Health inspection·December 4, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few after PRN Zofran is administered. Record review of Resident #3 progress note, authored by LVN I, dated 10/12/25 at 9:40 AM, reflected Emesis was brown in color that was observed on bed and second emesis had a yellow mucus in mouth. Record review of Resident #3's second progress note, authored by LVN I, dated 10/12/25 at 9:40 AM, reflected Resident has emesis X2, gave Zofran and tolerated well. Record review of photo provided by complainant titled 20251012_134427, with metadata (the data that describes a photograph, providing details about the image itself, the equipment used to capture it, and its content. This information can include camera settings like aperture and shutter speed, keywords, captions, copyright, GPS location, date and time) indicated the date and time the photo was taken was on 10/12/25 at 1:44 PM. The photo was of Resident #3 from his mid thighs up, lying in bed shirtless, with just his head raised. Along the left side of Resident #3 was a blue vomit bag with a significant amount of a brown substance contained inside the bag. The bag was lying next to Resident #3 on the bed and the substance contained inside appeared to be close to leaking out onto the resident. Resident #3's left thumb, left index finger, left middle finger were seen stained by a dried brown substance. Record review of a photo provided by the complainant titled 20251012_134528, the metadata indicated the date and time the photo was taken was on 10/12/25 at 1:45 PM, reflected Resident #3 lying in bed. The photo was of Resident #3 from the waist up, shirtless. A dried brown substance could be seen on the center of Resident #3's chest. A dried brown substance could also be seen on the center of his stomach. A dried brown substance could be seen underneath his chin and along his left clavicle (commonly referred to as the collarbone), left shoulder, left arm pit, and inner upper left arm. Dark colored detritus (waste or debris of any kind) could be seen on Resident #3's chin and throughout his facial hair. Significant large globules of a brown substance could be seen on his upper right chest area. Record review of the facility's ADL log, dated 10/18/25 at 3:53 PM, reflected personal hygiene with Resident #3 was only conducted at 8:23 AM, by CNA E, and 4:55 PM, by CNA N, on 10/12/25. The ADL log further defined personal hygiene as How resident maintains hygiene, including combing hair, brushing teeth, shaving, applying makeup, washing/drying face and hands (excludes bath and showers). Interview on 10/17/25 at 2:51 PM with the complainant. The complaint advised they visited Resident #3 on 10/12/25 and found him lying in his bed covered in what she identified as dried vomit. The Complainant stated when she found Resident #3 covered in what she believed to be dried vomit, she informed staff and they cleaned him up. The complainant was able to take photos of the condition Resident #3 was in and provided the photos. Resident #3 deteriorated quickly throughout the day on 10/12/25 and later expired at the hospital in the evening due to existing complex health conditions. An interview was conducted with MA L on 10/18/25 at 1:40 PM. MA L advised they were not working on 10/12/25. MA L stated if they were to observe a resident covered in a substance which appeared to be dried vomit, they would immediately attend to the resident and assist in cleaning them up. MA L said they are routinely in serviced on ANE and was able to define ANE, as well as provide examples of ANE, and identify the ANE coordinator for the facility. An interview was conducted with the DON on 10/18/25 at 2:00 PM. The DON stated they were aware of Resident #3's change of condition regarding their vomiting. The DON stated there is no way to determine how long Resident #3 was left lying in bed covered in the dried brown substance. The DON stated she believed it would take 1-2 hours for vomit to dry. The DON said she was aware Resident #3 had trouble swallowing and often would be unable to swallow their food and spit it out. The DON stated they would expect facility staff to clean a resident if they were observed to be dirty or had a dried brown substance on them. An interview was conducted with CNA M on 10/18/25 at 2:25 PM. CNA M stated if they observed a resident covered in a substance which appeared to be dried vomit, they would immediately attend to the resident and assist (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745017 If continuation sheet Page 2 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 - Few in cleaning them up. CNA M further stated they worked on 10/12/25 in Resident #3's hallway, but she was assigned to a group of rooms which did not include Resident #3's room. CNA M said CNA E was responsible for Resident #3's care on 10/12/25. CNA M said they were routinely in-serviced on ANE and was able to define ANE, as well as provide examples of ANE, and identify the ANE coordinator for the facility. An interview was conducted with RN B on 10/18/15 at 3:05 PM. RN B stated they worked on 10/11/25 and observed Resident #3 was vomiting. RN B continued to say they completed a CIC and notified the medical provider. RN B said they received updated orders for lab work and to start Resident #3 on