Health inspection·November 20, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some physician orders when she was hired in September of 2025. LVN A stated the facility policy for medication administration stated medications were due at the time they were ordered. LVN A stated she did not follow the facility policy. LVN A stated not administering medication such as morphine on time could negatively impact residents because they could have pain. During an interview with the DON on 10/10/25 at 6:48 pm, she stated Resident #1 had orders for Morphine 2 times a day, once at 9:00am and 5:00pm. The DON stated Resident #1 received his morphine late on 10/09/25 at 7:57pm. The DON stated LVN A was responsible for administering the medication to Resident #1 at the time it was late and stated it was late because Resident #1 had stuff going on with a family member trying to get power of attorney. The DON stated Resident #1 did not have any negative outcome due to receiving his medication late and did not verbalize any pain to her. The DON stated it was important that residents got their medications for the continuity of care and stated that residents with chronic pain were used to having medication at a certain time, and it was their duty to make sure they were free of pain and their pain was at a certain level to where they were comfortable. The DON stated LVN A had been trained upon hire by the SDC over medication administration and following the scheduled times. The DON stated as per their facility policy medication had to be given in a timely manner, and stated they had a 1-hour window to administer. The DON stated LVN A did her best to follow the policy in this situation, and did not state if she did or did not follow the policy. The DON stated not providing medication at the scheduled time could negatively impact residents because they could start to withdraw or start having behaviors and yelling out, or they could get anxiety. 2. Record review of Resident #3's face sheet, dated 10/10/25, revealed the resident was a [AGE] year old female who initially admitted to the facility on [DATE] with diagnoses that included: pain in left shoulder, type 2 diabetes (high blood sugar) without complications, hemiplegia (paralysis of one side of body) and hemiparesis (one side weakness) following cerebral infarction (a stroke - death of brain tissue due to lack of blood flow) affecting left non-dominant side, vascular dementia (changes in memory, thinking and behavior caused by impaired supply of blood to the brain), severe with agitation and psychotic disturbance. Record review of Resident #3's quarterly Minimum Data Set assessment dated [DATE] revealed Resident #3 had a BIMS score of 04 indicating severe cognitive impairment. Record review of Resident #3's care plan, with an initiation date of 03/25/25 had a focus that stated Resident #3 was on as needed pain medication therapy related to limited mobility, terminal prognosis, and occasional complaint of pain with a created date of 04/02/25 with interventions that included to administer analgesic medication as ordered by physician with an initiation date of 04/02/25. Record review of Resident #3's active physician's orders, retrieved on 10/10/25, revealed an order started on 06/23/25 for tramadol 50mg to be administered 2 times a day at 9:00 am and 5:00 pm. Record review of Resident #3's narcotic sheet revealed LVN A had signed that she administered Resident #3's tramadol at 8:00 pm on 10/09/25. LVN A was attempted to be reached for interview via telephone on 10/10/25 at 4:56 pm, 4:57 pm, 5:16 pm, 5:19 pm and 5:53 pm with no calls successfully answered or returned. During an interview with Resident #3 on 10/10/25 at 5:45 pm, she required re-direction to questions and stated she had no pain yesterday and she was good. Resident #3 was unable to answer any other questions coherently. During an interview with the DON on 10/10/25 at 6:48 pm, she stated she did not know Resident #3's scheduled time to receive her tramadol, but knew it was 2 times a day. The DON stated Resident #3 received her tramadol on 10/09/25 at 8:00 pm. The DON stated she was not in front of Resident #3 from their scheduled time of 5:00 pm until she received her medication at 8:00 pm, and could not tell me if she was in any pain. The DON stated LVN A was responsible for administering the medication to Resident #3 on 10/09/25. The DON stated it was late because they did not have a med aide and LVN A was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455687 If continuation sheet Page 2 of 9 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 455687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Oaks Nursing Center 1101 S Alameda Corpus Christi, TX 78404 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the one passing the medication. The DON stated Resident #3 did not have any negative outcome due to receiving her medication late. The DON stated it was important that residents got their medications for the continuity of care. She stated that residents with chronic pain were used to having medication at a certain time, and it was their duty to make sure they were free of pain and their pain was at a certain level to where they are comfortable. The DON stated LVN A had been trained upon hire by the SDC over medication administration and following the scheduled times. The DON stated, as per their facility policy, medication had to be given in a timely manner, and they had a 1-hour window to administer. The DON stated LVN A did her best to follow the policy in this situation, but did not state if she did or did not follow the policy. The DON stated not providing medication at the scheduled time could negatively impact residents because they could start to withdraw, start having behaviors and yelling out, or they could get anxiety. 