Health inspection·May 29, 2025

F 0553 Level of Harm - Minimal harm or potential for actual harm resident's care plan will be reviewed after each Admission, Quarterly, Annual and/or Significant Change MDS assessment, and revised based on changing goals, preferences and needs of the resident and in response to current interventions. The facility will provide the resident and resident representative, if applicable with advance notice of care planning conferences to enable resident/resident representative participation. The facility has held three care planning conferenced since resident's admission on [DATE]. Residents Affected - Some Resident #52 Record review of Resident #52's face-sheet dated 05/29/2025, revealed an [AGE] year-old female admitted to the facility on [DATE] with a readmission on [DATE]. Her diagnoses included Flaccid Hemiplegia affecting Left Dominant Side (a condition where the left side of the body, Including the arm, leg, face, experiences paralysis with limp, floppy muscles due to neurological Damage); Frontal Lobe and Executive Function Deficit Following Nontraumatic Intracerebral Hemorrhage (bleeding into the substance of the brain in the absence of trauma or surgery. Can damage the frontal lobe, leading to a range of executive function deficits such as planning, decision making, working memory, and impulse control.) Record review of Resident #52's quarterly MDS dated [DATE], reflected Resident #52's BIMS score was noted to be 0, which indicated severe cognitive impairment. Resident #26 required maximal assistance with care and could not speak and voice her needs. In an interview on 05/29/2025 at 1:50 PM Resident #52's family member revealed that he would like to meet with the staff to know what was going on with his loved one. Family member does not remember the last care plan meeting care plan meeting he attended. Family member received a letter to attend the care plan meetings. Resident #52 is not interviewable and would not understand the meeting. The Family member knew of only three meetings that he could remember and those occurred a long time ago. Record review of Resident #52's file revealed documentation of care plan meetings with resident or resident representative on the following dates: 02/22/2022, 05/24/2022, and 10/29/2024. The resident's care plan will be reviewed after each Admission, Quarterly, Annual and/or Significant Change MDS assessment, and revised based on changing goals, preferences and needs of the resident and in response to current interventions. The facility will provide the resident and resident representative, if applicable with advance notice of care planning conferences to enable resident/resident representative participation. The facility has held three care planning conferenced since resident's admission on [DATE]. Resident #55 Record review of Resident #55's face sheet dated 05/29/2025 revealed a [AGE] year-old female admitted to facility on 09/22/2022 with a readmission on [DATE]. Her diagnoses included Unspecified Diastolic Congestive Heart Failure (occurs when the heart's left ventricle can't relax properly between beats, preventing it from filling with enough blood, and thus pumping out less blood than it should); Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease (a serious complication of diabetes where the kidneys are damaged by high blood sugars); Cerebral Infarction due to Embolism of Left Middle Cerebral Artery (occurs when a blood clot travels to the brain and blocks the MCA, Middle Cerebral Artery, leading to tissue death and stroke. Embolism, a blood clot, embolus that travels from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 2 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0553 another part of the body, like the heart or another artery, to the brain. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #55's, quarterly MDS dated [DATE], reflected Resident #55's BIMS score was noted to be 14/15, which indicated intact cognition. Resident #55 required moderate to maximal assistance with care and was able speak and voice her needs. Residents Affected - Some On 05/29/2025 at 2:04 PM attempted to contact Resident #55's family member. Left message r/t reason for call and a call back number. Before the end of the day family member had not returned call. In an interview on 05/31/2025 at 1:42 PM Resident #55's family member revealed that she resided in another state, but the facility kept her informed of any medication changes or other issues that may be occurring with her loved one. Family member revealed that she has been invited to the care plan meetings, but living out of state she is unable to attend. Family member revealed she visits her loved one every three months and will meet with the staff to discuss Resident #55. Resident is unable to attend the care plan meetings per family member. Record review of Resident #55's file revealed documentation of care plan meetings with resident or resident representative on the following dates: 12/01/2022, 02/08/2023, 03/01/2023, 06/26/2023, and 12/27/2023. The resident's care plan will be reviewed after each Admission, Quarterly, Annual and/or Significant Change MDS assessment, and revised based on changing goals, preferences and needs of the resident and in response to current interventions. The facility will provide the resident and resident representative, if applicable with advance notice of care planning conferences to enable resident/resident representative participation. The facility has held