Health inspection·December 8, 2025

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and narrowing of the airways, making it difficult to breathe.), Osteomyelitis of Vertebra, lumbar region (infections of the bones in lower back). Sepsis (life threatening condition that occurs when the body's immune system overreacts to an infection.) Record review of Resident #9's quarterly MDS Assessment, dated 10/07/2025, reflected the resident BIMS score was 15 indicating his cognition was in-tact. The residents' ADL functioning required setup and cleaned up for oral hygiene, personal hygiene, eating, and partial to moderate assistance for showers. He required supervision and touching for toileting, lower body dress, and putting on footwear. Section O -special treatments, procedures, and programs: Resident #9's BiPAP (a device that provides air pressure to help patients with breathing problems.) and CPAP (machine used to deliver pressurized air through a mask to keep airways open during sleep.) were left blank. Section O4: Central PICC Line was left blank. (PICC lines are central lines designed for long-term therapies with different benefits and considerations.) Record review of Resident #9's care plan dated 10/09/2025 reflected he was receiving antibiotic therapy Cefazolin Sodium infections Solution.interventions administer the antibiotic medications as order by physician. Monitor and document side effects. Resident #9 was receiving IV medications Cefazolin. If IV is infiltrated: Antidote for vesicant/irritant med MAY be infused into IV catheter.prior to removal. Check nursing drug handbook or pharmacy for recommended antidote. Section: Respiratory reflected Resident #9 has altered respiratory status/difficulty breathing COPD.interventions -Admit to Cardiopulmonary Program.Monitor for difficulty breathing (Dyspnea) on exertion. Remind resident not to push beyond endurance.Monitor for s/s of potential respiratory infection.Monitor for s/sx of acute respiratory insufficiency: Anxiety, Confusion, Restlessness SOB at rest, Cyanosis (bluish discoloration of skin), Somnolence (strong drowsiness) . Monitor for s/sx of acute respiratory insufficiency.increased heart rate.Monitor vitals as orders.Monitor/document/report abnormal breathing patterns to MD. The care plan did not address BiPAP/CPAP. Record review of Resident #9's MD orders reflected dated 10/04/2025 Cefazolin Sodium Injection Solution Reconstituted 2 GM intravenously . Normal saline flush intravenously 10ml.Order dated 10/12/2025 Check PICC line dressing each shift.Change PICC line dressing every Monday, 7 days (sterile process). Change needleless connector every week with dressing change and flowing blood draws every Monday PICC LINE: measure upper arm circumference with dressing changes every Monday. IV PICC: Measure external catheter length with dressing changes every Monday. IV PICC: Monitor site and dressing document in progress note any s/sx of infection notify provider every shift. There was no order for BiPAP/CPAP. Resident #22 During an observation of resident #22's on 10/23/2025 at 1:30 PM, her CPAP machine mask was observed in the top drawer of her nightstand unbagged. Resident was wearing a nasal cannula receiving oxygen at the time. She stated that she uses her CPAP machine at night, and the mask had not been cleaned by staff. Record review of Resident 22's face sheet dated 10/23/2025 reflected she was a revealed [AGE] year-old-female that was admitted on [DATE] with current DX: Asthma (lung disease due to external agents), chronic respiratory failure ( a medical emergency where a person with a pre-existing, long-term lung condition experiences a sudden, severe worsening of their ability to breathe.), obstructive sleep apnea ( It is a sleep disorder characterized by pauses in breathing or instances of shallow breathing during sleep.). Record review of Resident #22's quarterly MDS Assessment, dated 09/30/2025, reflected the resident BIMS score was 15 indicating she was cognitively intact. The residents' ADL functioning required setup and cleaned up for oral hygiene, personal hygiene, and eating, and partial to moderate assistance for showers. She required supervision and touching for toileting, lower body dress, and putting on footwear. Section O -special treatments, procedures, and programs, did not address resident oxygen use nor BiPAP/CPAP treatments.Record review of Resident #22's care plan dated 10/03/2025 reflected she had an altered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676449 If continuation sheet Page 2 of 9 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 676449 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Fort Worth, LLC 6301 Oakmont Blvd Fort Worth, TX 76132 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete respiratory status/difficulty breathing, Asthma, CHF, and sleep apnea.interventions keep head of bed elevated, to prevent SOB.Maintain