Inspection·July 23, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Short Term Memory: Intact,; Long Term Memory: Intact; Language: WNL; Fund of Knowledge: WNL. Record review of social services note dated 7/18/25 at 2:11pm revealed: SW met with resident on 7/17/25 to interview regarding allegation over weekend regarding a male CNA. SW obtained clarification about what occurred involving male CNA. Resident is able to clearly give her narrative of events including date/time and details of interaction. Resident voices she does not now or previously have any concerns having male aides assist her. She reports despite this incident she feels safe at facility and loves it here.' She had some noted disappointment and sadness about the reported information but feels much better knowing she did the right thing and letting others know what happened. She was pleasant and easy to converse with and displayed non s/s anxiety during our discussion. Voiced no desire to leave facility and remains also on psych services for on going support overall. Record review of Psychiatric Subsequent assessment dated [DATE] revealed: Reason for Referral: Depression, Sleep Disturbance, Cognitive Testing For Medical Necessity, Other; Eval of cognition. Chief Complaint: the depression is easing up. Medical Necessity for visit: Patient seen today for multiple chronic conditions requiring prescription management. Reason: increase Zoloft. History of Presenting Illness: Pt seen for follow up visit. Last seen on 7/15/25, increase Zoloft and Melatonin. On exam, pt is in broom, sleeping in bed. (sic)Behavior's assessed and the response to psychotropic medications monitored. Patient appears calm and in no acute distress. Denies issues with sleep and appetite. Denies worsening feelings of hopelessness, restlessness, helplessness, worthlessness, poor mood, or anxiety. The depression is easing up. I'm sleeping much better. Pt spent the night with family. Reports pain is improved, and she is moving better. Looking forward to final surgery in the next month and getting back mobile. Pt has an overall improved outlook on situation. Pt made an allegation towards staff member being sexually inappropriate towards her. Police were called and incident reported to state. Pt endorses feeling safe and feels she made the right call. Concerned about this incident happening to residents who would not be able to speak for themselves. Denies lingering feelings and states she has moved on. Staff no longer works at facility. Collateral Information: Per staff, no exacerbation of psychiatric symptoms related to side effects of medications. Participating in ADL's and taking medications as prescribed.SW met with resident on 7/17/25 to interview regarding allegations over weekend regarding a male CNA. SW obtained clarification about what occurred involving male CNA. Resident is able to clearly give her narrative of events including date/time and details of interaction. Resident voices she does not now or previously have any concerns having male aides assist her. She reports despite this incident she feels safe at facility and loves it here.' She had some noted disappointment and sadness about the reported information but feels much better knowing she did the right thing and letting others know what happened. She was pleasant and easy to converse with and displayed non s/s anxiety during our discussion. Voiced no desire to leave facility and remains also on psych services for on going support overall. Record review of social services note dated 7/22/25 at 7:37 pm revealed: SW and Administrator visited resident for follow up status regarding recent allegation of abuse. Resident is in her room in bed comfortable. She states she had a unstressful weekend and got a lot of good rest. When asked how she was feeling regarding the incident last week, she replied, oh, I handled it, I'm fine, he never touched me/my person, she is calm and mood pleasant. Reports she did speak to state staff today to fill them in also. Resident smiling said she had no concerns at this time. No s/s anxiety or depression observed or voiced. Record review of Resident #1's facility provider investigation report dated and reported on 7/14/25 revealed: on 7/13/25 at 9:30 pm Resident #1 reported to facility HR and Administrator that CNA A kissed her on the lips and also brushed the back of her hand against his erected penis. Skin assessment completed-No new areas of concern (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676490 If continuation sheet Page 2 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few identified. No new injuries, redness, or bruising identified. Resident was also psychosocial/emotional assessed by SW was okay and not upset or crying. Also additionally assessed through observation and was not visibly upset or tearful, but uncomfortable when telling the Administrator & DON what occurred. Alleged perpetrator was immediately suspended and removed from the schedule. Responsible party and physician were notified. PD A was notified. Resident surveys were initiated, nothing adverse noted. Staff in-service on Abuse and Neglect (sic) was initiated. Facility Investigation Findings: Confirmed. Provider Action Taken Post-Investigation: Alleged Perpetrator was terminated from employment. Staff in-services on Abuse and Neglect training is on-going and was signed as completed by facility Administrator