Health inspection·July 16, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few remained in Resident #1's room until approximately 3:39am a total of about 12 minutes when he then exited the room and proceed down the hall to the nurse's station and briefly spoke with LVN B and C before he was noted returning down Resident #1's hall. At time of CNA A seen walking back down the hall video surveillance then skipped forward about a minute to 3:41am where CNA A was seen entering Resident #1's room for about 10 seconds and then exited and proceeded down hall way to nurses station to call LVN B and C when all 3 staff members went to Resident #1's room, prior to this time, CNA A was not seen entering Resident #1's room with any other staff member. During an interview with Administrator on [DATE] at around 6:00pm stated the time stamp on the video surveillance footage was 10 minutes ahead or 10 minutes behind. During an interview on [DATE] at 6:18pm with LVN B who stated she called EMS at 3:32am as per the time stamp of the call on her phone, when compared to the video footage time stamp LVN B is seen running back to the nurse's station to make call at 3:42am indicating the time stamp on the video surveillance was 10 minutes ahead. Record review of Resident #1's nursing notes dated [DATE] at 3:45am written by LVN B stated an aide had reported they found Resident #1 on the floor and saw blood, LVN B and other charge nurse (LVN C) went to assess and identified a laceration to scalp and active bleeding, pressure was applied to stop bleeding until the paramedics arrived, vitals were taken, 3rd party on call service was called, hospice and responsible party for Resident #1 were made aware. Resident #1 received order to be sent out to emergency room. Record review of Resident #1's physician orders reflected an order dated [DATE] at 3:45AM for her to be transferred to the emergency department. Record review of Resident #1 hospital records date [DATE] at 5:34M stated Resident #1 had a 12 cm scalp laceration to the right head extending from the forehead to the parietal region. Record review of Resident #1 hospital records reflected Resident #1 expired at the hospital on [DATE] at 10:34am. Record Review of TULIP (HHSC online incident reporting application) on [DATE] at 9:00am revealed the facility made a self-reported related to Resident #1's fall on [DATE] at 2:58pm, more than 2 hours after the fall had occurred on [DATE] at 3:30am. Record review of CNA A's undated statement about Resident #1 reflected he found Resident #1 on the floor while rounding between rooms and stated the last time he had changed her was around 12:00AM when he changed her (Resident #1) by himself. During an interview with CNA A on [DATE] at 2:58pm stated he worked on [DATE] and entered his shift about 10 minutes till 12:00am and worked until 6:00am. CNA A stated on [DATE] he worked with Resident #1. CNA A stated he entered Resident #1's room after 12:00am at some time close to 1:00am and stated at that time he checked if resident was wet or dry. CNA A stated she was dry and he repositioned her from supine (laying on back facing up) to her side and facing towards the door, CNA A stated he placed a wedge on Resident #1's back, used a blanket as a posey in the front of her body that had been placed under the fitted sheet, and placed a pillow between her legs. CNA A stated the air mattress Resident #1 had in place was working appropriately on [DATE]. CNA A stated he only moved her that one time when he repositioned her. CNA A stated he repositioned Resident #1 by himself and stated she should have been a 2 person assist and stated he did not use 2 people because he was not sure and stated he had done it on his own previously. CNA A stated he then went to check on Resident #1 at 3:30am and found her on the floor. CNA A stated he remembered entering Resident #1's room around 3:27am but stated he did not recall being in there for 13 minutes when checking her. CNA A stated he did have a linen cart with sheets and stated he may have taken some linen into Residents #1's room but he did not recall what time that was at. CNA A stated he did not recall going into Resident #1's room for 13 minutes or taking in linen to her room prior to finding her on the floor. CNA A denied Resident #1 falling while changing, repositioning or moving Resident #1. During a follow up interview with CNA A on [DATE] at 5:21pm stated Resident #1 was non verbal and mostly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 2 of 12 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 07/16/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few moaned or groaned and was unable to move herself. CNA A clarified that he had worked with Resident #1 on his own before with only 1 person assistance an stated nurses who he was unable to recall had seen him do so and had not told him anything. CNA A stated on [DATE] there were 2 other nurses and 2 other aides available to assist but he did not ask anyone for help. CNA A stated he had previously been trained and knew where to find a residents assistance level in their POC and Kardex and stated he did not know Resident #1 was a 2 person assist until later and thought she was a 1 person assist because he had provided 1 person assist in the past and no one had said much. CNA A stated he should have asked and checked the Resident #1's assistance levels. CNA A stated he had previously