three care planning conferenced since resident's admission on [DATE]. Resident #57 Record review of Resident #57's face sheet dated 05/29/2025 revealed a [AGE] year-old female admitted to facility on 03/04/2022. Her diagnoses included Cerebral Infarction, Unspecified (refers to a stroke, a type of brain attack where blood flow to the brain is blocked, leading to Tissue damage); Essential (Primary) Hypertension (a type of high blood pressure where no specific underlying cause, such as a medical condition, can be identified); Unspecified Protein-Calorie Malnutrition (the lack of sufficient energy or protein to meet the body's metabolic demands). Record review of Resident #57's, quarterly MDS dated [DATE], reflected Resident #57's BIMS score was noted to be 14/15, which indicated intact cognition. Resident #57 required partial to moderate to maximal assistance with care and was able speak and voice her needs. In an interview on 05/29/2025 at 1:00 PM with Resident #57 revealed she did not know what a care plan meeting was. Resident #57 said that her friend would know. Asked Resident #57 who her friend was, and she revealed she is the person who comes to see her when she needs personal items or snacks. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 3 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 05/29/2025 at 2:13 PM attempted to contact Resident #57's family representative. Left message r/t reason for call and a call back number. Before the end of the day family representative had not returned call. In an interview on 05/30/2025 at 2:14 PM Resident #57's resident representative revealed the facility will contact her with updates r/t Resident #57. The Resident representative said that she had not attended a care plan conference in over a year because of her own personal problems. Resident representative has received care plan invitations to attend the meetings, but not in a while. Resident does not attend the meetings because she does not get out of bed often. Record review of Resident #57's file revealed documentation of care plan meetings held with resident or resident representative on the following dates: 03/10/2022, 02/08/2023, and 04/05/2023. The resident's care plan will be reviewed after each Admission, Quarterly, Annual and/or Significant Change MDS assessment, and revised based on changing goals, preferences and needs of the resident and in response to current interventions. The facility will provide the resident and resident representative, if applicable with advance notice of care planning conferences to enable resident/resident representative participation. The facility has held three care planning conferenced since resident's admission on [DATE]. Resident #61 Record review of Resident #61's face sheet dated 05/29/2025 revealed a [AGE] year-old female admitted to facility on 01/07/2023 with readmission on [DATE]. Her diagnosis included Unspecified Dementia, Unspecified Severity, without Behavioral Disturbance, Mood Disturbance and Anxiety (unspecified dementia that does not present significant behavioral Disturbances, such as agitation, aggression, or psychosis); Chronic Kidney Disease, Unspecified (occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years); Essential (Primary) Hypertension (a type of high blood pressure where no specific underlying cause, such as a medical condition, can be identified). Record review of Resident #61's, quarterly MDS dated [DATE], reflected Resident #61's BIMS score was noted to be 05/15, which indicated severe cognitive impairment. Resident #61 required maximal assistance with care and could not speak and voice her needs. In an interview on 05/29/2025 at 2:04 PM Resident #61's family member revealed that he had not been asked to attend a care plan meeting for quite a while. The Family member had to cut the conversation short. In an interview on 05/29/2025 at 2:10 PM Resident #61's second family member revealed that he had previously attended two care plan meetings and believed this was about two years ago. Both family members received invitations to attend the care plan meetings. Resident #61 is unable to attend due to her dementia. The Family member stated he had not been notified of any further care plan meetings since that time or asked to attend. The Family member revealed the facility had his phone number and he was concerned because attending care plan meetings was something he would like to do. Record review of Resident #61's file revealed documentation of care plan meetings held with resident and resident representative on the following dates: 01/18/2023, 03/15/2023, 04/26/2023, and 07/05/2023. The resident's care plan will be reviewed after each Admission, Quarterly, Annual and/or Significant Change MDS assessment, and revised based on changing goals, preferences and needs of the resident and in response to current interventions. The facility will provide the resident and resident representative, if applicable with advance notice of care planning conferences to enable resident/resident representative participation. The facility has held three care planning conferenced since resident's admission on [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 4 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0553 Level of Harm - Minimal harm or potential for actual harm In an interview on 05/29/2025 at 11:35 AM the SW revealed that she was new to the facility and was in the process of becoming organized within the social services department. The SW revealed that