3. Record review of Resident #2's face sheet, dated 10/10/25, revealed the resident was a [AGE] year old female who initially admitted to the facility on [DATE] with diagnoses that included: heart failure (when the heart muscle does not pump blood as well as it should), chronic kidney disease, stage 5 (when kidneys have almost completely stopped filter waste from the blood), orthostatic hypotension (sudden drop in blood pressure when going to a standing position from sitting or lying), type 1 diabetes with neuropathic arthropathy (nerve and joint damage from long term diabetes) Record review of Resident #2's quarterly Minimum Data Set assessment dated [DATE] revealed Resident #2 had a BIMS score of 15 indicating no cognitive impairment. Record review of Resident #2's care plan, with an initiation date of 07/18/24 had a focus that stated Resident #2 was on pain medication therapy with a created date of 04/27/25 with interventions that included to administer analgesic medication as ordered by physician with an initiation date of 04/27/25. Record review of Resident #2's active physician's orders, retrieved on 10/10/25, revealed Resident #2 did not have an order for tramadol on 09/20/25. Resident #2's tramadol order was started on 09/22/25.Record review of Resident #2's narcotic sheet revealed LVN B had signed that he administered Resident #2 with tramadol on 09/20/25 at 2:00 pm. During an interview with LVN B on 10/10/25 at 3:06 pm, LVN B confirmed that he provided Resident #2 with tramadol on 09/20/25. LVN B stated Resident #2 had an order for tramadol for a long time, and she had gone to the hospital, and when she came back, the order was not put back in. LVN B stated Resident #2 asked for a tramadol and he administered it because he thought she still had the order, and after he administered it, he saw she did not have an order for tramadol. LVN B stated before administering medication, he should review the residents' charts to ensure they had orders for the medication. LVN B stated he did not review Resident #2's orders prior to providing her with tramadol. LVN B stated he should have reached out to the physician to request an order, but , he did not get a chance to. LVN B stated he should not have provided Resident #2 with the tramadol if she did not have an order. LVN B stated he had been trained over mediation administration and ensuring residents had orders in place prior to providing medication. LVN B stated he was trained about a month prior by the DON. LVN B stated the facility policy stated they could not administer a medication without an order. LVN B stated he did not follow the facility policy. LVN B stated administering medications without orders in place could cause an accidental overdose. LVN B stated Resident#2 had no negative impacts due to being administered tramadol. During an interview with Resident #2 on 10/10/25 at 4:00 pm, she stated she recalled getting tramadol on 09/20/25 after she requested it from LVN B. Resident #2 stated she did not have any negative side effects by receiving tramadol. During an interview with the DON on 10/10/25 at 5:45 pm, she stated she did not have any directly related in-services or trainings prior to the identified failures. During an interview with the DON on 10/10/25 at 6:48 pm, she stated staff should review residents charts to ensure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455687 If continuation sheet Page 3 of 9 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 455687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Oaks Nursing Center 1101 S Alameda Corpus Christi, TX 78404 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete they had orders for medication and stated the order should match the blister pack and the narcotic sheet. The DON confirmed that LVN B administered tramadol to Resident #2 on 09/20/25 at 2:00pm. The DON stated Resident #2 had gone to the hospital and when she came back the medication list they provided did not include the tramadol. The DON stated Resident #2 got orders for tramadol on 09/22/25. The DON stated she did not know if LVN B was aware the Resident #2 did not have orders for tramadol on 09/20/25 and did not know if he reviewed her orders before administering tramadol. The DON stated she was not aware of LVN B reaching out the physician to request an order for tramadol before providing it but stated LVN B should have done that. The DON stated LVN B should not have administered tramadol without an order. The DON stated when LVN B had orientation in July of 2025 he was trained over medication administration and ensuring residents had orders prior to administering medication. The DON stated, per their facility