Inspection·February 10, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 02/06/24 at 1:52 pm revealed Resident #57 was in his bed, drainage bag clipped to his bed rail, uncovered, and touching the floor. The drainage bag tubing was lying on the floor, without any plastic sleeve on the tubing. Interview on 02/06/24 at 1:54 pm with CNA L revealed Resident #57's drainage bag should be clipped to his bed rail , covered in a privacy bag, and not touching the floor. CNA L said the drainage bag and tubing should not be touching the floor because the bag could get contaminated. She said the drainage bag should be placed in privacy bag to respect the resident's dignity. CNA L said Resident #57's roommate's family members came to see the resident very often and could see the uncovered drainage bag. CNA L said it was the CNAs and charge nurse's responsibility to ensure the drainage bag was not on the floor and it should be covered for dignity. Interview on 02/06/24 at 2:21 pm with the DON revealed it was a team effort to ensure the drainage bag and tubing were off the floor to prevent contamination and to have the bag covered to respect Resident #57's dignity. A review of the facility's policy titled, Promoting/Maintaining Resident Dignity implemented 01/13/23 reflected, It is the practice of this facility to protect resident rights and to treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, that maintains or enhances resident's quality of life by recognizing each resident's individuality. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 2 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to consult with the resident's physician when there was a significant change in the resident's physical and mental status that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications for 2 of 6 (Resident #23 and Resident #38) residents reviewed for notification of change. The facility failed to communicate with the Registered Dietitian's recommendations to the Physician and to follow up with the physician when the physician did not return the call. These failures placed the residents at risk of worsening health conditions, continued unplanned weight loss, malnutrition, impaired skin integrity, and hospitalization. An IJ was identified on 02/08/24. The IJ template was provided to the facility on [DATE] at 6:15 pm. While the IJ was removed on 02/10/24 at 6:15 pm, the facility remained out of compliance at a scope of pattern and a scope of no actual harm with potential for more than minimal harm that is not is not immediate jeopardy because of the facility's need to monitor and evaluate the effectiveness of the corrective systems. Record review of Resident #23's admission record dated 02/07/24 reflected Resident #23 was an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #23' diagnoses included parkinsonism (clinical syndrome that is characterized by tremor, slowed movements, rigidity), dysphagia (difficulty in swallowing), disorder of kidney and ureter (blockage in one of the tubes), psychotic disturbance, mood disturbance (characterized by delusions, hallucinations, disorganized thoughts) and anxiety (normal response to stress). Record review of the quarterly MDS dated [DATE] reflected Resident #23. -had severe cognitive impairment, - had weight loss of 5% or more in the last month or loss of 10% or more in the last 6 months. -required supervision/maximal assistance with eating (the ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident. Record review of Resident #23's care plans dated 10/24/23 reflected Resident #23 had a nutritional problem or potential nutritional problem due to risk for malnutrition. Currently on regular fortified food with breakfast and lunch, revised on 10/24/23. Interventions initiated on 02/24/23 included: -administer medications as ordered. Monitor/document for side effects and effectiveness. -administer vitamins as ordered. -monitor, record/report to MD, PRN, s/sx of malnutrition: Emaciation (Cachexia), muscle wasting, significant weight loss; 3 lbs. in 1 week, more than 5% in 1 month, more than 7.5% in 3 months, more (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 3 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 than 19% in 6 months. Level of Harm - Immediate jeopardy to resident health or safety -provide, serve diets as ordered. Monitor intake and record q meal. Residents Affected - Some Record review of Resident #23's weight logs reflected the following. -RD to evaluate and make diet change recommendations PRN. 10/09/23 149.5 lbs. 11/09/23 140.0 lbs. 12/07/23 133.5 lbs. 01/18/24 126.0 lbs. 02/06/24 120.9 lbs. Record review of physician orders dated 11/16/23 revealed R#23's Physician DR A gave orders as per the Dietitian's recommendations. The orders were administered. R#23 continued to lose weight from December 2023 to January 2024. The orders included a complete metabolic panel lab work. Record review of the nutrition progress notes dated 12/20/23 for Resident #23 reflected resident with significant weight loss for 90 days and 180 days. Current body weight was 133.5 pounds. Ordered diet provides adequate kcal/protein. 15.2% weight loss for 90 days and 17.3% loss for 180 days notes. Weight loss has continued for 30 days but rate of loss has slowed and is non-significant at this time signifying intake may currently by adequate. Record review of the nutrition progress notes dated 01/19/24 for Resident #23 by the Dietitian Consultant reflected the follow up for weight loss. Weight loss continues for 30 days, current weight is 126 lbs. Per administration record resident is accepting 2.0 supplement as ordered. Intake likely inadequate aeb 5.6% weight loss for 30 days. Ordered diet, regular, regular texture, regular liquids consistency (fortified foods w/breakfast and lunch meals. Ordered supplement: House 2.0 (90ml tid). Recommends increase 2.0 supplement to 120ml tid for added nutritional provision, weekly weights for 30 days to monitor trend, continue diet as ordered. Record review of the progress notes dated 01/23/24 by nursing staff revealed patient with 10% weight loss in 5 months, current weight was 126 pounds, patient eats meals in room or at times attends dining room. Ordered supplement: House 2.0 (90ml tid). Response; RD review 01/19/24 pending response from pcp. Record review of progress notes dated 02/06/24 for Resident #23 by Dietary Manager reflected RD f/u for weight loss. Weight loss continues for 30 days. (4%, not significant but undesirable.) Significant weight loss x 90 days (13.6%). Record review of Resident #23's physician's orders dated 02/07/24 reflected orders: -house shakes three times a day for supplement between meals for 30 days, start date 02/07/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 4 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 -House supplement 2.0 three times a day for supplement give 120ml between meals, start date 02/06/24. Level of Harm - Immediate jeopardy to resident health or safety -weight weekly for four weeks every Tuesday, start date 02/13/24. Residents Affected - Some Interview on 02/05/24 at 2:56 pm with ADON M revealed on 01/22/24 Resident #23's physician had been called to get orders for the recommendations that were made on 01/19/24. R#23's physician did not return call, and no one followed up on calling the physician for orders. The charge nurses and ADONs were responsible to follow up on the recommendations for the residents. Interview on 02/06/24 at 11:52 am with the ADON M revealed staff had not followed up on the response from Resident #23's physician regarding the Dietitian recommendations. ADON M said no one had followed on a response from Resident #23 on 01/19/24. ADON/LVN M said it was her responsibility to ensure the orders from the physician were obtained. ADON M said they had not obtained orders from R#23's physician. Interview on 02/06/24 at 3:02 pm with the DON revealed the facility failed to follow up on Dietitian recommendations and implement interventions. These failures had a negative effect on R#23 with malnutrition, continued weight loss and deterioration in overall health. Interview on 02/08/24 at 5:00 pm with R#23's physician DR A revealed he was not informed of Resident #23's continued weight loss from November 2023 to 02/06/24. R#23's physician said he would attend the QA monthly meetings as Medical Director but had not been informed of Resident #23's significant weight loss of 13.0 % during the months of November 2023 to February 2024 until 02/05/24. This significant weight loss had the adverse effect of malnutrition, debility, susceptibility to infections. Interview on 02/08/24 at 5:35 pm with ADON A revealed she only had evidence she had notified R#23's physician about R#23's weight loss and Dietitian recommendations on 11/16/23. ADON A said she did not have any other information regarding the notification of R#23's weight loss to his physician. Record review of the facility Notification of Changes Policy dated 10/24/22 documented The purpose of this policy is to ensure the facility promptly informs the residents, consults the resident's physician, and notifies consistent with his or her or her authority, the resident's representative when there is a change requiring notification. 2.) Resident #38 Record Review of Resident #38's undated face indicated a [AGE] year-old male admitted on [DATE], readmitted [DATE] with diagnoses of multiple sclerosis (disease that causes nerve damage in the brain, spinal cord, and optic nerves that can result in numerous symptoms including numbness, mood changes, fatigue, pain, blindness, and/or paralysis), muscle wasting, dysarthria and anarthria (cannot control the muscles used for speaking), aphonia (loss of voice), gastrostomy (surgical hole in the stomach from the abdomen in which a tube is inserted to feed someone), and tracheostomy (surgical hole in the windpipe from the outside of the throat that provides an alternative airway). Record review of Resident #38's quarterly MDS dated [DATE] revealed a blank BIMS score indicating the resident is rarely/never understood and a SAMS score of 3 indicating that Resident #38 had severe cognitive impairment and required total assistance, or the physical assistance of 2 or more people for oral/ toileting/ personal hygiene, shower/bathe self, upper and lower body dressing, and bed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 5 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 Level of Harm - Immediate jeopardy to resident health or safety mobility. Resident #38 was coded for weight loss of 5% or more in the last month or 10% or more in the last 6 months, weight loss not on physician prescribed weight loss regimen. Record review of Resident #38's weight record revealed he had an 11.2 pound (5.59%) severe weight loss in one month (12/16/23 to 01/18/24) and an overall 22.4 pound (10.59%) severe weight loss over a six-month period (07/18/23 to 01/18/24). Residents Affected - Some 1/18/2024 16:52 189.1 Lbs 12/16/2023 22:08 200.3 Lbs 11/9/2023 17:58 200.6 Lbs 10/9/2023 16:21 203.5 Lbs 9/12/2023 08:03 207.5 Lbs 8/9/2023 15:11 207.1 Lbs 7/18/2023 16:17 211.5 Lbs Record review of RD note dated 01/19/24 read, RD follow up for tube feed and weight loss. Weight loss continues x30 days. NPO. Current body weight 189.1 lbs. Current BMI 26.4. Ordered tube feed and flushes do not satisfy estimated kcal/protein/fluid needs but needs may be overestimated aeb BMI class overweight. Tube feed likely adequate in protein but inadequate in energy aeb 5.6% weight loss x30 days. Note, weight has been consistently trending down over the last 6 months. Estimated needs: 2442-2543 kcal, 86-103 grams protein, 2579 mL fluid. Ordered tube feed TwoCal HN at 45mL/hr x18 hours; 200mL water flush every 8 hours provides: 1623 kcal, 68 grams protein, 1167 mL of fluid. Recommendation: Increase TwoCal HN to 60mL/hr x18 hours with 200mL water flushes every 4 hours, which will provide 2165 kcal, 91 grams protein, 1956 mL fluid; weekly weights for 30 days to monitor trend. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 6 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Goals: adequate nutrition/ hydration via tube feed, tube feed tolerance, CBW +/- 5% for 30 days. RD to continue to monitor. Record review of Resident #38's February 2024 physician orders revealed an order dated 01/18/24 for enteral feeding, TwoCal HN at 45mL/hr via G tube stationary pump. Down time 07:00 AM to 01:00 PM and an order dated 12/14/23 Every shift flush tube with 200mL of water every 8 hours. Residents Affected - Some Resident #38's February 2024 Physician's orders revealed no acknowledgement of the RD's recommendations, nor any new physician orders for increased tube feed amount. Record review on 02/07/24 at 01:27 PM revealed Nurse's notes documented 01/22/24 by LVN M/ADON that read, Resident has had a 5% weight loss in 1 month with current weight at 189.1 lbs. Previous weight 200.3 lbs. Date of last weight: 1/19/24. Resident has had a 10% weight loss in 5 months with a current weight 189.1 lbs. Previous weight 200.3 lbs. Date of last weight: 1/19/24. Current formula/supplement: HN2Cal at 45mL/hr. via g tube. Any new orders Yes/ No (neither checked) Orders: Dietary Recommendation: increase HN2Cal to 60cc/hr x 18 hrs with 200mL flushes Q4hrs (every 4 hours). There is no MD signature. The notation in the bottom right corner of the page indicated it was faxed on 01/22/24 and initialed by the nurse. Observation on 02/04/24 at 05:06 PM revealed Resident #38 was receiving TwoCalHN tube feed through his PEG tube at 45mL/hr via feeding tube pump. Observation on 02/06/24 at 03:00 PM revealed Resident #38 was receiving TwoCalHN tube feed through his PEG tube at 45mL/hr via feeding tube pump. In an interview on 2/07/24 at 02:21 PM with LVN M/ ADON B and DON, LVN M/ADON B stated in reference to the dietician recommendations dated 1/22/24 regarding Resident #38's weight loss, I am the one that put the note in. If it's not documented, I did not follow up on it. I will follow up today. Normally, I call the doctor or the nurse, usually the nurse, and inform that the resident was reviewed by the dietician, this is the situation, etc . then I send the communication with the current information and the recommendations. When asked about his responsibility as the DON and how he ensures that significant issues were followed up on, the DON responded, Lag time is an issue. Let me work with my medical director. There's a lot going on, but we need to be more diligent on documenting and making sure that things are followed up. We are revamping our morning meetings where we can document what things are still needing to be done. We're putting things in place to get better about following up. Prior to this, weight loss was one of the things reviewed in morning meetings, (intermittently) but we're looking at it once a week or every other week. Our greatest challenge is working to get the physician to respond. In an interview on 02/07/24 at 03:30 PM with RD-S she stated that she has only been working with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 7 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some this facility for about a month and that she comes into this facility 2 times a month. When asked to look at Resident #38's dietary recommendations dated 01/19/24, she stated that the only change she would make was to add weekly weights for a month to monitor the resident's status. To verify that the recommendations were put into place, she stated that she would look at the weekly weights. If they weren't documented, she would get with the ADON or DON and have the resident weighed while she was in the facility. Regarding the tube feedings, she would investigate the physician's orders to see if there were revisions. If there were no revisions, she would go to the RN to find out why the recommendations weren't being followed. RD-S stated she would find out if the resident did not tolerate the increase- was the resident having nausea, vomiting, or diarrhea, or some other sign or symptom indicating intolerance? RD S stated, if there was no sign of intolerance, or the recommendations just weren't followed, it could lead to malnutrition, significant weight loss, or skin break down. In a phone interview on 02/08/24 at 05:21 PM with MD X, when asked if he was aware of Resident #38's RD recommendations that were faxed to him, he stated that he did not have anything to sign right now and that he usually signs things on the weekends. He also stated he did not have anything pending. He stated that he usually physically rounds on his residents every 3 months, however his nurse practitioner went to the facility the last time which was 01/09/24. When asked specifically about Resident #38's weight loss, he stated, yes, he loses weight, then gains weight. When advised of Resident #38's amount of weight loss in 1 month and in 6 months he replied, that's too much. That's a concern. He stated that the facility had not called or sent him anything. He stated, I would expect them to text, call, or bring me the paperwork and I sign the paperwork. He stated he did not know the name of the person who takes him the paperwork, but it was usually left on his desk. An IJ was identified on 02/08/24. The IJ template was provided to the facility on [DATE] at 6:15 pm. The facility's Plan of Removal included: On February 8, 2024, the facility was notified by the surveyor, that an immediate jeopardy had been called and the facility needed to submit a letter of credible allegation. The Facility respectfully submits this Letter for Plan of Removal pursuant to Federal and State regulatory requirements. Submission of the Letter of Credible Allegation does not constitute an admission or agreement of the facts alleged or the conclusions set forth in the verbal and written notice of immediate jeopardy and/or any subsequent Statement of Deficiencies. The alleged immediate jeopardy allegations are as follows: Issue:

