Inspection·August 14, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few MG/0.1 ML 1 spray Alternating nostrils STAT for Adverse Reaction/Overdose ordered on 04/27/25. 3. Neurological Checks every one hour for 24 hours, report any significant changes to hospice provider ordered on 04/27/25 to start on 04/28/25 at 12:00 am. 4. Vital Signs every hour for 24 hours, report any significant changes to hospice provider, for monitoring due to medication error ordered on 04/27/25 to start on 04/28/25 at 12:00 am. Record review of Resident #1's April 2025 eMAR reflected the following:1. RN A documented an administration of 0.5ml of Lorazepam oral concentrate 2mg/ml (1mg) by mouth on 04/27/25 at 5:30 pm. 2. RN A documented an administration of 0.2ml/8mg of Narcan 0.1ml/4mg spray to each nostril at 11:33 pm. Record review of Resident #1's handwritten Lorazepam narcotic administration log sheet reflected RN A initially documented he gave 0.5 ml (1mg) of Lorazepam oral concentrate 2mg/ml to Resident #1 by mouth at 5:30 pm, however RN A wrote over the amount given to show he gave Resident #1 5ml (10mg) of Lorazepam oral concentrate 2mg/ml by mouth at 5:30pm. Record review of Resident #1's progress notes reflected the following entries:1. 04/27/25 at 11:33 pm RN A documented, Narcan Nasal Liquid 4 MG/0.1 ML 1 spray Alternating nostrils STAT for Adverse Reaction/Overdose Narcan 4 mg to each Nostril given.2. 04/27/25 at 11:49 pm RN A documented, 1800 Medication Lorazepam 0.5 ml scheduled. Medication error--Lorazepam 5 ml was given. During Narcotic count--Error was discovered -2225. Pt. was checked and Patient was very Lethargic. V/S--B/P=130/62, P=85, R=21 and 02 at 100% via Nasal cannula D.O.N was called and informed of situation. Hospice provider was called, RN on call called back, she gave Telephone orders as follows: give Naloxone 4mg Nasal spray. Resident was assessed, Naloxone 4mg of which was administered to each nostril--3 minutes apart. Resident becoming responsive to verbal commands, will continue to monitor closely. 3. 04/28/25 at 12:31 am RN A documented, RN with hospice arrived at facility and gave additional written orders 1) Neurologic checks to be completed every 1 hour and vital signs to be assessed every 1 hour as well. 2) Also, may administer another dose of Narcan if necessary. 4. 04/28/25 at 12:36 am RN A documented, Resident's RP was called to notify of incident however no answer. 5. 04/30/25 at 1:10 pm the ADON documented, Spoke with RP regarding incident that occurred 4/27/25. RP was made aware that Hospice provider was on site shortly after incident was reported. RP had no further questions.In an interview on 08/13/25 at 11:01 am, Resident #1's guardian stated he got a call out of the blue from the ADON at the facility to let him know that 2 or 3 days earlier they accidentally overdosed Resident #1. The guardian stated the ADON told him she saw that no one had called him when it happened, so she called; Otherwise, he would not have known about it. The guardian stated, Thankfully nothing happened because they gave him a counter-acting medication, but my issue is that they did not contact me. They are instructed to contact me for anything regarding the residentmedication changes, hospitalization, etc. Resident #1's guardian stated this was not the first time they had not called him about a change, but this was an important issue. The guardian stated, We have 3 different numbers/ people to call, and no one called any of them. It does not matter that it was a weekend, they still should have contacted me. He stated he went in once a month and as needed to see the resident. He stated he had been to the facility every month since 2019, and he felt like the facility needed to train the staff that they have to call the guardian for any changes or events with the resident.In an interview on 08/14/25 at 3:04 pm, the DON stated RN A contacted her on 04/27/25 between 10:30 pm and 11:00 pm and told her about the medication error. The DON stated the nurse tried to contact the RP/guardian for Resident #1 but there was no answer. Frequently, the nurse attempted to contact the RP several times but only documented it once if it was unsuccessful. The DON stated the nurses were trained to document every attempt to contact the RP or the physician. The DON stated it was important for the RP to know of any changes that were made to the resident's condition or treatment.In an interview on 08/14/25 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 2 of 14 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 08/14/2025 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 4:14 pm, LVN J stated if a resident was sick or something happened, she checked vital signs, called the doctor or nurse practitioner and contacted the family. LVN J stated the information on who was contacted was documented in a progress note. LVN J stated she tried 2 or 3 times, left a voicemail, if possible, but only documented once that she tried however many times. She stated if it was the end of her shift, and she was not able to contact family, she passed it on to the oncoming nurse to keep trying to contact them because the family needed to know how the resident was doing.In an interview on 08/14/25 at 4:37 pm, RN K stated if she could not get a hold of the family or RP when there was a change in resident condition, she made several attempts and documented in a progress note or risk management note how many times she tried. RN K stated it was important for the RP to be contacted so they knew what was going on with the resident and so they could okay any changes that needed to be made.A telephone interview was attempted with RN A on 08/14/25, however there was no answer, and the voicemail message stated he was out of the country. A message was left with a phone number for him to return the call, but he did not return the call.In an interview on 08/14/25 at 5:20 pm, Resident #1 was lying in bed with the television on. Resident #1 stated he was okay, and the staff was nice to him. Resident #1 did not recall the incident with the Lorazepam on 04/27/25. Resident #1 stated his guardian came to see him, sometimes. Record review of the facility's Notification of Changes policy dated 10/24/22 reflected in part: Policy:The purpose of this policy is to ensure the facility promptly informs the resident, consults the resident's physician; and notifies, consistent with his or her authority, the resident's representative when there is a change requiring notification.Definitions:Need to alter treatment significantly means a need to stop a form of treatment because of adverse consequences (such as adverse drug reaction) or