Inspection·August 23, 2023

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few CNA B said to Resident #1, How would you like it if I did that to your sister?. CNA C said Resident #1 went off (became angry). CNA C told CNA B she shouldn't say that in front of Resident #1, but it was after he was taken away. CNA C said she was in shock a little bit. CNA C said it was the first time she had seen something like that. CNA C said she didn't realize CNA B was talking to Resident#1 until after CNA B started talking about fucking his sister. During an interview with the Administrator on 7/28/2023 at 2:49 PM she said breakfast was over at around 9:00 AM on 7/25/2023. She said the DON removed CNA B from the floor and suspended her at around 10:30 AM. CNA B was working on the floor an hour and a half after the abuse occurred. The Administrator said the staff knew they had to call her immediately if abuse occurred. The Administrator said she was notified of the abuse at the same time as the DON. The Administrator said she thought the staff made a conscious decision not to call her immediately, and it was the wrong decision. During an interview with the Administrator on 7/28/2023 at 2:49 PM she said she would make sure CNA B was reported to the Nurse Aid Registry. During an interview on 8/21/2023 the DON displayed evidence CNA B was reported to the Nurse Aid Registry on 7/8/2023. During an interview with resident #1 on 8/21/2023 at 10:45 he said he thought he remembered CNA B. Resident #1 did not remember CNA B being mean to him. Resident #1 said he was not afraid of anyone at the facility. During and interview with the ADON on 8/21/2023 at 1:00 PM she said she was told at around 8:45 AM on 7/25/2023 that Resident #1 was upset because the CNAs told him No and attempted to re direct Resident #1 when he tried to grab them inappropriately. ADON said he often gets upset when told no. ADON said she was not told at that time CNA B was abusive to Resident #1 and learned the full scope of the incident when CNA A texted them during morning meeting at around 10:30 AM. ADON learned the full scope of the incident at the same time as the DON and the administrator. During an interview with MDS LVN on 8/21/2023 11:45 AM she said Resident #1 hit CNA B a couple of times in the face. MDS LVN said she saw that but did not hear CNA B say anything disparaging to Resident #1. MDS LVN said she was at the nurse's station and heard Resident #1 screaming. MDS LVN said after Resident #1 hit CNA B , she told CNA B to back away, and MDS LVN took Resident #1 to the nurse's station, just to get him out of the dining room. MDS LVN said she did not know CNA B was the cause of Resident #1s anger. MDS LVN said she was very familiar with Resident #1. MDS LVN said she tried to calm Resident #1 down at the nurse's station and said he was calm in less than a minute but was still more riled up than he usually was. Resident #1 was still agitated, but he wasn't screaming or hitting. He was just agitated. MDS LVN said it is not unusual that he doesn't remember the event. MDS LVN said that later on 7/25/2023 when she interviewed him, he didn't seem to remember it either. During interviews conducted on 7/28/2023 10:30 AM - 5:30 PM with all residents in their rooms during inspection of the 4th floor revealed no complaints about facility or staff. During a record review of in-services for abuse and neglect it was revealed staff received training on 7/25/2023, 7/12/2023, 6/12/2023, 5/11/2023, and 1/11/2023. A transcript of training for CNA B indicates she completed training for preventing abuse and managing aggressive behaviors on 4/16/2023 and completed training for quality dementia care on 1/4/2023. Record review of facility's policy on abuse (revised December 2017) indicated Abuse was defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 2 of 9 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 455575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Nursing and Rehabilitation Center of Morga 2322 Morgan Ave Corpus Christi, TX 78405 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 resulting physical harm, pain or mental anguish. Level of Harm - Immediate jeopardy to resident health or safety Record review of the facility's Abuse Policy dated 8/15/2022 indicated the facility will implement policies and procedures to prevent and prohibit all types of abuse that achieves: Assigning responsibility for the supervision of staff on all shifts for identifying inappropriate staff behaviors Residents Affected - Few Verification of the facility's response to the incident included: Record review: Facility staff training on abuse and neglect, notification of abuse prevention coordinator Investigation report and allegation of verbal abuse confirmed Alleged perpetrator reported to Nurse Aid registry 7/28/2023 Notification to police: case # 2307260117 Review of resident interviews CNA B employee record for completion of training 7/25/2023 Reviewed facility notes Resident abuse interview and observation. Resident #1 denies, (7) total residents all deny abuse. NAR of CNA B no issues searched 2/16/23 CNA A abuse training 7/10/23 Elder Abuse 7/21/23 Police report: Case # 2307260117 Nurse Aid B reported to Nurse Aid Registry 7/28/2023. Interviews: On 8/21/2023 between 2:30 PM and 3:00 PM interviews conducted across 2 shifts that included CNA A, CNA C, CNA D, CNA E, CNA F, CNA G, and CNA H to ensure training was completed. Responses were consistent with facility training and policy. Staff able to identify who the abuse prevention coordinator is and can find the number for the abuse prevention coordinator. Observations: Facility observations on 7/28/2023 revealed residents appeared content and no issues were noted. On 08/23/23 at 1:45 pm, the DON (Administrator not on duty) was notified of a Past Non-Compliance Immediate Jeopardy (IJ) had been identified due to the above failures. The IJ template was provided (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 3 of 9 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 455575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Nursing and Rehabilitation Center of Morga 2322 Morgan Ave Corpus Christi, TX 78405 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 to the DON at this time. Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 4 of 9 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 455575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Nursing and Rehabilitation Center of Morga 2322 Morgan Ave Corpus Christi, TX 78405 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. 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 implement its written policies and procedures to prohibit and prevent abuse, neglect, and exploitation of residents, for 1 of 3 residents (Resident#1) reviewed for abuse and neglect, in that: Residents Affected - Few The facility failed to ensure CNA A and CNA C immediately reported any alleged incidents of abuse to the abuse prevention coordinator. The non-compliance was identified as Past Non-Compliance. The Immediate Jeopardy (IJ) began on 07/25/23 and ended on 7/25/23. The facility corrected the non-compliance before the investigation began. These failures placed residents at risk of further abuse by leaving an alleged perpetrator remain in contact with facility residents. The findings were: During a record review of Resident #1's face sheet it was revealed he is a [AGE] year old male with a diagnosis of cerebellar ataxia, altered mental status, cognitive communication deficit, muscle wasting, dysphagia and a need or personal assistance. Record review of Resident #1's quarterly MDS assessment dated [DATE], he has a BIMS score of 6, which is considered a severe impairment to cognitive ability. Resident #1 was interviewed on the morning of 7/28/2023 with his sister present. He displayed no signs of distress. He nodded yes when asked if the staff treated him well. During a review of Resident #1's chart it was noted on 7/28/2023 at 11:25 AM Social Services interviewed Resident #1. Social Services note indicated all was good and that the resident did not mention an allegation. During an interview on 7/28/2023 at 1:55 PM CNA A said CNA B told Resident #1 during breakfast on 7/25/2023, I heard you like to touch my sister's boobs and ass. How would you like it if I took your sister and fucked her over your bed? CNA A said Resident #1 became upset. CNA A said she was afraid of CNA B and did not say anything to her. CNA A said she was supposed to report abuse to the charge nurse, and she was supposed to report it to the Administrator, but she did not report it to the Administrator. She said she told the charge nurse. CNA A said CNA B continued to work on the floor until approximately lunch time. During an interview on 8/21/2023 at 1:00 PM ADON said she was told at around 8:45 AM on 7/25/2023 that Resident #1 was upset because the CNAs told him No and attempted to re-direct Resident #1 when he tried to grab them inappropriately. ADON said he often gets upset when told no. ADON said she was not told at that time CNA B was abusive to Resident #1 and learned the full scope of the incident when CNA A texted them during morning meeting at around 10:30 AM. ADON learned the full scope of the incident at the same time as the DON and the administrator. During a record review dated 7/25/2023 at 8:45 AM late entry created on 7/25/2023 at 5:16 PM by the charge nurse it was charted she became aware of abuse after Resident #1 became calm and made ADON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 5 of 9 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 455575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Nursing and Rehabilitation Center of Morga 2322 Morgan Ave Corpus Christi, TX 78405 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 0607 aware of abuse. Level of Harm - Immediate jeopardy to resident health or safety During an interview with the charge nurse on 8/21/2023 at 11:30 AM indicates she was at the nurse's station and did not know why Resident #1 was upset. The charge nurse said there were already other staff there and the MDS nurse was trying to de-escalate Resident #1. Residents Affected - Few During an interview with the MDS nurse on 8/21/2023 she said she used to be the ADON on the floor and knew Resident #1 well. MDS nurse said she was at the nurse's station and did not hear anything CNA B said but heard Resident #1 screaming. The nurse's station is about 20 feet from the dining area. MDS nurse said she witnessed Resident #1 hit CNA B and so told CNA B to back away. MDS nurse then took Resident #1 to the nurse's station. MDS nurse said she did not know CNA B was the cause of Resident #1s anger. During an observation on 7/28/2023 at 3:30 PM the nurse's station on the 4th floor revealed signage clearly displaying the abuse prevention coordinator's name and instructions on how to notify him/her. During an interview on 7/28/2023 at 2:30 PM CNA C said she had finished feeding residents down the hall and came upon CNA B as she started talking to Resident #1 about touching her sister. CNA C said CNA B said to Resident #1, How would you like it if I did that to your sister? CNA C said Resident #1 went off. CNA C told CNA B she shouldn't say that in front of Resident #1, but it was after he was taken away. CNA C said she was in shock a little bit. CNA C said it was the first time she had seen something like that. CNA C said she didn't realize CNA B was talking to Resident#1 until after CNA B started talking about fucking his sister. CNA C said she notified her charge nurse. CNA C said she knew now to report it to the Administrator. CNA C said In Colorado, we are supposed to report it to our ADON. During iterviews conducted on 7/28/2023 10:30 AM - 5:30 PM with all residents in their rooms during inspection of the 4th floor revealed no complaints with facility or staff. During an interview with the DON on 7/28/2023 at 10:45 it was