F580- Notification of Changes Resident #23, the RD assessed, and new orders were obtained from the physician on 2/6/24. Resident #38, New orders were obtained from the physician based on dietary recommendations on 2/7/24. Resident # 76, RD assessed, and new orders were obtained on 2/6/24 by the Licensed Nurse. The care plan was reviewed and updated based on the new orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 8 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some On 2/7/24, the Director of Nursing/ designee reviewed the last 30 days of RD recommendations to ensure they were communicated to the physician and acted upon. On 2/7/24, the Attending MD and resident representative were notified of residents who were identified with significant weight loss or changes and the interventions put in place. On 2/7/24, the Attending MD was notified by licensed nurse of current nutritional recommendations and implemented orders as written. On 2/8/24, All direct care staff will be re-educated by the Administrator /designee on the following topics: oAbuse and Neglect oWeight Monitoring On 2/8/24, Licensed Nurses will be re-educated by the DON/Designee on the following topics: oNotification of Changes oTimely follow up and notification to MD of nutritional recommendations and implement orders as written and plan of care updated. Completion date of re-education of all staff will be 2/8/24, in person or via telephone. Those that are PRN, Agency and/ or out on FMLA/ LOA will have the education completed prior to accepting assignment for their next scheduled shift. Any staff member not re-educated in person or via phone today (2/8/24), will be removed from the schedule until re-education is provided. Verification of 100% of staff re-education will be verified by the Administrator/ Designee. Director of Nursing/designee will review during the morning clinical meeting that the nutritional assessment is completed. The Attending MD and resident representative will be notified of nutritional/hydration risk identified. MD orders will be implemented as written to include but not limited to dietary recommendations based on referral and evaluations. Plan of care will be reviewed and updated as needed based on assessment and orders. The Administrator will attend the morning meeting to ensure that the DON / Clinical Interdisciplinary Team review significant weight changes and RD recommendations timely. An Ad Hoc QAPI meeting was conducted on 2/8/24 attended by the Administrator, DON, Medical Director and Regional Clinical Specialist to discuss the immediate jeopardy concerning nutrition hydration maintenance and develop the above Action Plan. We respectfully submit this action plan for removal of immediate Jeopardy. Verification of the facility's Plan of Removal: Reviewed the facility conducted 100% review of all residents 11 identified with weight loss. Record review of Resident #2's care plan, care plan revised on 02/09/2024, and updated accordingly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 9 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 - no concerns noted. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #6 was audited for weight loss. Upon record review, facility implemented order of adding house shakes three times a day, as well as weekly weights for 4 weeks. Care Plan updated and no observable concerns. Residents Affected - Some Record review of Resident #23's care plan, and orders were updated and revised on 02/08/2024 to include weekly weight for 4 weeks, and house shakes three times a day. No concerns noted. Record review of Resident #38's care plan, and orders, which were both updated and implemented on 2/08/2024. No concerns noted. Record review of Resident #76's care plan, and orders, which were both updated and implemented on 02/07/2024 - no concerns noted. During an observation on 02/10/2024 at 12:15PM Observed Resident #3 being assisted to eat by CNA J no noted concerns. During an observation on 02/10/2024 at 5:39PM Observed ADON assisting Resident #23 eat his food. On the tray is soft mechanical food of chicken with gray, mash potatoes, and bread pudding. No observable concerns During an observation and interview on 02/10/2024 at 3:55PM Resident#38, observed Resident#38 in bed in lowest position, had HN 2cal tube feeding running at 60mL/HR with 200 Q4 free water flush. Observed no signs and symptoms of distress, when asked if he had any concerns, he motioned his head in a left/right motion, indicated no. During an interview on 02/10/2024@12:37PM, RN A was asked to assist with working on the floor. RN A stated prior to entering the facility, she attended an in-service on 02/09/2024 regarding steps to take if she witnessed a resident looking frail, which would be to fill out a stop and watch form noting the concern with weight and stature, followed by notifying the ADONs, DON, and Physician. RN A stated for she was also in-serviced during the same meeting about change in condition and was told to also fill out a stop and watch form, notating the change in condition followed by notifying the ADONs, DON, and physician. RN A stated if she were not able to initially get ahold of the Physician, she was instructed to then, secondly, contact the Medical Director. RN A stated she was also in-serviced to monitor the residents' weights weekly, for those that pose a weight loss concern, and that the CNAs will document the weights, and if the CNAs notice a concern, the CNAs will notify the nurse, and the nurses will follow up. During an interview on 02/10/2024 at 1:12PM, LVN A stated he was a travel nurse. LVN A stated he was in-serviced about weight loss, and the actions to take would be to notify ADON/DON, and Doctor's. LVN A stated he monitors meal intakes and if resident was not eating enough he would notify ADON/DON and physician, as well as advocate for nutritional supplementation. LVN A stated he monitors weekly weights, and that monitoring weekly weights give him a better idea on how residents were responding to the nutrition. During an interview on 02/10/2024 at 1:27PM RN B stated she was in-serviced a about 2 days ago about monitoring diet intake, weights, abuse (how to report it), how to de-escalate patient issue by removal and when needed, to separate and notify Administrator of the suspicion of abuse. RN B stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 10 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some for diet, CNAs will document food intake and weights weekly, and that CNAs will give meal percentage slips to the nurses, who will then look at them to see how much the residents are eating. During an interview on 02/10/2024 at 1:30PM CNA A stated she was in-serviced 2 days ago about weight loss and change in conditions. CNA A stated she was educated to notify nurse of the concern of either weight loss or change in condition, while also filling out the stop and watch form and giving it to the nurses. CNA A stated then the nurses were to give a copy of the form to the ADONs/DON. CNA A stated the form is for change in condition concern. CNA A stated Will do monthly unless ordered weekly weights. CNA A stated she was instructed to fill out the meal percentage form for each resident and give the form to the nurses. During an interview on 02/10/2024 at1:47PM CNA B: stated she was in-serviced a couple of days ago about food meal percentage forms, negligence, and meals. CNA B: stated if a resident doesn't want to eat, give options, and if they still don't want the options, she will let the nurses and ADON/DON know. CNA B: stated she will fill out meal percentage paper and turn in the ticket to the nurses. CNA B: stated if they see anything out of the ordinary regarding a resident, she will fill out an IMPACT paper and give kit to the nurse, and nurse will follow up. During an interview on 02/10/2024 at 1:54PM CNA C stated she will document the meal percentages on the meal forms, and give to the nurses, as well as and document in the resident's charts. CNA C stated she will report to nurses if she sees something out of the ordinary, and will document in Stop and Watch paper, then give it to the nurse. During an interview on 02/10/2024 at 2:41PM ADON B, and DON stated for weight management, those that do not have weight loss issues will have monthly weights and those that do have weight loss issues will have weekly weights taken. The restorative aides will document weights in the resident's electronic health record. ADON B and DON stated they have now implemented weight management during every morning daily meeting and will follow up on imposed weight management interventions that same day during their afternoon clinical meeting. Both stated monitoring weights and change in conditions was a collaborative effort for all staff members. Both stated nurses were a part of care and will monitor weights and change in conditions diligently every shift. Both stated nurse will monitor weights, nutrition, as well as nurses are to identify weight loss or if the resident is not eating properly, and will notify RP, ADON/DON. Both stated upon reviewing weights during their daily clinical meetings, for the resident's that trigger 5-10% weight loss, their diet, care plan, and orders will be reviewed, but will immediately implement weekly weights for 4 weeks. Both stated during the clinical reviews they will also update Care Plans on the spot and provide more oversight. Both stated for the travel nurses, the plan is to add weight management, and change of condition in-services and education during the on-boarding/orientation schedule. During an observation on 02/10/2024 at 3:07PM Resident #2(audited for weight loss), was sitting in a wheelchair at the entry of her room. Resident #2 was eating graham crackers, and states she likes the food, and ate all her lunch. Resident #2 stated she has been drinking her supplemental shakes. During an interview on 02/10/2024 at 3:43PM CNA F stated she was in-serviced on 02/09/2024 about abuse/neglect and weight management. CNA F stated when residents don't want to eat, they will offer alternatives once they get approval from the nurse. CNA F stated she will notify the nurse of any resident's refusal of eating. CNA F stated she will notify the nurse of any noticed changes whether it be food or body. CNA F will use Stop & Watch forms to notify nurses and verbal as well. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 11 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 02/10/2024 at 3:51pm the HA A stated she will answer call lights but does not perform hands on patient care. The HA A stated she was in-serviced recently about abuse/neglect, dietary, and weight loss. The HA A stated if a patient is not eating, she will report the issue to the nurse. The HA A stated she will report to nurse about Change of condition utilizing Stop and watch form. The HA A stated she does not measure weights. During an interview on 02/10/2024 at 4:06PM LVN N stated she was in-serviced just recently about weight, diet, abuse/neglect, and stop and watch. LVN N stated Stop and Watch paper forms will be filled out by any clinical staff and given to the nurse taking care of the resident, as well as a copy be given to the administration staff ADON/DON/Administrator. LVN N stated nurses will address issue and notify the chain of command. LVN N stated if a resident looks [NAME], they will notify physician and make a progress note documentation, and if unable to get ahold of physician they have been instructed to contact the medical director. LVN N stated when she notices a change in condition, she will again notify the primary physician or secondly, the medical director if she cannot get ahold of the initial physician. LVN N stated she will monitor and checks orders. During an interview on 02/10/2024 at 4:22PM, CNA J stated she was in-serviced about weight loss and change of conditions. CNA J stated if she notices any change in condition she will report to nurses and DON. CNA J stated if she notices a resident getting skinny, she will report to nurse and will utilize the Stop and Watch form to give to nurses. CNA J stated she will follow the nurse's direction. During an interview on 02/10/2024 at 4:51PM RN C stated she was given a recent in-service about weight loss, and if a resident was not eating, she will notify the doctor. RN C stated she would attempt to administer a nutritional supplement shake. RN C stated she works night, and does not work with breakfast, lunch, dinner, but if she is notified in bedside shift report a nutritional concern, she will notify the incoming day nurse about monitoring for weight loss. RN C stated for change of conditions, she will notify managerial staff, and will follow up and give report to morning nurse, as well as notify the doctor to get new orders. If she cannot get a hold of doctor, will document, and will give in report in the morning to follow up to call Medical Director. During an interview on 02/10/2024 at 5:13PM LVN N stated she was given a recent in-service on abuse, change in condition, and nutrition. LVN N stated for nutrition, if you were notified of a resident not eating, notify primary care physician, offer supplemental drinks, and advocate for orders. LVN N stated she works nights, so she does not weigh residents at night, but if she notices any change of condition or weight decline, she will report to ADON/DON and document using the stop and watch form. LVN N stated if she noticed change of condition, she would perform assessment, notify physician, and ask for recommendation. If physician doesn't call back by end of shift, will notify incoming nurse and notify ADON/DON about following up. During an interview on 02/10/2024 at 5:54PM the Administrator stated two concerns were identified which was the lack in notification of change in condition, and the follow up to the change in condition. The Administrator stated, the facility began education and in-servicing on the change in condition and weight management on 02/07/24 to all direct care staff to effectively communicate notification in change as well as regarding weight management. The Administrator stated the form called Stop and Watch can be used by anyone, and its' purpose was to ensure the nurses or CNAs document the concern and give the copy of the form to the ADONs/DON who would follow up daily. The Administrator stated the nurses have been educated on if they were not able to get ahold of the initial physician, the nurses have the capability to speak to the medical director to get guidance, orders, and needs to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 12 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some documented and notified to management. The Administrator stated CNAs will communicate notification of change to nurses, to give better care. The Administrator stated the Stop and Watch white form copy will go to the nurse and yellow to nurse management or ADONs. The Administrator stated he will follow up on DON, and will attend morning clinical meetings, and that the ADONs/DON were monitoring weights on a spread sheet. Record review of the facility's in-services regarding Abuse/Neglect, Change in Condition, notification of changes, and Weight Management system were conducted on 02/07/24, 02/08/24, and 02/10/24. Record review of the facility's Abuse and Neglect Policy and Procedures dated 08/15/22. Record review of the facility's Weight Management System Policy and Procedures undated. Record review of the facility's Notification of Changes Policy and Procedures dated 10/24/22. Record review of the facility's Ad Hoc meeting dated 02/08/24 topics of change of condition, notification of changes and weight loss management were reviewed, and a plan[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 13 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 includes measurable objectives and time frames to meet resident's mental and psychosocial needs, for two (Resident #57 and Resident #102) of eight residents reviewed for care plans. 