on 7/18/25. Observation and interview with Resident #1 on 7/21/25 at 10:24 am the resident was seated in her bed, appropriately dressed, and groomed. She appeared calm and in no apparent distress and was smiling. She said she had no care concerns, and everything was going well at the facility except on the Sunday before last, when she was sexually molested by a male, CNA A. Resident #1 said she had invited CNA A to have a popsicle with her in her room, at the end of his shift and CNA A kissed her on the lips and placed her hand on his erect penis which was moist. Resident #1 said she told him after the kiss, that he was behaving inappropriately and told him no. Resident #1 said after he placed her hand on his erect penis, it was gross, and wet, and she told him to leave her room. Resident #1 said the contact was over clothing and CNA A did not touch her anywhere on her body other than the kiss. Resident #1 said she felt like she handled the situation and CNA A left her room when asked to. Resident #1 said she felt safe at the facility and had no other issues with anything or anyone. Interview with Administrator on 07/21/25 at 10:33 am who said she was aware of the allegations Resident #1 made and had already reported the incident to the state on 7/14/25, when she was originally notified about the incident. The Administrator said HR first notified her of the incident because she was the assigned room ambassador for Resident #1's daily room rounds. The Administrator said HR reported the incident to her as soon as Resident #1 told HR about the incident. The Administrator said she completed the investigation and faxed everything into the state on Friday 7/18/25. Administrator said through her investigation, the allegations were confirmed, because CNA A did not deny the allegations told them he behaved inappropriately and unprofessionally during his interaction with Resident #1. The Administrator said the only difference in the two stories was that CNA A alleged Resident #1 touched his erect penis by herself. She said he was initially suspended but then immediately terminated over the phone and had not been back inside the building since the date of the incident which was Sunday 7/13/25 on the 2-10 shift. She said CNA A was only a prn staff member and worked throughout the building. She said the police were called and a report taken. The Administrator said Resident #1 has said and to her knowledge, continues to say she did not want to press charges against CNA A. The Administrator said there had been no other complaints or allegations against CNA A during the short time he worked at the facility which she said was for less than a month. Interview with HR on 7/21/25 at 11:51 am, HR said Resident #1 reported to her during her ambassador room rounds the morning of 7/14/25 that CNA A came to her room to have popsicles after she invited him to have a popsicle, and he kissed her on the lips and brushed her hand against his erect penis and his pants were moist. HR said Resident #1 told her she told CNA A to leave, and he left without any further contact or issue. HR said she was witness with Administrator of telephone interview with CNA A and a recorded transcript was part of the facility investigation evidence. HR said CNA A did not deny the kiss or inappropriate interaction and only refuted that he placed Resident #1's hand on his erect penis. He alleged Resident #1 touched his penis herself. CNA A was hired by the previous HR person as prn staff and only worked prn at the facility. HR said CNA A worked at several area (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676490 If continuation sheet Page 3 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few facilities prn and had a full-time position as transportation at another area SNF. HR said during orientation each department manager explained their department and there were also videos on ANE. HR said all of CNA A's criminal background, EMR and NA checks were completed before his hire/offer letter and came back clean. She said they also completed reference checks on CNA A and completed reference checks on all staff before hire because it was a requirement of the company. Interview with SW on 7/21/25 at 4:02 pm who said she interviewed and assessed Resident #1 a day or so after the incident because Resident #1 had been out on pass with family. SW said Resident #1 reported she had never met CNA A prior to her stay at this facility and only had one previous experience with CNA A providing care for her without any sexual inappropriateness. Resident # 1 told SW she did not feel uncomfortable with CNA A before the incident which occurred on Sunday, 7/12/25, around 8:30 pm. SW said Resident #1 reported she asked CNA A to help her get a popsicle from her bedside refrigerator/freezer and offered CNA A one. CNA A told Resident #1 he would return later at the end of his shift or after his shift. SW said Resident #1 reported to her she was sitting on the end of the foot of her bed (which was usual behavior for Resident #1), and CNA A made a comment saying Resident #1 was so beautiful and then kissed her on the lips. Resident #1 said she told CNA A no and told him it was inappropriate and then they traded popsicles licking one another's popsicles, when CNA A grabbed her hands and placed them around his popsicle and cupped his hands around hers like a shaft and was standing