Health inspection·June 26, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #20's Face Sheet dated 06/24/2025 revealed he was a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #20's diagnoses included dementia (memory, thinking, difficulty), muscle wasting, morbid (severe) obesity, hyperlipidemia (high cholesterol), injury of head, depression, insomnia (difficulty sleeping), lack of coordination, pain, urinary incontinence, foot drop (difficulty lifting the front part of the foot), vascular leukoencephalopathy (various conditions that affect the white matter of the brain), cerebellar ataxia (a neurological condition that affects the part of the brain responsible for coordinating voluntary muscle movements), and hypertension (high blood pressure). Record review of Resident #20's Quarterly MDS assessment dated [DATE] revealed Resident #20 had a BIMS score of 13 indicating intact cognitive response. Resident #42 Review of Resident #42's Face Sheet dated 06/24/2025 revealed she was a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #42's diagnoses included cerebral infraction (long term effects of a stroke), abnormalities of gait and mobility, pain, contracture of muscles (permanently shortening), sarcoid myocarditis (inflammation disease that affect different parts of the body), obstructive sleep apnea (breathing pauses while sleeping), heart failure, atrial fibrillation (abnormal heart rhythm), hyperlipidemia (high cholesterol), hypertension (high blood pressure), insomnia (difficulty sleeping), dysphagia following cerebral infraction (difficulty swallowing after stroke), aphasia (unable to comprehend and communicate due to damage to the brain), lack of coordination, and muscle wasting. Record review of Resident #42's Quarterly MDS assessment dated [DATE] revealed Resident #42 had a BIMS score of 11 indicating moderate cognitive impairment. Resident #44 Review of Resident #44's Face Sheet dated 06/24/2025 revealed she was a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #44's diagnoses included abnormalities of gait and mobility, dementia (memory, thinking, difficulty), muscle wasting, pain in right shoulder, nontoxic multinodular goiter (enlarged thyroid glands due to presence of multiple nodules), muscle weakness, aphasia (unable to comprehend and communicate due to damage to the brain), depression, mild cognitive impairment, soft tissue disorder, spastic hemiplegia (contractures of muscles on one side), myoclonus (muscle jerks), and paraneoplastic neuromyopathy and neuropathy (disorder that occurs as a remote effect of cancer, where the immune system mistakenly attacks the nervous system). Record review of Resident #44's Quarterly MDS assessment dated [DATE] revealed Resident #44 was not able to complete the BIMS interview due to severely impaired cognition. Resident #51 Review of Resident #51's Face Sheet dated 06/24/2025 revealed he was a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #51's diagnoses included abnormalities of gait and mobility, muscle wasting, muscle weakness, aphasia (unable to comprehend and communicate due to damage to the brain), morbid (severe) obesity, cerebral infraction (long term effects of a stroke), lack of coordination, pain, hearing loss, type 2 diabetes mellitus with other diabetic kidney complications (kidney complications due to diabetes), hyperlipidemia (high cholesterol), major depressive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 2 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0550 Level of Harm - Minimal harm or potential for actual harm disorder, heart disease, atrial fibrillation (abnormal heart rhythm), and hemiplegia and hemiparesis following cerebral infraction affecting left dominant side (paralysis and weakness on left side after stroke). Record review of Resident #51's Quarterly MDS assessment dated [DATE] revealed Resident #51 had a BIMS score of 11 indicating moderate cognitive impairment. Residents Affected - Some Observation of lunch being served in the dining room on 06/24/2025 at 12:00p.m., revealed that Resident #20 and Resident #42 were sitting at the table with Resident #33. Resident #33 got his meal tray at 12:00p.m. Resident #42 did not get her meal tray until 12:19p.m.; Resident #20 did not get his meal tray until 12:25p.m. Observation of halls on 06/24/2025 at 9:00a.m., revealed that CNA G did not knock on Resident #51's door before entering his room. Observation of halls on 6/25/2025 at 10:45a.m., revealed that CNA H did not knock on Resident #44's door before entering their room. Observation of halls on 6/26/2025 at 8:45a.m., revealed that CNA H did not knock on Resident #12's door before entering the room. An interview with Resident #44 was attempted on 06/24/2025 at 10:15a.m., revealed she was nonverbal and could not answer the surveyor. During an interview with Resident #42 on 06/25/2025 at 8:56am revealed that she was doing good. When Resident #42 was asked another question, she wheeled herself off. During an interview with CNA G on 06/26/2025 at 09:13a.m., revealed that she had been trained on resident rights. She said the policy for knocking on the resident's door was knock, wait for a response, introduce