Inspection·November 21, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that included measurable objectives and time frames to meet a resident's medical, nursing, and mental and psychosocial needs, for 1 (Resident #4) of 5 residents reviewed for care plans.The facility failed to develop a comprehensive person-centered care plan for Resident #4 to address the use of a fall mat.This failure could place the residents at risk of not receiving appropriate interventions and care to meet their current needs.Record review of Resident #4's face sheet dated 10/21/25 reflected a [AGE] year-old female admitted on [DATE] with diagnoses that included: dementia (decline in cognitive abilities), generalized muscle weakness, other lack of coordination, mood disorder (impacts emotional state), type 2 diabetes (high levels of sugar in blood), and chronic kidney disease. Record review of Resident #4's fall risk evaluation dated 10/02/25 reflected a score of 13 which indicated a high risk. Record review of Resident #4's MDS assessment dated [DATE] reflected Resident #4 had a BIMS score of 2, which indicated severe cognitive impairment. Record review of Resident #4's care plan, dated 10/21/25, reflected, [Resident #4] was at risk for falls related to gait balance problems, incontinence, unaware of safety needs, and wandering. Date initiated: was 03/20/23. Interventions included: call light within reach, encourage the use of call light for assistance, and ensure resident was wearing appropriate footwear. [Resident #4] had an actual fall on 07/28/25 with a laceration to back of head. Date initiated: was 07/28/25. Interventions included: continue interventions on the at-risk plan, monitor for signs/symptoms of pain or new injury for 72 hours, and neuro checks as ordered. [Resident #4] had a witnessed fall on 09/09/25 with a minor skin tear to left elbow. Date initiated: was 09/09/25. Interventions included: monitor for signs/symptoms of pain or new injury for 72 hours, therapy to evaluate, and treatment per orders. [Resident #4] had an unwitnessed fall on 10/02/25 with no apparent injury. Date initiated: was 10/02/25. Interventions included: determine/address causative factors for fall, monitor signs/symptoms of pain or new injury for 72 hours, neuro checks as ordered, and offer activities to distract resident. Resident #4's care plan did not reflect the use of a fall mat. On 10/22/25 at 2:15 PM, an attempted interview and observation with Resident #4, revealed she was not interviewable. Resident #4 did not answer baseline questions or questions related to the incident. Resident #4 laid in bed with the call light within reach. Resident #1 was observed with good personal hygiene, no injury, and not in distress. The bed was at its lowest position. A fall mat was in place next to the right side of the bed. On 10/23/25 at 11:15 AM, in an interview with the ADON, she said Resident #4 had several falls and was at risk for falls. The ADON said she was not sure if Resident #4 had a fall mat or when it was implemented. The ADON said if it was part of the interventions for falls, the fall mat should have been care planned. The ADON said it was important to have the fall mat care planned so staff were aware of the intervention and ensured the fall mat was in place. The ADON said the team ensured the interventions were implemented and care planned. On 10/23/25 at 1:05 PM, in an interview with the DON, she said Resident #4 was at risk for falls. The DON said she did not know if Resident #4 had a fall mat. The DON said if Resident #4 had a fall mat, the fall mat should have been care planned. The DON said it was important to have the fall mat care planned so that staff were aware that Resident #4 needed to have it in place to possibly prevent injury or harm. Record review of Care Plans, Comprehensive Person-Centered Policy dated December 2016, reflected:Policy statement: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455621 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 455621 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Grande Manor 1212 S Bridge Weslaco, TX 78596 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 0656 Level of Harm - Minimal harm or potential for actual harm developed and implemented for each resident. 8. The comprehensive, person-centered care plan will:g. incorporate identified problem areas.13. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455621 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 455621 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Grande Manor 1212 S Bridge Weslaco, TX 78596 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to maintain medical records in accordance with accepted professional standards and practices that were complete and accurately documented for 2 (Resident #4 and Resident #13) of 10 residents reviewed for accuracy of records.LVN E failed to document Resident #4's change of condition for a fall on 09/05/25.LVN F failed to document Resident #13's change of condition for aggressive behavior on 10/10/25.LVN D failed to document Resident #13's vital signs correctly on the change of condition form on 10/14/25 for a fall that occurred on 10/13/25.The DON failed to document Resident #13's vital signs correctly on the change of condition form on 10/21/25 for an incident of aggressive behavior that occurred on 10/10/25.These failures could place residents at risk for errors in care due to inaccurate or incomplete documentation and records. 