Health inspection·August 29, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few with Resident #1 on 08/28/2025 at 12:40 PM, Resident #1 stated that went outside after lunch around 1:30pm. Resident #1 stated the NA A took him outside and left him there. Resident #1 stated that he rolled himself in the sun but did not remember anything after that. Resident #1 stated it was very hot outside and he wanted to go back inside but nobody was around to take him back inside. During an interview with LVN A on 08/28/2025 at 10:25 AM, LVN A stated the NP possibly brought Resident #1 in from outside around 4:40pm, but she was not certain. LVN A stated the NP wheeled the resident to the nurse's station and asked if she could take his vitals because he wasn't responding to touch or verbal commands. LVN A stated she took Resident #1's blood pressure and pulse but did not take Resident #1's temperature. LVN A stated the facility put damp towels on Resident #1's arms, forehead, and the back of his neck to cool him down. LVN A stated she did not know how long Resident #1 was outside and stated she did not see him at 1:15pm when she went to lunch. LVN A stated she was not sure who was responsible for checking on the residents when they sat outside. LVN A stated that a negative outcome could be the resident could have heat exhaustion from sitting in the sun. During an interview with the DON on 08/28/2025 at 10:55 AM, the DON stated she was not aware of how Resident #1 got outside. The DON stated the resident was outside for about 30-45minutes per the GRC. The DON stated when she walked up Resident #1 was at the nurse station with LVN A receiving oxygen. The DON stated that Resident #1's vital were good but he was sent out per the NP. The DON stated that she was not aware that Resident #1's temperature was not taken prior to him going to the hospital. The DON stated while at the nurse station Resident #1 was slumped over with a little bit of drool coming from his mouth. The DON stated Resident #1 was not verbally saying anything at that time. The DON stated she was told that Resident #1 went outside daily to sit in the sun. The DON stated Resident #1 stated that someone would have had to open the door for him due to the resident not being able to open the front door. The DON stated a negative outcome from being in the sun for a long period of time could be heat exhaustion. The DON stated she did not remember the outside temperature on 08/26/2025 but in her opinion the resident did not suffer from heat exhaustion.During an interview with the GRC on 08/28/2025 at 11:05 AM, the GRC stated she did not let Resident #1 outside on 08/26/2025 nor was she aware who did. The GRC stated she went to lunch at 2:40pm and at that time Resident #1 was sitting by the door in the shade. The GRC stated when she returned to the facility around 3:50pm Resident #1 was sitting in the sun (sunning) but stated she did not think nothing of it because he was talking to her as she entered the facility. The GRC stated she did not see anyone bring Resident #1 back in the facility. The GRC stated prior to the incident residents who sat in front of the building were not required to sign out. The GRC stated that she was not sure who was supposed to check on the residents that sat outside. During an interview with the NP on 08/28/2025 at 11:45 AM, the NP stated someone came inside and told her there was a resident on the sidewalk that needed help. The NP stated she did not know the lady that alerted her about Resident #1 but thought it could have been a family member visiting the facility. The NP stated she did not know how long Resident #1 was outside. The NP stated she took Resident #1 immediately to the nurse station around 4:40pm. The NP stated that Resident #1 received oxygen, and damp cool rags prior to being taken by EMS. The NP stated Resident #1 was unresponsive but breathing. The NP stated when EMS put Resident #1 on the stretcher, he began to become alert. The NP stated it was 5-7 minute from the time she brought Resident #1 inside before EMS arrived. The NP stated a negative outcome would have to depend on the temperature outside and how long the resident was in the sun. The NP stated if Resident #1 suffered a heat stroke/heat exhaustion there would be signs of organ damage in which Resident #1 did not have. During an interview with NA A on 08/28/2025 at 1:10 PM, NA A stated he assisted Resident #1 outside around 2:40 PM. NA A stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745051 If continuation sheet Page 2 of 10 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 745051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing & Rehabilitation of College St 3105 Corsair Drive College Station, TX 77845 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few that Resident #1 was outside of the front door in the shaded area. NA A stated that Resident #1 was able to self-propel his wheelchair. NA A stated he did not check on Resident #1 while he was outside. NA A stated it was not until Resident #1 was brought in the facility unresponsive before he had seen him again. NA A stated when Resident #1 was brought in the facility, Resident #1 had his head down unresponsive and drooling. NA A stated he was the NA responsible for checking on the residents on Resident #1 hall. NA A stated that NAs were supposed to make rounds at least every two hours. NA A stated during rounds they should check to see if a resident needs water, go to the restroom and check to see if the resident was comfortable. NA A stated he was no aware who was responsible