revealed CNA B had a sister that also worked at the facility. During an interview on 7/28/2023 at 2:20 PM the DON said he found out on 7/25/2023 between 10:30 AM and 10:45 AM that the Resident #1 had been confronted by CNA B. During a review of in-services for abuse and neglect it was revealed staff received training on 7/25/2023, 7/12/2023, 6/12/2023, 5/11/2023, and 1/11/2023. A transcript of training for CNA B indicates she completed training for preventing abuse and managing aggressive behaviors on 4/16/2023 and completed training for quality dementia care on 1/4/2023. During an interview on 7/28/2023 at 2:49 PM the Administrator said breakfast was over at around 9:00 AM on 7/25/2023. She said the DON removed CNA B from the floor and suspended her at around 10:30 AM. CNA B was working on the floor an hour and a half after the abuse occurred. The Administrator said the staff knew they had to call her immediately if abuse occurred. The Administrator said she was notified of the abuse at the same time as the DON. The Administrator said she thought the staff made a conscious decision not to call her immediately, and it was the wrong decision. During an interview with the Administrator on 7/28/2023 at 2:49 PM she said she would make sure CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 6 of 9 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 455575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Nursing and Rehabilitation Center of Morga 2322 Morgan Ave Corpus Christi, TX 78405 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 0607 Level of Harm - Immediate jeopardy to resident health or safety B was reported to the Nurse Aid Registry. During an interview on 8/21/2023 the DON displayed evidence CNA B was reported to the Nurse Aid Registry on 7/8/2023. Record review of facility's policy on abuse (revised December 2017) indicated Abuse was defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Residents Affected - Few Record review of the facility's Abuse Policy dated 8/15/2022 indicated the facility will implement policies and procedures to prevent and prohibit all types of abuse that achieves: Assigning responsibility for the supervision of staff on all shifts for identifying inappropriate staff behaviors Verification of the facility's response to the incident included: Record review: Facility staff training on abuse and neglect, notification of abuse prevention coordinator Investigation report and allegation of verbal abuse confirmed Alleged perpetrator reported to Nurse Aid registry 7/28/2023 Notification to police: case # 2307260117 Review of resident interviews CNA B employee record for completion of training 7/25/2023 Reviewed facility notes Resident abuse interview and observation. Resident #1 denies, (7) total residents all deny abuse. NAR CNA B no issues searched 2/16/23 CNA A abuse training 7/10/23 Elder Abuse 7/21/23 CNA B reported to Nurse Aid Registry 7/28/2023 Interviews: On 8/21/2023 between 2:30 PM and 3:00 PM interviews conducted across 2 shifts that included CNA A, CNA C, CNA D, CNA E, CNA F, CNA G, and CNA H to ensure training was completed. Responses were consistent facility training and policy. Staff able to identify who the abuse prevention coordinator is and can find the number for the abuse prevention coordinator. Observations: Facility observations on 7/28/2023 revealed residents appeared content and no issues were noted (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 7 of 9 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 455575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Nursing and Rehabilitation Center of Morga 2322 Morgan Ave Corpus Christi, TX 78405 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 0607 Level of Harm - Immediate jeopardy to resident health or safety On 08/23/23 at 1:45 pm, the DON (Administrator not on duty) was notified of a Past Non-Compliance Immediate Jeopardy (IJ) had been identified due to the above failures. The IJ template was provided to the DON at this time. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 8 of 9 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 455575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Nursing and Rehabilitation Center of Morga 2322 Morgan Ave Corpus Christi, TX 78405 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility staff failed to maintain a safe environment by leaving electric wires exposed for 2 out of 30 rooms on the 4th floor inspected for electrical hazards. The failure placed residents in room [ROOM NUMBER] and 404 at risk by creating an environment that could shock or electrocute residents. The findings were: During an interview with a on 7/28/2023 at 9:45 AM a complainant said the electric boards had been pulled away from the wall and wires had been exposed in her brother's room. She said a maintenance man told her the nurses were pushing the beds up against the walls and hitting the outlets. During an observation of the 4th floor of the facility on 7/28/2023 at 11:00 AM it was revealed room [ROOM NUMBER] and room [ROOM NUMBER] had surface mounted electrical boxes and metal surface raceways that were damaged and pulled away from the wall with electrical wire clearly visible and accessible. The raceways were approximately 14 inches above the floor. During an interview with the Administrator on 7/28/2023 at 2:49 PM she said the building was old and scheduled to be remodeled soon. She said she would notify maintenance department, have all the rooms checked, and have it repaired. Record review of facilities policy titled Maintenance Service with a revision date of December 2009 reflected under policy statement, Maintenance service shall be provided to all areas of the building, grounds, and equipment . Under policy interpretation and implementation, the policy reflected, Functions of maintenance personnel include .b. Maintaining the building in good repair and free from hazards. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 9 of 9