clear airway by encouraging resident to clear own secretions (mucus) with effective coughing. If secretions cannot be cleared, suction as ordered/required to clear secretions. Monitor for difficulty breathing. monitor for respiratory infections.monitor for respiratory distress, monitor vital signs.give medications as order by MD.Monitor/document/report/abnormal breathing patterns to MD increased rate, decreased rate, periods of apnea. Record review of Resident #22's MD orders reflected dated 09/28/2025 admission Protocol: may administer supplemental oxygen as needed. During an interview with the MDS on 10/23/2025 at 3:24 PM, she stated that coding section G1 Non-invasive Mechanical Ventilator while a resident was sufficient to identify the BiPAP or CPAP treatments. The MDS coordinator stated in section she checked Midline for the IV, therefore specifying the general treatment for antibiotic treatment via IV. She stated that the MD does write orders for the BiPAP and CPAP treatment for the resident. During an Interview on 10/23/2025 at 3:38 PM with the DON she stated the MDS Coordinator was responsible for completing timely and accurate MDS assessments. The DON stated that once the assessment was completed an RN would review for accuracy, then sign as completed. The negative outcome to residents when not completed accurately was not addressed by the DON. During an interview on 10/23/2025 at 3:45 PM the ADM revealed it was his expectation for the MDS coordinators to complete the MDS assessments accurately addressing the resident's care and treatment at the facility. The surveyor requested policies for Conducting Accurate assessments on 10/23/25 at 9:30 AM and again at 1:15 PM. The policy was provided, however, neither electronic copy would open to review facility policy. Event ID: Facility ID: 676449 If continuation sheet Page 3 of 9 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 676449 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Fort Worth, LLC 6301 Oakmont Blvd Fort Worth, TX 76132 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that residents who needed respiratory care were provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences for 4 of 10 (Resident #1, Resident #9, Resident #14, and Resident #22) residents reviewed for respiratory care. The facility failed to ensure:Resident #1's, Resident #9's, and Resident #22's BiPAP/CPAP mask were stored properly when it was not in use, per facility protocol for sanitation. Resident #14's NC (a medical device that delivers supplemental oxygen through a flexible tube with two prongs that rest in the nostrils.) was discarded properly when changed, and dating the new NC tubing was installed.These deficient practices could place residents who receive respiratory care at an increased risk of developing respiratory complications and a decreased quality of care. Resident #1 During an observation and interview with Resident # 1 on 10/23/2025 at 1:17 PM revealed his BIPAP/CPAP mask on the floor on the left side of his bag. Resident #1 stated staff administer his treatment at night for sleep and he did not know how the mask got on the floor. Record review of Resident #1's face sheet dated 10/23/2025, reflected he was an [AGE] year-old male that was admitted on [DATE] with diagnosis including: infection and inflammatory reaction due to internal left knee prothesis, subsequent encounter (infection of other causes), Chronic Systolic (congestive) heart failure (condition of the heart muscle weakens overtime. Hypertensive heart disease with heart failure (a condition where prolonged high blood pressure (hypertension) damages the heart muscle over time). Record review of Resident #1's face sheet dated 10/23/2025, reflected he was an [AGE] year-old male that was admitted on [DATE] with diagnosis including: Obstructive Sleep Apnea (Adult), Chronic Systolic (congestive) heart failure (condition of the heart muscle weakens overtime. Record review of Resident #1's quarterly MDS Assessment, dated 10/07/2025, reflected the resident BIMS score was 15 indicating his cognition was in-tact. The residents required set up and cleaned up assistance for oral hygiene, personal hygiene, and eating, and partial to moderate assistance for showers. He required supervision and touching for toileting, lower body dress, and putting on footwear. Section O -special treatments, procedures, and programs, G1. reflected use of a Non-invasive Mechanical Ventilator while he was a resident, however, Sections O, G2. BiPAP and G3. CPAP were left blank, not identifying the specific treatment type. BiPAP (a non-invasive ventilation therapy that provides two different levels of air pressure to help patients with breathing problems.) CPAP (a treatment for sleep apnea that uses a machine to deliver pressurized air through a mask to keep airways open during sleep.) Record review of Resident #1's MD order dated 10/04/25 reflected 1. Wipe