for checking on the residents when they were outside. NA A stated a negative outcome form a resident being left outside on a hot day would be the resident could pass out and no one would know. During a interview with the ADM on 08/29/2025 at 2:45 PM, the ADM stated no one was assigned to check on Resident #1 while he was outside. The ADM stated Resident #1 was outside for 30-45 minutes per the GRC. The ADM stated prior to Resident #1 going to the hospital his vitals were within normal limits. The ADM stated that she was not aware the Resident #1's temperature was not taken prior to him going to the hospital. The ADM stated a negative outcome from sitting in the sun could be heat exhaustion. A record review of the facility's Abuse/Neglect policy, undated, reflected The resident has the right to be free of abuse neglect, and misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms. Residents should not be subjected to abuse by anyone including, but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving the residents, family members or legal guardians, friends, or other individuals. The facility will provide and ensure the promotion and protection of resident rights. It is each individual's responsibility to recognize report, and promptly investigate actual or alleged abuse, neglect, exploitation, mistreatment or residents or misappropriation of resident property abuse and situations that may constitute abuse or neglect to any resident in the facility. Definitions 7 Neglect: is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, mental anguish, or emotional distress. This was determined to be an Immediate Jeopardy on 08/28/2025 at 4:15 PM. The ADM was notified. The ADM was provided with the IJ template on 08/28/2025 at 4:15 PM. The Plan of Removal was accepted on 08/29/2025 at 10:27 AM and included the following: All listed items will be completed by 08/29/2025 with continued follow-up: Resident #1 was assessed by the DON for any signs of heat exhaustion on 8/28/25. No further signs and symptoms of heat exhaustion were noted. All residents who have been observed to be sitting outside in the last 24hrs were assessed for any signs of heat exhaustion by the DON, ADON and Charge Nurses. No further residents were noted with any signs of a change in condition. 3. The Administrator and DON were in-serviced 1:1 on the following policies:a. Abuse and Neglect: failure to check on residents every 1 hour while outside during hot weather could result in harm and be considered neglect. b. Notification of a change in condition policy: including sign and symptoms of heat exhaustion such as lethargy, unresponsive, and elevated temperature, excessive sweating, thirst cramping or elevated temperature. c. Residents who are sitting out on porch will be rounded on every 1hr. They will be checked on by the charge nurses, CNAs or designee for any signs of heat exhaustion and offered hydration. Staff rounds will continue during the hot weather until further directed by the Administrator. A sign out sheet/binder has been implemented by the administrator for residents that go outside of the facility. Staff have been in-serviced on this process. d. New Process: a hydration cooler will be placed outside of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745051 If continuation sheet Page 3 of 10 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 745051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing & Rehabilitation of College St 3105 Corsair Drive College Station, TX 77845 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few residents who sit on the porch. The charge nurse, CNA or designated staff member will round every hour on all residents outside for any signs of heat exhaustion. The staff members will offer residents hydration and the opportunity to return inside the facility. If any resident shows signs of heat exhaustion, the charge will be notified immediately. This process will start 8/28/25 and continue indefinitely. 4. Administrator and DON were provided with written in-service cheat sheets to place in name badge for quick reference, signature and verbal acknowledgements were obtained. 5. All staff were in-serviced on the following topics: Abuse and Neglect, notification of a change in condition policy, check on resident sitting outside every hour, signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside. Any staff member not present or in-serviced as of 8/28/25 will not be allowed to assume their duties until in-serviced. All new hires will be in-serviced during orientation. All PRN, agency staff, or staff on leave will in serviced prior to assuming their next assignment. Completion date 8/29/25. 6. A hydration cooler was placed outside for residents who sit on the porch. The charge nurse, CNA or designated staff member will round every hour on all residents outside for any signs of heat exhaustion. The staff members will offer residents hydration and the opportunity to return inside the facility. If any resident shows signs of heat exhaustion, the charge will be notified immediately. 