Health inspection·February 17, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm toilet with head in the bathroom shower. Resident states she did not know how she fell and was sitting on toilet prior to her fall. SN assessed V/S and blood sugar. V/S are 137/76, P 88, RR 20, O2 97%, blood sugar is 78. Skin assessment was completed and found to have a hematoma to left eyebrow. No other skin abnormalities were found. ROM was tested and resident was able to move all extremities with no complaints of pain. SN educated resident to use call light whenever in need of assistance in the bathroom. Residents Affected - Few Review of Resident #39's Progress Note on 01/27/24 at 12:45 p.m., written by RN M: RN N from DHR notified SN of resident returning to facility. RN reported CT pelvis, CT head and brain were negative for fractures. Chest X-ray was completed and found no abnormalities. Diagnosis soft tissue swelling. RP and PCP notified. In an observation and interview on 02/17/24 09:17 a.m., Resident #39 was sitting in hallway in her wheelchair. Resident #39 had dark discoloration under left eye. Resident stated she fell (Resident #39 had undocumented falls on 02/02/24 and 02/09/24), but she is better, and it no longer hurts. In an interview on 02/17/24 at 03:36 p.m., the DON stated they documented actual falls in the care plan with an intervention. The DON made aware Resident #39's unwitnessed fall on 01/27/24 was not reported. The DON stated she would look into it. In an interview on 02/17/24 at 07:52 p.m. the DON stated Resident #39 fell in the bathroom, but the RN (RN M) was outside the door. The DON stated the SBAR showed that the resident fell when she was trying to pull up her pants. The Administrator stated resident is in a private room, she fell, and there could be no abuse because she was in a private room. Policy and Procedures: Abuse, Neglect, and Exploitation Policy date implemented, 10/24/2022 reflects: -Policy Explanation and Compliance Guidelines: 2. The facility's Abuse Prevention Coordinator is responsible for reporting allegations or suspected abuse, neglect, or exploitation to the state survey agency and other officials in accordance with the law. VII: Reporting/Response A. The facility reports abuse and neglect allegations that include: 1.Reporting allegations involving staff to resident abuse, resident to resident altercations, injuries of unknown source, misappropriation of resident property/exploitation, and mistreatment. 2. Reporting of all alleged violations to the Administrator, state agency, adult protective services, and to all other required agencies within specified timeframes. a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 2 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0609 b. Level of Harm - Minimal harm or potential for actual harm Not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 3 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and observation, the facility failed to ensure each resident received adequate supervision and assistive devices to prevent accidents for 1 of 6 resident (Resident #51) reviewed for accidents. The facility did not provide supervision to prevent Resident #51's from sustaining multiple falls in the facility. This failure could place residents with a history of falls at risk for additional falls and injuries. The findings included: Record review of Resident #51's admission record dated, 8/15/2023, revealed he was an [AGE] year old male, with an initial date of 6/17/2019, and had the following diagnosis: multiple fractures of ribs to the right side with routine healing a laceration without foreign body of left forearm, unspecified fracture of first lumbar vertebra (the five bones in your lower back) with routine healing, a wedge compression fracture of second lumbar vertebra with routine healing, an abnormality of gait and mobility, a lack of coordination, age-related physical debility, unsteadiness on his feet, muscle wasting and atrophy, and a cognitive communication deficit. Record review of Resident #51's significant change MDS assessment dated [DATE], revealed Resident #51 had a BIMS score of 00 which indicated his cognition was not intact and he had unclear speech. He was sometimes understood and he could sometimes understand others. He required 1 person assistance for all ADLs, with extensive assistance for dressing, toilet use and personal hygiene. He required limited assistance with bed mobility and supervision for transfers, walking in room, walking in corridor, locomotion on the unit, locomotion off the unit, and for eating. Record review of Resident #51's Comprehensive Care Plan initiated 5/4/2020 and revised 12/13/2023 revealed: Focus: Resident #51 had a high risk for falls related to cognitive impairment, He had gait/balance problems. He was non-redirectable at times and insisted on not sitting down or using a wheelchair. Resident was non-compliant with the use of call light. He had a history of a fall with multiple rib fractures & compression fracture to the spine. He had impulsive behaviors. Date initiated: 5/4/2020. Interventions included: Anticipated and met the resident's needs. Placed items frequently used by the resident within easy reach when in the room. Educated the resident/family/caregivers about safety reminders and what to do if a fall occurs. Completed a fall risk screening upon admission and quarterly to identify risk factors. Placed the resident's call light within reach and encouraged the resident to use it for assistance as needed. Goal revised 8/14/2023 s/p fall: risk for falls and injury will be minimized through the next review date of 1/11/2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 4 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0689 Dates revised with interventions: Level of Harm - Actual harm 9/7/2023 - Helmet to aid with injuries prevention. Residents Affected - Few 9/28/2023 - Redirected to compliance with medical equipment for safety precaution. 10/25/2023 - Educated and redirected resident to use assistive devices. 11/1/2023 - Assisted with toileting q 2h and prn. 11/28/2023 - Therapy evaluated and treated, educated and reoriented to call for assistance. 12/12/2023 - Fall precautions wer placed at all times. 12/13/2023 - MD ordered Neuro checks and resident was redirected as needed. 2/13/2024 - Helmet was on at all times to aid with injuries prevention. Safety checks completed q 1 hrs. to monitor whereabouts due to fall risks. 2/15/2024 - Floor mats were placed next to bed Record review of Resident #51's orders dated 8/24/2023 revealed the resident was placed on Hospice care for DX: Other Specified Degenerative Disease of Nervous System. Record Reviewed of Incident/accident log: Falls on the following dates: 9/1/23, 9/3/23, 9/12/23, 9/19/23, 9/25/23, 10/16/23, 10/25/23, 11/11/23, 11/26/23, 12/7/23, 12/12/23, 12/18/23, 12/21/23, 12/25/23 x 3, and 12/27/23. Record review of Resident #51's fall incident dated 09/01/2023 at 05:49 - location: 202-A. Description: A loud noise heard from the nurse's station. Resident #51 found on bathroom floor in room. Resident able to stand up with assistance. Resident able to answer questions clearly and follow commands. Resident had redness to the forehead and abrasion to right forearm. Resident able to move all four extremities. Resident alert and oriented at the time of fall and during head-to-toe assessment. Resident stated that he fell but unable to explain how or if he hit any extremities during the incident. Reported no pain or discomfort throughout body. Vitals taken. RP was made aware of resident incident. Hospice nurse notified. Hospice PCP notified. 911 contacted. Transportation arranged. DHR ER contacted to give report. DON notified of fall. Resident refused treatment/transportation multiple times when EMS arrived at facility. Hospice nurse/PCP aware of refusal and pending eval. RP attempted to be contacted regarding refusal but no response - pending callback. Neuro checks were started. Post fall assessment recommendations: 9/1/23 - refer to rehab to screen and follow up with recommendations. Fall precautions at all times. All items within reach. Handle care gently and unhurried. Non-skid shoes or socks to aid with ambulation. CNA x 1 to assist with ADLs. Helmet to aid with safety. Keep close to nurse's station. Record review of Resident #51's fall incident dated 09/5/2023 at 21:39 - location: 202-A. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 5 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0689 Level of Harm - Actual harm Residents Affected - Few Description: CNA reported that resident fell while walking to bed. CNA stated resident tripped over his own feet and fell. Resident found on floor laying on left side in front of bed near dresser. Resident able to move all four extremities. Reports no pain or discomfort at the time. Resident had abrasion to the back of the scalp - no active bleeding to the areas. Resident alert and oriented. Resident able to follow commands. Pupils equal, round and reactive to light and accomodation present. Resident stated that he fell and unable to explain why or how incident occurred. No pain to head or other extremities reported. Complete head to toe assessment done. Vital signs taken. 