Health inspection·May 22, 2025

F 0740 Interventions: o Assess and anticipate resident's needs: food, thirst. toileting needs, comfort level, Level of Harm - Minimal harm or potential for actual harm body positioning, pain etc. Date Initiated: 04/26/2024. o (psychiatry) to evaluate and treat as ordered Date Initiated: 05/31/2024. Residents Affected - Few o Give as many choices as possible about care and activities. Date Initiated: 04/26/2024. o When becomes agitated, guide away from source of distress; engage calmly in conversation. If response was aggressive, staff to walk calmly away, and approach later. Date Initiated: 04/26/2024. Record review of a physician order for Resident #1 dated 05/30/2024 at 3:14 PM, confirmed by DON, reflected the following: Order Summary: psychiatry services to evaluate and treat. 2. Record review of Resident #2's face sheet, dated 05/22/25, reflected the resident was an [AGE] year-old male, with an admission date of 7/11/23. Resident #2 had diagnoses of Alzheimer's Disease (a progressive neurodegenerative disorder that primarily affects the brain, leading to a decline in memory, thinking, and other cognitive functions) and Cognitive Communication Deficit (communication difficulty). Record review of Resident #2's quarterly MDS assessment dated [DATE], reflected Resident #2 had a BIMS score of 15 indicating cognitively intact, and had inattention and disorganized thinking. Record review of Resident #2's undated care plan reflected the following: Focus: Potential for a psychosocial well-being problem r/t being kicked to leg by another resident 5/26/24 Date Initiated: 05/31/2024. Goal: Will have no indications of psychosocial well-being problem by/through review date. Date Initiated: 05/31/2024 Revision on: 04/15/2025 Target Date: 07/14/2025. Interventions: o 5/26/24 head-to-toe assessment Date Initiated: 05/31/2024 o Allow time to answer questions and to verbalize feelings perceptions, and fears. Date Initiated: 05/31/2024. Record review of a physician order for Resident #2 dated 05/30/2024 at 3:14 PM, confirmed by DON, reflected the following: Order Summary: psychiatry services to evaluate and treat. Record review of the Provider Investigation Report # 507305 dated 05/31/25, reflected the following: Other Action Taken: . . Psychiatry services to evaluate and treat both residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455925 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 455925 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veranda Rehabilitation and Healthcare 4301 S Expressway 83 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #1's and Resident #2's electronic record did not reflect any psychiatric consultation, any scheduled consultation, or any follow-up regarding the psychiatry consult order. In an interview on 5/21/25 at 3:28 pm DON said she remembered she received a call from staff and was informed Resident #1 was observed swinging and kicking at Resident #2. She said the facility implemented moving Resident #1 to a different hallway prevented the incident from happening again. She said Resident #1 had not exhibited those behaviors before, but the facility felt Resident #1 being moved prevented the behavior from happening again. She said Resident #1 did not receive the evaluation/treatment for psychiatry. She said the social worker who was working at that time did not follow through with the orders for psychiatry to evaluate and treat. The DON said she provided the order to the social worker at the time, and she did not follow through. The DON said the social worker was the designee for psychiatry referrals. The DON said that social worker no longer worked for the facility. The DON said there was not a negative outcome with this incident. In an interview on 5/22/25 at 2:20 pm the Administrator said Resident #2 loved to talk about religion. The Administrator said Resident #2 could preach a lot and could be unrelenting. The Administrator said he thought Resident #2 was doing that with Resident #1 and Resident #1 did not like it. The Administrator said the facility separated the two residents and placed everything on the investigation summary. The Administrator said everything listed on the investigation summary should have been done. The Administrator said the social worker at the time was responsible for carrying out those orders. The Administrator said with that behavioral/psychiatric referrals, the social worker was the designated person who made sure the referral happened. Record review of the facility's Behavioral Health Services policy with a revision date of 12/2023, reflected the following: Policy It is the policy of this facility to provide residents with necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Behavioral health encompasses a resident's whole emotional and mental well-being, which includes the prevention and treatment of mental and substance use disorders, as well as psychosocial adjustment difficulty, or those with history of trauma and/or post-traumatic stress disorder. Procedure . 