policy, medication could not be administered without an order. The DON stated LVN B did not follow this policy. The DON stated administrating medication without an order could negatively impact residents because it could be contraindicated. The DON stated Resident #3 did not have any negative outcome due to being administered tramadol on 09/20/25. Record review of an in-service completed 10/09/25 covering Administering of Medications revealed that LVN A had received the training. Record review of the facility's policy titled, Administration of Medications with a reviewed date of 09/09/25 revealed, 1. Medication administration is the responsibility of those individuals who through certification and licensure are authorized in their state to administer medication in a skilled nursing facility. 2. Staff who are responsible for medication administration will adhere to the 10 rights of Medication administration.e. Right Time and Frequency. Check the order for when it would be given and when was the last time it was given.3. A physician order that includes dosage, route, frequency, duration, and other required consideration including the purpose, diagnoses or indication for use is required for administration of medication. Event ID: Facility ID: 455687 If continuation sheet Page 4 of 9 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 455687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Oaks Nursing Center 1101 S Alameda Corpus Christi, TX 78404 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 - Some 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 interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that are complete and accurately documented for 3 of 3 residents (Resident #1, #2 and #3) reviewed for medical records accuracy, in that: 1. Facility staff failed to document Resident #1's administered tramadol on his medication administration record in September 2025 and October 2025. 2. Facility staff failed to document Resident #2's administered tramadol on her medication administration record in September 2025 and her administered morphine in October 2025. 3. Facility staff failed to document Resident #3's administered Morphine on her medication administration record in October 2025. This failure could affect residents whose records were maintained by the facility and could place them at risk for errors in care, treatment and medication administration.The findings included: 1.Record review of Resident #1's face sheet, dated 10/10/25, revealed the resident was a [AGE] year-old male who initially admitted to the facility on [DATE] with diagnoses that included: other chronic pain (pain that last more than 3 months), peripheral vascular disease (circulation disorder caused by narrowing, blockage or spasms in blood vessels), secondary osteoarthritis (joint degeneration caused by another medical condition), right ankle and foot, hemiplegia (paralysis of one side of body) and hemiparesis (one side weakness) following cerebral infarction (a stroke - death of brain tissue due to lack of blood flow) affecting left dominant side. Record review of Resident #1's quarterly Minimum Data Set assessment dated [DATE] revealed Resident #1 had a BIMS score of 15 indicating no cognitive impairment. Record review of Resident #1's care plan, with an initiation date of 06/17/24 had a focus that stated Resident #1 was on pain medication therapy related to chronic pain with an initiation date of 03/08/25 with interventions that included to administer analgesic medication as ordered by physician with an initiation date of 03/08/25. Record review of Resident #1's order summary report revealed an order for tramadol oral tablet 50 MG every 12 hours as needed for pain with a start date of 06/18/25 and discontinue date of 10/01/25. Record review of Resident #1's order summary report revealed an order for tramadol oral tablet 50 MG every 6 hours as needed for pain with a start date of 10/01/25 and a current order status of active as of 10/10/25. Record review of Resident #1's narcotic sheet revealed LVN C had signed that she administered Resident #1 with his ordered tramadol on 09/24/25 at 10:10am. Record review of Resident #1's narcotic sheet revealed LVN B had signed that he administered Resident #1 with his ordered tramadol on 09/24/25 at 9:00pm and on 10/05/25 at 8:00am and 8:00pm. Record review of Resident #1's order for tramadol on his September 2025 and October 2025 MAR revealed staff did not sign off that his medication was administered on 09/24/25 at 10:10am and 9:00pm and 10/05/25 at 8:00am and 8:00pm. During an interview with LVN C on 10/10/25 at 2:10 pm, she confirmed that she provided Resident #1 with his tramadol on 09/24/25 at 10:10 am. LVN C reviewed Residents #1's September MAR and stated it was blank, and it meant it was not signed as administered. LVN C stated she was responsible for documenting the administration of the medication. LVN C stated she did not recall why she did not document the medication was administered on Resident #1's MAR. LVN C stated the administration of Resident #1's medication should have been documented on his MAR and stated it was important to do for resident safety and because some physicians will look at the MAR and not the narcotic sheet