Health inspection·March 28, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few in a privacy bag to respect his dignity. LVN A said it was the direct care staff and nurse's responsibility to ensure that the bag was placed in a privacy bag. LVN A said this failure affected Resident #72's privacy and dignity. Interview on 03/27/24 at 8:58 am with CNA B revealed Resident #72's drainage bag should have been placed in a privacy bag to protect his dignity. CNA B said she worked on 03/25/24 and she might have overlooked to ensure Resident #72's catheter drainage bag was placed inside a privacy bag. CNA B said it was the CNAs and nurse's responsibility to ensure the drainage bag was placed inside a privacy bag. Interview on 03/27/24 at 9:16 am with the DON revealed it was the CNAs and charge nurse's responsibility to ensure Resident #72 had the catheter drainage bad in a privacy bag to protect his dignity. Record review of the facility policy titled Foley Catheter Bag Privacy dated October 2012 reflected It is the policy to prioritize, dignity and respect of all residents, including those utilizing Foley catheter bags. Staff members are required to uphold strict standards regarding the privacy and confidentiality of resident's personal medical information and equipment. This preserves their dignity and autonomy. Foley catheter bags will be securely attached to the resident's bed or wheelchair, ensuring they are positioned discreetly and out of plain sight. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 2 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0558 Reasonably accommodate the needs and preferences of each resident. 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 provide services with reasonable accommodation of resident needs and preferences, for 2 of 8 residents (Resident #11 and Resident # 35) reviewed for accommodation of needs. Residents Affected - Few The facility staff did not provide Resident #11 and Resident #35 with a call light that was within reach. This failure could place residents who utilized call lights at risk for not having his/her needs met. Findings included: 1)Record review of the admission record for Resident #11 dated 03/27/24 reflected Resident #11 was admitted to the facility on [DATE], was a [AGE] year-old female with diagnosis that included diabetes (sustained high blood sugar levels), morbid obesity (overweight), chronic obstructive pulmonary disease with acute exacerbation (lung disease), legal blindness and asthma (inflammatory disease of the airways of the lungs.) Record review of the admission MDS assessment dated [DATE] for Resident #11 reflected Resident #11's cognitive status was moderately impaired (decisions poor; cues/supervision needed and received anti-depressant medication. Record review of the care plans last revised on 10/18/23 for Resident #11 reflected a focus care area resident is at risk for falls r/t deconditioning, gait/balance problems, incontinence and vision problems. Interventions included be sure call light is within reach and encourage to use it for assistance as needed. Observation on 03/25/24 at 10:34 am revealed Resident #11 lying in bed, alert, with push button call light cord clipped to her left shoulder gown. Resident #11 stated she was blind and attempted to find and reach her call light using her right arm. Resident #11 stated she could not see or touch the call light. Resident #11 had very limited range of motion on her right arm. Resident #11 said she would use her call light to ask for help if she could find it. Observation on 03/26/24 at 2:45 pm revealed Resident #11 was lying in bed, with call light cord clipped to her gown and lying on her chest. Resident #11 said she could not see or reach her call light. Interview on 03/26/24 at 2:52 pm with CNA C revealed Resident #11 was not able to use her call light to ask for assistance because the call light was placed where she could not see it or touch it. Interview on 03/27/24 at 9:12 am with LVN A revealed all staff were responsible to ensure that call light for Resident #11 was placed where she could touch it and reach for the call light. Observation on 03/27/24 at 9:02 am revealed Resident #11 lying in her bed. A head touch pad call light had been clipped to Resident #11's pillow. The pillow had fallen over the head of the bed and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 3 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was lying on the floor behind Resident #11's bed and the wall. Resident #11 said she could not touch or feel a call light to ask for assistance. Interview on 03/27/24 at 9:02 am with CNA B revealed Resident #11's new head touch pad call light was clipped to her head pillow had fallen over the resident's bed. CNA B said she needed to ensure the pillow was secured in the bed under resident's head so resident could just slightly nod and touch the touch pad call light with her face or cheek. CNA B placed the pillow with the head touch pad call light next to resident's head while she was in bed. Resident #11 demonstrated she could nod towards the head touch pad call light and turn on the call light for assistance. 2)Record review of the admission record for Resident #35 dated 03/27/24 reflected Resident #35 was admitted to the facility on [DATE] and re-admitted on [DATE]. Resident #35 was a [AGE] year-old male with diagnosis that included encephalopathy, viral pneumonia, Parkinson's disease (progressive disorder that affects the nervous system), epilepsy, schizophrenic disorder, and repeated falls. Record review of the quarterly MDS assessment dated [DATE] for Resident #35 reflected. -had severe cognitive impairment. -needed assistance with bathing, dressing, using the toilet, or eating. Record review of the care plans dated 03/25/24 for Resident #35 reflected resident was at risk for falls related to gait and balance problems, unaware of safety needs. Interventions included to be sure the resident's call lights are within reach and encourage the resident to use it for assistance as needed, the resident needs prompt response to all requests for assistance. Observation on 03/25/24 at 11:26 am revealed Resident #35 lying in his bed and alert. The resident's push button call light was clipped to his left top side bed sheet. Resident #35 voiced he knew how to use the call light to ask for help but could not see or reach the call light. Resident #35 demonstrated he could not see or reach his call light using his right arm and hand. Observation on 03/26/24 at 