911 contacted. Hospice nurse notified. RP aware. DON aware. ER contacted for report. Resident refused transfer to hospital when EMS arrived. Post Fall assessment recommendations: 9/5/23-Monitor closely. Refer to rehab to screen and follow up with recommendations. Call light within his reach. Handle care gently and unhurried. Keep close to nurses' station when out of bed. Non-skid shoes or socks to aid with ambulation. Record review of Resident #51's fall incident dated 09/12/2023 at 19:20 - location: 202-A. Description: Resident found on floor in room in front of closet near ac unit. Resident alert and oriented. Resident reopened previous scalp abrasion. No active bleeding. Wound cleaned. Resident was grabbing something from the closet and fell back. No pain or discomfort during shift. Complete head to toe done. Vitals obtained. Hospice nurse, hospice PCP notified of incident. Resident refused transfer to hospital for treatment/eval. No pain or discomfort notified. RP notified of incident/refusal of hospital transfer. Orders implemented and neuro checks started. Safety precautions implemented. Call light left within reach. Resident educated on use of helmet when ambulating. Post Fall assessment recommendations: 9/12/23 - Refer to rehab to screen and follow up with recommendations. Monitor closely. Call light within his reach. Non-skid shoes or socks to aid with ambulation. Keep close to nurse's station when out of bed. Fall precautions at all times. Record review of Resident #51's fall incident dated 09/19/2023 at 13:30 - location: 202-A. Description: A bang was heard at the nurse station from the resident's room. Resident was lying on the floor to the left side next to the doorway. Appeared resident pushed his bedside table outside of his door and when heading back he lost his balance. Red mark noted to the top of the head, left side. Hospice made aware and nurse will come to assess. RP was notified. Soft helmet that was placed earlier was removed by resident. Resident unable to give description. Denied pain. Neuro checks initiated. ROM to all extremities. Post Fall assessment recommendations: 9/13/23 - Refer to rehab to screen and follow up with recommendations. Monitor closely. Call light withing his reach. Handle care gently and unhurried. [NAME] withing his reach. Keep close to nurses' station when out of bed. Encourage resident to wear helmet. Non-skid shoes or socks to aid with ambulation. Record review of Resident #51's fall incident dated 09/25/2023 at 04:58 - location: 202-A. Description: Resident seen walking with unsteady gait via walker. Resident found in restroom on knees next to toilet holding the bathroom rails. Resident with skin tear to left forearm and two small line impressions on forehead where head was against wall. Resident able to move all four extremities. Resident stated that he was using the bathroom and fell over. Did not hit head and does not report pain or discomfort. Vital signs taken. Complete head to toe done, hospice notified, orders (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 6 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0689 Level of Harm - Actual harm Residents Affected - Few implemented. TAO applied to skin tear as ordered, neuro checks started. RP attempted to be notified multiple times and pending call back. Resident seen walking around facility post fall with walker. No complaints with helmet and continues to remove. Post Fall assessment recommendations: 9/25/23-Refer to rehab to screen and follow up with recommendations. Monitor closely. [NAME] within his reach. Non-skid shoes or socks to aid with ambulation. Encourage resident to use call light for assist and change position slowly. Encourage resident to wear helmet. Record review of Resident #51's fall incident dated 10/16/2023 at 14:43 - location: 202-A. Description: A noise was heard from the nurse station. Resident was found lying on the floor in front of the closet. Resident was noted with unsteady balance and gait, uses a walker, and has a helmet for safety but does not always leave in place. ROM to all extremities. Resident unable to give description of incident. Neuro checks initiated. RP, hospice, and NP made aware of the incident. Post Fall assessment recommendations: 10/16/23 - Refer to rehab to screen and follow up with recommendations. Monitor closely. Handle care gently and unhurried. Call light within his reach. Non-skid shoes or socks to aid with ambulation. Helmet at all times. Fall precautions at all times. Record review of Resident #51's fall incident dated 10/25/2023 at 05:48 - location: 202-A. Description: Resident was seen standing near his bed without walker, near the window. I was walking pass his room and saw him lose balance and fall to the floor landing on his butt and right elbow. Resident did not hit his head during the fall. Resident able to move all four extremities with no abnormalities noted. No bruising skin tears, or other abnormalities noted during head-to-toe assessment. Resident able to come to standing position. Resident stated that he fell back. Resident denies pain with movement. Resident denies hitting head. Stated he only hit his butt and right elbow. Completed head to toe done. Vitals taken. Hospice Nurse notified. RP attempted to be called, voicemail left, pending call back. DON notified. Post fall assessment recommendations: Assess and follow up recommendations. Monitor closely. Call light within reach. Helmet on at all times. Fall precautions at all times. Encourage resident to use non-skid shoes or socks to aid with ambulation. Keep close to nurse's station when out of bed. Record review of Resident #51's fall incident dated 11/11/2023 at 20:40 - location: 202-A. Description: Resident found on the floor in room near his bed with walker on his back side. Resident was sitting up with pants semi down. Resident alert and oriented x 2, able to follow simple commands. Resident moves upper and lower extremities with no abnormalities determined. Small skin tear to left thumb noted. Call light left within reach and safety precautions implemented. Neuro checks implemented. Resident continues to use walker around facility/room. Non-compliant with use of helmet. Resident stated that he fell back and hit the floor. Complete head to toe done, vitals taken. Hospice nurse notified and pending assessment to be done in the morning. RP attempted to be contacted but no response - pending call back. Voice mail left. Post fall assessment recommendations: 11/11/23-Refer to rehab to screen and follow up with recommendations. Monitor closely. Handle care safely and unhurried. Call light within reach. Non-skid socks or shoes to aid ambulation. Fall precautions at all times. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 7 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0689 Record review of Resident #51's fall incident dated 11/26//2023 at 07:09 - location: 202-A. Level of Harm - Actual harm Description: Resident sitting on his buttocks beside the bed. Noted resident with skin tear to back of head. Has ROM to all 4 extremities. Assisted up and back to bed. Wound care nurse informed along with nurse at hospice and stated that she will send a nurse to assess him today. Left message for RP. DON made aware along with PCP. Resident unable to give description. Denies pain. Neuro checks initiated. Residents Affected - Few Post fall assessment recommendations: 11/26/23-Refer to rehab to screen and follow up with recommendations. Monitor closely. Call light within his reach. Handle care gently and unhurried. Non-skid shoes or socks to aid with ambulation. Fall precautions at all times. Record review of Resident #51's fall incident dated 12/7/2023 at 11:05 - location: 202-A. Description: Resident was up ambulating and standing in his doorway without his walker and the soft helmet the aides had just placed on him. [NAME] given to resident and reminded to use, then aide notified resident had a fall with a laceration to back of head. Pressure was applied until the bleeding stopped. Resident on floor turning himself back and forth. Resident unable to give description. 