Zofran PRN from the medical provider. RN B stated their usual method of operation was to try to check on each resident once every two hours, however residents with acute conditions, they try to check on resident's every 10-15 minutes. RN B stated they considered vomiting to be an acute condition and checked on Resident #3 several times throughout their shift. RN B stated they were not working on 10/12/25 and could not speak to if Resident #3 was routinely checked on throughout the day. An interview was conducted with LVN I on 10/18/25 at 3:26 PM. LVN I stated she worked on 10/12/25 and was aware of Resident #3's change in condition. LVN I stated when they started their shift at 6:00 AM in the morning, they performed initial rounds, to include checking on Resident #3. LVN I stated when they initially observed Resident #3, he was clean and was not vomiting. LVN I continued to say they returned to Resident #3's room approximately an hour and half later and observed Resident #3 had vomited. LVN I stated they told CNA E of Resident #3's condition and to help clean him up. LVN I said they believed CNA E was in Resident #3's room several times throughout the day and CNA E would have charted each time she performed ADL's with Resident #3. LVN I said they were routinely in serviced on ANE and was able to define ANE, as well as provide examples of ANE, and identify the ANE coordinator for the facility. An interview was conducted with CNA E on 10/18/25 at 4:15 PM. CNA E stated she worked on 10/12/25 and was aware of Resident #3's change in condition. CNA E stated she was in Resident #3's room more than five times throughout their shift to clean vomit. CNA E said they did not chart each time they performed ADL hygiene in the room because they did not have a place to chart. CNA E stated they could not recall if they observed Resident #3 with dried vomit on them. CNA E could not recall if they changed Resident #3's bed linen throughout the day due to being stained with a brown substance. CNA E denied being trained on ANE, could not define ANE, could not provide examples of ANE and did not know who the facility ANE coordinator was. An interview was conducted with the Administrator on 10/18/25 at 4:45 PM. The Administrator stated the facility protocol was to try to check on residents once every two hours. The Administrator stated there was the possibility of psychosocial harm for residents who were left to lay in their drying vomit. The Administrator could not provide an acceptable amount of time a resident could be allowed to lay in vomit or other detritus before they were helped and cleaned. The Administrator stated staff charting is completed by exception. The Administrator stated charting by exception is defined by staff only charting when they perform a service or care action. When asked if providing ADL hygiene assistance would be charted every time it was performed, the Administrator said it should be. Resident Rights policy was requested in the entrance email to the Administrator, during the entrance conference, and during the interview with the Administrator, but was not provided by time of exit. Record review of the facility's policy document titled Dressing and Undressing, Assisting the resident with, dated revised February 2018, reflected: The purposes of this procedure are to assist the resident as necessary with dressing and undressing and to promote cleanliness and may be part of the bath process. Dressing and Undressing, Assisting the resident with further reflected: DocumentationThe following information should be recorded in the resident's medical record:1. The date and time that the care/procedure was performed.2. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745017 If continuation sheet Page 3 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 name and title of the individual(s) who performed the care/procedure.3. If and how the resident participated in the procedure.4. How the resident tolerated the care delivered/procedure or any changes in the resident's ability to participate in the procedure. 5. Any problems, areas of concern or complaints made by the resident or noted during the care procedure.6. If the resident refused the procedure, the reason(s) why and the intervention taken.7. The signature and title of the person recording the data. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745017 If continuation sheet Page 4 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 0552 Ensure that residents are fully informed and understand their health status, care and treatments. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure the resident had the right to be informed of, and participate in, his or her treatment, including: The right to be fully informed in language that he or she could understand of his or her total health status, including but not limited to, his or her medical condition. for 2 of 12 residents (Residents #1 and #2) reviewed for resident rights. The facility failed to ensure the staff was adequately able to communicate with Residents #1 and #2 in their primary language, Spanish, for their care and service needs. This failure place residents at risk of their needs not being met, which could decrease their health and psychosocial well-being.Findings included: A)Record review of Resident #1's admission assessment dated [DATE] revealed a [AGE] year old Mexican American female with a preferred language of Spanish who admitted [DATE]. She had a BIMS score of 11 (Moderate impairment) and for daily preferences it was very important to make decision about choosing clothes to wear and taking care of personal belongings. She had lower extremity functioning impairment on one side and no upper impairment and used a walker and wheelchair. She needed substantial/maximal assistance with most ADLS's for self-care and mobility. She was always incontinent with bowel and bladder and had medically complex conditions. She was diagnosed with hypertension, renal insufficiency, urinary tract infection, hyperlipidemia, arthritis, enterocolitis, Osteoarthritis, obesity, pain in right knee, muscle weakness, lack of coordination, cognitive communication deficit, Right artificial knee joint. She was at risk of developing pressure ulcer/injuries and took antibiotics in the past 7 days. Record review of Resident #1's Care Plan dated 10/06/25 revealed ADL Self-care performance deficit related to muscle weakness, other lack of coordination, potential for pain related to chronic kidney disease, cystitis, right knee and osteoarthritis and at risk for falls related to history of fall, muscle weakness. She had potential for skin impairment related to decreased mobility, incontinence, potential for pain related to chronic kidney disease, acute cystitis, right knee pain and potential for nutritional problem related to clostridium difficile, hyperlipidemia, chronic kidney disease. And dated 10/07/25 revealed a potential for pressure ulcer development related to decreased mobility, renal insufficiency related to chronic kidney disease, altered cardiovascular status related to hyperlipidemia, hypertension. (There was no Spanish language care plan) Interview and observation on 10/16/25 at 5:35 pm Resident #1 was sitting up in bed but did not speak English and was not able to answer questions. There was not any communication boards, binders or devices anywhere on the bedside table or nightstand to communicate with. B) Record review of Resident #2's Quarterly MDS assessment dated [DATE] revealed, an [AGE] year old Mexican female who had a primary language of Spanish. She admitted [DATE] with a BIMS score of 10 (Moderate cognitive impairment). She had upper and lower functioning impairment of both side and used a wheelchair, and partial/moderate assist for self-care and mobility assistance. She was occasionally incontinent with bladder and occasionally incontinent with bowel, none Alzheimer's dementia, hemiparesis, depression, schizophrenia, asthma, third lumbar wedge compression fracture, right foot drop. Record review of Resident #2's Care Plan dated 02/19/25 revealed, The resident has an altercation in musculoskeletal status required use of Knee ankle foot orthoses. On 03/19/25 Resident was on anticonvulsant medication related to nerve pain. On 05/15/25 The resident has arthritis. (There was no Spanish language care plan). Interview and observation on 10/16/25 at 5:40 pm Resident #2 spoke Spanish and was not able to answer any questions. There was not any communication boards, binders or devices anywhere on the bedside table or nightstand to communicate with. Interview on 10/16/25 at 3:50 pm, ADON F stated for their Spanish speaking residents they had Spanish speaking staff to translate for them. She stated they Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745017 If continuation sheet Page 5 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some had communication boards at the nurses station and therapy room, but not in the resident's rooms. She stated if the staff spoke English to the Hispanic residents, it could result in them not understanding their care and needs. She stated she had used a translator on her phone to communicate with the Hispanic residents. Interview on 10/16/25 at 4:19 pm, MDS RN G stated for the Spanish speaking residents she would get a Spanish speaking CNA to help translate for her. Interview on 10/16/25 at 5:20 pm, SW H stated she had no complaints from anyone about the staff not knowing how to communicate in Spanish. She stated she did not know if the Hispanics had communication boards so they could visualize the picture to choose what their needs were. She stated it depended on the situation on how it could affect the residents. She stated the harm could be minimum or serious, such as needing to be changed more often. She stated the Hispanic residents needs would not be met if they were not able to figure out what the residents' needs were. Interview on 10/16/25 at 5:48 pm, the DON stated she started updating the care plans of the Spanish speaking residents today 10/16/25 because the HHSC Surveyor started asking the staff questions about them. She stated the staff needed to have a phone app to translate with the Hispanic residents to make sure their needs were met. She stated some of the staff used a phone app and ADON F would get a Hispanic therapist from the therapy department to translate to the residents at times. She stated today 10/16/25 RN B asked what would be the right way to communicate with the Hispanic residents. She stated yesterday afternoon on 10/15/25, CNA D asked her how should she communicate with the Spanish speaking