Health inspection·September 16, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete admission. The MDS nurse said once it was complete, the DON takes over with any follow-ups. The MDS nurse said he was not responsible for submitting the NFSS in the LTC Online Portal. The MDS nurse said the DON deals with that. In an interview on 9/16/25 at 3:50 pm the DON said he was responsible for PASSR submission in the online portal. He said once the original meeting was done by TTBH, they must notify the MD. Once they received the MD order for services such as PT, PT would then evaluate for habilitation services, then the NFSS would be completed with the recommended services, and he would submit the NFSS in the online portal. The DON said to his understanding, the submission of the NFSS form in the online portal were submitting within 21 business days of the IDT meeting. The DON said he recently took over the task in March of this year. The DON said the previous MDS/RN Coordinator oversaw the NFSS submissions in the online portal in collaboration with the DOR. The DON said they submitted the NFSS for Resident #1 and it was denied. The DON said he talked to someone in March, but he could not remember who, and he was told to submit the NFSS within a certain time frame, but it was denied because it was submitted incorrectly. The DON said the resident did receive the PT and OT services, but not through PASSR. The DON said they had a recent IDT meeting on the 3rd of September. The DON said PT and OT already did their assessments and they were pending MD signature. The DON said he the NFSS would be submitted within the 20 business calendar days. In an interview on 9/16/25 at 4:47 pm with the Administrator, he said it was his understanding that upon approval of services for PASSR, they had 20 business days to update that information onto the online portal. He said he believed the DON was in charge with the assistance of the DOR. He said he knew of the 20-business day requirement because he overheard it said by the DON in a discussion regarding the urgency of the time frame. Record review of the facility's admission Criteria policy revised December 2016 reflected: Policy Statement: Our facility will admit only those residents whose medical nursing care needs can be met. Policy Interpretation and Implementation: .8. Nursing and medical needs of individuals with mental disorders or intellectual disabilities will be determined by coordination with the Medicaid Pre-admission Screening and Resident Review program (PASARR) to the extent practicable.9. Potential residents with mental disorders or intellectual disabilities will only be admitted if the State mental health agency has determined (through the preadmission screening program) that the individual has a physical or mental condition that requires the level of services provided by the facility.10. The acceptance of resident with certain conditions or needs may require authorization or approval by the Medical Director, Director of Nursing Services, and/or the Administrator.12. The Administrator, through the Admissions Department, shall assure that the resident and the facility follow applicable admission policies. Event ID: Facility ID: 455802 If continuation sheet Page 2 of 5 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 455802 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spanish Meadows 440 E Ruben Torres Blvd Brownsville, TX 78520 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 1 of 3 residents (Resident #2) reviewed for medical records accuracy, in that: The facility failed to document Resident #2's physician ordered weekly skin assessment from 12/26/24 through 02/27/25 for a total of 10 out of 10 skin assessments that were not documented. This failure could affect residents whose records are maintained by the facility and could place them at risk for errors in care, and treatment. The findings included: Record review of Resident #2's face sheet, dated 09/16/25, revealed the resident was a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included: psoriasis ( skin cells build up and form scales and itchy, dry patches), unspecified dementia (loss of memory, language, problem solving and other thinking abilities that are severe enough to interfere with daily life ), unspecified severity, without behavioral disturbance, psychotic disturbance mood disturbance, and anxiety, contracture, unspecified joint, and essential (primary) hypertension (high blood pressure) Record review of Resident #2's quarterly MDS assessment, dated 08/22/25, revealed Resident #2 had a BIMS score of 01, indicating severe cognitive impairment. Record review of Resident #2's care plan with an initiation date of 05/02/25 reflected a focus of I'M AT RISK FOR SKIN BREAKDOWN AS I HAVE: (1) Anemia (2) Major Depressive Disorder (3) Dementia (4) Bony prominences (5) I require partial/moderate assistance with bed mobility and substantialassistance with transfers (6) I am incontinent of Bowel and Bladder with no initiated date and interventions of, WEEKLY SKIN ASSESSMENT BY LISCENCED [licensed] NURSE with no initiated date. Record review of Resident #2's active physician's orders revealed orders for, WEEKLY ASSESSMENT DUE THURSDAY, with a frequency of every night shift every Thu (Thursday) with an order date of 08/06/20 and an order type of Standard Order Treatment - [TAR] Record review of Resident #2's December 2024, January, February and March 2025 TAR reflected her order for weekly skin assessment was signed by LVN A weekly from 12/26/25 through 02/27/25 as administered. Record review of Resident #2's weekly skin assessment record document that included more details such as a body diagram to indicate location and description of any skin issues reflected Resident #2's last weekly skin assessment record document was completed on 12/19/24. There were no weekly skin assessment record documents identified from 12/26/25 through 02/27/25. During an interview with Resident #2 on 09/09/25 at 10:17am she was unable to answer any related questions coherently. During an interview and record review with the DON on 09/15/25 at 4:32pm he stated skin assessments were completed weekly and stated an assessment should be completed whether a resident had anything new or not. The DON reviewed Resident #2's assessments and confirmed that there was a gap without skin assessments from December 2024 till March 2025 that should not be there. The DON stated he had not noticed they were missing. The DON reviewed Resident #2's TAR and stated LVN A had documented that she done the skin assessment in December 2024 till March 2025 but there were no skin assessments document populated. The DON stated the nursing staff was responsible for completing the weekly skin assessments and stated he did not know why they were not done and