Inspection·August 17, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #1's Progress Notes dated 07/14/2025 at 03:41 pm written by SW revealed, SOCIAL WORKER FOLLOW UP VISIT: Met with resident with DON present in privacy of room to follow up on altercation situation; resident voiced not feeling good due to behavior of other resident and staff and reported being bullied by other resident. Administrator aware, will continue to follow up as needed. Record review of facility's incident report (#1203623) revealed the report of the resident-to-resident altercation was sent to the State reporting system on 07/14/2025 at 04:24 pm. Record review of Resident #1's Progress Notes dated 07/14/2025 at 04:30 pm written by DON revealed, Resident speaking with administrator acknowledged that he was disrespectful yesterday. he admitted he was drunk and had supper at (restaurant) and had beer. Record review of Resident #1's Progress Notes dated 07/15/2025 at 12:29 pm written by PA revealed, Upon evaluation today, the patient is resting in bed. Nursing team reported the patient got physically aggressive with a patient and physical contact was made. He is also reported coming back to facility intoxicated with alcohol in his hands. Behavioral team was contacted and patient has been accepted, sectioned for transfer to their facility. He is also noted with physical altercation with nursing staff. Report made by police. No acute issues per nursing team. 2. Record review of Resident #2's admission record dated 08/16/2025, revealed a [AGE] year-old male with an admission date of 05/16/2024. Resident #2's diagnoses included bipolar disorder (mood swings ranging from depressive lows to manic highs), peripheral vascular disease (a condition where the blood vessels in the arms, legs, feet or hands become narrowed or blocked), Type 2 Diabetes Mellitus (a chronic metabolic disorder characterized by the body's inability to properly use insulin, a hormone that regulates blood sugar levels), hypertension (high blood pressure), and heart disease (a disease that include diseased vessels, structural problems, and blood clots). Record review of Resident #2's 05/23/2025 Annual MDS dated [DATE] revealed Resident #2 had a BIMS score of 15 indicating he was cognitively intact. He could understand others and others could understand him. Resident #1 was frequently incontinent of bowel and bladder. There were no potential indicators of psychosis. No behavioral symptoms were exhibited. There was no overall presence of behavioral symptoms. An antidepressant was received on a routine basis. Record review of Resident #2's Care plan dated 06/06/2025 revealed the altercation between Resident #1 (aggressor) and Resident #2 (victim) had not been care planned. Record review of Resident #2's Progress Notes dated 07/13/2025 revealed there were no notes concerning the resident-to-resident altercation between Resident #1 (aggressor) and Resident #2 (victim). Record review of Resident #2's Progress Notes dated 07/14/2025 at 06:09 am written by LVN C revealed DAY 1- ALTERCATION (VICTIM), PT UP TO WC AT THIS MOMENT BY NURSES STATION, VOICES HE RESTED WELL. RESPIRATIONS EVEN AND UNLABOREDRED, 0 DISTRESS NOTED. CALL LIGHT AND HYDRATION WITHIN REACH. Record review of Resident #2's Progress Notes dated 07/14/2025 at 08:27 am written by SW revealed, SOCIAL WORKER FOLLOW UP VISIT: Met with resident in privacy of room to follow up on altercation situation; resident voiced feeling good and reported no physical pain or discomfort. Resident proceeded to state that he is not okay with staff being physically at risk by other residents. Administrator and DON aware, will continue to follow up as needed. Record review of facility's incident report (#1203623) revealed the report of the resident-to-resident altercation was sent to the State reporting system on 07/14/2025 at 04:24 pm. During an interview on 08/16/2025 at 04:15 pm, the Administrator stated the Resident-to-Resident incident she reported to State on 07/14/2025 was thoroughly documented in her report. She said her nurses were usually very good at documenting so she could not understand why there was no documentation in the Progress Notes for either resident concerning the resident-to-resident altercation on 07/13/2025. During an interview on 08/17/25 at 04:05 pm, Resident #2 stated the day when the other resident pushed the nurse at the nurse's station (07/1/2025), he had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455560 If continuation sheet Page 2 of 3 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 455560 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McAllen Nursing Center 600 N Cynthia St McAllen, TX 78501 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete not liked that Resident #1 had done that especially to a nurse. He said he stood up and was between the other resident (Resident #1) and the nurse when Resident #1 pushed him. He said the nurses stopped it. He said he would never start a fight, but if the other resident had hit him, he would have finished it. Resident #2 stated he was not at the facility to fight, but Resident #1 pushed a woman and he had not liked it. During an interview on 08/17/2025 at 04:30 pm, RN A stated if a resident would be aggressive verbally or physically with her, she would step back and try to calm the resident down. She said if the resident would not calm down, she would give the resident more space to try to calm him down. RN A stated she was not afraid of Resident #1, but she was sure some of the other residents were. She said he was difficult to deal with when he would get upset about things like not getting a cigarette whenever he wanted one. RN A stated Resident #2 was easy going and she never had any problems with him. During an interview on 08/17/2025 at 04:50 pm, The SW stated when she was notified of a resident-to-resident altercation, she would notify the administrator, would interview the residents involved once a day for 72 hours, and document the altercation and the interviews in PCC (electronic health record). The SW stated the administrator notified her of the altercation between Resident #1 and Resident #2. She said she followed protocol. During an interview on 08/17/2025 at 05:13 pm, the DON stated LVN B no longer worked at the facility. LVN B was one of the nurses working when the resident-to-resident occurred. In an attempted interview on 08/17/2025 at 05:15 pm, LVN C was not reachable. Her voice mailbox was full. No voicemail left. LVN C was the nurse who was involved with the resident-to-resident altercation. In an attempted interview on 08/17/2025 at 05:21 pm, LVN D was not reachable. A voicemail was left. There was no return call. In an attempted interview on 08/17/2025 at 05:22 pm, LVN E was not reachable. A voicemail was left. There was no return call. During an interview on 08/17/2025 at 05:30 pm, the DON stated for a resident-to-resident altercation, skin, vital signs, what the nurse did, how it happened, residents involved, that the residents were separated, etc., were to be documented on. The DON stated she could guess what happened and why there were no notes in Progress Notes about the resident-to-resident altercation between Resident #1 and Resident #2. She said the nurse's notes had not transferred over from the Incident Report the nurse completed for the resident-to resident altercation. The DON could not produce the incident report written by LVN C. Record review of facility's policy Clinical Document Guideline dated original date 03/14/2022, revised dated 03/25/2014, and reviewed date of 02/14/2020 revealed: PolicyThe patient's clinical record provides a record of the health status, including observations, measurements, history, and prognosis which serves as the primary document describing healthcare services provided to the patient.Fundamental InformationThe clinical record is used by the healthcare team to record, preserve, and to communicate the patient's progress and current treatment.DocumentationClinical record progress notes, physician orders, flow records. Event ID: Facility ID: 455560 If continuation sheet Page 3 of 3