Inspection·December 16, 2023

F 0689 indicated a moderate risk. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #1's progress note dated 12/02/23 at 5:55 a.m., written by LVN A indicated, the resident was documented to be pacing throughout the hallways and digging through the trash. Resident became agitated. Yelling at nurse, I'm not doing anything, I'm just playing with this, it's nothing, upon closer inspection resident had a small bag with white powder like substance stuffed into the connection tubing. Questioned resident what he has, resident took out the small bag from the tubing and threw it in cup writer had in her hand. Residents Affected - Few Record review of Resident #1's progress note dated 12/03/23 at 4:37 a.m., written by LVN B indicated the resident was documented to have come out of his room on the 2nd floor with all his belongings in his arms and stated he needed the front door open, and I'm going to leave to my friend's house for the night so I can get cigarettes and my lighter, I will be back He became agitated and started to yell out at nurse I just need a hit, I need to leave the f***ing place Record review of Resident #1's progress note dated 12/03/23 at 10:07 a.m., written by MDS Coordinator, indicated the resident was asking to leave the facility unsupervised to get fresh air and cigarettes. Noted delusions and flight of idea, consistent with schizophrenia dx. Record review of Resident #1's progress note dated 12/06/2023 at 3:06 a.m., written by LVN A indicated resident wandering most shift looking for food, resident noticed by staff digging in trashcan in kitchenette area, this nurse advised by staff that resident trying to leave out front door with visitors leaving facility. Record review of Resident #1's progress note dated 12/09/2023 at 8:11 a.m., written by LVN C, Approximately 7:30am I received a call from CNA stating that the resident was on [NAME] near the pawn shop by [a Restaurant] . I told her I would be right there, notified CMA and she followed me to the [NAME] Mar Multiservice Center on Ayers. I saw resident walking on the sidewalk . Record review of Resident #1's Against Medical Advice Form dated 12/09/2023 documented, this is to certify that I, Resident #1, a patient at Windsor Nursing and Rehabilitation Center of Morngan, am refusing at my own insistence and without the authoirity of and against the advice of my attending physician [physician] request to leave against medical advice. The medical risks/benefits have been explained to me by a member of the medical staff and I understnad those risks. I hereby release the medical center, its administration, personnel, and my attending and/or resident physician(s) from any responsibility for all consequences, which may result by my leaving. Signed Resident #1 date:12/09/2023. Witness: facility staff member signature. Interview with Resident #1 was attempted on 12/16/2023 at 12:03p.m. but was unsuccessful. During an observation on 12/16/2023 at 12:10 p.m., observed the main entrance door's alarm engage at the 10 second mark when a wander guard crossed door threshold and entrance door was pushed , the alarm was loudly audible. Resident #1 discharged himself from facility on the morning of 12/09/2023 and against medical advice. During an observation on 12/16/2023 at 12:12p.m., observed three unidentified residents in the outside patio being supervised by a CNA. During an observation of resident #1, #2, #3, #4, #5 who were identified as high risk for elopement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 2 of 6 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 12/16/2023 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and wore wander guard devices on 12/16/2023 at 12:20p.m. revealed they were all located at the first floor lobby area being monitored by Administrator and DON. During an interview 12/15/2023 at 2:51 p.m., the MDS Coordinator stated Resident #1 was not at facility long, and was admitted on [DATE], discharged [DATE], and was there for approximately 19 days. Resident #1's verbalized requests to leave, to leave for cigarettes, request to sleep at friend's place, and frequent flight of ideas would be implemented into a comprehensive care plan on the 21st day per state regulations. When asked about what would happen in-between if an incident/or behavior occurred, the MDS Coordinator stated the event and behaviors would be on a 24hr report, and verbalized to the clinical staff a midst shift report, who would then use their nursing expertise to implement common interventions i.e., redirection, or activities. The MDS coordinator stated the verbalized previously mentioned requests would not be implemented into the baseline care plan due the attempt to understand Resident #1's wants and needs before prematurely care planning the behavioral events. MDS stated due to wander assessment, she did not find it appropriate to use wander guard on Resident #1 due to low-moderate score and because Resident #1 was his own RP. Referencing progress note on 12/03/23 at 10:07 a.m, MDS Coordinator stated, she de-escalated and redirected Resident #1, and offered donation cigarettes, Resident #1 was then okay after. MDS Coordinator stated she attended an in-service on 12/11 regarding procedure with a resident goes missing. The MDS Coordinator stated the baseline care plan is done with 48 hours and encompasses immediate needs, and reiterated she knows state regulation only requires a baseline care plan within 48hours, and a comprehensive care plan by the 21st day after admission, as well as reiterated she is not mandated to update care plan prior to the 21st day after admission. During an interview on 