed to notify the physician, family, and document in a progress note. She said if Resident #4 or any residents refused, they were to chart and document the code (2) for refusal on the MAR. She said she was the admission nurse for Resident #4 when she was admitted to the facility. She said the discharge medication list for Resident #4 was in the packet provided by EMS from the hospital. She said she did not know why Entresto was not added to her medication orders, said she talked to the RP on the day of admission, and they discussed some of the medications that were ordered and compared her home list to the hospital list. Said the RP asked what medications had been ordered. She said she was not sure if she contacted the physician about reconciling the medications or not. She said when they entered the medications into the system, she thought the order went directly to the pharmacy to be filled. She said she was not aware if someone was looking to ensure orders were entered correctly. She said if medications were not entered correctly, it could be deadly, if they never received a medication, things could go left untreated. During a phone interview on 11/5/2025 at 9:01 AM, RN A said she had been employed at the facility for 6 months and worked day shift from 6 am-6 pm. She said she took care of Resident #4 when she was at the facility. She said she loved the resident, but Resident #4 would give other staff hell and Resident #4 would allow her to care for her when no one else could. She said Resident #4 would refuse to take some of her medications at times from the medication aides, but would take them later. She said a lot of Resident #4's refusals were that she wanted them done on her own time. She said the only time there would have been a blank on the MAR would be that she must have forgotten to mark that the resident took the medication. She said when she administered medications, she made sure it was for the right patient, gave them the medication, and then would document that it was given. She said it took a few seconds to document and sometimes she would get distracted. She said if it was not documented, then it was not done, and Resident #4 could be at risk for a blood clot if she was given the Eliquis that was ordered. During an interview on 11/12/2025 at 5:24 PM, the Administrator said residents' health could decline if they did not get their medications as ordered. She said the nurses were to notify the RP or family and educate them on risks if they refused. She said staff should document in the MAR/TAR, if they refused and state they refused. She said nurses were responsible for ensuring the residents receive the blood thinners. She said the nurse should oversee the medication aide to ensure medications were given. She said residents could run the risk of blood clots and other issues if they did not receive their medications as ordered. Record review of the facility's policy titled Adverse Consequences and Medication Errors revised November 2023 indicated, .6. Significant medication errors means one which causes the resident discomfort or jeopardizes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 31 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some his or her health and safety. 7. Examples of medication errors include: a. omission-a drug is ordered but not administered.Record review of the facility's policy titled Administering Medications revised April 2019 indicated, .Medications are administered in a safe and timely manner, and as prescribed. 4. Medications are administered in accordance with prescriber orders, including any required time frame. 21. If a drug is withheld, refused, or given at a time other than the scheduled time, the individual administering the medication shall indicate the refusal in the electronic health record MAR. The number 2 (two) is chosen when administering the medication to indicate resident refused dose.This was determined to be an Immediate Jeopardy (IJ) on 11/5/2025 at 2:10 PM. The facility's Administrator, DOCC and DON were notified. The Administrator was provided with the IJ template on 11/5/2025 at 2:46 PM and a Plan of Removal was requested.The following Plan of Removal (POR) submitted by the facility was accepted on 11/6/2025 at 12:16 PM. Immediate action: Immediately upon notification of the alleged deficient practice of Significant Medication Error on 11/5/25 @ 2:52 pm, the facility implemented the following measures: The administrative nursing team (Director of Nursing, Assistant Director of Nursing and MDS Coordinator) with the assistance of the Director of Clinical Operations and the Assistant Director of Clinical Operations will complete medication order reviews for all residents admitted and re-admitted within the past 30 days (working from the most recent to the latest) to ensure no residents are in jeopardy or threat of harm; this task will be completed by 11:59 pm 11/05/25. The immediate chart reviews of the remaining residents admitted and re-admitted in the past 60 days (working from the those admitted 31 days ago to 60 days ago) will be completed by the administrative nursing team (Director of Nursing, Assistant Director of Nursing and