Health inspection·August 13, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, which included measurable objectives and time frames to meet resident's medical, nursing, and mental and psychological needs that were identified in the comprehensive assessment for 1 out of 5 residents (Resident #8), reviewed for care plans. The facility failed to: - Update Resident #8's care plan with her correct code status and had both full code and DNR on it. The care plan also was not updated with the correct tube feeding. These failures could place residents at risk for not obtaining/maintaining their highest practicable wellbeing. Findings include: Record review of Resident #8's undated face sheet revealed she was a [AGE] year-old female originally admitted on [DATE], with the most recent admission on [DATE]. She had diagnoses of cerebrovascular infarction (stroke), hemiplegia and hemiparesis (paralysis and weakness), tracheostomy (tube into throat for breathing), gastrostomy (tube into stomach for nutrition), quadriplegia (paralysis in both arms and legs), aphasia (trouble speaking), dysphagia (trouble swallowing), and stage 4 pressure ulcer to sacral region (ulcer deep enough to show bone in the tailbone area). Record review of Resident #8's Quarterly MDS assessment dated [DATE] revealed a BIMS could not be completed because of the resident's medical condition. The resident had severely impaired cognitive skills for daily decision making. Resident #8 had impairment on both sides of her upper and lower extremities and was dependent with all ADL's (helper does all of the effort). The MDS confirmed the resident had a feeding tube and received 51% or more of her total calories through it. The MDS also revealed the resident had a stage 4 pressure ulcer and a tracheostomy. Record review of Resident #8's care plan dated 7/3/25, revealed a Focus: Advanced Care Planning: Code Status DNR (Start: 2/14/25, Revised: 7/24/25). The goal was to be informed of her right to complete the advanced directive to direct medical care (Target Date: 10/24/25, Revised: 7/24/25). The intervention was the advanced directive was completed and placed in the medical record (Start: 2/14/25). Focus: Resident #8 requests for be full code status (Start: 4/21/24, Revised: 7/24/25). The goal was that the resident's wishes and directions would be carried out in accordance with the advanced directives through the review date (Target Date: 10/24/25, Revised: 7/24/25). The interventions included arranging for clergy or social services as directed and discussing advanced directives with the resident or RP (Start: 4/21/24). Focus: Resident #8 received nutrition and hydration via g-tube (tube into stomach for nutrition) and was at risk for malnutrition and dehydration (Start: 4/21/24, Revised: 7/24/25). The goal was that Resident #8 would remain free of complications related to the g-tube (Target Date: 10/24/25, Revised: 7/24/25). Interventions included enteral (delivery of nutrients directly into digestive system) feeding: formula-Bolus (all at one time) feeding with Isosource HN 1.2 (type of feeding) 165ml TID via g-tube and flush tube with 150ml warm water before and after tube feeding administration (Start: 4/21/24.) Record review of Resident #8's Physician Orders from 7/31/25, revealed the following orders from MD H:- Code Status: Full Code. Ordered on 10/10/24 at 5:42pm. Discontinued on 1/3/25 at 10:57am.- Bolus Feeding Isosource HN 1.2 165ml TID via g-tube. Ordered on 4/17/24. Discontinued on 4/29/24 at 11:59am.- Code Status: DNR. Ordered on 1/5/25 at 1:32pm.- Enteral Feeding: Formula Two Kal HN 2.0 (type of feeding) 38ml/hr x 22hr via pump per g-tube with 275ml water flush via pump Q4hr. Ordered on 4/29/25. Record review of Resident #8's Dietary Progress Notes revealed a note from 5/15/24 at 1:41pm from RD W, revealed RD W recommended discontinuing the Isosource 1.2 bolus QID. Record review of Resident #8's Dietary Progress Notes revealed a note from 9/13/24 at 3:27pm from RD W that said the resident was receiving EN 2 Kcal HN at 45ml Qhr x 22hr. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676463 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crimson Heights Health & Wellness 19279 McKay Dr. Humble, TX 77338 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete In an observation on 7/29/25 at 9:45am, Resident #8 was lying in bed with a disconnected feeding tube next to her bed. The bag that was hanging was 2 Kal HN. In an interview on 7/31/25 at 2:50pm with the DON, she said the SW, or a nurse updated the care plan depending on what it was about. She said a nurse or the SW would update the code status or the type of tube feeding. She said the specifics of the tube feeding should not have been on the care plan because things changed so frequently. The DON said the MDS coordinator must have done a mass update on the care plans on 7/3/25 because the resident was not due for her review, and she must have missed the code status and tube feeding. She said having the incorrect code status on the care plan would not affect anything because DNR was listed in the resident's chart, and in the code book. She said the correct tube feeding was also ordered in the resident's chart so it would not have affected anything either. Record review of the facility's policy and procedure on Person-Centered Care Plan (Revised 10/1/20) read in part: .Will be reviewed and updated as needs are identified and after each MDS assessment (excluding discharge). The person-centered care plan is interdisciplinary and created to guide facility staff in providing the treatment, care and services necessary for the patient/resident to obtain and maintain the highest physical, mental, and psychosocial well-being possible. Event ID: Facility ID: 676463 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crimson Heights Health & Wellness 19279 McKay Dr. Humble, TX 77338 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 7%, based on 2 errors out of 27 opportunities, which involved 1 of 6 residents (Resident #11) reviewed for medication errors. MA V administered Oyster shell calcium instead of Calcium with Vitamin D to Resident #11 and administered Visine eye drops to both eyes instead of to the left eye only according to the Physician orders on 7/30/25. These failures could place residents at risk of inadequate therapeutic outcomes.Findings include: Record review of Resident #11's face sheet revealed a [AGE] year-old female who admitted on [DATE]. Her diagnoses included in part, mild intellectual disabilities, metabolic encephalopathy (a brain dysfunction caused by underlying metabolic disturbances, leading to symptoms like confusion, memory loss, and altered consciousness), asthma, schizophrenia, hypertension, and heart disease. Record review of Resident #'11's quarterly MDS assessment dated [DATE] revealed a BIMS score of 8 out of 15 which indicated moderate cognitive impairment. She required supervision or touching assistance with ADL care. Record review of Resident #11's care plan dated 5/23/25 revealed she had sneezing, watery eyes, scratchy throat, congestion headache related to seasonal allergies. The approach was to administer medications per order. Record review of Resident #11's Physician orders for July 2025 revealed orders for: Oyster Shell Calcium-Vit D3 500 mg - 5 mcg (200 unit); one tablet twice a day, order date 2/6/25;Visine dry eye relief 1% one drop in left eye three times a day, order date 2/6/25; In an observation on 7/30/25 at 7:28 a.m. revealed MA V prepared Resident #11's medication for administration. She prepared 14 medications which included Oyster shell calcium 500 mg (without Vitamin D) and Visine eye drops. MA V entered Resident #11's room and administered her the medication. Observation of the Visine eye drops revealed she administered one drop in Resident #11's left eye and one drop in her right eye. In an observation and interview on 7/30/25 at 7:53 a.m., MA V retrieved the Oyster shell calcium 500 mg from the medication cart and said she did not see Vitamin D3 listed as an ingredient on the medication bottle but only saw the Calcium. She said when she prepared the medication for Resident #11, she did not see the Vitamin D3 portion listed on the order. She said she did not have the combination of Calcium and Vitamin D3 available on her cart. She said the facility used to have the combination medication. She said the medication administered to Resident #11 and the medication prescribed were not same because of the Vitamin D3. She said she could notify her nurse or supervisor to change the order. MA V said the MD order for Visine eye drops was one drop in the left eye. She said she did not pay attention and should have read the directions on the order. She said the resident previously had an order for one drop in both eyes. She said the resident could have an allergic reaction. In an interview on 7/31/25 at 3:40 p.m. the DON said Resident #11 should have received whatever the order was written for. She said if the medication was not available the medication aide should mark the medication as not available, continue with the medication pass, look in the medication room for the medication and notify the nurse. She said the medication aide should not have picked up whatever was on the cart. She said when administering medications staff should read the bottle and only administer what was ordered. She said if the medication was not available it should have been documented. She said staff could also refer to the standing order and notify the MD for a change in order. The DON said when administering eye drops staff should check and verify the order. Record review of the facility's Medication Management Program revised 7/1/2016 read in part, .Preparing for the Medication Pass. 4. Authorized staff must understand. D. The 8 Rights for administering medication: . 