mask, nasal pillows daily with damp cloth 2. Prescriber Empty Humidifier Chamber3. Fill humidifier with warm Written soapy water, shake well 4. Rinse, air dry in the morning. admission Protocol: may administer supplemental oxygen as needed. Resident #9 During an observation 10/23/2025 at 1:20 PM of resident #9's BiPAP/CPAP mask was observed lying on his nightstand unbagged. Resident #9 stated that he could not recall the last use of the sleep apnea machine. Record review of Resident #9''s face sheet dated 10/22/2025 reflected he was a revealed [AGE] year-old-male that was admitted on [DATE] with current DX: COPD, Chronic Bronchitis (a long-term lung condition characterized by persistent inflammation of the airways (bronchi), leading to excessive mucus production and a chronic cough.), Acute respiratory failure with hypoxia (faint), pneumonia (lung infection). Record review of Resident #1's quarterly MDS Assessment, dated 10/07/2025, reflected the resident BIMS score was 15 indicating his cognition was in-tact. The residents' ADL functioning required setup and cleaned up for oral hygiene, personal hygiene, and eating, and partial to moderate assistance for showers. He required supervision and Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676449 If continuation sheet Page 4 of 9 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 676449 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Fort Worth, LLC 6301 Oakmont Blvd Fort Worth, TX 76132 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few touching for toileting, lower body dress, and putting on footwear. Section M-high risk drug class reflected he was taking antibiotics, anticoagulant, hypoglycemic, diuretic, and opioid as a resident. Section O -special treatments, procedures, and programs Resident #9's MDS was not coded for BiPAP/CPAP use. Record review of Resident #9's care plan dated 10/09/2025 reflected Resident #9 has altered respiratory status/difficulty breathing COPD.interventions Admit to Cardiopulmonary Program.Monitor for difficulty breathing (Dyspnea) on exertion. Remind resident not to push beyond endurance.Monitor for s/s of potential respiratory infection.Monitor for s/sx of acute respiratory insufficiency: Anxiety, Confusion, Restlessness SOB at rest, Cyanosis (bluish discoloration of skin), Somnolence (strong drowsiness). Monitor for s/sx of acute respiratory insufficiency.increased heart rate.Monitor vitals as orders.Monitor/document/report abnormal breathing patterns to MD. Record review of Resident #9's MD orders Record review of resident #9's MD orders dated 10/12/2025 reflected monitor vitals every shift (BP/P/R/T/02/sats). Resident #14 During an observation of Resident #14 on 10/23/2025 at 1:20 PM, the resident was wearing nasal cannula that was positioned in nostrils and tubing was not dated. A second NC was observed on the seat of the resident wheelchair. Resident stated that the overnight staff changed his tubing. Resident #14 has cognitive impairment and could not recall details such as date or person. Record review of Resident 14's face sheet dated 10/23/2025 reflected he was a revealed [AGE] year-old-male that was admitted on [DATE] with current DX: COPD (COPD is a chronic lung disease that causes ongoing inflammation and narrowing of the airways, making it difficult to breathe.), Acute Chronic Respiratory failure with hypercapnia ( is a condition where a patient with a pre-existing chronic respiratory problem experiences a sudden worsening of respiratory failure, leading to dangerously high levels of carbon dioxide in the blood.) Record review of Resident #14's quarterly MDS Assessment, dated 10/07/2025, reflected the resident BIMS score was 15 indicating his cognition was in-tact. The residents' ADL functioning required setup and cleaned up for oral hygiene, personal hygiene, and eating, and partial to moderate assistance for showers. He required supervision and touching for toileting, lower body dress, and putting on footwear. Section O -special treatments, procedures, and programs, addressed Resident #14's need for oxygen treatments.Record review of Resident #14's care plan dated 10/13/2025 reflected resident requires oxygen therapy, administer oxygen per MD orders, keep head of bed elevated to prevent shortness of breath, monitor vital signs as ordered, (skin color, pulse, airway functioning, degree of restlessness which may include hypoxia (passing out). Resident has altered respiratory status/difficulty breathing.interventions Monitor for difficulty breathing. monitor for respiratory infections.monitor for respiratory distress, monitor vital signs.give medications as order by MD.Monitor/document/report/abnormal breathing patterns to MD increased rate, decreased rate, periods of apnea. Record review of Resident #14's MD orders reflected dated 10/10/2025 MD orders dated 10/10/2025 reflected monitor 02 saturations every shift. Monitor 02 saturations