MDS Coordinator) with the assistance of the Director of Clinical Operations and the Assistant Director of Clinical Operations by 11:00 am on 11/06/25 to ensure accurate reconciliation of hospital discharge orders/admitting orders to those that were verified with the attending physician and transcribed into the electronic health record. The immediate chart reviews will ensure all diagnosis/health conditions of residents is being/has been addressed/noted in the electronic health record. On 11/5/25 at 6:15pm the Facility Administrator, Director of Nursing, Assistant Director of Nursing, and MDS Coordinator (administrative nursing team) were counseled and provided with an in-service by the Director of Clinical Operations and the Assistant Director of Clinical Operations regarding daily review of admission records, admission order reconciliation, review of 24/72 hour report, and reviewing the missing medication report each morning during the morning meeting process. The Facility Administrator will be responsible for ensuring the daily review of the missed medication report, admission record review, admission order reconciliation, and review of the 24/72-hour report. In the absence of the Facility Administrator the Director of Nursing will be responsible. All nurses and certified medication aides present at the time of the notification will be provided with in-service training regarding the admission/re-admission process, the admission/readmission medication reconciliation process, transcribing and carrying out physician orders, how to document different scenarios of medications not given (refused, spit out, held for vital signs outside of parameters, etc.), checking the dashboard throughout and at the end of their shift to ensure no medication documentation is missing. The immediate staff in-service will be conducted by the Administrative Nursing Team (Director of Nursing, Assistant Director of Nursing and MDS Coordinator) beginning on 11/05/2025 and will continue until all nurses and certified medication aides have been provided with the beforementioned education, the remaining nurses and certified medication aides will be educated prior to beginning their next shift. All newly hired nurses and certified medication aides will be educated regarding how to document missed doses, refused doses, and accessing the dashboard to ensure all doses are accounted for before the end of their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 32 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some shift before beginning their first assigned shift. An impromptu QAPI meeting was conducted on 11/5/25 at 6:49 pm with the Medical Director, Facility Administrator, Director of Nursing, Assistant Director of Nursing, MDS Coordinator, Corporate Director of Clinical Operations, and Assistant Corporate Director of Clinical Operations. The root cause analysis of the alleged deficient practice was reviewed and interventions to correct and prevent future occurrence were discussed. The Consultant Pharmacist was contacted by the Corporate Director of Clinical Operations on 11/6/25 at 10:39 am and discussed the alleged deficient practice, it was decided that effective immediately (11/6/25 at 11:00 am) all new and re-admissions to the facility will be reviewed by a pharmacist with the consultant pharmacy group every Monday, Wednesday and Friday. On 11/6/25 at 11:00 am the Consultant Pharmacist will review all residents admitted /re-admitted to the facility in the past 7 days. In addition to the regular medication regimen review the consulting pharmacist will reconcile current physician orders to those given from the discharging entity. Upon completion of his/her review, the consulting pharmacist will provide a summary of findings/recommendations to the Director of Nursing, Assistant Director of Nursing and Facility Administrator. Immediately upon receipt of the recommendations the Director of Nursing will ensure any physician recommendations are addressed and carried out. The recommendations from the consultant pharmacist will be reviewed during the morning meeting Monday through Friday and the Facility Administrator and Director of Nursing will verify they are complete with a physician acceptance or declination, orders corrected or changed as recommended/agreed to by physician, plan of care updated, and resident/resident representative informed of changes. On 11/6/2025 at 12:00 pm am the Corporate Director of Clinical Operations will provide an in-service to the Facility Administrator and administrative nursing staff (Director of Nursing, Assistant Director of Nursing, and MDS Coordinator) regarding the review of the pharmacy consultant admission/re-admission drug regimen review/medication reconciliation process that is to be reviewed during the morning meeting every Monday through Friday. The affected resident, Resident #4, was transferred to the hospital prior to surveyor entrance to the facility and remains in the hospital. The attending physician was notified of the alleged significant medication errors.Facilities Plan to ensure compliance quicklyThe facility nursing administration staff (Director of Nursing, Assistant Director