commence a new form of treatment to deal with a problem (for example. the use of any medical procedure, or therapy that has not been used on that resident before). Compliance Guidelines: The facility must inform the resident, consult with the resident's physician and /or notify the resident's family member or legal representative when there is a change requiring such notification. Circumstances requiring notification include:1. Accidentsa. Resulting in injury.b. Potential to require physician intervention.2. Significant change in the resident's physical, mental or psychosocial condition such as deterioration in health, mental or psychosocial status.This may include:a. Life-threatening conditions, orb. Clinical complications.3. Circumstances that require a need to alter treatment.This may include:a. New treatment.b. Discontinuation of current treatment due to:i. Adverse consequences. Additional considerations:2. Residents incapable of making decisions:a. The representative would make any decisions that have to be made.b. The resident should still be told what is happening to him or her. Event ID: Facility ID: 455528 If continuation sheet Page 3 of 14 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 08/14/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, observations, and interviews the facility failed to ensure residents were free from abuse for three (Resident #2, Resident #4, and Resident #6) of 10 residents reviewed for abuse.1. The facility failed to ensure Resident #2 was not hit on the arm and chest by Resident #3 on 04/04/25.2. The facility failed to ensure Resident #4 was not slapped on the arm by Resident #5 on 07/05/25.3. The facility failed to ensure Resident #6 was not hit on the arm and kicked on the leg by Resident #7 on 07/08/25.4. The facility failed to ensure Resident #2 was not slapped on the arm by Resident #3 on 08/06/25.These failures could place residents at risk for physical, mental, and psychosocial harm.The findings included:1. and 4. Record review of Resident #2's admission record reflected a [AGE] year-old female originally admitted to the facility on [DATE] and most recently admitted on [DATE]. Her diagnoses included Alzheimer's disease (progressive brain disorder that slowly destroys memory and thinking skills), dementia (loss of memory, language, problem solving and other thinking abilities that significantly impairs a person's ability to perform daily activities), cognitive communication deficit (difficulty with communication), anxiety disorder (mental disorder characterized by excessive and persistent worry, fear, or anxiousness which significantly interferes with daily life), and pseudobulbar affect (neurological condition that causes brief, intense uncontrollable episodes of laughing or crying).Record review of Resident #2's annual MDS assessment dated [DATE] reflected a BIMS was not conducted because she was rarely/ never understood and her cognitive skills for daily decision making were severely impaired. Record review of Resident #2's care plan dated 04/27/20 reflected she needed a structured environment in a secure unit, was a wanderer, had poor safety awareness, and had a communication problem related to her diagnoses of Alzheimer's and dementia. Record review of Resident #3's admission record reflected an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included cognitive communication deficit (difficulty with communication), dementia, moderate, with other behavioral disturbance (loss of memory, language, problem solving and other thinking abilities with behaviors beyond the typical cognitive decline associated with dementia, which significantly impairs a person's ability to perform daily activities), and anxiety disorder (mental disorder characterized by excessive and persistent worry, fear, or anxiousness which significantly interferes with daily life). Record review of Resident #3's quarterly MDS dated [DATE] and 07/18/25 reflected a BIMS score of 13 which indicated Resident #3's cognition was intact.Record review of Resident #3's care plan dated 12/29/16 reflected she needed a structured environment in a secure unit, was a wanderer, had poor safety awareness, had the potential to be verbally and/or physically aggressive, had a behavior problem of hitting other residents at times with interventions that included analyze of key times, places, circumstances, triggers, and what de-escalate behavior and document, assess resident's coping skills and support system, caregivers to provide opportunity for positive interaction, attention, stop and talk with her as passing by, and if reasonable, discuss the resident's behavior; explain/reinforce why behavior is inappropriate and/or unacceptable to the resident. Resident #2 also had a communication problem related to her diagnoses of Alzheimer's and dementia.Record review of the provider investigation report dated 04/11/25 reflected both Resident #2 and Resident #3 resided in the secured unit. Resident #2 had attempted to enter Resident #3's room and Resident #3 struck Resident #2's left arm several times with a closed fist. The residents were immediately separated by CNA D. LVN C completed a skin assessment and pain assessment, with no adverse injury or concern noted to either resident. Resident #3 was placed on one to one monitoring. The residents' families and physicians as well as the local police department were notified of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 4 of 14 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 08/14/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some incident. On 04/04/25, the Admin attempted to interview Resident #2 about the incident, however she was unable to be interviewed as she could not respond to questions appropriately. When Resident #3 was interviewed by the Admin and later by a police officer, she denied hitting anyone. On 04/04/25, Resident #3 was seen by a licensed psychologist regarding the incident and she again denied hitting anyone. It was noted by the psychologist that Resident #3's cognition and judgment were impaired. Resident safety surveys were completed with a sample of residents residing throughout the facility and no negative findings or concerns were noted. The facility initiated abuse/neglect, fall prevention, and resident to resident altercation in-service education on 04/04/25. The licensed psychologist provided in-service education to staff on 04/07/25 regarding caring for residents with dementia, behaviors, and difficult situations and how to address them. Resident #3 was seen by psychiatric services on 04/09/25 with new orders that included discontinue 1:1 monitoring, add Depakote ER 250mg at bedtime (medication used to treat bipolar disordera mental health condition that causes clear shifts in moods from extremely elated, irritable, or energized to sad, indifferent, or hopeless), add Vistaril 50mg every four hours as needed (medication used to treat anxiety), labs in 1 week, discontinue melatonin (medication used to help regulate the sleep cycle), and a cognitive impairment assessment.Record review of the facility's provider investigation report dated 08/13/25 reflected both Resident #2 and Resident #3 resided in the secured unit. LVN E heard Resident #3 yell at Resident #2 when Resident #2 reached for a cup on the hydration cart and before LVN E got to them, Resident #3 swatted Resident #2 on her left arm. Residents were immediately separated by facility staff when the incident occurred. Skin and pain assessments were performed on both residents by LVN E following the incident with no injuries noted for either resident. LVN E notified the ADON, Resident #2's and Resident #3's primary care physicians and responsible parties, and a police report was made. One-to-one monitoring was started with Resident #3. Resident #3 was evaluated by the psychiatric services nurse practitioner who was on site when the incident occurred. The psychiatric services nurse practitioner recommended continue current medications, continue one to one monitoring and refer to inpatient psychiatric hospital for Resident #3. The facility social worker sent the inpatient referral for Resident #3 to three psychiatric hospitals, but the referrals were all denied placement. A medication reconciliation was completed on 08/07/2025 for Resident #3. The following recommendations were made: Increase Oxcarbazepine to 300mg BID; Discontinue one to one observation; Place Resident #3 on 15 minute checks for four hours; if no issues with Resident #3's behaviors in that time, discontinue 15 minute checks. Resident #2 was seen by her primary care physician on 08/07/25 with no new recommendations. In-service education initiated on 08/06/25 covered Types of Abuse and Neglect: physical, verbal, emotional, sexual, resident to resident; Remember the 3 R's: Recognize, Remove, Report; De-escalating Behavior; Abuse and Neglect Coordinator name, phone number, and time frame for notification (immediately).An observation and interview on 08/14/25 at 3:39 pm, of Resident #2 reflected she was in her wheelchair in the secured unit self-propelling around the day room. Resident #2 self-propelled directly in front of Resident #3 and went past her without incident. Resident #2 stated she was doing good. Resident #2 stated she did not have any issues with any other residents. An observation and interview on 08/14/25 at 3:42 pm, of Resident #3 reflected she was sitting in her wheelchair in the day room watching tv and eating a banana. Resident #2 passed directly in front of Resident #3 with no reaction from Resident #3. Resident #3 stated she liked it here and did not have any issues with anyone.In an interview on 08/14/25 at 3:45 pm, AA F stated he had not observed any issues between Resident #2 and Resident #3 or either one of them with anyone else. AA F stated all the residents were friendly and social with each other and with staff. The AA named abuse the abuse coordinator, types of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 5 of 14 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 08/14/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some abuse, and what to do if abuse was witnessed whether between staff and residents or resident to resident. Last in-service on ANE was this week. In-services were usually at least once a month and as needed. In an interview on 08/14/25 at 3:47 pm in the memory care unit, Resident #8 stated she was doing well, got along with everyone and had not witnessed abuse of any kind. 2. Record review of Resident #4's admission record reflected an [AGE] year-old male originally admitted to the facility on [DATE] and most recently admitted on [DATE]. His diagnoses included cerebral infarction (stroke), vascular dementia (problems with thought processes and memory caused by brain damage from impaired blood flow) without behavioral, mood, or psychotic disturbances, and cognitive communication deficit (difficulty with communication).Record review of Resident #4's annual MDS assessment dated [DATE] reflected a BIMS score of 14 which indicated Resident #4 was cognitively intact.Record review of Resident #4's care plan dated 11/14/22 reflected Resident #4 preferred to participate in group activities, and he was at risk for emotional and/or physical harm due to aggression or inappropriate behavior from another resident which was initiated on 07/05/2025 with a goal of feeling safe and secure in his environment. Interventions included document any signs of distress or behavioral changes, educate resident about steps being taken to protect them, ensure adequate staff presence during high-risk time (meals, activities), offer counseling or mental health services (social worker, psychologist), provide reassurance and emotional support following the incident, and relocate seating or room assignments as appropriate to prevent contact.Record review of Resident #4's progress notes reflected an entry dated 07/05/25 at 6:44 pm by RN L that stated, upon returning to his room from an activity in the main dining room, he was being wheeled to his room by the assistant activity coordinator, with another resident directly in front of him and [Resident #5] behind the assistant activity coordinator. [Resident #5] began yelling profanities to both residents. I was about to enter a resident room when I heard a loud slap and someone saying no [Resident #5's name] stop that. My view was obstructed by a large meal cart. I immediately went over and the assistant activity coordinator was asking [Resident #5] to step back. I told [Resident #5], that's enough. And I then said let me take [Resident #4] to his room. I wheeled him into his room and assessed his right hand and arm. He stated multiple times, I'm ok. It doesn't hurt. There were no visible injuries noted. He explained to me that [Resident #5] got upset because he (Resident #4) was looking at a staff member's patriotic nail color. He then left the dining room, and she (Resident #5) followed him and the other resident who were being accompanied by AA M. [Resident #5] began yelling and approached [Resident #4], she (Resident #5) raised her hand, and he (Resident #4) raised his to prevent her from slapping him and she slapped the back of his right hand. He (Resident #4) then stated, That's when you arrived. Record review of Resident #4's progress note dated 07/07/25 at 