residents. She stated telling RN B and CNA D they could use their phone apps just as long as they did not discuss HIPPA sensitive information on them. She stated they had about 90 nursing staff and was not sure if they were using the phone apps on their phones or not. She stated the staff used communication boards in the Hispanic resident's rooms. She stated she had not done any staff trainings on language communication with non-English speaking residents. She stated she had to look to see if Residents #1 and #2 had communication language preference Care plans for being Spanish speaking. She stated she did not see any so she added those care plans today 10/26/25 to their care plans. She stated not properly training the staff to communication with non-English speaking residents could cause mixed communication resulting in the resident not be able to express their needs effectively. She stated the residents could have unmet needs like not getting water or clothes changed when they would like. She stated today 10/16/25, she started trainings with the staff on communication with the communication boards and google app to translate with. Interview on 10/16/25 at 6:21 pm, the Administrator stated he was unaware of any communication barrier issues between the staff and residents. He stated they had Spanish speaking staff translate with the Hispanics and communication boards were used. He stated their IDT composed of SW H, both ADONs, himself, therapy, MDS Coordinators and the DON. He stated the DON was responsible for updating the residents care plans and ensuring the staff effectively communicated with the residents. He stated the IDT was supposed to go over everything about the resident's needs. He stated the plan to prevent this issue from reoccurring was to get with therapy department and speech therapist to Inservice the staff. He stated the staff would be in serviced to make sure the staff and residents understood one another for better communication. He stated the staff needed to be made aware of the communication boards, get them laminated and use them. He stated the communication boards needed to be put in the residents rooms so the residents and staff could communicate better. Interview on 10/17/25 at 11:39 am, LVN I stated she did not speak Spanish and if she did not understand what the Hispanic residents said she would get MA J. She stated if MA J were not working she would get a nurse, Maintenance K or a Therapist to help translate for her. She stated they did not have communication boards in the resident's room. She stated they had laminated communication boards but did she not know what (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745017 If continuation sheet Page 6 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some happened to them. Interview on 10/17/25 at 12:19 pm, the FM stated Resident #1 stated the staff did not speak English and every time they visited. They stated They would appreciate if the staff spoke Spanish. They stated Resident #1 told them they wished somebody at the facility spoke more Spanish to her. They stated talking to Resident #1 in Spanish was a better way for her to communicate her needs. They stated having a concern about if everything was being done taken care of Resident #1. They stated seeing how hard it was for the staff to understand Resident #1 and had seen one male staff using a phone but no one else. They stated Resident #1 liked when a Spanish speaking male staff worked because she could communicate herself better. They stated Resident #1 was concerned when she had a virus in her stomach when she would call for the staff to change her and they would not. They stated whenever they were at the facility they would translate in Spanish for Resident #1 communicate with the staff. They stated not being sure how the staff communicated with Resident #1 and said it would be nice if more of the staff spoke Spanish. Interview on 10/17/25 at 12:45 pm, FM N stated Resident #2 had been at this facility for a year and a half. They stated since Resident #2 admitted they told SW H there needed to be better way to communicate with Resident #2. They stated they had just had a care plan meeting last week with SW H and they requested a Spanish speaking Doctor because the one she currently had was not bilingual. They stated the other facility doctor was not in Resident #2's insurance network. They stated they requested SW H to get Spanish speaking nurses and CNA's. They stated they put a camera in Resident #2's room because Resident #2 said the staff did not understand her even though she tried her best to get them to understand. They stated Resident #2 finally had a Spanish speaking therapist three times a week, who was good about getting her out of bed and putting the brace on her Right leg. They stated when reviewing Resident #2's room camera they did not see the staff assisting Resident #2 in the morning with dressing and getting out of bed to her wheelchair. They stated Resident #2 needed staff assistance because her hand and foot was weak and she had a right-sided weakness because of a stroke. They stated the facility had to retrain the staff because they had a high turnover rate which causes more issues. They stated last Wednesday ADON F and SW H was in Resident #2's Care plan meeting and they