7. Involvement of the Medical Director: The medical director was notified of the immediate jeopardy on 8/28/25 by the DON. 8. ADHOC QAPI: This meeting was completed by the interdisciplinary team to include the Medical Director on 08/28/2025 Monitoring: During an observation on 08/29/2025 at 9:45 AM, reflected there was 3 resident outside near the hydration cooler. The hydration cooler was observed to have cold water in it. Record review of the facility's Resident Sign Out/In sheet on 08/29/2025 at 9:50 AM, reflected the current residents sitting outside had been signed out properly. Record review of the facility's Nursing Progress notes on 08/29/2025 at 10:00 AM, reflected there was 5 residents observed setting outside in the last 24 hours. All were assessed and there were no signs of heat exhaustion noted. Record review of the facility's Abuse and Neglect, Notification of a change in condition policy, check on resident sitting outside every hour, Signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside inservices, on 08/29/2025 at 10:00 AM, reflected the ADM and DON had been inserviced on those topics. Record review of the facility's Monitoring Chart sheet on 08/29/2025 at 10:30 AM, reflected the resident sitting outside were being monitored hourly. Record review of the facility's Off Cycle (ADHOC) QA meeting document on 08/29/2025 at 10:45 AM, reflected the QA meeting was conducted on 08/28/2025 and there were 6 member that attended the meeting. During an observation on 08/29/2025 at 11:00 AM, reflected a CNA was monitoring the resident outside of the facility. During interviews and observations on 08/29/2025 from 12:00 pm - 1:30 pm with 14 staff members (3 6am - 6pm LVNs, 3 6am-6pm CNAs, 2 6pm - 6 am LVNs, 2 6pm - 6am CNAs, 2 7:00 am 3pm housekeepers, 2 dietary staff), reflected they were able to articulate information from the following in-services: abuse and neglect, notification of a change in condition policy, check on resident sitting outside every hour, signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside. All staff interviewed were observed with their in-service cheat sheet in their name badge. During an interview with the DON on 08/29/2025 at 2:30 PM, the DON was able to articulate information from the following in-services: abuse and neglect, notification of a change in condition policy, check on resident sitting outside every hour, signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside. The DON was observed with her in-service cheat sheet in their name badge. During an interview with the ADM on 08/29/2025 at 2:45 PM, the ADM was able to articulate information from the following in-services: abuse and neglect, notification (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745051 If continuation sheet Page 4 of 10 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 745051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing & Rehabilitation of College St 3105 Corsair Drive College Station, TX 77845 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety of a change in condition policy, check on resident sitting outside every hour, signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside. The ADM was observed with her in-service cheat sheet in their name badge.While the IJ was removed on 08/29/2025 at 10:27 AM, the facility remained out of compliance at a severity level of no actual harm that is not immediate jeopardy and at a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745051 If continuation sheet Page 5 of 10 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 745051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing & Rehabilitation of College St 3105 Corsair Drive College Station, TX 77845 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review the facility failed to ensure each resident received adequate supervision for 1 of 8 resident (Resident #1) reviewed for supervision. The facility failed to ensure Resident #1 had adequate supervision or was checked on for over two hours as he was found outside on 08/26/25 with a temperature of 104 degrees [F] and sent to the hospital due to being unresponsive and tachycardic (your heart is beating too fast, over 100 times a minute at rest). The temperature on 08/26/25 was a high of 97 degrees [F]. An IJ was identified on 08/28/2025 at 4:15 PM. While the IJ was removed on 08/29/2025 at 10:27 AM, the facility remained out of compliance at a level of no actual harm at a scope of isolated with a potential for more than minimal harm, that was not immediate jeopardy, due to the facility's need to evaluate the effectiveness of the corrective systems This deficient practice placed residents at risk for falls, injuries, dehydration, hospitalization, and death. Findings included: Record review of Resident #1's admission record, dated 08/28/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included: multiple sclerosis (a disease where your immune system mistakenly attacks the protective fatty covering around your nerve in the brain and spinal cord), sickle cell (a condition where red blood cells become abnormally sickle), scoliosis (an abnormal sideways curving of the spine that often looks like a C or S shape when viewed from the back), adult failure to thrive (a syndrome not a specific disease, characterized by a general decline in health, marked by weight loss, decreased appetite, poor nutrition, and increased inactivity), and unspecified lack of coordination (trouble controlling you movements, making them jerky, unsteady, and clumsy instead of smooth and precise). Record review of Resident #1's Quarterly MDS assessment, dated 06/06/2025, reflected the resident had a BIMS score of 15, which indicated cognitive intact. Resident #1 was dependent in the areas of eating, oral hygiene, toileting hygiene, shower/bathe self, upper body dressing, lower body dressing, putting on/taking off footwear and personal hygiene. Record review of Resident #1's care plan, dated 08/28/2025, reflected Resident #1 want to go outside and sit and move himself around by himself. This focus was not added to Resident #1's care plan until 