5:52 pm by the SW stated, Spoke with resident who expressed that he feels safe here in the facility after this weekend. He also shared that he was happy with vision services recently provided and is happy with his new roommate.Record review of Resident #5's admission record reflected a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included cerebral infarction (stroke), schizophrenia (a serious mental health condition that affects how people think, feel and behave), major depressive disorder, recurrent (persistent feeling of sadness and loss of interest that occurs in episodes lasting weeks to months), schizoaffective disorder, bipolar type (mental health problem characterized by thinking and behavior problems and includes bouts of hypomania or mania and sometimes major depression), and anxiety disorder (mental disorder characterized by excessive and persistent worry, fear, or anxiousness which significantly interferes with daily life). Record review of Resident #5's quarterly MDS assessment dated [DATE] reflected a BIMS score of 12 which indicated Resident #5 had moderate cognitive impairment. Record review of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 6 of 14 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 08/14/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #5's care plan dated 06/20/19 reflected she preferred group activities, had schizophreniform disorder with documented aggressive behavior toward other residents on 05/25/24, 10/22/24, and 07/07/25, and she became upset and physically aggressive, striking a male resident on the hand for declining to sit with her during a scheduled game, stating he was her good luck charm. Goals for that behavior were resident will demonstrate effective coping skills, verbalize understanding of need to control physically aggressive behavior, and will not harm self or others through the review date. Interventions included administer medications as ordered, psychiatric services, and monitor/notify family/RP and provider of inappropriate behavior, re-direct resident and explain inappropriate behavior, and when the resident becomes agitated/aggressive/upset: Intervene before agitation escalates; Guide away from source of distress; Engage calmly in conversation; If response is aggressive, staff to walk calmly away, and approach later.Record review of Resident #5's progress notes reflected an entry dated 07/05/25 at 6:33 pm by RN N that stated, On 07/05/2025 at approximately 3:30pm, [Resident #5] became physically aggressive toward [Resident #4] and struck him on the right hand with her own hand. Immediate assessments were conducted on both residents. No visible bruising, redness, or other signs of injury were observed. Both residents denied pain at the time of assessment. The Assistant Director of Nursing (ADON) and Director of Nursing (DON) were promptly notified. Nursing staff will continue to monitor both residents closely per facility protocol and document any changes in condition or behavior. Another entry dated 07/05/25 at 6:56 pm by RN N stated, [Resident] #5 placed on one-to-one observation for behavioral monitoring. No concerning behaviors observed [Resident #5] remains calm and cooperative at this time. RN N documented another entry dated 07/05/25 at 7:09 pm which stated, Behavioral concerns were reported to Psychiatric Services, and a phone evaluation of the incident was conducted. The nurse (RN N) informed the provider that the resident (Resident #5) remained calm throughout the shift and acknowledged that the behavior was in violation of facility policies. Based on the evaluation, the one-to-one observation order was discontinued by the nurse practitioner on call with the Psychiatric Services provider. No changes to [Resident #5]'s medications were made at this time. Nursing staff will continue to closely monitor [Resident #5]'s behavior and maintain ongoing observation for any further concerns or need for follow-up. An Activity Quarterly Progress Note dated 07/14/25 at 9:17 am by the AD stated, Demeanor/Behavior: [Resident #5] will have her good and bad days at times will have verbal disagreements with others during activities. Interests: [Resident #5] enjoys board games and activities that involve snacks or food. Participation Level: [Resident #5] continues to participate in group activities of choice. Resident will enjoy going to the patio on her own time. Resident will participate in religious services at her own time. Resident prefers to participate in board games such as Loteria or Bingo, at times will be prefer not to participate if she is having a bad day. Resident will participate in special event and celebration recently in 4th of July and birthday celebrations enjoyed the food. Resident continues to have errands done for her at least once a month. Resident is interested in outings but as per family request is not to participate in activities outings due to behaviors. Resident also enjoys doing her own leisure activities such as using her phone for in room entertainment or will visit other residents' room to socialize. Resident at times will need to be redirected due to arguments or differences she has with other residents. Resident will continue to be encouraged to participate in activities of choice. Functional Ability: Resident continues to need moderate support for activities participation. Resident continues to be able to voice her preferences. Resident continues to be able to get to activities with assisting device wheelchair.Record review of the facility's provider investigation report reflected the following: [Resident #4] and [Resident #5] normally participate in activities together sitting at the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 7 of 14 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 08/14/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some same table with no concerns noted. On the date of the incident [Resident #4] had decided to sit with a different resident during the activity. The facility took the following actions: 1) [Resident #4] and [Resident #5] were immediately separated by facility staff when the incident occurred. 2) Skin assessments were performed by facility charge nurses (RN L and RN N) following the incident on both residents. No injuries were noted for either resident. 3) Pain assessments were completed for both residents - no pain voiced or observed for either resident. 4) Residents' primary care physicians were notified of the incident. [Resident #4] is his own responsible party. [Resident #5]'s responsible party was notified of the incident. Police notification was made regarding the incident. 5) [Resident #5] was initiated on one-to-one monitoring. 