been trained prior to Resident #1's fall on Resident #1 being a 2 person assist. CNA A stated then stated that he had worked Resident #1 twice on [DATE], the first time around 12:00am when he repositioned her and checked if she was dry and then later around 1:00am he stated he thought that he had changed her. CNA A stated he took roughly 20 seconds to a minute to change Resident #1. CNA A stated he went to go see how Resident #1 was at around 3:00am or 3:30am when he found Resident #1 on the floor and went to call the nurses. CNA A stated Resident #1 was bleeding from her head and appeared in pain because she was grimacing. CNA A stated the facility policy was to use 2 people if a resident required 2 person assist, CNA A stated he did not follow the facility policy In this situation. CNA A stated using 1 person assist when a resident required 2 could negatively impact a resident because it would put a resident at risk for fall. During an interview with LVN B on [DATE] at 12:54pm LVN B stated she worked on [DATE] from 6:00pm till 6:00am and was the nurse for Resident #1 and worked with CNA A. LVN B stated CNA A did not ask her for any help and stated she did not assist CNA A with any care for Resident #1 on [DATE]. LVN B stated she went into Resident #1's room around 1:00am and to turn off her TV. LVN B stated at that time Resident #1 was positioned in the middle of the bed facing the door with a low bed. LVN B stated she did not see Resident #1 again until CNA A notified her that Resident #1 was on the floor at around 3:30am. LVN B stated CNA A told her he had just exited from resident room from across the hall when he entered Resident #1's room and saw her on the floor. LVN B stated Resident #1 was not verbal and only groaned. LVN B stated when she entered Resident #1's room she was on the floor flat on her back with the bed in a low position and the air mattress functioning and set appropriately. LVN B stated Resident #1 had a puddle of blood around her head and a cut. LVN B stated LVN C stayed to render help and LVN B ran to call 911 and get the paperwork ready. LVN B stated CNA A had stated he changed Resident #1 at around midnight by himself. LVN B stated Resident #1 required 2-person assistance and was unable to move on her own and would not have been able to roll herself off the bed. During a follow up interview with LVN B on [DATE] at 6:18pm stated she notified the administrator of Resident #1 fall and laceration at 3:50am after emergency medical services had taken her. LVN B stated she notified the Administrator that CNA A found Resident #1 On the floor during a round, and she had a laceration and was bleeding and was being sent to the hospital. LVN B stated the Administrator responded to her text at 3:51am. LVN B clarified that the cut she saw on Resident #1 was on her forehead. LVN B stated the facility policy stated they had to provide 2-person assist If the residents required it. LVN B stated CNA A did not follow the facility policy in this situation. LVN B stated using 1 person assist for residents who required 2 could negatively impact residents due to residents potentially falling if there was no staff on the other side of the bed to catch them. During an interview with LVN C on [DATE] at 11:45am she stated Resident #1 was not her resident on [DATE] during her shift from 6:00pm - 6:00am. LVN C stated CNA A had said he changed Resident #1 at least once prior to the fall but stated he did not say at what time. LVN B stated CNA A stated he had changed Resident #1 by himself. LVN B stated he did not help CNA A with Resident #1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 3 of 12 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 07/16/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on [DATE]. LVN B stated CNA A notified her and another nurse that he had seen Resident #1's feet on the floor and realized she was not on the bed and then went to notify them. During a follow up interview with LVN C on [DATE] at 7:02pm she stated when she was notified of Resident #1 was found on the floor she was in supine position (on her back) and there was a pool of blood and she saw an injury to her head on the right side and looked like her skin pulled back and placed pressure on her head while LVN B called 911 and the notifications. LVN C stated Resident #1 was awake and conscious. During an interview with the Administrator on [DATE] at around 8:07pm she stated the DON was on leave and out of the country and did not currently have cell phone service to receive calls. During an interview with the Administrator on [DATE] at around 8:07pm she stated on [DATE] at around 3:30am CNA A found Resident#1 on the floor while completing his round and notified LVN B and C. The Administrator stated through their investigation, interview and statement from CNA A they identified that CNA A did not have any assistance from other staff when he provided care to Resident #1. The Administrator stated Resident #1 required 2 person assistance for all ADLs, bed mobility, repositioning and when being changed and was not able to move herself. As per Administrator CNA A stated he knew Resident #1 was a 2 person assist and stated he had been trained on the POC (plan of care) but still decided to provide care by himself and said he could do it himself. The Administrator stated there were 2 other aides and 2 other nurses that were available to assist CNA A during