911 initiated and hospice made aware. Resident complaining of pain to head. ROM to all extremities with no pain verbalized. DON and RP made aware of incident and that resident being sent to ER. Report called in and transported out of building at 11:20. Post fall assessment recommendations: 12/7/23-Refer to rehab to screen and follow up with recommendations. Monitor closely. Call light within his reach. Handle care gently and unhurried. Non-skid shoes or socks to aid with ambulation. Fall precautions at all ties. Keep close to nurses' station when out of bed. Record review of Resident #51's fall incident dated 12/12/2023 at 20:16 - location: 202-A. Description: Resident had an un-witnessed fall and was found by the fish tanks. Resident had a small head abrasion to the back of the head. Resident found lying on his back side with walker next to him. Resident able to move upper and lower extremities with no pain or discomfort. No abnormalities noted. Head to toe completed. Pupils equal, round and reactive to light and accomodation present. Minor bleeding from abrasion noted. Hospice nurse notified and came to evaluate resident. No new orders given at this tie. Resident offered pain medication but refused. Resident able to voice needs. Alert to person and place with some confusion. Resident placed back into bed. Neuro checks implemented. Pending call back from RP. DON notified via phone. Post fall assessment recommendations: 12/12/23-Refer to rehab to screen and follow up with recommendation. Monitor closely. Call light within his reach. Handle care gently and unhurried. [NAME] within his reach. Non-skid shoes or socks to aid with ambulation. Keep close to nurse's station when out of bed. Record review of Resident #51's fall incident dated 12/18/2023 at 18:56 - location: 202-A. Description: Loud nose heard from nurse's station. SN went to resident room and resident was found on restroom floor near toilet with walker next to resident. Resident was alert and oriented to person and place. Resident table to stand up and sit on wheelchair. Resident able to move upper and lower extremities with full ROM. Redness noted to the left backside of resident's head. No skin tear, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 8 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0689 Level of Harm - Actual harm abrasion, pain or discomfort reported to the area by resident. Resident refused to be placed in bed. Resident's helmet placed again but resident removed helmet as soon as SN walked away. Completed head to toe. Vitals taken. Full ROM in upper and lower extremities. RP made aware. Hospice nurse RN aware and will come to evaluate resident later today. Neuro checks implemented. Residents Affected - Few Post fall assessment recommendations: 12/18/23 - Referred to rehab to screen and follow u with recommendations. Non-skid shoes or socks to aid with ambulation. Keep close to nurse's station when out of bed. Fall precautions at all times. Helmet on at all times. Record review of Resident #51's fall incident dated 12/21/2023 at 18:50 - location: 202-A. Description: Resident was found on the floor on his back in the hallway. Resident was wearing soft helmet and was using his walker while ambulating. Small pool of blood was noted on the floor behind back of his head. Resident had sutures intact to the back of his head due to previous unwitnessed fall. No new injuries noted. ROM to all extremities without difficulty or pain. Resident was unable to give description. Head to toe assessment completed. VS were within parameters. There was a small amount of bleeding to the back of his head. Resident transferred to his wheelchair used 3 persons for safety. Resident then placed in bed. No new injuries noted. Resident was instructed to use his call light for assistance if he was going to get out of bed. Resident nodded his head yes. Hospice was notified. Spoke to RN/DON and stated she will come by to see him. PR notified. ADON/DON notified. Neuro checks started for 72 hr. Low bed for safety. Call light placed withing reach and continued monitoring. Post fall assessment recommendations: 12/21/23-Referred to rehab to screen and followed up with recommendations. Monitored closely. Fall precautions placed at all times. Call light withing his reach. Non-skid or socks to aid with ambulation. Helmet used while out of bed. Kept close to nurses' station when out of bed. Record review of Resident #51's fall incident dated 12/25/2023 at 08:45 - location: 202-A. Description: Heard patient yell and something hit the wall. Walked into patient room and saw that patient was laying on the floor. Shoulder noted up against the wall and body laying sideways. Stated that his right wrist was hurting and denied hitting head. Resident unable to give description. Called for assistance. CNA was able to assist with getting patient off the floor. Resident placed in wheelchair and assessed. Hospice was called and a message was left of patient falling and requested a call back. Family member called and advised of incident. Resident with intact staples to back of right head. No bleeding/cuts or swelling noted at the time. Post fall assessment recommendations: 12/25/23- Medication changes: Added Temazepam. Refer to rehab to screen and follow up with recommendations. Handle care gently and unhurried. Helmet while out of bed. Non-skid shoes or socks to aid with ambulation. Record review of Resident #51's fall incident dated 12/27/2023 at 05:00 - location: 202-A. Description: SN heard loud noise from room. SN proceeded quickly. Pt found sitting on floor in between chair, walker, and bed. Resident unable to give description. SN assess - with pupils equal, round and reactive to light and accomodating. No changes in level of consciousness, no s/s of pain or discomfort. No injury or redness/swelling noted. Patient assisted back into bed with two people. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 9 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0689 Level of Harm - Actual harm Post fall assessment recommendations: 12/27/23-Refered to rehab to screen and follow up with recommendations Monitored closely. Call light placed within his reach. Handled care gently and unhurried. Non-skid shoes or socks to aid with ambulation. Encouraged resident to use call light for assistance. Helmet on while out of bed. Residents Affected - Few Observation on 02/13/24 at 03:00 PM. Resident # 51 in bed awake with head of bed elevated, bed in low position and floor mats to both side of bed. Call light in reach to left side of bed. Room and restroom free of clutter. Resident did not respond to any of my questions. No side rails. No injuries noted. Resident would not respond to any questions. In an interview on 2/14/24 at 10:00 AM with LVN/ADON G, she said she could not recall specific falls, but interventions were done with hospice. Staff had called family to see if they could come spend more time with resident. Resident was checked on every 2 hours. He did not like to be out of his room. Fall precautions included bed low position and floor mats since resident did not get up and walk as much on his own anymore. LVN/ADON G said they would get him up to the wheelchair when resident allowed. In an interview on 02/16/24 at 02:30 PM with DON, she said resident #51 had a history of stroke. He was very impulsive. He walked with a walker. Resident #51 was on hospice and they communicated with them regarding resident interventions and non-compliance. Since changing medication from Temazepam to Trazadone HCl Oral Tablet 100 MG at bedtime for insomnia, he was not as impulsive anymore. They did q 1 hr. checks to monitor and see if Resident #51 was wearing his helmet, because Resident #51 was not compliant. Last fall was on 12/27. The DON said they have completed the following interventions: Hospice, Med intervention, rehab, helmet, toileting because he was always going to closet/bathroom looking for items. They were constantly reassessing to see if Resident #51's needed any changes to his interventions. She said that they do monthly trainings, quarterly trainings and post-incident retrainings for falls. She stated that is ongoing. To monitor she stated that she did rounding at least 4-5 times a day, monitored staff interaction with residents, asked for feedback from ADONs in morning meetings and obtained resident feedback for any concerns. She also obtained information during IDT meetings. To prevent from falls from happening again, the DON stated that when nurses called her to inform her of a fall, she looked at the resident's POC to see what may have caused the fall. Based on that information, it may determine if she looked at other interventions. She opened up POC at the morning meetings, to see if they maxed out all interventions, looked for alternatives like getting the family involved, or move closer to the nurses. The DON stated that the Nurse Practitioner completed rounds Monday through Friday and made sure to assess residents if the Primary Care physician was not at the facility that day. She stated they also have an on call 3rd eye MD that will assess the residents if needed. In an interview on 2/17/24 at 9:31 AM, CNA E said he did rounds for resident #51 every 2 hrs. The first round was completed when CNA E arrived at facility. Resident was given extensive care. Resident was incontinent, and he became agitated easily. Resident #51 used to get up and be in the hallway a lot. Resident was a fall risk. Resident #51 stayed near him and walks with resident to the room. Resident has not had a fall while under his care. In an interview on 02/17/24 at 10:00 AM, the DON said if a fall happened, the protocol for fall management would be completed. Nursing would do their assessments and protocols of neuro checks. The immediate need would have been met. In an interview on 2/17/24 at 10:22 AM, CNA F said resident #51 required 2-person care. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 10 of 29 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 675044 B. Wing (X3) DATE SURVEY COMPLETED A. Building 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0689 Level of Harm - Actual harm had a helmet due to falls. CNA F said she checked on Resident #51 frequently, like every 20 minutes just to ensure he was ok. The staff had been doing hourly checks on Resident #51 for a couple months. CNA F said Resident #51's previous falls were not hard falls - there were no injuries, but staff always made sure not to move resident until the nurse checked him. Residents Affected - Few Record Review of the facility's Fall Management System Policy dated 2/19/2021 reflected: It is the policy of this facility that each resident will be assessed to determine his/her risk for falls, and a plan of care implemented based on the resident's assessed needs. Procedure includes: D. Documentation requirements for residents sustaining a fall 1. A licensed nurse will complete an Incident/Accident Report after each fall . 2. The licensed nurse will document the fall . 3. The licensed nurse will assess and document the condition of the resident at least once pre shift for at least 72 hrs post fall. 4. Documention in the nurs'es notes and/or care plan will reflect interventions attempted. 5. Un-witnessed falls are considered potential head injury and required completion of neurochecks. 6. The Resident Fall Tracking log is to reflect each fall individually of each resident . E. Investigation and follow-up of accidents involving falls. 1. The licensed nurse will initiate the Incident/Accident investigation immediately after each fall utiziing the Investigation Follow-up guideline. 2. Interventions will be implemented in an attempt to prevent the resident from sustaining further falls. Based on the investigation results, the licensed nurse will initiate intervention measures as soon as practicable (e.g., placing a chair alarm, removing obstacles out of path to B/R, placing resident on a low bed, ect.). 6. Falls are reported per Federal and State guidelines. Record review of of incident reports dated 9/1/2023 to 12/27/2023 showed documentation required under procedures and investigation and follow-up were completed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 11 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure incontinent bladder residents received appropriate treatment and services to prevent urinary tract infections and restore continence to the extent possible for 1 of 6 residents (Resident #85) reviewed for quality of care, in that: The facility failed to ensure Resident #85's indwelling catheter was not pulled or tugged on during incontinent care that would cause pain or discomfort. This failure could place residents at risk for discomfort, urethral trauma (injury to the duct in which urine is transported out of the body from the bladder), and urinary tract infections due to improper care. The findings were: 1. Record review of Resident #85's face sheet, dated 02/17/24, revealed a [AGE] year-old male admitted on [DATE] with diagnoses that included: End stage renal disease (or kidney failure, occurs when the kidneys can no longer support the body's needs), dialysis (a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly), functional quadriplegia (complete immobility due to severe disability or frailty caused by another medical condition), dementia (condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change), (Stage III pressure ulcer to left buttock (full thickness tissue loss), neuromuscular dysfunction of the bladder (a number of urinary conditions in people who lack bladder control [NAME] to a brain, spinal cord or nerve problem). Record review of Resident # 85's Medicare 5-Day MDS assessment, dated 11/13/23, revealed a BIMS score of 00 suggesting severe cognitive impairment. According to the MDS, Resident #85 had an indwelling catheter and was always incontinent of bowel. Record review of Resident #85's care plan, dated 01/08/24, revealed the resident's care plan addressed the resident's urinary catheter with the following: FOCUS: o Urinary Catheter: Resident #85 has a urinary catheter and is at risk for urinary tract infections and injury. Urinary catheter related to: neurogenic bladder, BPH, urinary retention Date Initiated: 11/21/2023 Revision on: 01/21/2024 GOALS: o Resident #85 will be/remain free from catheter-related trauma and complications through next review date. Date Initiated: 11/21/2023 Target Date: 04/07/2024 INTERVENTIONS/TASKS: o Monitor for and report to the physician any signs or symptoms of a urinary tract infection such as pelvic pain, burning with urination, blood tinged urine, cloudiness, no output, deepening of urine color, increased pulse, urinary frequency, foul smelling urine, fever, chills, altered mental status, changes in behavior, or changes in eating patterns. Date Initiated: 11/21/2023 CN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 12 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0690 o Monitor and document output. Date Initiated: 12/12/2023 C.N.A. CN Level of Harm - Minimal harm or potential for actual harm o Monitor for pain and discomfort due to the presence of a urinary catheter. Date Initiated: 12/12/2023 C.N.A. CN Residents Affected - Few o Provide urinary catheter care per facility practice. Date Initiated: 12/12/2023 C.N.A. CN o Use a stabilizer or securement device to keep the urinary catheter securely in place. Date Initiated: 12/12/2023 CN C.N.A. o Position catheter bag and tubing below the level of the bladder. Date Initiated: 12/12/2023 C.N.A. CN o Position catheter tubing to prevent kinks. Date Initiated: 12/12/2023 C.N.A. CN o Privacy bag over the drainage bag. Date Initiated: 12/12/2023 CN C.N.A. During incontinent care observation for Resident #85, on 02/17/24 at 10:22 a.m., CNA A wiped Resident #85's catheter tubing from head of penis down tube, pulling on tubing and not stabilizing penis. Resident #85 grimaced. CNA A did not hold penis while wiping catheter tubing. CNA A wiped head of penis down shaft. In an interview on 02/17/24 at 10:51 a.m., CNA A stated she thought she had stabilized Resident #85's penis and tubing while cleaning the catheter tubing. CNA A stated injury could happen, or the catheter could be pulled out if she did not stabilize the tubing or penis. CNA A stated training on incontinent care occured as necessary and every month or two months. In an interview on 02/17/24 at 03:17 p.m., CNA C stated when cleaning the catheter tubing on a male, the penis has to be held and the catheter tubing by the penis has to be held because the tubing cannot be pulled. CNA C stated incontinent care training was done every two months for all the CNAs. In an interview on 02/17/24 at 03:36 p.m., the DON stated catheter tubing was to be cleaned during incontinent care from the vagina or penis outward. The DON acknowledged surveyor notifying of CNA pulling on the catheter tubing during incontinent care with the Resident #85 grimacing. The DON stated, I will look into it. Catheter care policy was not requested nor obtained by surveyor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 13 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that a resident who needs respiratory care was provided with professional standards of practice for 1 of 3 residents (Resident # 103) reviewed for quality of care in that: Residents Affected - Few Resident #103's oxygen was administered at 2.5 Liters Per Minute instead of 3 Liters Per Minute via trach mask as ordered by physician. This failure could place residents who receive respiratory care at risk of developing respiratory complications and a decreased qualify of care. The findings included: Record review of Resident #103's face sheet dated 02/17/24, reflected he was a [AGE] year-old male who was initially admitted on [DATE]. Resident #103's relevant diagnoses were generalized epilepsy, quadriplegia (form of paralysis that affects all four limbs plus torso), diabetes, meningitis, hydrocephalus (excess fluid build-up in fluid-containing cavities of the brain), hypertension, acute respiratory failure, tracheostomy ( a hole that surgeons make through the front of the neck and into the windpipe), and chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructive airflow from the lungs). Record review of Resident #103's annual MDS assessment dated [DATE] reflected his BIMS score was not answered which indicated his cognition was severely impaired. Record review of Resident #103's comprehensive care plan dated 02/09/24 reflected Focus: Respiratory Status: Impaired [resident #103] has risk hypoxia. Interventions: Provide oxygen therapy as ordered by the physician. Focus: Tracheostomy status is related to respiratory