of Nursing, and MDS Nurse) with the assistance of the Director of Clinical Operations and the Assistant Director of Clinical Operations will begin (on 11/6/25 @ 8:00 am) begin a full audit of all resident medication orders. This task will be completed no later than 11/6/225 at 2:00 pm.The State Surveyors monitored the Plan of Removal as follows: Record review indicated that eight residents admitted /readmitted in the past 30 days had their medication orders reviewed and medications that were ordered matched the orders for the referring entity.Record reviews indicated that four residents admitted /readmitted in the past 60 days had their medication orders reviewed.Record review of an in-service titled Reconciliation of Admission/re-admission Orders dated 11/5/2025 was signed by Administrator, DON, ADON, and MDS coordinator. Record review of an in-service titled Missing medication documentation/Med Pass Completion on Dashboard dated 11/5/2025 was signed by Administrator, DON, ADON, and MDS coordinator.Record review of an in-service titled Reconciliation of Admission/re-admission orders dated 11/5/2025 was signed by seventeen nurses and medication aides. Record review of an in-service titled Missing medication documentation/Med Pass Completion on Dashboard dated 11/5/2025 was signed by sixteen staff including nurses and medication aides.Record review of a QAPI sign-in sheet indicated meeting was held on 11/5/25 at 6:49 pm - 7:02 pm and was signed by Medical Director; Administrator; DON; ADON; and MDS Coordinator and was also attended by Director of Clinical Operations.During a phone interview on 11/6/2025 at 3:04 PM, the Pharmacy Consultant said she was contacted by the facility that day. She said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 33 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some she was going to take on a new active role by reviewing new admissions and readmissions for the medication orders. She said the pharmacist would conduct those reviews. She said she reviewed one resident that day (Resident #1) and made recommendations and sent them to the facility and the physician would review. She said new admissions would be reviewed by her on Mondays, Wednesdays, and Fridays and monthly once a month. The recommendations would be sent to the DON, ADON, and regional consultant.Record reviews of resident records indicated forty-nine resident medication orders were reviewed and there were not any issues noted. All had the correct orders entered into the resident record.During an interview on 11/6/2025 at 3:27 PM, the MDS Coordinator said she would be responsible for new admissions in the facility. She said she would get the hospital discharge orders before medical records and be the one to double check that the orders were entered correctly. She attended the morning meetings and discussed new admissions and findings, and conducted an admit chart check. If she worked on the floor as a charge nurse, she said she would have the ADON or DON check the orders. She said she would run an order listing daily and 24-hour report, and review the missing medication report. She said she would make sure all medications were transcribed into PCC with no missing medications. She said if the physician did not want the medication, make a note, and if a resident refused, make a note, notify the physician and before end of shift check to make sure all meds were completed. She said the facility had a QAPI meeting and discussed a resident (Resident #4) who did not get an order transcribed. During an interview on 11/6/2025 at 3:35 PM, the ADON said she would review the missed medication report and monitor it daily. She said, for Saturday and Sunday, would run a 3-day report on Monday and find out the reason and action that was needed. She said she would now be the second person for reviewing admissions. She said when the facility had a new admission, the MDS Coordinator would review hospital discharge paperwork. She said the facility now had a check off list for admissions for nursing staff and it would be attached to a medication summary and placed in the provider folder. She said the MDS Coordinator would review it the next morning. She said when a resident returned from the hospital, orders would be sent to pharmacist and any recommendations would be sent to her, and she would make changes and get approval. She said the MDS Coordinator would review and make sure nothing was missed. She said they had multiple staff changes in administrative staff were not aware of the proper procedures for medication reconciliation and not followed. She said the pharmacy consultant would review every time someone new admitted to the facility. She said during the morning meetings, they would discuss missed medications, refused medication, review order listings, change in conditions, labs, orders, x-rays, wounds, and treatments. During an interview on 11/6/2025 at 3:46 PM, the DON said she had been employed at the facility since 10/27/2025 and was new to long term care. She said she was still training and in orientation. She said every morning they would run the 24-hour report to review missed medications and risk management along