Health inspection·March 6, 2025

F 0602 Resident #1 said he didn't realize the money was missing until he went to pay his water bill. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #2's face sheet dated 3/6/25, indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included, aftercare following joint replacement surgery. Residents Affected - Some Record review of Resident #2's admission MDS assessment, dated 1/17/25, indicated Resident #2 had adequate vision. The MDS indicated Resident #2 made herself understood and was understood by others. The MDS (BIMS of 15) indicated Resident #2 had no cognitive impairment Record review of Resident #2's care plan dated 1/16/25 did not address the right to be free from misappropriation. The care plan indicated Resident #2 was to receive assistance with ADLs including toileting, grooming, transferring and eating as needed. Record review of the facility investigation summary dated 2/18/25 stated, . Later that morning (2/14/25) (the ADON) was informed that (Resident #2) . had money missing as well. Upon interview (Resident #2) advised the ADON that she had $200 missing. (Resident #2) said she had a fall earlier and the suspect, CNA B with .staffing agency was in her room assisting with fall and rummaging through her belongings. After she was assisted to bed, the aid asked to borrow her key to the locked drawer where she had her money stored. She gave CNA B her key because she told her she was cleaning up. She asked for her key back when CNA B started to leave the room. She did not realize that the money was missing until the next morning when she went to get out money . Resident #2 described the suspect as having red curly hair that worked on Thursday night . During a phone interview on 3/6/25 at 11:03 a.m., Resident #2 said she had a little over 200 dollars stolen while at the facility. Resident #2 said she did not know the name of the CNA but described her as having red curly hair a little shorter than shoulder length. Resident #2 said the ends of her hair were a little lighter in color than the rest of her hair. Resident #2 described the CNA as having a medium build. Resident #2 described herself as being a little bit out of it as she got up during the night to use the restroom. Resident #2 said while in the bathroom she kinda slid down the wall and reached over and pulled the call light in the bathroom. Resident #2 said her nurse came and the CNA she described also came in the room. Resident #2 said the nurse helped her up and as she was assisting her into the bed she looked into the mirror and saw the CNA she described (CNA B) going through her makeup bag. Resident #2 said she said to CNA B put that down , that's not yours. Resident #2 said CNA B responded, I was just making sure everything was standing up straight. Resident #2 said she thought that was a weird response. Resident #2 said she got back in bed and was dosing back off to sleep. Resident #2 said she always kept the key to her locked drawer (each resident room has a lock drawer in the bedside table for which they are provided a key ) on a band on her wrist. Resident #2 said she had fallen back asleep, and something woke her. Resident #2 said she saw CNA B standing over the bedside table with the key in her hand. Resident #2 said she said to CNA B What are you doing? Give me that band and I'll lock the drawer. Resident #2 said she did not actually see CNA B take anything from the drawer. Resident #2 said all she kept in the drawer was a small wallet with a little cash. Resident #2 said CNA B handed her the band with the key and Resident #2 placed it back on her wrist. Resident #2 said she tried to go back to sleep. Resident #2 said CNA B then went over to her closet. Resident #2 explained she had not really unpacked anything since arriving to the facility and had bags in the closet. Resident #2 said CNA B began to look through the items in the closet. Resident #2 said she said, What are you doing? to CNA B. Resident #2 said CNA B responded, I'm just making sure everything is ok. Resident #2 said she eventually fell back to sleep and at one point CNA B was back in the room and placed her hand on my right arm and gently squeezed. Resident #2 said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676443 If continuation sheet Page 2 of 5 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 676443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Grande 3219 East Grande Boulevard Tyler, TX 75707 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 0602 Level of Harm - Minimal harm or potential for actual harm she just opened her eyes and looked at her. Resident #2 said she didn't realize there was actually any money missing until the next day. Resident #2 said she opened her wallet and there was nothing in it. Resident #2 said she questioned herself for a moment and said to herself I know I brought around 200 hundred dollars in cash with me. Resident #2 said she had some receipts and things as well in the