1) The facility did not develop and implement a comprehensive person-centered care plan that addressed Resident #57's indwelling catheter. 2) The facility failed to address Resident #102's respiratory treatments in her comprehensive person-centered care plan. This failure could place residents in the facility at risk of not receiving the necessary care and services to maintain their health and safety. The findings included: 1.) Resident #57 Record review of Resident #57's admission record dated 02/08/24, reflected Resident #57 was an [AGE] year old-male re-admitted to the facility on [DATE], with diagnoses which included, diabetes (a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel), major depressive disorder (mental state of low mood ), parkinsonism (clinical syndrome characterized by tremor, rigidity, and postural instability), bed confinement status, infection and inflammatory reaction due to indwelling urethral catheter and presence of urogenital implants (risk from using indwelling catheters). Record review of Resident #57's annual MDS dated , 12/21/23 reflected Resident #57 had severe cognitive impairment. and was incontinent of bowel and bladder. Record review of Resident #57's physician orders dated 02/06/24 reflected an order for a Foley catheter, change 16Fr with 10ml bulb as needed for patency, dislodgement, and leaking, start date 01/23/24. Record review of Resident #57's care plans last revised on 01/22/24 reflected no care plans to address resident used an indwelling catheter. An observation on 02/04/2024 at 3:40 pm revealed Resident #57 in his bed. Resident #57 was using a catheter bag. Interview on 02/06/24 at 3:17 pm with MDS R revealed Resident #57 went out to the hospital and was re-admitted on [DATE] with an order for catheter. Resident #57's care plans had been reviewed on 01/22/24 for his MDS assessment. MDS R said the nurse who re-admitted Resident #57 on 01/05/24 should have updated his care plan. MDS R said ADON A should have updated Resident #57's care plan that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 14 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 addressed his catheter. Level of Harm - Minimal harm or potential for actual harm Interview on 02/06/24 at 3:53 pm with ADON A revealed she had reviewed Resident #57's orders when he was re-admitted on [DATE] and obtained a new order to change from a 20 Fr catheter to a 16Fr catheter. ADON A said Resident #57's care plan should have been updated by the admitting charge nurse, LVN N. ADON A said she was responsible to ensure the care plans were updated. ADON A said she had overlooked Resident #57 did not include a care plan to address the catheter. Residents Affected - Few Interview on 02/06/24 at 4:01 pm with LVN N revealed she was not aware she was supposed to update and revise a resident's care plans, including Resident #57. LVN N said the care plan should be updated as needed to be kept informed of the resident's individualized care. Interview on 02/06/24 at 3:02 pm with the DON revealed the ADONs, charge nurses and MDS Coordinators were responsible to ensure resident's care plans were updated and revised as needed. The DON said failure to update or revise a care plan to address a resident's individualized care placed the resident at risk of not receiving the necessary care to meet his care. 2.) Resident #102 Record review of Resident #102's face sheet dated 02/06/24 reflected an [AGE] year-old female admitted on [DATE] with a diagnoses of acute respiratory failure, functional dyspnea (shortness of breath), pneumonia, influenza with specified pneumonia, and atrial fibrillation (irregular heart beat). Record review of Resident #102's quarterly MDS dated [DATE] revealed she had a BIMS score of 08 indicating moderate cognitive impairment. Resident #102 required extensive 1 to 2 person physical assist with bed mobility, transfer, dressing, toilet use, and personal hygiene. Record review of Resident #102's February 2024 physician's orders revealed Oxygen 3L via nasal cannula every shift for SOB Order date 01/06/24. Observation on 02/04/24 at 05:44 PM revealed Resident #102 received oxygen via NC at 3lpm utilizing a [NAME] 2 concentrator. The tape on the nasal cannula tubing was unreadable. Record review on 02/08/24 at 09:21 AM of Resident #102's comprehensive care plan dated 11/21/23 revealed that oxygen therapy was not included. Record review on 02/08/24 at 09:21 AM of Resident #102's Quarterly MDS dated [DATE] indicated that Resident #102 was receiving oxygen therapy. Record review of the facility policy titled Care Plan Revisions Upon Status Change implemented on 10/24/23 reflected The purpose of this procedure is to provide a consistent process for reviewing and revising the care plan for those residents experiencing a status change. The comprehensive care plan will be reviewed, and revised as necessary, when a resident experiences a status change. Care plans will be modified as needed by the MDS Coordinator or other designated staff member. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 15 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review the facility failed to provide residents who were unable to carry out activities of daily living received the necessary services to maintain good personal hygiene to dependent residents for 3 of 5 residents (Resident #88, Resident #55, and Resident #70) reviewed for ADL care. Residents Affected - Some Nursing staff did not shower Resident #88, Resident #55, and Resident #70 on 2 scheduled shower days. This deficient practice could affect 111 residents who required assistance with showers in the facility and it could contribute to poor hygiene and skin breakdown. The findings were: 1) Record review of Resident #88's face sheet, dated 02/04/24, revealed the resident was admitted to the facility on [DATE] with diagnoses that included age-related cognitive decline, dysphagia (difficulty swallowing foods or liquids, arising from the throat or esophagus, ranging from mild difficulty to complete and painful blockage), oropharyngeal phase, type 2 diabetes mellitus with hyperglycemia, and benign prostatic hyperplasia (age-associated prostate gland enlargement that can cause urination difficulty) without lower urinary tract Based on the MDS review for cognitive function, R #88 has a cognitive communication deficit and a BIMS of a 9. Record review of Resident #88's Nursing admission Assessment with Functional Abilities, dated 02/04/24, revealed the resident was incontinent of bowel and bladder and he required substantial/maximal assistance with bed mobility, transfers, sit to stand, and toileting transfer. The record also included an Interim Care Plan that revealed the resident had ADL self-care performance deficit related to missing limb and with interventions for bathing that the resident required 2 staff participation with bathing. 2) Record review of Resident #55's face sheet, dated 02/04/24, revealed the resident was admitted to the facility on [DATE] with diagnoses that included morbid (severe) obesity due to excess calories, hypothyroidism ( a condition in which the thyroid gland doesn't produce enough thyroid hormone), type 2 diabetes mellitus ( a long-term condition in which the body had trouble controlling blood sugar and using it for energy), hypertension, and tinea pedis ( a fungal infection that usually begins between the toes. This commonly occurs in people whose feet have become too sweaty and confined in tight-fitting shoes). Record review of Resident #55's Nursing admission Assessment with Functional Abilities, dated 02/04/24, revealed the resident had a history of pressure ulcers due to unable to reposition or transfer independently. The record also revealed the resident was incontinent of bowel and bladder and she required substantial/maximal assistance with bed mobility, transfers, sit to stand, and toileting transfer. The record also included an Interim Care Plan that revealed the resident had ADL self-care performance deficit related to the resident being a fall risk and with an intervention for bathing that the resident required 1 staff participation with bathing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 16 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0677 Level of Harm - Minimal harm or potential for actual harm 3) Record review of Resident #70's face sheet, dated 02/04/24, revealed the resident was admitted to the facility on [DATE] with diagnoses that included Gangrene (dead tissue caused by an infection or lack of blood flow), Hypothyroidism ( a condition in which the thyroid gland doesn't produce enough thyroid hormone), Type 2 Diabetes Mellitus, Hypertension, PVD, R-BKA (Peripheral Vascular Disease/Right Leg, Below-Knee Amputation), and Pressure ulcer of sacral region stage 2 . Residents Affected - Some Record review of Resident #70's Nursing admission Assessment with Functional Abilities, dated 12/7/17, revealed the resident had a wedge compression fracture of first lumbar vertebrae. The record also revealed the resident was incontinent of bowel and bladder and she required substantial/maximal assistance with bed mobility, transfers, sit to stand, and toileting transfer. The record also included an Interim Care Plan that revealed the resident had ADL self-care performance deficit related to the resident's morbid obesity and with interventions for bathing that the resident required 1 staff participation with bathing. During a Confidential Interview on 02/06/2024 at 10:00am it was revealed that Resident #88, Resident #55, and Resident #70 do not receive their showers on their scheduled days. The residents stated that their schedules were to receive a shower three times a week, and on a good week they may receive one shower a week. The residents stated that they have had this issue for over two months . On 02/06/24 on 11:12am, the Social Worker recalled the resident council meeting in December, and she recalled the meeting with the staff and the Ombudsman in regards to the shower schedules. The Social worker confirmed the schedule for the showers, but she agreed that there was an issue with the showers being completed when they were supposed to. The Social worker stated that when the residents go to her to discuss the shower schedule issue, she brought it to the nurses' attention during the daily morning meetings . During an interview on 02/06/24 at 1:18 p.m., Resident #55 revealed that she has not gotten a bath since the week before. Resident #55 stated that her shower schedule was Mondays, Wednesdays, and Fridays. Resident #55 stated she would like one, but the staff have not offered her a shower or bed bath. Observation and interview with Resident #70 on 02/07/24 at 10:41 A.M., revealed Resident #70 was sitting in the hallway waiting to have a Certified Nurse Assistant return. Resident #70 told he CNA she wanted a bath today because she wanted to smell good for her doctor appointment. Resident #70 revealed that she had been waiting for almost 30 minutes. Resident #70 repeated from the resident council meeting that she did not receive her showers on the days that were scheduled. Resident #70 stated that she was supposed to receive her showers on Mondays, Wednesdays, and Fridays, but will only receive a shower once a week . During an interview on 02/07/24 at 2:32 p.m. LVN E revealed Resident #55 gets showers per the shower book from 6a-2p on Mondays, Wednesdays, and Fridays. LVN E also revealed that Resident #55 could receive a shower or bed bath even on her non-scheduled days. She stated some days are slower than others, so the staff can make it work on any day that Resident #55 wanted . During an interview on 02/07/24 at 3:35 p.m., CNA H revealed that she had not given Resident #70 a bath or shower on her shift. CNA H also revealed she was not sure when the resident had a bath. CNA H looked through the shower sheet for the A hall with the state surveyor and confirmed that Resident #70's room did not have a record of the resident having had or refusing a bath/shower. CNA H then asked LVN N if Resident #70 was a hospice resident because CNA H said that the hospice staff usually (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 17 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some bathed their residents. LVN N responded that Resident #70 was not a hospice resident. CNA H then said that the resident may have had a shower in the morning . During an interview on 02/08/24 at 9:40 a.m., LVN N revealed the showering schedule for resident on the C hall was male showers on T-TH-SAT and female showers on M-W-F. LVN N and CNA H confirmed that there were no shower document sheets for the 2-10 shift in the shower binder for the C Hall. LVN N confirmed that there was no shower sheet for the 2-10 shift because the nurse probably had not made the new copies . These copies are the logs that the staff should be documenting when residents are showers. The staff that are responsible for these logs are the certified nursing assistants and if they run out of these forms they are responsible for making copies or notifying their assistant directors of nursing. If the nursing staff does not keep up with these forms or does not use the forms it could result in missing a resident's shower or a resident not receiving their shower when they are supposed to. The resident could develop and infection or become affected mentally if showers are not consistent. 