told them about how Resident #2 wanted to be able to express her pain to the staff. They stated they had never seen staff using any phone apps but when Resident #2 was in the hospital the staff usually used an interpreter screen to communicate on. They stated it seemed that the staff did what they needed to do caring for Resident #2 and kept going without talking to Resident #2. They stated one time Resident #2's Doctor wanted to look under her dress and she asked what was he doing because she did not understand him. They stated Resident #2 felt offended even though it was her Doctor. They stated sometimes they had to drive to the facility to make sure everything was communicated correctly for any issues. They stated they would like more staff to speak Spanish because Resident #2 had a hard time communicating when she was in pain. They stated was it so expensive for the facility to get a translating service and stated she had never seen the staff get Spanish speaking staff to translate. They stated MA J was good with communicating with Resident #2 which was good. They stated Resident #2 loved to communicate with MA J but it was limited because she was not there all the time. They stated Resident #2 said when their doctor asked her questions she just nodded her head even though she was in pain because she did not understand English. Record review of the Facility's Statement of Resident rights policy undated, revealed Pursuant to 40 TAC 19.401(b) a copy of the attached statement of Resident Rights must be given to each resident, next of kin or guardian, and Community staff member. The Community must maintain a copy of the statement signed by the resident or the resident's next of kin or guardian, in Community records. The statement must also be posted pursuant to 40 TAC 19.1921. You, the resident, do not give up any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745017 If continuation sheet Page 7 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete rights when you enter a nursing Community. The Community must encourage and assist you to fully exercise your rights. Any violation of these rights is against the law. It is against the law for any nursing Community employee to threaten, coerce, intimidate or retaliate against you for exercising your rights. You have a right to: (1) all care necessary for you to have the highest possible level of health. Record review of the Facility's Resident rights poster undated revealed, Participation in your care your have the right to: Communicate in your native language to acquire or receive treatment, care and services. Event ID: Facility ID: 745017 If continuation sheet Page 8 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 - Some 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 observation, interview and record review the facility failed to 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 for 2 of 12 residents (Residents #1 and #2) reviewed for care plans.The facility failed to ensure their IDT created a communication care plans for their Spanish speaking Residents #1 and #2.This failure could place residents at risk of their needs not being met, which could decrease their health and psychosocial well-being.Findings included: A)Record review of Resident #1's admission assessment dated [DATE] revealed a [AGE] year old Mexican American female with a preferred language of Spanish who admitted [DATE]. She had a BIMS score of 11 (Moderate impairment) and for daily preferences it was very important to make decision about choosing clothes to wear and taking care of personal belongings. She had lower extremity functional impairment on one side and no upper impairment and used a walker and wheelchair. She needed substantial/maximal assistance with most ADLS's for self-care and mobility. She was always incontinent with bowel and bladder and had medically complex conditions. She was diagnosed with hypertension, renal insufficiency, urinary tract infection, hyperlipidemia, arthritis, enterocolitis, Osteoarthritis, obesity, pain in right knee, muscle weakness, lack of coordination, cognitive communication deficit, Right artificial knee joint. She was at risk of developing pressure ulcer/injuries and took antibiotics in the past 7 days. Record review of Resident #1's Care Plan dated 10/06/25 revealed ADL Self-care performance deficit related to muscle weakness, other lack of coordination, potential for pain related to chronic kidney disease, cystitis, right knee and osteoarthritis and at risk for falls related to history of fall, muscle weakness. She had potential for skin impairment related to decreased mobility, incontinence, potential for pain related to chronic kidney disease, acute cystitis, right knee pain and potential for nutritional problem related to clostridium difficile, hyperlipidemia, chronic kidney disease. And dated 10/07/25 revealed a potential for pressure ulcer development related to decreased mobility, renal insufficiency related to chronic kidney disease, altered cardiovascular status related to hyperlipidemia, hypertension. (There was no Spanish language care plan) Interview and observation on 10/16/25 at 5:35 pm Resident #1 was sitting up in bed but did not speak English and was not able to answer questions. There was not any communication boards, binders or devices