in front of Resident #1. SW said Resident #1 recognized CNA A was erect and took her hand and placed it on his erect penis over his pants and Resident #1 reported it was wet. Resident #1 stated she told him to leave and told him she was reporting the incident to her family member]. Resident #1 said CNA A mouthed shush and left. SW said Resident #1 was back and forth on pressing charges and to her knowledge continued to decline to press charges against CNA A. SW said she conducted safety rounds on all units except short term unit and there were no other allegations of ANE. Record review of facility provided staff Daily Assignment Sheets on 7/22/25 at 4:55 pm revealed CNA A was documented as being assigned to work 400 hall and 400 Front on 7/13/25. Telephone interview with Resident #1's RP on 7/21/25 at 4:51 pm she stated Resident#1 and facility reported that CNA A had sexually assaulted her Resident #1. Resident #1's RP stated based on statement Resident #1 gave her, CNA A was her nurse for the night and when Resident #1 put on her call light CNA A responded and Resident #1 asked CNA A to get her a popsicle and then offered CNA A one. Resident #1's RP reported Resident #1 told her CNA A returned to Resident #1's room at the end of his shift and Resident #1 told her they were just hanging out and talking and then things got weird because they began swapping popsicles. Resident #1 said CNA A handed Resident #1 his popsicle on the shaft side and then pulled her legs off the bed, so they were facing one another and kissed her on the lips. Resident #1's RP said police were called and they (Resident #1's RP and Resident #1) had changed their minds and would be pressing charges. Resident #1's RP said she remained concerned because the facility still employed CNA A's family member that looked like him. Interview with MA A on 7/21/25 at 4:58 pm said she worked the night of the incident but did not know anything happened until the next day. MA A state Resident #1 told her she asked CNA A for her candy and lollipops and CNA A allegedly placed her hands on his privates and told her he could be her lollipop. Resident #1 told her the police came, and she had already spoken with the Administrator and her RP. MA A said she worked with CNA A at a different facility and was familiar with him over the last 10 years. MA A said she never heard of any other sexual complaints against CNA A. MA A said Resident #1 did not seem upset or scared, and she had not seen CNA A since the alleged day of the incident. MA A said the night of the incident CNA A had been pulled to work Resident #1's hall/unit because another staff member had called in. MA A said she had been trained on ANE (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676490 If continuation sheet Page 4 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few upon hire and multiple times per month and was able to articulate two examples and said she would report anything immediately to abuse coordinator who was also the Administrator. Telephone interview with CNA A on 7/22/25 at 11:34 am said Resident #1 was friendly with him and frequently complimented him on his appearance. CNA A said he only had a couple of encounters with Resident #1 while working at the facility and was assigned to her care on the day of the incident which was a Sunday. CNA A said throughout the day, they had little discussions about nothing serious and then the topic of eating popsicles came up and Resident #1 asked him to have a popsicle date. He said he came back towards the end of his shift between 9:00 pm and 9:30npm and they were having popsicles, sitting, and talking. CNA A said he was seated on Resident #1's rolling walker seat and Resident #1 was seated to the side of her bed with her legs dangling and they were facing each other. CNA A said Resident #1 asked him if he could keep a secret about their friendship and he replied that he could and asked her the same and Resident #1 replied that she would. CNA A said they discussed a friendship and began speaking about past relationships and exes after Resident #1 asked him if he had a girlfriend and asked why he was single because he was so [NAME] and he complimented Resident #1 back. CNA A said they ended up hugging twice when he got up to leave and say goodbye, he backed up they smiled at each other and lingered and then they kissed each other on the lips. He said it was a peck and then they hugged again and pecked on the lips again, no tongue or anything and no hands touching or rubbing body parts or anything. CNA A said he let his guard down and made a mistake. He said they were holding hands when he stood up, and he had her hand in his hand, and he took her hand and grazed his penis and Resident #1 then grabbed his penis and started rubbing it. CNA A said nothing came out of his penis. CNA A said he had been trained on ANE upon hire at the facility and had been trained on sexual abuse. CNA A said he did not consider the incident with Resident #1 abuse or sexual abuse or assault because he felt like Resident #1 provoked and initiated the interactions and the incident was consensual. CNA A said Resident #1 was never coerced, and nothing was malicious. CNA A said it was wrong, it was a mistake, but it happened, and it was unprofessional. CNA A said nothing like this had ever happened before in his CNA career and he had a bad couple of days over a 2-3-day