08/28/2025. Review of Resident #1's hospital records, dated 08/26/25, reflected He was apparently left outside in his w/c. He was found to be slumped in the WC with temp of 104 [F]. Initial temp here is 100.4 degrees [F] and he has sinus tachycardia (a normal, but faster than usual, heart rhythm) in the 110s. Record review of the local weather app with outside temperatures for the local area on 08/26/2025 was a high of 97 degrees [F}. Review of Resident #1's readmission Nurses' Note, dated 08/27/25, reflected the reason for his recent hospitalization was systemic inflammatory response syndrome (An exaggerated defense response from your body to a harmful stressor. It causes severe inflammation throughout your body. This can lead to reversible or irreversible organ failure and even death). During an interview with the Resident #1 on 08/28/2025 at 12:40 PM, Resident #1 stated that went outside after lunch around 1:30pm. Resident #1 stated that NA A took him outside and left him there. Resident #1 stated that he rolled himself in the but doesn't remember anything after that. Resident #1 stated it was very hot outside and he wanted to go back inside but nobody was around to take him back inside. During an interview with the LVN A on 08/28/2025 at 10:25 AM, the LVN A stated the NP possibly brought Resident #1 in from outside around 4:40pm, but she was not certain. LVN A stated that the NP wheeled the resident to the nurse's station and asked if she could take his vitals because he wasn't responding to touch or verbal commands. LVN A stated she took Resident #1 blood pressure, pulse, but did not take Resident #1 temperature. LVN A stated the facility put damp towels on Resident #1's arms, forehead, and the back of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745051 If continuation sheet Page 6 of 10 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 745051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing & Rehabilitation of College St 3105 Corsair Drive College Station, TX 77845 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few neck to cool him down. LVN stated she did not know how long Resident #1 was outside but stated she did not see him at 1:15pm when she went to lunch. LVN stated she was no sure who was responsible for checking on the residents when they sat outside. LVN A stated that a negative outcome could be resident could have heat exhaustion from setting in the sun. During an interview with the DON on 08/28/2025 at 10:55 AM, the DON stated she was not aware of how Resident #1 got outside. The DON stated that resident was outside for about 30-45minutes per the GRC. The DON stated when she walked up the Resident #1 was at the nurse station with LVN A receiving oxygen. The DON stated that Resident #1 vital were good but was sent out per the NP. The DON stated that she was not aware that Resident #1 temperature was not taken prior to him going to the hospital. The DON stated while at the nurse station Resident #1 was slumped over with a little bit of drool coming from his mouth. The DON stated Resident #1 was not verbally saying anything at that time. The DON stated she was told that Resident #1 goes outside daily to sit in the sun. The DON stated Resident #1 stated that someone would have had to open the door for Resident due to the resident not being able to open the front door. The DON stated there was nothing in place to monitor resident while they were outside. The DON stated a negative outcome from being in the sun for a long period of time could be heat exhaustion. The DON stated she does not remember the outside temperature on 08/26/2025 but in her opinion the resident was not suffering from heat exhaustion. During an interview with the GRC on 08/28/2025 at 11:05 AM, the GRC stated she did not let Resident #1 outside on 08/26/2025 nor was she aware who did. The GRC stated she went to lunch at 2:40pm and at that time Resident #1 was sitting by the door in the shade. The GRC stated when she returned to the facility around 3:50pm Resident #1 was sitting in the sun (sunning) but stated she did not think nothing of it because he was talking to her as she entered the facility. The GRC stated she did not see anyone bring Resident #1 back in the facility. The GRC stated prior to the incident resident who sat in front of the building were not required to sign out. The GRC stated that she was no sure who was supposed to check on the resident that sit outside. During an interview with the NP on 08/28/2025 at 11:45 AM, the NP stated someone came inside and told her they there the resident on the sidewalk that needed help. The stated she did not know the lady that alerted her about Resident #1 but thinks it could have been a family member visiting the facility. The NP stated she did not know how long Resident #1 was outside. NP stated she took Resident #1 immediately to the nurse station 4:40pm. The NP stated that Resident #1 received oxygen, and damp cool rags prior to being taken by EMS. The NP stated Resident #1 was unresponsive but breathing. The NP stated when EMS put Resident #1 on the stretcher, he began to be alert. The NP stated it was 5-7 minute from the time she brought Resident #1 inside before EMS arrived. The NP stated a negative outcome would have to depend on the temperature outside and how long the resident was in the sun. The NP stated if Resident #1 suffered a heat stroke/heat exhaustion there would be signs of organ damaged in which Resident #1 did not have. During an interview with the NA A on 08/28/2025 at 1:10 PM, NA A stated he assisted Resident #1 outside around 