12/15/2023 at 3:31 p.m., LVN A stated she remembered taking care of Resident #1, and remembered he was confused. LVN A stated Resident #1 would wander and not remember where he was, like he had dementia. LVN A stated she recalled one evening CNA A notified her that Resident #1 was found downstairs trying to leave and was notified that his reason for trying to leave was to go to the store. LVN A stated on 12/6 she kept a closer eye on Resident #1 and when she questioned Resident #1 why he was trying to leave, Resident #1 stated he wanted to get cigarettes. LVN A stated she was notified Resident #1 left when visitors would leave. LVN A stated she implemented diversional activities of puzzles, and activities to keep him engaged, but nothing to keep him hostage. LVN A stated after the redirection Resident #1 did not attempt to leave. LVN A stated she does not recall being notified of Resident #1's attempts to leave the facility in nurse-to-nurse report and is not part of morning clinical meetings due to being a night shift nurse. LVN A stated when CNA A notified her of Resident #1's attempt to leave, that she had a plan in place if Resident #1 attempted to leave again she had a wander guard in the nurse's cart that she would use but did not have to use. LVN A stated nobody ever voiced to her any desire to leave. LVN A stated she verbalized when she was amongst a CNA and an unknown nurse, that if Resident #1 tried to leave, after his first attempt, that she would have retrieve a wander guard that is kept in the nurse's cart and apply it to Resident #1. LVN A stated had Resident #1 presented an elevated behavior, she was prepated to de-escalate the situation and redirect and re-educate resident on the importance of maintaing safety within the facility. During an interview on 12/15/2023 at 3:50 p.m., LVN B stated Resident #1 was his own responsible party, and on 12/03/2023 around 3am Resident #1 came out of his room with all his clothes and stated he wanted to go to his friend's house to get high and get cigarettes. LVN B stated Resident #1 had schizophrenia and may have been his cause of agitation on 12/03/2023. LVN B stated after Resident #1 made the additional issue of not feeling comfortable with living with his roommate, LVN B moved Resident #1 to a different room. LVN B stated Resident #1 was not actively trying to exit or get out. LVN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 3 of 6 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 12/16/2023 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few B stated Resident #1 was wanting to leave to get a cigarette and wanted to get high and wasn't trying to physically leave just voiced that he wanted to leave. LVN B stated Resident #1 was in the middle of the second-floor dining area, and had a couple pants in hands, and voiced that he wanted to go right now, then began to yell, and just needed a hit around 3am in the morning. LVN B stated she was taught to first de-escalate the situation and redirected for Resident #1 to return to room, to which he did, and was okay after. LVN B stated she was not notified of Resident #1 wanting to leave previously any time before shift. LVN B stated had she been notified of Resident #1's desire to leave, it would have triggered her to read the progress notes and monitor him for trying to leave. LVN B stated she attended an in-service regarding procedure when a resident goes missing. During an interview on 12/15/2023 at 6:00 p.m., CNA A stated on 12/06/23 around 10-11PM, she heard the downstairs door alarm sounding off and went to go and investigate/turn off the alarm. CNA A stated once out of the elevator she was walking through to the main entrance door, and saw Resident #1 returning from outside, back to entrance door. CNA A stated she asked Resident #1 how he got outside, and he stated that he walked behind a visitor, and was coming back to get his cigarettes. CNA A stated she then escorted Resident #1 back upstairs and notified the nurse taking care of Resident #1. CNA A stated she observed Resident #1 in his room on the evening of 12/08/2023 at around 11:30p.m. and was the last time she saw the resident due to having other residents to attend to. During an interview on 12/16/2023 at 12:16p.m., the DON and Administrator both stated Resident #1 eloped between the night of Friday 12/08/2023 into Saturday 12/09/2023 morning. Both stated on the evening of Friday 12/08/2023 around 11:30p.m. a CNA offered Resident #1 a snack, and upon a midnight round around 12:40a.m on 12/09/2023, Resident #1 was noted to not be in his room nor facility. Both stated the facility notified the police department but were notified that the police department would not look for Resident #1 because he was of sound mind. Both stated, around 7am on 12/09/2023, two facility staff members located Resident #1 at the corner of a restaurant that was approximately 1.3miles away. Both stated, the two facility staff members attempted to persuade Resident #1 to return to the facility but were unsuccessful, and under the direction of the DON, Resident #1 was given an Against Medical Advice form to sign, which meant he was choosing to discharge against medical advice. Both stated, during a 24-hour clinical report clinical meeting, Resident #1's wandering and trash digging were discussed and were deemed as behaviors indicative of Resident #1's history of homelessness and planned to have snacks readily available for Resident #1 as well as have cigarettes for him. Both stated Resident #1's verbalized desire to sleep over at a friend's house, and leave were behaviors indicative of drug seeking but planned through redirection and re-education