02/08/2024 at 4:18 p.m. During an interview with the Local Ombudsman, she stated that she was present during the December resident council meeting and that all the residents during that council meeting expressed not being showered during their assigned scheduled days. The Ombudsman also stated that when she had the meeting with the nursing team, they stated they would immediately work on the issue . Per the Local Ombudsman, after the resident council meeting occurred there was a meeting held with the Administrator, Director of Nursing, Social Worker, Activity Director and the Local Ombudsman to discuss the shower concerns that were expressed at the resident council meeting. Per the Ombudsman, the Resident Council meeting and the meeting occurred on 12/07/23. The failure affects the resident because it can cause infections and illness if the residents are not kept clean and kept maintaining their health in the facility. During an interview on 02/08/24 at 5:02 P.M., the DON revealed that the facility staff usually charted resident's showers on the shower sheets for the hall and on the electronic medical record Task for ADL-Bath. The DON confirmed on the date 12/07/23, there was a meeting with the Local Ombudsman, the Activity Director, the Administrator, the Director of Nursing, and the Social Worker to discuss the concern that the residents verbalized during the December resident council meeting of not being showered on their scheduled days. Per the Director of Nursing the Ombudsman brought it to their attention and the facility stated they would do an in-service and immediately work on the issue . Information provided by the facility on 02/04/2024, revealed 62 residents who required assistance with showers in the facility, receiving a bath from admission up until 12/14/17. The DON also confirmed there were no shower sheets for the 2-10 shift printed up to use to indicate a resident was showered on that shift for the CNAs to fill out. Review of a facility policy titled, Shower/Tub Bath revised October 2010, revealed under the Documentation section the following information should be recorded on the resident's ADL record and/or the resident's medical record: 1. The date and time the shower/tub bath was performed. 2. the name and title of the individual(s) who assisted the resident with the shower/tub bath. 3. All assessment data (e.g., any reddened areas, sores, etc., on the resident's skin) obtained during the shower/tub bath. 4. How the resident tolerated the shower/tub bath. 5. If the resident refused the shower/tub bath, the reason(s) why and the intervention taken. 6. The signature of the person recording the data. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 18 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure that residents receive care, consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing for 1 (Resident #87) of 5 residents reviewed for pressure ulcers. Residents Affected - Some The facility failed to implement Resident #87's physician recommendation/order to float/off-load heels to remove pressure on pressure injuries of heels/feet. These failures could result in increased pain, infections, development of new pressure ulcers, and decline in quality of life for residents. Findings include: Record review of Resident #87's face sheet dated 02/06/24 indicated a [AGE] year-old female admitted on [DATE] with diagnoses of Alzheimer's disease, GERD (gastroesophageal reflux disease- acid reflux), dementia and bed confinement status. Record review of Resident #87's admission MDS dated [DATE] revealed she has a blank BIMS score indicating that she is rarely/never understood and a SAMS score of 3, indicating severe cognitive impairment. Resident #87 required substantial/maximal to complete assist with all ADLs including bed mobility and repositioning. Resident #87 was at risk of developing pressure ulcers/injuries, but that she did not have any unhealed pressure ulcers/injuries. It also indicated that Resident #87 did not have any venous or arterial ulcers or any other ulcers, wounds, or skin problems. Record review of Resident #87's comprehensive care plan dated 12/07/23 documented, The resident has pressure ulcers related to Immobility: 12/27/23- Unstageable Right heel, 12/27/23- Stage 2 Left heel. Date Initiated: 01/09/2024 Revision on: 01/11/2024. Interventions: Administer treatments as ordered and monitor for effectiveness. Date Initiated: 01/09/2024 - Monitor nutritional status. Weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue and exudate Date Initiated: 01/09/2024.In regard to Resident #87's care planned wounds; the care plan read: Problem: The resident has an alteration in skin integrity related to the presence of DTIs to both feet with a date of origin of 12/27/23. See skin integrity care plan for risk factors contributing to pressure ulcer/ injury development. 12/27/23 Unstageable DTI right 1st toe. 12/27/23 Unstageable DTI left 1st toe. Date initiated: 01/09/24. Revision on: 01/11/24. Goal: The resident's pressure ulcer /injury will show signs of healing AEB decrease in size /measurements, and I will remain free from signs and symptoms of complications (including infection) by/through next review date. Date Initiated: 01/09/2024. Target Date: 03/19/2024. Interventions: Apply treatment per Medical Practitioner's order (see e-TAR for specific treatment order) and monitor for effectiveness of current treatment. Date Initiated: 01/09/2024. Assess and document on status of pressure ulcer / injury weekly and as needed. Date Initiated: 01/09/2024. Consult(s) per Medical Practitioner's order if clinically indicated. Date Initiated: 01/09/2024. Weekly assessment and evaluation of pressure ulcer / injury - refer to Skin UDA's/Forms for weekly wound assessment, measurements, and description of ulcer. Date Initiated: 01/09/2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 19 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 Record review of Resident #87's initial wound evaluation and management summary done on 01/11/24 by Wound Care Physician indicated: Level of Harm - Minimal harm or potential for actual harm Site 1: Stage 2 Pressure wound of the left heel partial thickness. Residents Affected - Some Etiology (quality): Pressure MDS 3.0 Stage: 2 Duration: >2 days Objective: Healing/ Maintain healing Wound size (L x W x D): 2.5 x 2.3 x 0.1 cm Surface area: 5.75 cm squared Exudate: Light serous Dermis: Open areas with exposed dermis Treatment plan for site 1: Primary Dressing(s): Hydorgel gel, Apply once daily for 30 days Secondary Dressing(s): Gauze island with border. Apply once daily for 30 days. Plan of care reviewed and addressed. Recommendations: Float heels in bed; Off load wound. Site 2: Unstageable (due to necrosis) of the right heel full thickness. Etiology (quality): Pressure MDS 3.0 Stage: Unstageable Necrosis Duration: >7 days Objective: Healing/Maintain healing Wound size (L x W x D): 3.3 x 3.1 x Not measurable cm Depth is not measurable due to presence of nonviable tissue and necrosis Surface area: 10.23 cm squared Exudate: Light serous Thick adherent devitalized necrotic tissue: 90% (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 20 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 Granulation tissue: 10% Level of Harm - Minimal harm or potential for actual harm Treatment plan for site 2: Primary Dressing(s): Hydrogel gel apply once daily for 30 days Residents Affected - Some Secondary Dressing(s): Gauze Island with border. Apply once daily for 30 days. Plan of care reviewed and addressed. Recommendations: Float heels in bed; Off load wound. Reason for no sharp debridement: Telemedicine Site 3: Unstageable DTI of the left, first toe, undetermined thickness. Etiology (quality): Pressure MDS 3.0 Stage: Unstageable DTI with intact skin Duration: >7 days Objective: Healing/ Maintain healing Wound size (L x W x D): 0.5 x 0.3 x not measurable cm Surface area: 0.15 cm squared Exudate: none Skin: Intact with purple/maroon discoloration Treatment plan for site 3: Primary Dressing(s): skin prep apply once daily for 30 days Plan of care reviewed and addressed Recommendations: Off-load wound. Site 4: Unstageable DTI of the right, first toe, undetermined thickness Etiology (quality): Pressure MDS 3.0 stage: Unstageable DTI with intact skin Duration: >7 days Objective: Healing/ Maintain healing Wound size (L x W x D): 0.7 x 0.5 x not measurable cm Surface area: 0.35 cm squared (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 21 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 Exudate: None Level of Harm - Minimal harm or potential for actual harm Skin: Intact with purple/ maroon discoloration Treatment plan for site 4: Residents Affected - Some Primary dressing(s): Skin prep apply once daily for 30 days Plan of care reviewed and addressed Recommendations: Off load wound Record review of Resident #87's February 2024 physician's orders revealed, Wound Care: Stage 2: Left Heel: Reclassified from Stage 1 1/5/24: Cleanse with NS, pat dry, apply collagen with calcium alginate, cover with dry super absorbent dressing daily. Wound Care: Unstageable: Right Heel: Reclassified from stage 2 1/5/24: Cleanse with NS, pat dry, apply Santyl, with calcium alginate and cover with dry super absorbent dressing daily . Wound Care: DTI: Left 1st Toe: Cleanse with NS, pat dry, apply skin prep daily and leave open to air one time a day. Wound Care: DTI: Right 1st toe: Cleanse with NS, pat dry, apply sure prep daily and leave open to air one time a day. Provide total care for ADLs and provide skin breakdown precautions every shift for maintain hygiene and well being. Record review of Resident #87's Wound Care Telemedicine Follow Up Evaluation dated 02/02/24 by Wound Care Physician revealed: Site 1: Stage 2 Pressure wound of the left heel partial thickness. Etiology (quality): Pressure MDS 3.0 Stage: 2 Duration: >24 days Objective: Healing/Maintain healing Wound size (L x W x D): 1.1 x 0.4 x 0.1 cm Surface area: 0.44 cm squared Exudate: Moderate Serous Dermis: Open areas with exposed dermis Wound Progress: Improved as evidenced by decreased surface area Treatment plan for site 1: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 22 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 Primary Dressing(s): Alginate calcium. Apply once daily for 22 days Level of Harm - Minimal harm or potential for actual harm Secondary Dressing(s): Gauze island with border. Apply once daily for 8 days. Plan of care reviewed and addressed. Recommendations: Float heels in bed; Off load wound. Residents Affected - Some Site 2: Unstageable (due to necrosis) of the right heel full thickness. Etiology (quality): Pressure MDS 3.0 Stage: Unstageable Necrosis Duration: >29 days Objective: Healing/Maintain healing Wound size (L x W x D): 2.5 x 2.3 x 0.3 cm Surface area: 5.75 cm squared Exudate: Moderate serous Slough: 40% Granulation tissue: 60% Wound progress: Improved evidenced by decreased necrotic tissue. Treatment plan for site 2: Primary Dressing(s): Alginate calcium. Apply once daily for 22 days; Santyl. Apply once daily for 22 days. Secondary Dressing(s): Gauze Island with border. Apply once daily for 8 days. Plan of care reviewed and addressed. Recommendations: Float heels in bed; Off load wound. Reason for no sharp debridement: Telemedicine Site 3: Unstageable DTI of the left, first toe, undetermined thickness. Etiology (quality): Pressure MDS 3.0 Stage: Unstageable DIT with intact skin Duration: >29 days Objective: Healing/ Maintain healing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 23 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 Wound size (L x W x D): 0.3 x 0.3 x Not measurable cm Level of Harm - Minimal harm or potential for actual harm This visit's measurements are noted by the clinician to be exactly the same as the previous visit. Surface area: 0.09 cm squared Residents Affected - Some Exudate: None Skin: Intact with purple/maroon discoloration Wound progress: At goal Treatment plan for site 3: Primary Dressing(s): skin prep apply once daily for 8 days Plan of care reviewed and addressed Recommendations: Off-load wound Site 4: Unstageable DTI of the right, first toe, undetermined thickness Etiology (quality): Pressure MDS 3.0 stage: Unstageable DTI with intact skin Duration: >29 days Objective: Healing/ Maintain healing Wound size (L x W x D): 0.7 x 0.4 x not measurable cm Surface area: 0.28 cm squared Exudate: None Skin: Intact with purple/ maroon discoloration Wound progress: At goal Treatment plan for site 4: Primary dressing(s): Skin prep apply once daily for 8 days Plan of care reviewed and addressed Recommendations: Off load wound Observation on 02/04/24 at 05:30 PM revealed Resident #87 was in bed with a stuffed animal under her feet that her heels were resting on. Heels were not off-loaded or floated. Observation on 02/06/24 at 11:09 AM of Resident #87 revealed she was lying in bed on her left side. Resident #87's feet rested on the bed, not off-loaded or floated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 24 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with RN O on 02/06/24 at 03:04 PM. RN stated interventions for pressure ulcer management include repositioning with 2 people, air mattresses, wedge pillows, hydration/nutrition, and checking weight loss. RN O stated offloading is done with pillows, specialty pillows such as egg crate and regular pillows. RN O stated, We use heel protectors. RN O stated off loading to heels means to raise them so that the weight of their leg was not on their heel; elevation. RN O stated, we are all responsible for repositioning/ offloading. It's important to keep skin hydrated with moisture creams. Keep the skin as dry as possible. Monitor fluid intake. RN O states positioning/offloading is supposed to be checked/done every 2 hours, at least. In response to how the RN ensures that the CNAs were repositioning/offloading RN O stated, we have to rely on the honor system. The CNAs team up and go room to room to room and then they come back and do it all again. In between we have physical therapy coming in which is also beneficial for the patients. If they're in bed- physical therapy will work on range of motion or getting them up in the wheelchair and taking them to the therapy room. RN O stated it's important to offload because it increases circulation of the pressure points and decreases the possibility of skin breakdown/ulcers. RN O stated if they were not repositioned or off loaded, it can result in decreased circulation, skin breakdown, even possibility of clots due to loss of movement, possibly even contractures. They can have 3rd spacing also. Observation of Resident #87's wound care done on 02/07/24 at 10:44 AM by WCN and LVN M/ADON B revealed right great toe: WCN stated, I see Intact skin, with red and a little purple around the edge. Measures 0.5cm length x 0.5cm width Left great toe: WCN stated, I see intact skin and a little dot of discolored skin. Measures 0.3cm length x 0.3cm width Left heel: WCN stated, I see intact skin. measures 0.2cm width x 1.0cm length Right heel: WCN stated, I see an open wound with granulation, slough and the edges are a little macerated. Around that the skin looks normal and healthy. Measures 2.1cm length x 1.9cm width x (resident refused depth measurement) . In an interview with LVN M/ADON B on 02/07/24 at 11:00 AM, when asked about floating heels/ offloading wounds, LVN M/ADON B stated, When the resident is on an air mattress were not supposed to put anything other than a sheet on the mattress. When asked about floating the heels, LVN M/ADON B responded, the heels do not touch the mattress when they are off loaded. I do read the wound care evaluation and treatment. I would put a pillow between her knees so that they are not touching, but nothing under her heels. I think that the purpose of the air mattress is for offloading. If it was allowed with this bed, I don't think it would hurt her to put a pillow under her legs. She came from the hospital from those foam booties for heel protection. I will reach out to Restorix (company that provides programs, services, education, and supplies regarding wounds and wound care) again to make sure it's ok to use a pillow for off loading. LVN M/ADON