Inspection·April 15, 2025

F 0656 recommendations such as eating fried chicken). Level of Harm - Minimal harm or potential for actual harm Interview with CMA F on 04/15/25 at 11:00 AM revealed CMA F said Resident #1 was getting wound care but Resident #1 was not keeping on her heel protectors like she was supposed to in order for her feet to not have pressure. CMA F said Resident #1 removed the heel protectors and was always sitting up in her chair. Residents Affected - Few Interview with RN C on 04/15/25 at 3:25 PM revealed RN C said Resident #1 was on a fluid restriction because she received dialysis, but Resident #1 was always asking for ice. RN C said she explained to Resident #1 that ice melted into water and that could cause fluid overload but Resident #1 was very adamant that she wanted ice. RN C said Resident #1 called the dialysis center herself and canceled her treatment appointments. RN C said she explained to Resident #1 the importance of her receiving dialysis but she was still able to make those decisions and refused to go. RN C said they ordered waffle boots (heel protectors) and therapy evaluated Resident #1 to help address Resident #1's wounds. RN C said therapy indicated that Resident #1 should not bear weight on her feet because the wounds were getting worse. RN C said Resident #1 was non-complaint and tried to stand on her feet especially when her family took her out on pass. RN C said they explained the importance of not bearing weight to Resident #1 and her family, but they did not know if they followed the recommendations when they took Resident #1 out on pass. RN C said Resident #1's family brought her food all the time such as fried chicken, crackers, or food from restaurants that were unhealthy and did not aid in wound healing. Interview with the ADON on 04/15/25 at 3:55 PM revealed the ADON said Resident #1 had arterial wounds on her heels. The ADON said Resident #1 had very poor circulation and had diabetes. The ADON said Resident #1 received dialysis but she drank sodas and did not like to stay off her feet or offload. The ADON said she would place a pillow under Resident #1's feet to help relieve pressure but Resident #1 would remove the pillow. Interview with the DON on 04/15/25 at 5:10 PM revealed the DON said Resident #1's family brought her outside food such as food from a steak house and fried chicken which had too much sodium. The DON said Resident #1 received dialysis and refused to follow the renal diet or fluid restrictions. The DON said they ensured to document and explained the risks of not following the diet. The DON said Resident #1 liked to drink sodas and liked ice. The DON said they explained the limit on the fluids but Resident #1 still asked her family to bring her what she wanted. The DON said the wounds Resident #1 had were arterial wounds. The DON said Resident #1 had the offloading booties (heel protectors) but she did not leave the booties on. The DON said they explained the importance of her wearing them. The DON said Resident #1 was educated that the booties were to help prevent the wounds from getting worse. The DON said she was informed maybe of one time that Resident #1 refused to go to dialysis but she was unsure if it was more than that or if there was a history of Resident #1 refusing dialysis. The DON said Resident #1's non-compliance with care should have been care planned. The DON said those behaviors of noncompliance would place residents at risk for their condition to worsen, not improve, or other adverse effects, so they should have ensured the behaviors were care planned. The DON said it was important for Resident #1's behaviors to be care planned so that staff were aware and knew what to do if Resident #1 exhibited behaviors. The DON said the care plan would have reflected the interventions implemented specific for Resident #1's behaviors such as to redirect, re-educate, and document that she was made aware of the adverse effects of being noncompliant. The DON said if it was not care planned, maybe it was not communicated to the IDT. The DON said any changes noted such as noncompliance with care were noted by staff and should have been communicated with the team so that they could have developed interventions and updated the care plan. The DON said she was not sure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455672 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 455672 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/15/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few why Resident #1's behaviors were not care planned. The DON said the renal diet, fluid restriction, heel protectors, offloading, and dialysis were important for wound healing. The DON said if the behaviors were not care planned, that could result in Resident #1's condition worsening. Record review of the facility's Comprehensive Person-Centered Care Planning policy dated December 2023 reflected - Policy: It is the policy of this facility that the interdisciplinary team shall develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet the resident's medical, nursing, mental, and psychosocial needs that are identified. 5. The resident has the right to refuse or discontinue treatment. In the event that a resident refuses certain services posing a risk to resident's health and safety, the comprehensive care plan will identify care or service declined, the associated risks, IDT's effort to educate the resident and resident representative and any alternate means to address risk. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455672 If continuation sheet Page 3 of 3