and may discontinue a medication if they see It was not being given. LVN C stated she had been trained over medication administration and documentation and stated she was last trained on 10/09/25. LVN C stated the facility policy stated they were to document medication provided on both the narcotic sheet and the MAR. LVN C stated she had not followed the facility policy. LVN C stated not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455687 If continuation sheet Page 5 of 9 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 455687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Oaks Nursing Center 1101 S Alameda Corpus Christi, TX 78404 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 - Some documenting the administration of medication on the MAR could impact residents safety. During an interview with LVN B on 10/10/25 at 3:06pm, he confirmed that he provided Resident #1 with his tramadol on 09/24/25 at 9:00pm and on 10/05/25 at 8:00am and 8:00pm. LVN B reviewed Residents #1's September and October MAR and stated he had not documented on the MAR. LVN B stated he was responsible for documenting the administration of the medication. LVN B stated he was planning to go back and document but he forgot. LVN B stated the administration of Resident #1's medication should have been documented on his MAR, and it was important to do so to ensure someone was not over medicated and make sure it was being monitored correctly. LVN B stated he had been trained over medication administration and documentation, and he was last trained by the DON a week or 2 prior. LVN B stated the facility policy stated they were to document medication provided on both the narcotic sheet and the MAR. LVN B stated he had not followed the facility policy. LVN B stated not documenting the administration of medication on the MAR could negatively impact residents by medication accidently being given again or the physician may not know what's being administered and if something were to occur with the residents they may not respond appropriately. During an interview with the DON on 10/10/25 at 6:48pm, she stated LVN C administered Resident #1 with tramadol on 09/24/25 at 10:10am and LVN B provided it on 09/24/25 at 9:00pm and on 10/05/25 at 8:00am and 8:00pm. The DON stated both staff members were responsible for documenting the administration of those medications. The DON stated she had already reviewed the MAR and confirmed those dates were not documented for in the MAR. The DON stated she thought the staff would sign the narcotic sheet and then get distracted and would forget to sign the MAR. The DON stated staff should document on the MAR and stated it was important to ensure they were not double dosing or giving an inaccurate dose and for the continuity of care. The DON stated staff had been trained over medication administration and documentation during their orientation and annually. The DON stated the facility policy stated when administering narcotics, they had to be documented in 2 places, the narcotic sheet and the MAR. The DON stated staff had not followed the facility policy in this situation. The DON stated not documenting medication administration in the MAR could negatively impact residents by not controlling their pain or side effects. 1. 2.Record review of Resident #2's face sheet, dated 10/10/25, revealed the resident was a [AGE] year old female who initially admitted to the facility on [DATE] with diagnoses that included: heart failure (when the heart muscle does not pump blood as well as it should), chronic kidney disease, stage 5 (when kidneys have almost completely stopped filter waste from the blood), orthostatic hypotension (sudden drop in blood pressure when going to a standing position from sitting or lying), type 1 diabetes with neuropathic arthropathy (nerve and joint damage from long term diabetes) Record review of Resident #2's quarterly Minimum Data Set assessment dated [DATE] revealed Resident #2 had a BIMS score of 15 indicating no cognitive impairment. Record review of Resident #2's care plan, with an initiation date of 07/18/24 had a focus that stated Resident #2 was on pain medication therapy with a created date of 04/27/25 with interventions that included to administer analgesic medication as ordered by physician with an initiation date of 04/27/25. Record review of Resident #2's physician's orders, retrieved on 10/10/25, revealed Resident #2 had an order for tramadol oral tablet 50MG to be administered every 8 hours as needed for pain with a start dated of 09/22/25 and an indefinite end date.Record review of Resident #2's physician's orders, retrieved on 10/10/25, revealed Resident #2 had an order for morphine sulfate extended release tablet 15MG wit directions to administer .5 tablet every 8 hours as needed for pain with a start dated of 09/23/25 and an indefinite end date.Record review of Resident #2's narcotic sheet revealed LVN D had signed that he administered Resident #2 with tramadol on 09/22/25 at 11:15AM. Record review of Resident #2's narcotic sheet revealed LVN C had signed that she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455687 If continuation sheet Page 6 of 9 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 