yourself and tell the resident what you are going to do. She said any staff going into the resident's rooms should knock before they enter. She said the only time that staff do not need to knock before entering was in an emergency. She said if staff did not knock then the resident may feel like their privacy was being invaded. She said the nurses were responsible for monitoring to ensure staff were knocking. She said nurses monitored by observations. She said she did not know why she did not knock on Resident # 51's door before entering. She said that she had been trained on meal tray passes in the dining room. She said the policy was to bring the trays to groups. She said the residents may get upset if they did not get their meal tray with the others at their table. She also said it was rude to have one resident eating and the others watching that resident eat. She said everyone in the dining room was responsible to ensure the residents got their meal trays together. She said meal tray pass was monitored by observations. She said she did not know why Resident #20 and Resident #42 did not get their meal tray with their table mate. She said all the residents should have gotten their meal trays together. During an interview with CNA H on 06/26/2025 at 9:27 a.m., revealed she had been trained on resident rights. She said the policy for knocking on the residents' doors was to knock two or three times even if the resident could not respond, staff still needed to knock. She said that staff should always knock on the resident's door before entering. She said the resident may feel like staff are invading their privacy. She said staff did not need to knock on the door in the event of an emergency. She said that the charge nurse was responsible for monitoring to ensure staff knocked. She said that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 3 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some knocking was monitored through observations and the nurses walking around. She said she did not knock on Resident #12, and Resident #44's room because the residents were asleep. She said that she had been trained on meal tray pass in the dining room. She said that the policy was that all residents at the same table get their meal trays before going to the next table. She said residents may get aggravated if the meal trays come out at separate times. She also said that residents at the same table do not always get their meal tray together. She said that the nurse aides were responsible for making sure all residents at the same table got their meal trays together. She said that the kitchen did not have the resident's meal trays ready and that was why they did not get their meal trays at the same time. During an interview with Resident #12 on 06/26/2025 at 11:53am revealed that staff do not always knock on the door. He said he would like for the staff to knock all the time, but it was not always available. He said it did upset him when staff did not knock on the door. He said that he has also had to ask staff to knock before coming into his room. During an interview with Resident #51 on 06/26/2025 at 11:55am revealed that it was not very often that staff knocked before entering. He said that he would like for staff to knock all the time. He said he does not get upset when staff do not knock. He also said he has had to ask staff to knock before coming into his room. During an interview with Resident #20 on 06/26/2025 at 12:04pm revealed that he had to wait at least twice a week to get his meal tray when his table mate already got theirs. He said he would like to get his meal tray when his table mates get their meal trays. He said he did not get upset when he did not get his meal tray. During an interview with the VPO on 06/26/2025 at 1:56pm revealed that he and staff have been trained on resident rights. He said that the policy was that staff knock on the resident's doors and request to enter. He said all staff were to always knock before going into the resident's room. He said if staff did not knock before entering the room the resident may feel their privacy was being taken away. He said the only time staff did not have to knock on the door before entering was in the event of an emergency. He said knocking was monitored by the ADM and himself. He said that knocking was monitored through observations. He said that staff were too comfortable with the residents or in a hurry. He said the policy for meal tray passes was all residents get their meal trays together. He said the meal trays for each table should come at a similar time of each other. He said some residents might feel left out or forgotten if they did not get their meal tray at the same time as their table mate. He said the charge nurse in the dining room was responsible for monitoring especially the department heads. He said it was monitored through observations. He said he did not know why Resident #20 and Resident #42 had to wait so long for their meal trays. During an interview with the DON on 06/26/2025 at 2:06pm revealed that she and staff have been trained on resident rights. She said the policy for knocking was staff should knock before entering, wait