span in the days leading up to the incident. CNA A said he felt like a buildup things in his personal life mixed with a combination of stress and pressure just made him act out of character. CNA A said the police had not contacted him to date and reiterated that there was no under clothing contact of any kind. CNA A said he had a family member that looked like him who also worked at the facility. Follow up interview and observation with Resident #1 on 7/23/25 at 10:52 am who was laying in her bed. She was appropriately dressed and groomed with her call light and hydration within reach. She appeared calm and relaxed. Resident #1 said she did not report the incident to anyone the night it happened. Resident #1 said she called her best friend after the incident that evening but did not report anything to any facility staff member or her family. Resident #1 said she did not report the incident to any staff member that night because she felt like she handled things. Resident #1 said she did not feel threatened or afraid because she had worked with men all her life and was a [NAME] in clubs in her past life. Resident #1 said she had a conversation about her history as a club [NAME] with CNA A on one separate occasion prior to the incident and felt like maybe CNA A was thinking about the previous conversation during the incident on Sunday. Resident #1 said she was uncomfortable during the incident but never afraid of CNA A but felt like he could do it to someone else who was not as alert and with it as she was. Resident #1 said CNA A never pulled the privacy curtain around them during the interaction and her roommate was in the bathroom. Resident #1 said she reported the incident to HR the next morning and HR brought the Administrator back to her bedside and at the same time her daughter showed up (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676490 If continuation sheet Page 5 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few to visit her, so the reporting of everything happened simultaneously. Resident #1 said the police arrived a short time after and took statements. Resident #1 said she did not want to press charges against CNA A because she did not want to put herself or her family through any ordeal and wanted to just focus on her upcoming surgery, recovery and planned to go home. Observation and Interview with Resident #2 on 7/23/25 at 11:01 am who was observed wheeling herself out of the shared bathroom inside the double occupancy room via her wheelchair. She was appropriately dressed and groomed and returned to her side of the room and her bed and said she did not recall hearing or seeing anything happen between her roommate (Resident #1) or anyone. Resident #2 said no male CNA or any CNA had ever touched her or spoken to her in any inappropriate way. Resident #2 said she had no issues or concerns and liked living at the facility. Resident #2 said staff were friendly and nice and had never witnessed anyone being inappropriate or kissing and touching her roommate or anyone else. Follow up interview with facility Administrator on 7/23/25 at 9:37 am who said they had not conducted a QAPI of the incident but one was scheduled for next week. Administrator said they helped prevent ANE and checked to ensure there was no ANE through daily ambassador rounds that included all department heads conducting daily rounds on a specific set of resident rooms. Administrator said HR was the ambassador responsible for conducting daily rounds with Resident #1. Administrator they also tried to prevent resident ANE through their on-going staff trainings and hiring processes that included EMR and licensure checks and verifications, criminal background and misconduct registry checks and orientation which were all conducted prior to on-boarding staff or having them work with residents. She said they also conducted reference checks and followed up on grievances as well as, employee competencies and performance evaluations. The Administrator said Resident #1 reported the incident to HR who was also her room ambassador the day after the incident and HR reported it to her as the Abuse Coordinator. Administrator said she was unsure if CNA A had family member that resembled him and confirmed CNA A's family member worked at the facility as a MA. The Administrator said CNA A's family member worked on Resident #1's hall but was instructed not to provide care for her. The Administrator said she was unsure if any male direct care providers were still assigned to Resident #1 and said Resident #1 had not requested to have no male care providers. Administrator also said she did not refer CNA A to the NA registry because she tried 3 years ago and was told she could not do it by the state. Record review on 7/22/25 at 5:01pm of local PD email to facility that revealed: the report has been completed. Due to the nature of this report, it is not releasable. Attempted to contact local PD Officer A via telephone contact number provided on 7/22/25 5:30pm and received recorded message that number was not a working number. Record review of the facility's document titled, Reporting Abuse to Facility Management dated 2020 revealed in part, 1. Our Facility will not condone resident abuse, by anyone, including associates (associates herein refer to covered individuals), staff members, physicians, consultants, volunteers, staff of other agencies serving