9:18 am revealed Resident #35 lying in bed and alert. The resident's call light was clipped to his mattress sheet on his left side. The call light button was under his sheet on his left side. Resident #35 said he could not see or reach his call light. Interview on 03/26/24 at 3:01 pm with CNA C revealed Resident #35 did use his call light to ask for assistance. CNA C said Resident #35's call light should have been placed close to him so that he could see and reach it. CNA C said she did not know who had placed his call light where he could not reach it. CNA C said all staff were responsible to ensure his call light was placed where Resident #35 could see and reach it. Interview on 03/27/24 at 9:12 am with LVN A revealed all staff were responsible to ensure call lights were placed with sight and within reach including for Resident #11 and Resident #35. Interview on 3/27/24 at 9:16 am with the DON revealed every staff member was responsible to ensure the call lights were placed within sight and within reach. The DON said it was his responsibility to ensure that residents had the proper call light devices they could use. The DON said if the proper call lights were not used or placed within reach, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 4 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0558 resident's needs would not be met to ask for assistance in all areas of care. Level of Harm - Minimal harm or potential for actual harm Record review of the facility policy titled Resident Room Call Light Check dated August 2023 reflected. It is the policy to ensure the safety and well-being of all residents by maintaining proper placement and appropriation of call lights within their rooms. All staff entering a resident's room must conduct a thorough check to ensure the call light is easily accessible and functioning properly. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 5 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs for 1 of 8 residents (Resident #11) reviewed for care plans in that: The facility failed to develop a care plan to address Resident #11's in-room activities. These failures could place residents at risk of not receiving individualized interventions for their care needs. The findings included: Record review of the admission record for Resident #11 dated 03/27/24 reflected Resident #11 was admitted to the facility on [DATE], was a [AGE] year-old female with diagnosis that included diabetes (sustained high blood sugar levels), morbid obesity (overweight), chronic obstructive pulmonary disease with acute exacerbation (lung disease), legal blindness and asthma (inflammatory disease of the airways of the lungs.) Record review of the admission MDS assessment dated [DATE] for Resident #11 reflected Resident #11: -cognitive status was moderately impaired (decisions poor; cues/supervision needed). -was somewhat important to participate in religious services and listen to music. -not very important to go outside to get fresh air when weather was good or keep up with the news. -not important at all to be around animals (pets). -important but can't do or no choice to do favorite activities or have books, newspapers, and magazines to read. Record review of the care plans last revised on 10/18/23 for Resident #11 did not include a care plan to address Resident #11's in room activities. Observation and interview on 03/25/24 at 3:05 pm revealed Resident #11 lying in bed and alert. Resident #11 said she spent most of her day in her room. Resident #11 said she was blind and preferred to stay in her room and did not remember if she was provided with any in room activities. Interview on 03/28/24 at 10:10 am with Activity Director revealed she had overlooked developing a care plan to address Resident #11's activity care plans. Resident #11 was provided with in-room activities. The activities provided to Resident #11 were documented in paper forms and currently were documented in electronic clinical chart. The Activity Director said she was responsible for developing the activity care plan for Resident #11. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 6 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of In-room activities dated January, February and March 2024 reflected Resident #11 was provided with in-room activities. Interview on 3/28/24 at 10:15 AM MDS/LVN K revealed the Activity Director was responsible to develop a care plan for activities for Resident #11. MDS/LVN K said she would sign off on the comprehensive care plans, and she had not seen that a care plan for activities for Resident #11 had not been developed. Interview on 03/28/24 at 10:50 am with the DON revealed the Activity Director was responsible to develop a care plan for activities and MDS/LVN K was responsible to ensure the care plan had been developed. The DON said the facility failed to develop a care plan to address the activities for Resident #11. This failure placed residents at risk for depression and not interacting socially. Record review of the facility policy titled Care Plans, Comprehensive Person-Centered dated March 2022 reflected A comprehensive, person-centered care plan should include measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 7 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to ensure a resident who entered the facility with an indwelling catheter and is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections for one of 8 residents (Resident #72) reviewed for incontinent care and catheter care, in that. The facility failed to obtain documented MD orders from re-admission from hospital for catheter use which included catheter size, balloon inflation parameter and frequency of care for Resident #72. This deficient practice could place residents at-risk for infection due to improper catheter care practices. Findings included: Record review of Resident #72's admission record dated 03/24/24, reflected Resident #72 was a [AGE] year-old-male admitted to the facility on [DATE] and was re-admitted on [DATE], with diagnoses which included, schizophrenia (severe mental disorder that affects the way a person thinks), bipolar disorder (mental disorder characterized by periods of depression and abnormally elevated moods), metabolic encephalopathy (brain dysfunction caused by various diseases), functional quadriplegia (complete inability to move due to severe disability) and history of traumatic brain injury (injury caused by a blow to the head or body.) Record review of Resident #72's quarterly