6) Both residents were interviewed by the facility administrator regarding the incident. 7) [Resident #5] was evaluated by Psychiatric Services. 8) Residents' care plans were reviewed and updated. Conclusion: During interviews with the facility administrator, both residents were able to explain what happened in the incident. [Resident #4] stated [Resident #5] was upset with him because he sat with another resident during the activity 'loteria'. [Resident #4] further explained that when [Resident #5] started yelling at him, he told her to calm down. [Resident #5] confirmed that she had struck [Resident #4] on his right arm because she was upset with him for not sitting with her during the activity. [Resident #5] explains that [Resident #4] brings her good luck during the activity they had participated in, and she did not win a single game that day. When interviewing [Resident #5], she was apologetic for her actions and explains that she could have reacted differently. [Resident #5] recalled [Resident #4] telling her to calm down. When asked if the same situation occurred again, [Resident #5] explained that she would not act the same way. She explained she would go to her room instead. Following the incident, [Resident #5] was immediately placed on one-to-one monitoring to avoid any further altercations. [Resident #5] was evaluated the same day by the facility's psychiatric services provider. The psychiatric services nurse practitioner did not make any medication changes for [Resident #5]. The nurse practitioner also discontinued the one-to-one monitoring. [Resident #5] was also subsequently seen by the psychiatric services provider on 07/09/25, with no changes or new orders recommended. The police officer responding to the incident interviewed only [Resident #4]. [Resident #4] did not want to press charges on [Resident #5] as they are friends. Furthermore, [Resident #4] requested to the police officer that [Resident #5] not get into any trouble regarding this incident. In subsequent interviews, [Resident #4] does not state any concerns or emotional distress from the incident. Prior to the incident, [Resident #4] was already receiving routine psychological services. Those services will continue. The Investigation does not support the allegation of Abuse and finds the allegation to be UNCONFIRMED. The facility does acknowledge that while the incident did occur, the facility does not suspect Abuse or Neglect. The incident was isolated, and the residents remained with no negative or emotional effects noted related to the allegation. Further review of the facility's provider investigation report reflected in-service education was initiated with staff on 07/05/25 about Types of Abuse and Neglect: physical, verbal, emotional, sexual, resident to resident; Remember the 3 R's: Recognize, Remove, Report; De-escalating Behavior; Abuse and Neglect Coordinator name, phone number, and time frame for notification (immediately).In an interview on 08/14/25 at 4:30 pm, Resident #5 stated she was doing ok. She stated, I hit somebody that I was not supposed to. Resident #5 stated she hit Resident #4 because they had played Bingo, and she did not win. Resident #5 stated, I hit him because he was helping someone else, and she was winning, and I was not. Resident #5 stated she felt safe there.In an interview on 08/14/25 at 4:58 pm, Resident #4 stated, It's great here. He stated he remembered when Resident #5 smacked his hand. Resident #4 stated Resident #5 was friends with his friend and when they split up (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 8 of 14 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 08/14/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some she went to Resident #4 and asked if he liked her. He told her he did, but she misunderstood it to mean that he was her boyfriend. That day, he was in the dining room, and he was looking at one of the staff member's nail polish and Resident #5 got mad at him for it and smacked his hand. The facility reported it, and the police came, but he did not want to press charges or anything. He stated he did not get hurt, there was no bruising or anything, and he and Resident #5 were still friends. 3. Record review of Resident #6's admission record reflected a [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included encephalopathy (a group of conditions that cause brain dysfunctions such as confusion, memory loss, and/or personality changes), recurrent major depressive disorder (persistent feeling of sadness and loss of interest that occurs in episodes lasting weeks to months), dementia (loss of memory, language, problem solving and other thinking abilities which significantly impairs a person's ability to perform daily activities), cognitive communication deficit (difficulty with communication), cerebral palsy (a group of conditions that affect movement and posture that is caused by damage that occurs to the developing brain, most often before birth), anxiety disorder (mental disorder characterized by excessive and persistent worry, fear, or anxiousness which significantly interferes with daily life), and schizophrenia (a serious mental health condition that affects how people think, feel and behave).Record review of Resident #6's quarterly MDS assessment dated [DATE] reflected a BIMS score of 13 which indicated Resident #6 was cognitively intact.Record review of Resident #6's care plan dated 05/23/17 reflected Resident #6 was at risk for emotional distress and/or physical harm due to aggression or inappropriate behavior from another resident dated 07/08/25. The goal was Resident #6 would feel safe and secure in his environment. Interventions included document any signs of distress or behavioral changes, educate resident about steps being taken to protect him, ensure adequate staff presence during high-risk time (meals, activities), offer counseling or mental health services (social worker, psychologist), provide reassurance and emotional support following the incident, and relocate seating or room assignments as appropriate to prevent contact. Resident #6 also was/had potential to be verbally aggressive related to history of behaviors, mental/emotional illness initiated: 12/20/23. The goal was Resident #6 would demonstrate effective coping skills through the review date. Interventions included administer medications as ordered, monitor/ document for side effects and effectiveness, analyze of key times, places, circumstances, triggers, and what de-escalates behavior and document, assess and anticipate resident's needs: food, thirst. toileting needs, comfort level, body positioning, pain etc.Record review