the resident, family members, legal guardians, sponsors, other residents, friends, or other individuals. The facility will not employ persons who have been found guilty of abuse, neglect, or mistreatment or have had a finding entered into a state registry or licensing authority concerning such behaviors.d). Sexual abuse is non-consensual sexual contact of any type with a resident and is defined as, but is not limited to, sexual harassment, sexual coercion, or sexual assault. Record review of the facility's document titled Responding to Residents' Sexually Inappropriate Behavior dated 2017 revealed in part, Learning Objectives.Identify six potential reasons for residents to display sexually inappropriate behavior.content Outline.Need for touch.Desire for relationship.Helpful responses to inappropriate sexual behaviors include: Responding firmly and respectfully.Redirecting the behavior.Discussing the behavior with interdisciplinary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676490 If continuation sheet Page 6 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few team.Asking for help.Don't encourage the behavior. On 7/22/25 at 3:05 p.m., the facility's Administrator and DON were notified of the past noncompliance IJ. A plan of removal was not requested. An IJ template was provided to the Administrator on 7/22/25 at 3:05 p.m. Interviews were conducted with staff on 7/21/25 from 10:33 am until 4:58 pm including Administrator, HR, SW and MA A and 7/23/25 from 9:37 am until 4:33pm including LVN B, CNA B, MA B, DM, Transport, DOR, Maintenance Director, Cook, Dishwasher A, Dishwasher B, RN A, LVN C, and RN B to verify staff in-service trainings were conducted and validate staff understanding of information presented to them. No concerns were found regarding understanding of requirements, training material, and expectations. MA A, LVN B, LVN C, RN A, RN B, MA B, HR, SW, DOR, DM, Transport, CNA B were able to explain the importance of recognizing abuse and neglect and reporting as well as immediately reporting abuse to the abuse coordinator. Interview with CNA B on 7/23/25 at 11:42 am said he worked at facility for 3 years and never witnessed any ANE or any sexually inappropriate behaviors or interactions between staff and residents. CNA B said he was trained on ANE upon hire and had regular in-service trainings at least monthly. He said the facility had provided an in-service training last week or so and it was specifically on dealing with sexual behaviors and what to do if a resident is flirtatious or has sexually inappropriate behaviors. CNA B said he would politely remove himself from the situation if approached in an inappropriate manner by a resident and he would report it to charge nurse to help find someone else to provide care for the resident and then the Administrator/DON for another assignment. CNA B was able to articulate 3 examples of ANE and said they would report immediately to Abuse Coordinator who was also the Administrator. Interview with MA B on 7/23/25 at 12:22 pm. MA B family member of CNA A. MA B said he was trained on ANE upon hire and almost weekly since then. MA B said he had only worked at the facility a couple of weeks and did not provide care to Resident #1 as instructed. MA B was able to articulate sexual, physical, emotional and misappropriation as examples of ANE and said he had not witnessed any ANE at the facility. MA B said if he did ever witness any ANE he would immediately report it to the Administrator who was also the Abuse Coordinator. MA B said they had specific in-service training on how to handle sexual behaviors in residents about one week ago. MA B said he would remove himself from any inappropriate situation and report to charge nurse first, so someone else could care for the resident and then report to DON and Administrator so his assignment could be changed. Interview on 7/23/25 at 12:25 pm with DM who said he had been trained on ANE including sexual behaviors when he was hired and again last week. DM articulated physical, verbal, and sexual as examples of ANE and said staff also completed monthly in-service trainings that included ANE. DM said he would report any ANE immediately and if approached by any resident sexually or inappropriately he would be polite and professional but remove himself from the situation and report it immediately to Administrator. Interview on 7/23/25 at 12:27 pm with facility Transport who said he had been trained on ANE during orientation and again last week which included specific training on sexual behaviors and interactions. Transport was able to articulate verbal, physical and mental as examples of ANE. Transport said they would report any ANE immediately to Administrator. Transport said if they were approached by a resident inappropriately, they would politely deflect and immediately report to Administrator. Interview on 7/23/25 at 12:30 pm of DOR who said he was trained on ANE upon hire, yearly and anytime there was an incident, or anything happened at the facility. DOR said they had been trained last week on ANE and sexual behaviors after an incident at the facility involving a staff member and a resident. The DOR said they had never witnessed any ANE and was able to articulate 3 examples of ANE. The DOR said they would report any type of ANE to Administrator immediately because she was also the Abuse Coordinator. The DOR said