with an order listing report to discuss during the morning meeting. She said if she were working as a nurse, she would make sure work and medications were completed and given, and document refusals along with notifying the physician and the family. She said she along with the ADON and MDS Coordinator would ensure new admission orders were reconciled. She said the facility would have the Pharmacy Consultant review new admissions and readmissions into the facility every Monday, Wednesday, and Friday. During an interview on 11/6/2025 at 3:50 pm, LVN E said on admissions, she would ensure all medication orders were accurately entered and would follow the checklist to ensure all assessments were done, all notifications were made appropriately. She said when she administered resident medications, she would immediately sign off on the MAR and if a medication were not given for any reason, she would immediately document the reason and make appropriate notifications. She said she would not leave any holes on the MAR, she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 34 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete would ensure everything was documented appropriately.During an interview on 11/6/2025 at 4:00 pm, MA O said after administering medications, she would immediately document the medication that was given. She said if a medication were not administered for any reason, she would notify the charge nurse immediately and document a reason why medication was not given. She said she would not leave holes in the MAR.During an interview on 11/6/2025 at 4:08 PM, the Administrator said she would be in charge to review the missed medication reports every morning and ensuring medications were being reconciled by the admitting nurse, entered in, corrected if needed and tracked. She said the DON, ADON, and MDS Coordinator would review as well. She said the Pharmacy consultant would look at new admissions and readmissions on Mondays, Wednesdays, and Fridays. She said the facility had an impromptu QAPI and discussed Resident #4's incident and went over the plan of correction and root cause analysis. She said in-services to the nurses and medication aides were conducted about refusals and if the medication aide documented to let the nurse know and document the refusal and notify the physician and family.The Administrator was informed that the Immediate Jeopardy was removed on 11/6/2025 at 4:15 PM. The facility remained out of compliance at a scope of a pattern and a severity level of no actual harm with potential for more than minimal harm that was not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 676439 If continuation sheet Page 35 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 10 residents (Resident #2, Resident #17, and Resident #13) and 3 of 5 staff (CNA H, LVN F, and MDS Coordinator) reviewed for infection control. The facility failed to ensure CNA H changed her gloves and washed/sanitized her hands during incontinent care provided to Resident #2 on 11/4/2025.The facility failed to ensure LVN F changed her gloves when she changed from dirty to clean during wound care provided to Resident #17 on 11/4/2025.The facility failed to ensure the MDS Coordinator wore appropriate PPE for enhanced barrier precautions when wound care was provided to Resident #13 on 11/20/2025.These failures could place residents at risk of exposure to infectious diseases due to improper infection control practices.Findings included:1. Record review of an admission Record for Resident #2 dated 11/5/2025 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of major depressive disorder (persistent sadness or loss of interest in doing things), type 2 diabetes, and hypertensive heart disease with heart failure (high blood pressure that makes it more difficult for the heart to pump blood through the body). Record review of a Significant Change MDS assessment dated [DATE] for Resident #2 indicated she did not have any impairment in thinking with a BIMS score of 15. She required set-up or clean-up assistance with eating and oral hygiene but was dependent on staff for toileting. She was frequently incontinent of urine/bowel.Record review of a care plan for Resident #2 revised 12/29/2023 indicated she had occasional bladder incontinence related to an overactive bladder. Interventions included to clean peri-area with each incontinence episode. During an observation on 11/4/2025 at 11:11 AM, MA R and CNA H were in the room of Resident #2 to perform incontinent care. MA R sanitized her hands and applied gloves. CNA H did not wash or sanitize her hands and applied gloves. CNA H removed wipes from the package and Resident #2 rolled onto her left side. Resident #2 was not wearing a brief. CNA H wiped her buttocks and rectal area from front to back and rolled the linens underneath her buttocks. CNA H placed a clean fitted sheet on the bed using the same gloves and Resident #2 was rolled onto her right side and the dirty linens were removed and placed in a plastic bag. Resident #2 rolled onto her back and CNA H removed a wipe from the package to clean her abdominal skin fold. MA R removed the gown from Resident #2 and CNA H placed