failure, COPD, SOB. Interventions: monitor O2 sat per MD order. Record review of Resident #103's physician order summary, dated 01/29/2024, reflected O2 at 3 LMP via trach mask every shift, secure with trach tie. In an observation on 02/13/24 at 9:15 a.m., revealed Resident #103 was lying in bed asleep, he had a trach, feeding tube and oxygen in place. His bed was set to the lowest position, head elevated, floor mats in place, and extra trach at bedside. Resident #103's oxygen level on the oxygen concentration machine was 2.5 lpm. An interview on 02/14/24 at 03:25 p.m., LVN J, revealed this surveyor escorted LVN J to Resident #103's room. LVN J kneeled down and assessed the oxygen concentrator setting and stated the oxygen concentrator was set at 2.5 liters per hour. Resident did not appear to be in distress. LVN J then went over to her laptop and verified the order in her computer for Resident #103 and verified his oxygen level order was ordered at 3 liters per hour. LVN J said she was not sure why it was set to 2.5 liters. She said she checked Resident #103's orders for any changes and was not able to find any. LVN J said nursing staff round every 2 hours and that included checking oxygen levels for those (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 14 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few residents who were on oxygen. She said had had checked Resident #103's oxygen level one time since she started her shift but did not notice any discrepancies. LVN J was not able to say what negative effects Resident #103 could sustain if O2 order was not followed. An interview on 02/15/24 at 10:28 a.m., NP I, said Resident #103 would not have any negative effects by having his oxygen level at 2.5 lpm. NP I said if [Resident #103] were to be in respiratory distress, ½ liter of oxygen would not make a difference but the facility should always follow Resident #103's physician order. An interview on 02/16/2024 at 9:20 a.m., the DON was not able to say what if any negative effects Resident #103 might have been caused if his oxygen level was set at 2.5 lpm instead of 3 lpm as ordered. Record review of the facility's Oxygen Administration policy and procedure dated 01/05/20 revealed Policy: To describe methods for delivering oxygen to improve tissue oxygenation .Procedure: 1. Verify physician order . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 15 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure residents were given psychotropic medications to treat specific diagnoses for 1 (Resident #22) of 5 Residents, reviewed for pharmacy services in that: The facility failed to ensure that Resident #22 did not receive an antipsychotic (Risperdal/risperidone) that was not necessary to treat Vascular Dementia. This failure could affect residents who received medications in the facility and put them at risk for adverse consequences such as impairment or decline in an individual's mental or physical condition or functional or psychosocial status. The findings included: Record review of Resident #22's face sheet reflected an [AGE] year-old female with an admission date of 01/24/2024 and original admission date of 05/21/2014. Her diagnosis were Vascular Dementia, Parkinson's, Acute Kidney Failure, Dysphagia (difficulty swallowing), Type 2 Diabetes Mellitus, Bipolar disorder, Cerebrovascular Disease (a group of conditions that affect blood flow in the brain) , Atherosclerotic Heart Disease (thickening or hardening of the arteries), Alzheimer's Disease, Hyperlipidemia (high cholesterol), and Hypothyroidism (underactive thyroid gland). Record review of Resident #22's quarterly MDS assessment, dated 01/02/24 a BIMS score of 08, indicating Resident #22 was moderately cognitive impairment. Record review of Resident #22's comprehensive person-centered care plan, date revised 09/19/2023 reflected Focus Resident #22 uses antipsychotic and antidepressant meds for bipolar, as well as depression. Antianxiety for anxiety. Intervention Administer medications as ordered. Monitor/record/report to MD prn side effects and adverse reactions of psychoactive medications: Record review of Resident #22's physician orders dated 01/24/2024 reflected an order for Risperdal oral tablet 0.5mg (an antipsychotic medication used to treat schizophrenia and bipolar disorder) that reflected Give 1 tablet by mouth at bedtime related to Vascular Dementia . Interview on 02/16/24 at 09:16 AM with LVN F, stated the nurse receiving resident as a new admission transcribed medication orders into the facility's electronic health records system. She stated she was the admitting nurse for Resident #22. She stated Risperdal is used for diagnosis of labial moods, bipolar, and schizophrenia. LVN F checked Risperdal order for Resident #22 in her computer and verified Risperdal had a diagnosis of vascular dementia. This surveyor asked if this was an acceptable diagnosis for Risperdal, LVN F stated she would have to check to see what diagnosis can be used for that antipsychotic medication. This surveyor asked what would happen if Risperdal was administered to a resident who does not have a psychotic diagnosis, LVN F stated she does not think they would order that medication for someone who does not need it. Attempted a call on 02/16/24 at 10:00 AM with the pharmacy consultant. There was no answer, left voicemail. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 16 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 02/16/24 at 03:31 PM with the DON stated that the nurse doing the admission was the one that transcribes the medication orders into facility's electronic health records system. If that nurse is falling behind in her work, then she will assist. She stated that the nurses and the ADONs will validate the medication orders for accuracy and timeframe. She stated that NP H sees Resident #22. She stated that they had taken her off Risperdal in the past, she did ok but then her aggression came back. The DON stated Risperdal is an antipsychotic medication, so it is used for diagnosis of Huntington, schizophrenia, and Tourette's. She stated when she talked to psychiatrist, NP H, if a resident has any of the following acute psychosis, psychotic episodes, and/or delusions then they need to be on antipsychotics. This surveyor asked what diagnosis was indicated for Risperdal for Resident #22. She responded with, I need to go back and look at her medical records. She stated NP H has it on her note to see justification of why she would need to be on Risperdal. The DON stated they cannot administer medication without a doctor's order. The pharmacist comes in monthly and let's doctor know that there is or there isn't an appropriate diagnosis. They check the residents' symptoms and if the benefit outweighs the risks, then they continue or if they might try alternatives. Interview on 02/16/24 04:45 PM with Nurse Practitioner H via phone stated that Resident #22 has long history of mental illness. She stated that every time she took Resident #22 off Risperdal or if she tried to decrease it, Resident#22 can be very aggressive. NP H stated she does not put Vascular Dementia as a diagnosis for Risperdal. She does not believe that she wrote that prescription because she knows better. She stated sometimes facilities had new staff and maybe they do not know what they are doing when transcribing information. This surveyor asked what the negative outcome would be if Risperdal was prescribed to a resident with Vascular Dementia, NP H stated that Risperdal was usually given for delusions or bipolar, and/or schizophrenia. Interview on 02/17/24 at 04:08 PM with ADON G revealed the nurses who are doing the admission are the ones that transcribe the medication orders into the facility's electronic health records system and if they are falling behind on their work, then she will assist. ADON G stated she reviews the medication orders in the facility's electronic health records system to make sure they were entered correctly as they come in. She stated she reviews that the medication orders were transcribed properly. ADON G stated if an order was an antipsychotic then she will make sure they have consents. She stated Risperdal was an antipsychotic and the diagnosis it was indicated for are bipolar and schizophrenia. ADON G stated if Risperdal has a diagnosis of Dementia, then she will notify doctor and whatever psychiatrist they are seeing and will let them know. This surveyor asked if the diagnosis of Dementia was adequate for Risperdal, but she stated that she was not sure. She stated that she just transcribed the diagnosis that the doctor writes. She stated Risperdal has adverse reaction, so they make sure they monitor the residents. This surveyor asked what the negative outcome of administering Risperdal to a resident with Dementia, she stated they follow doctors' orders. Record review of the facility's Unnecessary Drugs-Without Adequate Indication for Use policy, dated 10/18/2023, revealed Policy: It is the facility's policy that each resident's drug regimen is managed and monitored to promote or maintain the resident highest practicable mental, physical, and psychosocial well-being free from unnecessary drugs. Definitions: Indication for use is the identified, documented clinical rationale for administering a medication that is based upon an assessment of the resident's condition and therapeutic goals and is consistent with manufacturers recommendations and/or clinical practice guidelines, clinical standards of practice, medication referenced, clinical studies, or evidence-based review articles that are published in medial and/or pharmacy journals. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 17 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0758 Policy Explanation and Compliance Guidelines: Level of Harm - Minimal harm or potential for actual harm 2. The attending physician will assume leadership in medication management by developing, monitoring, and modifying the education regimen in collaboration . Residents Affected - Few c. Indication and clinical need for medication 3. Documentation will be provided in the resident's medical record to show adequate indications for the medications use and the diagnosed condition for which it was prescribed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 18 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards or food service safety for 1 of 1 kitchen reviewed for sanitation in that: 1. The facility failed to ensure equipment was clean and sanitized 2. The facility failed to maintain cleanliness of the floor in the kitchen These failures could place residents at risk of foodborne illnesses. The findings included: An observation of the kitchen on 02/13/2024 at 8:45 a.m. revealed the floor behind the stove, oven, and fryer had debris behind it. The kitchen's hand washing sinks had a whitish substance adhered to the faucets, and backsplash. The seal around the strainers had a rusty color. The faucets spout had a whitish, and brownish substance around it. The fryer had a white substance adhered to the side and front panels. The oven had a whitish substance adhered the front and side panels. The oven doors had a thick brown substance adhered to them. The paper towel dispenser had a thick brown film on top and on the front panel. The kitchen floor grout had a thick black substance adhered to it. The kitchen floor had several broken tiles. The corner edges of the floor bed had a black substance adhered to it. In an interview on 02/15/2024 at 11:20 a.m., the Dietary Manager said the floors had been cleaned two weeks ago. She said kitchen staff were responsible for cleaning their areas including the kitchen floor. Dietary Manger said her staff have experienced a hard time removing the black substance from the floor grout and floor bed because they only use a regular mop. She said, I guess we are going to have to scrub the floor and the floor beds with a brush because the black substance does not come off with a regular mop. She said the ovens were cleaned every other Saturday. She said she had a daily, monthly and a week-end cleaning schedule that she kept in her office. The Dietary Manager said she is responsible for inspecting the area her staff cleans to ensure it was done correctly. The Dietary Manager said she understood the kitchen needed a more thorough cleaning and would be working on it as soon as possible. She was not able to say how not having a sanitary kitchen could negatively affect the residents. In an interview on 02/16/24 at 9:05 a.m., Dietary Aide K said each staff member were responsible for cleaning their area throughout their shift and at the end of their shift. She said the Dietary Manager has a weekly cleaning schedule they follow. She said throughout the day she would be responsible to clean the counters where she prepped the food and the floors. She said she would clean the floors by first sweeping and them mopping them with water and a special chemical. Dietary Aide K said if a regular mop did not remove all the stains from the floor she would not scrub it. Dietary Aide K said the Dietary Manager would conduct daily inspections to ensure the cleaning was done correctly. In an interview on 02/16/24 at 9:15 a.m., [NAME] L said she was responsible for cleaning the steamer, oven, stove, fryer, and puree area at the end of her shift. [NAME] L said the dietary manager has a daily, weekly, and monthly cleaning schedule which included all kitchen staff. She said the ovens were cleaned every other Saturday and the fryer was cleaned one time a week. [NAME] L said she also (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 19 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few cleaned the floor in her area by sweeping and mopping with water and a chemical. She said the grease stains on the walls, floor beds, and equipment panels was cleaned by hand. She said, they are hard to clean and even though I tried the grease does not come off. [NAME] L said the dietary manager would conduct daily inspections to ensure the cleaning was done correctly. In an interview on 02/16/24 at 9:32 a.m., the Dietary Manger said she conducted an in-service on all kitchen staff on the topic of sanitation annually. In an interview on 02/16/24 at 9:45 a.m., the Administrator said the Dietary Manager was responsible to ensure the kitchen was maintained in a sanitary condition. The Administrator said there was no negative effects on the residents since the grime and hard water only affected the appearance of the appliances and not the quality of food. The administrator said she was going to ensure the kitchen was cleaned as soon as possible. Record review of kitchen staff In-Service Program Attendance Record reflected their annual training on the topic of cleaning schedules was conducted on 02/01/24. All kitchen staff were present. Record review of facility's Food and Nutrition Services Policy and Procedure Manual (Equipment Cleaning Procedures) dated 10/2005 and revised on 12/13//2017 revealed: Policy: It is the policy of this facility that all dietary equipment and the environment are cleaned and sanitized in a manner that meets local (if applicable), state, and federal regulations. Fundamental Information: Cleaning is the practice of removing soil and dirt with an approved cleaning agent. A warm detergent should be used to remove soil and dirt. For areas that accumulate grease it may be advisable to use a degreaser and warm water for cleaning. Procedure: 4. The Director of Food and Nutrition Service may keep maintenance/cleaning schedule of major equipment to ensure that all equipment is clean and in proper working condition. 9. Splashes and spills will be removed (cleaned and sanitized) from surfaces as soon as they occur. 16. Scrub or use brush to remove heavy soil. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 20 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 - Few 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 ensure medical records were accurately documented, for one Resident (Resident #39) of six residents reviewed for accuracy of medical records. The facility failed to document Resident #39's falls in the Progress Notes. This failure could place all residents with falls at risk of not receiving adequate care and services. The findings were: Record review of Resident #39's admission Record file reflected an [AGE] year-old female, with an original admission date of 01/17/2022. Her diagnoses included: Osteoporosis (bones become weak and brittle) left knee, history of falling, contusion (a bruise from the result of a direct blow or impact, such as a fall) of other part of head, fall on same level, hypertension (high blood pressure), dementia (condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change), cognitive communication deficit (difficulties with thinking and how someone uses language). Record review of Resident #39's quarterly MDS assessment dated [DATE] reflected Resident #39 had a BIMS score of 12/15 (cognitively intact, mildly impaired ) and required supervision or touching assistance for toilet transfer (getting on and off the toilet). Record review of Resident #39's Care Plan dated 01/22/2024 reflected there were no falls documented. Review of facility''s incident/accident reports dated February 2024 revealed Resident #39's had a fall on 02/02/24 and 02/09/24. In an interview on 02/17/24 at 07:52 p.m., the DON stated Resident #39's fall on 01/27/24 was documented. The DON acknowledged the falls on 02/02/24 and 02/09/24 were not documented in the progress notes, but the falls were on the incident/accident log. Record review of facility's Clinical Documentation Guideline revised 03/25/14, revealed: Policy: The patient's clinical record provides a record of the health status, including observations, measurements, history, and prognosis and serves as the primary document describing healthcare services provided to the patient. Fundamental Information The clinical record is used by healthcare team to record, preserve and communicate the patient's progress and current treatment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 21 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 Documentation Level of Harm - Minimal harm or potential for actual harm Clinical record progress notes, physician orders, flow records. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 22 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to establish an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, for two residents (Resident #85 and Resident #91) of four residents observed for infection control issues, in that: Residents Affected - Some 1. The CNA A and CNA B did not wash their hands for a minimum of 20 seconds while performing incontinent care on Resident #85. 2. The CNA D removed her dirty gloves and applied clean gloves without sanitizing hands between glove changes while performing incontinet care on Resident #91. These deficient practices could place residents at-risk for infection due to improper care practices. The findings were: 1. Record review of Resident #85's admission Record, dated 02/17/24, revealed a [AGE] year-old male admitted on [DATE] with diagnoses that included: End stage renal disease (or kidney failure, occurs when the kidneys can no longer support the body's needs), dialysis (a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly), functional quadriplegia (complete immobility due to severe disability or frailty caused by another medical condition), dementia (condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change), (Stage III pressure ulcer to left buttock (full thickness tissue loss), neuromuscular dysfunction of the bladder (a number of urinary conditions in people who lack bladder control [NAME] to a brain, spinal cord or nerve problem). Record review of Resident #85's Medicare 5-Day MDS, dated [DATE], revealed a BIMS of 00 suggests severe cognitive impairment, and under section H Bowel and Bladder, indwelling catheter was selected and always incontinent of bowel. Record review of Resident #85's care plan, dated 01/08/24, revealed the resident's care plan addressed the resident's urinary catheter with interventions. During an incontinent care observation for R#85, on 02/17/24 at 10:22 a.m., the CNAs knocked on door before entering R#85's room. CNA A washed hands for 17 seconds and put on new gloves prior to incontinent care. CNA A used one wipe per swipe front to back motion on rectal area and buttock. CNA A tucked brief under R#85's right hip. CNA A removed gloves, washed hands with water only, for 5 seconds, and put on new gloves. CNA A and CNA B repositioned resident higher up in bed. CNA A removed gloves, used hand sanitizer, and put on new gloves. CNA B removed gloves, did not use hand sanitizer, and put on new gloves. CNA B covered resident with sheet. CNA A removed trash from room throwing it away in bathroom trash. CNA B lowered bed and raised head of bed. CNA B removed gloves. CNA A removed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 23 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some gloves and took away bag of dirty linen and trash outside the door. CNA A washed hands for 12 seconds. CNA B washed hands for 16 seconds. In an interview on 02/17/24 at 10:51 a.m., CNA A stated she was supposed to wash her hands for 20-30 seconds. CNA A stated if she did not wash her hands for 20-30 seconds, there was a risk of infection. CNA A stated training on incontinent care occurred as necessary and every month or two months. In an interview on 02/17/24 at 10:55 a.m., CNA B stated she used hand sanitizer every time she changed her gloves. CNA B stated she had missed one time of using hand sanitizer when changing her gloves. CNA B stated contamination can happen if she did not use hand sanitizer when she changed her gloves. CNA B stated she received training on incontinent care and hand hygiene at least once a month. In an interview on 02/17/24 at 03:36 p.m., DON ICP stated handwashing time was a minimum of 20 seconds. DON stated she would look into it. 2. Record review of Resident #91's electronic face sheet dated 02/16/2024 revealed the resident was an [AGE] year-old female admitted to the facility on [DATE]. Her diagnosis included Alzheimer's Disease, Dysphagia (difficulty swallowing), Hyperlipidemia (high cholesterol), Dementia, Depression, Essential Hypertension (high blood pressure), Chronic Ischemic Heart Disease, Foot Drop, Muscle wasting and Atrophy, Cognitive Communication Deficit. Record review of Resident #91's quarterly MDS assessment, dated 01/03/2024 a BIMS score of 06, indicating Resident #91's cognition was severely impaired. Resident #91's bowels was always incontinent. Record review of Resident #91's comprehensive person-centered care plan, date revised on 12/19/2023, reflected Focus [Resident #91] was incontinent of bowel/bladder related to Alzheimer's, Dementia. Intervention [Resident #91] INCONTINENT; check frequently for wetness and soiling and change as needed. Briefs or incontinence products as needed for protection. Apply barrier cream to skin after incontinent episodes as needed. Observation of Resident #91 on 02/15/24 at 2:03 PM revealed CNA D applied gloves and cleaned Resident #91's perineal area of feces, CNA D removed her dirty gloves and applied clean gloves without sanitizing hands between glove changes. After CNA D applied barrier cream to Resident #91's buttocks and anus area with her gloved hand, CNA D removed her gloves and applied clean gloves without sanitizing hands prior to applying clean gloves. Interview on 02/15/24 at 12:14 PM with CNA D, stated she changed gloves to do all care correctly. She stated the negative outcome of not using hand sanitizer in between glove changes was contamination. CNA D stated in service on infection control-hand hygiene was done about a month ago. Interview on 02/15/24 at 12:20 PM with LVN E, stated she constantly monitored CNAs. She stated the use of hand sanitizer in between glove changes was important for infection control. LVN E stated the negative outcome of not sanitizing hands in between glove changes was the resident can be prone for infection. She stated if she witnesses a CNA not sanitizing hands in between glove changes, she will immediately talk to the CNA and notify DON. She stated facility was constantly giving in-services on infection control. The most recent was done last week. Interview on 02/15/24 at 12:58 PM with the DON, revealed the procedure for hand hygiene between (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 24 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some glove changes was that staff has been trained to remove gloves, wash hands for 20 seconds dry and put gloves back on. She stated the ADON and herself are in charge of doing skill check offs. She stated in-services for infection control-hand hygiene are done if not every month, then every 6 weeks; especially with COVID 19 outbreaks. The DON stated the most recent in-service for infection control hand hygiene was done about a week and a half ago. She stated the negative outcome if they do not do this process was that they want to make sure they keep residents safe, give them the best quality of life by preventing infection, and cross contamination. Record review of CNA D, Validation Checklist: Hand Hygiene dated 01/11/24 indicated she performed hand hygiene procedures in accordance with the facility's standard of practice. Record review of CNA D's Hand Hygiene Video/Policy Review Test dated 01/11/24 indicated CNA D took and passed her posttest that included Hand hygiene should be completed before the following: contact with residents, putting on gloves, inserting or manipulating a device. Hand hygiene should be completed after the following: contact with resident skin, bodily fluids ., removing gloves . Record review of facility's Hand Hygiene implemented 11/12/2017, revealed: Policy: Staff involved in direct resident contact will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. Policy Explanation and Compliance Guidelines: 1. Hand hygiene is a general term that applies to either handwashing or the use of an antiseptic hand rub, also known as alcohol-based hand rub (ABHR). 2. Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice. 3. Hand hygiene is indicated and will be performed under the conditions listed in, but not limited to, the attached hand hygiene table. 4. Hand hygiene technique when using an alcohol-based hand rub: a. Apply a palmful of product to palm of one hand and rub hands together. b. Cover all surfaces with the product until hands feel dry. c. This should take about 20 seconds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 25 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0880 5. Hand hygiene technique when using soap and water: Level of Harm - Minimal harm or potential for actual harm a. Wet hands with water. b. Apply enough soap to cover all hand surfaces. Residents Affected - Some c. Rub hands together vigorously for at least 20 seconds, covering all surfaces of the hands and fingers. Based on observation, interview, and record review, the facility failed to establish an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, for two residents (Resident #85 and Resident #91) of four residents observed for infection control issues, in that: 1. The CNA A and CNA B did not wash their hands for a minimum of 20 seconds while performing incontinent care on Resident #85. 