455687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Oaks Nursing Center 1101 S Alameda Corpus Christi, TX 78404 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 - Some administered Resident #2 with morphine on 10/06/25 at 12:00pm. Record review of Resident #2's narcotic sheet revealed LVN D had signed that he administered Resident #2 with morphine on 10/07/25 at 11:15am. Record review of Resident #2's order for tramadol on her September 2025 MAR revealed staff did not sign off that her medication was administered on 09/22/25 at 11:15am.Record review of Resident #2's order for morphine on her October 2025 MAR revealed staff did not sign off that her medication was administered on 10/06/25 at 12:00PM and 10/07/25 at 11:15am. During an interview with LVN C on 10/10/25 at 2:10pm, she confirmed that she provided Resident #2 with her morphine on 10/06/25 at 12:00pm. LVN C reviewed Residents #2's October 2025 MAR, and stated it was blank and stated it meant it was not signed as administered. LVN C stated she was responsible for documenting the administration of the medication. LVN C stated she recalled having Resident #2's MAR open, clicking it, signing the narcotic book, and then administering the medication. LVN C stated she thought she got busy assisting Resident #2 with getting up and when she returned to click save on the MAR, it was already gone and she did not remember to sign it. LVN C stated the administration of Resident #2's medication should have been documented on her MAR, and it was important to that do for resident safety and because some physicians would look at the MAR and not the narcotic sheet and may discontinue a medication if they see it was not being given. LVN C stated she had been trained over medication administration and documentation. LVN C stated she was last trained on 10/09/25. LVN C stated the facility policy stated they were to document medication provided on both the narcotic sheet and the MAR. LVN C stated she had not followed the facility policy. LVN C stated not documenting the administration of medication on the MAR could impact residents safety. During an interview with LVN D on 10/10/25 at 1:45pm he confirmed that he provided Resident #2 with her tramadol on 09/22/25 at 11:15am and her morphing on 10/07/25 at 11:15am. LVN D reviewed Residents #2's September and October 2025 MAR and stated they were both blank and stated it meant he had not signed the MAR that the medications were administered. LVN D stated he was responsible for documenting the administration of the medication. LVN D stated he did not document on the MAR because he was just busy but did state the administration of Resident #2's medication should have been documented on her MAR and stated it was important to do so they could be accountable for the narcotics and to see how residents were doing and to do an evaluation. LVN D stated he had been trained over medication administration and documentation and stated he knew better. LVN D stated the facility policy stated they had to sign off on the MAR. LVN D stated he thought he had followed his facility policy. LVN D stated not documenting administered medication on the MAR could negatively impact residents because you couldn't prove that a resident got it and there would be no documentation when the physician reviewed the MAR and if they saw that someone's not taking the medication and they may discontinue it. During an interview with the DON on 10/10/25 at 6:48pm she stated LVN C administered Resident #1 with tramadol on 09/24/25 at 10:10am and LVN B provided it on 09/24/25 at 9:00pm and on 10/05/25 at 8:00am and 8:00pm. The DON stated both staff members was responsible for documenting the administration of those medications. The DON stated she had already reviewed the MAR and confirmed those dates were not documented for in the MAR. The DON stated she thought the staff would sign the narcotic sheet and then get distracted and would forget to sign the MAR. The DON stated the MAR should be documented on and stated it was important to ensure they were double dosing or giving an inaccurate dose and for the continuity of care. The DON stated staff had been trained over medication administration and documentation during their orientation and annually. The DON stated the facility policy stated when administering narcotics they had to be documented for in 2 places, the narcotic sheet and the MAR. The DON stated staff had not followed the facility policy in this situation. The DON stated not documenting medication administration in the MAR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455687 If continuation sheet Page 7 of 9 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 455687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Oaks Nursing Center 1101 S Alameda Corpus Christi, TX 78404 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 - Some could negatively impact residents by not controlling their pain or side effects. 