clean gown on the resident. CNA H removed her gloves and placed them in the trash. Resident #2 was repositioned in bed. Both MA R and CNA H removed their gloves and placed them in the trash and sanitized their hands. CNA H removed the trash and exited the room. MA R exited the room.During an interview on 11/4/2025 at 11:20 AM, CNA H said she had been employed at the facility since April 2025. She said she had a skills checkoff about 6 months ago in the facility by the previous DON. She said during the care provided to Resident #2 she did not wash her hands or sanitize before she applied gloves. She said she should have started at the front of her body instead of the back of her body but because of her tumor that was in the way of her vagina that it made it hard for the staff to clean at the front first. She said she should have changed her gloves when she touched and changed tasks from dirty to clean items and she should not have placed clean items on the bed with her dirty gloves. She said residents could be at risk for infections or cross contamination if staff did not change gloves or wash or sanitize their hands.2. Record review of an admission Record dated 11/5/2025 for Resident #17 indicated he admitted to the facility on [DATE] and was [AGE] years old with diagnoses of GERD (acid reflux), depression (sadness or loss of interest in doing things), type 2 diabetes and hypertension.Record review of active physician orders Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 36 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dated 11/5/2025 for Resident #17 indicated an order for wound care to his right heel to be performed that started on 11/2/2025.Record review of active physician orders dated 11/5/2025 for Resident #17 indicated an order for skin prep to his left heel daily that started on 11/3/2025.Record review of a Quarterly MDS assessment dated [DATE] for Resident #17 indicated he did not have any impairment in thinking with a BIMS score of 15. He had one unhealed pressure ulcers/injuries that was a stage 4 (full thickness tissue loss with exposed bone, tendon, or muscle). Record review of a care plan revised on 10/21/2025 for Resident #17 indicated he had a stage 4 pressure ulcer/pressure injury to right heel/left heel. During an observation on 11/4/2025 at 1:41 PM, LVN F was at the door of Resident #17's room to perform wound care. LVN F washed her hands in the bathroom. There was a sign on door for EBP. She applied gloves to both hands and cleaned the over bed table of the resident with a sani-cloth bleach wipe and a tray for supplies. She placed a protective barrier on the table and removed her gloves and sanitized her hands. She applied clean gloves and placed the wound care supplies on the barrier that was on the tray. She cleaned a pair of scissors using a sani-cloth bleach wipe and placed it on the tray. She entered the room and placed the tray with supplies on the over bed table. She removed her gloves and placed them in the trash and washed her hands in the bathroom. She donned (put on) a gown and gloves. A dressing was noted to Resident #17's right heel that was dated 11/3/2025 with the initials of LVN F. LVN F removed the dressing and placed it in the trash. LVN F cleaned Resident #17's right heel with normal saline and gauze and she patted the wound dry with a gauze. She applied calcium alginate to the wound bed and covered it with a dressing. She removed her gloves and placed them in the trash. She sanitized her hands and applied clean gloves and applied skin prep to his left heel. She removed her gown and gloves and placed them in the trash. She removed the trash, exited the room, and washed her hands.During an interview on 11/4/2025 at 2:04 PM, LVN F said during the wound care provided to Resident #17 she should have changed her gloves between cleaning the wound and applying the clean dressing and then would have needed to sanitize or wash her hands. She said residents could be at risk of infections if staff did not change gloves when changing from dirty to clean. 3. Record review of an admission Record for Resident #13 dated 11/10/2025 indicated she was admitted to the facility on [DATE] and was [AGE] years old with diagnoses of cerebral infarction (stroke), hypertension (high blood pressure), and dysphagia (difficulty eating).Record review of active physician orders for Resident #13 dated 11/10/2025 indicated she required enhanced barrier precautions during episodes of high contact care that started on 11/4/2025. An order for wound care to her right lateral ankle to clean with wound cleanser or normal saline, apply calcium alginate and dry dressing daily and prn with a start date of 10/21/2025.Record review of a Quarterly MDS Assessment for Resident #13 dated 10/23/2025 indicated she had severe impairment in thinking with a BIMS score of 3. She had one unhealed pressure ulcer/injury that was a stage 4 wound.Record review of a care plan for Resident #13 dated 10/29/2025 indicated she had a stage 4 pressure ulcer to right lateral ankle. Interventions included: required EBP (enhanced barrier precautions) gown and gloves were required to be worn during high contact care. During an