they also completed annual CEU[TT10] trainings that included ANE (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676490 If continuation sheet Page 7 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete training. Interview on 7/23/25 at 12:34 pm with Maintenance Director who said they had worked at facility for 3 years and had never witnessed any ANE. Maintenance Director said they had ANE training when hired and at least monthly. Maintenance Director said they had another in-service training last week on ANE and sexually inappropriate behaviors and how to respond, last week. The Maintenance Director said physical, verbal, sexual and isolation and restraints were examples of ANE, and he would report any type of ANE to Administrator immediately. Interview on 7/23/25 at 12:38 pm with [NAME] who said he worked the evening shift at the facility. The [NAME] said they had ANE training during their orientation for hire and at least every 6 months. The [NAME] articulated theft/misappropriation, verbal and mental as examples of ANE and said he would report anything to the facility Abuse Coordinator who was the Administrator, immediately. Interview on 7/23/25 at 12:40 pm with Dishwasher A who said he worked day shift and had worked at the facility for 2 years. Dishwasher A said they had been trained on ANE upon hire and at least every 90 days. Dishwasher A articulated verbal and physical as examples of ANE and said they would report anything to Administrator immediately. Dishwasher A said they rarely come into direct contact with any of the residents, but if they were approached by a resident in a sexual manner, they would immediately politely excuse themselves from the situation and report to charge nurse if after hours and to Administrator during regular hours. Interview with Dishwasher B on 7/23/25 at 12:42 pm he said he worked evening shift and only worked at the facility for a few months. Dishwasher B said they were trained on ANE upon hire and had another training a week ago that included sexual behaviors and how to handle inappropriate conversations and sexual behaviors. Dishwasher B said they rarely come into contact with any of the residents but would immediately excuse himself form any inappropriate situation and tell his supervisor and then call the administrator. Dishwasher B was able to articulate verbal and physical as examples of ANE. Interview with RN A on 7/23/25 at 2:12 pm who said they worked on 400 hall and had been working as the charge nurse on that hall since February of 2025, on the evening shift. RN A said they were not working the date of the incident between Resident #1 and CNA A. RN A said they heard about the incident later and had ANE trainings upon hire and again last week that included training in how to deal with residents with sexual behaviors and dementia and things like that. RN A said physical, sexual, verbal, and mental were some examples of ANE and said he had not witne Event ID: Facility ID: 676490 If continuation sheet Page 8 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0641 Ensure each resident receives an accurate assessment. 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 each resident receives an accurate assessment reflecting the resident's status for 3 of 23 residents reviewed for assessment accuracy (Residents #7, #58, #63, #99).Bed rails used for positioning and turning were coded on the MDS as physical restraints for Residents #7, #58, #63, #99. These failures placed residents at risk of having inaccurate assessments and receiving improper care and services. Findings include: Resident #7Record review of Resident #7's face sheet revealed admission date 1/31/23 with diagnoses including Alzheimer's disease (loss of memory and mental functions), heart disease, major depressive disorder (depression or loss of interest affecting daily life), hypertension (high blood pressure), Myocardial infarction (decreased blood flow to the heart), cerebral infarction (stroke). Record review of Resident #7's Quarterly MDS dated [DATE] revealed short -and long -term memory loss, moderately impaired cognitive skills, assistance for ADL's including maximum assist for dressing and toileting, partial assist for hygiene, and dependent on staff for shower/bathing. The Restraints/Alarms section coded bed rails, used daily, as physical restraints. Record review of Resident #7's care plan, initiated 7/22/25, revealed resident uses mobility/enabler bar in bed for bed mobility. Resident #58Record review of Resident #58's face sheet revealed admission date 9/27/22 with diagnoses including Parkinson's disease (nerve cell damage affecting movement), Rheumatoid arthritis (chronic inflammatory disorder affecting small joints), Diabetes (high blood glucose), heart failure (inability of heart to pump blood effectively, hypertension (high blood pressure), anxiety disorder (worry, anxiety, feat affecting daily life). Record review of Resident #58's Annual MDS dated [DATE] revealed modified independence in cognitive skills, assistance for ADL's including supervision in hygiene, moderate assistance for dressing, and maximum assistance for toileting and shower. The Restraints/Alarms section coded bed rails used daily as physical restraints. Record review of Resident #58's care plan, initiated 5/22/24, revealed resident uses mobility/enabler bar on bed for better bed mobility, not as a restraint. Observation