stated he had not spoken to LVN A yet and did not know if LVN A completed Resident #2's skin assessment and did not document them or if she had not done them. The DON stated completing weekly skin assessments were important to see if there was any abnormal development of skin issues and to make sure they were attended to properly. The DON stated staff had been trained over completely skin assessments weekly and stated they completed annual competencies that covered skin. The DON stated the wound care nurse was responsible for monitoring and reviewing skin assessments to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455802 If continuation sheet Page 3 of 5 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 455802 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spanish Meadows 440 E Ruben Torres Blvd Brownsville, TX 78520 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 ensure they were completed. The DON stated LVN B who was the previous wound care nurse was responsible for reviewing the skin assessments during the time of the identified gap. The DON stated LVN B no longer worked at the facility and stated their current wound care nurse had recently started but was still in training and had not yet been on the floor. The DON stated he and the ADON had weekly meetings where they wound go over documentation which included progress on wounds and the completion of their systems. The DON stated their facility policy stated staff should develop a new skin assessment document anytime one was scheduled and stated staff did not follow their policy in this situation. The DON stated he had reviewed Resident #2's chart and did not identify any deterioration of Resident #2's skin from December 2024 through March 2025 when no skin assessments were populated. The DON stated not completing skin assessments as ordered could negatively impact residents because they could develop skin issues that do not get treated on time or appropriately. During a telephone interview on 09/15/25 at 11:00pm with LVN A she stated nurses were responsible for completing skin assessments for residents weekly and stated sometimes the wound care nurse would also complete skin assessments. LVN A stated they had to assess the resident's skin, sign off on the TAR and should document on the body diagram. LVN A stated the body diagram should be completed whether or not there were any changes in skin integrity. LVN A stated she was not aware of Resident #2 not having a skin assessment document populated from 12/26/24- 02/27/25. LVN A stated she recalled assessing Resident #2 during her night shifts with the assistance of a CNA and stated Resident #2 did not have any deterioration from 12/16/24 -03/06/25 during the time she did not populate a skin assessment document. LVN A stated she did not know why she did not document Resident #2's skin assessment and stated she knew how to complete the body diagram and stated she did not know if she was in a hurry or didn't have time to document it on the body diagram. LVN A stated she had previously been trained over completion and documentation of skin assessments every year during their annual competencies. LVN A stated it was important to document residents skin assessment on the body diagram weekly to observe any changes. LVN A stated she thought the ADON was responsible for monitoring and ensuring the nurses skin assessments were completed but was not sure how the ADON did so. LVN A stated their facility policy stated they should document on the body diagram. Although LVN A did not follow the facility policy in this situation LVN A stated in this situation she had followed the facility policy. LVN A stated Resident #2 had no deterioration but stated a negative impact if they did not document skin assessments could be that they would not know if something was new or not. During a telephone interview on 09/16/25 at 3:45pm with LVN B who was the previous wound care nurse she stated she would do the initial skin assessment and skin assessments for residents who had any wound and nurses were responsible for completing skin assessments for resident's weekly who did not have any wounds. LVN B stated she recalled Resident #2 and stated from December 2024 to March 2025 the nurses would have been responsible for completing her weekly skin assessments. LVN B stated they had to sign off on the TAR and populate the body diagram and document anything that was noticed on there. LVN B stated the body diagram had to be populated every time regardless if a resident had any changes or not to their skin integrity. LVN B stated she was not aware of Resident #2 not having a skin assessment document completed from 12/26/24 - 02/27/25 and did not know why that was not documented and was not sure if the skin assessment had been completed and not documented on the body diagram. LVN B stated she was previously the wound care nurse at the time and stated the wound care nurse or DON were responsible for monitoring and ensuring nurses skin assessment were completed by running reports to see if the skin assessments were completed. LVN B stated she never ran any reports and stated the DON would run the report and then show her what was not complete and then she would track down the nurse and tell them. LVN B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455802 If continuation sheet Page 4 of 5 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 455802 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spanish Meadows 440 E Ruben Torres Blvd Brownsville, TX 78520 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 stated was trained over the completion and documentation of skin assessment when she first got hired in September of 2023. LVN B stated she did not recall the facility skin policy. LVN B stated it was important to document on the body diagram for things to be reported and treated when noticed and stated not documenting a resident skin assessment could negatively impact them because something could go unnoticed or intreated. Record review of LVN A's skills verification checklist dated 05/07/24 indicated she had met the skill for skin assessment sheet. Record review of facility policy titled, Pressure Ulcer Injury/Injury Risk Assessment with a revised date of July 2017 stated, .b. Once inspection of skin is completed document the findings on a facility- approved skin assessment tool.The following information should be recorded in the resident's medical record utilizing facility forms: 1. The type of assessment (s) conducted.5. The condition of the resident's skin (i.e., the size and location of any red or tender areas), if identified.11. Initiation of a (pressure or non-pressure ) form related to the type of altercation in skin if new skin alteration noted. Event ID: Facility ID: 455802 If continuation sheet Page 5 of 5