of Resident #6's progress notes reflected an entry dated 07/08/25 at 2:00 pm by RN O that stated, 1340 Nurse near nurses' station when screaming could be heard down the hall. Nurse noted [Resident #6] sitting down on his wheelchair facing towards the dining Room appeared getting a drink from the hydration cart while [Resident #7] was on his wheelchair on [Resident #6]'s left side both were noted to be verbally aggressive towards each other while the tone kept on increasing, nurse attempted to catch their attention while running towards them, however both disregarded nurse and continued their verbal aggression towards each other, as nurse was about to reach residents, [Resident #7] stood up from his wheelchair and starting swinging his closed fists towards [Resident #6] nurse called resident to stop, [Resident #7] disregarded and continued to attempt to hit however nurse did not see any physical contact between each other, on the second time that [Resident #7] attempted to swing his closed fist at [Resident #6], resident fell back onto his wheelchair nurse arrived, separated both residents while both continued to be verbally aggressive using profanity and loud tone. A CNA was placed to closely monitor any further aggression. As CNA was removing [Resident #6] from the scene to help deescalate, [Resident #7] swiftly turned his wheelchair around, towards [Resident #6] and kicked him and physically (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 9 of 14 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 08/14/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some connected on [Resident #6]'s left leg/knee. Nurse intervened, residents were separated, and both were assessed, head to toe preformed. No skin issues noted at this time. Both residents verbally deny any pain. RP, MD/FNP notified aware of situation. new orders as follows: 1. Collect UA for Urine analysis with culture and sensitivity. 2. Hydroxyzine Pamoate 50mg (an antihistamine that is used for certain types of anxiety), one time dose only for agitation (resident accepted medication at 3:35 pm) Obtain verbal consent over the phone with RP (RP aware and in agreement), psychiatric services were notified at 2:05 pm, as per psychiatric services, if resident continues with behaviors report to psychiatric services. RP and resident aware and in agreement with new orders. [sic] Another progress note dated 07/11/25 at 5:06 pm by the SW stated, Spoke with resident who was observed socializing with other resident in the dining area. Resident states everything is good, he feels safe and calm here. [sic]Record review of Resident #7's admission record reflected a [AGE] year-old male originally admitted to the facility on [DATE] with most recent admission on [DATE]. Diagnoses included non-traumatic subarachnoid hemorrhage (bleeding in the brain), cerebral infarction (stroke), dysarthria following cerebral infarction (when the muscles used for speech are weak or are hard to control which often causes slurred or slow speech that can be difficult to understand), aphasia (an impairment in the ability to read, write, and speak), and dysphagia (difficulty swallowing). Record review of Resident #7's care plan dated 03/01/23 reflected he was/had the potential to be physically aggressive with the goal to demonstrate effective coping skills through the review date which was initiated on 07/29/25 and he had a communication problem related to expressive aphasia with the goal for the resident would be able to make needs known on a daily basis. Interventions included be conscious of resident position when in groups, activities, dining room to promote proper communication with others. Record review of Resident #7's progress notes reflected an entry dated 07/08/25 at 2:42 pm by RN O that was the same as for Resident #6 except for new orders which were, 1. One to one monitor for aggressive behavior. 2. Refer to Psychiatric services due to aggressive behavior. 3. Behavioral health to evaluate and treat due to aggressive behavior. Other new orders and further progress note included, 1. Hydroxyzine HCL tablet 25mg 1 tablet by mouth every 12 hours as needed for agitation. Resident was moved to a private room for time being to assist with de-escalation. Nurse notified of all new orders and room change to resident and RP, both aware and in agreement. RP stated that perhaps later today she might go to see resident. At this time, resident was transitioned to another hall, surroundings were explained to resident, bed controls. Nurse gave report and medications to that hall nurse. Resident accepted, no further questions at this time. Another progress noted dated 07/08/25 at 3:30 pm by RN P stated, Resident was in hallway sitting on the wheelchair and started to become verbally aggressive with any resident that in the hallway. The resident was escorted to his room and will have one to one assistance in the room until seen by Behavioral Health or Psychiatric services. PCP and RP are aware. A progress noted dated 07/09/25 at 6:58 pm by RN O reflected the following, NP rounds on resident and orders: 1. Increase sertraline (antidepressant medication) to 50mg every morning. 2. Oxcarbazepine (used to treat bipolar) 150mg twice daily. 3. Stop hydroxyzine HCL. 4. Vistaril (medication used to treat anxiety) 50mg every 4 hours PRN x 14 days. 5. Discontinue one to one monitoring.Record review of the facility's provider investigation report dated 07/16/25 reflected Resident #7 had a BIMS of 5. The report further reflected Resident #6 stated Resident #7 had physically struck him on the left arm and left leg prior to staff intervention. The facility staff immediately separated the residents, skin and pain assessments were performed on both residents with no injuries noted, and no pain voiced or observed for either resident. A police report was made. Resident #7 was moved to another hall, placed on one to one monitoring, and was referred to behavioral health and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 10 of 14 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 08/14/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete psychiatric services due to his sudden change in behavior. The provider investigation report stated, Negative outcomes/ Injury of Patient: No negative outcomes were noted for either resident. There were no injuries identified related to this incident. Residents did not voice nor indicate emotional distress as a result of the incident. Both residents continue their normal daily routines. Conclusion: During an interview with the facility administrator, Resident #6 was able to verbalize what occurred during the incident. Resident #6 