B states, It was in August or October that the CNAs were trained on positioning and off loading. When asked about repositioning residents on an air mattress, LVN M/ADON B stated that it is still necessary to reposition residents, even when using an air mattress so that they don't develop pressure injuries to their sacrum or buttocks. Interview with MD Z on 02/08/24 at 09:35 AM , MD Z stated when there are pressure injuries to specifically a resident's heels, they should be floated and off loaded. MD Z stated that an air mattress could be useful, however repositioning and offloading are still necessary because we cannot solely rely on the air mattress. MD Z verified resident #87 would benefit to assist in healing of offloading/ floating her heels to eliminate pressure. MD Z stated the best way to float/off load heels was to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 25 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some use specialty devices or pillows to keep the heels off of the bed or any other surface and any pressure off of the heels. In an interview with DON and Administrator on 02/08/24 at 10:05 AM in reference to Resident #87's pressure ulcer recommendations for treatment written by the wound care doctor in her wound care evaluations, the DON stated, recommendations are recommendations, not orders. The doctor says it's a reminder. We need to clarify with the doctor about what devices she wants us to use. We have air mattresses. The DON stated that they need to be more specific on orders when the care plan intervention reads, Follow physician orders. The DON also confirmed that the wound care nurse was a contract employee and stated they are working on getting their own wound care nurse. In an interview with RN T, Care Management Specialist on 02/08/24 at 10:18 AM, RN T stated, If there is an open wound, it would be added to interventions on the care plan. It would say off load or whatever. When asked about needing a specific order from the doctor, RN T stated, the wound care evaluation should suffice as the order. We can't include an intervention on the MDS that isn't able to be signed off as being done by the nurse. If something didn't get into the care plan', the failure is on the nurse's side because they failed to transcribe that order so that it can be coded in the MDS. In an interview on 02/08/24 at 11:53 AM, MD Z stated, I wanted to clarify some stuff- my opinion. Where I put recommendations, it's meant to be intentionally vague- it depends on the resident's condition. I don't think these things should be care planned specifically. I do think the air loss mattress should be an order because it needs to have a paper trail- it has to be specialty ordered. In terms of floating heels- it shouldn't be ordered specifically (pillow, vs wedge vs boots). We should be ordering floating heels, but not necessarily HOW. Things should be care planned specific to each wound. Record Review of the facility's policy procedure indicated: Pressure Injury Prevention and Management Date Implemented: 08/15/22 Policy: This facility is committed to the prevention of avoidable pressure injuries and the promotion of healing of existing pressure injuries. Definitions: Pressure Ulcer/lnjury refers to localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. Policy Explanation and Compliance Guidelines: .2.The facility shall establish and utilize a systematic approach for pressure injury prevention and management, including prompt assessment and treatment; intervening to stabilize, reduce or remove underlying risk factors; monitoring the impact of the interventions; and modifying the interventions as appropriate. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 26 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0686 3.Assessment of Pressure Injury Risk Level of Harm - Minimal harm or potential for actual harm a.Licensed nurses will conduct a pressure injury risk assessment, on all residents upon admission/readmission, or whenever the resident's condition changes significantly. Residents Affected - Some b.The tool will be used in conjunction with other risk factors not captured by the risk assessment tool. Examples of risk factors include, but are not limited to: 4.Interventions for Prevention and to Promote Healing a.After completing a thorough assessment/evaluation, the interdisciplinary team shall develop a relevant care plan that includes measurable goals for prevention and management ofpressure injuries with appropriate interventions. b.Interventions will be based on specific factors identified in the risk assessment, skin assessment, and any pressure injury assessment (e.g., moisture management, impaired mobility, nutritional deficit, staging, wound characteristics). c.Evidence-based interventions for prevention will be implemented for all residents who are assessed at risk or who have a pressure injury present. Basic or routine care interventions could include, but are not limited to: i. Redistribute pressure (such as repositioning, protecting and/or offloading heels, etc.); ii. Minimize exposure to moisture and keep skin clean, especially of fecal contamination; iii. Provide appropriate, pressure-redistributing, support surfaces; iv. Maintain or improve nutrition and hydration status, where feasible. ii.Treatment decisions will be based on the characteristics of the wound, including the stage, size, amount of exudate, and presence of pain, infection, or non-viable tissue. f.Interventions will be documented in the care plan and communicated to all relevant staff. g.Compliance with interventions will be documented in the weekly summary charting. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 27 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation interview and record review, the facility failed nesure the residents environment as free of accidents and hazards as is as possible in that: Residents Affected - Some 1.) Water in the resident bathroom's were not functioning and maintained in 2 of 19 resident (Resident #5, Resident #31 and Resident #96) rooms sampled on Hall A of the facility. 2.) The facility failed to ensure bathroom sinks in occupied resident rooms for Resident's #37, 56, 27, 87, and 38 hot water temperatures were below 110 degrees Fahrenheit. This failure could affect residents by placing them at risk for diminished quality of life due to the lack of a well-kept environment and no water in Resident #5, Resident #31, and Resident #96's bathroom. Water temperatures over 110 degrees Fahrenheit put residents at risk of being in an unsafe environment and at risk for burn injuries. Findings included: Observation on 02/06/24 at 9:50 AM revealed 2 out of 19 rooms on Hall A had no working water in the sink of their bathrooms for Resident #5, Resident #31, and Resident 96). In an interview on 02/06/24 at 09:58 AM Resident # 96 stated, he was unaware the water in his bathroom was not working as he did not use the bathroom in his room and did not know how long the water had been out. In an interview on 02/06/24 at 10:49 AM the Maintenance Director stated the reason the two rooms on Hall A for Resident #5, Resident #31, and Resident #96 had no water was because a part for the sink was on back order and the water had to be shut off to the sink. The Maintenance Director stated the water had been shut off to the two rooms for a few days and the part had been ordered and was going to be fixed as soon as possible. In an interview on 02/07/24 at 09:48 AM the Administrator stated he was not aware there was no running water in two of Resident #5, Resident #31, and Resident #96 bathrooms on Hall A but the plumbing company had been notified after speaking with the Maintenance Director and it was getting fixed immediately. Record review on 02/08/24 at 09:56 AM of waterlog book dated 2/2/24 reflected rooms A8 and A10 for Resident #5, Resident #31, and Resident #96 were not working. In an interview on 02/08/24 at 10:27 AM the Administrator stated there was no policy for physical environment and the facility was currently working on getting a policy on physical environment. Observation on 02/08/2024 at 1:44 PM revealed running water had been restored to rooms A8 and A10 for Resident #5, Resident #31, and Resident #96 and was in working order. Resident roster reflected 17 residents lived on Hall A. 2.) Observation during environmental rounds on 02/05/24 beginning at approximately 2:45 PM revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 28 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 - Minimal harm or potential for actual harm rooms for Resident #37, 56, 27, 87, and 38's bathroom sink hot water felt hot to the touch, non-bearable, turning this state surveyor's hand red, and visualized steam rising from the hot water pouring out of the faucets. The residents in each identified room were observed to be bedridden and immobile. Continued observation revealed no resident was seen wandering or entering any of the five rooms identified with excessive hot water temperatures. Residents Affected - Some Observation and interview during environmental rounds with the MD on 02/06/24 beginning at 3:18 PM revealed the MD checked the following resident bathroom sink water temperatures with his digital thermometer: Resident #37 - 118 degrees Fahrenheit Resident #37 - 113 degrees Fahrenheit Resident #37 - 117.3 degrees Fahrenheit Resident #37 - 117 degrees Fahrenheit Resident #37 - 118.2 degrees Fahrenheit The MD stated the water temperatures should not exceed 110 degrees Fahrenheit, The water should be between 100-110 degrees Fahrenheit to prevent any burn injuries. The MD stated he and the ES shared the duty of daily random hot water temperature checks throughout the building. The MD said he last checked hot water temperatures a couple of days ago and none were over 110 degrees Fahrenheit. The MD said the routine for checking water temperatures was to check random rooms daily in each hall then document that in the temperature log. Interview with the ES on 02/07/24 at 8:48 AM revealed she stated she was solely responsible for checking the water temperatures during the time the facility did not have a maintenance director which was over a month ago. The ES clarified that as of a month ago, she was no longer responsible for checking the temperatures. The ES said she was checking random rooms daily, checking a couple of rooms in each hall. The ES said none of her checked temperatures exceeded 110 degrees Fahrenheit. The ES said the water temperatures should be between 100-110 degrees Fahrenheit. The ES said any temperature over 110 degrees Fahrenheit place residents at risk of a burn injury. Subsequent interview with the MD on 02/07/24 at 3:32 PM revealed he explained that the mixing valve was currently being repaired by a plumbing company. The MD said the mixing valve was not functioning properly therefore, it was not sustaining at the temperature it was set at which was 102 degrees Fahrenheit. The MD said he did not know when the mixing valve stopped working correctly. Interview with the Administrator on 02/08/24 at 11:00 AM revealed he said the MD was responsible for checking the water temperatures throughout the facility. The Administrator stated the MD was to check random rooms daily on each hall to check for maintenance of water temperatures and ensure they were below 110 degrees Fahrenheit. The Administrator said any temperature over 110 degrees Fahrenheit place anyone at risk for burn injuries. The Administrator said he reviewed the temperature logs randomly and weekly to ensure compliance. Record review of the facility's Water Temperature Log from dates 01/01/24-02/05/24 indicated there were 13-15 random room checks in each hall conducted daily which ranged from 101-108 degrees (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 29 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 Fahrenheit. No temperatures were greater than 110 degrees Fahrenheit. Level of Harm - Minimal harm or potential for actual harm Record review of the facility's undated Water Temperature Daily Monitoring Procedure indicated Ensure patient room water temperatures are between 100-110 degrees Fahrenheit (or as specified by state requirements) .California and Texas - 100-110 degrees Fahrenheit. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 30 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrated that this was not possible, or resident preferences indicate otherwise for three of eight residents (Resident #23, Resident #38 and Resident #76) reviewed for nutrition. Residents Affected - Some 1.) The facility failed to ensure Resident #23 did not sustain a significant weight loss of 13.64% in less than three months. 2.) The facility failed to ensure Resident #38 did not sustain a significant weight loss of 11.2 pound/5.59% weight loss in one month and an overall 22.4 pound/10.59% weight loss over six months. Staff did not follow up on an RD (Registered Dietician) recommendation to increase Resident #38's tube feeding solution order from 45 mL/hr to 60 mL/hr x 18 hours on 01/19/24 until 02/07/24, for a total of 14 days. 3.) The facility failed to ensure Resident #76 did not sustain a significant weight loss of 5.40 % in less than one month. An IJ was identified on 02/08/24. The IJ template was provided to the facility on [DATE] at 6:15 pm. While the IJ was removed on 02/10/24 at 6:15 pm, the facility remained out of compliance at a scope of a pattern and severity of no actual harm with potential for more than minimal harm that is not is not immediate jeopardy because of the facility's need to monitor and evaluate the effectiveness of the corrective systems. This failure placed residents at risk of unplanned weight loss and malnutrition. Findings include: 1.) Resident #23 Record review of Resident #23's admission record dated 02/07/24 reflected Resident #23 was an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #23' diagnoses included parkinsonism (clinical syndrome that is characterized by tremor, slowed movements, rigidity), dysphagia (difficulty in swallowing), disorder of kidney and ureter (blockage in one of the tubes), psychotic disturbance, mood disturbance (characterized by delusions, hallucinations, disorganized thoughts) and anxiety (normal response to stress). Record review of the quarterly MDS dated [DATE] reflected Resident #23. -had severe cognitive impairment, - had weight loss of 5% or more in the last month or loss of 10% or more in the last 6 months. -required supervision/maximal assistance with eating (the ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 31 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #23's care plans dated 10/24/23 reflected Resident #23 had a nutritional problem or potential nutritional problem due to risk for malnutrition. Currently on regular fortified food with breakfast and lunch, revised on 10/24/23. Interventions initiated on 02/24/23 included: -administer medications as ordered. Monitor/document for side effects and effectiveness. -administer vitamins as ordered. -monitor, record/report to MD, PRN, s/sx of malnutrition: Emaciation (Cachexia), muscle wasting, significant weight loss; 3 lbs. in 1 week, more than 5% in 1 month, more than 7.5% in 3 months, more than 19% in 6 months. -provide, serve diets as ordered. Monitor intake and record q meal. -RD to evaluate and make diet change recommendations PRN. Record review of Resident #23's weight logs reflected the following. 