care plan conferences will be on her list to be scheduled monthly with the assistance from the MDS Coordinator. The SW was aware that the care plan conferences needed to be a priority. The SW could not show any documentation r/t care plan invitations sent to residents Residents Affected - Some and resident's representatives. In an interview on 05/29/2025 at 11:55 AM the MDS Coordinator revealed that it was her responsibility to make the monthly MDS schedule for the departments responsible for completing the quarterly MDS for each resident. The quarterly care plans were scheduled in conjunction with the MDS schedule. The MDS Coordinator revealed that she will provide a monthly calendar with the scheduled MDSs due for the following month to the SW to send invites to the resident and resident representatives to scheduled care plan meetings. The MDS Coordinator was unaware of if there were any documentation r/t care plan invitations sent to residents and resident's representatives. The MDS Coordinator was new to the facility in the position. In an interview on 05/29/2025 at 2:45 PM the DON revealed that all residents and resident's family members had the right to participate in the care plan meetings. The DON said the SW set up the meetings with the resident and invited family members by sending a letter of invitation. Quarterly meetings were usually triggered along with the scheduled MDSs. The SW was new, and the plans were to bring family members together for a meeting first. The goals will be to ensure that the residents and resident representatives are invited to participate in care plan meetings. In an interview on 05/29/2025 at 5:06 PM the ADM revealed that his expectations r/t resident care plans were that all residents and resident representatives were invited to participate in the quarterly meetings according to the MDS schedule provided by the MDS Coordinator. The SW will mail out letters to invite the resident and resident representative to the scheduled care plan meetings as scheduled. Record review of the facility's policy on Comprehensive Care Planning in the of the Nursing Policy & Procedure Manual (no policy date) revealed in part, The resident's care plan will be reviewed after each Admission, Quarterly, Annual and/or Significant Change MDS assessment, and revised based on changing goals, preferences and needs of the resident and in response to current interventions. Facility staff will assist residents to engage in the care planning process, e.g., helping residents and resident representatives, if applicable understand the assessment and care planning process; holding care planning meetings at the time of day when the resident is functioning best; planning enough time for information exchange and decision making; encouraging a resident's representative to participate in care planning and attend care planning conferences. The facility will provide the resident and resident representative, if applicable with advance notice of care planning conferences to enable resident/resident representative participation. Resident and resident representative participation in care planning can be accomplished in many forms such as holding care planning conferences at a time the resident representative is available to participate, holding conference calls or video conferencing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 5 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the Comprehensive MDS Assessment for one (Resident #79) of six residents reviewed for comprehensive care plans. The facility failed to care plan chronic pain for Resident #79 when her Comprehensive MDS Assessment indicated she had constant pain. This failure placed residents at risk for not receiving pain medication causing them to not get pain relief and lowering their quality of life. The findings included: Record review of Resident #79's admission record dated 5-28-2025, revealed an [AGE] year-old female who admitted to the facility on [DATE] with a primary diagnosis of metabolic encephalopathy (a brain dysfunction resulting from underlying metabolic problems or organ dysfunction, rather than direct brain injury) and secondary diagnoses of type 2 diabetes mellitus (high blood sugar levels due to the body's inability to use insulin properly, known as insulin resistance), cognitive communication deficit (difficulty communicating due to problems with cognitive functions rather than problems with speech or language), thrombocytopenia (lower-than-normal number of platelets in the blood for proper clotting), and pain unspecified. Record review of Resident #79's Comprehensive MDS Assessment, dated 5-5-2025 revealed she had a BIMS score of 13 indicating being cognitively intact. In the Pain Assessment Interview of Resident #79's MDS, it was assessed that Resident #79 had pain almost constantly, pain frequently disturbed her sleep, pain frequently interfered with day-to-day activities, and showed a pain intensity of 5 on a Numeric Pain Rating Scale of (00-10). Record review of Resident #79's Comprehensive Care Plan dated 4-30-2025 and revised on 5-5-2025 indicated the facility failed to implement care planning for pain. Record review of Resident #79's Physician Orders dated 5-23-2025 indicated Resident #79 was prescribed one Tylenol Extra Strength Oral Tablet 500 MG to be given by mouth every 6 hours as needed for pain. Record review of Resident #79's MAR revealed Resident #79 was given 15 dosages of Tylenol Extra Strength Oral Tablet 500 MG from 5-23-2025 