Inspection·February 15, 2023

F 0677 underneath. Level of Harm - Minimal harm or potential for actual harm During an observation on 02/14/23 at 07:30 a.m. Resident #29 was asleep. His fingernails were untrimmed but did not have a brown substance underneath. Residents Affected - Few During an interview on 02/14/23 at 2:25 p.m., CNA D said CNAs were responsible for cleaning and trimming Resident's fingernails and it was done on shower days, when a resident requested, or when a CNA noticed they needed trimming. She said long nails increased a Resident's risk of scratching themselves. During observation and interview on 02/15/23 at 07:30 a.m., Resident #29's fingernails remained long and had dark brown substance caked under each nail. He said the last time his nails were trimmed that his family member had trimmed them, and the facility trimmed them a long time ago. He then scraped under one nail with another nail and a clump of brown substance flew into the air. He said he didn't know how his nails got so dirty. Resident said his nails were dirty, look like claws right now and he would like them to be cut. During an observation and interview on 02/15/23 at 8:22 a.m., LVN E said she was charge nurse caring for Resident #29. She said his fingernails were long and needed to be cleaned and trimmed. She said Resident #29 had a hospice aide who does his bathing and ADL care, but he often refused care. LVN E said she had not noticed Resident's nails until surveyor intervention, but she would get them cleaned and trimmed. She said the hospice aide should have cleaned and trimmed them, but if he refused for her nursing staff at the facility should have taken care of his nails. During an interview on 02/15/23 at 10:30 a.m., the DON said she expected the nursing staff to keep resident's fingernails trimmed and clean. She said she had done many in-services with nursing staff regarding ADL care and nail care. During an observation and interview on 02/15/23 at 10:40 a.m., Resident #29 showed the surveyor his nails and said the nurse had cleaned and trimmed them for him. He said he felt much better knowing his nails were not long and dirty. 2. Record review of physician orders dated February 2023 indicated Resident #40, admitted [DATE], was [AGE] years old with a diagnosis of cerebral infarction (stroke). Record review of the most recent MDS dated [DATE] indicated Resident #40 had moderate cognitive impairment, had a diagnosis of cerebral infarction, was totally dependent for personal hygiene and had one sided weakness to the upper extremities. Record review of a care plan dated 9/30/20 to present indicated Resident #40 had a potential for alteration in comfort related to contracture of right hand, apply carrot/ hand roll when resident allows. A care plan dated 11/17/21 indicated Resident #40 had contractures and is at risk for skin breakdown, increased pain from affected areas and injuries. Contractures located to right upper hand. A care plan dated 9/30/20 indicated Resident #40 required assistance with ADL care. One of the interventions was to set-up, assist, give shower, shave, oral, hair, nail care schedule and prn. Record review of a treatment sheet dated February 2023 did not indicate Resident #40's fingernails were to be trimmed or had been trimmed. The treatment sheet indicated: Place Hand Roll in Right Hand . Keep 4 hours on, 4 hours off during day time. Keep it overnight. Order Date: 2/14/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455538 If continuation sheet Page 2 of 5 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 455538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Manor 4400 Gulf St Groves, TX 77619 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 - Few Record review of the ADL sheets dated January 2023 and February 2023 indicated Resident #40 was totally dependent for personal hygiene and bathing. There was no documentation to indicate the resident's nails had been trimmed. During observation and interview on 2/13/23 at 10:37 a.m., Resident #40 was lying in bed sleeping. Observations of the resident's right hand indicated all fingers were firmly contracted inward towards the palm of the hand. The resident's fingernails to all fingers on both hands bilaterally were approximately ¾ inch in length past the tips of the fingers. The 4th and 5th digits of the right contracted hand were firmly curled inward toward the resident's palm. LVN A and LVN B entered the room. LVN A pulled the 4th and 5th digits away from the palm of the resident's right hand to reveal two deep indentations into the center of the palm. LVN A said she was the floor manager. She said the fingernails were too long and there were indentations in Resident #40's right palm of her hand. She said the resident's fingernails needed to be trimmed and the resident did have a hand roll but kept taking it out of her hand. LVN B looked for a handroll in the resident's drawers; no handroll was found. When asked who was responsible for the resident's care, LVN B said she was. LVN B said the resident's nails were too long, should be kept trimmed and a hand roll placed in the resident's hand at all times. She said the aide was ultimately responsible for cutting the resident's fingernails, but she should have cut them when she saw they were too long . She said the possible negative outcome would be altered skin integrity and infection. During an interview on 02/13/23 at 11:10 AM, CNA C said she was responsible for making sure Resident #40's fingernails were trimmed. She said the resident's nails were long and did need trimming. She said Resident #40 was not diabetic and she was responsible for trimming the resident's nails, however she had not trimmed the resident's nails and did not know she was supposed to. When asked if she was responsible for ADL care for the resident, she said yes, she was responsible for ADL care and agreed trimming fingernails was part of ADL care. She said Resident #40 had never had a handroll in her hand and she had never been told to put a handroll in her hand. She said the possible negative outcome of not trimming the resident's fingernails could be they could cut into the resident's skin. During an interview on 02/14/23 at 10:04 a.m., the DON said all resident's fingernails should be kept trimmed and her expectations were for the facility to be in compliance with ADL care. She said not trimming the resident's fingernails could cause an alteration in their skin integrity and possible infection. Record review of the Personal Care policy and procedures dated March 2013 indicated: .Bath-Shower . Purpose: To cleanse and refresh the patient; and to observe the skin. Procedure: . Perform Nail Care. Report any reddened areas, skin discolorations or skin breaks to the charge nurse. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455538 If continuation sheet Page 3 of 5 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 455538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Manor 4400 Gulf St Groves, TX 77619 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure a resident with limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion for 1 of 18 residents reviewed for range of motion. (Resident #40) The facility failed to maintain Resident #40's contractures of the right hand. The resident did not have a handroll in place to maintain ROM and prevent a decline. This failure could place the residents at risk for not receiving the care and services to maintain their highest level of well-being. Findings included : Record review of physician orders dated February 2023 indicated Resident #40, admitted [DATE], was [AGE] years old with a diagnosis of cerebral infarction (stroke). The resident was admitted to hospice services 8/14/21. An order dated 2/14/23, after surveyor intervention, indicated to place hand roll in right Hand. Keep 4 hours on, 4 hours off during daytime. Keep it on overnight. Record review of the most recent MDS dated [DATE] indicated Resident #40 had moderate cognitive impairment, had a diagnosis of cerebral infarction, was totally dependent for personal hygiene and had one sided weakness to the upper extremities. Record review of the admission MDS dated [DATE] indicated Resident #40 was cognitively impaired, had a diagnosis of a stroke, required extensive assistance for personal hygiene and had impairment to one side of the upper extremities. Record review of a care plan dated 9/30/20 to present indicated Resident #40 had a potential for alteration in comfort related to contracture of right hand, apply carrot/ hand roll when resident allows. A care plan dated 11/17/21 indicated Resident #40 had contractures and is at risk for skin breakdown, increased pain from affected areas and injuries. Contractures located to right upper hand. Goals indicated contractures will not increase, skin breakdown will not occur, increased pain will be relieved within hour of intervention. The care plan did not indicate the resident would remove the handroll from her hand. Record review of the clinical record for Resident #40 from admission on [DATE] to 02/14/23 did not indicate the resident received occupational or physical therapy. An order dated 02/14/23, after surveyor intervention, indicated the resident was to be evaluated by therapy services for contracture prevention/maintenance of the right hand. A PT Evaluation and Plan of Treatment dated 2/14/23 indicated the goals for Resident #40 were contracture prevention/maintenance of the right hand. Handroll to be applied 4 hours on and 4 hours off during the day and on overnight. A section titled, Potential for Achieving Rehab Goals indicated the resident demonstrated good rehab potential as evidenced by active participation in skilled treatment. During observation and interview on 2/13/23 at 10:37 a.m., Resident #40 was lying in bed sleeping. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455538 If continuation sheet Page 4 of 5 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 455538 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Manor 4400 Gulf St Groves, TX 77619 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observations of the resident's right hand indicated all fingers were firmly contracted inward towards the palm of the hand. The resident's fingernails to all fingers on both hands bilaterally were approximately ¾ inch in length past the tips of the fingers. The 4th and 5th digits of the right contracted hand were firmly curled inward toward the resident's palm. LVN A pulled the 4th and 5th digits away from the palm of the resident's right hand to reveal two deep indentations into the center of the palm. LVN A said she was the floor manager. She said the resident did have a hand roll but kept taking it out of her hand. LVN A and LVN B entered the room. LVN B looked for a handroll in the resident's drawers; no handroll was found. When asked who was responsible for the resident's care, LVN B said she was. LVN B said a hand roll should be placed in the resident's hand at all times. During an interview on 02/13/23 11:10 AM, CNA C said she was responsible for Resident #40's care. She said Resident #40 had never had a handroll in her hand and she had never been told to put a handroll in her hand. During an interview on 02/13/23 at 1:46 p.m., the PT said Resident #40 was admitted to the facility on hospice services, so she had not ever been referred to therapy services. He said he had looked all through the resident's clinical record and there was no documentation of the resident receiving therapy. He said the residents that are on hospice do not get therapy services. He said the nurses usually just ask the PT what should be done when they have someone with contractures and they tell them to place a handroll in their hand. He said the care plan indicated Resident #40the resident should have a handroll. During observation and interview on 02/14/23 at 9:15 a.m., the PT was wheeling Resident #40 down Hall 200. The PT said the resident was being brought back from therapy. The resident began wheeling herself down the hall using the left hand. The right hand had a handroll in it. The PT said he had evaluated the resident for therapy. When asked why he decided to evaluate her for therapy, he said he remembered the resident being able to transfer herself in and out of bed but now she could not. He said she had hospice as her payer source, and it took adjusting to get her placed on therapy. During an interview and record review on 02/14/23 at 9:41 a.m., the DON said they had put an action plan in place for ROM. The Action Plan was dated 12/15/22. One of the approaches was to assess all residents for contractures. The section status indicated the plan was implemented and monitored monthly. When asked if the action plan was effective, she said it was not. The DON said her expectations were for the residents to maintain their ROM to what could be best expected. During an interview on 02/14/23 at 10:04 a.m., the DON said her expectation was for Resident #40 to receive the care needed to prevent a decline in ROM. Record review of the Range of Motion policy dated June 14, 2006 indicated: . Objectives- . to increase joint motion to the best possible range. to stimulate circulation. To prevent deformities, and any contractures from becoming worse. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455538 If continuation sheet Page 5 of 5