wallet and it was all gone. Resident #2 said at that point she immediately suspected CNA B. Residents Affected - Some Record review of Resident #3's face sheet dated 3/6/25, indicated she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included, compression fracture of the T9-T10 vertebra. Record review of Resident #3's admission MDS assessment, dated 1/17/25, indicated Resident #3 had adequate vision. The MDS indicated Resident #3 made herself understood and was understood by others. The MDS (BIMS of 15) indicated Resident #3 had no cognitive impairment. Record review of Resident #3's care plan dated 1/16/25 did not address the right to be free from misappropriation. The care plan indicated Resident #3 was to receive assistance with ADLs including grooming, bathing and personal hygiene. Record review of the facility investigation summary dated 2/18/25 stated, .(Resident #3) in room [ROOM NUMBER] also reported that the aid matching the same description was going through her makeup bag and purse. (CNA B) said to (Resident #3) that she really liked that makeup brand when (Resident #3) caught her going through her things. CNA B proceeded to chat with (Resident #3) telling her that she lived .and where she was originally from . in an attempt make small talk. (Resident #3) reported that the day after the pilfering (stealing) occurred, she received a text notification of a fraud alert for someone trying to purchase an item through Amazon on her missing card. She did not even realize the card was missing until she received this notification and went to locate her card. (Resident #3) also realized that she was missing $60 cash . During an interview and observation 2/20/25 on at 11:00 a.m., Resident #3 sat in her bed. Resident #3 said everything had been great at the facility other than having some money taken. Resident #3 said she knew the police had been called. Resident #3 said it was sad to think someone would steal 60 dollars of cash. Resident #3 said she also had a card taken from her wallet and didn't realize it until she had received a fraud alert. During a phone interview on 3/6/25 at 11:20 a.m., Resident #3 said the CNA taken care of here the night before she received the fraud alert and realized the money was missing, the aide was about 5'7 brownish dyed red hair and had the faint smell of smoke. Resident #3 said the CNA was thicker in the midsection but would not describe the woman as fat. Resident #3 said the CNA described (CNA B), had helped her to the toilet. Resident #3 said she got up from the toilet on her own and as she came into the room, she saw CNA B going through her makeup bag. Resident #3 said she stared at her and when CNA B noticed her, she responded I'm just going through your makeup. I have some of the same brand. Resident #3 said she thought to herself well, ok whatever. Resident #3 said CNA B then went over to the chair where her purse was and saw her (CNA B) bent over my purse. Resident #3 said she asked CNA B what she was doing, and she (CNA B) responded she was looking for something. Resident #3 said she had not realized that CNA B had taken anything form her purse until the next day. Resident #3 said she got a fraud alert the following morning on her Target card when someone tried to make a purchase through Amazon. Resident #3 said she got her purse and wallet and saw that the card was still in her wallet but her $60.00 dollars cash was missing. Resident #3 said I guess she wrote the card information down, but she was so quick. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676443 If continuation sheet Page 3 of 5 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 676443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Grande 3219 East Grande Boulevard Tyler, TX 75707 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #4's face sheet dated 3/6/25, indicated he was a [AGE] year-old male re-admitted to the facility on [DATE] with diagnoses which included, COPD (Chronic Obstructive Pulmonary Disease is a group of lung diseases that cause long-term breathing problems). Record review of Resident #4's admission MDS assessment, dated 2/15/25, indicated Resident #4 had adequate vision. The MDS indicated Resident #4 made herself understood and was understood by others. The MDS indicated Resident #4 had no cognitive impairment (BIMS of 13). Record review of Resident #4's care plan dated 1/16/25 did not address the right to be free from misappropriation. The care plan indicated Resident #4 was to receive assistance with ADLs including grooming, bathing and personal hygiene. Record review of the facility investigation summary dated 2/18/25 stated, .Later that day the ADON overheard a patient talking to a therapist regarding missing money. She approached (Resident #4) . who was out of room when she did previous interviews. She went and discussed with (Resident #4) the situation and was advised that he also had $400 cash missing from his room. He did not realize his money was missing