MDS assessment dated , 02/15/24 reflected Resident # 72 had severe cognitive impairment and was incontinent of bowel and bladder. Record review of Resident #72's physician orders dated 03/27/24 reflected no order for an indwelling catheter. Record review of Resident #72's care plans last revised on 03/18/24 reflected no care plans to address resident used an indwelling catheter. Record review of the hospital records for Resident #72 dated 03/15/24 revealed no orders for a Foley catheter. Record review of the progress notes for Resident #72 dated 03/15/24 by LVN E reflected this nurse called hospital to get report on resident, spoke with nurse, resident admitted to hospital on [DATE] with diagnosis of hypokalemia, leukocytosis, 16Fr , F/C, pending resident arrival. An observation and interview with Resident #72 on 03/27/24 at 10:05 AM revealed Resident #72 lying in bed, eating his breakfast, with his catheter drainage bag clipped to his right-side bed rail below his bladder level. Resident #72 was unable to respond to surveyor due to cognitive impairment. Interview on 03/27/24 at 11:55 am with LVN A revealed she was not aware Resident #72 did not have MD orders for a Foley catheter in his clinical chart. LVN A said the charge nurse who admitted Resident #72 on 03/15/24 should have verified the hospital orders and obtained orders from Resident #72's physician. LVN A said she did not know which charge nurse had re-admitted Resident #72 on 03/15/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 8 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few LVN A said she had provided catheter care on 03/18/24 for Resident #72 but had not documented in his clinical chart. Interview on 03/27/24 at 10:52 am with the DON revealed that Resident #72 was re-admitted from the hospital on [DATE] by LVN I. LVN I failed to obtain MD orders for the Foley catheter for Resident #72 and enter into the resident's clinical records. The only documentation completed for Resident #72's foley catheter care was entered in the progress notes by LVN E on 03/15/24 at 6:06 pm. LVN E left before Resident #72 was re-admitted back to the facility by LVN I. Interview on 03/27/24 at 11:51 am with LVN E revealed he called the hospital on [DATE] at 6:06 pm to get an update on Resident #72 coming back to the facility. LVN E documented his notes on his progress notes, which included Resident #72 had a foley catheter. LVN E said he left work before Resident #72 was re-admitted to the facility on [DATE]. LVN E said when any resident was admitted , the admitting nurse must call the resident's MD and verify the hospital orders and enter in the resident's clinical chart. LVN E said usually the orders for a foley catheter would include to assess the foley catheter for proper placement, clean and empty the catheter bag. This treatment would be document into the MARs. LVN E said all nurses were able to enter the orders if they receive the MD orders. Interview on 03/27/24 at 1:26 pm with CNA G revealed she would empty the catheter bag for Resident #72 and document in the ADLs task. Resident #72 had returned to the facility since 03/15/24 with a catheter bag. Interview on 03/27/24 at 1:55 pm with LVN H revealed she had provided catheter care to Resident #72 but was not aware there was no orders for the foley catheter. LVN H said she did not document she had provided catheter care to Resident #72 in his clinical chart or in his progress notes. LVN H said she had worked in Resident #72's hall on 03/16/24 in the night shift. Interview on 03/28/24 at 7:55 am with LVN I revealed he admitted Resident #72 to the facility on [DATE] after receiving his hospital orders. LVN I said he called the hospital to verify the resident's orders. LVN I said Resident #72 came in with a foley catheter and he got verbal orders from Resident #72's MD for a foley catheter but he forgot to enter the foley catheter orders into Resident #72's clinical chart. LVN I said he came to work in Resident #72's hall on 03/22/24 and he documented a note in Resident #72's progress notes but not his foley catheter care. LVN I said he did not remember if he provided catheter care to Resident #72 that day. Interview on 03/28/24 at 10:53 am with the DON revealed LVN I failed to transcribe the MD orders for the foley catheter into Resident #72's clinical chart. The DON said LVN A did not document she provided catheter care for Resident #72 and LVN H did not document she provided catheter care for Resident #72 on 03/16/24 in his electronic clinical chart. The DON said on 03/28/24 Resident #72's MD had made orders for a catheter. The order was entered into Resident #72's electronic clinical chart and orders transferred into the MARs. The DON said staff failed to document catheter care in Resident #72's electronic clinical chart beginning on the day Resident #72 was admitted on [DATE]. The DON said failure to transcribe MD orders into Resident #72's clinical chart placed the resident at risk of infection for not checking the foley catheter every shift as needed. The DON said failure to document the care that was provided was a significant failure that no one caught the Resident #72 was missing the MD orders and the MARs did not indicate the required documentation when care was provided. The DON said he was responsible to ensure that staff had the correct orders, and they documented the care that was provided. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 9 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of the facility policy titled Physician Orders dated November 2014 reflected The purpose of this procedure is to establish uniform guidelines in the receiving and recording of medication orders. When recording orders for medication, specify the type, route, dosage, frequency, and strength of the medication ordered. Record review of the facility policy titled Charting and Documentation dated December 2022 reflected The services provided to the resident progress toward care plan goals. Any notable changes in the resident's medical, physical, functional, or psychosocial condition observed by staff, should be documented in the resident's medical record. The medical record is a format that facilitates communication between the interdisciplinary team. Event ID: Facility ID: 455423 If continuation sheet Page 10 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observation, interview, and record review, the facility failed to ensure residents fed by enteral means received the appropriate treatment and