1. Record review of Resident #4's face sheet dated 10/21/25 reflected a [AGE] year-old female admitted on [DATE] with diagnoses that included: dementia (decline in cognitive abilities), generalized muscle weakness, other lack of coordination, mood disorder (impacts emotional state), type 2 diabetes (high levels of sugar in blood), and chronic kidney disease. Record review of Resident #4's MDS assessment dated [DATE] reflected Resident #4 had a BIMS score of 2, indicating severe cognitive impairment. Record review of Resident #4's care plan dated 10/21/25 reflected [Resident #4] was at risk for falls related to gait balance problems, incontinence, unaware of safety needs, and wandering. Date initiated: 03/20/23. Record review of Resident #4's progress note dated 09/05/25 at 6:54 PM, reflected LVN E was alerted that Resident #4 was on the floor. LVN E ran to the scene where LVN E observed Resident #4 on the floor laying down talking to herself. LVN E assessed Resident #4's vital signs which were within normal limits. RP aware. Resident #4 ate her dinner in the living area with RP by her side. LVN E will continue to monitor for behaviors. 2. Record review of Resident #13's admission record, dated 10/21/25, reflected an [AGE] year-old female admitted on [DATE] and re-admitted on [DATE]. Her diagnoses included Alzheimer's disease (progressive brain disorder that slowly destroys memory and thinking skills), dementia, mild, with mood disturbance (loss of memory, language, problem solving and other thinking abilities which significantly impair a person's ability to perform daily activities with marked disruptions in emotions), dementia, moderate, with agitation, and emotional lability (a rapid and intense change in a person's emotions or mood, typically inappropriate to the setting). Record review of Resident #13's quarterly MDS, dated [DATE], reflected a BIMS score of 00 which indicated severe cognitive impairment.Record review of Resident #13's assessments screen in PCC reflected the only assessment completed on 10/10/25 for Resident #13 was a skin observation tool completed and signed by the DON on 10/13/25. The change of condition form that documented Resident #13's aggressive behavior was in the miscellaneous forms screen and was a handwritten document completed and signed by the DON on 10/21/25 and scanned into Resident #13's EMR.Record review of Resident #13's change of condition form for the incident of aggressive behavior dated 10/10/25 and completed/signed by the DON on 10/21/25 reflected in section B-Vital Signs Evaluation:2. Most recent blood pressure: 133/68; Date: 10/21/253. Most recent pulse: 91; Pulse type: radial; Date: 10/21/254. Most recent respiration: 19; Date: 10/21/255. Most recent temperature: 98.0; Route: Forehead (no contact); Date: 10/21/256. Most recent weight: 129; Scale: Standing; Date: 10/21/257. Most recent O2 sats: 96%; Method: Room air; Date: 10/21/25Record review of Resident #13's change of condition form for her fall dated 10/13/25 at 9:35 PM and signed by LVN D reflected in section B- Vital Signs Evaluation:2. Most recent blood pressure: 142/58; Date: 10/13/25 at 9:35 PM3. Most recent pulse: 85; Pulse type: Regular; Date: 10/13/25 at 12:31 PM4. Most recent respiration: 20; Date: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455621 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 455621 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Grande Manor 1212 S Bridge Weslaco, TX 78596 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 10/13/25 at 12:31 PM5. Most recent temperature: 98.1; Route: Forehead (non- contact); Date: 10/13/25 at 12:31 PM6. Most recent weight: 129; Scale: Standing; Date: 10/21/257. Most recent O2 sats: 99%; Method: Room air; Date: 02/22/25 at 1:04 PM8. Most Recent Blood Glucose: Blood Glucose: 108; Date: 08/27/23 at 9:47 PMOn 10/22/25 at 2:15 PM, an attempted interview and observation with Resident #4, revealed she was not interviewable. Resident #4 did not answer baseline questions or questions related to the incident. Resident #4 laid in bed with the call light within reach. Resident #4 was observed with good personal hygiene, no injury, and not in distress. The bed was at its lowest position. A fall mat was in place next to the right side of the bed. On 10/22/25 at 4:15 PM, in an interview with LVN E, she said Resident #4 was on the floor on 09/05/25, but it was not considered a fall. LVN E said she was down the hall and heard a resident call out for help which was another resident. LVN E said she saw Resident #4 on the floor of another resident's room. LVN E said the other resident told her that Resident #4 went into her room crawling on the floor. LVN E said it was not considered an unwitnessed fall based on what the other resident told her. LVN E said she checked her vitals and they were normal. LVN E said notified the RP and then the RP showed up about 15-20 minutes later. LVN E said notified the doctor. LVN E said she documented a note but did not document that she notified the NP. LVN E verified she notified the NP. LVN E said she did not remember what orders the NP gave at that time, if any. LVN E said she did not complete a change of condition form. LVN E said a change of condition form was done for any change such as fever, falls, skin change, or any change to the resident. LVN E said she did not do the change of condition form for this incident. LVN E said she did not know why she did not do the form. LVN E said she did not do a fall risk evaluation because Resident #4 was not injured. LVN E said she checked Resident #4's eyes which were equal and reactive. LVN E said she did not initiate neuro checks because the other resident was able to say that Resident #4 didn't fall and that she was crawling into the room. LVN E said the other resident was coherent and was able to tell her what happened. LVN E said Resident #4 did not have a head injury or signs/symptoms of a head injury. LVN E said she checked