thru 5-28-2025 for pain. An Interview, on 5-27-2025 at 12:31 PM, revealed Resident #79 had ongoing pain from arthritis and was receiving pain medication from the facility. In an interview with the MDS Coordinator on 5-29-2025, at 11:45 AM, it was revealed she had worked at the facility for 5 months. The MDS Coordinator stated the MDS Coordinator completed the Comprehensive and Quarterly Care Plans and was responsible to ensure residents were care planned correctly. The MDS Coordinator said she did not know why Resident #79 was not care planned for pain. The MDS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 6 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinator said the potential risk to residents not being care planned completely was that a resident might not receive the care she needed. In an interview with the DON on 5-29-2025 at 2:35 PM, it was acknowledged she had worked at the facility for 5 months. The DON said the MDS Coordinator was responsible for retrieving the information from the MDS Assessments and putting it into Care Plans. The DON said she did not know why Resident # 79 was not care planned for pain. The DON said she expected resident's care plans to contain the information assessed on their MDS Assessments. The DON said the potential risk to a resident who was not care planned, with all the MDS Assessment information, was that residents and family members could fail to be educated on the care that was needed. Record review of the facility's policy on Care Plan Planning titled Comprehensive Care Planning stated: The facility will develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment . Each resident will have a person-centered comprehensive care plan developed and implemented to meet his other preferences and goals, and address the resident's medical, physical, mental, and psychosocial needs. When developing the comprehensive care plan, facility staff will, at a minimum, use the Minimum Data Set (MDS) to assess the resident's clinical condition, cognitive and functional status, and use of services. If a Care Area Assessment (CAA) is triggered, the facility will further assess the resident to determine whether the resident is at risk of developing, or currently has a weakness or need associated with that CAA, and how the risk, weakness or need affects the resident. Documentation regarding these assessments and the facility's rationale for deciding whether or not to proceed with care planning for each area triggered will be recorded in the medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 7 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 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 observations, interviews, and record review, the facility failed to provide pharmaceutical services (including procedures that ensured drugs and biologicals were accurately acquired, received, dispensed, and administered) to meet the needs of each resident for one (600 Hall medication supply room) of two medication rooms reviewed for pharmacy services. The facility failed to ensure expired medications were removed from the 600 Hall medication room. These failures could place residents receiving medications at risk for possible adverse medication effects. Findings included: In an interview and observation on 05/27/25 at 09:15 am the following expired medications were noted in the Hall 600 medication supply room: 1.) Pink Bismuth 236 ml bottle (3 unopened bottles) with manufacturer expiration date of 02/ 2025 . 2.) Good Sense Hemorrhoidal Ointment (2 unopened tubes), 2 ounces each, with manufacturer expiration dates of 08/2024 (one tube) and 09/2023 (one tube). 3.) Banatrol Plus with Bimuno Prebiotic for Diarrhea and Loose Stools (2 unopened boxes), .38 ounces per packet, 75 packets per box, with manufacturer expiration dated 03/10/2025 (1 box) and 12/22/2024 (1 box). 4.) Bisacodyl 10 mg laxative suppository (3 unopened boxes), 12 suppositories per box, with manufacturer expiration date of 01/2025 (1 box) and 07/2024 (2 boxes). 5.) Geri-Max Antacid and Antigas 355 ml unopened bottle with manufacturer expiration date of 03/2025. The DON declined to state the risk of expired medications but stated, for now, we go by the pharmacy policy and she removed the medications from the supply for immediate disposal. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 8 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0755 Level of Harm - Minimal harm or potential for actual harm In an interview on 05/27/25 at 09:50 am, the ADM reported that expired medications were to be removed from supply and that the nurse or medication aide who found the expired medications or supplies were responsible for removing and disposing of them and that the clinical management team consisting of the DON and ADONs were also responsible. He declined to state the potential risks that expired medications may pose to residents. Residents Affected - Some Record review of the facility policy titled, Expired Medications and Medications with Shortened Expiration Dates reflected the policy was to prevent having expired medications in the facility and that, All OTC (Over the Counter) medications may be used until manufacturer's expiration date is reached or per the individual State Board of Pharmacy and State Health Departments rules and regulations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 9 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food safety in the facility's only kitchen observed for sanitization and storage: 1. The facility failed to clean dishes and eating utensils in accordance with proper sanitization standards when the facility's only chemical dishwasher was broken. 