3.Record review of Resident #3's face sheet, dated 10/10/25, revealed the resident was a [AGE] year old female who initially admitted to the facility on [DATE] with diagnoses that included: pain in left shoulder, type 2 diabetes (high blood sugar) without complications, hemiplegia (paralysis of one side of body) and hemiparesis (one side weakness) following cerebral infarction (a stroke - death of brain tissue due to lack of blood flow) affecting left non-dominant side, vascular dementia (changes in memory, thinking and behavior caused by impaired supply of blood to the brain), severe with agitation and psychotic disturbance. Record review of Resident #3's quarterly Minimum Data Set assessment dated [DATE] revealed Resident #3 had a BIMS score of 04 indicating severe cognitive impairment. Record review of Resident #3's care plan, with an initiation date of 03/25/25 had a focus that stated Resident #3 was on as needed pain medication therapy related to limited mobility, terminal prognosis, and occasional complaint of pain with a created date of 04/02/25 with interventions that included to administer analgesic medication as ordered by physician with an initiation date of 04/02/25. Record review of Resident #3's physician's orders, retrieved on 10/10/25, revealed an order started on 04/15/25 for morphine sulfate oral solution 10MG/5ML for 1ML to be provide every hours for her pain and with no end date. Record review of Resident #3's narcotic sheet revealed SDC had signed that she administered Resident #3 her morphine on `10/03/25t at 8:00AM. During an interview with the SDC on 10/10/25 at 2:38pm she confirmed she provided Resident #3 with her morphine on 10/03/25 at 8:00am. SDC stated she had already reviewed Resident #3's October MAR and stated it was blank and was not signed as administered and stated it looked as if Resident #3 had not received the medication but SDC stated she did. The SDC stated she probably did not document it on the MAR because she was probably busy. The SDC stated she was responsible for documenting medication administration on the MAR and stated she should have documented on the MAR and stated it was important to document on the MAR because the physician might not see a medication being administered and could discontinue it and because the following nurse would not know the last time something was given and might end up giving it again too soon. The SDC stated she had been trained over medication administration and documentation about 2 months prior by LVN C. The SDC stated the facility policy stated the narcotic sheet needed to match their MAR and stated they had to document their medication administration on both the narcotic sheet and resident's MAR. The SDC stated she did not follow the facility policy. The SDC stated not documenting medication administration on the MAR could negatively impact residents by giving them too much medication or the physician may see that it was not being given and discontinue the medication. During an interview with the DON on 10/10/25 at 5:45pm, she stated she did not have any directly related in services or trainings prior to identified failures. During an interview with the DON on 10/10/25 at 6:48pm, she stated the SDC administered Resident #3 with morphine on 10/03/25 at 8:00am. The DON stated the SDC was responsible for documenting the administration of medication. The DON stated she had already reviewed the MAR and confirmed that date was not documented for in the MAR. The DON stated she thought the staff would sign the narcotic sheet, and then get distracted and would forget to sign the MAR. The DON stated the MAR should be documented on, and it was important to ensure they were not double dosing or giving an inaccurate dose and for the continuity of care. The DON stated staff had been trained over medication administration and documentation during their orientation and annually. The DON stated the facility policy stated when administering narcotics, they had to be documented for in 2 places, the narcotic sheet and the MAR. The DON stated staff had not followed the facility policy in this situation. The DON stated not documenting medication administration in the MAR could negatively impact residents by not controlling their pain or side effects. Record review of Inservice (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455687 If continuation sheet Page 8 of 9 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 455687 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Oaks Nursing Center 1101 S Alameda Corpus Christi, TX 78404 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete completed 10/09/25 covering Administering of Medications revealed that LVN C had received the training. Record review of the facility's policy titled, Administration of Medications with a reviewed date of 09/09/25 stated, 1. Medication administration is the responsibility of those individuals who through certification and licensure are authorized in their state to administer medication in a skilled nursing facility. 2. Staff who are responsible for medication administration will adhere to the 10 rights of Medication administration.F. Right documentation. Make sure to write the time and any remarks on the chart correctly. Medication administration should be documented timely following the administration to the resident. Controlled substances should be signed out from the descending count sheet and documented on the MAR for each routine and PRN dose of medication administered. Event ID: Facility ID: 455687 If continuation sheet Page 9 of 9