as needed for s/sx of low 02 saturations. Continuous 02 via NC at 4 LPM every shift. change 02 tubing every night shift every Sunday and as needed. Resident #22 During an observation of resident #22's on 10/23/2025 at 1:30 PM, her CPAP machine was on her nightstand, and she was wearing a nasal cannula that was dated 10/19/2025. Her NC was connected to oxygen concentrator (medical device for therapy to provide supplemental oxygen to people with respiratory. Issues. Resident #22 stated that the mask had not been cleaned since being admitted to the facility. Record review of Resident 22's face sheet dated 10/23/2025 reflected he was a revealed [AGE] year-old-female that was admitted on [DATE] with current DX: Asthma (lung disease due to external agents), chronic respiratory failure ( a medical emergency where a person with a pre-existing, long-term lung condition experiences a sudden, severe worsening of their ability to breathe.), obstructive sleep apnea ( It is a sleep (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676449 If continuation sheet Page 5 of 9 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 676449 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Fort Worth, LLC 6301 Oakmont Blvd Fort Worth, TX 76132 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few disorder characterized by pauses in breathing or instances of shallow breathing during sleep.). Record review of Resident #22's quarterly MDS Assessment, dated 09/30/2025, reflected the resident BIMS score was 15 indicating she was cognitively intact. The residents' ADL functioning required setup and cleaned up for oral hygiene, personal hygiene, and eating, and partial to moderate assistance for showers. She required supervision and touching for toileting, lower body dress, and putting on footwear. Section O did not address her need for BIPAP and CPAP treatment, and oxygen Record review of Resident #22's care plan dated 10/03/2025 reflected she altered respiratory status/difficulty breathing, Asthma, CHF, and sleep apnea.interventions keep head of bed elevated, to prevent SOB.Maintain clear airway by encouraging resident to clear own secerns (mucus) with effective coughing. If secretions cannot be cleared, suction as ordered/required to clear secretions. Monitor for difficulty breathing. monitor for respiratory infections.monitor for respiratory distress, monitor vital signs.give medications as order by MD.Monitor/document/report/abnormal breathing patterns to MD increased rate, decreased rate, periods of apnea.The care plan did not address the residents' use for oxygen and BiPAP and CPAP. Record review of Resident #22's MD orders dated 09/28/2025 reflected admission protocol: may administer oxygen as needed. Monitor vitals every shift (blood pressure, respirations, temperature, and 02 saturations . MD orders for 02 liters per minute. During an interview with CNA on 10/23/2025 at 3:04 PM she had not observed Resident #14's NC tubing in his wheelchair during rounds. She stated that both the nurse and aide conduct rounds, and medical equipment found that was old and not in use should be discarded immediately and notify the nurse. She said if a resident's mask was found on the floor, she would report to the nurse. During an interview on 10/23/2025 at 3:10 PM, with the ADON, she stated Resident's prescribed sleep apnea and oxygen should be cleaned by the nurse and observed for sanitation every shift. She stated that all masks should be stored in a plastic bag and dated when not in use. She stated the failure could cause residents to get an infection from when not stored and cleaned according to the facility policy for sanitation. She stated the overnight shift nurse changes the NC on Sundays, and the NC should be discarded immediately after administering the new to prevent resident access and a clean clinical environment. During an interview on 010/23/2025 at 3:38 PM, the DON said the nursing staff were responsible for ensuring a resident's oxygen tubing was changed weekly and tubing dated. She stated Resident #14's old NC should be discarded immediately upon removing and replacing the new NC. She expects nursing staff to follow MD orders for cleaning BiPAP/CPAP mask, and to store them in a dated plastic bag when not in use to prevent cross contamination. She stated the failing to follow procedure could result in the Resident's obtaining respiratory devices could result in respiratory infections. During an interview with the ADM on 10/23/2025 at 3:45PM revealed he expects the nursing staff to follow facility policies and MD orders for resident clinical needs. Record review of facility policy titled CPAP/BiPAP respiratory care, dated 07/2020. Policy reflected in morning, clean mask .Cleaning of unit Humidification chamber needs to be cleaned out frequently to prevent bacteria build-up and prevent calcification.Unplug unit before cleaning it.Using a damp cloth, wipe