Inspection·August 31, 2023

F 0656 could cause misinformed communication with Resident #54. Level of Harm - Minimal harm or potential for actual harm Interview on 08/29/23 at 2:25 pm with CNA G and CNA H revealed Resident #54 did have slurred and unclear speech but they were able to understand her because they had assisted her with care for a long time and they understood her when she verbalized her needs to them. CNA G and CNA H said if they didn't understand sometimes, they would ask her to repeat her words. Residents Affected - Few Both CNA G and CNA H staff said that if a new staff would come and provide her with care, they might not be able to understand her. Sometimes other staff from other halls would come to replace them if they were out for some reason. Interview on 08/29/23 at 2:30 pm with LVN E revealed the CNAs that worked regularly with the resident understood Resident #54 better than anyone. LVN E said Resident #54 did have slurred speech and was difficult to understand what she was saying. If a new staff came to assist Resident #54, they would have trouble understanding her slurred speech. The care plans are developed to provide interventions to address the concern. Interview on 08/31/23 at 9:57 am with the DON revealed care plans needed to be developed and interventions implemented to address areas of care concerns. The DON said not developing care plans with interventions for focused areas of concern would place residents at risk of not receiving the necessary care for their individual needs. The IDT team would meet to address areas of concerns as assessed by their MDS assessment. It was his responsibility to ensure the care plans needed to be developed and implemented as needed based on the assessments. The DON said he did not know why the care plan for Resident'#54's focus area of slurred speech had not been developed. Record review of the facility policy titled Comprehensive Person-Centered Care Planning dated January 2022 reflected The facility IDT will develop and implement a comprehensive person-centered care plan for each resident within seven (7) days of completion of the Resident Minimum Data Set (MDS) and will include resident's needs identified in the comprehensive assessment, any specialized services as a result of PASARR recommendation, and residents goals and desired outcomes, preferences for future discharge and discharge plans. The resident's comprehensive plan of care will be reviewed and/or revised by the IDT after each assessment, including both the comprehensive and quarterly review assessments. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 2 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident who was unable to carry out activities of daily living (ADLs) received the necessary services to maintain nutrition, grooming and personal and oral hygiene for 2 of 8 residents (Resident #54 and Resident #11) reviewed for ADLs. Residents Affected - Some 1. The facility failed to ensure Resident # 54 was provided a shower as scheduled. 2. The facility failed to ensure Resident #11 was provided shower or bed bath as scheduled. These failures could place residents at risk for discomfort, and dignity issues. Findings included: 1.Record review of Resident #54's admission record dated 8/31/23 reflected Resident #54 was re-admitted to the facility on [DATE] and was a [AGE] year-old female with diagnosis that included schizophrenia (mental disorder characterized by continuous or relapsing episodes of psychosis) and dysphagia (difficulty in swallowing). Record review of Resident #54's quarterly MDS dated [DATE] reflected Resident # 54 -was cognitive independent -required total dependence on two persons for bathing. -required total dependence on two persons for transfers. -required extensive assistance by two persons for dressing, and toilet use. Interview on 8/28/23 at 2:33 pm with CNA K revealed Resident #54 was bathed on Thursdays and per the schedule. CNA K said she would document the task provided in the computerized ADLs tasks. Interview and observation on 08/28/23 at 2:33 pm with Resident #54 revealed Resident #54 in her bed. Resident #54 stated she had not been showered since last Thursday (08/24/23). Resident #54 was dressed in her gown, clean and hair combed. On 08/29/23 at 2:48 pm CNA G and CNA H said they showered the residents in their hall during their shift at 6:00 am to 2:00 pm on rooms 1 to 7 on Monday, Wednesdays, and Fridays. The second shift from 2:00 pm to 10:00 pm showered the rest of the rooms. Resident #54' s room was in this same hall but on their shift. Record review of the shower schedule (undated) reflected Resident #54's bathing schedule was Monday, Wednesdays, and Fridays in the afternoon shift, 2:00 pm to 10:00 pm. Record review of the computerized ADL tasks dated 08/18/23 to 08/31/23 reflected Resident #54 had not received a shower on Friday, 08/18/23, Monday 08/21/23 and Friday, 08/25/23 and Wednesday 08/08/23 as scheduled. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 3 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0677 Level of Harm - Minimal harm or potential for actual harm 2. Record review of admission record for Resident #11 reflected Resident #11 had been re-admitted to the facility on [DATE], was an [AGE] year-old female with diagnosis that included need for assistance with personal care and cognitive communication deficit (difficulties with thinking.) Record review of the quarterly MDS dated [DATE] for Resident #11 reflected Residents Affected - Some -was cognitively impaired -required total dependence on two persons for bathing. Record review of the care plans for Resident #11 reflected Resident #11 had impairment to skin integrity r/t rash to upper back and all affected areas, date initiated, 08/18/23. Interview on 08/30/23 at 1:35 pm revealed Resident #11's RP L was visibly upset that no one had bathed Resident #11 since the previous week. Resident #11's RP L said she had told a staff member that she wanted Resident #11 to be bathed in the morning and not in the afternoon as she had been scheduled previously. Interview on 08/30/23 at 1:32 pm with CNA A revealed she worked from 6:00 am to 2:00 pm. CNA A said no one had told her to bathe Resident #11 in the mornings. Resident #11 was a Hoyer lift for transfers and had to be assisted by two persons. CNA A said if she was working by herself, she had to find another staff from another hall to assist with showers. CNA A said she might have not provided baths to Resident #11 and when she did, she would document in the computerized ADL tasks. Record review of the shower schedule for Resident #11 reflected Resident #11 was to be bathed on Mondays, Wednesdays, and Fridays in the afternoon shift, from 2:00 pm to 10:00 pm. Record review of the computerized ADL tasks for Resident #11 from 08/17/23 to 08/30/23 reflected Resident #11 had not been provided with a bath on Friday 08/18/23, Wednesday 08/23/23, Friday 08/25/23 and Wednesday 08/30/23 as of 08/30/23 at 3:04 pm as scheduled. Resident #11 had received a sponge bath on Monday 08/28/23. Record review of Grievance Resolution Forms for Resident #11 reflected three grievances had been completed by Resident #11's RP L. -grievance form dated 03/14/23 reflected RP concerned resident had not been showered. Resolution reflected the shower days would be moved to morning shift, signed by the facility Administrator. -grievance form dated 05/09/23 reflected RP L concerned that resident was not being showered. Resolution reflected the resident showered. The grievance form was signed by the facility Administrator. -grievance form dated 06/12/23 reflected RP L concerned resident not showered and questioned the cream application. Resolution reflected a shower aide program initiated, resident showered, shower schedule moved to mornings as requested by RP. The grievance form was signed by facility Administrator. Interview on 08/31/23 at 9:57 am with the DON revealed he had several conversations with Resident #11's RP L about the resident not getting any showers. The DON said he implemented a shower aides' program that was not effective in that shower aides quit recently, and the program had been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 4 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some discontinued. The DON said as of 08/09/23, the CNAs on the floor were responsible to provide showers to the residents in their halls according to the shower schedule. The CNAs should document on the computerized ADLs tasks when they provide showers or residents refuse. The DON said the charge nurses were responsible to ensure CNAs provided showers to residents as scheduled. The DON said that Resident #11's RP L had requested to provide showers to Resident #11 and had not been scheduled as she requested. The DON said he was responsible to ensure the charge nurses checked to see if residents were getting their scheduled showers. Record review of the facility policy titled Quality of Care dated July 2017 reflected It is the policy of this facility that residents are given the appropriate treatment and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. If a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming, toileting, and personal oral hygiene will be provided by qualified staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 5 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that each resident received adequate supervision for one Resident (Resident #218) of three residents reviewed for supervision. The facility failed to ensure Resident #218 received two-person assist when providing incontinent care. This failure could place residents at risk for accidents and injury. The findings were: Record review of Resident #218's face sheet dated 8/30/23 revealed a [AGE] year-old female with an admission date of 7/31/23 and diagnoses which included: Stroke, peripheral vascular angioplasty status (a procedure to help blood flow better), and chronic kidney disease (longstanding disease of the kidneys leading to renal failure). Record review of Resident #218's admission MDS assessment dated [DATE] revealed she required