that shift at that station and in total 10 other staff in the facility that could have helped. The Administrator stated CNA A stated at around 1:00AM or 1:15am on [DATE] he went into resident #1's room to provide incontinent care and reposition Resident #1 and left her in the center of the bed facing the door. The Administrator stated CNA A had been previously trained over the POC and Kardex and where to find residents levels of assistance. The Administrator stated CNA A did not mentioned anything about dropping Resident #1 or working with her when she fell. The Administrator all staff including CNA A had been trained previously to Resident #1's on Resident #1 requiring 2 person assistance. The Administrator stated she was thinking Resident #1's fall occurred due to body alignment and stated she was thinking Resident #1 was possibly not centered in the bed. The Administrator stated the facilities policy regarding following a residents plan of care when they required 2 person assisted stated therapy evaluation will determine if a resident is 1 or 2 person and in return the plan of care will show the level of care needed and if staff did not follow the plan of care for safety then it was an immediate termination for the staff member. The Administrator stated CNA A did not follow this policy in this situation. The Administrator providing residents who required 2 person assistance with only 1 person assistance could impact residents safety and cause injury. During an interview on [DATE] at 5:50pm with the Administrator she stated she was the abuse coordinator and responsible for reporting any incident or allegation of abuse, neglect or exploitation to state agencies. The Administrator stated she completed annual training over reporting requirements along with going over provider letters a trainings from an online training program the facility used and stated staff was trained over abuse and neglect frequently and stated that training was provided to her by the Regional Director of Operations and to the staff by the DON or one of the ADONs. The Administrator confirmed that Resident #1 was found on the floor with a laceration to her head on [DATE] and was unable to explain what happened and was not witnessed and required to be sent out to the hospital for treatment. The Administrator stated she received a text from LVN B on [DATE] at around 3:40am or 3:50am that stated Resident #1 had an unwitnessed fall, laceration with active bleeding with first aide rendered, notifications made to a 3rd party on call service used by facility, 911 activated, doctor and responsible part of Resident #1 were notified. The Administrator stated she did see the message until about 5am. The Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 4 of 12 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 07/16/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stated around 12:00pm on [DATE] she was notified by family of Resident #1 that she had expired. The Administrator stated incidents like this was to be reported with 2-hours to HHSC and she stated she reported when she found out that Resident #2 had expired and stated she did not report with into two hours of her unwitnessed fall because the severity of the laceration was not said, and the incident report was not alarming or suspicious. The Administrator stated to ensure staff provided her with sufficient information and assessment of resident's incidents to allow her to determine reporting timeline she would ask questions, review the incident report and reach out for any updates on residents at the hospital. The Administrator stated the facility policy for reporting allegations and incidents abuse, neglect and exploitation referred to a provider letter but was unable to state which provider letter aside from stating it was the most recent one. The Administrator stated she did follow the facility policy in this situation and stated not appropriately reporting allegation or incidents of abuse, neglect and exploitation could negatively impact residents because their safety can be impacted, and their resident's safety was their priority. Record review of facility Inservice training report dated [DATE] that covered allegations of abuse, neglect and exploitation to be reported immediately and no later than 2 hours and other incidents that are reportable to be reported immediately but not later than 24 hours to HHSC. Review of sign in attendance sheet for Inservice reflected the Administrator had completed this Inservice. Record review of facility policy titled, Policy and Procedure: Abuse, Neglect and Exploitation with an revised date of [DATE] stated under section, IV. Identification of Abuse, Neglect, and Exploitation.B. Possible indicators of abuse include, but are not limited to.3. Physical injury of a resident, of unknown source.8. Failure to provide care needs such as comfort, safety, feeding, bathing, dressing turning & repositioning VII. Reporting/Response A. The facility reports abuse and abuse allegations that include:1. Reporting allegations involving staff to-resident abuse, resident-to resident altercations involving allegations of abuse, 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 (e.g., law enforcement when applicable) within specified timeframes:a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involves Abuse (with or without bodily injury)b. An Incident that results in serious bodily injury and