2:40 PM. NA A stated that Resident #1 was placed outside of the front door in the shaded area. NA stated he did not check on Resident #1 while he was outside. NA A stated it was not until Resident #1 was brought in the facility unresponsive before he had seen him again. NA A stated when Resident #1 was brought in the facility, Resident #1 had his head down unresponsive and drooling. NA A stated he was the NA responsible for checking on the resident on Resident #1 hall. NA A stated that NAs are supposed to make rounds at least every two hours. NA A stated during round you should check to see if a resident needs water, go to the restroom and check to see if the resident was comfortable. NA A stated he was no aware on who was responsible for checking on the residents when they were outside. NA A stated a negative outcome form a resident being left outside (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745051 If continuation sheet Page 7 of 10 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 745051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing & Rehabilitation of College St 3105 Corsair Drive College Station, TX 77845 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few on a hot day would be the resident could pass out and no one would know. During an interview with the ADM on 08/29/2025 at 2:45 PM, the ADM stated no one assigned to check on Resident #1 while he was outside. The ADM stated there was nothing in place to monitor resident while they were outside. The ADM stated Resident #1 was outside for 30-45 minutes per the GRC. The ADM stated prior to Resident #1 going to the hospital his vital were within normal limits. The ADM stated that she was not aware the Resident #1 temperature was not taken prior to him going to the hospital. The ADM stated a negative outcome from sitting in the sun could be heat exhaustion. Review of the facility's Resident Rights policy, revised dated 11/28/2016, reflected The residents has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this policy. A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognized each resident's individuality. The facility must protect and promote the rights of the resident. Respect and dignity - The resident has a right to be treated with respect and dignity, including:3. The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health and safety of other residents. This was determined to be an Immediate Jeopardy on 08/28/2025 at 4:15 PM. The ADM was notified. The ADM was provided with the IJ template on 08/28/2025 at 4:15 PM. The Plan of Removal was accepted on 08/29/2025 at 10:27 AM and included the following: All listed items will be completed by 08/29/2025 with continued follow-up: Resident #1 was assessed by the DON for any signs of heat exhaustion on 8/28/25. No further signs and symptoms of heat exhaustion were noted. All residents who have been observed to be sitting outside in the last 24hrs were assessed for any signs of heat exhaustion by the DON, ADON and Charge Nurses. No further residents were noted with any signs of a change in condition. 3. The Administrator and DON were in-serviced 1:1 on the following policies:a. Abuse and Neglect: failure to check on residents every 1 hour while outside during hot weather could result in harm and be considered neglect. b. Notification of a change in condition policy: including sign and symptoms of heat exhaustion such as lethargy, unresponsive, and elevated temperature, excessive sweating, thirst cramping or elevated temperature. c. Residents who are sitting out on porch will be rounded on every 1hr. They will be checked on by the charge nurses, CNAs or designee for any signs of heat exhaustion and offered hydration. Staff rounds will continue during the hot weather until further directed by the Administrator. A sign out sheet/binder has been implemented by the administrator for residents that go outside of the facility. Staff have been in-serviced on this process. d. New Process: a hydration cooler will be placed outside of residents who sit on the porch. The charge nurse, CNA or designated staff member will round every hour on all residents outside for any signs of heat exhaustion. The staff members will offer residents hydration and the opportunity to return inside the facility. If any resident shows signs of heat exhaustion, the charge will be notified immediately. This process will start 8/28/25 and continue indefinitely. 4. Administrator and DON were provided with written in-service cheat sheets to place in name badge for quick reference, signature and verbal acknowledgements were obtained. 5. All staff were in-serviced on the following topics: Abuse and Neglect, notification of a change in condition policy, check on resident sitting outside every hour, signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside. Any staff member not present or in-serviced as of 8/28/25 will not be allowed to assume their duties until in-serviced. All new hires will be in-serviced during orientation. All PRN, agency staff, or staff on leave will in serviced prior to assuming their next assignment. Completion date 8/29/25. 6. A hydration cooler was placed outside for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745051 If continuation sheet Page 8 of 10 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 745051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing & Rehabilitation of College St 3105 Corsair Drive College Station, TX 77845 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete residents who sit on the porch. The charge nurse, CNA or designated staff member will round every hour on all residents outside for any signs of heat exhaustion. The staff members will offer residents hydration and the opportunity to return inside the facility. If any resident shows signs of heat exhaustion, the charge will be notified immediately. 