6. The physician, in collaboration with the IDT team, will determine the appropriate psychiatric or psychological treatment or rehabilitative services needed. Treatment will be provided as ordered by the physician. 7. Social services will make the appropriate professional services referral, if needed, following agreement from the resident and/or resident representative. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455925 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 455925 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veranda Rehabilitation and Healthcare 4301 S Expressway 83 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for one (Resident #3) of six residents. The facility failed to ensure that Resident #3 received his eye drops to his left eye as prescribed on the physician's prescription orders dated 2/26/25. Resident #3 received 1 drop twice a day instead of 1 drop three times a day to his left eye. This facility's failure placed residents receiving medications at risk for drug diversion, drug overdose, and decrease efficacy of medications. Findings included: Record review of Resident #3's face sheet, dated 05/22/25, reflected the resident was a [AGE] year-old male, with an original admission date of 1/17/24. Resident #3 had diagnoses of Dementia (a decline in cognitive functioning, affecting memory, thinking, and language to such an extent that it interferes with a person's daily life and activities), cystoid macular degeneration, right eye (a condition where the central part of the retina responsible for detailed vision, swells and forms cyst-like fluid collections) and presence of intraocular lens (an artificial lens implanted in the eye to replace the natural lens). Record review of Resident #3's quarterly MDS assessment dated [DATE], reflected Resident #3 had a BIMS score of 13 indicating cognitively intact. Record review of Resident #3's undated care plan reflected the following: Focus: impaired visual function r/t presence of intraocular lens, cystoid macular degeneration, right eye, combined forms of age-related cataract, bilateral, diabetes 2/11/25 s/p right eye cataract surgery. 2/24/25 s/p left eye cataract surgery. Date Initiated: 01/31/2024 Revision on: 03/19/2025. Goal: Will have no indications of acute eye problems through the review date. Date Initiated: 01/31/2024 Revision on: 02/12/2025 Target Date: 07/28/2025. Interventions: o 2/17/25 eye drops as ordered Date Initiated: 02/18/2025 o 2/26/25 eye drops as ordered Date Initiated: 02/27/2025 o 3/3/25 eye drops as ordered Date Initiated: 03/03/2025 Revision on: 03/04/2025 o appt. with ., OD 03/10/25 @ 8:00 am Date Initiated: 03/03/2025 o appt. with ., OD ***03/25/25 Date Initiated: 03/17/2025 o eye drops as ordered Date Initiated: 03/10/2025 Revision on: 03/19/2025 o f/u appt with . Surgical Center ***02/26/25 @ 8:15am*** [M .,Tx] Date Initiated: 02/25/2025 o f/u (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455925 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 455925 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veranda Rehabilitation and Healthcare 4301 S Expressway 83 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with ophthalmologist as needed Date Initiated: 06/04/2024 o Monitor/document/report to MD the following s/sx of acute eye problems: Change in ability to perform ADLs, decline in mobility, sudden visual loss, pupils dilated, gray or milky, c/o halos around lights, double vision, tunnel vision, blurred or hazy vision. Date Initiated: 01/31/2024. Record review of a prescription order for Resident #3 from eye doctor's office, signed by OD and dated 2/26/25 reflected the following: Drop orders: Right eye Prednisolone i gtt OD BID, Left Eye Prednisolone i gtt OS TID . Record review of a physician order on PCC for Resident #3 dated 2/25/25 reflected Prednisolone Acetate Ophthalmic Suspension 1% in both eyes 1 drop two times a day, everyday post cataract surgery, start date 2/26/25. In a phone interview on 5/20/25 at 6:10 pm LVN A said one of Resident #3's eye drops had been discontinued with the previous cataract surgery, so she could not resume those drops without clarified orders. LVN A said nurses are required to obtain detailed physician orders to administer any medications. LVN A said if they did not have detailed orders, they must call the physician to receive clarified orders. LVN A said she could not recall if she received a written prescription order or a verbal order for the eye drops. LVN