2. The CNA D removed her dirty gloves and applied clean gloves without sanitizing hands between glove changes while performing incontinent care on Resident #91. These deficient practices could place residents at-risk for infection due to improper care practices. The findings were: 1. Record review of Resident #85's admission Record, dated 02/17/24, revealed a [AGE] year-old male admitted on [DATE] with diagnoses that included: End stage renal disease (or kidney failure, occurs when the kidneys can no longer support the body's needs), dialysis (a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly), functional quadriplegia (complete immobility due to severe disability or frailty caused by another medical condition), dementia (condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change), (Stage III pressure ulcer to left buttock (full thickness tissue loss), neuromuscular dysfunction of the bladder (a number of urinary conditions in people who lack bladder control [NAME] to a brain, spinal cord or nerve problem). Record review of Resident #85's Medicare 5-Day MDS, dated [DATE], revealed a BIMS of 00 suggests severe cognitive impairment, and under section H Bowel and Bladder, indwelling catheter was selected and always incontinent of bowel. Record review of Resident #85's care plan, dated 01/08/24, revealed the resident's care plan addressed the resident's urinary catheter with interventions. During an incontinent care observation for R#85, on 02/17/24 at 10:22 a.m., the CNAs knocked on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 26 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some door before entering R#85's room. CNA A washed hands for 17 seconds and put on new gloves prior to incontinent care. CNA A used one wipe per swipe front to back motion on rectal area and buttock. CNA A tucked brief under R#85's right hip. CNA A removed gloves, washed hands with water only, for 5 seconds, and put on new gloves. CNA A and CNA B repositioned resident higher up in bed. CNA A removed gloves, used hand sanitizer, and put on new gloves. CNA B removed gloves, did not use hand sanitizer, and put on new gloves. CNA B covered resident with sheet. CNA A removed trash from room throwing it away in bathroom trash. CNA B lowered bed and raised head of bed. CNA B removed gloves. CNA A removed gloves and took away bag of dirty linen and trash outside the door. CNA A washed hands for 12 seconds. CNA B washed hands for 16 seconds. In an interview on 02/17/24 at 10:51 a.m., CNA A stated she was supposed to wash her hands for 20-30 seconds. CNA A stated if she did not wash her hands for 20-30 seconds, there was a risk of infection. CNA A stated training on incontinent care occurred as necessary and every month or two months. In an interview on 02/17/24 at 10:55 a.m., CNA B stated she used hand sanitizer every time she changed her gloves. CNA B stated she had missed one time of using hand sanitizer when changing her gloves. CNA B stated contamination can happen if she did not use hand sanitizer when she changed her gloves. CNA B stated she received training on incontinent care and hand hygiene at least once a month. In an interview on 02/17/24 at 03:36 p.m., DON ICP stated handwashing time was a minimum of 20 seconds. DON stated she would look into it. 2. Record review of Resident #91's electronic face sheet dated 02/16/2024 revealed the resident was an [AGE] year-old female admitted to the facility on [DATE]. Her diagnosis included Alzheimer's Disease, Dysphagia (difficulty swallowing), Hyperlipidemia (high cholesterol), Dementia, Depression, Essential Hypertension (high blood pressure), Chronic Ischemic Heart Disease, Foot Drop, Muscle wasting and Atrophy, Cognitive Communication Deficit. Record review of Resident #91's quarterly MDS assessment, dated 01/03/2024 a BIMS score of 06, indicating Resident #91's cognition was severely impaired. Resident #91's bowels was always incontinent. Record review of Resident #91's comprehensive person-centered care plan, date revised on 12/19/2023, reflected Focus [Resident #91] was incontinent of bowel/bladder related to Alzheimer's, Dementia. Intervention [Resident #91] INCONTINENT; check frequently for wetness and soiling and change as needed. Briefs or incontinence products as needed for protection. Apply barrier cream to skin after incontinent episodes as needed. Observation of Resident #91 on 02/15/24 at 2:03 PM revealed CNA D applied gloves and cleaned Resident #91's perineal area of feces, CNA D removed her dirty gloves and applied clean gloves without sanitizing hands between glove changes. After CNA D applied barrier cream to Resident #91's buttocks and anus area with her gloved hand, CNA D removed her gloves and applied clean gloves without sanitizing hands prior to applying clean gloves. Interview on 02/15/24 at 12:14 PM with CNA D, stated she changed gloves to do all care correctly. She stated the negative outcome of not using hand sanitizer in between glove changes was contamination. CNA D stated in service on infection control-hand hygiene was done about a month ago. Interview on 02/15/24 at 12:20 PM with LVN E, stated she constantly monitored CNAs. She stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 27 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0880 Level of Harm - Minimal harm or potential for actual harm use of hand sanitizer in between glove changes was important for infection control. LVN E stated the negative outcome of not sanitizing hands in between glove changes was the resident can be prone for infection. She stated if she witnesses a CNA not sanitizing hands in between glove changes, she will immediately talk to the CNA and notify DON. She stated facility was constantly giving in-services on infection control. The most recent was done last week. Residents Affected - Some Interview on 02/15/24 at 12:58 PM with the DON, revealed the procedure for hand hygiene between glove changes was that staff has been trained to remove gloves, wash hands for 20 seconds dry and put gloves back on. She stated the ADON and herself are in charge of doing skill check offs. She stated in-services for infection control-hand hygiene are done if not every month, then every 6 weeks; especially with COVID 19 outbreaks. The DON stated the most recent in-service for infection control hand hygiene was done about a week and a half ago. She stated the negative outcome if they do not do this process was that they want to make sure they keep residents safe, give them the best quality of life by preventing infection, and cross contamination. Record review of CNA D, Validation Checklist: Hand Hygiene dated 01/11/24 indicated she performed hand hygiene procedures in accordance with the facility's standard of practice. Record review of CNA D's Hand Hygiene Video/Policy Review Test dated 01/11/24 indicated CNA D took and passed her posttest that included Hand hygiene should be completed before the following: contact with residents, putting on gloves, inserting or manipulating a device. Hand hygiene should be completed after the following: contact with resident skin, bodily fluids ., removing gloves . Record review of facility's Hand Hygiene implemented 11/12/2017, revealed: Policy: Staff involved in direct resident contact will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. Policy Explanation and Compliance Guidelines: 1. Hand hygiene is a general term that applies to either handwashing or the use of an antiseptic hand rub, also known as alcohol-based hand rub (ABHR). 2. Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice. 3. Hand hygiene is indicated and will be performed under the conditions listed in, but not limited to, the attached hand hygiene table. 4. Hand hygiene technique when using an alcohol-based hand rub: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 28 of 29 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 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Manor Advanced Rehab & Healthcare 1100 W Minnesota Rd Pharr, TX 78577 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 0880 a. Apply a palmful of product to palm of one hand and rub hands together. Level of Harm - Minimal harm or potential for actual harm b. Cover all surfaces with the product until hands feel dry. c. This should take about 20 seconds. Residents Affected - Some 5. Hand hygiene technique when using soap and water: a. Wet hands with water. b. Apply enough soap to cover all hand surfaces. c. Rub hands together vigorously for at least 20 seconds, covering all surfaces of the hands and fingers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 29 of 29