7. Involvement of the Medical Director: The medical director was notified of the immediate jeopardy on 8/28/25 by the DON. 8. ADHOC QAPI: This meeting was completed by the interdisciplinary team to include the Medical Director on 08/28/2025 Monitoring: During an observation on 08/29/2025 at 9:45 AM, reflected there was 3 resident outside near the hydration cooler. The hydration cooler was observed to have cold water in it. Record review of the facility's Resident Sign Out/In sheet on 08/29/2025 at 9:50 AM, reflected the current residents sitting outside had been signed out properly. Record review of the facility's Nursing Progress notes on 08/29/2025 at 10:00 AM, reflected there was 5 residents observed setting outside in the last 24 hours. All were assessed and there were no signs of heat exhaustion noted. Record review of the facility's Abuse and Neglect, Notification of a change in condition policy, Check on resident sitting outside every hour, Signs and symptoms of heat exhaustion, and The hydration cooler placed outside for resident who sit outside inservices, on 08/29/2025 at 10:00 AM, reflected the ADM and DON had been inserviced on those topics. Record review of the facility's Monitoring Chart sheet on 08/29/2025 at 10:30 AM, reflected the resident sitting outside were being monitored hourly. Record review of the facility's Off Cycle (ADHOC) QA meeting document on 08/29/2025 at 10:45 AM, reflected the QA meeting was conducted on 08/28/2025 and there were 6 member that attended the meeting. During an observation on 08/29/2025 at 11:00 AM, reflected a CNA was monitoring the resident outside of the facility. During interviews and observations on 08/29/2025 from 12:00 pm - 1:30 pm with 14 staff members (3 6am - 6pm LVNs, 3 6am-6pm CNAs, 2 6pm - 6 am LVNs, 2 6pm - 6am CNAs, 2 7:00 am - 3pm housekeepers, 2 dietary staff), reflected they were able to articulate information from the following in-services: abuse and neglect, notification of a change in condition policy, check on resident sitting outside every hour, signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside. All staff interviewed were observed with their in-service cheat sheet in their name badge. During an interview with the DON on 08/29/2025 at 2:30 PM, the DON was able to articulate information from the following in-services: abuse and neglect, notification of a change in condition policy, check on resident sitting outside every hour, signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside. The DON was observed with her in-service cheat sheet in their name badge. During an interview with the ADM on 08/29/2025 at 2:45 PM, the ADM was able to articulate information from the following in-services: abuse and neglect, notification of a change in condition policy, check on resident sitting outside every hour, signs and symptoms of heat exhaustion, and the hydration cooler placed outside for resident who sit outside. The ADM was observed with her in-service cheat sheet in their name badge. While the IJ was removed on 08/29/2025 at 10:27 AM, the facility remained out of compliance at a severity level of no actual harm that is not immediate jeopardy and at a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 745051 If continuation sheet Page 9 of 10 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 745051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points Nursing & Rehabilitation of College St 3105 Corsair Drive College Station, TX 77845 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and interview, and record review the facility failed to ensure nurse staffing data was posted daily and readily accessible to residents and visitors with all required information for 3 (08/26/2025, 08/27/2025, 08/28/2025) of 4 days reviewed for nurse staffing posting.The facility failed to post the daily staffing information in a prominent place on 08/26/2025, 08/27/2025, and 08/28/2025. This failure could place residents, families, and visitors at risk of not being informed of the census and number of staff working each day to provide care on all shifts. Findings:During an observation on 08/28/2025 at 9:06 am, revealed the nursing staffing information posted outside out the DON's office was dated 08/25/2025.During an interview with the DON on 08/29/2025 at 2:30 PM, the DON stated she was responsible for posting the nursing staffing information. The DON stated she had not posted the nursing staff information since 08/25/2025. The DON stated the residents would not be affected by the nursing information not being posted. The DON stated the nursing staffing show transparency of the number of staff present for each shift. During an interview with the ADM on 08/29/2025 at 2:45 PM, the ADM stated the nursing staffing information should be posted daily. The ADM it was the DON's or the ADON's responsibility to ensure it was posted daily. The ADM stated the purpose of posting the nursing staffing information was to show that the facility had adequate staffing. The ADM stated the residents would not suffer any adverse effects if the nursing staff information was not posted. The ADM stated the facility did not have a policy regarding the posting of the nursing staff information. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745051 If continuation sheet Page 10 of 10