10/09/23 149.5 lbs. 11/09/23 140.0 lbs. 12/07/23 133.5 lbs. 01/18/24 126.0 lbs. 02/06/24 120.9 lbs. Record review of meal intakes for Resident #23 reflected Resident #23 ate four of 0 -25% of meals provided, nine of 26- 50% of meals provided, twelve of 51-75% of meals provided and seven of 76-100% of meals provided between 01/25/24 and 02/06/24. Record review of the Dietitian Consultant's recommendation dated 01/22/24 for Resident #23 reflected Resident #23 had a weight loss of 10% in three months with current weight of 126 lbs from date of last weight on 01/19/24. Current diet included regular diet, multivitamin daily, vitamin C, house supplement 2.0 90 ml TID. The recommendation was faxed to facility on 01/22/24. The recommendation document indicated a space for MD signature and was left blank. The recommendation was not signed by a Dietitian Consultant. Record review of the nutrition progress notes by Dietitian Consultant dated 12/20/23 for Resident #23 reflected resident with significant weight loss for 90 days and 180 days. Current body weight was 133.5 pounds. Ordered diet provides adequate kcal/protein. 15.2% weight loss for 90 days and 17.3% loss for 180 days notes. Weight loss has continued for 30 days but rate of loss has slowed and is non-significant at this time signifying intake may currently by adequate. Record review of the nutrition progress notes dated 01/19/24 for Resident #23 by the Dietitian Consultant reflected the follow up for weight loss. Weight loss continues for 30 days, current weight is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 32 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 126 lbs. Per administration record resident is accepting 2.0 supplement as ordered. Intake likely inadequate aeb 5.6% weight loss for 30 days. Ordered diet, regular, regular texture, regular liquids consistency (fortified foods w/breakfast and lunch meals. Ordered supplement: House 2.0 (90ml tid). Recommends increase 2.0 supplement to 120ml tid for added nutritional provision, weekly weights for 30 days to monitor trend, continue diet as ordered. Record review of the progress notes dated 01/23/24 by nursing staff revealed patient with 10% weight loss in 5 months, current weight was 126 pounds, patient eats meals in room or at times attends dining room. Ordered supplement: House 2.0 (90ml tid). Response; RD review 01/19/24 pending response from pcp. Record review of progress notes dated 02/06/24 for Resident #23 by Dietary Manager reflected RD f/u for weight loss. Weight loss continues for 30 days. (4%, not significant but undesirable.) Significant weight loss x 90 days (13.6%). Record review of Resident #23's physician's orders dated 02/07/24 reflected orders: -house shakes three times a day for supplement between meals for 30 days, start date 02/07/24. -House supplement 2.0 three times a day for supplement give 120ml between meals, start date 02/06/24. -weight weekly for four weeks every Tuesday, start date 02/13/24. Observation on 02/04/24 at 6:01 pm revealed Resident #23 sitting up in his bed in his room. CNA K prepared Resident #23 meal so he could eat on his own. CNA K asked Resident #23 if he wanted to eat on his own and he voiced he did. CNA K told Resident #23 someone else would come in and him eat. Observation on 02/05/24 at 12:48 pm revealed Resident #23 in his room lying down. CNA K asked Resident #23 if he wanted to eat and resident replied he did. CNA K said he did want assistance to sit up in his chair. Resident #23 sat up in his bed and said he wanted to eat on his own. Resident #23 grabbed his coffee cup and a fork and started picking at his food. AT 12:55 pm Resident #23 was observed lying in his bed, with coffee cup in hand and his meal tray on his bed. The meal contained approximately 50% of his food. Resident #23 said he did not want to eat anymore. Interview on 02/06/24 at 11:35 am with CNA L revealed Resident #23 sometimes appeared to be too weak to grab his utensils or cup and she would assist Resident #23 to eat his meals. CNA L said she had reported to the charge nurses Resident #23 sometimes needed assistance to eat his meals. Observation of Resident #23 on 02/06/24 at revealed resident was lying in bed and a snack of cookies and a glass of water was his bedside table. Resident #23 appeared confused and did not answer surveyor. Interview on 02/06/24 at 11:52 am with ADON M revealed the Dietitian made a recommendation on or about 01/19/24 for a nutritional supplement of 120 ml, add nutritional provision and weekly weights for 30 days. ADON M said she knew staff had called Resident #23's physician to get the orders for the Dietitian's recommendation. ADON M said Resident #23's physician would not return the calls made to his office and staff had to follow up and get the orders. ADON M said she did not know who had made the follow up calls to Resident #23's physician about the orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 33 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Interview on 02/06/24 at 2:56 pm the DON and ADON M revealed ADON M said staff called Resident #23's physician to approve the recommended orders as it was noted in the progress notes on 01/23/24. ADON M said no one followed up with Resident #23's physician and the recommendations were never received as orders and were not carried out. ADON M said she had called Resident #23's physician earlier and had received the orders for the recommendations made by the Dietitian. Resident #23's physician had also ordered lab work. The DON said the nurses and the ADONs were responsible to follow up with physicians for orders. ADON M said Resident #23's ideal body weight was 157 pounds. The DON said staff failed to get the orders from physician for added nutrition, supplements and to weigh Resident #23 weekly for 30 days. Resident #23 also lost a total of 28.6 pounds in the last three months. This failure resulted in not providing Resident #23 the added nutrition beginning 01/19/24 and to miss weighing him on 01/23/24 and 01/30/24 as recommended by the Dietitian. The DON said staff did not notify his physician to address Resident #23's significant weight loss with his physician as needed. Interview on 02/07/24 at 1:27 pm with Dietitian Consultant revealed she had only been the Dietitian for the facility less than a month. The previous Dietitian Consultant had made the recommendations for Resident #23 on 01/19/24. The Dietitian Consultant said her coworker who made the recommendations on 01/19/24 had not been acted on. Resident #23 had lost 6 pounds since the recommendation had been made to 02/06/24 and had lost 28.6 pounds over the last three months. The Dietitian said she had not reviewed Resident #23's clinical chart on this visit to the facility. The Dietitian said this failure to obtain orders for the recommendations caused the resident to lose unnecessary weight due to the recommendations were not acted on. This was a negative effect on the resident when the current weight loss of 6.8 pounds could have been identified and addressed as they occurred. The Dietitian said Resident #23's weight loss had not been addressed by the facility as needed. Interview on 02/07/24 at 1:33 pm with COTA P revealed she did assessments for Resident #23, and she had currently noticed a change in Resident #23's eating, he was jumpy and sometimes agitated. COTA P said she had reported her assessments to RN O, to the Administrator and ADON M when the DON had been absent from the facility on 02/01/24. Record review of the COTA P's Occupation Therapy Treatment Encounter Notes dated 02/01/24 for Resident#23 reflected patients significant decline was reported to RN O and to Administrator, patient demonstrates significant confusion inability to follow instructions, required max assist from therapist to transfer/feed and complete hygiene/grooming. Patient also appears to be combative at times. Interview on 02/07/24 at 2:15 pm with LVN N revealed she told her staff to assist Resident #23 to eat if he was unable or did not want to eat. LVN N said she was not aware of the Dietitian's recommendations. Interview on 02/07/24 at 4:50 pm with RN O revealed she was not aware of the Dietitian's recommendations. RN O said she told staff to assist Resident #23 to eat if he was not able. 2.) Resident #38 Record Review of Resident #38's undated face indicated a [AGE] year-old male admitted on [DATE], readmitted [DATE] with diagnoses of multiple sclerosis (disease that causes nerve damage in the brain, spinal cord, and optic nerves that can result in numerous symptoms including numbness, mood changes, fatigue, pain, blindness, and/or paralysis), muscle wasting, dysarthria and anarthria (cannot (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 34 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some control the muscles used for speaking), aphonia (loss of voice), gastrostomy (surgical hole in the stomach from the abdomen in which a tube is inserted to feed someone), and tracheostomy (surgical hole in the windpipe from the outside of the throat that provides an alternative airway). Record review of Resident #38's quarterly MDS dated [DATE] revealed a blank BIMS score indicating the resident is rarely/never understood and a SAMS score of 3 indicating that Resident #38 had severe cognitive impairment and required total assistance, or the physical assistance of 2 or more people for oral/ toileting/ personal hygiene, shower/bathe self, upper and lower body dressing, and bed mobility. Resident #38 was coded for weight loss of 5% or more in the last month or 10% or more in the last 6 months, weight loss not on physician prescribed weight loss regimen. Record review of Resident #38's weight record revealed he had an 11.2 pound (5.59%) severe weight loss in one month (12/16/23 to 01/18/24) and an overall 22.4 pound (10.59%) severe weight loss over a six-month period (07/18/23 to 01/18/24). 1/18/2024 16:52 189.1 Lbs 12/16/2023 22:08 200.3 Lbs 11/9/2023 17:58 200.6 Lbs 10/9/2023 16:21 203.5 Lbs 9/12/2023 08:03 207.5 Lbs 8/9/2023 15:11 207.1 Lbs 7/18/2023 16:17 211.5 Lbs Record review of RD note dated 01/19/24 read, RD follow up for tube feed and weight loss. Weight loss continues x30 days. NPO. Current body weight 189.1 lbs. Current BMI 26.4. Ordered tube feed and flushes do not satisfy estimated kcal/protein/fluid needs but needs may be overestimated aeb BMI class overweight. Tube feed likely adequate in protein but inadequate in energy aeb 5.6% weight loss x30 days. Note, weight has been consistently trending down over the last 6 months. Estimated needs: 2442-2543 kcal, 86-103 grams protein, 2579 mL fluid. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 35 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Ordered tube feed TwoCal HN at 45mL/hr x18 hours; 200mL water flush every 8 hours provides: 1623 kcal, 68 grams protein, 1167 mL of fluid. Recommendation: Increase TwoCal HN to 60mL/hr x18 hours with 200mL water flushes every 4 hours, which will provide 2165 kcal, 91 grams protein, 1956 mL fluid; weekly weights for 30 days to monitor trend. Goals: adequate nutrition/ hydration via tube feed, tube feed tolerance, CBW +/- 5% for 30 days. RD to continue to monitor. Record review of Resident #38's February 2024 physician orders revealed an order dated 01/18/24 for enteral feeding, TwoCal HN at 45mL/hr via G tube stationary pump. Down time 07:00 AM to 01:00 PM and an order dated 12/14/23 Every shift flush tube with 200mL of water every 8 hours. Resident #38's February 2024 Physician's orders revealed no acknowledgement of the RD's recommendations, nor any new physician orders for increased tube feed amount. Record review on 02/07/24 at 01:27 PM revealed Nurse's notes documented 01/22/24 by LVN M/ADON that read, Resident has had a 5% weight loss in 1 month with current weight at 189.1 lbs. Previous weight 200.3 lbs. Date of last weight: 1/19/24. Resident has had a 10% weight loss in 5 months with a current weight 189.1 lbs. Previous weight 200.3 lbs. Date of last weight: 1/19/24. Current formula/supplement: HN2Cal at 45mL/hr. via g tube. Any new orders Yes/ No (neither checked) Orders: Dietary Recommendation: increase HN2Cal to 60cc/hr x 18 hrs with 200mL flushes Q4hrs (every 4 hours). There is no MD signature. The notation in the bottom right corner of the page indicated it was faxed on 01/22/24 and initialed by the nurse. Observation on 02/04/24 at 05:06 PM revealed Resident #38 was receiving TwoCalHN tube feed through his PEG tube at 45mL/hr via feeding tube pump. Observation on 02/06/24 at 03:00 PM revealed Resident #38 was receiving TwoCalHN tube feed through his PEG tube at 45mL/hr via feeding tube pump. In an interview on 2/07/24 at 02:21 PM with LVN M/ ADON B and DON, LVN M/ADON B stated in reference to the dietician recommendations dated 1/22/24 regarding Resident #38's weight loss, I am the one that put the note in. If it's not documented, I did not follow up on it. I will follow up today. Normally, I call the doctor or the nurse, usually the nurse, and inform that the resident was reviewed by the dietician, this is the situation, etc . then I send the communication with the current information and the recommendations. When asked about his responsibility as the DON and how he ensures that significant issues were followed up on, the DON responded, Lag time is an issue. Let me work with my medical director. There's a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 36 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some lot going on, but we need to be more diligent on documenting and making sure that things are followed up. We are revamping our morning meetings where we can document what things are still needing to be done. We're putting things in place to get better about following up. Prior to this, weight loss was one of the things reviewed in morning meetings, (intermittently) but we're looking at it once a week or every other week. Our greatest challenge is working to get the physician to respond. In an interview on 02/07/24 at 03:30 PM with RD-S she stated that she has only been working with this facility for about a month and that she comes into this facility 2 times a month. When asked to look at Resident #38's dietary recommendations dated 01/19/24, she stated that the only change she would make was to add weekly weights for a month to monitor the resident's status. To verify that the recommendations were put into place, she stated that she would look at the weekly weights. If they weren't documented, she would get with the ADON or DON and have the resident weighed while she was in the facility. Regarding the tube feedings, she would investigate the physician's orders to see if there were revisions. If there were no revisions, she would go to the RN to find out why the recommendations weren't being followed. RD-S stated she would find out if the resident did not tolerate the increase- was the resident having nausea, vomiting, or diarrhea, or some other sign or symptom indicating intolerance? RD S stated, if there was no sign of intolerance, or the recommendations just weren't followed, it could lead to malnutrition, significant weight loss, or skin break down. In a phone interview on 02/08/24 at 05:21 PM with MD X, when asked if he was aware of Resident #38's RD recommendations that were faxed to him, he stated that he did not have anything to sign right now and that he usually signs things on the weekends. He also stated he did not have anything pending. He stated that he usually physically rounds on his residents every 3 months, however his nurse practitioner went to the facility the last time which was 01/09/24. When asked specifically about Resident #38's weight loss, he stated, yes, he loses weight, then gains weight. When advised of Resident #38's amount of weight loss in 1 month and in 6 months he replied, that's too much. That's a concern. He stated that the facility had not called or sent him anything. He stated, I would expect them to text, call, or bring me the paperwork and I sign the paperwork. He stated he did not know the name of the person who takes him the paperwork, but it was usually left on his desk. 3.) Resident #76 Record review of the admission Record for Resident #76 dated 02/06/24 reflected Resident #76 was re-admitted to the facility on [DATE]. Resident #76 was a [AGE] year-old male with diagnoses that included Alzheimer's