explains that he was planning to attend an activity in Wing A which started at 2 p.m. Resident #6 stated that Resident #7 was attempting to tell him something in the hallway, but he could not understand what Resident #7 was saying and asked him to repeat himself. Resident #6 states that he did raise his voice when he was unable to understand what Resident #7 was saying. Resident #6 explains that when he raises his voice, it does not mean he is upset. It was then that Resident #6 alleges that Resident #7 started to attempt to hit him. Resident #6 states he told Resident #7 to be careful because he was going to fall and to stop or otherwise, he was going to react. In an interview with the facility administrator, Resident #7 denied the incident occurred. Resident #7 denied hitting anyone. The resident seemed upset about being asked questions related to the incident. When asked what he would do if a situation arose and he became upset with another resident, he said he would leave. The police officer responding to the incident interviewed only Resident #6. Resident #6 did not want to press charges. Resident #6 further explained to the officer that he was concerned that Resident #7 would fall because he was standing up from his wheelchair without assistance. In a subsequent interview, Resident #6 does not state any concerns or emotional distress from the incident. Prior to the incident, Resident #6 was already receiving routine psychological services from Behavioral Healt Event ID: Facility ID: 455528 If continuation sheet Page 11 of 14 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 08/14/2025 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to ensure residents were free of any significant medication errors for one (Resident #1) of five residents reviewed for medication errors. The facility failed to ensure that (RN A) did not administer 5ml (10mg) of Lorazepam (a benzodiazepine medication used to treat anxiety disorders that slows down the nervous system) instead of the physician ordered 0.5ml (1mg) of Lorazepam to Resident #1 on 04/27/25.This failure could result in residents not receiving the physician ordered dose of medications which could lead to an adverse reaction, overdose, hospitalization, or death.The findings included:Record review of Resident #1's admission record reflected a [AGE] year-old male initially admitted to the facility on [DATE] and most recently admitted on [DATE]. The only contacts listed for him were his guardian (Bill to, Responsible Party, and Emergency Contact #1) with two phone numbers, a fax number, and an email address, and himself. His diagnoses included epilepsy (a long-term (chronic) disease that causes repeated seizures due to abnormal electrical signals produced by damaged brain cells), bipolar disorder (mental health condition that causes clear shifts in moods from extremely elated, irritable, or energized to sad, indifferent, or hopeless), unspecified psychosis not due to a substance or know physiological condition (psychotic symptoms not aligned with a specific psychotic disorder or mental illness), mood disorder due to known physiological condition (a mental health condition characterized by a disturbance in mood (like depression or mania) that is directly caused by a medical or physiological condition), mild cognitive impairment (a condition in which people have more memory or thinking problems than other people their age), cognitive communication deficit (difficulty with communication), cerebellar stroke syndrome (impairments in motor control and posture), and dementia (loss of memory, language, problem solving and other thinking abilities which significantly impairs a person's ability to perform daily activities). Record review of Resident #1's quarterly MDSs dated 04/22/25 and 06/25/25 reflected BIMS scores of 2 and 7 which indicated Resident #1 had severe cognitive impairment. Record review of Resident #1's care plan dated 07/19/17 reflected he had a seizure disorder, potential for mood problem, was resistive to care, displayed verbal behaviors, had a communication problem and unclear speech related to diagnoses of bipolar disorder, psychosis, and history of stroke. Interventions included administer medications as ordered and observe/document for side effects and effectiveness, behavioral health consults as needed, observe for signs and symptoms of mania or hypomania racing thoughts or euphoria; increased irritability; frequent mood changes; pressured speech; flight of ideas; marked change in need for sleep; agitation or hyperactivity, and praise the resident when behavior was appropriate. Record review of Resident #1's Order Summary Report on 08/13/25 reflected the following orders:1. LORazepam Oral Concentrate 2 MG/ML (Lorazepam) Phone Give 0.5 milliliter by mouth three times a day related to mood disorder due to known physiological condition ordered on 08/04/24. 2. Narcan Nasal Liquid 4 MG/0.1 ML 1 spray Alternating nostrils STAT for Adverse Reaction/Overdose ordered on 04/27/25. 3. Neurological Checks every one hour for 24 hours, report any significant changes to hospice provider ordered on 04/27/25 to start on 04/28/25 at 12:00 am. 4. Vital Signs every hour for 24 hours, report any significant changes to hospice provider, for monitoring due to medication error ordered on 04/27/25 to start on 04/28/25 at 12:00 am.Record review of Resident #1's April 2025 eMAR reflected the following:1. RN A documented an administration of 0.5ml of Lorazepam oral concentrate 2mg/ml (1mg) by mouth on 04/27/25 at 5:30 pm. 2. RN A documented an administration of 0.2ml/8mg of Narcan 0.1ml/4mg spray to each nostril at 11:33 pm.Record review of Resident #1's handwritten Lorazepam narcotic administration log sheet reflected RN A initially documented he gave 0.5 ml (1mg) of Lorazepam oral concentrate 2mg/ml to Resident #1 by Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 12 of 14 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 08/14/2025 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few mouth at 5:30 pm, however RN A wrote over the amount given to show he gave Resident #1 5ml (10mg) of Lorazepam oral concentrate 2mg/ml by mouth at 5:30pm.Record review of Resident #1's progress notes reflected the following entries:1. 04/27/25 at 11:33 pm RN A documented, Narcan Nasal Liquid 4 MG/0.1 ML 1 spray Alternating nostrils STAT for Adverse Reaction/Overdose Narcan 4 mg to each Nostril given.2. 