A said she could not recall if the drops were prescribed two or three times a day. LVN A said if she did not clarify the order, she could have given the wrong medication or the wrong dose and that would have been an error. In a phone interview on 5/21/25 at 10:17 am RN B said nurses could not give eye drops or any medications without a physician's order. RN B said if the eye drops had been given without an order or clarification, they could have given the wrong medication or the wrong dose, which could have damaged the resident's eyes and could have affected her nursing license. RN B said nurses received orders and ensured orders were accurate which was protocol. She said as a nurse they clarified any order that needed clarification prior to administering a medication. In an interview on 5/22/25 at 10:20 am, the DON said nurses cannot administer medications without a complete prescription order. The DON said if there was missing information, such as the specific medication name, frequency, dosage, etc., the nurses were required to clarify those orders. The DON said they received a written prescription for the eye drops. The DON looked up the order on PCC and said the prednisolone for both eyes was prescribed two times a day. She looked up the prescription on the Provider Investigation Report and read the prednisolone for the left eye was prescribed three times a day. She said she really was not sure if there was another prescription or what happened. She said the thing with Resident #3 was he went to two different clinics, one in one town and one in another town, so she was not sure if they received a different order as well. The DON also said Resident #3 was resistant to providing the facility/nurses with post doctor visit orders. The DON said they could not administer medications without a complete prescription order. The DON said Resident #3 received his eye drops so she could not tell this surveyor if there would have been a negative outcome. The DON said if nurses did not give medications as prescribed, a resident could get worse for whatever reason they were receiving the medication. In an interview on 5/22/25 at 2:20 pm Administrator said any incident involving medications, he let his DON manage it. The Administrator said if the facility received a completed physician's order, they gave the resident exactly what was ordered on that written order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455925 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 455925 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veranda Rehabilitation and Healthcare 4301 S Expressway 83 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In a phone interview on 5/22/25 at 4:15 pm with the Ophthalmic Assistant at the eye doctor's office stated that patients usually have a follow up appointment the day after cataract surgery and were given their prescriptions at that time. She said patients were usually prescribed prednisolone 1 drop three times a day x 1 week, then it was decreased to 1 drop two times a day x 2 weeks, then 1 drop one time a day x 1 week. She said that was what was ordered Resident #3. She said from 2/26/25 to 3/3/25 Resident #3 should have received 1 drop 3 times a day to his left eye. She said if he received 1 drop two times a day instead, it would have minimal to no effect on the patient. She reviewed the Resident #3's record and said it showed no inflammation to the back of his left eye, so it had no effect to this patient. Record review of the Medication Administration - Eye Drops check-off dated 2/28/25 revealed the following: .Title: Check. Description: Verify the five rights of medication administration: (right person, medication, route, time, and dose) by checking the medication label to the MAR three times, upon removal from storage, before preparation, and before administration. Rational: Prevents medication errors with a check-off under Met. . Title: Administer. Description: Rest your dominant hand on the individual's forehead and instill the prescribed number of drops into the conjunctival sac. Rational: Ensures proper administration of the medication and prevents discomfort with a check-off under Met. . Title: Administer. Description: Repeat the procedure on the other eye as ordered. Rational: Prevents medication errors with a check-off under Met. Record review of the facility's Policy/Procedure - Nursing Clinical reviewed 8/2022 revealed: Policy: .It is the policy of this facility to accurately implement orders in addition to medication orders (treatment, procedures) only upon the written order of a person duly licensed and authorized to do so in accordance with the resident's plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455925 If continuation sheet Page 6 of 6