outside of unit.Remove chamber from humidifier carefully so water does not enter the CPAP machine.Open chamber and wash with warm, soapy water.Rinse well with water and allow to dry on a clean cloth or paper towel out of direct sunlight.Fill with distilled water (may also use filtered water Weekly humidifier chamber will be soaked in solution of 1 part white vinegar/3 parts water for 15-20 minutes prior to thoroughly rinsing with distilled water.Ensure unit is thoroughly dry before plugging it in again Immerse humidifier in warm, soapy water.Fill humidifier with soapy water and shake vigorously.Rinse with clean water and allow to air dry.Ensure BIPAP/CPAP mask and/or tubing and oxygen tubing is stored in a clean bag when not in use.Using oxygen If physician (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676449 If continuation sheet Page 6 of 9 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 676449 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Fort Worth, LLC 6301 Oakmont Blvd Fort Worth, TX 76132 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 0695 Level of Harm - Minimal harm or potential for actual harm has ordered oxygen during CPAP/bi-level therapy, observe all fire and safety rules associated with oxygen use.Documentation Requirements Specific physician orders.Specific individualized instructions to staff on comprehensive individualized plan of care.Daily cleaning procedures performed. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676449 If continuation sheet Page 7 of 9 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 676449 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Fort Worth, LLC 6301 Oakmont Blvd Fort Worth, TX 76132 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure drugs and biologicals were stored in accordance with state and federal laws in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys for 1 of 3 Residents reviewed for medication storage. LVN-C failed to ensure Resident #1's PICC line medication was secured in a locked compartment. This failure could place residents at risk for consuming or tampering with medications that could result in adverse medication reactions.Record review of Resident #1's face sheet dated 10/23/2025, reflected he was an [AGE] year-old male that was admitted on [DATE] with diagnosis including: infection and inflammatory reaction due to internal left knee prothesis, subsequent encounter (infection of other causes). Record review of Resident #1's quarterly MDS Assessment, dated 10/09/2025, reflected the resident BIMS score was 15 indicating his cognition was in-tact. Resident #1's ADL functioning required setup and clean up for oral hygiene, supervision and touching, depending on staff for showers. He required supervision and touching for toileting, lower body dress, and putting on footwear. Section M-skin conditions reflected he had a surgical wound, nutrition or hydration interventions, and applications of ointments. Section N-high risk drug class reflected he was taking antibiotics. Section O -special treatments, procedures, and programs, reflected resident was receiving IV medications (medical procedure where a needle or catheter is inserted in the vein to administer fluid.), IV access were addressed. Record review of Resident # 1's Care Plan dated 10/04/2025 reflected he was on Enhanced Barrier Precautions related to IV therapy and interventions included Provide Enhanced Barrier Precautions as indicated.Involves the use of personal protective equipment (PPE), specifically gowns and gloves, during high contact resident care activities (i.e., prolonged direct contact) Resident #1 was receiving IV medication(s).Vancomycin , ceftriaxone (a potent antibiotic used to treat serious bacterial infections.The resident will not have any complications related to IV.Intervene accordingly before discontinuing IV site. IV DRESSING: Observe dressing. Record review of Resident #1's MD orders reflected an order dated 10/04/2025 at 3:48 AM, Wipe mask, nasal pillows [NAME] with damp cloth Empty humidifier chamber. Fill humidifier with warm soapy water, shake well.Rinse, air dry in the morning. Record review of Resident #1's MD order dated 10/04/2025 at 5:39 PM reflected ceftriaxone Sodium Intravenous Solution Reconstituted 2 GM (Ceftriaxone Sodium) Use 2 gram intravenously in the afternoon for L knee infection until 11/11/2025 11:59 PM. MD orders dated 10/04/2025 at 5:43 PM reflected Change needleless connector every week with dressing change and following blood draws every day shift every 7 day(s) for per protocol.changes occurred on 10/05/2025, 10/12/2025, and 10/19/2025. Change PICC (a thin, flexible tube inserted into a vein in the upper arm and threaded into a larger vein near the heart.) line dressing every 7 days (sterile process disinfecting and sterilization of reusable medical instruments) every day shift every Sun for PICC Line IV PICC: order monitor site