services to prevent complications of enteral feedings for 2 of 4 residents (Resident #77 and Resident #81) reviewed for enteral nutrition, in that: The facility failed to follow physician's orders to ensure that Resident #77 and Resident #81 received the appropriate amount of enteral nutrition. This deficient practice could affect residents receiving optimal enteral nutrition and place them at risk of health complications and decline. The findings include: Record review of care plan for Resident # 77 revealed: Resident is totally dependent on (1) staff for peg tube feedings. Patient is NPO . Initiated/revised 2/16/2024. Resident requires tube feeding r/t dysphagia. Refer to physician orders for peg tube care and feedings. Date initiated: 2/16/24. Record review of admission record/face sheet for Resident #77 revealed: Diagnosis of unspecified protein-calorie malnutrition and gastrostomy status. Record review of MAR revealed Resident #77's enteral feed of Nepro at 65 mL/Hours x 20 Hrs with start date of 3/23/24. MAR showed formula being given beginning 3/23/24 at 7pm - 7am shift to 3/28/24 7am 7pm shift. Record review of Order Summary for Resident #77 revealed Enteral Feed: Nepro at 65 mL x 20 hours. Start date 3/23/24. Record review of Nurse's Note for Resident #77 dated 3/23/24 at 15:10:08 (3:10 pm) created by LVN M reveal: Dietary recommendations agreed by DR. DC order for NEPRO at 60 mL x 20 hours Begin Nepro at 65 mL x 20 hours . Orders carried out and noted. Observation of Resident # 77 on 03/26/24 at 11:30 AM revealed resident in bed with head of bed elevated and Nepro feeding at 60 mL/hr with approximately 500 cc remaining. G tube supplies next to bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 11 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0693 Record review of care plan for Resident # 81 revealed: Level of Harm - Minimal harm or potential for actual harm Resident is totally dependent on (1) staff for tube feeding. Date initiated/revised on 3/13/24. Residents Affected - Few Resident requires tube feeding r/t dysphagia, swallowing problem. Refer to feeding tube orders on physician orders. Date initiated 3/13/24. Record review of admission record/face sheet for Resident #81 revealed: Diagnosis for unspecified severe protein-calorie malnutrition and encounter for attention to gastrostomy. Record review of MAR revealed Resident #81 enteral feed of Nepro at 55 mL/Hr x 20 Hrs. Start date 3/16/24. MAR showed current order provided beginning 3/16/24 at 7am-7pm shift to 3/28/24 7am-7pm shift. Record review of Order Summary for Resident #81 revealed enteral feed: Nepro at 55 mL/Hr x 20 hrs. Start date 3/16/24. Record review of Nurse's Note for Resident #81 dated 3/15/24 at 19:31:03 (7:31 pm) revealed: Dietary recommendation by RDN: .DC Nepro at 45 mL x 22 hrs, Begin Nepro at 55 mL x 20 hrs. DR notified and agrees with orders. Observation of Resident #81 on 03/26/24 at 11:40 AM revealed resident in bed with head of bed elevated and Nepro with Carbsteady feeding at 60mL/hr with approximately 100 cc remaining. G tube supplies at bed side. Interview on 3/27/24 at 2:30 pm with LVN M, LVN M searched PCC (electronic medical record) and she stated that as per MD orders, Resident #77 is ordered Nepro at flow rate of 65 mL/hr x 20 hrs and Resident #81 is ordered Nepro at flow rate of 55 mL/hr x 20 hrs. LVN checked the rate set on the pumps and what was written on the supplement bags. She then checked nurses notes to verify. She verified the orders were correct. She said those orders were the last orders written in Nurse's notes. She said that all the nurses on the floor for each of their residents is responsible for ensuring the g-tube feeding pumps are set correctly. LVN M stated that the consequences for a resident not receiving the feeding at the rate ordered was Resident #77 could lose weight by receiving less than ordered and Resident #81 could gain weight, not tolerate the amount, and have emesis (vomiting) by receiving more than ordered. She said that she is unaware of another reason for not providing the feeding as ordered. She said that residents are currently at dialysis, and it was time to change tubing and hang a new bag for feeding. She said that she would have made sure everything was correct before they returned from dialysis. Interview on 3/27/2024 at 3:00 pm with ADON. She stated that when she does rounds, she periodically matches the bag with the flow rate, but that ultimately, it is the floor nurse's responsibility to ensure the flowrate of feedings are correct. She said that if a resident is not receiving enough feeding, nutrients will deplete which could lead to weight loss and deficiency and metabolic imbalances. She said that if residents are getting too much nutrition, it could cause weight gain and fluid overload. She said that there have been no issues with Resident #77 or Resident #81 that she is aware of. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 12 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 3/27/2024 at 3:15 pm with DON. He stated that every shift nurse should be checking off on the g-tube feeding orders. All orders should be checked off q shift per nurse/floor nurse. He said that the negative effects for residents receiving less nutrition than ordered by MD could lead to malnutrition or not sufficient nutrition. He stated that the negative effects for residents receiving more nutrition than MD ordered could be over hydration or too much for their stomach to handle. Record review of policy titled Enteral Nutrition with revision date of November 2018 revealed: Adequate nutritional support through enteral nutrition is provided to residents as ordered. 4. Enteral nutrition is ordered by the provider based on the recommendations of the dietitian. 11. The Nurse confirms that orders for enteral nutrition are complete. Complete orders include: . e. Volume and rate of administration Record review of policy titled Enteral Feedings - Safety Precautions with revision date of November 2018 revealed, To ensure the safe administration of enteral nutrition. Preparation 2. The facility will remain current in and follow accepted best practices in enteral nutrition. Preventing errors in administration 1. Check the enteral nutrition label against the order before administration. Check the following information: . f. Method (pump, gravity, syringe); and Rate of administration (mL/hr). 