disease (brain disorder that causes memory loss), diabetes (high blood sugar levels), anorexia (life threatening eating disorder), and dysphagia (difficulty in swallowing). Record review of Resident #76's quarterly MDS dated [DATE] reflected. -cognitive status was severely impaired. -required substantial/maximal assistance with eating. -had weight loss of 5% or more in the last month or loss of 10% or more in last 6 months. Record review of the care plan for Resident #76 reflected Resident #76 had a nutritional problem or potential nutritional problem related anorexia diagnosis. Interventions included. -administer medications as ordered. Monitor/Document for side effects and effectiveness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 37 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some -monitor/record/report to MD PRN s/sx of malnutrition, emaciation (cachexia), muscle wasting, significant weight loss; 3 lbs. in one week, more than 5% in one month, more than 7.5% in three months, and more than 10% in six months. -RD to evaluate and make diet change recommendations PRN. Record review of Resident #76's physician orders dated 02/06/24 reflected an order for weekly weights for four weeks one time a day every Tuesday for weight loss, start date, 01/23/24. Record review of Resident #76's weight charts reflected Resident # 76 weight on 01/18/24 was 153.7 pounds and on 02/06/24 his weight was 145.4 pounds. The total weight loss was 8 pounds from 01/18/24 to 02/06/24. Observation on 02/05/24 at 1:05 pm revealed Resident #76 in his bed. Resident #76 was assisted by CNA Q. Interview on 02/05/24 at 1:30 pm with ADON M revealed Resident #76's weights had not been taken on 01/23/24 and 01/30/24 on Tuesdays as ordered by his physician. ADON M said they had overlook weighting the resident on 01/23/24 and 01/30/24. The negative outcome of not following physician orders resulted in an unwanted weight loss. Interview on 02/06/24 at 9:44 am with RN O revealed she had overlooked the physician's order to weight Resident #76 every Tuesday beginning on 01/23/24. On 02/06/24 at 11:35 am CNA L said she assisted Resident #76 to eat his meals and documented his meal intake and reported to nurse if Resident #76 ate less than 25% of his meal. Interview on 02/06/24 at 3:02 pm with ADON M and the DON revealed the orders to weight Resident #76 had not been carried as per physician orders to weigh Resident #76 weekly beginning on 01/23/24. Resident #76 had been weighed as of this date and was found to have lost eight pounds from 01/18/24 to present. The DON said staff failed to follow physician orders for Resident #76. The adverse effects for both Resident #23 and Resident #76 placed residents at risk for malnutrition, continued weight loss and deterioration in overall health for both residents. Interview on 02/07/24 at 11:26 am with Dietitian Consultant revealed Resident #76's ideal body weight was 142 pounds. Observation on 02/08/24 at 8:06 am revealed Resident #76 was assisted with his meal by ADON A. Record review of the facility policy titled Weight Management System undated reflected. Residents are weighed at admission, readmission, and per physician orders. Weekly weights may be completed for an additional three weeks (or longer if not stable) on the following. admit, readmit. Weekly weights may also be performed for weight change of 5% or more in one month or less, 7.5% in 3 months or 10% in 6 months or per physician's orders. This was determined to be an Immediate Jeopardy (IJ) on 02/08/24. The Administrator was notified. The Administrator was provided with IJ template on 02/08/24 at 6:00 pm. The following Plan of Removal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 38 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 submitted by the facility was accepted on 02/10/24 at 6:37 pm. Level of Harm - Immediate jeopardy to resident health or safety The facility's Plan of Removal included: Residents Affected - Some On February 8, 2024, the facility was notified by the surveyor, that an immediate jeopardy had been called and the facility needed to submit a letter of credible allegation. The Facility respectfully submits this Letter for Plan of Removal pursuant to Federal and State regulatory requirements. Submission of the Letter of Credible Allegation does not constitute an admission or agreement of the facts alleged or the conclusions set forth in the verbal and written notice of immediate jeopardy and/or any subsequent Statement of Deficiencies. The alleged immediate jeopardy allegations are as follows: Issue:

F692 - Nutrition/Hydration Status Maintenance Resident #23, the RD assessed, and new orders were obtained from the physician on 2/6/24. Resident #38, New orders were obtained from the physician based on dietary recommendations on 2/7/24. Resident # 76, RD assessed, and new orders were obtained on 2/6/24 by the Licensed Nurse. The care plan was reviewed and updated based on the new orders. On 2/7/24, the Director of Nursing/ designee reviewed the last 30 days of RD recommendations to ensure they were communicated to the physician and acted upon. On 2/7/24, the Attending MD and resident representative were notified of residents who were identified with significant weight loss or changes and the interventions put in place. On 2/7/24, the Attending MD was notified by licensed nurse of current nutritional recommendations and implemented orders as written. On 2/8/24, All direct care staff will be re-educated by the Administrator /designee on the following topics: oAbuse and Neglect oWeight Monitoring On 2/8/24, Licensed Nurses will be re-educated by the DON/Designee on the following topics: oNotification of Changes oTimely follow up and notification to MD of nutritional recommendations and implement orders as written and plan of care updated. Completion date of re-education of all staff will be 2/8/24, in person or via telephone. Those that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 39 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some are PRN, Agency and/ or out on FMLA/ LOA will have the education completed prior to accepting assignment for their next scheduled shift. Any staff member not re-educated in person or via phone today (2/8/24), will be removed from the schedule until re-education is provided. Verification of 100% of staff re-education will be verified by the Administrator/ Designee. Director of Nursing/designee will review during the morning clinical meeting that the nutritional assessment is completed. The Attending MD and resident representative will be notified of nutritional/hydration risk identified. MD orders will be implemented as written to include but not limited to dietary recommendations based on referral and evaluations. Plan of care will be reviewed and updated as needed based on assessment and orders. The Administrator will attend the morning meeting to ensure that the DON / Clinical Interdisciplinary Team review significant weight changes and RD recommendations timely. An Ad Hoc QAPI meeting was conducted on 2/8/24 attended by the Administrator, DON, Medical Director and Regional Clinical Specialist to discuss the immediate jeopardy concerning nutrition hydration maintenance and develop the above Action Plan. We respectfully submit this action plan for removal of immediate Jeopardy. Verification of the facility's Plan of Removal: Reviewed the facility conducted 100% review of all residents 11 identified with weight loss. Record review of Resident #2's care plan, care plan revised on 02/09/2024, and updated accordingly - no concerns noted. Record review of Resident #6 was audited for weight loss. Upon record review, facility implemented order of adding house shakes three times a day, as well as weekly weights for 4 weeks. Care Plan updated and no observable concerns. Record review of Resident #23's care plan, and orders were updated and revised on 02/08/2024 to include weekly weight for 4 weeks, and house shakes three times a day. No concerns noted. Record review of Resident #38's care plan, and orders, which were both updated and implemented on 2/08/2024. No concerns noted. Record review of Resident #76's care plan, and orders, which were both updated and implemented on 02/07/2024 - no concerns noted. During an observation on 02/10/2024 at 12:15PM Observed Resident #3 being assisted to eat by CNA J no noted concerns. During an observation on 02/10/2024 at 5:39PM Observed ADON assisting Resident #23 eat his food. On the tray is soft mechanical food of chicken with gray, mash potatoes, and bread pudding. No observable concerns During an observation and interview on 02/10/2024 at 3:55PM Resident#38, observed Resident#38 in bed in lowest position, had HN 2cal tube feeding running at 60mL/HR with 200 Q4 free water flush. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 40 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0692 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Observed no signs and symptoms of distress, when asked if he had any concerns, he motioned his head in a left/right motion, indicated no. During an interview on 02/10/2024@12:37PM, RN A was asked to assist with working on the floor. RN A stated prior to entering the facility, she attended an in-service on 02/09/2024 regarding steps to take if she witnessed a resident looking frail, which would be to fill out a stop and watch form noting the concern with weight and stature, followed by notifying the ADONs, DON, and Physician. RN A stated for she was also in-serviced during the same meeting about change in condition and was told to also fill out a stop and watch form, notating the change in condition followed by notifying the ADONs, DON, and physician. RN A stated if she were not able to initially get ahold of the Physician, she was instructed to then, secondly, contact the Medical Director. RN A stated she was also in-serviced to monitor the residents' weights weekly, for those that pose a weight loss concern, and that the CNAs will document the weights, and if the CNAs notice a concern, the CNAs will notify the nurse, and the nurses will follow up. During an interview on 02/10/2024 at 1:12PM, LVN A stated he was a travel nurse. LVN A stated he was in-serviced about weight loss, and the actions to take would be to notify ADON/DON, and Doctor's. LVN A stated he monitors meal intakes and if resident was not eating enough he would notify ADON/DON and physician, as well as advocate for nutritional supplementation. LVN A stated he monitors weekly weights, and that monitoring weekly weights give him a better idea on how residents were responding to the nutrition. During an interview on 02/10/2024 at 1:27PM RN B stated she was in-serviced a about 2 days ago about monitoring diet intake, weights, abuse (how to report it), how to de-escalate patient issue by removal and when needed, to separate and notify Administrator of the suspicion of abuse. RN B stated for diet, CNAs will document food intake and weights weekly, and that CNAs will give meal percentage slips to the nurses, who will then look at them to see how much the residents are eating. During an interview on 02/10/2024 at 1:30PM CNA A stated she was in-serviced 2 days ago about weight loss and change in conditions. CNA A stated she was educated to notify nurse of the concern of either weight loss or change in condition, while also filling out the stop and watch form and giving it to the nurses. CNA A stated then the nurses were to give a copy of the form to the ADONs/DON. CNA A stated the form is for change in condition concern. CNA A stated Will do monthly unless ordered weekly weights. CNA A stated she was instructed to fill out the meal percentage form for each resident and give the form to the nurses. During an interview on 02/10/2024 at1:47PM CNA B: stated she was in-serviced a couple of days ago about food meal percentage forms, negligence, and meals. CNA B: stated if a resident doesn't want to eat, give options, and if they still don't want the options, she will let the nurses and ADON/DON know. CNA B: stated she will fill out meal percentage paper and turn in the ticket to the nurses. CNA B: stated if they see anything out of [TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 41 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the residents requiring respiratory care were provided such care consistent with professional standards of practice for 2 of 2 (Resident #56 and Resident #102) residents who were reviewed for respiratory care. Residents Affected - Some 1)The facility failed to ensure that Resident #56 and Resident #102's nasal cannula tubing were dated. 2)The facility failed to ensure that the tubing connecting the humidifier bottle to the oxygen concentrator machine for Resident #56 was dated. 3)The facility failed to ensure that Resident #102's nebulizer tubing was dated. 4)The facility failed to ensure that Resident #56 was receiving oxygen as per the physician's order. These failures could place the residents who receive oxygen care at risk for developing respiratory complications or infections and a decreased quality of care. Findings included: Record review of Resident #56's face sheet dated 02/06/24 indicated a [AGE] year-old male admitted on [DATE], readmitted on [DATE] with a diagnoses of unspecified dementia, mild cognitive impairment, chronic obstructive pulmonary disease (chronic lung disease that makes it hard to breathe) with acute (emergent) exacerbation (worsening). Record review of Resident #56's quarterly MDS dated [DATE] revealed he had a BIMS score of 07, indicating severe cognitive impairment. Resident #56 required maximal (the physical assistance of 2 people) to total assistance (the physical assistance of 2 or more people) with oral, toileting, and personal hygiene, bed mobility, dressing, and showering/bathing. Resident #56 was coded as received oxygen therpy as a resident. Record review of Resident #56's care plan dated 11/07/23 revealed the resident had (Problem) Emphysema/COPD (Chronic obstructive pulmonary disease- lung disease that makes it difficult to breathe), at risk for complications. Date Initiated: 11/07/2023 Revision on: 11/07/2023. (Goal) The resident will display optimal breathing patterns daily through review date. Date Initiated: 11/07/2023 Revision on: 11/07/2023 Target Date: 05/02/2024. Give PRN medications for anxiety as ordered. Date Initiated: 11/07/2023. Monitor/document/report PRN any s/sx of respiratory infection: Fever, Chills, increase in sputum (document the amount, color and consistency), chest pain, increased difficulty breathing, increased coughing and wheezing. Date Initiated: 11/07/2023. Oxygen as ordered. Date Initiated: 11/07/2023. Record review of Resident #56's physician orders for February 2024 revealed an order that stated Oxygen 4L via nasal cannula continuous every shift for SOB related to CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH (ACUTE-(emergent))EXACERBATION (worsening)(J44.1) AND as needed related to UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 42 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0695 DISTURBANCE, AND ANXIETY (F03.90) 1-5LPM PRN to Maintain oxygen saturation >88%. Level of Harm - Minimal harm or potential for actual harm Observation on 02/05/24 at 01:19 PM revealed Resident #56 was on humidified oxygen via nasal cannula at 6 liters per minute using the Invacare Platinum 10 oxygen concentrator. Humidification water bottle was dated 02/04/24, however the tubing connecting the humidifier to the oxygen concentrator and the nasal cannula tubing were not dated. Residents Affected - Some Observation of Resident #56 on 02/06/24 at 02:31 PM revealed that neither the nasal cannula tubing nor the tubing connecting the humidifier to the oxygen concentrator were dated. The oxygen flow rate was 6 liters per minute. In an interview with RN O, on 02/06/24 at 02:37 PM she stated she was the nurse