of Resident #58 on 7/23/25 at 1:15pm revealed she was resting in bed, and there were 1/4 side rails attached to the head of the bed. Interview at that time revealed she uses the side bar to help her turn or move up in bed, and she demonstrated how she could reach for it to help her move in bed. Resident #99Record review of Resident #99's face sheet revealed admission date 4/11/25 with diagnoses including dementia (loss of memory and intellectual functioning), hypertension (high blood pressure), hemiplegia and hemiparesis (muscle weakness and paralysis on one side of the body), cerebral infarction (stroke), Diabetes (high blood glucose). Record review of Resident #99's Quarterly MDS dated [DATE] revealed BIMS 08 indicating moderately impaired cognitive skills, assistance with ADL's including supervision for toileting and hygiene, moderate assistance for showers/bathing, and set-up for dressing. The Restraints/Alarms section coded bed rails used daily as physical restraints. Record review of Resident #99's care plan, initiated 4/25/25, revealed resident uses side rails to enhance positioning and mobility. Observation of Resident #99 on 7/23/25 at 1:40pm revealed he was resting in bed and there were 1/4 side rails attached to the head of the bed. Interview at that time revealed he uses the left side bar to help him turn and move up in bed and does not use the right-side bar since his right arm is paralyzed. Interview with the MDS nurse on 7/23/25 at 2:30 pm revealed the facility uses the RAI manual as a guideline to complete the MDS using resident information from the staff. She said they are using a new questionnaire to help with the coding of restraints, and in the question about bed rails as an enablers is answered yes, it would not be coded as a physical restraint. She said the MDS for Residents #7, #58, #99 was incorrectly coding bed rails as physical restraints, and would be corrected. Interview with the Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676490 If continuation sheet Page 9 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete DON on 7/23/25 at 2:30 pm revealed bed rails used as enablers for turning and repositioning should not be coded as physical restraints and said they would be corrected. Record review of facility policy on Minimum Data set revealed, in part, .as a policy the facility completes an MDS and codes the Minimum Data Set (MDS) per the RAI manual and coding is based upon clinical assessments, interviews, interventions, etc. Record review of the RAI manual revealed, in part: a restraint is any manual method, or physical or mechanical device attached or adjacent to the body.restricts freedom of movement or normal access to the body.bed rails are considered a restraint when they are used to intentionally prevent a person from getting in and out of bed. Event ID: Facility ID: 676490 If continuation sheet Page 10 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 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. Based on observation, interview and record review, the facility failed to ensure medications were stored in accordance with currently accepted professional principles for 1 of 1 medication fridges and 1 of 4 medication carts reviewed for storage. The facility failed to ensure that medication fridges and medication carts were free of expired medications. The failure could place residents at risk of receiving expired medications. Findings included:Observation and interview with ADON A on 7/21/25 at 3:25 p.m. of the facility's medication room revealed expired medications in the medication refrigerator. The expired medications were as follows:*one dose of Ceftriaxone 2 mg/100 ml with expiration date of 7/13/25, *two doses of Meropenem 500 mg/100 ml with expiration date of 6/19/25, and *three doses of Meropenem 500 mg/100 ml with expiration date of 6/14/25.ADON A said regarding the Meropenem the resident labeled to that medication had been in the hospital a long time. ADON A said they usually checked the medication refrigerator once a week for expired medications. ADON A said those types of antibiotics (referring to the expired medications) went out of date really quickly. ADON A said an adverse reaction a resident could experience if they received expired medications was that the resident might not receive the full therapeutic dose.Observation on 7/22/25 at 10:50 a.m. of Hallway-100 medication aide medication cart revealed expired medications. The medications were as follows: *Zinc 50 mg with best by date of April 2025, *Slow-Release Iron with expiration date of May of 2025, and *Geri-Dryl Diphenhydramine HCL 25 mg with expiration date of June of 2024. The expired medications were immediately removed from the medication cart by LVN A. During interview on 7/22/25 at 1:15 p.m., the DON said the ADONs checked the medication room for expired medications daily. The DON said the ADONS checked the medication carts every Friday, she believed. The DON said the medication aides and nurses should be checking the medication carts whenever they were in the cart to administer medications. The DON said she did not know what kind of training the staff received regarding medications because the staff had been here before she started which was 6/2/2025 but medication training was discussed in orientation. The DON said an adverse effect that could occur if a resident received an expired