Health inspection·February 6, 2026

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few cannot put [Resident #1] out, that we must give him 30 days. [Family/RP] was informed that his LCD is tomorrow and that we were able to verify that he has not submitted a Medicaid application for long term stay. [Family/RP] provided my description to the police and then walked away when I informed her that [Resident #1] is expected to discharge on Friday. [Family/RP] replied, No sir, and walked away. Police arrived at the facility. [Family/RP] proceeded to point admin out to th [sic] police. Officers listened to explanation of discharge process. [Family/RP] responded that [Resident #1] was under the influence and not able to make informed decisions. Administrtaor [sic] informed [family/RP] that [Resident #1] is his own responsible party and thus we must speak directly to him. Officers responded that [NAME] [sic] is a civil matter and asked about [Resident #1's] admission and his plans for discharge upon admission. [Family/RP] insisted that officers lay eyes on [Resident #1] which they did. [Resident #1] was awake, alert and oriented when visited earlier. In an interview on 02/05/26 at 2:45 PM, Resident #1's family/RP stated Resident #1 was initially admitted to the facility for rehabilitation and she was told that he could transition to LTC. The family/RP stated she spoke with the BOM about documents needed for LTC, and she was still working on gathering Resident #1's social security card and identification card. The family/RP stated she handled all of Resident #1's business with the facility and signed all documents because the resident was not coherent enough due to being heavily medicated and unable to read well; however, when it came to Resident #1's discharge notice, she was not notified or provided with the document to sign. She stated the facility provided Resident #1 the document to sign without her being present. The family/RP stated Resident #1 called and told her that he had to sign some papers and was being kicked out of the facility. The family/RP stated she went to the facility and was told that she needed to take Resident #1 home with her. The family/RP stated the Administrator was short-tempered and did not explain the discharge process or offer any assistance. The family/RP stated she was still under the impression that Resident #1 could do LTC at the facility. She stated the facility's BOM was previously helping her with the LTC process, but she had not seen her at the facility for several days. In an interview on 02/06/26 at 9:27 AM, the Administrator stated Resident #1 admitted to the facility in January under an HMO policy (a type of health insurance plan that typically requires members to use a specific network of doctors, hospitals, and other healthcare providers), and the facility had to report updates on the resident's condition every 6-7 days until Resident #1 received a NOMNC on 02/02/26. The Administrator stated the discharge plan from the beginning was for Resident #1 to discharge home with family; however, it was never specified which family member. The Administrator stated he called Resident #1 into his office with the receptionist as a witness and explained the NOMNC and appeal process to the resident. The Administrator stated Resident #1's family, who was listed as the resident's RP in the EHR, was not present. The Administrator stated Resident #1 was his own RP and was able to comprehend what was being explained to him regarding the NOMNC when he signed it. He stated he was not sure why Resident #1 was not listed as his own RP in the EHR or why he did not sign his own admission documents. The Administrator stated he knew that Resident #1 understood the NOMNC process because he called and told his family that he was being discharged . The Administrator stated Resident #1's family came to the facility, and he explained the NOMNC process to her, but she tried to bully her way through any conversations about the discharge. The Administrator stated since Resident #1 did not appeal the NOMNC, his last cover date was on 02/05/26, and he needed to either discharge home or switch to private pay because there was no Medicaid application pending. The Administrator stated corporate had already issued Resident #1 a letter notifying him that he was now considered private pay, and Resident #1 tossed the letter aside and stated he did not want it. The Administrator stated Resident #1's family/RP (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745056 If continuation sheet Page 2 of 4 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 745056 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southern Oaks Therapy and Living Center 3350 Bonnie View Rd Dallas, TX 75216 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few had discussed LTC at the facility; however, she never initiated an application for LTC Medicaid and did not provide the facility with the required documents for them to assist her with the process. In an observation and interview on 02/06/26 at 12:30 PM, Resident #1 was observed lying in his bed dressed and well-groomed but appeared to be thin and fragile. Resident #1 stated he was ill from cancer and worried about where he was going to live since he had to leave the facility. Resident #1 was trying to see the battery percentage