Inspection·September 29, 2022

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of DON's progress notes dated 9/6/2022 Weight change note: resident with weight loss no significant changes. New Order for weekly weights x4. Record review of Resident #29 electronic weight records revealed weight dated 7/5/2022 as 182.1 lbs, weight dated 8/4/2022 as 179.8 lbs, and weight dated 9/1/2022 as 166.9 lbs. There were no records of any weekly weights taken. During an interview on 9/29/22 at 12:02 pm, DON stated whenever there was a professional recommendation, the facility's process was to run the recommendations by the physician via a communication form, if the physician agreed with the recommendations, then it will be implemented. She stated the time frame for implementing an order is 48-72 hours. She stated Resident #29 had some recent weight changes, but it was not believed that the resident had a weight loss. She stated the resident did not have any indications of weight loss, and there was no concern about the resident's diet. She stated it was believed that the facility scale was inaccurate, due to the scale being moved from the Memory Care Unit sometime in August 2022 due to ongoing renovations, and the scale needed recalibration. She stated the Dietician recommended a weekly weight x4 for Resident #29 to establish a new baseline weight for the resident. She stated she was responsible for coordinating resident weights at the facility. She admitted that Resident #29 weights had not been taken and recorded weekly since the Dietician's recommendation. She stated it was probably due to no internet connectivity, and the recent ongoing renovation within the facility. She stated the Dietician's recommendation on weekly weights x 4 did not require the physician's approval. She stated there was no risk associated with the failure to follow the Dietician's recommendation of weekly weights x4, because Resident #29 ate well, and it was believed that the scale needed recalibration due to moving it recently. During an interview on 9/29/22 at 12:18 pm, Resident #29 stated her weights were taken once monthly, around the first of the month, she stated the next weight will be taken probably around the weekend (October 1, 2022). She stated she used to be an overweight person, but she lost weight and then gained it back. She stated she wanted to loss more weight because she had arthritis and she had a lot of weight on her back. During an interview on 9/29/22 at 01:20 pm, the Dietician stated whenever she gave a recommendation, her expectation was for the facility to get a physician's approval and then implement it within 72 hours. She stated the recommendation for Resident #29 weekly weight x4 was at the physician's discretion to agree or not. She stated the weekly weight was recommended because she was aware that the facility scale was recalibrated, and there was a need to get a new baseline weight for Resident #29. However, there was no concern about the resident's diet. She also stated the weekly weight was dependent on if the resident agreed to allow staff to take her weight. She stated the negative outcome associated with the facility not following her recommendation included, Resident #29 was at risk of further weight loss, and a decline in independence. During an attempted interview on 9/29/2022 at 1:40 pm, the Physician was telephoned but there was no response. A voice message was left with a call back number. The Physician did not callback before exit. Record review of progress notes from 9/6/22 through 9/29/22 revealed there was no documentation of weight refusals. Record review of scale calibration invoice from PTOT service dated 8/1/22 and due date 8/16/22, quarterly scale calibration was the service provided. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676470 If continuation sheet Page 2 of 7 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 676470 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Caraday of Houston 6534 Stuebner Airline Road Houston, TX 77091 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of facility undated policy titled: Implementation of recommendations policy number: 06.005 read in part . Policy: Recommendations submitted by the nutrition professional, or Nutrition and Dietetics Technician Registered (NDTR), as assigned will be implemented as soon as possible, but no later than 72 hours after submission in order to ensure the best nutritional care possible for the residents of the facility. Event ID: Facility ID: 676470 If continuation sheet Page 3 of 7 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 676470 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Caraday of Houston 6534 Stuebner Airline Road Houston, TX 77091 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interviews, and record review the facility failed to ensure in accordance with State and Federal laws, all drugs and biologicals were stored securely in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for one (Medication Cart #1) of two medication carts observed for storage of medications. The facility failed to ensure the Medication Cart #1 was secured when unattended. This deficient practice could place residents at risk for loss of prescribed medications, resident's safety, and drug diversion. Findings included: Observation on 09/28/2022 at 7:16 AM revealed Medication Cart #1 observed unlocked and no person near cart in the 100 hall nursing station area. Interviewed and observation with LVN A on 09/28/2022 at 7:17AM, when LVN A was notified Medication Cart #1 was unlocked, she pressed the lock. She stated the medication cart should be locked when not attended, so people cannot get in it (she didn't continue). Observation on 09/29/2022 at 10:00 AM of Medication Cart #1 inventory revealed the following: Medication Cart #1 Left side: Drawer #1: Resident over the counter minerals/ supplement, 81 mg aspirin, cardiac meds, straws, cups, Mucinex Drawer#2: Resident locked narcotic box. Drawer#3: Resident medicated lotion, gauze, band aids, masks. Drawer #4: Resident non medicated lotion, tuberculosis syringes, blood pressure machine, diabetic machine. Medication Cart #1 Right side: Drawer #1: Diabetic testing supplies. Drawer #2: Liquid medications, exam gloves, sanitizer, tongue depressor. Drawer #3: Liquid medications, insulin auto shield. Drawer #4: Miscellaneous medication supplies, wound care supplies, pharmacy scanner, narcotic drug book. Interviewed Director of Nursing (DON) on 09/28/2022 at 8:35 AM, she stated all medication carts (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676470 If continuation sheet Page 4 of 7 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 676470 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Caraday of Houston 6534 Stuebner Airline Road Houston, TX 77091 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were to be locked when left unattended and the staff must take the key. The risk of the medication cart not being locked was anyone can get into the cart and take something out they should not have. Plan of correction was to in-service and re-educate the staff. Interviewed Administrator on 9/29/22 at 11:40 am regarding policy and procedure regarding locked medication carts. She reported the med cart should be locked by pushing the lock button in when not attended and the keys are held by the person assigned to that cart for the day. The reason the cart should be locked was to keep medications secure, prevent drug diversion, resident safety, prevent resident illness, injury or death. She reported education regarding locking medication carts is given in orientation, as needed and annually. Record review of the facility's policy, 2017 Omnicare. Page 1 of 4; 5.3 Storage and Expiration of Medications, Biologicals, Syringes and Needles read in part .Policy Statement: 3.3 Facility should ensure that all medications and biologicals, including treatment items, are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676470 If continuation sheet Page 5 of 7 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 676470 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Caraday of Houston 6534 Stuebner Airline Road Houston, TX 77091 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Caraday of Houston Based on observation, interview, and record review, the facility failed to ensure staff had the appropriate competencies and skills for 2 (DC- A and DC- B) of 6 dietary staff reviewed for Dietary support personnel. 1. The facility failed to ensure that DC- A and DC- B were working with within the active date of their food handler's certification. This failure could place residents who consumed food prepared from the kitchen at risk of food-borne illness. Findings included: During an observation of the kitchen on 9/27/22 at 11:36am, 3 Food Manager's Certifications were on display. Each certification was currently active and up to date. During an interview with the DM on 9/27/22 at 11:36am, she stated that out of 6 dietary staff members, 3 were up to date with their certifications, 1 staff member was a new hire, and DC-A and DC- B were currently working on their certification. She stated that they use to do the classes in person, but because of Covid, the in-person classes stopped, and they are now only offered online. During an interview with DC-B on 9/27/22 at 11:45am, she stated that had worked at the facility for about 9-10 years. On 9/28/22, at 9:15am, an interview was attempted with DC-B, but she was not at work. The DM stated that she would be off for the next 3 days. During an interview with DC-A on 9/28/22 at 9:39am, it was revealed that DC-A was currently working on her Food Manager's Course, and she did not have a reason as to why she did not have it completed sooner. When asked when it expired, she stated that it was believed to have been some time last year. During an interview with the HR on 9/28/22 at 11:45am, she stated that during the hiring process, she is responsible for ensuring all future employees undergo a background check, certification/licensure check, electronic medical record review, and a vaccination status check. For 3 of the dietary staff, a certification was provided. When asked about DC-B, she stated that she has her certification, but she would have to pull it up through their online portal because she did not have a printed copy. In a follow up interview with HR on 9/28/22 at 12:04pm, she stated that dietary aides do not have to acquire a certificate in a certain amount of time after hire and DC-A did not need to have a certificate because she is not a cook. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676470 If continuation sheet Page 6 of 7 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 676470 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Caraday of Houston 6534 Stuebner Airline Road Houston, TX 77091 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record Review of the facility roster reviewed on 9/28/22 revealed that DC-A is titled at the facility as a dietary cook. On 9/28/22 at 2:45pm, the policy on dietary certifications for dietary staff was requested from the administrator. The facility was not able to provide a policy on this subject because they did not have one for their facility. Record review of the requested Personnel Files form completed by the facility on 9/29/22 displayed that the licensure number and expiration date for DC-A was not available. For DC-B, a licensure number was provided, but the expiration date was not available. Record review of the facility's dietary certifications on 9/29/22 revealed that DC- A Food Manager's Certification had expired on 3/07/2021 and DC-B's Food Manager's Certification had expired on 5/13/22. During an interview with the admin on 9/29/22 at 12:17pm, it was stated that the DM thought that the staff were able to work under her license but was now aware that all staff is required to complete their Food Manager's Certification within 30 days of hire. Record review of the Texas Administration Code, Title 25, Part 1, Chapter 228 subchapter B updated August 8, 2021, indicates: . Certified Food Protection Manager and Food Handler Requirements. (d) . All food employees, except for the certified food protection manager, shall successfully complete an accredited food handler training course, within 30 days of employment. (e) The food establishment shall maintain on premises a certificate of completion of the food handler training course for each food employee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676470 If continuation sheet Page 7 of 7