2. On the formula label initial that the label was checked against the order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 13 of 24 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 455423 B. Wing (X3) DATE SURVEY COMPLETED A. Building 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to ensure a prescribed medication was given for 1 of 5 residents (Residents # 25) reviewed for Medication Pass. Residents Affected - Few The facility failed to prevent Resident #25 from missing his daily nose spray . These failures could place the residents at risk of not receiving the therapeutic dosage of medications prescribed by the physician. The findings included: Record review of Order Summary revealed Resident #25 ordered Fluticasone Propionate Nasal Spray 2 sprays in each nostril daily for Nasal Congestion. Record review of Resident #25's MAR revealed Fluticasone Propionate Nasal Spray not given on 3/26/24 with a numerical code of 9 = Other/See Nurse Notes. Nurse notes on medication order for Fluticasone Propionate revealed medication last order date 3/26/24. No other notes noted. Observation of Medication Pass on 03/26/24 at 07:31 AM with LVN H revealed Resident #25 did not receive his nasal spray. In an interview with LVN H on 3/26/24 at 7:40 am after the med pass for Resident #25 was complete, she stated that she needed to order the medication because she checked in the medication supply room and there was none in the facility. She stated that medications ordered usually come in the same day. Record review of Resident #25's MAR revealed that resident was scheduled to receive Flonase (Fluticasone Propionate) Nasal Suspension 50 mcg /spray, 2 sprays in both nostrils one time a day for Nasal Congestion. In an interview on 3/27/24 at 12:00 pm with LVN H, when asked if resident received medication yesterday by end of day, she stated that she was not able to access information due to currently completing an assessment. When asked if she contacted the MD regarding need for Flonase to be ordered, she stated that she only needs to call MD if that medication is missed for more than 2 days. In an interview on 3/27/2024 at 3:00 pm with the ADON, she stated that if the facility needed to order medication for a resident, the nurse would be responsible for placing the order. The nurse would need to call the MD to inform and follow any orders received. In an interview on 3/27/2024 at 3:15 pm with the DON, he stated that anytime there is a medication not available, the nurse needs to call the doctor to inform that the resident may miss a dose. The nurse must inform the doctor and resident or RP. Record review of policy titled Administering Medications with revision date of April 2023 revealed: Medications are administered in a safe and timely manner, and as prescribed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 14 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3. Staffing schedules are arranged to ensure that medications are administered without unnecessary interruptions. 4. Medications are administered in accordance with prescriber orders, including any required time frame. 5. Medication administration times are determined by resident need and benefit, not staff convenience. Factors that are considered include: a. Enhancing optimal therapeutic effect of the medication . 20. For residents not in their rooms or otherwise unavailable to receive medication on the pass, the MAR may be flagged. After completing the medication pass, the nurse will return to the missed resident to administer the medication. 21. If a drug is withheld, refused, or given at a time other than the scheduled time, the individual administering the medication shall initial and circle the MAR space provided for that drug and dose. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 15 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure any drug regimen irregularities reported by the Pharmacist Consultant were acted upon, for one Resident (R#14) of nineteen residents whose medications were reviewed, in that: The facility's Pharmacy Consultant recommended that the physician review the use of duplicate antipsychotic therapy with Risperidone and Quetiapine. The facility failed to ensure the attending physician documented his rationale for making changes to Resident #14's antipsychotic therapy in Resident #14's medical record. These failures could place all residents receiving anti-psychotic medications at risk for adverse drug consequences. The findings were: 1) Record review of Resident #14's Physician's orders for March 2024 revealed Resident #14 was admitted to the facility on [DATE] and was a [AGE] year-old female with diagnosis that included schizophrenia (characterized by thoughts or experiences that seem out of touch with reality, disorganized speech or behavior, and decreased participation in daily activities), major depressive disorder (a persistent feeling of sadness and loss of interest and can interfere with daily activities) and anxiety disorder ( excessive, ongoing anxiety and worry). The same orders included the medications quetiapine fumarate oral tablet 50 mg, give 1 tablet via g-tube one time a day for schizophrenia with start date of 01/13/24 and risperidone oral tablet 2 mg, give 1 tablet via g-tube at bedtime for schizophrenia, start date of 01/19/24. Record review of Resident #14's quarterly Minimum Data Set (MDS) assessment, dated 03/01/24, revealed Resident #14 had severe cognitive impairment, did not have behavioral symptoms, had received anti-psychotic medications on a regular basis, has not had a GDR attempted and GDR has not been documented by a physician as clinically contraindicated. Record review of Resident #14's care plan, dated 2/20/24, revealed Resident #14 had a diagnosis of Schizophrenia with potential for disruptive and verbally abusive behaviors. Approaches included administer medications as ordered, monitor/document for side effects and effectiveness, intervene as necessary to protect the rights and safety of others, and approach/speak in a calm manner. Record review of Resident #14's care plan dated 02/20/24 indicated Resident #14 uses psychotropic medications due to schizophrenia. The approaches included administer medications as ordered, consult with pharmacy, MD to consider dosage reduction when clinically appropriate at lease quarterly, monitor/document/report PRN any adverse reactions of psychotropic medications such as unsteady gait, tardive dyskinesia, frequent falls, refusal to eat,, difficulty swallowing, dry mouth, suicidal ideations, social isolation and monitor/record occurrence of target