Inspection·November 8, 2024

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 observations, interviews, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 1 (room [ROOM NUMBER]) of 5 rooms reviewed for environment. The facility failed to ensure the facility was in good repair as the facility did not repair gaps/holes on the restroom door frame in room [ROOM NUMBER]. This failure could affect all residents, staff, and the public by placing them at risk for diminished quality of life due to the lack of a well-kept environment. The findings included: Observation on 11/01/24 at 10:35 AM revealed room [ROOM NUMBER] in hall 3 had 2 holes on the door frame for the restroom. There was a gap/hole on the outer part of the door frame about 5 inches wide x 4 inches long x 4 inches deep and another gap/hole on the inner part of the door frame about 5 inches wide x 4 inches long x 4 inches deep. The holes were not connected and not able to see to the inside of the restroom through the holes. Observation on 11/08/24 at 10:50 AM revealed room [ROOM NUMBER] still had the holes on the restroom door frame. There were fragments of wood/materials in both holes. The door frame was tapped/hit and nothing came out of the holes. Interview with MN C on 11/08/24 at 11:20 AM revealed MN C said if the staff saw something that they needed to fix, the staff told the maintenance staff or wrote it in the maintenance binder at the nurse's station. MN C said MN D checked the binder daily and if it was something they could not fix, MN D called the contracted companies to fix the issue. MN C said he was not informed of a hole needed to be fixed in room [ROOM NUMBER]. Interview with MN D on 11/08/24 at 12:00 PM revealed MN D said the staff told him of anything that needed to get fixed. MN D said they tried to fix the issue that same day and if it was something he could not fix, he called the companies the facility used. MN D said the staff told him verbally and if not documented the issue on the binder at the nurse's station. MN D said he checked the binder daily. MN D said he had not been informed about anything needed to get fixed in room [ROOM NUMBER]. MN D said it was important to keep the building safe and functional in order to ensure the residents were safe. MN D said they tried to maintain the facility as best as they could to provide a nice, odor free, home environment for the residents, family, and staff, but most importantly for the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 455586 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 11/08/2024 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)