Health inspection·March 22, 2023

F 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record Review of Guest Experience Reports indicated that facility failed to provide documentation of Resident #31's warm welcome but did not address Resident Council topics. Resident #17 Record review of the face sheet for Resident #17 dated 03/17/2023 revealed a [AGE] year-old female admitted to the facility on [DATE]. Her primary diagnoses included displaced intertrochanteric fracture of left femur subsequent encounter for closed fracture with routine healing. Record Review of Resident #17's admission MDS assessment dated [DATE] revealed a BIMS score 13 out of 15; indicating residents' cognition was intact. Record Review of Resident #17's admission Packet signed and dated by the resident on 2/03/2023. Record Review of Resident #17's Guest Experience Report dated 02/02/2023 indicated that warm welcome was completed but did not address Resident Council topics. Resident #37 Record review of the face sheet for Resident #37 dated 03/17/2023 revealed an [AGE] year-old female admitted to the facility on [DATE]. Her primary diagnoses included hemiplegia and hemiparesis following cerebral infarction (paralysis and weakness following stroke). Record Review of Resident #37's admission MDS assessment dated [DATE] revealed a BIMS score 13 out of 15; indicating residents' cognition was intact. Record Review of Resident #37's admission Packet signed and dated by the resident on 01/20/2023. Record Review of Resident #37's Guest Experience Report dated 01/18/2023 indicated that warm welcome was completed but did not address Resident Council topics. Resident #7 Record review of the face sheet for Resident #7 dated 03/17/2023 revealed an [AGE] year-old female admitted to the facility on [DATE]. Her primary diagnoses included disruption of internal operation surgical wound and encounter for surgical aftercare following surgery on digestive system. Record Review of Resident #7's admission MDS assessment dated [DATE] revealed a BIMS score 12 out of 15; indicating resident had moderate cognition. Record Review of Resident #7's admission Packet signed and dated by the resident on 02/14/2023. Record Review of Resident #7's Guest Experience Report dated 02/14/2023 indicated that warm welcome was completed but did not address Resident Council topics. In an interview on 03/14/2023 at 9:22 am with CNO, he said that he has worked at the facility since 2019, and the facility has never offered Resident Council or had a President. He said that the facility is short term with 14 day average length of stay. He said that most residents are discharged from the facility before a President can be selected or a meeting can be held. He said that for a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 2 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0565 Level of Harm - Minimal harm or potential for actual harm resident to be admitted longer than 30 days is rare. He said that the Director of Hospitality should complete a warm welcome with residents at admission, explain what Residential Council was, offer a chance to attend, and document residents' response on a hospitality report. He said that there is a plan for the Director of Entertainment to take over the role of Resident Council, but it has not been put in place. He said that the Director of Care Transitions would assist with organizing a Resident Council Meeting. Residents Affected - Some In an interview on 3/14/2023 at 12:36pm with Director of Care Transitions, she said that she is an LVN, and she has worked at the facility since 2021. She said that she did not know what Resident Council was. She said that she worked with the SW, and she would reach out to the SW for clarification. She agreed to make efforts to schedule Resident Council for 03/15/2023 at 3:00pm. In an interview on 3/15/2023 at 10:00 am with Director of Hospitality, she said she has been in her position since April of 2022. She said that the facility did not have Resident Council because residents are not admitted to the facility for more than 30 days. She said that she does not offer residents an opportunity to participate in resident council upon admission, and the information was not advertised or posted in the facility. She said that during the warm welcome she welcomes residents upon admission, and she asked about concerns or grievances. She said that if a resident had a concern or grievance, she gives the information to the GM of CNO. She said she provides residents with information on daily activities. She said that she goes to each resident's room daily after the warm welcome. She said that she documents her warm welcome and room visits on a hospitality report. She said that the hospitality report did not have information that she offered Resident Council to residents, or address the topics that are covered during Resident Council She said that she was not sure of the facilities policy for Resident Council. She said that she reports to the GM. In an interview on 03/15/2023 at 10:20 am with the [NAME] President of Clinical Nursing, he said that the facility did not have Resident Council because it was a short term stay facility, but the facility was operating as a skilled nursing facility. He agreed to provide the facilities policy for Residents Rights and Resident Council. In an interview on 3/15/2023 at 12:36pm with Director of Care Transitions, she said that she did not make efforts to schedule Resident Council, and she was not able to reach the SW for clarification. She said that the SW would return on 03/16/2023. She agreed to provide a list of residents that had been admitted for 30 days. In an interview on 03/16/2023 at 9:41 am SW, she said that she has worked at the facility for 3 years and there has never been a Resident Council because residents are not at the facility long term. She said that the Director of Hospitality should meet with each resident at admission and provide the information that a resident would receive during Resident Council. She said that she was unsure of the facilities policy on Resident Council, but she would assume it would be similar to other long term facility that a meeting should be held monthly. She said that the GM was over site for the Director of Hospitality. She provided a list of residents that had been admitted for 30 days or more (Residents#10,11,12,13, and 14). She said that staff went into each residents room on 03/15/2023, 5 resident expressed interest in attending Resident Council, and the meeting will be held on 03/16/2023 at 10:00 am. In a meeting held on 03/16/2023 10:10 am with 5 residents who said they had not been admitted longer than 30 days. 5 residents who said they had no knowledge of what a Resident Council Meeting was prior to 03/15/2023 when they were asked to attend. 5 residents in attendance said they would have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 3 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some liked to have the information about Resident Council at admissions to include a date, time, and location of the meeting. In an interview on 03/16/2023 at 11:20 am with Resident #7, she said that she was only made aware of Resident Council meeting on 3/15/2023 when she was asked to attend. She said that she did not attend the schedule meeting because it was held during her therapy session. She said that it would have been nice to have the had the information in advance so that she could have attended. In an effort to complete an interview on 03/16/2023 at 11:24 am with Resident #31, he refused. In an interview on 03/16/2023 at 11:30 am with Resident #16, she said that she did not know what Resident Council meeting was, and she was not asked to attend. In an interview on 03/16/2023 at 11:35 am with Resident #17, she said that she did not know what Resident Council meeting was, and she was not asked to attend. In an effort to complete an interview on 03/16/2023 at 11:38 am with Resident #37, she refused. In an interview on 3/17/2023 at 11:20 am with the [NAME] President of Clinical Nursing, he said the Director of Hospitality should offer upon admission information on Resident Council, and the GM would be the oversight. He said that he was unsure if residents received the information at admission, and he would follow up. In an interview 03/17/2023 12:15pm with Director of Hospitality and [NAME] President of Clinical Nursing. Both said that the information that would be received during Resident Council would not be included during the warm welcome and documented on the hospitality report. The [NAME] President of Clinical Nursing stated that the facility would need to hold a meeting monthly, advertise the meeting, and take attendance for those that attend. In an interview an observation on 3/17/2023 12:20pm with Director of Hospitality, she said that the facility did post a sign in the facility informing the date, time, and location of Resident Council meeting. Observation of sign posted in main dining room that read in part, Resident council Meeting 3rd Monday of the Month 10 am in multi-purpose room. She said that the sign had been posted in the same location since survey entrance. In an interview 03/17/2023 12:25pm with [NAME] President of Clinical Nursing, he said that the sign for Resident Council meeting was posted on 3/17/2023. In an interview on 03/18/2023 at 11:32 am with GM, and [NAME] President of Clinical Nursing present. She said that the facility has never offered resident council. She said that it is the duty of the Director of Hospitality to meet with residents upon admission to provide the information that would be received at Resident Council, and the information would be documented on the hospitality report. She said that she was the oversight for the Director of Hospitality. She said that she would need to review the facilities policy for Resident Council, but she believed that it was the same as other skilled facility. She stated, I will just take the hit on the citations, because it has never been questioned in the past about the facility not conducting Resident Council. Corporate just needs to update their policy. Maybe Corporate will change the policy after the citation. She agreed to provide the hospitality reports for the admission dates of Residents#10, 11, 12, 13, and 14. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 4 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of the facility admission Packet undated red in part, Statement of Resident Rights. No resident shall be deprived of any rights, benefits, or privileges guaranteed by law .27. The right to participate in a residents advisory council at the community; . Record review of the facility policy titled, Resident Council, revision dated March 2020 read in part, 1. Coordination of the monthly resident council meeting and process will be done by the Director of Entertainment and/or designee. 2. All residents will be invited to attend resident council monthly. Any resident not physically unable to attend resident council will separately be interviewed by staff and their comments and concerns voiced to the council. 3. Attendance of all residents and staff present will be recorded at resident council. 4. The previous council meeting's minutes will be read, reviewed, and approved by the council. 5. Old Business including resident council concerns from the previous meeting will reviewed with follow-up provided from staff members/departments involved. 6. Other areas of review will included but aren't limited to: Review of Ombudsman program, location of survey results, location of posting of staffing numbers, resident rights, any/all new policies implemented by facility since the last meeting . Event ID: Facility ID: 676460 If continuation sheet Page 5 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - 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 were free from physical restraints imposed for the purposes of convenience, and not required to treat the resident's medical symptoms for 1 of 8 residents (Resident #40) reviewed for physical restraints. Residents Affected - Few -The facility failed to ensure that physical restraints were not used on Resident #40 during medication administration via G- tube (a tube inserted through the belly that brings nutrition directly to the stomach), which resulted in Resident #40 suffering from emotional distress and increased behaviors. This failure could place the residents at risk for psychological harm, emotional distress and at risk for injury. Findings included: Record review of Resident #40's face sheet dated 03/15/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included hemiplegia and hemiparesis (half body paralysis) affecting the right dominant side, dysphagia (difficulty swallowing) type 2 diabetes, hypertension, gastrostomy, muscle weakness, depression, aphasia (inability to speak) and anxiety disorder. Resident #40 was listed as her own responsible party and there was no one listed as having a financial or healthcare durable power of attorney. Resident discharged from the facility on 03/18/23. Record review of Resident #40's admission MDS dated [DATE] revealed, no serious mental illness, intellectual disability or other related conditions, admission from an inpatient rehabilitation facility, resident has unclear speech, usually makes herself self-understood, usually understood by others, moderately impaired cognitive skills for daily decision making, no acute change in mental status, continuous non-fluctuating inattention, continuous non fluctuating disorganized thinking, and no hallucinations or delusions. She was coded as having no behavioral symptoms, no rejection of care, total dependence for most ADLs, use of a wheelchair, active stroke diagnosis, anxiety disorder, depression, no diagnoses of bipolar disorder or psychotic disorder, 2-day use of antipsychotic, 6 day use of antianxiety, 7 day use of antidepressant, receiving speech therapy/occupational therapy and physical therapy. Behavioral symptoms did not trigger a care area and no care planning decision was checked. Physical restraints did not trigger a care area and no care planning decision was checked. Record review of Resident #40's undated care plan revealed, focus- hemiplegia/hemiparesis r/t stoke; intervention- give medications s ordered and pain management as needed. Focus- use of anti-anxiety medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-anxiety therapy. Focus- use of anti-depressant medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-depressant therapy. Focus- requires tube feeding r/t dysphagia; interventions- may crush medications and administer per G-tube, provide Glucerna 1.5 Cal Oral Liquid. Resident #40's care plan did not include her behaviors, refusal of care or the use of restraints. Record review of Resident #40's Hospital Records dated 02/01/23 revealed, agitation, on right upper extremity restraints. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 6 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0604 Record review of Resident #40's Physician's Orders dated 02/25/23 revealed, enteral- may crush medications and administer per G-tube. Level of Harm - Actual harm Record review of Resident #40's Order Summary Report dated 03/15/23 revealed, no orders for restraints. Residents Affected - Few Record review of Resident #40's EMR on 03/15/23 revealed , no RAP for restraints or documented informed consent for the use of restraints. Record review of the ACNO's notarized witness statement dated 03/15/23 revealed: Resident #40 accepted us but as soon as nurse began to check for placement and residual of gtube, resident swung her arms upwards toward the nurse. Writer (the ACNO) put hands out with palms open, between nurse and patients arm and guided patients arm towards writer explaining she (LVN A) was just checking placement to give medication. Writer and patient held hands once again as patient was emotional. I rubbed her arm holding her close to me reassuring her and comforted her that we were here to help her . As medication went down patient once again became irate and began swinging. Due to patient's agitation nurse stopped medication administration. Record review of the Director of Culture and Engagement's notarized statement dated 03/15/23 revealed: when helping CNA and CMA with transfer from wheelchair to bed, Resident #40 began to fight staff. Resident #40 was yelling and crying the whole time without following any instruction. Resident #40 continues to yell and cry after staffs assisted patient back to bed with 3 people total. Staff attempted to calm patient down by talking to her. Record review of CNA H 's notarized statement dated 03/15/23 revealed, Resident #40 is yelling and fighting she is very agitated today . patient refused Hoyer transfer so we 3 people transferred. Record review of LVN C's notarized statement dated 03/15/23 revealed, writer has never seen patient act like she did today. Resident #40 was yelling , I could hear her all the way to the nurses station. An observation on 03/15/23 at 09:03 AM revealed, LVN A preparing medication for administration via g-tube for Resident #40. She verified the resident information against the MAR, retrieved the medications placing them in individual cups, and crushed the medications. At 09:08 AM, LVN A entered Resident #40's room, the resident initially appeared calm in a hospital gown but as LVN A approached her right side of the bed, raising the blanket and then her gown, Resident #40 began to swat at LVN A's hands. Resident #40's right arm appeared to be paralyzed on the right side, and she moaned as she attempted to move her right arm with her left arm. Resident #40 continued to lift her right arm with her left hand, groaning and grimacing with each attempt. LVN A talked to Resident #40 stating that she would be administering pain medication to help Resident #40 and placed a pillow under Resident #40's right arm to attempt to relieve the resident's discomfort. As LVN A attempted to access Resident #40's G-tube, the resident continued to wale inaudible words and swat at LVN A's hands. The ACNO then entered Resident #40's room and said she normally needs 2 people to help administer medication via G-tube, referring to the resident. The ACNO walked to the left side of Resident #40's bed and held on to Resident #40's left hand. As Resident #40 continued to wail and swat, the ACNO held on to Resident #40 with both arms wrapped around the resident's arm, placing Resident #40's only arm in a fixed position and pulling the resident's arm closer to her body. Resident #40 continued to resist care, swinging her only moveable left arm. The ACNO continued to use force to restrict the resident's movement as she screamed inaudibly, recoiled her body and her left leg. The ACNO continued to restrain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 7 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0604 Level of Harm - Actual harm Residents Affected - Few Resident #40 as she said, stop fighting, and LVN A started to administer medication via the G-tube, checking for residual and then administering flushes and medications as Resident #40 continued to fight, rile up on her left side and wail. As Resident #40 continued to resist care, riling up as the ACNO restrained her left arm, her G-tube began to backflow. LVN A said she would stop G-tube medication administration due to Resident #40's resistance. An observation on 03/17/23 at 01:35 PM, revealed Resident #40 well dressed, well-groomed in no immediate distress lying in bed with family at bedside. An observation on 03/18/23 at 12: 08 PM revealed, Resident #40 in bed, appeared in no immediate distress with family at bedside and personal items packed. In an interview on 03/15/23 at 09:46 AM, the CNO said Resident #40 was a new admission who had just experienced a new CVA and was under psych consult. He said when Resident #40 admitted to the facility, she would not communicate her needs but was much more controlled now. The CNO said that Resident #40 needed a lot of patience, explanation, and encouragement. The surveyor informed the CNO of the observed used of force to restrict the resident's movement and when asked if facility staff are allowed to restrict a resident with force, the CNO said nursing staff should not forcefully restrict a resident's movement when care was refused but should stop and come back later. He said if a resident continues to refuse care the issue should be escalated to the MD and he was not informed that force was used during G-tube medication administration for Resident #40. In an interview on 03/15/23 at 10:05 AM, LVN A said earlier in the morning Resident #40 refused medication administration via G-tube, so she notified the NP who ordered her to administer Lorazepam as needed. She said usually, the resident's family member was at her bedside but he was not today, leaving the resident irritated and agitated. When asked if holding the resident or using force to restrict the resident's movement was acceptable, she said the ACNO had to use force to prevent Resident #40 from hitting the G-tube. She said it was a special circumstance in which force was used on 03/15/23. LVN A said when the resident initially admitted she was not able to give G-tube medications due to Resident #40's behaviors and the family got mad. In an interview on 03/15/23 at 10:38 AM, the ACNO said that Resident #40 was usually agitated, cries a lot, requires redirection, reassurance and seeing new people agitates her. She said when a resident was agitated nursing staff should redirect/reassure residents and that she was holding Resident #40 to reassure her and not using force to restrict movement. She said physical touch was Resident #40's preference and use of restraints was not allowed. The ACNO said she was hugging Resident #40's arm for Reassurance. In an interview on 03/15/23 at 10:43 AM, the NP said LVN A notified her today (03/15/23)that Resident #40 was resisting/refusing oral meds, so she ordered that the medication be administered via G-tube. She said Resident #40's resistance/refusal of medications has been ongoing since her admission [DATE]). The NP said Resident #40 was normally verbal and required distraction and redirection. She said she received a call from LVN A stating resident was refusing oral meds or she ordered her PRN meds via G-tube. The NP said that force should not be used on resident's who refuse care, but staff should try to redirect and if unsuccessful return at a later time. The NP said she was not called a second time by LVN A, and she was not informed force was used. She said Resident #40 was receiving anti-anxiety meds via IM injection at the previous facility and the use of IM medications when the resident was exhibiting behaviors/refusing care was discussed with her family and was currently pending consent with Resident #40's family. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 8 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0604 Level of Harm - Actual harm Residents Affected - Few In an interview on 03/15/23 at 01:17 PM, the CNO said the facility was a restraint free facility and that there were no orders for any residents to be restraint and that there was no situation where it would be ok to restrain a resident. He said at no point in time did LVN A and the ACNO inform him that restraints was used. When asked if resident remained agitated despite those attempts and resident fighting, would you expect them to continue with med pass , he said he would expect them to give space because maybe the patient needs more space, more time, and to give resident time to acclimate. In an interview on 03/15/23 at 02:00 PM, the VP of Clinical Operations said he was informed that there were issues passing mediations to Resident #40 via G-tube today (03/15/23) and the resident had a history of agitation and anxiety. He said he was only told staff held her hand. The VP of Clinical Operations said when a resident refuses care nursing staff should back off, give the resident space, notify the MD/family, and come back at a different time. The VP of Clinical Operations said nursing staff were not expected to use force and hugging a resident's arm to stop movement was not acceptable. He said the use of force could place residents at short term risk of psychological trauma and could increase behaviors and in the long term led to more aggressive behaviors. The VP of Clinical Operations said nurses must report all allegations of restraint use must be reported immediately to the CNO who was required to report to the state and necessary entities within 2 hours and an investigation was to be started immediately. He said failure to report restrictions places residents at risk for further restriction. In an interview on 03/15/23 at 02:50 PM, LVN A said looking back at the medication administration from this morning (03/15/23), she would handle it the same way. She said the ACNO held Resident #40's hand to stop her from pulling the G-tube An observation and interview on 03/15/23 at 03:07 PM revealed , Resident #40 in low bed. The resident was hanging half off the bed with legs dangling and feet touching the floor. Staff entered the resident's room and closed the door. Resident #40 was yelling and moaning through the closed door. The Wound Care Nurse said that the resident's observed behaviors was common, Resident #40 was usually restless and would yell, moan and or make noises. She said LVN A and everyone was aware that Resident #40 had those behaviors. In an interview on 3/15/23 at 03:19 PM, Resident #40's family member said he was notified by the facility that force was used while administering medication via G-tube to the resident and he said, what is wrong with it. The family member said that he has had to hold her hand down before in order for staff to administer medication via G-tube to Resident #40. In an interview on 03/15/23 at 03:23 PM, LVN A said restraints was when one was physically trying to stop someone from causing harm to themselves or others. She said the facility was a restraint free facility and he doesn't think this incident involved abuse because abuse would be stopping the patient against their will but Resident #40 was held for reassurance. LVN A said that normally Resident #40's family member helps her every day and when asked if force was ever used in his presence she said, sometimes he needs to do it. She said the family was aware and understands that they had to hold her hands to prevent her from moving or pulling on the G-tube. In an interview on 03/16/23 at 01:21 PM, MD A said Resident #40 admitted to the facility post CVA and had issues in her previous facility with delirium and confusion. He said the resident had metabolic encephalopathy and the only way to treat it would be to treat her symptoms of delirium and electrolyte imbalances. MD A said this was Resident #40's 3rd facility, she had dementia but was never (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 9 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0604 fully diagnosed in an outpatient environment. He said that the use of force in response to behaviors was not appropriate and he was never informed force was used on Resident #40. Level of Harm - Actual harm Residents Affected - Few In an interview on 03/22/23 at 09:53 AM, LVN A said that nursing administration was aware of the difficulties in administering medication via G-tube to Resident #40 because the family member notified the ACNO. She said when Resident #40 admitted she was unable to administer medications via G-tube so, the family was yelling at her because the resident's previous facility was able to do it so she documented it, notified the MD and the resident received a psych consult. LVN A said she knew that a resident could not be forced but the facility was working with the resident. Record review of the facility policy titled 'Restraint Policy' dated 11/2018 revealed, restraints will not be utilized without the consent of the resident and/or responsible party or will not restrain a resident against their will. The facility practices a restraint free environment unless there is an emergency situation that requires a restraint in order to protect the resident or the other residents in the facility in accordance with all state and federal requirements. Physical Restraint- means any manual method or physical or mechanical device material, or equipment attached to the resident's body, which the individual cannot remove easily, and which restricts freedom of movement or normal access to one's body. Physical restraints shall be used by this facility only when it has been determined that they are required to treat a resident's medical symptoms or as therapeutic intervention, as ordered by a physician, and based on overall assessment, a physical restraint assessment, and the care planning process. The facility shall only apply a physical restraint after obtaining the informed consent of the resident, the resident's guardian, or other authorized representative. Informed consent shall include documented information about the potential risks and benefits of all options under consideration including using a restraint, not using a restraint and alternative to restraint use. A physical restraint shall only be applied to a resident by staff who have been in-serviced in the application of the particular type of physical restraint. Record review of the facility policy titled Refusal of Treatment and Medications dated 11/2020 revealed, the facility recognizes that residents have the right to refuse medications and or treatments. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 10 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation interview and record review the facility failed to ensure all alleged violations involving abuse was reported immediately, or not later than 24 hours if the events that caused the allegation do not involve abuse and do not result serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term facilities) in accordance with State law through established procedures for 1 of 8 residents (Resident #40) reviewed for abuse in that: - LVN A failed to report use of restraint, a form of abuse, by a family member on Resident #40 prior to 03/15/23 This failure could place residents at risk of psychological harm, emotional distress and further abuse. Findings included: Record review of Resident #40's face sheet dated 03/15/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included hemiplegia and hemiparesis (half body paralysis) affecting the right dominant side, dysphagia (difficulty swallowing) type 2 diabetes, hypertension, gastrostomy, muscle weakness, depression, aphasia (inability to speak) and anxiety disorder. Resident #40 was listed as her own responsible party and there was no one listed as having a financial or healthcare durable power of attorney. Resident discharged from the facility on 03/18/23. Record review of Resident #40's admission MDS dated [DATE] revealed, no serious mental illness, intellectual disability or other related conditions, admission from an inpatient rehabilitation facility, resident has unclear speech, usually makes herself self-understood, usually understood by others, moderately impaired cognitive skills for daily decision making, no acute change in mental status, continuous non-fluctuating inattention, continuous non fluctuating disorganized thinking, and no hallucinations or delusions. She was coded as having no behavioral symptoms, no rejection of care, total dependence for most ADLs, use of a wheelchair, active stroke diagnosis, anxiety disorder, depression, no diagnoses of bipolar disorder or psychotic disorder, 2-day use of antipsychotic, 6 day use of antianxiety, 7 day use of antidepressant, receiving speech therapy/occupational therapy and physical therapy. Behavioral symptoms did not trigger a care area and no care planning decision was checked. Physical restraints did not trigger a care area and no care planning decision was checked. Record review of Resident #40's undated care plan revealed, focus- hemiplegia/hemiparesis r/t stoke; intervention- give medications s ordered and pain management as needed. Focus- use of anti-anxiety medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-anxiety therapy. Focus- use of anti-depressant medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-depressant therapy. Focus- requires tube feeding r/t dysphagia; interventions- may crush medications and administer per G-tube, provide Glucerna 1.5 Cal Oral Liquid. Resident #40's care plan did not include her behaviors, refusal of care or the use of restraints. Record review of Resident #40's Physician's Orders dated 02/25/23 revealed, enteral- may crush (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 11 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0609 medications and administer per G-tube. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #40's Order Summary Report dated 03/15/23 revealed, no orders for the use of restraints. Residents Affected - Few Record review of Resident #40's EMR on 03/15/23 revealed , no RAP for restraints or documented informed consent for the use of restraints. An observation on 03/15/23 at 09:03 AM revealed, LVN A preparing medication for administration via g-tube for Resident #40. She verified the resident information against the MAR, retrieved the medications placing them in individual cups, and crushed the medications. At 09:08 AM, LVN A entered Resident #40's room, the resident initially appeared calm in a hospital gown but as LVN A approached her right side of the bed, raising the blanket and then her gown, Resident #40 began to swat at LVN A's hands. Resident #40's right arm appeared to be paralyzed on the right side, and she moaned as she attempted to move her right arm with her left arm. Resident #40 continued to lift her right arm with her left hand, groaning and grimacing with each attempt. LVN A talked to Resident #40 stating that she would be administering pain medication to help Resident #40 and placed a pillow under Resident #40's right arm to attempt to relieve the resident's discomfort. As LVN A attempted to access Resident #40's G-tube, the resident continued to wale inaudible words and swat at LVN A's hands. The ACNO then entered Resident #40's room and said she normally needs 2 people to help administer medication via G-tube, referring to the resident. The ACNO walked to the left side of Resident #40's bed and held on to Resident #40's left hand. As Resident #40 continued to wail and swat, the ACNO held on to Resident #40 with both arms wrapped around the resident's arm, placing Resident #40's only arm in a fixed position and pulling the resident's arm closer to her body. Resident #40 continued to resist care, swinging her only moveable left arm. The ACNO continued to use force to restrict the resident's movement as she screamed inaudibly, recoiled her body and her left leg. The ACNO continued to restrain Resident #40 as she said, stop fighting, and LVN A started to administer medication via the G-tube, checking for residual and then administering flushes and medications as Resident #40 continued to fight, rile up on her left side and wail. As Resident #40 continued to resist care, riling up as the ACNO restrained her left arm, her g-tube began to backflow. LVN A said she would stop G-tube medication administration due to Resident #40's resistance. In an interview on 03/15/23 at 09:46 AM, the CNO said nursing administration was not aware that force was used for G-tube administration to Resident #40. In an interview on 03/15/23 at 10:43 AM, the NP said Resident #40's resistance/refusal of medications has been ongoing since her admission [DATE]). She said was not informed force was used during medication administration to Resident #40. In an interview on 03/15/23 at 01:17 PM, the CNO said restraints were a form of abuse and should be reported to him or the administrator immediately He said that staff had been trained already to report any suspected abuse or restraint to nursing administration. In an interview on 03/15/23 at 02:00 PM, the VP of Clinical Operations said nurses must report all allegations of abuse immediately to the CNO who is required to report to the state and necessary entities within 2 hours. The VP of Clinical Operations said that once reported an investigation is to be started immediately. He said failure to report abuse could place residents at risk for further restriction. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 12 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 3/15/23 at 03:19 PM, Resident #40's family member said he was notified by the facility that force was used while administering medication via G-tube to the resident and he said what is wrong with it. The family member said that he has had to hold her hand down before in order for staff to administer medication via G-tube to Resident #40. In an interview on 03/15/23 at 03:23 PM, LVN A said restraints is when one is physically trying to stop someone from causing harm to themselves or others. she said the facility was a restraint free facility and she didn't think this incident involved abuse because abuse would be stopping the patient against their will but Resident #40 was held for reassurance. LVN A said that normally Resident #40's husband usually helps her every day and when asked if force is ever used in his presence she said sometimes he needs to do it. She said the family was aware and understood that they have to hold her hands to prevent her from moving or pulling on the G-tube and she didn't report it because she thought it wasn't abuse. In an interview on 03/16/23 at 01:21 PM, MD A said Resident #40 admitted to the facility post CVA and had issues in her previous facility with delirium and confusion. He said that the use of force in response to behaviors is not appropriate and her was never informed force was used on Resident #40. In an interview on 03/22/23 at 09:53 AM, LVN A said that nursing administration was aware of the difficulties in administering medication via G-tube to Resident #40 because the family member notified the ACNO. She said when Resident #40 admitted she was unable to administer medications via G-tube so the family was yelling at her because the resident's previous facility was able to do it. She documented it, notified the MD and the resident received a psych consult. LVN A said she knew that a resident could not be forced but the facility was working with the resident. Record review of LVN A's Abuse Competency- Post Test dated 01/14/23 revealed, 1- abuse can be verbal, physical, mental or sexual; true. 2- if you witness abuse, you should immediately tell your supervisor; true. 5- A family may yell at a resident or treat them roughly; false. 8- everyone in the facility is responsible for watching for and reporting abuse. Record review of LVN A's Senate [NAME] 9 Acknowledgment signed 04/06/22 revealed, 2- any employee is guilty of a Class A misdemeanor (fine up to $1,000 and or up to 180 days in jail) who knowingly fails to report a situation of resident abuse or neglect. Record review of the ACNO's undated Abuse Competency- Post Test revealed, 1- abuse can be verbal, physical, mental or sexual; true. 2- if you witness abuse, you should immediately tell your supervisor; true. 5- A family may yell at a resident or treat them roughly; false. 8- everyone in the facility is responsible for watching for and reporting abuse. Record review of LVN A's Senate [NAME] 9 Acknowledgment signed 04/08/22 revealed,1- any employee violating ay rule or regulation of the licensing agency that is determined to threaten the health and safety of a resident can be liable a civil penalty of $100. To $500 for each violation. 2- any employee is guilty of a Class A misdemeanor (fine up to $1,000 and or up to 180 days in jail) who knowingly fails to report a situation of resident abuse or neglect. Record review of the facility's 'Abuse Policy revised 11/2018 revealed, Investigation- any allegation of abuse must be reported immediately to the facility Director of Nursing and Administrator . If an individual is identified in the allegation, that individual will be removed from the facility and prohibited from returning while the investigation is completed. If a staff member is identified in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 13 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0609 the allegation, they will immediately be suspended from duty until the investigation is completed. Level of Harm - Minimal harm or potential for actual harm Record review of facility's policy titled 'Abuse and Neglect' dated 10/2022 revealed, abuse may include verbal, mental, sexual, or physical abuse, corporal punishment or involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms. All facility employees . are educated that all alleged or suspected violations involving mistreatment, neglect, abuse or exploitation including injuries of unknown origin and involuntary sections and misappropriation of resident property are reported IMMEDIATELY to the administrator no later than 2 hours after alleged incident without fear of retribution, retaliation or reprisal. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 14 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews the facility failed to ensure residents who were fed by enteral means received the appropriate treatment and services to restore, if possible, oral eating skills and prevent complications of enteral feeding including but not limited to aspiration, pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities and nasal-pharyngeal ulcers for 1 of 1 resident (Resident #40) reviewed for enteral nutrition. - The facility failed to ensure Resident #40's Glucerna, a nutritional supplement, was administered via G-tube as ordered by administering it when the patient ate greater than 50% of her meal. - The facility failed to track all of Resident #40's meal intake in order to determine if the resident's Glucerna should be given. These failures could place residents at risk of insufficient nutritional supplementation and weight loss. Findings Included: Record review of Resident #40's face sheet dated 03/15/23 revealed a 74 -year-old female admitted to the facility on [DATE] with diagnoses which included hemiplegia and hemiparesis (half body paralysis) affecting the right dominant side, dysphagia (difficulty swallowing) type 2 diabetes, hypertension, gastrostomy, muscle weakness, depression, aphasia (inability to speak) and anxiety disorder. There is no diagnosis of dementia of metabolic encephalopathy included on the face sheet. Record review of Resident #40's admission MDS dated [DATE] revealed, no serious mental illness, intellectual disability or other related conditions. The resident admitted from an inpatient rehabilitation facility, resident has unclear speech, resident usually makes self-understood , usually understood by other. The resident had moderately impaired cognitive skills for daily decision making, no acute change in mental status, continuous non-fluctuating inattention, continuous non fluctuating disorganized thinking, no hallucinations or delusions. The resident had more behavioral symptoms, no rejection of care, total dependence for most ADLs, and used a wheelchair. The resident had active stroke diagnosis, anxiety disorder, depression, no diagnoses of bipolar disorder or psychotic disorder, 2-day use of antipsychotic, 6-day use of antianxiety, 7-day use of antidepressant, was receiving speech therapy/occupational therapy and physical therapy. Behavioral symptoms did not trigger a care area and no care planning decision was checked. Physical restraints did not trigger a care area and no care planning decision was checked. Record review of Resident #40's undated care plan revealed, focus- hemiplegia/hemiparesis r/t stoke; intervention- give medications s ordered and pain management as needed. Focus- use of anti-anxiety medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-anxiety therapy. Focus- use of anti-depressant medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-depressant therapy. Focus- requires tube feeding r/t dysphagia; interventions- may crush medications and administer per G-tube, provide Glucerna 1.5 Cal Oral Liquid. Resident #40's care plan did not include her behaviors, refusal of care or the use of restraints. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 15 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An observation on 03/15/23 at 09:03 revealed, LVN A preparing medication for administration via g-tube for Resident #40. She verified the resident information against the MAR, retrieved the medications placing them in individual cups, and crushed the medications. At 09:08 LVN A entered into Resident #40's room, the resident was calm lying in bed dressed in a hospital gown but as LVN A approached her right side of the bed, raising the blanket and then her gown, Resident #40 began to swat at LVN A's hands. Resident #40's right arm appeared to be paralyzed and moaned as she attempted to move her right arm with her left arm. Resident #40 continued to lift her right arm with her left hand, groaning and grimacing with each attempt. LVN A talked to Resident #40 stating that she would be administering pain medication to help Resident #40 and placed a pillow under Resident #40's right arm to attempt to relieve the resident's discomfort. As LVN A attempted to access Resident #40's G-tube, the resident continued to wale inaudible words and swat at LVNA's hands. The ACNO then entered into Resident #40's room and said she normally needs 2 people to help administer medication via G-tube, referring to the resident. The ACNO walked to the left side of Resident #40's bed and held on to Resident #40's hand. As Resident #40 continued to wail and swat, the ACNO held on to Resident #40 with both arms wrapped around the resident's arm, placing Resident #40's only arm in a fixed position and pulling the resident's arm close to her body. Resident #40 continued to resist care, swinging her only moveable left arm, the ACNO continued to use force to restrict the resident's movement as she screamed inaudibly, recoiled her body and her left leg. The ACNO continued to restrain Resident #40 as she said, stop fighting, and LVN A started to administer medication via the G-tube, checking for residual and then administering flushes and medications as Resident #40 continued to fight, rile up on her left side and wail. As Resident #40 continued to resist care, riling up as the ACNO restrained her left arm, her g-tube began to backflow resulting and LVN A said she would stop G-tube medication administration due to Resident #40's resistance. Record review of Resident #40's Physician's Orders dated 03/01/23 revealed, Glucerna 1.5 Cal Oral Liquid - give 150 ml via G-tube three times a day for nutrition only if patient eats less than 50% of her meal. Record review of Resident #40's PO Intake for 30 days dated 03/15/23 revealed, Resident #40's meal intake was partially documented on: 03/01/23 at 10:54 AM and 04:27 PM, there was no documentation of her evening meal 03/02/23 at 09:14 AM and 02:58 PM, there was no documentation of her evening meal 03/03/23 at 12:33 PM and 12:34 PM, there was no documentation of her morning and evening meals 03/04/23 at 3:09 PM and 03:10 PM, there was no documentation of her morning and evening meals. 03/05/23 at 12:26 PM, there was no documentation of her morning and evening meals 03/06/23 at 3:14 PM, there was no documentation of her morning and evening meals 03/07/23 at 12:09 PM and 2:57 PM, there was no documentation of her morning meal 03/08/23 at 4:57 PM and 4:58 PM- There was no documentation of her morning and evening meals. 03/09/23 at 12:15 PM and 12:16 PM, there was no documentation of her morning and evening meals (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 16 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0693 03/10/23 at 10:01 AM ad 4:06 PM, there was no documentation of her evening meal Level of Harm - Minimal harm or potential for actual harm 03/11/23 at 05:59 PM, there was no documentation of her morning or afternoon meals 03/12/23 at 5:20 PM, there was no documentation of her morning or afternoon meals Residents Affected - Few 03/15/23 at 5:31 PM, there was no documentation of her morning and afternoon meals Record review of Resident #40's March MAR revealed, Resident #40 was administered Glucerna 150 ml outside of physician's orders on: 03/03/23 for morning and evening schedules even though her meal intake was not documented 03/04/23 for morning and evening schedules even though her meal intake was not documented 03/08/23 for morning schedule even though her meal intake was not documented 03/11/23 for morning and afternoon dose even though her meal intake was not documented 03/12/23 for morning and afternoon dose even though her meal intake was not documented 03/13/23 for evening dose, even though her meal intake was documented as 51-75% 03/14/23 for morning and afternoon dose, even though her meal intake was not documented In an interview on 03/20/23 at 12:53 PM RD B said nutritional assessments are completed by evaluating records of their intake (eating), medication, weights and conditions. She said that nursing staff was supposed to look at the resident's tray after they eat it and document it. In an interview on 03/20/23 at 12:59 PM, the VP of Clinical Operations said the only method for tracking meal intake is in the POC. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 17 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Level of Harm - Actual harm Residents Affected - Few Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure a resident who displays or was diagnosed with a mental illness or psychosocial adjustment difficulty, or who had a history of trauma and/or post-traumatic stress disorder, received appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being for 1 of 8 Residents (Resident #40) reviewed for behavioral services. - The facility failed to appropriately treat Resident #40's behaviors by staff restraining the resident during G-tube medication administration. This use of restraints resulted in the resident experiencing acute emotional distress. - The facility failed to appropriately send notifications of Resident #40's behaviors to her attending physician resulting in the MD being unaware of the resident's continuous behaviors/refusal of care. These failures could place residents at risk of mental and psychosocial harm and injury. Findings included: Record review of Resident #40's face sheet dated 03/15/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included hemiplegia and hemiparesis (half body paralysis) affecting the right dominant side, dysphagia (difficulty swallowing) type 2 diabetes, hypertension, gastrostomy, muscle weakness, depression, aphasia (inability to speak) and anxiety disorder. She did not have a documented diagnoses of dementia, metabolic encephalopathy or any other mental disorders. Resident #40 was listed as her own responsible party and there was no one listed as having a financial or healthcare durable power of attorney. Resident discharged from the facility on 03/18/23. Record review of Resident #40's admission MDS dated [DATE] revealed, no serious mental illness, intellectual disability or other related conditions, admission from an inpatient rehabilitation facility, resident has unclear speech, is usually makes self understood, usually understood by others, moderately impaired cognitive skills for daily decision making, no acute change in mental status, continuous non-fluctuating inattention, continuous non fluctuating disorganized thinking, no hallucinations or delusions. No physical behavioral symptoms directed towards others (e.g. hitting, kicking, pushing, scratching, grabbing .), no verbal behavioral symptoms directed towards other, no other behavioral symptoms not directed towards others (hitting, scratching self, disruptive sounds No overall presence of behavioral symptoms, no rejection of care, anxiety disorder, depression, no diagnoses of bipolar disorder or psychotic disorder, 2 day use of antipsychotic, 6 day use of antianxiety, 7 day use of antidepressant, receiving speech therapy/occupational therapy and physical therapy. Behavioral symptoms did not trigger a care area and no care planning decision was checked. Physical restraints did not trigger a care area and no care planning decision was checked. Record review of Resident #40's undated care plan revealed, focus- hemiplegia/hemiparesis r/t stoke; intervention- give medications s ordered and pain management as needed. Focus- use of anti-anxiety medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 18 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Level of Harm - Actual harm Residents Affected - Few effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-anxiety therapy. Focus- use of anti-depressant medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-depressant therapy. Focus- requires tube feeding r/t dysphagia; interventions- may crush medications and administer per G-tube, provide Glucerna 1.5 Cal Oral Liquid. Resident #40's care plan did not include her behaviors, refusal of care or the use of restraints or a diagnosis of dementia. Record review of Resident #40's Hospital Records dated 01/31/23 revealed, Agitation- still has right upper extremity restrained. Record review of Resident #40's Hospital Records dated 02/01/23 revealed, agitation, on right upper extremity restraints. Record review of Resident #40's TX admission Packet dated 02/25/23 revealed, Resident #40 signed her admissions packet. The admission's document was signed on 03/03/2023. Record review of Resident #40's progress note dated 02/25/23 at 8:36 PM revealed, nursing evaluation- pt has expressive aphasia and is unable to make her needs known, completely dependent on staff or family to meet needs. Record review of Resident #40's progress note dated 02/26/23 at 08:13 AM revealed, patient refused her enteral feed and note read patient crying, yelling and combative, very agitated this morning. Patients [family] at bedside would like to skip feeing and attempt to feed her breakfast, hold until next scheduled feeding time. Record review of Resident #40's progress note dated 02/26/23 at 5:45 PM revealed, Pt agitated and anxious, yelling and striking out at staff and family members. MD notification was not documented. Record review of Resident #40's progress note dated 02/26/23 at 08:33 PM revealed, Pt would not lie still for feeding and flush, striking out at staff and yelling. MD notification was not documented. Record review of Resident #40's progress note dated 02/26/23 at 8:50 PM revealed, Additional Comments: Pt is unable to make needs known and is totally dependent on staff and family to meet needs. Pt is very anxious and agitated, yells out and strikes at staff and family members, very difficult to redirect verbally, even with family ,pt does have medication ordered that is effective for the anxiety and agitation. MD notification was not documented. Record review of Resident #40's progress note dated 03/01/23 at 8:16 PM signed by LVN D revealed, pt has frequent outbursts of agitation and is combative at times often striking staff and family members, verbal redirection not effective at all times and pt is medicated for anxiety and agitation. MD notification was not documented. Record review of Resident #40's progress note dated 03/02/23 at 04:58 AM revealed signed by LVN D, there has not been a change in the resident's baseline cognition. Pt continues to be combative and agitated with staff and family members. Pt is totally dependent on staff or family for all needs, she is unable to communicate verbally or non-verbally, frequently agitated and combative with staff and family, staff is not always able to administer meds or bolus feedings and flushes per gtube. MD notification was not documented. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 19 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Level of Harm - Actual harm Record review of Resident #40's progress note dated 03/02/23 at 10:08 AM signed by LVN A revealed, unable to administer bolus feeding or check her sugar this morning. Patient is fighting, slapping, yelling and screaming. Tried 2 times during this morning. Psych will reevaluate patient today during her rounds. Family member was at her bedside. Residents Affected - Few Record review of Resident #40's progress note dated 03/02/23 at 12:09 PM signed by LVN A revealed, medication was able to administer with bolus feeding with help of another nurse. Record review of Resident #40's undated Care Management note dated 03/02/23 at 12:27 PM revealed, an initial care management meeting was held and the Resident, Resident Representative, Therapy, and the CNO were present. There was no mention of the resident's behaviors or refusal of care and MD notification was not documented. Record review of Resident #40's progress note dated 03/02/23 at 11:49 AM signed by LVN D revealed, resident refused her 120 ml water flush via G-tube. MD notification was not documented. Record review of Resident #40's progress note dated 03/02/23 at 11:51 AM signed by LVN D revealed, resident refused her order for Glucerna 1.5 Cal Oral Liquid- 150 ml via G-tube three times a day only if resident eats less than 50% of her meal. MD notification was not documented. Record review of Resident #40's Progress Note dated 03/03/23 at 09:01 PM signed by LVN I revealed, there has not been a change in the resident's baseline cognition. There was no mood/behavior notes or additional comments. Record review of Resident #40's Progress Note dated 03/04/23 at 10:56 PM signed by LVN I revealed, there has not been a change in the resident's baseline cognition. There was no specific mood/behavior notes or additional comments. Record review of Resident #40's Progress Note dated 03/05/23 at 10:57 PM signed by LVN I revealed, there has not been a change in the resident's baseline cognition. There was no specific mood/behavior notes or additional comments. Record review of Resident #40's progress note dated 03/06/23 at 07:46 AM signed by LVN I revealed, Pt was showing signs of anxiety. Constantly fidgeting, screaming, unable to calm down. PT was given morning meds at 07:20 AM that consist of buspirone to help treat her anxiety. After the pt was given meds through G-tube, the patient aspirated 10 min later at 07:30 AM. Patient was then cleaned up. Pt has calmed down prior to oncoming shift. Notified oncoming shift, will continue to monitor. MD notification was not documented. Record review of Resident #40's Progress notes dated 03/06/23 at 4:25 PM signed by the ACNO revealed, Patient very agitated and anxious, x2 episodes of vomiting. Very agitated constantly needing to be repositioned due to almost falling out of bed. NP in facility assessed patient, new order for Zofran 4mg q6h prn and KUB. Unable to administer any PRN due to constant agitation and combative. Psych notified and ordered a 1xorder of Ativan 1mg IM. Administered and effective. Able to perform KUB, abnormalities noted. Able to administer medications and feedings as ordered. Family aware of behavior, no family at bedside today. MD notification was not documented. Record review of Resident #40's Progress Note dated 03/06/23 at 8:02 PM signed by LVN D revealed, resident refused Glucerna feeding. MD notification was not documented. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 20 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Record review of Resident #40's progress note dated 03/07/23 at 03:33 AM signed by LVN D revealed, resident refused her 120 ml G-tube water flush. MD notification was not documented. Level of Harm - Actual harm Residents Affected - Few Record review of Resident #40's Progress Note dated 03/07/23 at 08:29 PM signed by LVN D revealed, there has not been a change in the resident's baseline cognition. There was no mood/behavior notes or additional comments. Record review of Resident #40's Progress Note dated 03/08/23 at 09:37 PM signed by LVN I revealed, there has not been a change in the resident's baseline cognition. There was no mood/behavior notes or additional comments. Record review of Resident #40's Progress Note dated 03/09/23 at 09:12 PM signed by LVN I revealed, there has not been a change in the resident's baseline cognition. There was no mood/behavior notes or additional comments. Record review of Resident #40's Progress Note dated 03/10/23 at 08:20 PM signed by LVN D revealed, Pt is able to express herself for some things with gestures and sounds and is refusing formula feeding, she will acceptH2o flush and meds per tube at this time. MD notification was not documented. Record review of Resident #40's Progress Note dated 03/11/23 at 05:05 AM signed by LVN D revealed, resident refused bladder scan. MD notification was not documented. Record review of Resident #40's Progress Note dated 03/11/23 at 07:24 PM signed by LVN D revealed, Pt is able to express herself for some things with gestures and sounds and is refusing formula feeding, she will acceptH2o flush and meds per tube at this time. MD notification was not documented. Record review of Resident #40's Progress Note dated 03/12/23 at signed by LVN D 03:11 AM revealed, resident refused bladder scan. MD notification was not documented. Record review of Resident #40's progress note dated 03/12/23 at 6:00 PM signed by LVN A revealed, Medication and treatments well tolerated during dayshift. PO administration attempted with PRN Pain medication and was unsuccessful, patient refused. Family at bedside. Patient was calmed today, able to get up in WC and rolling around the facility. Record review of Resident #40's progress note dated 03/12/23 at 07:28 PM signed by LVN D revealed, Pt is able to express herself for some things with gestures and sounds and is refusing formula feeding, she will accept H2o flush and meds per tube at this time. MD notification was not documented. Record review of Resident #40's progress note dated 03/13/23 at 01:32 AM signed by LVN D revealed, Pt refused feeding, shaking head no and hand gestures, does not want the tube feeding. Pt has been eating small amounts frequently throughout the day per family members. MD notification was not documented. Record review of Resident #40's progress note dated 03/13/23 signed by LVN J revealed, behaviors were observed at 07:39 AM, 09:03 AM, 09:04 AM, and 09:05 AM. The exact behavior observed was not documented. Record review of Resident #40's Progress Note dated 03/15/23 at 10:09 AM signed by LVN A revealed, NP was doing rounds at this time, reported about patient's behavior. No new orders at this time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 21 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Level of Harm - Actual harm Record review of Resident #40's Behavioral and Psychotropic Medication Evaluation progress note dated 03/15/23 at 4:36 PM revealed, Patient noted very agitated this morning, Patient's family were not at bedside today as usually every morning. Reported to NP and received the orders to administer medication via G-Tube. Residents Affected - Few Usually, patient is calm and let nurses administer peg tube medicine when partner is at bedside. When we administer medicine in the morning, usually family hold patient's hand while nurse administer medication. Consult for Psych in place. Record review of Resident #40's progress note dated 03/15/23 at 05:47 PM revealed, MD A was doing rounds at this time, gave to this nurse verbal orders for Clonazepam 0.5 Bid schedule. Family were notified. Family signed the consents for medication. He also signed for Lorazepam 2mg/ml Q8H PRN for agitation. Record review of Resident #40's progress note dated 03/15/23 at 9:16 PM revealed, Resident #40s Clonazepam was Unable to dispense, the exact reason was not documented. Record review of Resident #40's IDT meeting summary dated 03/16/23 revealed, emergency meeting held to identify actions in patient's plan of care in regard to behaviors, diagnosis and overall-wellbeing . NP noted patient's dementia diagnosis on progress note, diagnosis was not previously listed on patient's overall diagnosis or facility care plan. It is also noted that patient had refusal of care and behaviors at previous care setting . IDT team agrees that holding hands/soothing serves as a good intervention. Hand holding has been added to the patient's care plan, acknowledging that movement is not restricted. Record review of Resident #40's progress note dated 03/16/23 at 07:21 AM revealed, entered room to check on Resident #40. Family member at bedside in recliner. Resident was quiet upon my entry. She started crying and moaning while I was speaking with [family member]. He stated that resident had a quiet night. Will continue to monitor guests well-being. He had no questions or concerns regarding her care. Record review of Resident #40's progress note dated 03/16/23 at 08:53 AM signed by the VP of Clinical Operations revealed, attempt made for peg tube medication administration. Resident kicking, screaming, and grabbing nurse's arm. Documented refusal and attempted crushed medications. Facility staff attempted to communicate with guest the importance of taking the prescribed medications. Resident again refused crushed medications. Physician notified of refusal awaiting further orders. Family aware at bedside. Record review of Resident #40's Progress notes dated 03/16/23 at 10:16 AM- 11:03 AM signed by LVN C revealed, patient refused meds, slapped writers hand. MD notification was not documented. Record review of Resident #40's Progress notes dated 03/16/23 at 12:39 PM signed by LVN C revealed, received order from MD A to send patient out for altered mental status. Record review of Resident #40's Progress notes dated 03/16/23 at 7:30 PM signed by LVN K revealed, Patient readmitted from the hospital, CR scan of head/brain and chest x-ray showed no changes or findings. The hospital did a UA which indicated the beginning of UTI and an antibiotic was prescribed. The hospital nurse said Resident #40 was anxious during the ER visit and family and other staff had to assist to comfort and reassure the resident to get through the exams. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 22 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Level of Harm - Actual harm Residents Affected - Few Record review of Resident #40's progress note dated 03/16/23 at 8:02 PM signed by LVN K revealed, pt agitated when nurse entered the room and would not allow nurse to come close/ did not allow assessment to be done. CNA and nurse entered room together. family at bedside. plan of care continues. Record review of Resident #40's progress note dated 03/16/23 at 8:41 PM signed by LVN K revealed, a morning dose of Lorazepam for anxiety was administered and the day shift nurse reported it was not effective. Record review of Resident #40's progress note dated 03/17/23 at 02:07 AM signed by LVN K revealed, nurse attempted to administer PRN Tramadol50 mg and PRN lorazepam 0.5mg crushed in apple sauce per spouse request however pt refused at this time. MD notification was not documented. Record review of Resident #40's progress note dated 03/17/23 at 02:18 AM signed by LVN K revealed, nurse repositioned Resident #40 for comfort. Family educated on plan of care. Pt refused medication to be administered PO as ordered. Record review of Review of Resident #40's progress not dated 03/17/23 at 04:43 AM signed by LVN K revealed, family member upset due to nurse not being able to give medication via gtube. explained plan of care and doctors' orders but pt.'s family continued to yell at staff and made threats to nurse. MD/NP to follow up during morning rounds. DON notified and aware pt agitated and did not allow writer to come close to her. CNA in room with nurse. Record review of Resident #40's progress note dated 03/17/23 at 05:02 AM signed by LVN K revealed, Resident #40 refused her enteral fee, did not allow the nurse to get close to her and refused care from the nurse. Family at bedside, safety checks throughout shift however pt continued to scream and kick at nurse. Record review of Resident #40's progress note dated 03/17/23 at 09:01 AM revealed, Resident #40 was under the care of MD A with dx of vascular dementia, aphasia, CVA, right hemiparesis following CVA, dysphagia, Hypertension, depression, and anxiety. Resident has behavior of shouting, grabbing, crying, refusal of care/ treatment Record review shows that patient was on restraints at some point during her stay at the hospital. Record review of Resident #40's progress note dated 03/17/23 at 02:07 AM revealed, nurse attempted to administer PRN Tramadol50 mg and PRN lorazepam 0.5mg crushed in apple sauce per spouse request however pt refused at this time. Record review of Resident #40's progress note dated 03/18/23 at 12:30 AM revealed, all medications and blood sugar checks refused by Resident #40 this am and at this time, several attempts made. Resident #40 continued to clamp her mouth shut, crying and pushing medications away. will continue to monitor for changes and report as needed. family member at bedside. Record review of Resident #40's progress note dated 03/18/23 at 2:06 PM revealed, nursing staff tried to administer medications again. Resident #40 is still refusing with pushing, and crying, family members at bedside. An observation on 03/15/23 at 09:03 AM revealed, LVN A preparing medication for administration via g-tube for Resident #40. She verified the resident information against the MAR, retrieved the medications placing them in individual cups, and crushed the medications. At 09:08 AM, LVN A entered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 23 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Level of Harm - Actual harm Residents Affected - Few Resident #40's room, the resident initially appeared calm in a hospital gown but as LVN A approached her right side of the bed, raising the blanket and then her gown, Resident #40 began to swat at LVN A's hands. Resident #40's right arm appeared to be paralyzed on the right side, and she moaned as she attempted to move her right arm with her left arm. Resident #40 continued to lift her right arm with her left hand, groaning and grimacing with each attempt. LVN A talked to Resident #40 stating that she would be administering pain medication to help Resident #40 and placed a pillow under Resident #40's right arm to attempt to relieve the resident's discomfort. As LVN A attempted to access Resident #40's G-tube, the resident continued to wale inaudible words and swat at LVN A's hands. The ACNO then entered Resident #40's room and said she normally needs 2 people to help administer medication via G-tube, referring to the resident. The ACNO walked to the left side of Resident #40's bed and held on to Resident #40's left hand. As Resident #40 continued to wail and swat, the ACNO held on to Resident #40 with both arms wrapped around the resident's arm, placing Resident #40's only arm in a fixed position and pulling the resident's arm closer to her body. Resident #40 continued to resist care, swinging her only moveable left arm. The ACNO continued to use force to restrict the resident's movement as she screamed inaudibly, recoiled her body and her left leg. The ACNO continued to restrain Resident #40 as she said, stop fighting, and LVN A started to administer medication via the G-tube, checking for residual and then administering flushes and medications as Resident #40 continued to fight, rile up on her left side and wail. As Resident #40 continued to resist care, riling up as the ACNO restrained her left arm, her g-tube began to backflow. LVN A said she would stop G-tube medication administration due to Resident #40's resistance. An observation on 03/17/23 at 08:47 AM revealed, Resident #40's family member approach LVN H as she stood at her nursing cart. He asked LVN H to administer medication via G-tube to Resident #40 but LVN H said she could not because there was not an order. The family member asked for Resident #40's MDs phone number because the facility was too scared to do anything and then walked back to the resident's room, closing the door behind him. An observation on 03/17/23 at 08:52 AM revealed, Resident #40's door shut but resident could be heard screaming in room. In an interview on 03/15/23 at 09:46 AM, the CNO said Resident #40 was a new admission who had just experienced a new CVA and was under psych consult. He said when Resident #40 admitted to the facility she would not communicate her needs but was much more controlled now. In an interview on 03/15/23 at 10:38 AM, the ACNO said that Resident #40 was usually agitated, cries a lot, required redirection, reassurance and seeing new people agitates her. In an interview on 03/15/23 at 10:43 AM, the NP said LVN A notified her that Resident #40 was resisting/refusing oral meds, so she ordered that the medication be administered via G-tube. She said Resident #40's resistance/refusal of medications has been ongoing since her admission [DATE]). The NP said Resident #40 was normally verbal and required distraction and redirection. She said Resident #40 was receiving anti-anxiety meds via IM injection at the previous facility and the use of IM medications when the resident was exhibiting behaviors/refusing care was discussed with her family and was currently pending consent with Resident #40's family. In an interview on 03/15/23 at 01:17 PM, the CNO said Resident #40 had a history of refusing care, shouting, behaviors, received antipsychotics and was on psych services. He said to his knowledge the resident didn't have a diagnosis of dementia or Alzheimer's disease. He said residents with behaviors should be care planed for behaviors because care plan should be patient centered and Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 24 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Level of Harm - Actual harm Residents Affected - Few #40's care plan should have addressed her behaviors and resisting care. He said documentation of behaviors should be accurate and reflect the state of the resident in real time. When asked if resident remained agitated despite those attempts and resident fighting, would you expect them to continue with med pass, the CNO said he would expect staff to give space because maybe the patient needed more space, more time and to give resident time to acclimate. In an interview on 03/15/23 at 02:00 PM, the VP of Clinical Operations said Resident #40 had a history of agitation and anxiety. He said that residents with behaviors and continual refusal of care should be care planed for behaviors and these behaviors should be documented in a behavioral note, on the MAR and TAR in order for staff to know about the resident's behaviors and how to approach the resident. An observation and interview on 03/15/23 at 03:07 PM revealed , Resident #40 in low bed. The resident was hanging half off the bed with legs dangling and feet touching the floor. Staff entered the resident's room and closed the door. Resident #40 was yelling and moaning through the closed door. The Wound Care Nurse said that the resident's observed behaviors was common, Resident #40 was usually restless and would yell, moan and or make noises. She said LVN A and everyone was aware that Resident #40 had those behaviors. In an interview on 3/15/23 at 03:19 PM, when Resident #40's family member was asked if he was notified by the facility that force was used while administering medication via G-tube to the resident he said what is wrong with it. The family member said he has had to hold her hand down before in order for staff to administer medication via G-tube to Resident #40. In an interview on 03/16/23 at 10:13 AM, the VP of Clinical Operations said that Resident #40 has remained combative and continues to refuse care. He said that nursing staff have been unable to provide Resident #40 medications or G-tube feeds due to her behaviors, so MD A ordered for her to be sent out for altered mental status. In an interview on 03/16/23 at 10:16 AM, the VP of Clinical Operations said that Resident #40's behaviors had increased, and earlier in the morning (03/16/23) she grabbed Family Member #1 by the throat when he was being assertive trying to get the resident to take medications via G-tube. In an interview on 03/16/23 at 11:05 AM, the Director of Admissions said she was involved in the admission of Resident #40 and she completed a bedside visit at the resident's previous fac. She said the staff who function as clinical liaisons usually meet with the resident prior to admission to complete an assessment on the resident but could not determine if a bedside visit was completed for Resident #40. The Director of Admissions said the Clinical Liaison Staff had to have clinical training or clinical credentials to assess the residents and a red, yellow, green sheet was used to determine if a resident is admitted (green), needs further clinical evaluation (yellow), or cannot be admitted (red). She said resident's that fall in the yellow grid require further evaluation by nursing prior to admission but facility was unaware of Resident #40's behaviors prior to admission and as a result no one with nursing credentials reviewed the resident's chart prior to admission. The Director of Admissions said that Resident #40's admission was determined only by the clinical liaison. She said she did not have any documentation to show Resident #40's assessment prior to admissions. In an interview on 03/16/23 at 01:21 PM, MD A said Resident #40 admitted to the facility post CVA and had issues in her previous facility with delirium and confusion . He said the resident had metabolic encephalopathy and the only way to treat it would be to treat her symptoms of delirium and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 25 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 Level of Harm - Actual harm Residents Affected - Few electrolyte imbalances. MD A said this was Resident #40's 3rd facility, she had dementia but was never fully diagnosed in an outpatient environment. MD A said he would expect to be notified of a resident's continuous refusal of care/medications/nutritional support. He said when medications or non-medical interventions are unable to control a resident's behaviors then the resident should be accessed for any acute problems or change in condition MD A said he was not informed of Resident #40's continuous refusal and the family never shared any concerns about her behaviors. He said if he was informed, he would have performed an acute assessment to identify any change of conditions and called a family meeting in regards to her behaviors. He said once the facility was unable to medically manage Resident #40 then she should have been sent out for further evaluation. In an interview on 03/16/23 at 01:48 PM, the Director or Rehabilitation said therapy completed Resident #40's initial assessment on 02/26/23 and she her chart was documented for staff to take precautions due to her aphasia and behaviors. She said on 03/15/23 Resident #30 was emotional and attempted to hit therapist. In an interview on 03/16/23 at 02:08 PM, PT A said that Resident #40 had been combative since admission and on and off. She said the resident would hit or scratch the PT staff but the resident understood the staff. PT A said that Resident #40 would grab at her family member jacket, as well as hit and swat at him during her PT sessions . She said she performed therapy with the resident on 03/15/23 and Resident #40 was the most tearful, emotional, and agitated as she had ever seen her. PT A said Resident #40 was not safe to be alone and that the resident swatted at her, so she backed away. She said she heard Resident #40 was non-compliant with medication administration the last week and would spit out her meds. In an interview on 03/16/23 at 02:35 PM, the VP of Clinical Operations said Resident #40's G-tube medication administration was discontinued by the MD and upon further review of the resident's admission records from the in hospital rehab facility, it was identified that the resident had to be physically restrained while she was in there due to her behaviors. He said no one saw it in her records, and no one saw her history of behaviors or restraints. The VP of Clinical Operations said an admission grid should be used in determining if a resident was green, yellow or red. He said since the behaviors and use of restraints was missed the resident did not go under further evaluation or nursing review prior to admission. The VP of Clinical Operations said if the facility was aware of the Resident #40's behaviors or use of restraints prior to admission they would have waited until the resident had a decrease in behaviors and was restraint free before she was admitted . In an interview on 03/17/23 at 08:42 AM, LVN H said that Resident #40 has been fighting care this morning. She said the resident would not allow her BP to be checked and refused her medication. She said Resident #40's family kept insisting that the resident receive medication through her G-tube, but the doctor had not approved administration of medication via g-tube. She said that when she last worked on Tuesday (03/14/23) Resident #40 received medication via G-tube because when she tried to give it to her by mouth the resident would take the pill and try and pocket it. LVN H said Resident #40 seemed more agitated today. In an interview on 03/17/23 at 10:10 AM, the Psychiatric Practitioner said she had only seen Resident #40 twice. She said on admission Resident #40 was screaming, restless, sporadic, impulsive and could not be redirected. The resident could not follow direction, gestures and was incoherent . The Psychiatric Practitioner said Resident #40 wasn't properly diagnosed coming into the facility and she had no prior history of mental disorders. She said that the Resident had vascular dementia and the facility was treating the symptoms with psychotropic medications. The Psychiatric Practitioner