Inspection·March 20, 2024

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Some A quarterly MDS assessment dated [DATE] indicated Resident #1 had a BIMS (Brief Interview for Mental Status) of 01 which indicated severe cognitive impairment and the resident had not exhibited signs of wandering. Record review of Resident #1's care plan, undated revealed, Resident #1 was at risk for elopement related to impaired safety awareness, impulsiveness, and poor insight due to dementia. A record review of Resident #1's progress notes dated 3/11/2024 indicated Resident #1 attempted to elope had refused care from staff. The Resident's representative expressed the recent increase of behaviors was due to increase of family member visits. A Record review of Resident #'1s progress notes dated 3/18/2024 indicated Resident #1 was on one-to-one monitoring due to exit seeking behaviors and elopement risk. The resident's representative was contacted on 3/18/2024 and approved transfer to a different facility. Record review of Resident #1's progress note dated 3/18/2024 at 9:10 a.m., reflected the resident was on a 1:1 (a 1:1 is where a staff member stays with a resident and does not allow the resident out of eyesight) and remained on a 1:1 until discharge, thus keeping the resident safe until other arrangements were made for Resident #1. Record review of Resident #'1s progress notes on 3/19/2024 and 3/20/2024 indicated transfer of Resident #1 but did not reflect a reason for the transfer. Record review of Resident #1's nursing progress notes dated 3/19/2024 indicated the Ombudsman was informed about the transfer, however, Resident #1 was transferred on 3/18/2024. During an interview on 3/19/2024 at 2:02 p.m., the Social Worker stated he drove to Resident #1's family members home to inform her of the transfer of Resident #1 and stated at first the family member did not agree but after being told they had 5 days to find Resident #1 a place to go if they did not accept this transfer, the family member agreed. During a phone interview on 3/19/2024 at 3:42 p.m., with the Nurse Practitioner, he/she stated it was a risk to the other residents to keep Resident #1 in the facility and stated staff had expressed the need for Resident #1 to be transferred due to Resident #1's high risk of elopement. The Nurse Practitioner stated he/she was not aware of the facility's internal policies or process for discharging Resident #1. The Nurse Practitioner stated the facility could not provide 30 days of 1:1 care for Resident #1. During an interview on 3/20/2024 at 1:35 p.m., the Administrator stated Resident #1 needed urgent medical care and this met the exemption to provide a 30-day notice for discharge because the facility could not provide the level of care, Resident #1 needed due to his attempts to elope. Record review of facility's Transfer and Discharge policy dated 10/13/2022 stated, a notice must be provided at least 30 days prior to a facility-initiated transfer or discharge of the resident. Exceptions to the 30-day requirement apply when the transfer or discharge is effected because: the health and/or safety of the individuals in the facility would be endangered due to the clinical or behavioral status of the resident; the president's health improves sufficiently to allow a more immediate transfer or discharge; an immediate transfer or discharge is required by the resident's urgent medical needs; or a resident has not resided in the facility for 30 days. The facility's Transfer and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 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 455575 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/20/2024 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 0623 Level of Harm - Potential for minimal harm Discharge policy also included verbiage stating, documentation of the reason for transfer or discharge and the necessity for the resident's welfare and the needs that cannot be met in the facility, and the service available to meet the needs will be documented in the resident's medical record. And in exceptional cases a notice must be provided to the resident, the resident's representative if appropriate, and the Long-Term Care Ombudsman as soon as practicable before the transfer or discharge. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455575 If continuation sheet Page 3 of 3