medication depended on the medication but could be an adverse effect. The DON said the Pharmacist checked the medication room and medication carts.During interview on 7/22/2025 at 1:20 p.m., ADON A said regarding medication training for staff they talk about medications in orientation and on the floor during orientation. ADON A said the Pharmacist walked with staff and educated about the importance of cart audits and checking the over the counter medications/blister packs before administering medications. ADON A said she checked the medication carts every week for cleanliness and expired medications. ADON A said she checked the #300 and #400 hallway medication carts. ADON A said the Pharmacist checked the medication room and medication carts but unsure how thorough she was. ADON A said we have asked the medication aides and nurses to check the medication carts every Friday and every time they were in the medication cart to pull a medication. During interview on 7/22/2025 at 1:35 p.m., ADON B said she usually split the facility with ADON A with ADON B covering the hallways 100 and 200 and ADON A covering the hallways 300 and 400. ADON B said both ADONS check the medication fridge, and the DON checked sometimes. ADON B said she tried to check the medication fridge weekly but at least every other week. ADON B said her and ADON A checked the medication carts depending on the hall weekly but at least every other week to do full audits. ADON B said the medication aides and nurses knew to check the medication carts as well. ADON B said the Pharmacist watched medication pass and audited a random cart but unsure if they checked all the medication carts. ADON B said regarding staff training they have a lot of in-services regarding medication administration and have yearly medication pass that was observed. ADON B said the facility did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676490 If continuation sheet Page 11 of 12 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 676490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sylan Shores Health and Wellness 3950 Underwood Rd LA Porte, TX 77571 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 FORM CMS-2567 (02/99) Previous Versions Obsolete in-services if they saw anything or a complaint. ADON B said she had found expired blister packs and responded by taking them off the cart to be destroyed. ADON B said if a resident expired then they took their medications off the cart to be destroyed. During interview on 7/23/2025 at 10:08 a.m., the Pharmacist said she had come to the facility about 2 1/2 years. the Pharmacist said she did one medication cart audit and medication room checks when she came to the facility monthly. The Pharmacist said during the audits she looked for outdated medications and anything she found she pulled and gave to the nurse. The Pharmacist said she usually found expired medications during her monthly checks and the findings were part of the facility's audit report. The Pharmacist said the expired medications were usually not that old. The Pharmacist said staff must be routinely checking and pulling over the counter medications. The Pharmacist said over the counter medications could go over the best by date if stored properly but our goal was to have those medications removed by those dates. The Pharmacist said regarding adverse effects to the resident if they received expired medication, she would look at the medication to see the type of medication and how it was stored to figure out the potential adverse effect. The Pharmacist said over the counter medications can sometimes go 1-2-3 years past their best by/use by dates, but you have to look at how potent the medication was. The Pharmacist said regarding medication training for staff she has done medication pass, medication usage, procedural type, anything they ask me to do, GDR , falls, survey readiness, anything they may or not be doing, so any topic. The Pharmacist said regarding discussed supplement storage on the last audit report, it covered topics of did they date the supplement, did they store the supplement properly, should the supplement have been refrigerated, and how long does the supplement last past the open date. The Pharmacist said that it was dependent on the facility, but the fridge should be checked routinely. The Pharmacist said she recommend the medication carts be checked weekly and medication fridge should be checked monthly. Record review of Areas of Improvement Report completed by the Pharmacist dated 5/28/25 revealed medication room was checked at this visit. Facility recommendations included routinely check all medication storage areas for expired and discontinued medications. Record review of Areas of Improvement Report completed by the Pharmacist dated 6/25/25 revealed medication room was checked at this visit and had discussed supplement storage on medication carts. Facility recommendations included routinely check all medication storage areas for expired and discontinued medications. Facility recommendations also included survey readiness regarding working on cart maintenance and routinely checking and pulling expired and discontinued medications. Record review of facility's policy Storage of Medications revised November 2020 revealed Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. Event ID: Facility ID: 676490 If continuation sheet Page 12 of 12