that involves any of the following: Neglect Exploitation Mistreatment Injuries of unknown source Misappropriation of resident propertyC. Not later than 24 hours after the incident occurs or is suspected. An incident that does not result in serious bodily injury but that involves any of the following: Neglect Exploitation A missing resident Misappropriation of resident property Drug thief Fire Emergency situation that pose a threat to resident health and safety A death under unusual circumstances Communicable disease situation that pose a threat to resident health and safety Event ID: Facility ID: 675044 If continuation sheet Page 5 of 12 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 07/16/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure adequate supervision was provided to prevent accidents for 1 of 4 residents (Resident #1) reviewed for supervision.CNA A did not follow 2-person assist as stated on Resident #1's care plan when providing incontinent care and repositioning on two separate occasions on [DATE] at around 12:00am and 1:00am. On [DATE] at 3:30am CNA A found Resident #1 on the floor. Resident #1 was sent to the hospital and later expired on [DATE].An IJ was identified on [DATE]. The IJ template was provided to the facility on [DATE] at 3:51pm. While the IJ was removed on [DATE], the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with potential for more than minimal harm due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. These deficient practices could affect residents who require 2-person assist by placing them at risk of injuries and not receiving the appropriate level of assistance and care. The findings included: Record review of Resident #1's face sheet, dated [DATE], revealed the resident was an [AGE] year-old female who was initially admitted to the facility on [DATE] with diagnoses that included: cerebral infarction (blocked blood flow to brain causing brain tissues damage), hemiplegia (paralysis or severe weakness to one side of body) and hemiparesis (weakness to one side of body) following unspecified cerebrovascular disease (conditions that affect blood flow to brain) affecting left non-dominant side. Cognitive communication deficit (difficulties in communication could be from cognitive impairment), vascular dementia (decline in thinking skills caused by conditions that block or reduce blood flow to brain), unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Record review of Resident #1's quarterly MDS assessment, dated [DATE], revealed Resident #1 was rarely/never understood and indicated a BIMS should not be conducted. Resident #1 was coded as dependent for rolling left and right and toileting/hygiene. Record review of Resident #1's care plan with a closed date of [DATE] reflected Resident #1 was bed bound and required total x2 assist (2-person assistance) for bed mobility and toileting. Record review of Resident #1's task care record reflected CNA A turned and repositioned Resident #1 at 1:13 am on [DATE]. Record review of Resident #1's task care record reflected CNA A checked off that Resident #1 had a small bowel movement at 1:13 am on [DATE]. Observation of facility surveillance footage of Resident #1's hallway on [DATE] revealed CNA A had entered or exited Resident #1's room approximately 4 times between 12:00am and 3:26am for no more than roughly one minute at a time on video footage that was able to be reviewed without any instances of skipped footage. The video surveillance would at times skip forward and miss seconds to a minute of footage, 1 of the 4 times identified did not show CNA A entering Resident #1's room when the footage skipped roughly 45 seconds from 3:23am to 3:24am where CNA A was then seen exiting Resident #1's room. LVN B was noted to have entered Resident #1's room at 1:19am and exited by 1:20am. At 3:27am CNA A was seen on video footage taking an item from a linen cart into Resident #1's room, CNA A remained in Resident #1's room until approximately 3:39am a total of about 12 minutes when he then exited the room and proceed down the hall to the nurse's station and briefly spoke with LVN B and C before he was noted returning down Resident #1's hall. At time of CNA A seen walking back down the hall video surveillance then skipped forward about a minute to 3:41am where CNA A was seen entering Resident #1's room for about 10 seconds and then exited and proceeded down hall way to nurses station to call LVN B and C when all 3 staff members went to Resident #1's room, prior to this time, CNA A was not seen entering Resident #1's room with any other staff member.During an interview with Administrator on [DATE] at around 6:00pm stated the time stamp on the video surveillance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 6 of 12 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 07/16/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few footage was 10 minutes ahead or 10 minutes behind. During an interview on [DATE] at 6:18pm with LVN B who stated she called EMS at 3:32am as per the time stamp of the call on her phone, when compared to the video footage time stamp LVN B is seen running back to the nurse's station to make call at 3:42am indicating the time stamp on the video surveillance was 10 minutes ahead. Record review of Resident #1's nursing notes dated [DATE] at 3:45am written by LVN B stated an aide had reported they found Resident #1 on the floor and saw