extensive assistance/two person physical assistance for bed mobility, dressing, and toilet use. Resident #218 was always incontinent of bowel and bladder. Record review of Resident #218's Care Plan dated 08/21/23 revealed she required assistance extensive to: wash hands, adjust clothing, clean self, transfer onto toilet, transfer off toilet, to use toilet. Resident #218 required 1-2 staff participation to reposition and turn in bed. Observation on 08/28/23 at 10:10 a.m., revealed Resident #218 requested to be changed. CNA B came in to change the resident. In an interview on 08/30/23 at 08:55 a.m., Resident #218 stated 2 people would get her up to put her in her wheelchair. Resident #218 stated sometimes two people would come in to change her and sometimes only one person would come in to change her. Resident #218 stated she needed changed at this time, and pressed her call light (09:07 AM). Observation on 08/30/23 at 09:07 a.m., revealed CNA A answered Resident #218's call light and Resident #218 told CNA A she needed changed (her brief was soiled). CNA A left Resident #218's room to gathered the supplies needed to change the resident. Observation on 08/30/23 at 09:09 a.m., revealed CNA A entered Resident #218's room to change Resident #218. Resident #218 asked surveyor to leave the room so she had privacy during incontinent care. Observation on 08/30/23 at 09:14 a.m., revealed CNA B entered Resident #218's room where CNA A was changing Resident #218's brief. Observation on 08/30/23 at 09:18 a.m., revealed CNA A and CNA B left Resident #218's room. In an interview on 08/30/23 at 09:20 a.m., CNA B stated one person could change Resident #218. CNA B stated on Monday (August 28, 2023) when the surveyor was talking with Resident #218 and Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 6 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #218 had asked CNA B to change her soiled brief, CNA B stated she changed her by herself. CNA B stated Resident #218 can move so she (CNA B) can change Resident #218 by herself. CNA B stated the CNAs can find in Tracker (CNAs computer system where they check for care and document care) how many persons had to assist a resident for changing. Surveyor observed Tracker as showing 2 person assistance required for toileting Resident #218. CNA B stated she just went into Resident #218's room to help CNA A pull Resident #218 up in the bed, but CNA A was the one who changed Resident #218. CNA B stated if a resident was a 2 person assist for changing and 1 person only changed a resident, either the CNA or the resident could get hurt. In an interview on 08/31/23 at 12:43 p.m., CNA A stated yesterday (08/30/23), she changed Resident #218 by herself, and CNA B had come to help at the end of the care. CNA A stated if a resident was dirty she would clean them and not leave them dirty. CNA A said lots of times she was on the hall by herself and would not have help. CNA A stated she sometimes will call for someone to help her if she sees them in the hall. CNA A stated if a resident was a two person assist and only one person assisted, either the CNA or the resident could get hurt. CNA A stated Resident #218 was able to move in the bed, so she (CNA A) had changed Resident #218 by herself. In an interview on 08/31/23 at 02:04 p.m., LVN E stated when a CNA would come to say they need help, LVN E stated if he was not in the middle of something, his cart was locked, and everything was good, he would go with the CNA to assist with whatever they needed. LVN E stated for mornings, like today (08/31/23), there were eight CNAs and one CNA in training working on the floor. LVN E stated he thought that was enough staff to be working at that time. In an interview on 08/31/23 at 02:50 p.m., the DON stated CNAs would come ask him for help if they needed it and he would go assist them. The DON stated he told CNAs to ask for help if they would have a heavy resident. The DON stated CNAs could also go to their kiosk or POC (computer used by the CNAs) to check how many people would be needed to assist the resident. The DON said nurses would look first at the MDS for how much assist a resident needed for ADLs. The DON stated they would then check the resident's care plan, but the first check would be MDS. DON stated the negative outcome for a CNA or resident using a one person assist on a resident instead of two person assist could be improper care, falls or injury. Review of facility's policy titled Nursing Services Quality of Care, revised 07/2015, revealed: Policy: It is the policy of this facility that residents are given the appropriate treatment and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. Procedures: 1. Maintenance and restorative programs will be provided to residents in accordance with the resident's comprehensive assessment 6. ADL care, including personal hygiene, oral care, transfers, grooming, dressing, mobility, ambulation, etc. provided according to resident's assessed needs and level of support. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 7 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents fed by enteral means received the appropriate treatment and services to prevent complications of enteral feedings for 1 (Resident #267) of 6 residents reviewed for enteral nutrition, in that: The facility failed to appropriately label the formula bag for Resident #267 per the facility's policy. This failure could affect residents receiving enteral nutrition/hydration and place them at risk of health complications and decline in health. Findings included: Record review of Resident #267's face sheet revealed the resident was [AGE] year-old female admitted on [DATE] with a diagnosis that including unspecified sequelae of cerebral infarction, heart failure, and gastrostomy status. Record review of Resident #267's quarterly MDS dated [DATE], revealed a BIMS at not able to conduct interview. The assessment reflected Resident #267's required total dependence with eating, and is bed bound. Resident #267's the resident's nutritional approach was feeding tube. Record review of Resident #267's care plan revised dated 08/27/2023 revealed requires tube feeding r/t dysphagia aphasia. Goal: Will be free of s/sx of infection through the review date. Care plan created 08/22/2023 revealed potential nutritional problem r/t gastrostomy status. Goal: Will maintain adequate nutritional status as evidenced by maintaining weight with no s/sx of malnutrition through review date. Record review of Resident #267's physician's order revealed Jevity 1.5 @ 50ml/hr and H2O 150ml every 6 hrs. Observation 08/28/23 at 2:28 PM revealed Resident #267 was asleep, lying-in bed. Observed a feeding pump next to Resident #267. The feeding pump was infusing at 50ml/hr and flush is set at 150ml every 6 hrs. A bag of enteral feeding was hanging from the pole with no formula name, time, date, and initials of who administered the feeding. The surveyor observed the formula bag had about less than half left inside. A bag of water was hanging on the other side of the pole with a label. Interview on 08/28/23 at 2:35 PM with LVN I, he stated he was the nurse for Resident #267. LVN I was informed the formula bag had no formula name, time, date, or initials. LVN I was unaware Resident #267's formula bag was not labeled. LVN I stated he had just came on shift 45 minutes ago. He stated LVN J was the previous nurse. LVN I stated they did bedside report during shift change. LVN I stated he did not go into Resident #267 room today, 08/28/23. Interview on 08/28/23 at 2:50 PM with LVN J, he stated he was nurse for Resident #267. LVN J was informed the formula bag had no formula name, time, date, or initials. LVN J stated she had clarified with the DON and ADON, that since bags came together as a dual bag with only one label then it was okay to put label only on one bag. LVN , stated that one label would have both information for water (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 8 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0693 and feeding. Level of Harm - Minimal harm or potential for actual harm Observation on 08/28/23 at 02:58 PM revealed LVN I held the completed label up which included, formula name, date, and initials. He showed it to LVN J and LVN I proceeded to walk into Resident #267's room to apply label on formula bag. Residents Affected - Few Interview on 08/30/23 at 02:00 PM the DON stated the formula bag and water bag should be labeled individually. The DON stated formula bags were labeled as a precaution. The DON stated the double bags also needed to be labeled individually. Interview on 08/31/23 at 11:50 AM ADON L stated she had been working at the facility for 14 years. ADON L stated she monitors staff every morning. She also does the annual skill checks on nurses. ADON L stated she does rounds with new hires. She stated the feeding formula bags come with one sticker but are now encouraging nursing staff to label both the formula bag and water bag individually. The surveyor asked when did the facility start to encourage this, and the ADON stated she was not sure of when it was initiated. Record review of the Enteral Feeding Administration Pump facility policy revised 05/2007 revealed #2 Label bag with formula, residents name, amount, date, time and initials. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 9 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to establish and maintain an infection prevention and control program, designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, for one resident (Resident #126) observed for incontinent care, in that: Residents Affected - Few CNA C did not use one wipe per swipe on the perineal and buttock area during incontinent care on Resident #126. CNA C did not change her gloves during incontinent care for Resident #126. CNA C did not wash her hands before leaving Resident #126's room after performing incontinent care. These failures could place residents at risk for infections and cross contamination. The findings included: Record review of Resident #126's Face Sheet dated 08/31/23, reflected a [AGE] year old male admitted to the