anywhere on the bedside table or nightstand to communicate with. B) Record review of Resident #2's Quarterly MDS assessment dated [DATE] revealed, an [AGE] year old Mexican female who had a primary language of Spanish. She admitted [DATE] with a BIMS score of 10 (Moderate cognitive impairment). She had upper and lower functioning impairment of both side and used a wheelchair, and partial/moderate assist for self-care and mobility assistance. She was occasionally incontinent with bladder and occasionally incontinent with bowel, none Alzheimer's dementia, hemiparesis, depression, schizophrenia, asthma, third lumbar wedge compression fracture, right foot drop. Record review of Resident #2's Care Plan dated 02/19/25 revealed, The resident has an altercation in musculoskeletal status required use of Knee ankle foot orthoses. On 03/19/25 Resident was on anticonvulsant medication related to nerve pain. On 05/15/25 The resident has arthritis. (There was no Spanish language care plan). Interview and observation on 10/16/25 at 5:40 pm Resident #2 spoke Spanish and was not able to answer any questions. There was not any communication boards, binders or devices anywhere on the bedside table or nightstand to communicate with. Interview on 10/15/25 at 3:35 pm, CNA A stated he did not know Spanish but used a phone translator for communicating with the Hispanic residents. Interview (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745017 If continuation sheet Page 9 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 - Some on 10/15/25 at 4:52 pm, RN B stated he could not speak Spanish to the Hispanic residents. He stated two of the Hispanics spoke a little English but the others did not understand English. He stated he was effective with speaking to the resident in Spanish with a translator assist on his phone. Interview on 10/16/25 at 9:54 am, CNA C stated she did not speak Spanish but used a translator on her phone if there did not have other staff to help translate. Interview on 10/16/25 at 10:30 am, CNA D stated Resident #1 needed a translator because she only spoke Spanish. Interview on 10/16/25 at 3:24 pm, CNA E stated there was no communication binder in the resident's rooms who spoke other languages. Interview on 10/16/25 at 3:50 pm, ADON F stated for their Spanish speaking residents they had Spanish speaking staff to translate for them. She stated they had communication boards at the nurses station and therapy room, but not in the resident's rooms. She stated if the staff spoke English to the Hispanic residents, it could result in them not understanding their care and needs. She stated she had used a translator on her phone to communicate with the Hispanic residents. Interview on 10/16/25 at 4:19 pm, MDS RN G stated for the Spanish speaking residents she would get a Spanish speaking CNA to help translate. She stated they should have Spanish care plans for the residents whose primary language was not English. She stated once the MDS Assessment was completed the Care plan should have been created. She stated she did not see Care plans for Residents #1 and #2 was would have to check. She stated after she checked again that Residents #1 and #2 had Spanish communication care plans that was just created. She stated she was not sure why they were just created today by the DON. Interview on 10/16/25 at 5:20 pm, SW H stated she had no complaints from anyone about the staff not knowing how to communicate in Spanish. She stated she did not know if the Hispanics had communication boards so they could visualize the picture to choose what their needs were. She stated it depended on the situation on how it could affect the residents. She stated the harm could be minimum or serious, such as needing to be changed more often. She stated the Hispanic residents needs would not be met if they were not able to figure out what the residents' needs were. Interview on 10/16/25 at 5:48 pm, the DON stated she started updating the care plans of the Spanish speaking residents today 10/16/25 because the HHSC Surveyor started asking the staff questions about them. She stated the staff needed to have a phone app to translate with the Hispanic residents to make sure their needs were met. She stated some of the staff used a phone app and ADON F would get a Hispanic therapist from the therapy department to translate to the residents at times. She stated today 10/16/25 RN B asked what would be the right way to communicate with the Hispanic residents. She stated yesterday afternoon on 10/15/25, CNA D asked her how should she communicate with the Spanish speaking residents. She stated telling RN B and CNA D they could use their phone apps just as long as they did not discuss HIPPA sensitive information on them. She stated they had about 90 nursing staff and was not sure if they were using the phone apps on their phones or not. She stated the staff used communication boards in the Hispanic resident's rooms. She stated she had not done any staff trainings on language communication with non-English speaking residents. She stated she had to look to see if Residents #1 and #2 had communication language preference Care plans for being Spanish speaking. She stated she did not see any so she added those care plans today 10/26/25 to Residents #1 and #2's care plans. She stated she