blood, LVN B and other charge nurse (LVN C) went to assess and identified a laceration to scalp and active bleeding, pressure was applied to stop bleeding until the paramedics arrived, vitals were taken, 3rd party on call service was called, hospice and responsible party for Resident #1 were made aware. Resident #1 received order to be sent out to emergency room. Record review of Resident #1's physician orders reflected an order dated [DATE] at 3:45am for her to be transferred to the emergency department. Record review of Resident #1 hospital records date [DATE] at 5:34am stated Resident #1 had a 12 cm scalp laceration to the right head extending from the forehead to the parietal region. Record review of Resident #1 hospital records reflected Resident #1 expired at the hospital on [DATE] at 10:34am. Record review of CNA A's undated statement about Resident #1 reflected he found Resident #1 on the floor while rounding between rooms and stated the last time he had changed her was around 12:00am when he changed her by himself. During an interview with CNA A on [DATE] at 2:58pm stated he worked on [DATE] and entered his shift about 10 minutes till 12:00am and worked until 6:00am. CNA A stated on [DATE] he worked with Resident #1. CNA A stated he entered Resident #1's room after 12:00am at some time close to 1:00am and stated at that time he checked if resident was wet or dry. CNA A stated she was dry and he repositioned her from supine (laying on back facing up) to her side and facing towards the door, CNA A stated he placed a wedge on Resident #1's back, used a blanket as a posey in the front of her body that had been placed under the fitted sheet, and placed a pillow between her legs. CNA A stated the air mattress Resident #1 had in place was working appropriately on [DATE]. CNA A stated he only moved her that one time when he repositioned her. CNA A stated he repositioned Resident #1 by himself and stated she should have been a 2 person assist and stated he did not use 2 people because he was not sure and stated he had done it on his own previously. CNA A stated he then went to check on Resident #1 at 3:30am and found her on the floor. CNA A stated he remembered entering Resident #1's room around 3:27am but stated he did not recall being in there for 13 minutes when checking her. CNA A stated he did have a linen cart with sheets and stated he may have taken some linen into Residents #1's room but he did not recall what time that was at. CNA A stated he did not recall going into Resident #1's room for 13 minutes or taking in linen to her room prior to finding her on the floor. CNA A denied Resident #1 falling while changing, repositioning or moving Resident #1. During a follow up interview with CNA A on [DATE] at 5:21pm stated Resident #1 was non verbal and mostly moaned or groaned and was unable to move herself. CNA A clarified that he had worked with Resident #1 on his own before with only 1 person assistance an stated nurses who he was unable to recall had seen him do so and had not told him anything. CNA A stated on [DATE] there were 2 other nurses and 2 other aides available to assist but he did not ask anyone for help. CNA A stated he had previously been trained and knew where to find a residents assistance level in their POC and Kardex and stated he did not know Resident #1 was a 2 person assist until later and thought she was a 1 person assist because he had provided 1 person assist in the past and no one had said much. CNA A stated he should have asked and checked the Resident #1's assistance levels. CNA A stated he had previously been trained prior to Resident #1's fall on Resident #1 being a 2 person assist. CNA A stated then stated that he had worked Resident #1 twice on [DATE], the first time around 12:00am when he repositioned her and checked if she was dry and then later (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 7 of 12 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 07/16/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few around 1:00am he stated he thought that he had changed her. CNA A stated he took roughly 20 seconds to a minute to change Resident #1. CNA A stated he went to go see how Resident #1 was at around 3:00am or 3:30am when he found Resident #1 on the floor and went to call the nurses. CNA A stated Resident #1 was bleeding from her head and appeared in pain because she was grimacing. CNA A stated the facility policy was to use 2 people if a resident required 2 person assist, CNA A stated he did not follow the facility policy In this situation. CNA A stated using 1 person assist when a resident required 2 could negatively impact a resident because it would put a resident at risk for fall. During an interview with LVN B on [DATE] at 12:54pm LVN B stated she worked on [DATE] from 6:00pm till 6:00am and was the nurse for Resident #1 and worked with CNA A. LVN B stated CNA A did not ask her for any help and stated she did not assist CNA A with any care for Resident #1 on [DATE]. LVN B stated she went into Resident #1's room around 1:00am and to turn off her TV. LVN B stated at that time Resident #1 was positioned in the middle of the bed facing the door with a low bed. LVN B stated she did not see Resident #1 again until CNA A notified her that Resident #1 was on the floor at around 3:30am. LVN B stated CNA A told her he had just exited from resident room from across the hall when he entered Resident #1's room and saw her on the floor. LVN B stated Resident #1 was not verbal and only groaned. LVN B stated when she entered Resident #1's room she was on the floor flat on her back with the bed in a low position and the air mattress functioning and set appropriately. LVN B stated Resident #1 had a puddle of blood around her head and a cut. LVN B stated LVN C stayed to render help and LVN B ran to call 911 and get the paperwork ready. LVN B stated CNA A had stated he changed Resident #1 at around midnight by himself. LVN B stated Resident #1 required 2-person assistance and was unable to move on her own and would not have been able to roll herself off the bed. During a follow up interview with LVN B on [DATE] at 6:18pm stated she notified the administrator of Resident #1 fall and laceration at 3:50am after emergency medical services had taken her. LVN B stated she notified the Administrator that CNA A found Resident #1 On the floor during a round, and she had a laceration and was bleeding and was being sent to the hospital. LVN B clarified that the cut she saw on Resident #1 was on her forehead. LVN B stated the facility policy stated they had to provide 2-person assist If the residents required it. LVN B stated CNA A did not follow the facility policy in this situation. LVN B stated using 1 person assist for residents who required 2 could negatively impact residents due to residents potentially falling if there was no staff on the other side of the bed to catch them. During an interview with LVN C on [DATE] at 11:45am stated Resident #1 was not her resident on [DATE] during her shift from 6:00pm - 6:00am. LVN C stated CNA A had said he changed Resident #1 at least once prior to the fall but stated he did not say at what time. LVN B stated CNA A stated he had changed Resident #1 by himself. LVN B stated he did not help CNA A with Resident #1 on [DATE]. LVN B stated CNA A notified her and another nurse that he had seen Resident #1's feet on the floor and realized she was not on the bed and then went to notify them. During a follow up interview with LVN C on [DATE] at 7:02pm stated when she was notified of Resident #1 was found on the floor she was in supine position (on her back) and there was a pool of blood and she saw an injury to her head on the right side and looked like her skin pulled back and placed pressure on her head while LVN B called 911 and the notifications. LVN C stated Resident #1 was awake and conscious. During an interview with the Administrator on [DATE] at around 8:07pm stated the DON was on leave and out of the country and did not currently have cell phone service to receive calls. The Administrator said that on [DATE] at around 3:30am CNA A found Resident#1 on the floor while completing his round and notified LVN B and C. The Administrator stated through the facility investigation which included an interview and statement from CNA A, the facility identified that CNA A did not have any assistance from other (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 8 of 12 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 07/16/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few staff when he provided care to Resident #1. The Administrator stated Resident #1 required 2 person assistance for all ADLs, bed mobility, repositioning and when being changed and was not able to move herself. As per Administrator CNA A stated he knew Resident #1 was a 2 person assist and stated he had been trained on the POC (plan of care) but still decided to provide care by himself and said he could do it himself. The Administrator stated there were 2 other aides and 2 other nurses that were available to assist CNA A during that shift at that station and in total 10 other staff in the facility that could have helped. The Administrator stated CNA A stated at around 1:00AM or 1:15am on [DATE] he went into resident #1's room to provide incontinent care and reposition Resident #1 and left her in the center of the bed facing the door. The Administrator stated CNA A had been previously trained over the POC and Kardex and where to find residents levels of assistance. The Administrator stated CNA A did not mentioned anything about dropping Resident #1 or working with her when she fell. The Administrator all staff including CNA A had been trained previously to Resident #1 requiring 2 person assistance. The Administrator stated she was thinking Resident #1's fall occurred due to body alignment and stated she was thinking Resident #1 was possibly not centered in the bed. The Administrator stated the facilities policy regarding following a resident's plan of care when they required 2 person assist and stated therapy evaluation will determine if a residents were 1 or 2 person and in return the plan of care will show the level of care needed and if staff did not follow the plan of care for safety then it was an immediate termination for the staff member. The Administrator stated CNA A did not follow this policy in this situation. The Administrator providing residents who required 2 person assistance with only 1 person assistance could impact residents safety and cause injury. During an interview on [DATE] at 5:50pm the Administrator stated she was the abuse coordinator and responsible for reporting any incident or allegation of abuse, neglect or exploitation to state agencies. The Administrator stated she completed annual training over reporting requirements