facility on [DATE], with diagnoses that included local infection of the skin and subcutaneous tissue (layer of tissue that underlies the skin), Extended Spectrum Beta Lactamase (ESBL) Resistance (enzymes that are resistant to most beta-lactam antibiotics including penicillin, cephalosporins, and the monobactam aztreonam), resistance to vancomycin (vancomycin is an antibiotic used for abscesses, wounds, or peritonitis), sacral stage 4 pressure ulcer (full thickness skin loss with extensive destruction; tissue death); or damage to muscle, bone, or supporting structure such as tendon, or joint capsule below the lumbar spine and above the tailbone), right hip stage 4 pressure ulcer, and left hip stage 4 pressure ulcer, feeding tube, colostomy (a surgical operation in which a piece of the colon is diverted to an artificial opening in the abdominal wall so as to bypass a damaged part of the colon), tracheostomy (an opening surgically created through the neck into the windpipe to allow air to fill the lungs). Record review of Resident #126's Quarterly MDS dated [DATE], revealed Resident #126's cognitive status was severely impaired, he was totally dependent with two-person assistance for bed mobility, dressing, and toilet use, was totally dependent on one person assistance for eating and personal hygiene. Record review of Resident #126's Care Plan dated 08/13/23, revealed Resident #126 had ADL (Activities of Daily Living) self-care performance deficit related to totally dependent on staff secondary to anoxic brain injury (caused by a complete lack of oxygen to the brain, which resulted in the death of brain cells after approximately four minutes of oxygen deprivation). Resident #126 was totally dependent on 1 -2 staff for personal hygiene and oral care. Resident #126 was on hospice. Record review of Resident #126's Weekly Skin assessment dated [DATE] revealed Sacral Stage 4 Pressure Ulcer measurements: 13cm (L) x 11cm (W) 30% slough 30% red skin to bone. Right hip Stage 4 pressure ulcer measurements: 6cm (L) x 8 cm (W) x 1.5cm (D) 70% red 30% yellow, undermining 2.5 cm. Left hip Stage 4 Pressure Ulcer measurements: 7cm (L) x 6.5cm (W) x 2cm (D) undermining 2cm. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 10 of 11 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 455586 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Terrace Rehabilitation and Healthcare 812 W Houston Ave 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 08/31/23 at 03:46 p.m., during incontinent care on Resident #126, revealed CNA C washed her hands for 45 seconds when she entered the resident's room and put on gloves. During incontinent care CNA C used one wipe, wiping twice on the area between Resident #126's scrotum and left leg. CNA C then used one wipe, wiping four times on Resident #126's left buttock area wiping over the dressing of the left hip pressure ulcer. CNA C used one pair of gloves for incontinent care, not changing her gloves. CNA C removed her gloves after performing incontinent care on Resident #126 and left the room. CNA C did not wash her hands before leaving Resident #126's room. In an interview on 08/31/23 at 04:30 p.m., CNA C stated one wipe should be used for one swipe. CNA C stated she used new gloves two times, when she went in the room and when she left Resident #126's room for incontinent care. CNA C stated she was supposed to change her gloves because if she did not change her gloves during pericare, she could contaminate more. CNA C stated she was supposed to wash her hands when she entered the room and when she left the room. CNA C stated she washed her hands in another room after she left the resident's room. In an interview on 08/31/23 at 04:36 p.m., CNA D stated one wipe for each swipe should be used during incontinent care. CNA D stated when one removed their gloves, one should use hand sanitizer, and then put new gloves on. CNA D stated when gloves are soiled one should wash their hands and one should wash their hands when entering the room, if gloves are visibly soiled, and before one exits the room. CNA D stated if one did not do those things, one could cause cross contamination. In an interview on 08/31/23 at 06:00 p.m., the DON stated when performing incontinent care one wipe was to be used for each swipe. The DON stated gloves are to be removed when dirty or visibly soiled and hands are to be washed when entering the room, when gloves/hands are visibly soiled, and before leaving the room. The DON stated when that was not done, there was a risk for infection or cross contamination. When surveyor asked DON for policies on incontinent care and hand hygiene, surveyor was given the following policy: Review of the facility's policy/procedure - Nursing Clinical Routine Procedures Incontinent Care (not dated) revealed: Procedure: 4.D. Cleanse perennial/rectal area and doff gloves. E. Wash hands/perform hand hygiene, don gloves and then apply a new brief. F. Remove gloves and perform hand hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455586 If continuation sheet Page 11 of 11