Inspection·July 22, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were 18. Record review of Resident #1's Kardex (a quick reference or an extension of the care plan, derived from the care plan, used by CNAs and other staff to stay updated on residents key needs and care) dated [DATE] revealed a communication section with interventions to include: ask yes or no questions to determine resident's needs, Resident #1 prefers to communicate in Vietnamese, Resident #1 required communication cue cards which were located in the bedside table and ensure availability and functioning of adaptive communication equipment. In an interview on [DATE] at 10:05 AM, CNA-B stated Resident #1 spoke Vietnamese, so she could not understand her, but she would smile in response when spoken to like she understood some things which were said to her in English, but other than this, the staff had no way to formally communicate with this resident or understand what Resident #1 was saying to them or needing from them. CNA-B stated Resident #1 would get worked up frequently and yell, but she had never seen her get combative. CNA-B stated she walked into Resident #1's room on [DATE] after Resident had fallen out of bed. She stated she had offered assistance with the resident since she had showered her earlier in the day and had a good rapport with her. She stated Resident #1 was talking and yelling in Vietnamese but was not crying or grimacing like she was in pain. She stated she had no other way to communicate with her or understand her, as CNA-C had already tried the translator device, and it had not worked. It was not typically used for this resident as it would not pick up what she was saying or yelling. She did say she could answer some simple yes or no questions if they point to things and asked, such as pointing to or rubbing stomach and asking if it hurt. In an interview on [DATE] at 10:39 AM, CNA-C stated after Resident #1 fell out of bed on [DATE], she was being combative and yelling and speaking in Vietnamese, but she could not understand what Resident #1 was saying. CNA-C stated she and RN-A tried to use the translator to understand Resident #1, but it was not picking up or understanding what the resident was saying. She also stated Resident #1 yells frequently, which was typical for her. She stated she had no other way to formally communicate with Resident #1 to find out what she was saying or what she needed, but she would shake her head yes or no to simple questions such as pain.In an interview on [DATE] at 11:09 AM the ADON stated it was either her or the MDS nurse which typically updated the clinical care plans. She stated at some point in time between the previous care plan which was initiated [DATE] and the current care plan, which was initiated [DATE], there was a behavior problem listed, but it must have dropped off, been deleted, or gotten closed out, and this was why there was a new problem for resistive to care added on [DATE]. She stated she was not sure why the goals and interventions were not added to the care plan until [DATE], the day Resident #1 expired, and she also stated she did not remember if it was herself or the MDS nurse who had added them. The ADON stated Resident #1 had always been combative and verbally aggressive with incontinent care and ADLs, and it was something which should have always been care planned, so it dropping off or being removed was by mistake. She stated Resident #1 was able to nod in response or say simple phrases like thank you, but she did have the cue cards at bedside to assist with communication. She stated the CNAs utilized the Kardex, which was derived from the care plan, to learn and know more about the residents they were caring for, and Resident #1's language preferences were on the care plan and the Kardex. She stated if a CNA did not typically work the hall of a resident, then they may not have known the cue cards were in the bedside table. She stated the CNAs should have been looking at the Kardex, but many times they may have only skimmed it for the highlights such as transfer and mobility status. She stated she felt like maybe the CNAs needed more training on what the Kardex was and how it was used. In an interview on [DATE] at 1:17 PM, the MDS Nurse stated she hadn't really started working on care plans because she was new and just started this job and was still training. She also stated Resident #1's MDS assessment and care plan probably (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455974 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 455974 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rockport Nursing and Rehabilitation Center 1902 Fm 3036 Rockport, TX 78382 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 FORM CMS-2567 (02/99) Previous Versions Obsolete were not the best due to the language barrier with Resident #1, and she was not able to ask Resident #1 any questions, so she mostly asked staff which took care of her on a daily basis regarding the MDS questions. She also stated she was not able to consult with family as Resident #1 did not have any family, and the only contact was a friend who never returned phone calls or came to care plan meetings or to visit Resident #1. The MDS nurse stated the care plan problem resistive to care or refuses care was care planned previously, and she wasn't sure why it was ever removed or dropped off; she also was not sure why the current care plan was initiated [DATE], but the goals and interventions were not initiated until [DATE]. In an interview on [DATE] at 2:31 PM, CNA-B stated she knew what a Kardex was because she learned about it in her CNA program, and she knew she was supposed to be reviewing it and using it, but she admitted the Kardex rarely got used, and she had not reviewed it for Resident #1. She stated she had not known there were cue cards in Resident #1's bedside table. CNA-B also stated she had never had an in-service or training in this facility regarding the use of the Kardex. She stated if she and the other staff had reviewed the Kardex, they would have known there were cue cards in the bedside table, and they may have been able to better communicate with Resident #1 and understand what she was yelling about. Record review of the facility's Comprehensive Care Plan Policy, dated [DATE], revealed It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, which includes measurable objectives and timeframes to meet a resident's medical, nursing and mental and psychosocial needs which were identified in the resident's comprehensive assessment. The care planning process will include an assessment of the resident's strengths and needs and will incorporate the resident's personal and cultural preferences in developing goals of care. Event ID: Facility ID: 455974 If continuation sheet Page 3 of 3