caring for Resident #56. RN O stated Resident #56's physician order was for oxygen at 4 liters per nasal cannula. RN O stated Resident #56 had a habit of adjusting his oxygen concentrator settings himself. RN O said she did not recall the last time she checked Resident #56's concentrator for the correct setting. RN O said Resident #56 was not allowed to adjust his concentrator but still did it. RN O said she changed Resident #56's oxygen tubing yesterday but did not recall if she dated it because she may not always have a marker or tape with her. RN O stated it was important to check Resident #56's oxygen flow rate to make sure he did not get ARDS from too much oxygen. Resident #102: Record review of Resident #102's face sheet dated 02/06/24 indicated an [AGE] year-old female admitted on [DATE] with a diagnoses of acute respiratory failure, functional dyspnea (shortness of breath), pneumonia, influenza with specified pneumonia, and atrial fibrillation (irregular, sometimes fast heart beat). Record review of Resident #102's comprehensive care plan dated 11/21/23 reflected the care plan did not address oxygen therapy. Record review of Resident #102's quarterly MDS dated [DATE] revealed she had a BIMS score of 08 indicating moderate cognitive impairment. Resident #102 required extensive 1-to-2-person physical assist with bed mobility, transfer, dressing, toilet use, and personal hygiene. Oxygen therapy was not included in her quarterly MDS. Record review of Resident #102's February 2024 physician's orders revealed Oxygen 3LPM via nasal cannula every shift for SOB. Order date 01/06/24. Observation on 02/04/24 at 05:44 PM revealed Resident #102 received oxygen via NC at 3lpm utilizing a [NAME] 2 concentrator. The tape on the nasal cannula tubing was unreadable. Observation on 02/05/24 at10:26 AM revealed the tape on Resident #102's nasal cannula tubing had not been changed and was still unreadable. Observation of Resident #102's nasal cannula tubing on 02/06/24 at 10:01 AM revealed that the same unreadable tape was on the NC tubing. The nebulizer tubing was also not dated. Observation and interview with RN O on 02/06/24 at 10:09AM revealed she assessed Resident #102's oxygen and nebulizer tubing verifying that she could not read the date on the Nasal Cannula tubing and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 43 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that the nebulizer tubing did not have a date on it. She stated that the night nurse was responsible for changing the oxygen tubing on Monday nights every week, however all nurses were responsible for checking and correcting it if there were an issue. She stated that she had not noticed it. She stated that it should be changed and dated weekly to prevent any bacterial build up and/or infection to the resident. She stated she did not know the policy by memory. RN O said other than all nursing staff caring for Resident #102 being responsible for implementing her oxygen therapy as ordered, she did not know who else would be responsible for monitoring. Record review of the policy indicated: Oxygen Safety Date: 1/26/24 Policy: It is the policy of this facility to provide a safe environment for residents, staff, and the public. This policy addresses the use and storage of oxygen and oxygen equipment. Policy Explanation and Compliance Guidelines: .g.Any flammable gas, liquid, or vapor shall not be stored with oxygen cylinders. j.Precautionary signs readable from 5 feet shall be maintained on the door or gate where oxygen is used or stored. (Example: OXYGEN STORED WITHIN - NO SMOKING). The policy did not address following the physician's orders nor dating/changing nasal cannula, nebulizer tubing, or any tubing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 44 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to establish and maintain an infection prevention and control program, designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, for four of six Residents (Resident #38, Resident #100, Resident #102 and Resident #57) that were reviewed for infection control and transmission-based precautions policies and practices. Residents Affected - Some 1)RN O did not maintain one clean hand and one dirty hand while providing tracheostomy care for Resident #38. 2)Wound Care nurse did not pat dry wound while performing wound care for Resident #100 3)Wound Care nurse did not provide a barrier pad while performing wound care on Resident #102 4)The facility failed to maintain an infection and prevention control program that included, at a minimum, a system for preventing and controlling Legionella through a program that identifies areas in the water system where Legionella bacteria can grow and spread. 5)Resident #57's catheter and tubing were touching the floor. These failures could place residents at risk for infection through cross contamination of pathogens and infectious diseases. The findings included: 1)Record review of Resident #38's Face Sheet dated 02/08/2024, reflected a [AGE] year-old male with an admission date of 04/16/2013 and a re-admission date of 12/14/2023. Diagnoses included multiple sclerosis (chronic, typically progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord), acute respiratory syndrome (respiratory illness), bipolar disorder (disorder associated with episodes of moods swings ranging from depressive lows to manic highs), schizophrenia (disorder that affects a person's ability to think, feel, and behave clearly), chronic obstructive pulmonary disease (respiratory airflow limitation), hypertension (high blood pressure), and atrial fibrillation (irregular, often rapid heart rate that causes poor blood flow). Record review of Resident #38's physician orders stated: Order Summary: Dated 12/14/2023. Tracheotomy care - Cleanse with normal saline with 4X4 (medical guaze) around tracheostomy stoma, pat dry, apply T-drain sponge (medical drainage sponges/drain pads, that are absorbent pads for excess fluids) and secure with tracheostomy collar every shift. On 02/07/2024 at 2:54 PM during an observation of Resident #38's tracheostomy care, RN O, (ADON A observing) after cleansing Resident #38's tracheostomy stoma with normal saline, grabbed 4x4 gauze with both gloved hands (clean and dirty) and pat dry Resident #38's tracheostomy stoma with a 4x4 gauze. RN O then grabbed the T-drain sponge and applied to Resident #38's tracheostomy stoma with both gloved hands (clean and dirty). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 45 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 02/07/24 at 03:59 PM RN O stated she was very nervous and did not realize she used both gloved hands (clean and dirty) to grab Resident #38's supplies. RN O stated Resident #38 could get skin or respiratory infections induced by cross contamination of supplies. RN O stated she had hands on respiratory care training about a week ago. In an interview on /07/24 at 4:00 PM ADON A stated she saw RN O use both hands to grab Resident #38's supplies causing cross contamination. ADON A stated possible negative outcomes for Resident #38 could be to cause skin infections to the stoma site and could cause a respiratory infection. ADON A stated there was a respiratory consultant that provided hands on training about a week ago and RN O was a part of that training. In an interview on 02/07/24 at 4:58 PM the DON stated cross contamination of Resident #38's supplies could lead to respiratory and skin infections. The DON stated hands on education was conducted last week and would be conducted starting this week again for re-education. 2)Record review of Resident #100's face sheet dated 02/05/2024, reflected a [AGE] year-old male with an admission date of 02/09/2023. Diagnoses included Alzheimer's disease (progressive disease that destroys memory and other important mental functions), chronic obstructive pulmonary disease, unstageable (full thickness pressure injury in with the base is obscured by slough and/or eschar), pressure ulcer to left heel, and stage 2 (partial thickness loss of dermis) pressure ulcer to right buttock. Record review of Resident 100's physician orders stated: Order Summary: Dated 12/7/23. Wound Care: Stage 3: Left Heel: (Reclassified from Unstageable 10/6/2023): Cleanse with normal saline, pat dry, apply Silver Alginate Dressing, wrap in bandage roll, and secure with tape three times a week and PRN if soiled/loose dressing until resolved, one time a day every Monday, Wednesday, Friday, and as needed. On 02/05/2024 at 3:03 PM during an observation of Resident #100's wound care, the Wound Care nurse did not pat dry as stated in physician orders after cleansing Resident #100's stage 3 left heel pressure ulcer with normal saline. In an interview on 02/05/24 03:23 PM with the Wound Care nurse, she stated she was nervous and did not realize she did not pat dry Resident 100's wound after cleansing with normal saline. The Wound Care nurse stated the negative outcome for Resident #100 could be the wound could stay moist and cause potential growth of bacteria and Resident 100's wound could not heal and could become macerated (become softened by soaking in liquid). The Wound Care nurse stated she had been working at the facility for about 3 months and was an agency nurse. The Wound Care nurse stated while working at the facility, she had not had any training as she already had her wound care certificate with the agency she worked for. In an interview on 02/06/24 at 9:27 AM the DON stated Resident 100's wound could worsen as bacteria could grow and the wound could become macerated by not patting dry the affected area. The DON stated the Wound Care nurse had no training while working at the facility since she already had her wound care certification. The DON stated the Wound Care nurse was observed performing wound care and no concerns were identified at that time. The DON stated an in-service on Infection Control and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 46 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0880 Following Physician orders were already being conducted with staff. Level of Harm - Minimal harm or potential for actual harm 3)Record review of Resident #102's face sheet dated 02/08/2024 reflected an [AGE] year-old female with an admission date of 04/02/2023 and a re-admission date of 11/21/2023. Diagnoses included dementia (progressive or persistent loss of intellectual functioning, especially with memory impairment), acute respiratory failure, chronic pain due to trauma, hypertension (high blood pressure), and atrial fibrillation (irregular, often rapid heart rate that causes poor blood flow). Residents Affected - Some Record review of Resident #102's physician orders stated: Order Summary: Dated 1/11/2024. Wound Care: Stage 4: Sacrum: (Reclassified from stage 2 12/13/23): Cleanse with normal saline, pat dry, apply therahoney gel, calcium alginate, cover with dry super absorbent dressing daily and PRN until resolved, one time a day AND as needed daily. On 02/06/2024 at 1:48 PM during an observation of Resident 102's sacrum wound care, the Wound Care nurse rolled Resident #102 on to her left side. She partially removed Resident 102's brief, exposing the sacrum wound without applying a barrier pad between Resident 102's sacrum wound and brief to prevent Resident 102's wound from potentially coming in to contact with the brief. In an interview on 02/06/2024 at 2:03 PM the Wound Care nurse stated she forgot to place a barrier pad between Resident #102's wound and brief. The Wound Care nurse stated by not placing that barrier pad, Resident #102's open wound could have come in contact with Resident #102's brief or bed causing cross contamination and possibly led to Resident #102 getting an infection. In an interview on 02/06/2024 at 3:13 PM the DON stated Resident #102's sacrum wound could worsen by not having a barrier pad to prevent possible cross contamination to Resident #102's open wound. The DON stated infection control in-services had begun with staff and the Wound Care nurse for re-education. 4)During an interview with the Administrator on 02/06/2024 at 10:40 AM, he stated the facility did not currently have a Legionella policy and there was no current testing for Legionella in the facility. The Administrator stated they were working on coming up with a plan to start testing and getting a waterflow chart for the facility. Interview on 02/06/24 at 11:09 AM the DON stated the facility was not currently checking for Legionella. The DON stated the residents could possibly get sick if the water was contaminated and the facility could have an outbreak especially since the resident's immune system were weakened. The DON stated since the last survey, no residents had contracted Legionella to his knowledge and there had been a high turnover in maintenance staff and was unsure if the previous maintenance personnel was checking for Legionella. Interview on 02/08/24 at 09:40 AM the Maintenance Director stated he had been working at the facility for approximately three to four weeks and had not checked for Legionella since he started. The Maintenance Director stated there was no water flow chart that he knows of and there had been no Legionella testing or logbook of testing that he could find. 5) Record review of Resident #57's admission record dated 02/08/24, reflected Resident #57 was an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 47 of 48 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 455528 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo West Nursing and Rehabilitation Center 1200 Lane Laredo, TX 78043 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 0880 Level of Harm - Minimal harm or potential for actual harm [AGE] year old-male re-admitted to the facility on [DATE], with diagnoses which included, diabetes (a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel), major depressive disorder (mental state of low mood ), parkinsonism (clinical syndrome characterized by tremor, rigidity, and postural instability), bed confinement status, infection and inflammatory reaction due to indwelling urethral catheter and presence of urogenital implants (risk from using indwelling catheters). Residents Affected - Some Record review of Resident #57's annual assessment MDS dated , 12/21/23 reflected Resident #57 had severe cognitive impairment and was incontinent of bowel and bladder. Record review of Resident #57's physician orders dated 02/06/24 reflected an order for a Foley catheter, change 16Fr with 10ml bulb as needed for patency, dislodgement, and leaking, start date 01/23/24. An observation on 02/04/2024 at 3:40 pm revealed Resident #57 was in his bed. The observation revealed Resident #57's catheter drainage bag hanging on his bed rail, uncovered. The drainage bag was one fourth full of yellow urine and was facing the doorway. Observation on 02/06/24 at 1:52 pm revealed Resident #57 was in his bed, drainage bag clipped to his bed rail, uncovered, and touching the floor. The drainage bag tubing was lying on the floor, without any plastic sleeve on the tubing. Interview on 02/06/24 at 1:54 pm with CNA L revealed Resident #57's drainage bag should be clipped to his bed rail and not touching the floor. CNA L said the drainage bag and tubing should not be touching the floor because the bag could get contaminated. CNA L said it was the CNAs and charge nurse's responsibility to ensure the drainage bag and tubing was not on the floor. Interview on 02/06/24 at 2:21 pm with the DON revealed it was a team effort to ensure the drainage bag and tubing were off the floor to prevent contamination. Record review of Infection Prevention and Control Program policy dated 05/13/2023 stated: This facility has established and maintains an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections as per accepted national standards and guidelines. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 48 of 48