behavior symptoms (delusions, pacing, wandering, disrobing, violence/aggression toward others. Record review of Pharmacy Consultant's recommendation letter titled, Note to Attending Physician/Prescriber for Resident #14's physician dated 03/04/24. The letter indicated: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 16 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0756 Level of Harm - Minimal harm or potential for actual harm Two Antipsychotics. She was on Seroquel (Quetiapine) 50 mg daily. She was also on Risperdal (Risperidone) 2mg at bedtime. In many cases, the combined use of two or more antipsychotic medications had not been demonstrated to be more effective than a single agent and had the potential for increased side-effects. Please review the duplicate antipsychotic therapy with Risperidone and Quetiapine and choose from the following: Residents Affected - Few 1. New order or order to discontinue therapy for______, 2. both medications are to be continued as they improve the quality of this resident's life. The benefit outweighs the risks. 3. Other. The Recommendation Letter also included a section for the Physician's Response, which included: Agree, Disagree, or Other. Resident #14's Physician checked Disagree, but no rationale was provided. There was a handwritten note by ADON/LVN L that indicated Dr. in disagreement, continue as ordered, dated 03/06/24. Record review of Resident #14's medical record did not contain any documentation of a rationale for the continued use of the Risperidone and Quetiapine. In an interview on 03/28/24 at 2:16 PM, ADON L said she was responsible for sending the Pharmacy Consultant Recommendation Letters to the physicians. Resident #14's physician did not provide a rationale for the use of two antipsychotic medications. ADON L said they have called the physician, but he is difficult to contact and when they do speak with him, he still would not provide a rationale. ADON L said the Pharmacy Consultant sent a recommendation for a GDR three months ago for Resident #14 and the physician refused the recommendation for the GDR and did not give a rationale at that time either. ADON L said their other doctors provide a rationale but not Resident 14's physician. ADON L said there was no negative outcome for Resident #14 because she was not overly sedated. In an interview on 03/28/24 at 2:23 PM, The DON said they met with Resident #14's physician last week because they had difficulty contacting him when they had something to discuss with him and because he would not provide a rationale when refusing the Pharmacy Consultant's recommendations. The DON said Resident #14 was the only resident with that physician. The DON said they would speak to Resident #14's RP and request a change in physician. The DON said they met with Resident #14's physician several times and the physician still would not provide a rationale. In an interview on 03/28/24 at 2:36 PM, The Pharmacy Consultant said she sent the Note to Attending Physician/Prescriber letter on 03/04/24. The Pharmacy Consultant said when using two antipsychotic medications for the same condition there is a concern that it might increase the side effects and they wanted to prevent that. The goal was to have the least amount of medication. However, it is up to the physician to decide if both medications would be continued, but a rationale for the continued use of the medications needs to be documented. In an interview on 03/28/24 at 2:57 PM, the Administrator said Resident #14's family member requested a change of physician to provide medical services for Resident #14. The facility informed R#14's physician of the request. The Administrator said Resident #14's physician sent the facility a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 17 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0756 Level of Harm - Minimal harm or potential for actual harm strongly worded letter asking why the facility removed him as Resident #14's physician. The family later requested Resident #14 stay with Resident #14's usual physician. The Administrator said the physician had been ignoring their calls and their requests for providing a rationale when he denied the Pharmacy Consultants recommendation for a GDR. The Administrator said Resident #14 had a new RP and the Administrator would request a meeting with the RP and the physician. Residents Affected - Few Record review of facility's policy and procedure for Tapering Medications and Gradual Dose Reduction indicated: Policy Statement: 1. After medications are ordered for a resident, the staff and practitioner shall seek an appropriate dose and duration for each medication that also minimizes the risk of adverse consequences. 2. All medications shall be considered for possible tapering. Tapering that is applicable to psychotropic medications are referred to as gradual dose reductions. 3. Residents who use psychotropic medications shall receive a gradual doses reductions and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs. Policy Interpretation and Implementation 13. For any individual who is receiving a psychotropic medication for a psychiatric disorder other than behavioral symptoms related to dementia (for example, schizophrenia, bipolar mania, or depression with psychotic features), the GDR may be considered contraindicated, if: a. the continued use is in accordance with relevant current standards of practice and the physician has documented the clinical rationale for why an attempted dose reduction would be likely to impair the resident's function or cause psychiatric instability by exacerbating an underling psychiatric disorder. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 18 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored and labeled in accordance with currently accepted professional principles and include the appropriate accessory and cautionary instructions, and the expiration date when applicable in 1 of 2 medication rooms (medication storage located in 100 hallway) reviewed for medication storage and labeling. The facility failed to ensure that all medical supplies in the medication storage room in the 100 hallway were not past their expiration date. The facility's failure could result in residents receiving expired medical supplies, such as formula, as well as those supplies not being maintained at their best therapeutic level. The findings include: Observation of medication storage room in the 100 hallway on 03/26/24 at 04:15 PM revealed 12 cartons of Diabetisource tube feed formula passed the used by date of March 11, 2024 were located among currently dated cartons of Diabetisource tube feed formula. Interviewed LVN G who witnessed the medication storage and labeling review of the medication rooms on 3/26/24 at 4:15 pm and she stated that whenever she collected her supplies, she checked expiration dates to ensure residents do not receive expired formulas. If the supplies are expired, she marked them as expired and placed them in an appropriate shelf or location. LVN G stated that if a resident is given an expired supplement, they may not tolerate it well and may result in emesis (vomiting). Interviewed the ADON on 3/27/24 at 3:00 pm and she stated that she tries during rounds to investigate storage to look for expired medications/milk. She stated that she speaks to nursing staff and informs them if they spot anything, they can remove it and place in the appropriate location. She stated that the responsibility is on all staff. ADON L said that if expired formula is not located, and the resident was given an expired formula, it could cause the resident to not meet his or her nutritional needs. She said that staff are all trained on looking for expiration dates on all items. Interviewed the DON on 3/27/24 at 3:15 pm and he stated disposal of all medications is done with ADON and pharmacist. Staff remove any expired items and place them in an appropriate location. He stated that they will go into that specific cabinet or location to retrieve and discard. The DON logs anytime that medication has expired. He said narcotics going into locked cabinet at DON room. They go in once a week or 2 weeks, place the expired medication in the system and tag it. They place it in a biohazard bag. The pharmacist reconciles and signs and she takes it to destruct. They keep a log/record for all destroyed medications. Narcotics are done there with the pharmacist who brings a Drug Buster and DON and pharmacist sign the log sheet. The DON said the log was kept usually for 3 years, then it went into storage and stayed for 5 years. Record review of policy titled Medication Labeling and Storage with revision date of February 2023 revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 19 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0761 Level of Harm - Minimal harm or potential for actual harm The facility stores all medications and biologicals in locked compartments under proper temperature, humidity, and light controls. Only authorized personnel have access to keys. 2. The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. Residents Affected - Few 3. If the facility has discontinued, outdated, or deteriorated medications or biologicals, the dispensing pharmacy is contacted for instructions regarding returning or destroying these items. Record review of policy titled Enteral Feedings - Safety Precautions with revision date of November 2018 revealed, To ensure the safe administration of enteral nutrition. Preparation 2. The facility will remain current in and follow accepted best practices in enteral nutrition. Preventing contamination 2. Maintain strict adherence to storage conditions and timeframes: . c. Maintain inventory controls and discard any formula past the expiration date. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 20 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for one of one kitchen reviewed for kitchen sanitation. The facility failed to label and date frozen food items in one of one walk in freezers. These failures could residents at risk for food contamination and food-borne illness and impact the health and nutrition of residents. Findings included: Observation on 03/25/24 at 9:02 am of the walk-in freezer revealed frozen food items, 10 bags of peas, 5 bags of green beans, 10 bag of corn, 5 bags of beef, 3 bags of pork and 2 bags of chicken that were undated. Interview on 03/25/24 at 9:15 am with the Dietary Manager revealed all the listed frozen food items had not been dated when they were received and placed in the walk-in freezer because he would keep inventory of food items placed in the freezer and made sure those items were used first and then he would order more food items to place in the freezer. The Dietary Manager said the freezer temperature was kept at -20 degrees Fahrenheit and foods were frozen solid. Observation on 03/26/24 at 12:05 pm revealed the frozen food items were dated with date of 03/06/24. Interview with Dietary Manager on 03/26/24 at 8:49 am with the Dietary Manager revealed he had dated the food items. The Dietary Manager said the failure to date the foods in the freezer had the potential that staff would not now which food items to use first in, first out. Record review of the facility policy titled Inventory and Cost Control dated 2019 reflected the director of the food and nutrition services will be responsible for maintaining a department budget and cost per-resident-day that meets goals set by the administrator. Follow the first in, first out method to use all food before it expires. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 21 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, in accordance with accepted professional standards and practices, the facility failed to maintain medical records on each resident that were complete, accurately documented, readily accessible, and systematically organized for 1 (Resident #72 ) of 8 residents reviewed for accurate medical records. The facility failed to correctly transcribe the physician orders for Resident #72 related to indwelling catheter and document the treatment orders for catheter care. This failure could place resident at risk of not receiving needed care or treatments by misleading care providers regarding what care or treatment resident should receive. The findings include: Record review of Resident #72's admission record dated 03/24/24, reflected Resident #72 was a [AGE] year-old-male admitted to the facility on [DATE] and was re-admitted on [DATE], with diagnoses which included, schizophrenia (severe mental disorder that affects the way a person thinks), bipolar disorder (mental disorder characterized by periods of depression and abnormally elevated moods), metabolic encephalopathy (brain disfunction caused by various diseases), functional quadriplegia (complete inability to move due to severe disability) and history of traumatic brain injury (injury caused by a blow to the head or body.) Record review of Resident #72's quarterly MDS assessment dated , 02/15/24 reflected Resident # 72 had severe cognitive impairment and was incontinent of bowel and bladder. Record review of Resident #72's physician orders dated 03/27/24 reflected no order for an indwelling catheter. Record review of Resident #72's care plans last revised on 03/18/24 reflected no care plans to address resident used an indwelling catheter. Record review of the hospital records for Resident #72 dated 03/15/24 revealed no orders for a Foley catheter. Record review of the progress notes for Resident #72 dated 03/15/24 by LVN E reflected this nurse called hospital to get report on resident, spoke with nurse, resident admitted to hospital on [DATE] with diagnosis of hypokalemia, leukocytosis, 16Fr , F/C, pending resident arrival. An observation and interview with Resident #72 on 03/27/24 at 10:05 AM revealed Resident #72 lying in bed, eating his breakfast, and his catheter drainage bag clipped to his right-side bed rail below his bladder level. Resident #72 was unable to respond to surveyor due to cognitive impairment. Interview on 03/27/24 at 11:55 am with LVN A revealed she was not aware Resident #72 did not have MD orders for a Foley catheter in his clinical chart. LVN A said the charge nurse who admitted Resident #72 on 03/15/24 should have verified the hospital orders and obtained orders from Resident #72's physician. LVN A said she did not know which charge nurse had re-admitted Resident #72 on 03/15/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 22 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few LVN A said she had provided catheter care on 03/18/24 for Resident #72 but had not documented in his clinical chart. Interview on 03/27/24 at 10:52 am with the DON revealed that Resident #72 was re-admitted from the hospital on [DATE] by LVN I. LVN I failed to obtain MD orders for the Foley catheter for Resident #72 and enter into the resident's clinical records. The only documentation completed for Resident #72's foley catheter care was entered in the progress notes by LVN E on 03/15/24 at 6:06 pm. LVN E left before Resident #72 was re-admitted back to the facility by LVN I. Interview on 03/27/24 at 11:51 am with LVN E revealed he called the hospital on [DATE] at 6:06 pm to get an update on Resident #72 coming back to the facility. LVN E documented his notes on his progress notes, which included Resident #72 had a foley catheter. LVN E said he left work before Resident #72 was re-admitted to the facility on [DATE]. LVN E said when any resident was admitted , the admitting nurse must call the resident's MD and verify the hospital orders and enter in the resident' clinical chart. LVN E usually said the orders for a foley catheter would include to assess the foley catheter for proper placement, clean and empty the catheter bag. This treatment would be document into the MARs. LVN E said all nurses were able to enter the orders if they receive the MD orders. Interview on 03/27/24 at 1:26 pm with CNA G revealed she would empty the catheter bag for Resident #72 and document in the ADLs task. Resident #72 had returned to the facility since 03/15/24 with a catheter bag. Interview on 03/27/24 at 1:55 pm with LVN H revealed she had provided catheter care to Resident #72 but was not aware there was no orders for the foley catheter. LVN H said she did not document she had provided catheter care to Resident #72 in his clinical chart or in his progress notes. LVN H said she had worked in Resident #72's hall on 03/16/24 in the night shift. Interview on 03/28/24 at 7:55 am with LVN I revealed he admitted Resident #72 to the facility on [DATE] after receiving his hospital orders. LVN I said he called Resident #72 to verify the resident's orders. LVN I said Resident #72 came in with a foley catheter and he got verbal orders from Resident #72's MD for a foley catheter but he forgot to enter the foley catheter orders into Resident #72's clinical chart. LVN I said he came to work in Resident #72's hall on 03/22/24 and he documented a note in Resident #72's progress notes but not his foley catheter care. LVN I said he did not remember if he provided catheter care to Resident #72 that day. Interview on 03/28/24 at 10:53 am with the DON revealed LVN I failed to transcribe the MD orders for the foley catheter into Resident #72's clinical chart. The DON said LVN A did not document she provided catheter care for Resident #72 and LVN H did not document she provided catheter care for Resident #72 on 03/16/24 in his electronic clinical chart. The DON said on 03/28/24 Resident #72's MD had made orders for a catheter. The order was entered into Resident #72's electronic clinical chart and orders transferred into the MARs. The DON said staff failed to document catheter care in Resident #72's electronic clinical chart beginning on the day Resident #72 was admitted on [DATE]. The DON said failure to transcribe MD orders into Resident #72's clinical chart placed the resident at risk of infection for not checking the foley catheter every shift as needed. The DON said failure to document the care that was provided was a significant failure that no one caught when the Resident #72 was missing the MD orders and the MARs did not indicate the required documentation when care was provided. The DON said he was responsible to ensure that staff had the correct orders, and they documented the care that was provided. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455423 If continuation sheet Page 23 of 24 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 455423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Hills Post Acute 901 Wildrose LN Brownsville, TX 78520 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of the facility policy titled Physician Orders dated November 2014 reflected The purpose of this procedure is to establish uniform guidelines in the receiving and recording of medication orders. When recording orders for medication, specify the type, route, dosage, frequency, and strength of the medication ordered. Record review of the facility policy titled Charting and Documentation dated December 2022 reflected The services provided to the resident progress toward care plan goals. Any notable changes in the resident's medical, physical, functional, or psychosocial condition observed by staff, should be documented in the resident's medical record. The medical record is a format that facilitates communication between the interdisciplinary team. Event ID: Facility ID: 455423 If continuation sheet Page 24 of 24