Health inspection·June 6, 2023

F 0624 Home and Home Health. Level of Harm - Minimal harm or potential for actual harm Review of progress note, documented by Social Worker on 06/5/2023 at 10:15 AM, revealed Effective date 05/10/23 Residents Affected - Few Late Entry: Note Text: Discharge Wednesday, May 10, 2023 [Resident #1] @TBD [Home Address] Transport: family DME: wheelchair, 3 in 1 HH: [Home Health provider] Pharm: [Pharmacy Name] PCP: Home Health to assist with making follow up appointment Review of progress note, documented by Social Worker on 05/23/23 at 13:13 [1:13 PM] revealed Notified by [Home Health provider] that they were unable to accept referral per OON. Review of progress note, documented by Social Worker on 05/26/23 at 11:58 AM revealed Referral to [Home Health provider] for HH services. Review of facility Admission/discharged To/From Report , dated 06/05/23, reflected Resident #1 discharged on 5/10/23 to a private home/apt. with home health services. Interview on 06/05/23 at 9:23 AM with Resident #1 family member revealed Resident #1 was discharged from the facility on 5/10/23 late afternoon around 6:00 PM and with the expectation that home health was set up for her. Family member stated Resident #1 did not arrive home until approximately 7:00 PM and had no medications with her only a list of her prescriptions and wound care supplies. Family member stated they were able to get medications the following day 05/11/23; however Resident #1 was a diabetic and needed her insulin for her night dose on 5/10/23. Family member stated Resident #1 had an amputation and needed home health to provide physical therapy, wound care, and an aid. Family member stated they were unaware when home health was going to visit Resident #1. Family member stated they reached out to the home health provided a few days later after resident's discharge on [DATE] and were informed that Resident #1 referral was declined due to insurance. Family member contacted the facility on 5/15/23 to asked about home health and facility were unaware that Resident #1 referral had been declined. Family member stated they were able to get home health to come an assess Resident #1 on 5/31/23. Interview on 06/05/23 at 2:01 PM with Wound Care Nurse revealed she provided wound care for Resident #1 on 05/10/23 prior to her discharged . WC Nurse stated she provided Resident #1 with wound care supplies for a few days because it was unknown when home health would visit Resident #1. She stated from her understanding home health was already set up prior to Resident #1 discharge. She stated they would not discharge a resident if home health were not set up yet or if it was pending. WC Nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676492 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 676492 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Methodist Transitional Care Center-Desoto LLC 109 Methodist Way Desoto, TX 75115 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 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated it was the Social Worker responsibility to send home health referrals. She stated Resident #1 was ready to go home. WC Nurse stated she was unaware home health was pending when Resident #1 discharged . She stated she provided Resident #1 family member with a folder that included her discharge summary, prescription list and provide verbal explanation to the family member on how to provide wound care to the resident. She stated cart medications are not given to residents when discharged per policy and stated it was the family or resident responsibility to get their own medications once discharge. Interview by phone on 06/06/23 at 11:18 AM with Resident #1 revealed she was at the facility for less than 2 weeks. Resident #1 stated she was provided with a folder upon discharged that included her prescription list and discharge plan. Resident #1 stated she was informed that she would discharge with home health already in place. Resident #1 stated she was never notified that home health was pending approval. Resident #1 stated her right foot was amputated and she needed home health for physical therapy, wound care, and an aid to assist her. Resident #1 stated the Social Worker and Case Manager were assisting her with all her discharge plannings. Resident #1 stated she just recently got assessed for home health on 5/31/23. Resident #1 stated when she discharged , she was not provided with her medications, she was only provided with a prescription list. Resident #1 stated she was glad she had family support who were able to get her medication the following day unless she would not have anyone to pick them up or request them for her. Resident #1 stated she was unsure why her medications were not provided to her upon discharge. Resident #1 stated she had an appointment with her foot doctor when she was at the facility and was informed that she was not able to bare weight and there was no need for physical therapy at the facility. She stated she was only at the facility for physical therapy and since she was not receiving physical therapy, they were okay with her discharging home with home health and continue with physical therapy with home health. Resident #1 stated since the first day she admitted to the facility she wanted to go home; she stated if she was informed home health was pending, she would have considered to stay until it was confirmed. Interview on 06/06/23 at 11:40 AM with Case Manager revealed she assisted Resident #1 with home health referrals. She stated Resident #1 and family initiated the discharge on [DATE]. She stated Resident #1 wanted to go home prior to her 21 days stay were over, she stated Resident #1 was in a rush to go home. Case Manager stated she met with Resident #1 on 05/05/23 and Resident #1 told her that she wanted to go home. She stated she asked Resident #1 to give her time to request her equipment and Resident #1 agreed. Case Manager stated she requested Resident #1 home equipment on 05/05/23 at 1:52 PM and the equipment was provided on 05/10/23. She stated Resident #1 needed home health for physical therapy, occupational therapy, and for wound care. Case Manager stated she sent the first home health referral on 05/10/23 when Resident #1 was ready to discharge. When asked why she did not send the home health referral on 05/05/23 when the home equipment referral was sent, Case Manager stated she was hoping Resident #1 would change her mind and stay a little longer due to her wound care. Case Manager stated Resident #1 did not want to wait and wanted to discharge on ce her home equipment had arrived. Case Manager stated she explained to Resident #1 that home health was pending. Case Manager stated she failed to document in the Resident #1 clinical records/notes regarding Resident #1 initiating discharge or refusing to stay at the facility pending home health approval or when referrals were sent to home health providers. Interview on 06/06/23 at 12:21 PM with Home Health Representative revealed they received Resident #1 referral later afternoon on 5/10/23; however, due to referral being sent late they were not able to review the referral until the following day on 5/11/23. HH Representative stated Resident #1 referral was denied due to insurance and they contacted the facility on 5/11/23 to notify them Resident #1 was denied. HH Representative stated referrals are reviewed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676492 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 676492 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Methodist