until he went to get some to give to his brother to purchase him some snacks. (Resident #4) did not see anyone going through his things in his room but also resided in the section CNA B worked . During an interview and observation on 3/3/25 at 2:40 p.m., Resident #4 sat in his recliner. Resident #4 said he had 400 dollars stolen from his room. Resident #4 said he had the money in his locked bedside drawer. Resident #4 said he had laid the key on his bedside table. Resident #4 said he did not realize the money was missing until the next day when he attempted to give his brother some money. Resident #4 said 4, 100-dollar bills had been taken from his wallet and 4 single dollar bills were left in the wallet. Resident #4 said he didn't see anyone going through his things but suspected it had been taken by the CNA that had cared for him the night before the money went missing. Resident #4 described her as having red hair and a piercing in her nose. Record review of the facility investigation summary dated 2/18/25 indicated the police department had been notified and the facility provided the responding officers with the full name of CNA B, her social security number, copy of her driver's license, phone number, CNA certificate number which was obtained through the staffing agency she had been hired from. During an interview on 3/6/25 at 10:57 a.m., Resident #5 also reported she saw a CNA matching the description of CNA B going through her personal items but had nothing missing. During an interview on 3/6/25 at 10:57 a.m., Resident #6 also reported he saw a CNA matching the description of CNA B going through his personal items but had nothing missing. During an interview on 3/6/25 at 10:30 a.m., the investigating officer with the police department said the investigation was ongoing. The officer said the investigation was supporting that CNA B had stolen various amounts of money and card information from residents at the facility. The officer stated he was still working to build a solid criminal case. During an interview on 3/6/25 at 1:50 pm the ADON said video footage showed the CNA B going in out of the victimized residents' rooms throughout the shifts on 2/11/25 to 2/12/25 on the night shift and 2/13/25 to 2/14/25 on the night shift. The ADON said the video footage doesn't actually show her taking anything as there are no cameras in the resident rooms but in the hallways. The ADON said we (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676443 If continuation sheet Page 4 of 5 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 676443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Grande 3219 East Grande Boulevard Tyler, TX 75707 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some received a text message from CNA B asking if she offended someone (she explained this was when they had notified the staffing agency of the situation and she was removed from coming back to work her additional scheduled shifts). The ADON said we interviewed all the residents that were assigned to her care and notified the police and reported to the state agency. During an interview on 3/6/25 at 1:51 pm the DON said she to, saw the footage that showed CNA B going in out of the victimized residents' rooms throughout the shifts on 2/11/25 to 2/12/25 on the night shift and 2/13/25 to 2/14/25 on the night shift. The DON said the staffing agency was notified we did not allow her to return to the facility. During an interview on 3/6/25 at 1:52 the Administrator was not able to share the video footage they had. The Administrator said the maintenance man was working to get the footage to supply it to the police department but was unable to do so. The Administrator said she did not know what else she could do to keep residents from being victims of misappropriation other than not using agency staff at all. The Administrator said when she hires staff she goes beyond convictions barring employment and will not hire anyone with a history of theft. The Administrator with shift key they (we the facility) can be picky about who they hire and had do so only taking CNAs with high star ratings (she explained star ratings came from other facilities) and that CNA B had a 4- or 5-star rating). The Administrator said CNA B also had a high reliability rating (indicating her attendance to scheduled shifts). The Administrator said the facility did everything correctly in response to allegations of misappropriation, including conducting a prompt investigation, not allowing CNA B to return to the facility, notifying the staffing agency of the allegations, reporting to the state agency, reporting local police department and in servicing the facility staff. Record review of the facility policy and procedure titled Abuse Neglect and Misappropriation, dated February of 2021, stated each resident had the right to be free from .misappropriation of resident property . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676443 If continuation sheet Page 5 of 5