for a response, and knock again. She said staff should knock any time they go into the residents' rooms. She said if staff did not knock on the resident's door the resident may feel like they didn't have enough privacy and that their space is not being respected. She said that the only time staff did not have to knock was in the event of an emergency. She said the charge nurses and the department heads were responsible for monitoring to ensure staff were knocking. She said knocking was monitored by observations and if it were a widespread issue the facility would in-service. She said she did not know why staff were not knocking on the residents' doors. She said the policy for meal trays was that everyone at the same table was to get their meal tray before moving to the next table if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 4 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some possible. She said that a resident may feel left out or hungry because they are watching someone else eat. She said the charge nurses that were in the dining room were responsible for making sure all residents at the same table got their tray. She said the nurses monitor through observation. She said she did not know why Resident #20 and Resident #42 had to wait so long to get their meal tray. During an interview with the ADM on 06/26/2025 at 5:14pm revealed that he and staff have been trained on resident rights. He said that the policy was that staff should knock, wait for an answer and if no answer, knock again and announce your self-coming in. He said all staff were to always knock before going into the resident's room. He said if staff did not knock before entering the room the resident may get startled. He said the only time staff did not have to knock on the door before entering was in the event of an emergency. He said knocking was monitored by everyone, especially managers. He said that knocking was monitored through observations. He said that he did not know why staff did not knock before entering. He said the policy for meal tray passes was staff should pass meal trays to one table at a time. He said the meal trays for each table should come within a reasonable amount of time of each other. He said some residents do not care while others might feel something. He said anyone in the dining room were responsible for monitoring especially the department heads. He said it was monitored through observations. He said he did not know why Resident #20 and Resident #42 had to wait so long for their meal trays. Record review of Serving a Meal Policy revised on 11/2024 revealed the policy did not have any information on passing trays to all residents at the same time. Record review of Promoting/Maintaining Resident Dignity revised 11/2024 revealed except in an emergency, knock on the resident's door prior to entering. If the resident does not respond, knock again, and announce yourself when entering. Record review of the Resident Rights Policy revised on 11/2024 revealed that the policy provided was not on resident rights. The policy was what the facility would to inform the residents of their rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 5 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that based on the comprehensive assessment of a resident, that residents receive treatment and care in accordance with the residents' choices, and professional standards for 1 (Resident #8) of 25 residents assessed for quality of care. Residents Affected - Few The facility failed to monitor and treat consistently Resident #8's neuropathy. This failure could lead to increased pain, depression, and a lower quality of life. Findings include: Resident #8 Record review of Resident #8's face sheet on 06/24/2025 dated 06/24/2025 revealed an [AGE] year old woman admitted to the facility on [DATE] with relevant diagnoses of galactosemia (an inherited genetic deficiency that causes the inability to metabolize a specific type of carbohydrate at a cellular level), chronic kidney disease (failing kidneys), type two diabetes (the inability to digest the carbohydrates consumed), Crohn's disease (an inflammatory disease causing lesions on the small intestine), and dementia (progressive loss of brain function). The face sheet failed to mention chronic pain in the feet or neuropathy (a chronic neurological condition that results in neuropathic pain) listed as a medical diagnosis. Record review of Resident #8's quarterly MDS dated [DATE] revealed she used a walker and was independent while eating. Resident #8 had a BIMS score of 5 that indicated severe cognitive impairment . Record review of Resident #8's care plan updated 06/23/25 stated Resident #8 had been physically aggressive causing harm and had delusions thinking roommate was attempting to hurt her. With Interventions that included, Assess for pain and offer pain medications as needed. The care plan failed to address burning feet or neuropathy and to treat with specific interventions. Record review of behavior progress notes dated 03/15/24 at 09:54 am reflected Resident very confused this shift. Resident has come to nurses' station multiple times stating her feet were on fire. Feet assessed