was responsible for updating the resident's care plans and that all of the department heads spoke daily in their morning meetings to determine which care plans needed to be updated. She stated not properly training the staff to communication with non-English speaking residents could cause mixed communication resulting in the resident not able to express their needs effectively. She stated the residents could have unmet needs like not getting water or clothes changed when they would like. She stated the IDT was responsible for updating the residents' care plan. She stated today 10/16/25, she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745017 If continuation sheet Page 10 of 11 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 745017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lodge of Saginaw Health and Wellness 848 W McLeroy Blvd Saginaw, TX 76179 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete had started trainings with the staff on communication with the communication boards and google app to translate with. She stated their plan to prevent was for the IDT was going to go over their plan in their morning meeting by making sure they had communication boards in the residents rooms. Interview on 10/16/25 at 6:21 pm, the Administrator stated he was unaware of any communication barrier issues between the staff and residents. He stated they had Spanish speaking staff translate with the Hispanics and communication boards were used. He stated their IDT composed of SW H, both ADONs, himself, therapy, MDS Coordinators and the DON. He stated the DON was responsible for updating the residents care plans and ensuring the staff effectively communicated with the residents. He stated the IDT was supposed to go over everything about the resident's needs. He stated the plan to prevent this issue from reoccurring was to get with therapy department and speech therapist to Inservice the staff. He stated the staff would be in serviced to make sure the staff and residents understood one another for better communication. He stated the staff needed to be made aware of the communication boards, get them laminated and use them. He stated the communication boards needed to be put in the residents rooms so the residents and staff could communicate better. Interview on 10/17/25 at 11:39 am, LVN I stated she did not speak Spanish and if she did not understand what the Hispanic residents said she would get MA J. She stated if MA I were not working she would get a nurse, Maintenance K or a Therapist to help translate for her. She stated they did not have communication boards in the resident's room. She stated they had laminated communication boards but did she not know what happened to them. Record review of the Facility's Care plan policy undated revealed, PURPOSE: The facility IDT team utilizes the CMS requirements of RAI as policy for reviewing and revising care plans. Responsible Disciplines IDT members, resident, Resident Representative STEPS - Care Plan Completion: Care plan completion based on the CAA process is required for OBRA-required comprehensive assessments. It is not required for non- comprehensive assessments (Quarterly, SCQA), PPS assessments, Discharge assessments, or Tracking records. However, the resident's care plan must be reviewed after each assessment, as required by S483.20, except discharge assessments, and revised based on changing goals, preferences and needs of the resident and in response to current interventions. After completing the MDS and CAA portions of the comprehensive assessment, the next step is to evaluate the information gained through both assessment processes in order to identify problems, causes, contributing factors, and risk factors related to the problems. Subsequently, the IDT evaluates the information gained to develop a care plan that addresses those findings in the context of the resident's goals, preferences, strengths, problems, and needs (additional information is described in detail in Chapter 4 of the CMS RAI manual). The care plan completion date (item V0200C2) must be either later than or the same date as the CAA completion date (item V0200B2), but no later than 7 calendar days after the CAA completion date. The MDS completion date (item Z0500B) must be earlier than or the same date as the care plan completion date. In no event should either date be later than the established time frames as described in Section 2.6 in the CM RAI Manual. For Annual assessments, SCSAs, and SCPAs, the process is basically the same as that described with an admission assessment. NOTE, In these cases, however, the care plan will already be in place. Review of the CAA(s) when the MDS is complete for these assessment types should raise questions about the need to modify or continue services and result in either the continuance or revision of the existing care plan. A new care plan does not need to be developed after each Annual assessment, SCSA, or SCPA type of assessment. Residents' preferences and goals may change throughout their stay, therefore the IDT should have ongoing discussions with the resident and resident representative, and staff member, so that changes can be reflected in the comprehensive care plan. Reference: CMS RAI Manual. Event ID: Facility ID: 745017 If continuation sheet Page 11 of 11