2. The facility failed to ensure food items, stored facility's only dry storage room, were sealed and dented cans discarded. These failures could affect residents by placing them at risk for cross-contamination and/or food-borne illness. Findings included: Observations and interviews, during the initial tour of the kitchen, on 5-27-2025 at 9:00 AM, revealed the following: Dry Storage Pantry Area: 1. 1- bag of cornbread mix was torn open exposed to air 2. 1- 11 lb. container of chocolate icing was dented and punctured at the bottom exposing the contents to the air. 3. 1-7lb can of lemon pudding was severely dented from one side to the other 4. 1- 8lb can of Apple Jelly was dented 5. 2- 50 oz cans of soup were dented In an interview with the Dietary Manager on 5-27-2025 at 9:05 AM it was revealed he did not know there were dented cans, torn packages, and punctured containers in the dry storage pantry. The Dietary Manager said it was his responsibility to ensure proper storage of dry foods and that food was not served from these deficiencies. The Dietary Manager stated he expected staff to check items stored in the dry storage area for torn or ripped packages and dented cans and for them to make sure all items were sealed and dated properly. The Dietary Manager stated the risk to residents being served food from punctured containers and items exposed to air was the possibility of getting food-borne illness. Dishwashing Area: The facility's only dishwasher was observed not being used and broken. Kitchen staff were observed using a 3-sink system with no sanitization solution in the third sink. In the same room, a single sink was being used to wash dishes with a spray nozzle and a plastic container of dirty looking water by Dietary Aide A. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 10 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many In an interview with the Dietary Manager on 5-27-2025 at 9:05 AM, it was revealed that the Dietary Manager did not know what type of dishwasher the facility had. The Dietary Manger said he had been working at the facility for 4 days. The Dietary Manager acknowledged the facility's only dishwasher had been broken since Friday 5-23-2025. The Dietary Manger said he found out about the broken dishwasher on Monday 5-26-2025, as he had been off all weekend. The Dietary Manager stated that the facility's Maintenance Supervisor was responsible for getting the dishwasher fixed. In an interview on 5-27-2025 at 9:10 AM, Dietary Aide A said she was washing dishes in her sink and another person was using the 3-compartment sink to wash dishes. When Dietary Aide A was informed this was not a sanitary procedure, to hand wash dishes, she said oh, I am just rinsing them off for the 3-compartment sink. In an interview on 5-27-2025 at 9:15 AM the Maintenance Supervisor indicated the facility had one chemical dishwasher and it broke down on Thursday 5-22-2025 in the morning hours. The Maintenance Supervisor stated he contacted the repair company to get the dishwasher repaired and was informed the company would charge overtime pay if they came out over the weekend. The Maintenance Supervisor said the repair company would not be able to come to the facility until Wednesday (5-28-2025) or Thursday (5-29-2025) of the following week. The Maintenance Supervisor said, the responsibility of getting the dishwasher fixed was thrown on him. In an interview with the Administrator on 5-27-2025 at 9:53 AM it was conveyed that the repair company could not come to the facility until Wednesday or Thursday. The Administrator stated the facility is using a 3-compartment sink to wash dishes and doing hand washing. The Administrator said the facility was not going to use paper plates until the dishwasher was fixed but was going to keep using the same dishes. The Administrator said he did not know what the risk to residents could be if dishes and silverware were not cleaned properly. The Administrator said the Maintenance Supervisor was responsible to ensure the facility's only dishwasher worked properly. The Administrator said his expectations were for the kitchen staff to us the 3-compartment sink to wash dishes and to follow the proper protocols to keep dishes properly sanitized for the residents. In an interview on 5-27-2025 at 9:45 AM Dietary Aide A was asked if she was doing temperature checks while she was only using one sink to wash dishes. Dietary Aide A got angry and said what are you asking me for, I feel like I am being ganged up on! Dietary Aide did not answer the question. On 5-27-2025 at 10:15 AM an observation was made revealing a test strip, was dipped in the sanitizing sink of the 3-compartment sink, by Dietary Aide A. The test strip revealed a 0 rating of a 50-ppm test. Dietary Aide A was informed that this failed the sanitization test. Dietary Aide A did not respond to questions after that. In an interview on 5-27-2025 at 12:30 PM, the Administrator stated that the facility's only dishwasher had been repaired and was working. In an observation on 5-27-2025 at 1:30 PM, it was revealed that the facility's dishwasher was working, reached 120 F, and indicated 50 ppm sanitization. In an interview on 5-29-2025 at 9:50 AM it was revealed Dietary Aide A had worked at the facility for 1.5 years. Dietary Aide A said her kitchen duties included making