and dressing. Document in progress note any signs and symptoms of infection, notify provider of s/sx of infection every shift for per protocol. Normal Saline Flush Solution (Sodium Chloride saltwater Flush) every shift for PICC Line Patency (being open allowing for free flow of fluids, air, or blood) as well as before and after each infusion (a method of putting fluids including drugs into the bloodstream.) Change PICC line dressing every 7 days (sterile process) every day [NAME] every Sun for PICC Line. Check IV dressing each shift and PRN every shift. reflected Enhances Barrier Precautions-IV/PIPC every shift. Vancomycin HCI Intravenous Solution 750 MG/150ML (Vancomycin HCI) Use 1500 mg intravenously every 24 hours for L Knee joint (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676449 If continuation sheet Page 8 of 9 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 676449 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Fort Worth, LLC 6301 Oakmont Blvd Fort Worth, TX 76132 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Infection until 11/11/2025 11:59 PM. Record review of Resident #1's October MAR/TAR Vancomycin HCI (powerful antibiotic used to treat serious bacterial infections) Intravenous 24-hour use was administered on 10/23/2025, the day of the investigation at 12:00 PM, by LVN C. Ceftriaxone was administered on 10/23/2025 at 12:00 PM by LVN C During an observation and interview with Resident # 1 on 10/23/2025 at 1:15 PM revealed he was receiving antibiotic therapy via IV for infections. During an observation on 10/23/2025 at 1:17 PM revealed Resident #1's PICC line medication labeled Ceftriax 2G/100 ML was observed lying on the exit door handle located at the end of the resident hall. The medication was exposed to the sunlight reflecting through the glass door. The medication was prescribed to Resident #1. The medication was observed with a light blue sticker that stated, keep refrigerated. The nurse MDS nurse was notified of the concern. She went to observe the medication then left the hall to locate LVN-C. During an Interview with LVN-C on 10/23/2025 at 3:10 PM, revealed he was the assigned nurse that left the IV/PICC line medication on the door handle of the back door until he was able to destroy it appropriately. LVN-C said the medication was prescribed to Resident #1. LVN-C said he forgot that the medication was on the door handle until he was notified by the MDS coordinator. LVN-C said he destroyed the medication by cutting the valve that held the liquid and pouring the liquid down the toilet. LVN-C said that the medication could be discarded in the toilet. LVN-C said the failure could result in him forgetting the medication, and other residents accessing the medication and ingestion the liquids, or other adverse reactions. During an interview with the ADON on 10/23/2025 3:10 PM, she revealed her expectation was for staff administering medications to discard in the medication room container immediately. ADON said failure to discard and document medications immediately could lead to other residents' accessing the medication, resident's overdosing, and other adverse reactions. She said it was her responsibility to monitor and educate staff on medication protocol. She said the facility had completed in-services on medication administration and destruction. The surveyor asked for the in-service that was completed after the interview. During an interview with MDS on 10/23/2025 at 3:24 PM, she stated that she was a LVN and was familiar with procedures to destroy medication. MDS said she removed the medication from the door handle and took it to LVN-C to destroy. She also notified ADON and DON that the medication was left on the door handle. MDS said destruction of IV/PICC line medication included cutting the plastic globe and pouring down the toilet or taking it to the medication storage room and discarding in the container. During an interview with CNA on 10/23/2025 at 3:04 PM, she had not observed the IV PICC medications left by LVN-C. CNA stated that failing to store medications could result in resident's accessing the medications and digesting.During an interview on 10/23/2025 3:38 PM with DON revealed her expectation was for staff administering IV medications to document on the MAR. DON said medication should be discarded immediately when dropped or contaminated. DON stated that the failure placed residents at risk of having access to medication and possible adverse medical reactions, illnesses, and a medical emergency. DON said it was the responsibility of the DON and ADON to audit the medication carts and perform random checks ensuring medication protocol and storage protocol were followed. Interview on 10/23/2025 3:45 PM with ADM, he expected nursing staff to ensure medications were secured away from residents and destroyed according to policy. Event ID: Facility ID: 676449 If continuation sheet Page 9 of 9