said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 26 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0742 she was not informed of R[TRUNCATED] Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 27 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of 2 of 8 residents (Resident #109, CR #1) reviewed for pharmacy services. - The facility failed to ensure that Resident #109 received her full dose of medications by not leaving the medication at the resident's bedside. - The facility failed to ensure that the Kindle Medication Room did not contain expired IV medications. These failures could place residents at risk of not receiving the therapeutic benefit of medications and/or adverse reactions to medications. Findings included: Resident #109 Record review of Resident #109's face sheet dated 03/15/23 revealed, a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included: seizures, hypertension, and UTI. Record review of Resident #109's entry MDS dated [DATE] revealed, admissions from an acute hospital stay. Record review of Resident #109's undated care plan revealed, focus- ADL self-care performance deficit and limited mobility r/t decline in functional ADLs. Record review of Resident #109's Physician's Orders dated 03/08/23 revealed the following orders: Polyethylene Glycol, a stool softener, give 17 grams by mouth one time a day for constipation. Cholecalciferol, Vitamin D 125 mcg (5000 UT)- give 1 tablet by mouth one time a day for supplement. Record review of Resident #109's Physician's Orders dated 03/10/23 revealed, Arginaid Oral packet, a nutritional supplement, give 1 packet by mouth one time a day for supplement. An observation on 03/15/23 at 08:05 AM revealed, MA A preparing medication for administration for Resident #109, 11 solid forms of medication and suspended 17 g of polyethylene glycol and 1 packet of Arginaid of in 4-8 ounces of water separately. At 08:06 AM, MA A entered Resident #109's room and administered the 11 solid medications and held the cups of Arginaid and Polyethylene Glycol to the resident's mouth to allow her to drink. MA A did not observe Resident #109 drink the entire dose of Arginaid and Polyethylene glycol, leaving the room with both suspended medications at the resident's bedside as she exited the room. An observation and interview on 03/15/23 at 08:18 AM revealed, the cups of resuspended Arginaid and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 28 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 Polyethylene Glycol still sitting on the resident's bedside tray. Resident #109 said that nursing staff normally left the liquid medications at her bedside because she consumes them slowly. In an interview on 03/15/23 at 09:46 AM, the CNO said that prior to administering medications staff must first verify the resident, medication, and explain to the resident that they will be administering medication. He said if vitals collected were within parameters, nursing staff can then administer medication to the resident making sure to observe the entire process and they were not allowed to leave medicine unattended to ensure the dose was taken. The CNO said failure to observe the entire medication process places residents at risk of receiving an incorrect dose leading to insufficient supplementation and decreased therapeutic effect. An observation on 03/15/23 at 09:56 AM revealed, the cups of Arginaid and Polyethylene Glycol on Resident #109's bed tray. Both liquids appeared to be at the same level previously observed at 08:18 AM. In an interview on 03/15/23 at 09:58 AM, MA A said that prior to administering medications to residents, nursing staff must first verify the resident information and medication against the MAR and the perform medication administration after performing hand hygiene. She said that nursing staff were expected to observe the entire administration of medication and not leave medication at the bedsid but she left the cup of Polyethylene Glycol and Arginaid at Resident #109's bedside so the resident could continue drinking it. MA A said failure to observe the entire medication administration process could place residents at risk for choking or adverse reactions and failure to treat the resident's disease state since you can't ensure the resident got the ordered dose. Record review of facility policy titled 'Medication Administration Policy' approved 09/2022 revealed, Verify the resident identity using two identifiers such as name and date of birth or picture. Verify medication name and label compared to physician order or MAR, verify dosage, and verify route of administration . Do not leave medications at bedside. Stay until medications are consumed by guest. CR #1 Record review of CR #1's face sheet dated 03/15/23 revealed, an [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: Osteomyelitis (bacterial infection of the bone), pressure ulcers, Enterococcus and Staphylococcus bacterial infections. The resident discharged from the facility on 02/12/23. Record review of CR #1's undated care plan revealed, focus- antibiotic therapy r/t osteomyelitis, wound infection, surgical debridement of pressure ulcers to both hips; focus- IV medication r/t infection-osteomyelitis. Record review of CR #1's admission MDS dated [DATE] revealed, the resident was severely impaired cognition as indicated by a BIMS score of 02 out of 15, extensive assistance to total dependence on most ADLs, use of a wheelchair, always incontinent of both bladder and bowel, stage 1 pressure ulcer, stage 2 pressure ulcer, 2 stage 4 pressure ulcers and 1 unstageable pressure ulcer. Record review of CR #1's Physician's Orders dated 01/11/23 revealed, Vancomycin 1.5gm/NS250 mL- use 1.5 g intravenously at bedtime for osteomyelitis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 29 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 An observation and interview on 03/14/23 at 09:00 AM, inventory of the 300/400 Hall Nursing Cart with LVN C revealed: - 3 expired 250 mL bags of IV Vancomycin for CR #1 LVN C said all nurses were responsible for checking the medication carts and medication rooms daily for expired medications . She said expired Vancomycin cannot be used and must be discarded in the drug disposal bin because it could be contaminated or have decreased potency and its use could lead to failure to treat the infection. In an interview on 03/20/23 at 1:48 PM, the CNO said nursing staff were expected to check the carts and medication rooms frequently for expired medications but the discharge nurse was responsible for ensuring all medications for discharged residents were pulled from circulation. He said the pharmacist is also responsible for checking the carts and med rooms for expired medications. When the CNO was asked what the risk to patients was with expired medications in the facility, the Administrator interjected and said, I have never been asked that in 30 years and the VP of Clinical Operations said there was very little risk to patients if the staff followed the patient verification process prior to use because CR #1 discharged from the facility. Record review of MA A's Competency Validation Checklist signed 10/18/22 revealed, MA A was assessed as competent in medication administration. Record review of the facility policy titled ' Medication Administration Infection Control' dated 09/2022 revealed, expired medications are to be properly discarded. Medications are labeled and expiration dates are checked regularly but not less than weekly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 30 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0759 Ensure medication error rates are not 5 percent or greater. 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 the medication error rate was not five percent (%) or greater. The facility had a medication error rate of 8 percent based on 2 errors out of 34 opportunities, which involved 1 of 7 residents (Resident #109) reviewed for medication errors. Residents Affected - Few - MA A failed to administer Resident #109's Vitamin D (cholecalciferol) as ordered by administering 25 mcg (1000 UT) instead of 125 mcg (5000 UT). - MA A failed to administer Resident #109's full dose of Polyethylene Glycol. These failures could place residents at risk of inadequate therapeutic outcomes, increased negative side effects, and a decline in health. Findings included: Record review of Resident #109's face sheet dated 03/15/23 revealed, a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included: seizures, hypertension, and UTI. Record review of Resident #109's entry MDS dated [DATE] revealed, admission from an acute hospital stay. Record review of Resident #109's undated care plan revealed, focus- ADL self-care performance deficit and limited mobility r/t decline in functional ADLs. Record review of Resident #109's Physician's Orders dated 03/08/23 revealed orders for: Polyethylene Glycol, a stool softener, give 17 grams by mouth one time a day for constipation. Cholecalciferol, Vitamin D 125 mcg (5000 UT)- give 1 tablet by mouth one time a day for supplement. An observation on 03/15/23 at 08:05 AM revealed, MA A preparing medication for administration for Resident #109. She retrieved 1 tablet of Vitamin D 25 mcg (1,000 UT) as well as 10 other solid forms of medication and suspended powdered medications including 17 grams of Polyethylene Glycol in 4-8 ounces of water. At 08:06 AM, MA A entered Resident #109's room and administered the 11 solid medications and held the cups with a liquid dietary supplement and Polyethylene Glycol to the resident's mouth to allow her to drink. MA A did not observe Resident #109 drink the entire dose of Polyethylene glycol, the cup of Polyethylene Glycol was left at the resident's bedside as she exited the room. An observation and interview on 03/15/23 at 08:18 AM revealed, the cup of suspended Polyethylene Glycol still sitting on the resident's bedside tray. Resident #109 said that nursing staff normally left the liquid medications at her bedside because she consumed them slowly. An observation on 03/15/23 at 09:56 AM revealed, the cup of Polyethylene Glycol on Resident #109's bed tray. The cup of polyethylene glycol appeared to be at the same level previously observed at 08:18 AM. In an interview on 03/15/23 at 09:46 AM, the CNO said that prior to administering medications resident's must first verify the resident, medication, and explain to the resident that they will be administering medication. He said After checking that any vitals collected are within parameters, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 31 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few nursing staff can then administer medication to the resident making sure to observe the entire process and are not allowed to leave medicine unattended to ensure the dose is taken. The CNO said failure to observe the entire medication process or administer medications as ordered could place residents at risk of receiving an incorrect dose leading to insufficient supplementation and decreased therapeutic effect. In an interview on 03/15/23 at 09:58 AM, MA A said that prior to administering medications to residents nursing staff most first verify the resident information and medication against the MAR and the perform medication administration after performing hand hygiene. She said that nursing staff are expected to observe the entire administration of medication and not leave medication at the bedside but she left the cup of Polyethylene Glycol at Resident #109's bedside so she could finish drinking it. MA A said failure to observe the entire medication administration process could place residents at risk for choking or adverse reactions and failure to treat the resident's disease state since you can't ensure the resident got the ordered dose. She said all medications should be administered as ordered. Record review of MA A's Competency Validation Checklist signed 10/18/22 revealed, MA A was assessed as competent in medication administration. Record review of facility policy titled 'Medication Administration Policy' approved 09/2022 revealed, Verify the resident identity using two identifiers such as name and date of birth or picture. Very medication name and label compared to physician order or MAR, verify dosage, and verify route of administration . Do not leave medications at bedside. Stay until medications are consumed by guest. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 32 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain medical records on each resident, in accordance with accepted professional standards and practices, which were complete and accurately documented for 8 of 15 residents (Resident # 40, Resident #7, Resident #10, Resident #24, Resident #29, Resident #31, Resident #54 and Resident #308 ) whose records were reviewed. - Nursing staff failed to properly document Resident #40's behaviors. - LVN A documented administration of Glucerna (a nutritional supplement) to Resident #40 on 03/15/23 even though it was not performed - The facility failed to ensure their system of documenting weights for residents was accurate. These failures could affect any resident, placing them at risk of inaccurate information and resulting inappropriate care. Findings included: Resident #40 Record review of Resident #40's face sheet dated 03/15/23 revealed a 74 -year-old female admitted to the facility on [DATE] with diagnoses which included hemiplegia and hemiparesis (half body paralysis) affecting the right dominant side, dysphagia (difficulty swallowing) type 2 diabetes, hypertension, gastrostomy, muscle weakness, depression, aphasia (inability to speak) and anxiety disorder. Record review of Resident #40's admission MDS dated [DATE] revealed, no serious mental illness, intellectual disability or other related conditions, admission from an inpatient rehabilitation facility, resident has unclear speech, usually makes self-understood, usually understood by others, moderately impaired cognitive skills for daily decision making, no acute change in mental status, continuous non-fluctuating inattention, continuous non fluctuating disorganized thinking, no hallucinations or delusions. No behavioral symptoms, no rejection of care, total dependence for most ADLs, use of a wheelchair, active stroke diagnosis, anxiety disorder, depression, no diagnoses of bipolar disorder or psychotic disorder, 2-day use of antipsychotic, 6-day use of antianxiety, 7-day use of antidepressant, receiving speech therapy/occupational therapy and physical therapy. Behavioral symptoms did not trigger a care area and no care planning decision was checked. Physical restraints did not trigger a care area and no care planning decision was checked. Record review of Resident #40's undated care plan revealed, focus- hemiplegia/hemiparesis r/t stoke; intervention- give medications s ordered and pain management as needed. Focus- use of anti-anxiety medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-anxiety therapy. Focus- use of anti-depressant medications; interventions- administer anti-anxiety medications as ordered, monitor for effects and effectiveness every shift, monitor/document/report PRN any adverse reactions to anti-depressant therapy. Focus- requires tube feeding r/t dysphagia; interventions- may crush medications and administer per G-tube, provide Glucerna 1.5 Cal Oral Liquid. Resident #40's care plan did not include her behaviors, refusal of care or the use of restraints. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 33 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An observation on 03/15/23 at 09:03 revealed, LVN A preparing medication for administration via g-tube for Resident #40. She verified the resident information against the MAR, retrieved the medications placing them in individual cups, and crushed the medications. At 09:08 LVN A entered into Resident #40's room, the resident was calm lying in bed dressed in a hospital gown but as LVN A approached her right side of the bed, raising the blanket and then her gown, Resident #40 began to swat at LVN A's hands. Resident #40's right arm appeared to be paralyzed and moaned as she attempted to move her right arm with her left arm. Resident #40 continued to lift her right arm with her left hand, groaning and grimacing with each attempt. LVN A talked to Resident #40 stating that she would be administering pain medication to help Resident #40 and placed a pillow under Resident #40's to attempt to relieve the resident's discomfort. As LVN A attempted to access Resident #40's G-tube, the resident continued to wale inaudible words and swat at LVNA's hands. The ACNO then entered into Resident #40's room and said she normally needs 2 people to help administer medication via G-tube, referring to the resident. The ACNO walked to the left side of Resident #40's bed and held on to Resident #40's hand. As Resident #40 continued to wail and swat, the ACNO held on to Resident #40 with both arms wrapped around the resident's arm, placing Resident #40's only arm in a fixed position and pulling the resident's arm close to her body. Resident #40 continued to resist care, swinging her only moveable left arm, the ACNO continued to use force to restrict the resident's movement as she screamed inaudibly, recoiled her body and her left leg. The ACNO continued to restrain Resident #40 as she said, stop fighting, and LVN A started to administer medication via the G-tube, checking for residual and then administering flushes and medications as Resident #40 continued to fight, rile up on her left side and wail. As Resident #40 continued to resist care, riling up as the ACNO restrained her left arm, her g-tube began to backflow resulting and LVN A said she would stop G-tube medication administration due to Resident #40's resistance. Record review of Resident #40's physicians orders dated 03/01/23 revealed, Glucerna 1.5 Cal oral liquid, give 150 ml via G-tube three times a day for nutrition only if patient eats less than 50% of her meal. Record review of Resident #40's physicians orders dated 03/07/23 revealed, Glucerna 1.5 continuously overnight via g-tube at 35 ml every 12 hours as tolerated. The order was discontinued on 03/14/23. Record review of Resident #40's Progress Notes- Comprehensive Nutrition assessment dated [DATE] at 03:31 PM revealed, Due to pt. complaints of abdominal pain r/t Glucerna boluses and improved PO intake, it could be beneficial to provide continuous night feeds of Glucerna 1.5 to minimize discomfort. Writer recommends providing Glucerna 1.5 continuously overnight via G Tube at 35mL x 12 hours as tolerated to provide an additional 630 kcals and 35g protein. Record review of Resident #40's progress notes dated 03/07/23 22:30 signed by LVN D revealed, Bolus feeding changed to continuous 12 hour feeding with 12-hour bowel rest and regular meals throughout the day. Record review of Resident #40's Match 2023 MAR revealed, LVN A administered 150 ml of Glucerna on: 03/10/23 for morning and mid-day doses 03/11/23 for morning and mid-day doses. 03/12/23 for morning and mid-day doses. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 34 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 03/15/23 for morning and mid-day doses. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #40's progress notes dated 03/15/23 at 10:09 AM revealed, NP was doing rounds at this time, reported about patient's behavior. Residents Affected - Some Record review of Resident #40's March 2023 MAR revealed, Staff documented no behaviors observed. In an interview on 03/15/23 at 01:17 PM, the CNO said staff are expected to document timely and accurately. He said documentation should mirror care given and if a resident experiences behaviors then it should be documented. In an interview on 03/15/23 at 02:25 PM, LVN A said she had not administered any Glucerna #150 ml bonuses to Resident #40 because Resident #40's orders had been changed to nocturnal continuous feeds. In an interview on 03/15/23 at 03:20 PM, LVN A said she had not administered a Glucerna 150 ml bolus to Resident #40 today (03/15/23) In an interview on 03/15/23 at 02:00 PM, the VP of Clinical Operations said facility staff are expected to document timely and accuracy He said failure to document accurately or timely can result in other staff not knowing of a resident's behaviors or how to approach the resident. Record review of the facility Weights and Vitals Exceptions report dated 03//15/23 at 08:15 AM revealed, the following residents had identified weight exceptions: - Resident #7 weight exception on 02/20/23, 17.9 lbs. severe weight loss in comparison to 02/13/23. Weight exception 02/27/23, 33.4 lbs. severe weight loss of 12.4 % in comparison to 02/13/23. Weight exception 03/07/23, 31.1 lbs. severe weight loss of 11.6% in comparison to 02/13/23. - Resident #10 weight exception on 02/21/23, 19.8 lb. severe weight loss of 11.3% in comparison to 02/19/23. Weight exception of 03/07/23- 16.6 lb. severe weight loss of 9.5% in comparison to 02/19/23. - Resident #24 weight exception on 03/07/23 12.6% 24.5 lb. weight increase from 02/26/23. 03/13/2316.8% severe weight loss of 36.7 lbs. in comparison to weight on 03/07/23 - Resident #29 Weight exception on 02/27/23 at 12:53 PM, with a 12.0% severe weight loss of 19.2 lbs. in comparison to 02/24/23. Warning by RD C - Resident #31 weight exception 02/13/23, 12. 4 lbs. severe weight loss in comparison to 02/04/23. Weight warning 02/21/23, 22.8 lbs. severe weight loss of 10.2% in comparison to 02/04/23. 02/27/23 weight exception, 24.4 lbs. severe weight loss of 11.5% in comparison to 02/04/23. Weight exception 03/06/23, 73.4 lbs. severe weight loss of 34.5% in comparison to 02/04/23. Weight exception 03/14/23, 13.4 lbs. severe weight loss of 6.7% in comparison to 02/13/23. - Resident #54 weight exception on 02/27/23, -6.4 lbs. severe loss of 14.6 lbs. in comparison to 02/25/23. 03/08 weight exception- 20.4 lbs. severe weight loss of 9% in comparison to 02/25/23. - Resident #308 weight exception on 03/13/23, 27.6 lb. severe weight loss of 9.9% in comparison to 03/02/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 35 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Record review of the facility provided document titled Significant Weight loss dated 03/18/23 revealed: Level of Harm - Minimal harm or potential for actual harm - Resident #24, -12lbs, 6% from 02/26/23 - Resident #29, notes- inaccurate admission weight, 159 lbs. (2/24/23) Residents Affected - Some - Resident #30, notes- -5 lbs., 4% from 02/27/23 - Resident #31- -16 lbs., 7.9% from 02/27/23 - Resident #308- Inaccurate admission weight, 278 lbs. (03/02/23) Resident #7 Record review of Resident #7's face sheet dated 03/19/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of morbid obesity, pressure ulcers, anemia and kidney disease. Resident discharged on 03/17/23 Record review of Resident #7'ss admission MDS dated [DATE] revealed, weight 269 lbs., no loss of 5% or more in the last month or loss of 10% or more in the last 6 months. Record review of Resident #7's undated care plan revealed, focus- potential for nutritional deficit and weight fluctuations. Intervention- evaluate weight changes. Determine percentage changed and follow facility protocol for weight change; date initiated 03/21/23. Monitor/record/report to MD PRN s/sx of malnutrition: muscle wasting, significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. Date initiated 03/21/23 An observation and Interview on 03/20/23 at 02:21 PM revealed, Resident #10 in the bathroom and unavailable. The resident said she was doing good and was getting ready to go home. Record review of Resident #7's progress notes dated 02/20/23 to 02/02/21/23 revealed no mention on Resident #7's 17.9 lbs. weight loss from 02/13/23 to 02/20/23. Record review of Resident #7's progress notes dated 02/24/23 12:22 PM revealed, comprehensive nutrition assessment- weight 250.9 lb. Current intake is 26-50%, stage 4 pressure ulcer, inadequate PO intake for wound healing. Added 30 ml liquid protein three times a day for 30 days. Maintain weight +/- 3%. There was no mention of Resident #7's 17.9 lbs. weigh loss from 02/13/23 to 02/20/23. Record review of Resident #7' progress notes dated 02/27/23 revealed, no mention of the residents 15.9 lbs. weight loss from 02/27/23 to 02/21/23. Record review of Resident #7's progress notes dated 03/07/23 3:09 PM signed by RN C revealed, comprehensive nutrition assessment- weight warning 237.7 bs., 31.1 lbs. severe weight loss of 11.6 %. Adding house shake one time a day as tolerated for 14 days to increase energy for wound healing. Record review of Resident #7's Weight and vitals summary dated 03/19/23 6:34 PM revealed, 02/13/23 10:05 PM 268.8 lbs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 36 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 02/20/23 05:59 PM 250.9 lbs. Level of Harm - Minimal harm or potential for actual harm 02/21/23 03:59 PM 250.9 lbs. 02/27/23 2:54 PM 235.4 lbs. Residents Affected - Some 03/06/23 05:47 PM 237.7 lbs. 03/07/23 03:59 PM 237.7 lbs. There are no weights after this date. Resident #10 Record review of Resident #10's face sheet dated 03/19/23 revealed, an [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included: Heart failure, hypertension and muscle weakness. Record review of Resident #10's admission MDS dated [DATE] revealed, weight 155 lbs.- no loss of 5% or more in the last month or loss of 10% in the last 6 months. Record review of Resident #10's undated care plan revealed, focus- nutritional deficit with potential for weight fluctuations; Interventions- Monitor/record/report to MD PRN s/sx of malnutrition: muscle wasting, significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. Date initiated 03/21/23. Record review of Resident #10's progress notes dated 02/21/23 revealed, no mention of residents 19.8 lb. weight loss from 02/19/23 to 02/21/23. Record review of Resident #10's Physician Note dated 02/23/23 at 06:08 AM revealed, no edema . There was no mention of weight loss. Record review of Resident #10's progress notes dated 03/02/22 at 12:30 PM revealed, comprehensive nutrition assessment- Weight loss of 20lb x 2 days was likely inaccurate weight capture. Resident was at risk for weight loss r/t low po intake, presence of pressure ulcer , age and diagnoses, however she is not receiving diuretics. Resident would benefit from oral nutritional supplement TID with meals (will order) Requested reweigh 3/2. Record review of Resident #10's weights and vitals summary dated 03/19/23 at 6:27 PM revealed, 02/19/23 01:59 AM - 175 lb. 02/21/23 07:20 AM - 155.2 lb. 03/07/23 07:19 AM - 158.4 lbs. 03/19/23 12:14 PM- 156.2 lbs. Record review of Resident #10's weight summary dated 03/22/23 at 01:17 PM revealed, Resident #10's 2/19/23 01:59 AM weight of 175. 0 lb. was struck out on 03/21/23 1:22 PM by the CNO with a note of re-weighed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 37 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Resident #24 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #24's face sheet dated 03/19/23 revealed, a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included: type 2 diabetes, chronic kidney disease, and morbid obesity. Residents Affected - Some Record review of Resident #24's admission MDS dated [DATE] revealed, weight- 192 lbs., no loss or gain of 5% or more in the last month or 10% or more in last 6 months Record review of Resident #24's undated care plan revealed, focus- potential for nutritional deficit r/t left extremity weakness with potential for weight fluctuations focus- evaluate weight changes- initiated 03/21/23. Intervention- Monitor/record/report to MD PRN s/sx of malnutrition: Emaciation (Cachexia), muscle wasting, significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. Initiated 03/21/23 Record review of Resident #24's Comprehensive Nutrition assessment dated [DATE] at 03:23 PM signed by RN A revealed, Weight 192.2 lbs. on 02 /27/23 at 12:54 PM with wheelchair scale. Record review of Resident #24's progress notes dated 03/07/23 revealed, no mention of Resident #24's 24.5 lb. weight gain from 02/26/23 to 03/07/23. Record review of Resident #24's progress notes dated 03/08/23 at 12:09 PM signed by RD A revealed, accuracy of 3/7/23 weights? Unlikely weight gain of 26.9 lbs. in 8 days . Record review of Resident #24's progress notes dated 03/13/23 revealed, no mention of Resident #24's 36.7 lb. weight loss from 03/07/23. Record review of Resident #24's progress notes dated 03/17/23 at 12:32 PM signed by RD A revealed, 3/7 weights inaccurate- unlikely weight gain of 26.9 lbs. in 8 days. Record review of Resident #24's weights and vitas report dated 03/19/23 at 6:35 PM revealed: 02/26/23 at 05:40 PM- 194.4 lbs. performed by the ACNO 02/27/23 at 12:54 PM- 192.lbs performed by the RN A 03/07/23 at 3:40 PM - 218.9 lbs. performed by RN A, weight was struck out by the dietary manager on 03/18/23 at 11:14 AM with the note incorrect documentation 03/07/23 at 05:55 PM - 218.9 lbs. performed by CNA E; weight was struck out by the dietary manager on 03/18/23 at 11:14 PM with the note incorrect documentation 03/13/23 at 3:09 PM- 182.2 lbs. performed by RN A Record review of Resident #24's progress notes dated 03/20/23 signed by RD A revealed, Resident has flagged for significant 1 month weights of ~16-18.2lbs during admission. PO intake has been consistent and appropriate for energy requirements at 76-100% of all meals. Based on previous admission in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 38 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm August 2022 and current admission, resident appears to have a usual body weight of ~185 lbs Due to appropriate, consistent PO intake, wt. loss likely r/hemiplegia ( half body paralysis)-related lean body mass atrophy. Resident #29 Residents Affected - Some Record review of Resident #29's face sheet dated 03/19/23 revealed, a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included: history of falling, dementia, muscle wasting and atrophy. No diagnosis of dialysis, heart failure or edema. Record review of Resident #29's admission MDS dated [DATE] revealed, K0200- height 65 inches, weight140 lbs. No or unknown weight loss of 5% of more in the last month or loss of 10% or more in the last 6 months. Record review of Resident #29's undated care plan revealed, on 03/21 the facility added focus- potential for nutritional deficit; interventions- evaluate weight changes, determine percentage changed and follow facility protocol for weight change. Monitor/record/report to MD PRN s/sx of malnutrition significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. Record review of Resident #29's progress notes dated 02/27/23 revealed, no mention of significant weight loss of 19.4 lbs. in 3 days, no mention of inaccurate weights or request for re-weights. Record review of Resident #29's physician's note signed on 02/27/23 at 01: 43 PM by MD B revealed, Weight: 159.4 lbs., no edema of extremities. Patient was n hydrochlorothiazide and enalapril for high blood pressure. Protein calorie malnutrition- patient had low albumin in the hospital. We will make sure she is on protein supplements. There is no mention of significant weight loss, or diuretic use for excessive fluid. Record review of Resident #29's NP note dated 02/28/23 revealed, Resident #29 was awake alert, sitting up in bed in no acute distress. The resident had no edema noted or use of diuretics. Record review of Resident #29's physician's note signed on 03/06/23 at 6:22 PM by MD B revealed, no edema of the extremities. There is no mention of Resident #29's 22.8 weight loss between 02/24/23 at 06:00 PM and 03/23 at 03:09 PM, no use of diuretics or edema. Record review of Resident #29's Comprehensive Nutritional Assessment on 03/07/23 at 12:35 PM revealed, weight on 02/24/23 is likely inaccurate or related to diuretic use due to the unlikelihood of a 19.2 lb. loss in 3 days. Current weight remaining stable around 135-140. Record review of Resident #29's weights and vitals summary dated 03/19/23 at 6:11 PM revealed: 02/24/23 at 06:00 PM- 159.4 lbs. by LVN G 02/27/23 12:53 PM- 140.2 lbs. by RNA 03/06/23 03:09 PM 136.6 lbs. by RN A 03/06/23 05:10 PM 136.6 lbs. by CNA E (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 39 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 03/13/23 03:10 PM 139.8 lbs. by RN A Level of Harm - Minimal harm or potential for actual harm Record review of Resident #29's progress note dated 03/20/23 at 05:07 PM signed by RD A revealed, Resident was incorrectly flagged for significant weight loss during admission due to inaccurate admission weight of 159 lbs. on 2/24/23. This wt. was inaccurate due to the unlikelihood of a 19.2lb wt. loss in 3 days and stable weights over the last month (2/27/23-3/23/23) ranging between ~136-140 lbs. Excluding the inaccurate admission wt. (159#) from 2/24, this resident has experienced no significant weight loss during admission. Residents Affected - Some Record review of Resident #29's weights and vitals dated 03/22/23 at 7:13 AM revealed: Resident #29's weight on 02/24/23 at 06:00 PM- 159.4 lbs. by LVN G was struck out on 03/21/23 at 11:12 PM by the CNO with the note data entry error. Resident #31 Record review of Resident #31's face sheet dated 03/19/23 revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnosis which included: seizures, hemiplegia, fluid overload and chronic kidney disease. Record review of Resident #31's admission MDS dated [DATE] revealed, weight 203 lbs. no loss of 5% or more in the last month or loss of 10% or more in the last 6 months. Record review of Resident #31's undated care plan revealed, focus- potential for nutritional deficit and weight fluctuations. Intervention- evaluate weight changes. Determine percentage changed and follow facility protocol for weight change. Monitor/record/report to MD PRN s/sx of malnutrition: muscle wasting, significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. An observation and interview on 03/20/23 at 02:36 PM revealed, Resident #31 appeared thin. He said he has lost weight but he is not hungry and there was nothing you can do about it. He said he has never been like this and even though the hospital's food was bad, the facility's food was worse. Record review of Resident #31's 02/07/23 to 02/13/23 progress notes revealed, no mention of Resident #31's, 12.4 lb. weight loss form 02/04/23 to 02/13/23. Record review of Resident #31's progress notes dated 02/14/23 signed by RD C revealed, comprehensive nutrition assessment- weight 200.6 lb., assessment- 10 lb. weight loss in 1 day noted and is likely inaccurate. Record review of Resident #31's progress note dated 02/15/23 at 10:23 AM signed by RD C revealed, weight warning, value 200.6, 24 lb. weight loss = 5.8%. See full assessment on 02/14/23. Weight loss likely inaccurate. Record review of Resident #31's progress notes dated 03/03/23 signed by RD C revealed, weight warning value 188.6 lbs. 24.4 lbs. 11.5% loss over 30 days. Shakes added to tray. Record review of Resident #31's physician's orders dated 03/07/23 revealed, house shakes with meals for supplements for 14 days. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 40 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #31's progress notes dated 03/07/23 at 2:26 PM by RD C revealed, weight warning value 139.6 lbs. Wt. from 3/6 is inaccurate due to the unlikelihood of a 49 lbs. weight loss between 02/27/23 and 03/06/23. Resident has also had gradual wt. shifts over admission likely due to fluid retention. In an interview on 03/15/23 at 12:11 PM, RD A said there were no residents monitored for weight issues/weight loss. Record review of Resident #31's weight and vitals summary dated 03/19/23 at 6:28 PM revealed:, 02/04/23 11:09 am- 213 lbs. weight was stuck out be the Dietary Manager on 03/18/23 with the note incorrect documentation. 02/04/23 06:09 PM- 213 lbs. weight was stuck out be the Dietary Manager on 03/18/23 with the note incorrect documentation. 02/07/23 5:59- 203.2 lbs. 02/13/23 04:56 PM 200.6 lbs. 02/21/23 12:36 Pm- 191.2 lbs. 02/27/23 2:55 PM 188.6 lbs. 03/06/23 3:54 PM 139.6 lbs. weight was stuck out be the Dietary Manager on 03/18/23 with the note wrong chart 03/07/23 3:57 PM 139.6 lbs. weight was stuck out be the Dietary Manager on 03/18/23 with the note wrong chart 03/09/23 11:46 PM 186.8 lbs. 03/14/23 06:21 PM 187.2 lbs. Record review of Resident #31's Order summary report dated 03/19/23 revealed, no orders for diuretics. Resident # 54 Record review of Resident #54's face sheet date 03/19/23 revealed, a [AGE] year-old male admitted to the facility on [DATE] with diagnosis of hemiplegia, morbid obesity, type 2 diabetes and difficulty swallowing. Record review of Resident #54's admission MDS dated [DATE] revealed, weight 214 lbs., no loss of 5% or more in the last month or loss of 10% or more in last 6 months. Record review of Resident #54's un dated care plan revealed, focus- nutritional deficit with potential for weight fluctuations; Interventions- Monitor/record/report to MD PRN s/sx of malnutrition: muscle wasting, significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 41 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 >10% in 6 months. Date initiated 03/21/23 Level of Harm - Minimal harm or potential for actual harm An observation an interview on 03/20/23 at 02:45 PM, Resident #54 in room, well-groomed with oxygen in place and in no immediate distress. He said he lost weight since he entered the facility and he currently weighed 202 lbs. Resident #54 said he did not have much of an appetite but does have the option to choose meals and receives a health shakes. Residents Affected - Some Record review of Resident #54's progress note dated 03/03/23 revealed, comprehensive nutrition assessment- weight 214.4 lbs., maintain weight +/- 3%. There was no mention of Resident #54's 12.6 lb. weight loss from 02/25/23 to 02/28/23. Record review of Resident #54's Progress Note dated 03/17/23 at 12:29 PM revealed, nutrition/dietary note- wt. from 02/25/23 is inaccurate due to the unlikely 15.4 lb. loss in 2 days between 02/25/23 and 02/27/23. Record review of Resident #54's weight and vitals summary dated 03/19/23 revealed, 02/25/23 11:36 AM- 227 lbs. 02/27/23 04:22 PM- 212.4 lbs. 02/28/23 12:29 PM- 214.4 lbs. 03/08/23 12:04 Pm 206.6 lbs. Resident #308 Record review of Resident #308's face sheet dated 03/19/23 revealed, a [AGE] year-old male admitted to the facility on [DATE] with diagnoses which included: type 2 diabetes, morbid obesity, repeated falls. Record review of Resident #308's admission MDS dated [DATE] revealed, weight 278 lbs.; no weight loss of 5% or more in the last month or loss of 10% or more in the last 6 months. Record review of Resident #308's undated care plan revealed, Focus- potential nutritional deficit; intervention- Monitor/record/report to MD PRN s/sx of malnutrition: muscle wasting, significant weight loss: 3lbs in 1 week, >5% in 1 month, >7.5% in 3 months, >10% in 6 months. Date initiated 03/21/23 Record review of Resident #308's Order Summary Report dated 03/19/23 at 6:52 PM revealed, protein supplement 30 ml once a day for supplement and no prescribed diuretics. Record review of Resident #308's progress note dated 03/08/23 at 10:32 AM signed by RD A revealed, comprehensive nutrition assessment- weight 278 lbs. on 03/02/23. Nutrition Monitoring and Evaluationweight to remain stable +/- 3% x 30 days. Record review of Resident #308's progress notes dated 03/13/23 revealed, no notes about resident #308's 27.6 lbs. weight loss between 03/02/23 and 03/13/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 42 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #308's progress note dated 03/17/23 signed by RD A revealed, requesting reweigh due to unlikely 28.4ln loss between 3/2 and 3/13. Record review of Resident #308's weights and vitals for March 2023 revealed the next weight measurement for Resident #308 was on 03/20/23. Residents Affected - Some Record review of Resident #308's weights and vitals summary dated 03/19/23 revealed:, 03/02/23 at 04:14 PM, 278 lbs. performed by RN C03/13/23 at 05:27 PM, 250.4 lbs. performed by LVN F Record review of Resident #308's progress notes dated 03/20/23 at 5:23 PM signed by RD A revealed, Resident was incorrectly flagged for significant loss during admission due to inaccurate admission wt. of 278# on 3/2/23. admission wt. was inaccurate due to the unlikelihood of a 28.4# wt. loss over 11 days and stabilization at ~250 between 3/13 and 3/20. Resident is also on diuretics which could cause fluctuations r/t fluid shifts. Record review of Resident #308's Weight summary dated 03/22/23 at 12:36 PM revealed, Resident #308's weight of 278.0 on 03/02/23 at 04:14 PM was struck out by the CNO on 03/21/23 at 1:10 PM with a note of re-weighed. In an interview on 3/15/23 at 2:45 PM, the Dietary Manager said he was not monitoring any patients for weights. In an interview on 03/18/23 at 09:50 AM, when the Administrator was asked for a list of residents with weight loss she said she could not provide it at that time. She said the facility was currently having an IDT meeting and will need the IDT meeting to be completed in order to provide a list of residents being monitoring for weight loss. In an interview on 031/8/23 at 11:34 with the Administrator and the VP of Clinical Operations, the VP of Clinical Operations said the IDT meeting identified an error in admissions weights . He said nursing staff were retrieving admission weights from hospital records and that most likely led to inaccurate weights being documented in resident charts. The Administrator said CNAs of the day are responsible for performing resident weights, that the weights showed up on their tasks in the POC. She said weights were documented in the POC by the CNAs. When asked if weight exceptions were supposed to be discussed daily as documented in the facility action plan dated in February, the VP of Clinical Operations said that it should have been but the errors in the weight system was not caught until the IDT meeting (held earlier in the morning of 03/18/23). The Administrator said the facility will have to redo their weight process. In an interview on 03/19/23 at 12:17 PM CNA A said all documented weights are physically taken by nursing staff on admission, weekly for 4 weeks and documented in the POC. She said CNAs had no access to hospital records to retrieve resident weights. CNA A said she completed a competency assessment for weights and vitals before she was allowed to perform those tasks by herself and she was trained to notify her nurse of any identified weight discrepancies immediately. She said she had not observed any discrepancies. In an interview on 03/19/23 at 12:35 PM, CNA B said the CNO would send out of a list of residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 43 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm to be weighed and that all weights were actually performed on the facility equipment. She said that CNAs did not have access to resident hospital records to retrieve hospital weights. CNA B said she was training prior to performing weights by the lead CNA prior to completing the tasks by herself. She said if a weight discrepancy was identified she would alert the nurse and put it in her notes. CNA B had not observed any weight discrepancies. Residents Affected - Some In an interview on 03/19/23 at 01:09 PM, CNA I said residents are weight on admission and then weekly with documentation in the POC. She said that she was trained and assessed prior to performing weights on her own. CNA I said she had no access to hospital records to retrieve weights and all documented weights were actually performed on facility equipment. She said that the nurse should be notified of any weight discrepancies, and she had not observed nor reported any. In an interview on 03/19/23 at 01:22 PM, CNA C said resident weights are collected upon admission and weekly for 4 weeks. She said all weights are documented in the POC and the tasks are assigned by assignment. CNA C said she was trained prior to performing weights on her own. She said she actually looks at the resident's previous weight and if there were any discrepancies or significant weight changes she would reweigh the resident and then notify the charge nurse. CNA C said she had not observed any significant weight changes. In an interview on 03/20/23 at 12:53 PM, RD B said a resident's weights , meal Intake, medications and health conditions are evaluating when completing a resident's nutritional assessment. When asked the importance of accurate weights when completing nutritional assessment RD B would not answer. In an interview on 03/21/23 at 11:33 AM, MD A said he does not believe Resident #10 had actual weight loss and he had no indication from reports from nursing or the RD about specific concerns, he said he was not notified of FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 44 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, comfortable, and homelike environment for 1 of 2 staff (Housekeeper A) reviewed for safe and sanitary environment for residents. - Housekeeper A had an unlabeled, undated, unnamed bottle of liquid on her housekeeping cart used for cleaning. This could place the facility at risk of inadequate disinfection and transmission of communicable diseases and infections. Findings include: Observation and interview on 3/14/23 at 10:37 with Housekeeper A deep cleaning empty resident room [ROOM NUMBER], who when asked what product/s she used to clean resident rooms and the facility, pulled a transparent plastic, unlabeled, undated, unnamed, red nozzle spray bottle, off her housekeeping cart that was more than half-way filled with a clear liquid. She was unable to provide the name of the product or the contact time for using it. She said that they get the product from a dispenser in the closet. She said she cleans rooms daily and that the resident had discharged so they were deep cleaning the room. She said that the bottles were usually labeled with the product name, and she was unsure who was supposed to ensure the bottles used on the carts were labeled. She did not know why her bottle was unlabeled but said she only refilled the spray bottle. Interview with Maintenance Director on 3/14/23 at 12:29 pm who said that he was over the housekeeping and laundry departments. He said he conducted some training with housekeeping staff, but the lead Housekeeping Supervisor was out sick and was responsible for most of the training with the housekeeping staff. He said that the facility used a bleach-based EPA approved product to clean and disinfect the facility against COVID-19 and other illnesses. In a follow up interview with Maintenance Director on 3/14/23 at 1:10 pm he said he had been mistaken, and the facility used a peroxide based cleaner, instead of a bleach-based product. When asked if the bottled cleaners used on housekeeping carts should have been labeled, he said yes. When asked who labels the bottles, he said the lead Housekeeping Supervisor. He said that housekeeping staff should know to label their bottles and have lables on all bottled cleaners on their carts. He said that he had proof of Housekeeper A's staff training and would provide it. On 3/14/23 at 1:44 pm Maintenance Director returned and said he had no proof of documentation on training of any housekeeping staff on the cleaning products used since January of 2023 and had no evidence of training on contact times for the products used. He said he had no documentation of any training on the peroxide-based products the facility was currently using. He said that the staff were trained upon hire and then periodically and perhaps lead Housekeeping Supervisor had not had the chance to in-service or train staff on the new product/s. Record review on 3/14/23 at 2:05 pm of Housekeeper A's employee file revealed she had been trained upon hire in April of 2022 with no other documentation of training until 12/22/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 45 of 46 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 676460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Webster, LLC 16130 Galveston Rd Webster, TX 77598 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 3/15/23 at 9:05 am with lead Housekeeping Supervisor who said that she had just trained her staff on the chemicals used. She said that Product A and Product B were both EPA approved cleaners. She said that prior to 3/15/23 she had not in-serviced staff because she did not have the information/MSDS for the cleaners. She said that the staff should have been in-serviced as soon as the facility switched cleaning products but that she did not have the sheets, so it had not been done. She said that she had not in-serviced any staff on product contact times and said that she should have. Record review of facility provided training dated March 2023, entitled Inservice of Labeling on Bottle and disinfection of wet contact time read in part .1. All solution must be placed into a container with label and wet contact time .2. Know the appropriated wet contact time to ensure disinfection depending on solution. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676460 If continuation sheet Page 46 of 46