Transitional Care Center-Desoto LLC 109 Methodist Way Desoto, TX 75115 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 0624 as soon as possible to confirmed it patient is approved or denied. Level of Harm - Minimal harm or potential for actual harm Interview on 06/06/23 at 12:29 PM with Social Worker revealed they had a care plan meeting on 05/03/23 and were informed that Resident #1 would discharge home within the following 2 weeks with home health. Social Worker stated Resident #1 and family were adamant to leaving early. She stated she was informed on 05/05/23 by Case Manager that Resident #1 wanted to go home. She stated she was on leave at the time and the Case Manager assisted with sending the home equipment referral. Social Worker stated family contacted the facility on 05/15/23 to informed them that Resident #1 home health had not been started yet. Social Worker stated Case Manager had sent two referrals on 05/10/23 and 5/11/23 to different home health providers. She stated another referral was sent on 05/15/23. She stated there was no reason for concerns that Resident #1 was not going to be approved for home health. Social Worker stated it was not unusual to send referrals upon discharged to home health; however best practice would have been to send the referral when the equipment referral was completed on 05/05/23. Residents Affected - Few Interview on 06/06/23 at 1:07 PM with the DON revealed when a resident is discharge home with home health her expectation is for home health to be established prior to resident discharge. The DON stated when a resident is discharged , they provide the resident or family with a folder with any instructions, discharge plan and prescription list. The DON stated as far as she knows home health was already set up for Resident #1. She stated Resident #1 was in a hurry to discharge; however, she was not aware that home health was not set up upon discharge. The DON stated it was the social services responsibility to send referrals to the proper providers prior to resident discharge. The DON stated medications are not given to residents upon discharge, she stated she is unsure why but it had to do with the facility policy. The DON stated they only provide the resident with a prescription list and they are responsible to get the medications. The DON was asked what happens to the resident's medication that are left in the nurse's medication cart, she stated the medications are sent to drug destruction and pharmacist are notified. Interview on 06/06/23 at 1:48 PM with the Administrator revealed she was not involved in Resident #1 discharge planning. She stated when a resident is discharging her expectations are for her staff to send any referrals if needed on the date of when discharge is initiated. The Administrator stated depending on the insurance and family preference on home health; home health can take some time to set up. The Administrator stated she was not aware of Resident #1 home health had not been set up until she reviewed the grievance that was made . The Administrator stated they were having difficulty setting up home health to do insurance coverage. The Administrator stated Resident #1 initiated the discharge, she stated she was unsure of the date. She stated if it is a plan discharge, they will send the referral right away; however, since Resident #1 had initiated the discharge, resident was discharged pending home health. The Administrator stated Resident #1 discharged with her prescription list. The Administrator stated per facility policy depending on the payer source and if the physician allows it a resident can take the cart medications with them when discharge. The Administrator stated depending on the circumstanced at times they would provide residents with their medications upon discharge for two weeks. The Administrator stated any medications left in the medication cart they are to notify the pharmacist and the payer source. Review of facility Grievance/Complaint Report, dated 05/15/23, received by Social Worker, revealed Family member called upset that home health [has] not been started. LMSW was informed by patient that discharge would take place when she wished and occurred before adequate DC plan was established and continued services in the community. Follow up: Insurance denial initiated referral & second referral continuing to work sources for placement Actions Taken: The following referral were sent to (HH provider name) on 5/10 and (HH provider name) on 5/11 and a new referral to (HH provider name) on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676492 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 676492 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Methodist Transitional Care Center-Desoto LLC 109 Methodist Way Desoto, TX 75115 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 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 5/15. Resolution of Grievance/Complaint: LMSW informed family on referral process and potential delays w/insurance verification and challenges w/placement during last minute DC planning prior to DC on 05/3/23 - discussed need for additional feedback from therapy and wound team. Grievance was signed by grievance officer and administrator on 5/31/23. Review of facility policy titled, Discharge Summary and Plan, revised date December 2016, reflected the following: When a resident's discharge is anticipated, a discharge summary and post-discharge plan ill be developed to assist the resident adjust to his/her new living environment . 10. Residents transferring to another skilled nursing facility or who are discharged to a home health agency, long term care hospital or inpatient rehabilitation facility will assist in selecting a post-acute care provider that is relevant and applicable to the resident's goals of care and treatment preference. Data used in helping the resident select an appropriate facility includes the receiving facility's: a. standardized patient assessment data; b. quality measure data; and c. data on resource use. 11. The resident or representative 9sponsor0 should provide the facility with a minimum of a seventy-two (72) hour notice of a discharge to assure that an adequate discharge evaluation and post discharge plan can be developed. 12. A member of the IDT will review the final post-discharge plan with the resident and family at least twenty-four (24) hours before the discharge is to take place. Review of facility policy titled, Discharge Medications, revised date December 2016, reflected the following: Medications may be sent with the resident upon discharge based on availability, payor source and physician direction. Controlled substances may not be released to the resident upon discharge. 1.A physician must be contacted for an order to discharge a resident with medications before they will be dispensed. If medications are not sent with the resident at discharge a request for prescriptions to be provided shall be made. 2. When medications are sent with the resident. The Charge nurse shall verify that the medications are labeled consistent with current physician orders including instruction for use. 5. The nurse shall review medication instructions with the resident, family member or representative before the resident leaves the facility. 6. The nursing staff shall forward completed drug disposition records to medical records. The complete list of the resident's medication shall also be provided to the resident upon discharge. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676492 If continuation sheet Page 5 of 5