and were normal. Record review of psychiatric progress note dated 03/18/24 reflected, Staff reports resident says her feet are on fire. Tells staff daily they are burning her feet. On Gabapentin for neuropathy (DM [Diabetes Mellitus] type 2) Intermittent anxious behavior. Resident currently denied her feet were hurting. Review of symptoms revealed neuropathy listed. Record review of podiatry note on 04/11/24 reflected a diagnosis of type two diabetes with diabetic neuropathy. Record review of incident progress notes dated 04/14/24 at 10:05 am reflected Resident was very anxious and was combative with staff screaming that she was being burned. New order was received and put in for amitriptyline. Record review of nursing progress notes from 04/14/24 to 06/23/25 revealed no mention of painful or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 6 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0684 burning feet. Level of Harm - Minimal harm or potential for actual harm Record review of incident report dated 06/23/25 at 1:22 am revealed an incident where Resident #8 was grabbing her roommates' arm and repeatedly yelling 'she's burning my feet.[sic] Residents Affected - Few Record review of physician's orders on 06/24/25 revealed a verbal discontinued order of Gabapentin 100 mg capsule 3x daily for Neuropathy that started and ended 03/26/24. There was a second verbal order for gabapentin 100 mg that was started 03/15/24 and discontinued 03/16/24. Physician's orders revealed a general acetaminophen 500 mg as needed for general pain. An order for amitriptyline for anxiety and behaviors was discontinued 07/28/25. A current order for gabapentin for neuropathy was started 06/23/25 at 2:55 am. Record review on 06/24/25 of diagnoses revealed a diagnosis of unspecified pain with a start date of 02/29/2025. No diagnosis of neuropathy present. Record review of pain interview assessment completed 06/25/25 reflected Resident #8 stated she had answered No, I have not had pain or hurting in the last 5 days. Observation of Resident #8 on 06/24/25 at 11:48 am revealed Resident #8 sitting at a table in the dining room eating lunch. The resident was smiling at people while eating her food. Interview with RP for Resident #8 on 06/24/25 1:30pm he stated that he knew she had burning feet happen at her previous facility. He stated the facility had not talked to him about the neuropathy at the last few care plan meetings. He said no incident had occurred again until last weekend. He stated that he expected them to take care of Resident #8 and all her needs. He stated that he was sad because if she had been in pain and he had no idea. Interview with Resident #8 on 06/25/25 at 11:24 am she stated that she thought she had been at the facility for a month. She stated that she had no idea why she was being supervised by a CNA. She stated that she was healthy, her feet did not hurt and that she was fishing, hunting, running, and swimming yesterday. Interview with LVN C on 06/26/25 at 12:57 pm stated that she had been the charge nurse for Resident #8 for 2 months. She was unaware that there had been two other instances of this burning feet episode. She stated she thought her feet burning was painful . If any resident started complaining, they would contact the physician for gabapentin and there were other options for nerve pain management. She stated neuropathy can come and go that depended on many individual health factors. She stated once the diagnosis is given of neuropathy, it typically does not disappear forever. She stated that Resident #8 should have had a diagnosis and meds for her neuropathy. She said that if a resident is constantly in pain, it will decrease their quality of life. Interview with LVN E on 06/26/25 at 1:31 pm she revealed that Resident #8 was a kind person, but vocal about her difficulties. She stated that she believed that if she were in pain, Resident #8 would have said something. She stated it was important to have an accurate diagnosis, medication, and plans, even if it is not used on a regular basis. She said excessive pain could make someone depressed. Interview with CNA A on 06/26/25 at 1:53 pm she stated that she had known Resident #8 for 1 year. She stated she had not heard about the burning feet incident happening before. She asked Resident #8 at least one time per shift how she was feeling and if she was comfortable. She stated that if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 7 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #8 had needed pain medication she would have advocated for her. She said all residents deserved to be free from pain and have pain medicine available. Interview with LVN D at 06/26/25 01:59 pm she revealed that it was a surprise to her to hear that Resident #8 had neuropathy. She stated she was unaware there was a prior occurrence. She stated Resident #8 speaks her mind and would have told them if she had pain. She stated it would have been the charge nurse's duty to ensure that an accurate diagnosis and treatment plan comes together after the doctor visited and gave the formal diagnosis. She stated that they should have had the diagnosis and some medications