sure residents had their proper diet, serving food, and washing dishes. Dietary Aide A said she first learned the chemical dishwasher was broke on Friday 5-23-2025. Dietary Aide A said she did not know who was responsible to ensure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 11 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0812 Level of Harm - Minimal harm or potential for actual harm dishes were properly sanitized. Dietary Aide A said the last time she was trained, on the proper use of the chemical dishwasher and hand washing dishes, was when she was first hired. Dietary Aide A said the proper way to hand wash dishes was to use a 3-compartment sink where one sink was to wash, the 2nd sink was to rinse, and the 3rd sink was to sanitize dishes. Dietary Aide A said the risk to residents, if dishes were not properly sanitized, was the transference of bacteria and the potential of making them sick. Residents Affected - Many In an interview on 5-29-2025 at 10:15 AM the Dietary Manager revealed he had been working at the facility for 1.5 weeks. The Dietary Manager stated he was responsible to ensure the kitchen's dishwasher was working properly. The Dietary Manager stated he was making the initial kitchen tour rounds with the surveyor and heard Dietary Aide A say she was washing dishes in the single sink and not the 3-compartment sink. The Dietary Manager stated Dietary Aide A was not doing any temperature checks when she was cleaning dishes in the single sink, and she was not following proper procedures. The Dietary Manager stated he gave in-services on sanitization procedures in washing dishes on Wednesday 5-21-2025 and was doing more because of what he witnessed today. The Dietary Manager said the risk to residents if dishes were not properly sanitized was that they could get sick. The Dietary Manger stated he did in-services with the kitchen staff on proper dishwashing and handwashing techniques. Record review of the kitchen's Dishwashing Machine Temperature Check Log, dated 5-2025, revealed the exact same temperatures were entered into the log for 5-18-2025 thru 5-27-2025 during breakfast times for wash, rinse, and ppm checks. However, observations and interviews indicated the dishwashing machine had been broken since 5-22-2025 and temperature checks would not have been possible. Record review of Kitchen Staff's in-service training on 6-5-2025, revealed proper dishwashing procedures for 3-compartment washing, dishwashing procedures, and proper storage and labeling were completed on 5-27-2025 and 5-28-2025. Record review of the facility's food storage policy titled Food Storage and Supplies dated 2012 stated: All facility storage areas will be maintained in an orderly manner that preserves the condition of food and supplies. We will ensure storage areas are clean, organized, dry and protected from vermin, and insects . 3. Dry bulk foods (e.g. flour, sugar) are stored in seamless metal or plastic containers with tight covers or bins which are easily sanitized . 4. Open packages of food are stored in closed containers with covers or in sealed bags, and dated as to when opened . 8. On perishable foods, microorganisms such as molds, yeasts, and bacteria can multiply and cause food to spoil . Record review of the facility's Dishwashing Policy titled Dishwashing Preparation and Dishwashing dated 2012, stated: The facility will complete the dishwashing process in a sanitary manner to provide clean and sanitary dishes and utensils. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 12 of 13 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 745006 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing and Rehabilitation 1901 N Hampton Rd 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 0812 Procedure: Level of Harm - Minimal harm or potential for actual harm 1. Prior to washing, all eating utensils shall be pre-flushed or pre-scraped to remove gross particles. This area is separate from the clean dish processing area . Residents Affected - Many 10. Manual dishwashing of eating utensils will be used only in the event of dish machine failure. a. Prior to washing, all utensils and equipment will be pre-scraped or pre-flushed, and when necessary, pre-soaked to remove gross waste. b. Effective concentration of detergent will be used. c. The detergent solution will be kept reasonably clean. d. All equipment and utensils will be thoroughly rinsed free of the detergent solution. e. All equipment and utensils shall be sanitized by one of the following methods: 1.) Immersion for at least one-half minute in clean, hot water at temperature of at least 180 degrees F, or 2.) Immersion for a period of at least one minute in a sanitizing solution containing: a. At least 50 ppm of available chlorine at a temperature of not less than 75 degrees F, mix 1 oz. chlorine compound per 12 gallons of water to equal 50 ppm, or b. At least 12.5 ppm of available iodine in a solution having a pH not higher that 5.0 and a temperature of not less than 75 degrees F (mix 2 oz. iodine compound per 5 gallons of water to equal 12.5 ppm), or c. At least 150-400 ppm of a quaternary ammonium compound a temperature of around 70 degrees F, (mix 1 oz. Quaternary ammonium compound per 4 gallons of water to equal 200 ppm.) d. Any other approved chemical sanitizing agency containing at least twice the minimum strength of solutions used for immersion sanitation . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745006 If continuation sheet Page 13 of 13