04/27/25 at 11:49 pm RN A documented, 1800 Medication Lorazepam 0.5 ml scheduled. Medication error--Lorazepam 5 ml was given. During Narcotic count--Error was discovered -2225. Pt. was checked and Patient was very Lethargic. V/S--B/P=130/62, P=85, R=21 and 02 at 100% via Nasal cannula D.O.N was called and informed of situation. Hospice provider was called, RN on call called back, she gave Telephone orders as follows: give Naloxone 4mg Nasal spray. Resident was assessed, Naloxone 4mg of which was administered to each nostril--3 minutes apart. Resident becoming responsive to verbal commands, will continue to monitor closely.3. 04/28/25 at 12:31 am RN A documented, RN with hospice arrived to facility and gave additional written orders 1) Neurologic checks to be completed every 1 hour and vital signs to be assessed every 1 hour as well. 2) Also, may administer another dose of Narcan if necessary.In an interview on 08/14/25 at 3:04 pm the DON stated RN A contacted her on 04/27/25 around 10:30 pm to 11:00 pm and told her about the medication error. The DON stated the next morning (04/28/25) an in-service was done with all nursing staff by the DON that was over medication administration policy and procedure and verification of the 6 rights of medication administration and a one on one in-service was done with RN A, also.In an interview on 08/14/25 at 4:14 pm LVN J stated the last in-service on medication administration was last week and narcotics were verified at the beginning and end of each shift. LVN J stated if a medication error was made, she called the provider for orders, the DON, then the family/RP. In an interview on 08/14/25 at 4:37 pm RN K stated she knew about Resident #1 and his Lorazepam overdose. RN K stated she worked the day after, and they were doing vital sign and neurological checks every hour. RN K stated she was not the nurse on Resident #1's hall on 04/28/25, but she knew Resident #1's vital signs were stable throughout her shift because she was talking with the primary nurse about it. RN K stated if she had a medication error, she immediately assessed the resident, notified the DON and/or the ADON, and notified the nurse practitioner. RN K stated if the resident was not stable or was critical, she called the physician first and if they did not answer she called the medical director. Narcotics were verified at beginning and end of shift as well as when narcotics were given. RN K stated the last in-service on medication administration was about a week ago.A telephone interview was attempted with RN A on 08/14/25, however there was no answer, and the voicemail message stated he was out of the country. A message was left with a phone number for him to return the call, but he did not return the call. In an interview on 08/14/25 at 5:20 pm Resident #1 was lying in bed with the television on. Resident #1 stated he was okay, and the staff was nice to him. Resident #1 did not recall the incident with the Lorazepam on 04/27/25.Record review of the facility's in-service documentation reflected an in-service was done by the DON with all on 04/28/25 that covered medication administration. Record review of RN A's employee record on 08/13/25 reflected he was hired on 04/10/25 and his RN license was originally issued 11/13/01; current expiration date was 02/28/27. RN A had an Employee Counseling Report dated 04/28/25 with an incident description that stated, On 04/27/25, failed to follow medication administration guidelines resulting in a medication administration error placing a resident at risk for adverse effects of an overdose. On this same day, employee carelessly documented incorrect information on same resident's chart. Employee has also not been completing all required documentation pertaining to patient care, in spite of being instructed to do so directly by his supervisors. The performance improvement plan stated this was the final warning. It was signed by RN A, the DON, the ADON, and the Human Resources (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455528 If continuation sheet Page 13 of 14 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 08/14/2025 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Coordinator. The performance review documented on 05/28/25 stated no medication errors occurred this period and was signed by the DON. There was also documentation of a one on one in-service was done by the ADON on 04/28/25 at 2:30pm. The subject was Medication Administration Policy and Procedure, and the Return Demonstration Outcomes were: I have read Policy and Procedure for Medication Administration. I will be getting a second license nurse to verify dosage administered with every Narcotic given for 4 weeks. When in doubt, I will ask a co-worker, ADON, or DON for assistance in completing task. I will verify all information before documenting on PCC. I received a copy of the medication administration policy and procedure. It was signed by RN A and the ADON. Record review of the facility's Medication Administration Incident Report dated 04/27/25 reflected the following:The incident was discovered by RN A (the off going nurse) and RN R (the oncoming nurse) on 04/27/25 at 10:24 pm. The nurse was notified and gave a telephone order for Narcan to be administered immediately and neurologic checks and vital signs to be done every one hour for 24 hours on 04/27/25 at 10:55 pm. The Employee's statement was handwritten and signed by RN A on 04/28/25 and stated, RN A gave scheduled medication- Lorazepam 0.5ml, but I accidentally gave 5ml. Discovery of medication error was made during change of shift medication count. The Management section was handwritten and signed by the DON on 04/28/25 and stated, RN A will have another nurse witness his medication administration (narcotics) for the next 30 days. This form was also signed by the Admin on 04/28/25.Record review of the facility's medication administration policy in-service dated 04/28/25 reflected that 25 of 26 RNs and LVNs attended the training.Record review of the facility's Medication Administration Policy dated 10/24/22 reflected in part: Policy: Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection.Policy Explanation and Compliance Guidelines:3. Identify resident by photo in the MAR (medication administration record).10. Review MAR to identify medication to be administered.11. Compare medication source (bubble pack, vial, etc.) with MAR to verify resident name, medication name, form, dose, route, and time.14. Administer medication as ordered in accordance with manufacturer specifications.17. Sign MAR after administered. For those medications requiring vital signs, record the vital signs onto the MAR.18. If medication is a controlled substance, sign narcotic book.19. Report and document any adverse side effects or refusals.20. Correct any discrepancies and report to nurse manager. Event ID: Facility ID: 455528 If continuation sheet Page 14 of 14