from facility staff to care for Resident #1. Both stated, Resident #1 did not have order to be out on pass due to drug seeking behavior. When the DON and Administrator were questioned about the plan of care for Resident #1, and what plan they had in place to ensure the safety of Resident #1's behaviors of drug seeking, sleeping over at a friend's house, wandering, and trash digging both replied, the staff would use in conjunction with the 24-hour report, redirection, and re-education to care for Resident #1. Both stated additionally, Resident #1's wander assessments were discussed within a morning clinical meeting, and with the MDS Coordinator, did not find it appropriate to implement a wander guard onto Resident #1's person, given that his assessment scores were low to moderate and was his own RP. The Administrator stated after Resident #1's successful elopement on 12/09/2023, they changed the door alarm system from 15seconds to a 10 second delay followed by alarm engagement. The DON and Administrator stated after 8p.m. all first floor exiting doors will alarm if engaged, and the alarm will continue to alarm until a staff member inputs a code. Both stated on 12/06/2023 during the day, Resident #1 did not exit the facility, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 4 of 6 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 12/16/2023 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and continued by stating, they were notified by staff that as a facility staff member was holding the door open for visitors to leave on 12/06/2023, the staff member caught Resident #1 attempting to leave behind the visitors but was kept from leaving by staff member. Both stated, the drug seeking behaviors, the verbalization to leave, the wandering and trash digging, would be on the comprehensive care plan, but reiterated that they knew the state legislation regarding care plans, and did not have to have a care plan before the 21 days. When the DON and Administrator were asked what their process would be if an event or issue occurred prior/ in between the 21 days, the Administrator stated they would monitor Resident #1, as well as stated the facility could actively have a working care plan but did not have, and again reiterated they knew state regulations, and knew the facility did not have to have a care plan till the 21st day after the admission of Resident #1. Record review of the facility's Elopement drill L code [NAME] Missing Resident conducted 12/11/2023 Record review of the facility's in-service indicated If a residence presence is unknown, alert all personnel including the DON and Administrator. All the police, alert the administrator and designate staff to search for the resident in-service conducted on 12/09/2023. - Inservice Missing Resident: 1. Ensure resident is not on floor in another room, shower room, bathroom, etc . 2. Once sure resident not on floor or on downstairs lobby, page overhead Code green- (floor number) 3. Nurses immediately do head count of resident and ensure all resident accounted for 4. Call to floor with code and find out what resident missing 5. Initiate search party of neighborhood 6. Nurse to check medication list for life-saving medications 7. Notify Administrator and DON and on call of missing resident and time lifesaving medication is due to be administered 8. Notify physician, RP, and CCPD with description and picture of resident 9. Figure out how resident eloped from facility and ensure all doors closing and alarms sounding. Record review of the facility's AdHoc QAPI Meeting date 12/09/2023. Issue: Resident who exhibited wandering behavior x 2 eloped on 12/09/2023. Plan: Re-educated staff on elopement protocols, care planning and intervening if a resident is exhibiting wandering tendency Review nurses notes and 24hr report daily for any resident exhibiting wandering behaviors. Complete elopement drills per P&P Alarm on door to stairwell reactivated and will be monitored by maintenance director and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 5 of 6 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 12/16/2023 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 0689 administration. Level of Harm - Immediate jeopardy to resident health or safety Wander guard system audit completed, alarm system in place and followed per protocol. Record review of the facility's How to check wander guard with tested to ensure its functioning properly in-service conducted 12/11/2023. Residents Affected - Few Interviews with the following staff revealed they received in-service training re: Elopement drill L code [NAME] Missing Resident, If a residence presence is unknown, alert all personnel including the DON and Administrator. All the police, alert the administrator and designate staff to search for the resident, How to check wander guard with tested to ensure its functioning properly , and Procedures for Elopements and Wandering Residents, and were knowledgable and able to verbalize the procedures correctly by: MDS Coordinator on 12/15/2023 at 2:51p.m., LVN A on 12/15/2023 at 3:31p.m., LVN B on 12/15/2023 at 3:50p.m., CNA A on 12/15/2023 at 6:00p.m., and DON and Administrator on 12/16/2023 at 12:16p.m. Record review of the facility's Elopements and Wandering Residents date implemented 11/21/2022 revealed, Monitoring and Managing Resident at Risk for Elopement Or Unsafe Wandering c. Interventions to increase staff awareness of the resident's risk, modify the resident's behavior, or to minimize risks associated with hazards will be added to the resident's care plan and communicated to appropriate staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 6 of 6