on his cell phone, and he was squinting his eyes and having a hard time, so he asked the surveyor to look for him. Resident #1 stated he was partially blind in one eye from a cataract and was not comfortable reading, so he allowed his family to take care of his business, including at the facility. Resident #1 stated the facility allowed his family/RP to sign all his paperwork for him; however, one day he was on his way to the dining area when the Administrator stopped him and called him into his office. Resident #1 stated the Administrator told him that he had to sign some paperwork. Resident #1 stated he did not understand what he was signing and just signed it because the Administrator told him he had to. Resident #1 stated he called his family/RP after signing the paperwork and she told him that he messed up and signed discharge papers. In an interview on 02/06/26 at 1:33 PM, the Receptionist stated she was present when the Administrator provided Resident #1 with his NOMNC notice. She recalled hearing the Administrator explain the notice to Resident #1 before he signed it, but she could not state exactly what was explained, or if Resident #1 understood it. The Receptionist stated she was also present when Resident #1's admission agreement was signed. The Receptionist stated getting admission agreements signed was not part of her normal work duties, but she was helping the facility out. The Receptionist stated she was the one who explained the services and agreement to Resident #1's family/RP and had her sign where the former BOM had highlighted. The Receptionist stated the former BOM told her to have Resident #1's family to sign the admission agreement on his behalf because the resident probably would not understand what he was signing. In an interview on 02/06/26 at 3:21 PM, CNA A revealed he worked at the facility for about a year. He stated he worked with Resident #1 and the resident was independent with a lot of his ADLs, but staff would assist him when needed. CNA A stated the only thing he would see Resident #1 reading was his bible. CNA A stated Resident #1 did not wear eyeglasses normally but anytime he was reading his bible he would have them on. CNA A stated he did not know if Resident #1 was partially blind in one eye, he just knew that he needed his eyeglasses when he was reading. Record review of the facility's Transfer and Discharge (including AMA) policy, revised 01/01/25, reflected in part the following:Policy:It is the policy of this facility to permit each resident to remain in the facility, and not initiate transfer or discharge for the resident from the facility, except in limited circumstances.Definitions:. Discharge refers to the movement of a resident from a bed in one certified facility to a bed in another certified facility or other location in the community, when return to the original facility is not expected.Policy Explanation and Compliance Guidelines:1. The facility will evaluate and determine the level of care needed for the resident prior to admission toensure the facility's ability to meet the resident's needs.2. Once admitted , the resident has the right to remain at the facility unless their transfer or dischargemeets one of the following specified exemptions:a. The transfer or discharge is necessary for the resident's welfare and the resident's needscannot be met in the facility.b. The transfer or discharge is appropriate because the resident's health has improved sufficientlyso that the resident no longer needs the services provided by the facility.c. The safety of individuals in the facility is endangered due to the clinical or behavioral status ofthe resident.d. The health of individuals in the facility would otherwise be endangered.e. The resident has failed, after reasonable and appropriate notice, to pay or have paid underMedicare or Medicaid (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745056 If continuation sheet Page 3 of 4 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 745056 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southern Oaks Therapy and Living Center 3350 Bonnie View Rd Dallas, TX 75216 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete for his or her stay at the facility. Nonpayment applies if the resident doesnot submit the necessary paperwork for third party payment or after the third party, includingMedicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay.f. The facility ceases to operate.4. The facility's transfer/discharge notice will be provided to the resident and the resident's representative in a language and manner in which they can understand. Review of the Centers for Medicare and Medicaid Services (CMS) website, https://www.cms.gov/medicare/appeals-and-grievances/mmcag/downloads/nomncinstructions.pdf reflected in part the following: Form Instructions for the Notice of Medicare Non-Coverage (NOMNC) CMS-10095.The notice must be validly delivered. Valid delivery means that the enrollee must be able to understand the purpose and contents of the notice in order to sign for receipt of it. The enrollee must be able to understand that he or she may appeal the termination decision. If the enrollee is not able to comprehend the contents of the notice, it must be delivered to and signed by a representative . Event ID: Facility ID: 745056 If continuation sheet Page 4 of 4