Inspection·February 23, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the hospital and was not provided with a copy of the Bed Hold Policy. Resident #1 went to the hospital and was told that he had three days in which he could come back and still be accepted to the facility. Resident #1 went to the hospital on a Friday, and he returned on a Monday but was told he no longer had a bed available. Ombudsman said she assisted Resident #1 to appeal the discharge and the judge made the decision that the discharge should be reversed, and Resident #1 could then return to the facility. The Ombudsman said the judge signed the order on December 15th and Resident #1 still has not been returned to the facility. Interview with the facility SW on 02/21/24 at 2:57 PM revealed the SW said Resident #1 had a life-threatening infection and the doctor gave orders to send to the hospital. The SW said Resident #1 refused to go to the hospital and they were finally able to convince him to go. The SW said they explained about the bed hold and Resident #1 said he could not pay for the bed hold. The SW said Resident #1 was told if the hospital released him within three days, he would be able to return to his room. The SW said Resident #1 came back a day early, but he did not have any doctor's orders because he left the hospital AMA. Resident #1 was insisting the facility accept him back, but they told Resident #1 they could not admit him until they had doctor's orders. The doctor would not give orders because he left the hospital against medical advice. The Resident finally agreed to go back to the hospital but then he was transferred to a Long-Term Care Acute Hospital. Resident #1 was discharged from the facility. Resident #1 appealed the discharge and the judge decided that the discharge be reversed. In an interview on 02/21/24 at 3:38 PM Resident #1 said he was sent to the hospital and was told that he had three days before his bed would be taken. Resident #1 said he did not sign a bed hold or discharge paperwork. The facility did not tell him about the bed hold. Resident #1 said after discharged from the hospital he was transferred to a Long-Term Care Acute Hospital for two weeks. Resident #1 said he went to the hospital due to osteomyelitis and was in isolation. Resident #1 said he is not contagious and would only be able to infect someone if they touched his wound without gloves and the only ones that would touch him would be the nurses and they wore gloves. Resident #1 said he appealed the discharge, and the decision was that he could return to the facility. The facility kept saying they were full and did not have any beds available. Resident #1 said he still wanted to return because he was hoping to go upstairs to the ALF. Resident #1 said he had friends at the facility and would visit with them. Resident #1 said he hated being at the current facility and did not want to be there. Resident #1 said he spoke with the Administrator yesterday and he would be returning to the facility. In a telephone interview on 02/21/24 at 3:53 PM the former DON said he did remember Resident #1 but did not recall the incident when he went to the hospital. The former DON said he did not recall if Resident #1 was provided with discharge information or if he went to a Long-Term Care Acute Hospital. The former DON said he did recall that Resident #1 did not want to go to the hospital and that everyone was trying to convince Resident #1 that he needed to go. The DON said he could not provide any further information. In an interview on 02/21/24 at 4:12 PM the Administrator said the facility had not accepted Resident #1 because they did not have a long-term bed available, and they finally have one available. The Administrator said they have a Pending admission List and Resident #1 was on it. The Administrator said they also had not accepted Resident #1 because he was on isolation, and he would not stay in his room. The Administrator said they were afraid that Resident #1 would not stay in his room and would infect other residents. The Administrator said they could provide a copy of the Pending admission List. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455672 If continuation sheet Page 2 of 4 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 455672 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Palms Rehabilitation and Retirement 2101 Treasure Hills Blvd Harlingen, TX 78550 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 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the Copy of the Pending admission List dated 01/15/24 indicated Resident #1 was approved for admission. In an interview on 02/21/24 at 4:15 PM RN/Clinical Resource said Resident #1 was sent to the hospital due to a life-threatening infection. Resident #1 refused to do a bed hold. Resident went to the hospital and then went to a Specialty Acute Hospital. RN/Clinical Resource said the facility did not have an available bed for Resident #1 when he was ready to return. Record review of Fair Hearing - Medicaid Nursing Facility Residents - Discharge Order dated 12/15/2023, ordered by the Lead Hearing Officer Health and Human Services Commission revealed: In accordance with the decision, Facility is instructed to allow Appellant to remain in, or immediately be re-admitted back to into its facility, if the Appellant and his representative so desire, and not transfer or discharge the Appellant from the facility. The Facility must report compliance with this order within 10 days from the date of this decision by completing and faxing the attached Health and Human Services Commission (HHSC) form H4807 (Action Taken on Hearing Decision) to the Hearings Officer. Facility is not precluded from issuing a new 30-day notice of discharge meeting program guidelines in the future. Record review of facility's Policy for Criteria for Transfer and discharge date d November 2016 and revised/reviewed in December 2023 indicated: It is the policy of this Facility that each resident will remain in the Facility, and not be transferred or discharged unless the discharge or transfer is appropriate as per the existing criteria. When the Facility transfers or discharges a resident, the Facility shall ensure the transfer or discharge is documented in the resident's medical record and appropriate information is communicated to the receiving health care institution or provider. Procedure: 1. The facility shall permit each resident to remain in the Facility, and not transfer or discharge the resident from the Facility unless: i. The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the Facility. ii. The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the Facility. iii. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455672 If continuation sheet Page 3 of 4 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 455672 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Palms Rehabilitation and Retirement 2101 Treasure Hills Blvd Harlingen, TX 78550 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 0626 The safety of individuals in the Facility is endangered to the clinical or behavioral status of the resident. Level of Harm - Minimal harm or potential for actual harm 2. Residents Affected - Few If the resident and/or their representative) exercises their right to appeal the transfer or discharge notice, the Facility shall not transfer or discharge resident while the appeal is pending, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the Facility. The Facility will document the danger that failure to transfer, or discharge would pose. Record review of Admissions from 12/15/23 to 02/20/24 revealed there were 82 residents admitted from Acute care hospital, five residents admitted from home, three admitted from Long Term Care Acute Hospital, and two residents were transferred from another skilled nursing facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455672 If continuation sheet Page 4 of 4