to give when it started. She stated she was unaware if it was consistent pain or not. She stated there are many risks to not treating pain and all of them are not good for the residents. Interview with RP and Resident #8 on 06/26/25 at 3:59 pm Resident #8 stated that she knew her feet hurt because sometimes they would swell, and her shoes did not fit right. RP stated that her feet did swell from her kidney disease. Resident #8 stated that she knew she had enemies in the facility, and they were the ones that burned her feet constantly. She could not say who those people were, but insisted the burning was from her enemies. The RP tried to explain to his mom that it was neuropathy, but she refused to listen to his conversation and left the room. Interview with DON at 06/26/25 at 5:05 pm she revealed she had only been DON for 4 days. She stated that any burning should be treated with gabapentin or a medicine that the doctor orders. She stated the staff said it was the first time the burning feet had been reported to them. She stated she made sure that something was put into place for the resident but let the facility staff were responsible for ensuring her pain was controlled. She stated not having pain controlled was unacceptable and could cause significant emotional and more physical harm to the residents. Interview with ADM on 06/26/25 at 5:27 pm he stated that after the first incident and diagnosis of neuropathy the charge nurses were responsible for ensuring the continuity of care. He expected the charge nurses to place in orders, new diagnosis and update any pertinent records. He stated that the staff members did the right thing but notifying the physician and getting orders immediately. He stated that if Resident #8 had not complained of pain for a year that they did not have to keep the medications there. He stated risks to the residents were depression or other mood alterations. Called Resident #8's doctor on 06/26/25 at 4:35 pm with no response. Record review of Standard of Care Page titled, Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2025 in the Diabetes Care Journal published by the American Diabetes Association professional practice committee states. Symptoms and signs of autonomic neuropathy (central nervous system nerve dysfunction) should be assessed in people with diabetes starting at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes, and at least annually thereafter, and with evidence of other microvascular complications, particularly kidney disease and diabetic peripheral neuropathy. Screening can include asking about orthostatic dizziness, syncope, early satiety, erectile dysfunction, changes in sweating patterns, or dry cracked skin in the extremities. Signs of autonomic neuropathy include orthostatic hypotension, a resting tachycardia, or evidence of peripheral dryness or cracking of skin. Recommendations include: Assess and treat pain related to diabetic peripheral neuropathy and symptoms of autonomic neuropathy to improve quality of life. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 8 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Several pharmacologic therapies exist for treatment of pain in diabetes. The [professional organization] update suggested that gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRIs), sodium channel blockers, and tricyclic antidepressants (TCAs) all could be considered in the treatment of pain in DPN. Neuropathic pain can be severe and can impact quality of life, affect sleep, limit mobility, and contribute to depression and anxiety. No compelling evidence exists in support of glycemic or lifestyle management as therapies for neuropathic pain in diabetes or prediabetes, which leaves only pharmaceutical interventions/ A recent guideline by the [Professional Association] recommends that the initial treatment of pain should also focus on the concurrent treatment of both sleep and mood disorders because of increased frequency of these problems in individuals with DPN Record review of facility policy titled, Provision of Quality of Care dated 11/24 stated, will ensure that residents receive treatment and care by persons in accordance with professional standards of practice, the comprehensive care plans, and the residents' choices. 1. Each resident will be provided care and services to attain or maintain his/her highest practicable physical, mental, and psychosocial well-being. 2. A comprehensive care plan will be developed for each resident in accordance with procedures for development of the care plan. 3. Responsibility for interventions on the care plan will be clearly identified. 4. Policies and procedures will reflect current professional standards of practice. a. All employees are responsible for following established policies and procedures. b. Violations of policies and procedures will result in disciplinary action up to and including termination. 5. The facility will employ on a full-time, part-time or consultant basis those professionals necessary to carry out the provisions of the residents' care plans. 6. The facility will follow relevant procedures to ensure professional staff are licensed, certified, or registered in accordance with applicable state laws. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 9 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide each resident with a diet that meets their daily nutritional needs and special dietary needs for 1 (Resident #8) of 10 residents reviewed for appropriate diets. The facility failed to provide a therapeutic diet for Resident #8 with a diagnosis of galactosemia. This could lead to a toxic buildup of chemicals in the blood that could cause confusion, agitation, and a decreased quality of life. Findings Include: Resident #8 Record review of Resident #8's face sheet dated 06/24/2025 revealed an [AGE] year old woman admitted to the facility on [DATE] with relevant diagnoses of galactosemia (an inherited genetic deficiency that causes the inability to metabolize a specific type of carbohydrate found in dairy that causes toxic by product build up in the blood), chronic kidney disease (failing kidneys), type two diabetes (the inability to absorb the carbohydrates consumed), Crohn's disease (an inflammatory disease causing lesions on the small intestine), dementia (progressive loss of brain function). Record review of Resident #8's quarterly MDS dated [DATE] revealed she uses a walker and was independent while eating. Record review of Resident #8's care plan dated 03/13/24 stated (resident) at risk for complications related to Galactosemia. Galactosemia means galactose in the blood. This inherited disorder prevents your body from breaking down the sugar galactose, causing it to build up to toxic levels in your blood. Interventions included, Assess labs as ordered by MD, serve diet as ordered, Monitor, document, report to MD: Loss of appetite Lethargy, Vomiting, Diarrhea, Severe weight loss. Record review of Residents #8's physician orders on 06/26/25 revealed no diet orders for a Galactosemia based diet. Record review of quarterly dietary profile dated 03/07/2024 revealed a current diet order of low concentrated sweets with mechanical soft texture. There was no mention of allergies or intolerances. No family concerns noted about the diet. Observation of Resident #8 on 06/24/25 at 11:48 pm revealed Resident #8 sitting at a table in the dining room eating lunch. The meal was chicken fried steak, mashed potatoes, and asparagus tips. Interview with RP for Resident #8 on 06/24/25 1:30pm he stated that Resident #8 used to avoid dairy products because it messed her stomach up. He wanted her to gain weight while she was in the facility but had no idea that she had galactosemia. He stated she had trouble making decisions for herself due to her cognition. He stated the conversation with the surveyor was the first time he had heard the word galactosemia and had no education about the diagnosis. He stated that when she admitted to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 10 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the facility, she needed to gain weight, but had no idea that eating dairy would cause a toxic buildup in her blood stream. He thought that eating an inappropriate diet would not help her conditions at all. He stated that he was disappointed because if I had known better, I would have done better. Interview with Resident #8 on 06/25/25 at 11:24 am she stated that she thought she had been at the facility for a month. She stated that she had no idea why she was being supervised by the CNA. She stated that she was healthy, her stomach never hurt and that she was fishing, hunting, running, and swimming yesterday. She stated she did not remember what she had for lunch. Interview with the Dietitian on 06/25/25 at 4:45 pm she revealed that she knew the Resident #8 was diagnosed with galactosemia. She stated that the family desired weight gain for the resident, so they liberalized her diet. She stated she does not remember the conversation with the family to ensure that they were educated on the risks and benefits of the diet. She stated they try to avoid lactose, but she is not (on) a dairy free diet. The Dietitian said she does not think it would be toxic to the resident. She stated that it was possible Resident #8 could be showing the effects of the inappropriate diet, but she was not sure what symptoms to look for. Interview with LVN C on 06/26/25 at 12:57 pm stated that she had been the charge nurse for Resident #8 for 2 months. She stated she did not know what galactosemia was or that Resident #8 had it. She stated that they should be treating it. She stated that the Resident can liberalize her diet if she desires, but there needed to be a risk vs benefit conversation. She stated if Resident #8 consumed an improper diet it could have made her health conditions worse. Interview with LVN E on 06/26/25 at 1:31 pm she revealed that she had no knowledge of galactosemia, and that Resident #8 was a good eater. She stated Resident #8 was on a low concentrated sweets diet. She stated that residents should eat specific diets that their bodies needed. She stated that there could be many adverse effects, but she could not give specific because she was not educated on the disease state. Interview with an CNA A on 06/26/25 at 1:53 pm she stated that Resident #8 had never told