observation on 11/10/2025 at 9:51 AM, Resident #13 did not have a sign on her door for EBP. The MDS Coordinator was in the hallway gathering supplies to perform wound care to Resident #13. She washed her hands and cleaned the over bed table using a sanicloth wipe. She washed her hands and placed the wound care supplies on a barrier on the table and applied gloves to both hands. She entered the room and did not put on a gown and removed the old dressing from Resident #13's right ankle that was dated 11/9/2025 and placed it in the trash with her gloves. She washed her hands and applied clean gloves to both hands and cleaned the right ankle with normal saline and gauze and patted the wound dry with a gauze. She removed her gloves and placed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 37 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some them in the trash and washed her hands. She applied clean gloves applied and placed calcium alginate on the wound bed and covered it with a dressing on Resident #13's right ankle. She dated the dressing 11/10/2025 and initialed it. She removed her gloves and placed them in the trash and washed her hands. She gathered and removed the trash, exited the room, and sanitized her hands. During an interview on 11/10/2025 at 10:05 AM, the MDS Coordinator said during the wound care provided to Resident #13, she should have put on a gown as the resident had a wound and was on EBP. She said if a resident had a chronic wound, then a gown and gloves should be worn when care was provided to prevent staff from passing germs to the residents. She said residents could be at risk for infections.During an interview on 11/12/2025 at 5:01 PM, the ADON said residents who had wounds, foley catheters, IV's, tracheostomies or any opening with a source of entry were required to be on enhanced barrier precautions and staff should wear a gown and gloves when care was provided. She said staff had training on EBP with in-services. She said the resident should have a sign on the door to indicate who required EBP. She said hand hygiene, which included washing or sanitizing hands should be done before care was started, during care, and when care was complete. She said gloves should be changed after going from dirty a dirty task to clean and hand hygiene be performed between changing gloves. She said staff should never touch clean items with dirty gloves. She said residents could be introduced to infections if staff did not wear the appropriate ppe when care was provided or they did not perform hand hygiene appropriately.During an interview on 11/12/2025 at 5:24 PM, the Administrator said the ADON and DON were responsible for training staff on infection control. She said the DON was new to long term care and had only been employed at the facility for a little over a week. She said hand hygiene should be performed between glove changes, before care was started, when care was complete, and when hands were visibly soiled. She said staff should change their gloves and perform hand hygiene after gloves were removed. She said enhanced barrier precautions were to protect the residents from infections that staff or residents carried, and staff should wear gowns and gloves when care was provided. She said residents who had chronic wounds were on enhanced barrier precautions. She said residents could be at risk for infections if staff did not perform hand hygiene, change gloves or wear the appropriate ppe when a resident was on enhanced barrier precautions.Record review of a facility in-service dated 11/10/2025 indicated staff were trained on proper technique when wound care was provided that included enhanced barrier precautions and the MDS Coordinator and LVN F were in attendance. Record review of a facility policy titled Personal Protective Equipment-Enhanced Barrier Precautions revised April 2024 indicated, .To ensure personal protective equipment appropriate to specific task requirements is available at all times for staff residents when rendering high-contact direct care activities for residents with chronic wounds. 2. Personal protective equipment provided to our personnel includes but is not necessarily limited to: a. gowns; b. gloves. 4. Enhanced Barrier Precautions (EBP) are indicated for residents with any of the following: b. Wounds; i. Wounds include chronic wounds (pressure ulcers) .Record review of a facility policy titled Handwashing/Hand Hygiene revised August 2019 indicated, .This facility considers hand hygiene the primary means to prevent the spread of infections. 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. 7. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: a. before and after coming on duty; h. before moving from a contaminated body site to clean a body site during resident care; m. after removing gloves; 8. Hand hygiene is the final step after removing and disposing of personal protective equipment. 9. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 38 of 39 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 hygiene is recognized as the best practice for preventing healthcare-associated infections. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 39 of 39