Resident #4's vitals and were no concerns noted. LVN E said she notified the previous DON, but she was no longer an employee.An attempted interview and observation on 10/22/25 at 4:21 PM, revealed Resident #13 was not interviewable. Resident #13 was in her bed with bed in low position and call light within reach. Resident #13 was able to state her name but stated, Ask my husband, when asked if she had fallen while she was at the facility. On 10/23/25 at 9:40 AM, in an interview with FM O, she said Resident #4 had a fall on 09/05/25. FM O said LVN E called her to notify her but they could not exactly say if it was a fall. FM O said LVN E told her that they found Resident #4 in the next room and she was crawling on the floor. FM O said LVN E did not say how Resident #4 ended up on the floor or in the other room. FM O said she did not know other details but Resident #4 was not hurt at that time.On 10/23/25 at 11:15 AM, in an interview with the ADON, she said the new hires watched videos during orientation regarding several topics. The ADON said the staff were in-serviced on falls probably monthly and after every fall. The ADON said staff were instructed to complete a head to toe assessment on the resident, complete the change of condition form, initiate the risk management assessments which included the pain tool, skin assessment for any injuries, details of injury, and fall risk assessment. The ADON said the staff were also trained to notify the doctor, RP, and the DON/ADON. The ADON said the staff were aware that they needed to document all assessments and notes. The ADON said she did not work on 09/05/25, so LVN E would have notified the previous DON who no longer worked at the facility. The ADON said LVN E had been an employee long enough and knew the protocol for the falls as she had been trained during orientation and while on the floor. The ADON said LVN E should have known to assess, notify the doctor, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455621 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 455621 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Grande Manor 1212 S Bridge Weslaco, TX 78596 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete notify the RP, and complete all risk management forms. The ADON said if LVN E was notified by another resident of what happened, LVN E should have still considered the incident a fall since she did not see or know for sure how Resident #4 ended up on the floor. The ADON said another resident may or may not have had the cognitive ability to say what happened. The ADON said LVN E did not document that the doctor was notified or if the doctor gave any orders, nor did she document the assessments for the incident. In reference to Resident # 13, the ADON stated anytime there was a change in condition, the nurse was supposed to document what happened in the progress notes and fill out the change of condition form. She stated LVN F should have done a progress note and a change in condition form done for Resident #13 on 10/10/25 about her incident of aggressive behavior. The ADON stated LVN D should have documented the most recent blood pressure, pulse, respiratory rate, oxygen saturation, and temperature for the change of condition form for Resident #13's fall on 10/13/25 and documenting a blood sugar from 2 years prior was not appropriate for a change of condition assessment.On 10/23/25 at 1:05 PM, in an interview with the DON, she said she reviewed Resident #4's progress notes and read the progress note by LVN E on 09/05/25. The DON said LVN E did not document that the doctor was notified, only the RP. The DON said if LVN E was told Resident #4 was crawling on the floor by another resident, the DON could not say if LVN E should have treated this incident as a fall. The DON said she was not aware of the entire situation. The DON said LVN D, LVN E, and LVN F were trained and in-serviced on falls, what to do for incidents, to identify changes of condition, and initiate the risk management forms which included the pain assessment, fall risk assessment, skin assessment, neuro checks, and change in condition form. The DON stated she was not at the facility at the time of Resident #13's incident of aggressive behavior on 10/10/25, but she got a phone call about it. She stated LVN F was the primary nurse for both residents and she told him when to do the change of condition form for Resident #13 and the other resident when he called, but he did not do them. The DON stated the risk assessments were done on both residents so it triggered for her to look at them and ensure the associated assessments and notes were done. She stated when she saw that the change of condition was not done for Resident #13, she called LVN F, and they did it over the phone. She stated she did the skin assessment on Monday morning 10/13/25 because it had not been done by LVN F on 10/10/25. The DON stated LVN F had not worked in the facility since 10/10/25. The DON said her expectation for nursing staff was to document everything accurately and timely. The DON said if staff failed to document, residents could go without the care needed.Record review of Charting and Documentation Policy dated April 2008, reflected:Policy statement: All services provided to the resident, or any changes in the resident's medical or mental condition, shall be documented in the resident's medical record.3. All incidents, accidents, or changes in the resident's condition must be recorded.6. Documentation of procedures and treatments shall include care-specific details and shall include at a minimum:f. Notification of family, physician or other staff, if indicated. Event ID: Facility ID: 455621 If continuation sheet Page 6 of 6