2. The Right Drug, 3. The Right Dose. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676463 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crimson Heights Health & Wellness 19279 McKay Dr. Humble, TX 77338 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 8 residents (Residents #48, #11 and #79) reviewed for infection control.The facility failed to ensure contents from Resident #48's consumed breakfast tray did not spill onto Resident #11's and #79's unconsumed lunch tray on 7/29/25. This failure could place residents at risk of infection. Findings include:Record review of Resident #48's face sheet revealed a [AGE] year-old male who admitted on [DATE]. His diagnoses included in part, age related cognitive decline, type 2 diabetes, disturbances in tooth eruption, diarrhea, seasonal allergic rhinitis, localized swelling, mass and lump, lower limb, and asthma.Record review of Resident #11's face sheet revealed a [AGE] year-old female who admitted on [DATE]. Her diagnoses included in part, mild intellectual disabilities, metabolic encephalopathy (a brain dysfunction caused by underlying metabolic disturbances, leading to symptoms like confusion, memory loss, and altered consciousness), asthma, schizophrenia, hypertension, and heart disease.Record review of Resident #79's face sheet revealed a [AGE] year-old female who readmitted to the facility on [DATE]. Her diagnoses included in part, dementia, psychotic disturbance, anxiety, multiple sclerosis (an autoimmune condition that affects your brain and spinal cord), and hungry bone syndrome (a condition that causes low calcium levels in the blood after parathyroid or thyroid surgery or metastatic prostate cancer).In an observation and interview on 7/29/25 at 11:53 a.m. of the meal cart on the 300-hallway revealed Resident #48's breakfast tray was on the top rack and contained a half empty cup of red juice, a spoon in a bowl and a covered plate. Items on the tray appeared to be eaten ( dirty). Resident #79's lunch tray was below Resident #48's breakfast tray and appeared to be untouched ( clean). There were plastic tops on Resident #79's beverages and a cover on the plate and bowls. Resident #79's meal ticket and plastic juice lid were soiled with red juice. Red juice also appeared to be spilled on the side of the meal cart rack and on Resident #48's breakfast tray. CNA H said she just picked up Resident #48's breakfast tray and juice from the tray spilled over on other trays. She said Resident #79 had not received her lunch tray yet. CNA H removed the juice from Resident #79's lunch tray and delivered the remainder of the tray to Resident #79. She said she would replace the juice. She said she knew not to put the dirty tray right next to the clean tray. She said she honestly did not know if a dirty tray could be placed above the clean tray and was not told that would be an issue. In an observation and interview on 7/29/25 at 12:00 p.m. of Resident #11 in her room revealed she was eating her lunch. Her tray, meal ticket, and butter container were soaked with juice. CNA H said the juice from Resident #48's breakfast tray also spilled on Resident #11's tray and she tried to clean it up. In an interview on 7/29/25 at 12:50 p.m. ADON D said dirty and clean trays should not be placed together on the cart. She said CNA H informed her she messed up and put a dirty tray on top of a clean tray and contents from the dirty tray spilled. ADON D said that could be an infection control issue and residents could be at risk of an unknown virus. She said the DON and ADON conducted infection control in services, including meal tray service, all the time. In an interview on 7/29/25 at 3:53 p.m. the DON said she expected staff to remove the trays after breakfast. She said there should not be used trays stored with clean food due to infection control issues and cross contamination. She said the facility trained staff a lot on infection control.Record review of the facility's Nutrition Policies and Procedures dated 6/20/23 read in part, .meal delivery . Procedures: .13. Do not return trays to the tray delivery cart until all unserved trays have been passed . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676463 If continuation sheet Page 5 of 5