her she needed to avoid milk. CNA A stated that if she needs a specific diet the Resident should have it. She stated that she was not involved in making diet orders or changes. She was responsible for making sure that the tray of food matches the meal ticket. She stated that the nurses oversaw diet orders. She stated she was concerned because eating a diet that caused toxic products could have made her sensitive condition worse. Interview with LVN D at 06/26/25 01:59 pm she revealed that she was unaware that Resident #8 had galactosemia. She stated she was trained that the nurses, upon admission of a resident, are supposed to place the diet orders in and communicate to the kitchen . She stated after admission orders, the kitchen and the dietitian should be communicating with the resident and the family. She revealed that they should be feeding her the appropriate diet that the doctor or the dietitian recommended. She stated that if the facility fed a resident an inappropriate diet it could make their health conditions worse. Interview with DM on 06/26/25 at 2:32 pm she stated that diet orders are inputted by nursing that would print the diet slips from the kitchen. She stated she was serving Resident #8 a low concentrated sweets diet but had no awareness or education about galactosemia. She stated that she had been serving Resident #8 dairy based foods. She stated that the dietitian would help her implement a galactosemia diet if necessary. She stated it was important to follow the prescribed diets because it's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 11 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0800 directly associated with a disease state and not just overall general health. Level of Harm - Minimal harm or potential for actual harm Interview with the DON at 06/26/25 at 5:05 pm she revealed that she had only been the DON since Monday, 06/23/25. She stated that although she was unfamiliar with galactosemia, it should be treated like any other nutrition related disease with the proper diet. She said the Dietitian should have been triggered for a consult upon admission. She expected nursing, during an initial care plan meeting, to ask the family how the resident managed their disease before admission. She stated that the risk to the Resident would be continuing to eat things that worsened her other diseases. Residents Affected - Few Interview with the ADM on 06/26/25 at 5:27 pm he stated that the facility worked on liberalizing their diet to keep the residents happy. He stated that he was unaware of Resident #8's galactosemia diagnosis before today. He stated they would give her medications or change her diet, but resident and family preferences are the most important. He stated that the family and Resident should have had the opportunity to be educated and decide which diet to choose for themselves. He reiterated if the doctor was concerned about the effects of galactosemia on her health, he would have ordered a specific diet. Called Resident #8's doctor on 06/26/25 at 4:35 pm with no response . Record review on 06/26/25 of facility policy titled, Therapeutic Diet Orders dated 11/24 stated, (facility) provides all residents with foods in the appropriate form and/or the appropriate nutritive content as prescribed by a physician and/or in accordance with his/her goals and preferences. 1. Each resident's nutritional status is assessed in accordance with assessment policies. 2. Therapeutic diets, including mechanically altered diets where appropriate, will be based on the resident's individual needs as determined by the resident's assessment. Therapeutic diets may be considered in certain situations, such as, but not limited to: a. Inadequate nutrition b. Nutritional deficits c. Weight loss d. medical conditions such as diabetes, renal disease, or heart disease e. Swallowing difficulty 3. Therapeutic diets are provided only when ordered by the attending physician. 4. The reason for a therapeutic diet is to be documented in the medical record and/or indicated on the resident's plan of care. All diet orders are to be communicated to the dietary department in accordance with facility procedures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 12 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 0800 5. Dietary and nursing staff are responsible for providing therapeutic diets in the appropriate form and/or the Level of Harm - Minimal harm or potential for actual harm appropriate nutritive content as prescribed by the Physician. 6. For resident classification and care planning purposes, the dietary manager or RAI coordinator will follow Residents Affected - Few instructions in the current RAI manual when coding therapeutic or mechanically altered diet on the MDS. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 13 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 Based on observation, interview, and record review the facility failed to establish and 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 4 (CNA A, CNA B, CNA F, and CNA G) of 5 staff reviewed for infection control. Residents Affected - Some 1. The facility failed to ensure CNA B, CNA F, and CNA G conducted hand hygiene between residents during lunch tray pass. 2. The facility failed to ensure CNA A sanitized her hands with a glove change when performing Foley catheter care. These failures could place residents at risk of transmission of disease and infection. Findings include: Observation on 06/24/25 at 11:47 AM of the 200-hall lunch tray pass revealed CNA B brought a lunch tray into Resident #5's room, and hand hygiene was conducted. CNA B then passed a lunch tray to Resident #30, and no hand hygiene conducted. She then passed a lunch tray to Resident #12, and no hand hygiene conducted. CNA B passed a lunch tray to Resident #51, positioning provided, and tray set up, and no hand hygiene observed. CNA B then brought a tray of drinks to Resident #25's room, and no hand hygiene observed. She then passed another lunch tray to Resident #10, and no hand hygiene conducted. Observation on 06/24/25 at 11:55 am revealed CNA F walking out of a resident room grabbing another tray and walking into another resident's room. No hand hygiene was conducted. Observation on 06/24/25 at 12:10 pm revealed CNA G in the dining room grabbed a tray from the kitchen with food and brought it to a resident sitting at a table. CNA G proceeded to grab the cup by the top and place it down on the table. No hand hygiene was conducted before grabbing the tray. Observation on 06/25/25 at 01:47 PM of peri-care and Foley catheter care for Resident #3. CNA A did not conduct hand hygiene or a glove change after cleansing Resident #3's peri-area and went on to cleansing the Foley catheter tubing. An interview on 06/25/25 at 02:06 PM with CNA A, who stated she should have sanitized her hands and changed her gloves before moving on to Foley catheter care. CNA A further stated not conducting hand hygiene and glove changes when providing Foley catheter and peri-care could lead to cross-contamination for the resident. CNA A had received training on infection control and hand hygiene but could not recall when. Interview on 06/26/25 at 01:26 PM with the DON revealed staff should be conducting hand hygiene between glove changes, and hand hygiene with glove change should be done when going from one body part to another. The DON stated not conducting hand hygiene with glove changes, and not conducting hand (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 14 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 hygiene and glove change when going from clean to dirty could lead to cross-contamination and a possible infection for residents. Level of Harm - Minimal harm or potential for actual harm Review of Catheter Care policy dated 11/2024 reflected, Residents Affected - Some Policy: It is the policy of the facility to ensure that residents with indwelling catheters receive appropriate catheter care and maintain their dignity and privacy when indwelling catheters are in use. Policy Explanation: 1. Catheter care will be performed every shift and as needed by nursing personnel. Compliance Guidelines: 1. Knock and gain permission to enter the resident's room. 2. Explain the procedure. 3. Provide privacy by closing the door, closing the blinds/curtains, pulling the room dividing curtain, etc. 4. Gather supplies needed. 5. Assist resident to a lying position or the most comfortable position for the resident. 6. Drape resident to expose only the perineal area. 7. Perform hand hygiene. 8. [NAME] gloves. Female: 9. Gently separate the labia to expose the urinary meatus. 10. Wipe from front to back with a clean cloth moistened with water and perineal cleaner (soap). 11. Use a new part of the cloth or different cloth for each side. 12. With a new moistened cloth, starting at the urinary meatus moving out, wipe the catheter making sure to hold the catheter in place to not pull on the catheter. 13. Dry area with towel. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 15 of 16 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 745004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Brixton at Horseshoe Bay 15101 West Fm 2147 Horseshoe Bay, TX 78657 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 Review of Hand Hygiene policy, dated 11/2024, reflected, Level of Harm - Minimal harm or potential for actual harm Policy: Residents Affected - Some All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. Definitions: Hand hygiene is a general term for cleaning your hands by handwashing with soap and water or the use of an antiseptic hand rub, also known as alcohol-based hand rub (ABHR). Policy Explanation and Compliance Guidelines: 1. Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice. 2. Hand hygiene is indicated and will be performed under the conditions listed in, but not limited to, the attached hand hygiene table. 6. Additional considerations: a. The use of gloves does not replace hand hygiene. If your task requires gloves, perform hand hygiene prior to donning gloves, and after removing gloves. Hand Hygiene Table: o Between resident contacts o After handling contaminated objects o When, during resident care, moving from a contaminated body site to a clean body site. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745004 If continuation sheet Page 16 of 16