along with going over provider letters or trainings from an online training program the facility used and stated staff was trained over abuse and neglect frequently and stated that training was provided to her by the Regional Director of Operations and to the staff by the DON or one of the ADONs. The Administrator confirmed that Resident #1 was found on the floor with a laceration to her head on [DATE] and was unable to explain what happened and was not witnessed and required to be sent out to the hospital for treatment. The Administrator stated she received a text from LVN B on [DATE] at around 3:40am or 3:50am that stated Resident #1 had an unwitnessed fall, laceration with active bleeding with first aide rendered, notifications made to a 3rd party on call service used by facility, 911 activated, doctor and responsible part of Resident #1 were notified. The Administrator stated she did see the message about 5am. The Administrator stated around 12:00pm on [DATE] she was notified by family of Resident #1 that she had expired. The Administrator stated incidents like this was to be reported with 2 hours to HHSC and she stated she reported when she found out that Resident #2 had expired and stated she did not report with into two hours of her unwitnessed fall because the severity of the laceration was not said and the incident report was not alarming or suspicious. The Administrator stated to ensure staff provided her with sufficient information and assessment of resident's incidents to allow her to determine reporting timeline she would ask questions, review the incident report and reach out for any updates on residents at the hospital. The Administrator stated the facility policy for reporting allegations and incidents abuse, neglect and exploitation referred to a provider letter but was unable to state which provider letter aside from stating it was the most recent one. The Administrator stated she did follow the facility policy in this situation and stated not appropriately reporting allegation or incidents of abuse, neglect and exploitation could negatively impact (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 9 of 12 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 07/16/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few residents because their safety can be impacted and their residents safety was their priority. Record Review of a document titled, Termination Form and dated [DATE] reflected CNA A's termination date as [DATE].Record review of facility Inservice training report dated [DATE] that stated staff must review all assigned plans of care to assure appropriate staff was in place prior to rendering care and staff had to be able to demonstrate how to access the plan of care, how to reach and what it meant and the importance of being complaint. Review of sign in attendance documentation reflected CNA A had completed this Inservice. Record review of facility ADL care policy provided and with an origination date of [DATE] did not mention any verbiage related to following resident care plan when 2-person assistance is required. During an interview on [DATE] at 4:18pm the Administrator stated she reached out to cooperate and was told that their ADL policy was the care plan policy. Record review of facility Inservice training report dated [DATE] that covered allegations of abuse, neglect and exploitation to be reported immediately and no later than 2 hours and other incidents that are reportable to be reported immediately but not later than 24 hours to HHSC. Review of sign in attendance sheet for Inservice reflected the Administrator had completed this Inservice. Record review of facility policy titled, Policy and Procedure: Abuse, Neglect and Exploitation with an revised date of [DATE] stated under section, IV. Identification of Abuse, Neglect, and Exploitation.B. Possible indicators of abuse include, but are not limited to.3. Physical injury of a resident, of unknown source.8. Failure to provide care needs such as comfort, safety, feeding, bathing, dressing turning & repositioning VII. Reporting/Response A. The facility reports abuse and abuse allegations that include:1. Reporting allegations involving staff to-resident abuse, resident-to resident altercations involving allegations of abuse, 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 (e.g., law enforcement when applicable) within specified timeframes:a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involves Abuse (with or without bodily injury)b. An Incident that results in serious bodily injury and that involves any of the following: Neglect Exploitation Mistreatment Injuries of unknown source Misappropriation of resident propertyC. Not later than 24 hours after the incident occurs or is suspected. An incident that does not result in serious bodily injury but that involves any of the following: Neglect Exploitation A missing resident Misappropriation of resident property Drug thief Fire Emergency situation that pose a threat to resident health and safety A death under unusual circumstances Communicable disease situation that pose a threat to resident health and safety. This was determined to be an Immediate Jeopardy (IJ) on [DATE] at 3:51pm. The administrator was notified. The Administrator was provided with the IJ template on [DATE] at 5:46pm The following Plan of Removal (POR) submitted by the facility was accepted on [DATE] at 1:25 pm: Tag Cited: F-689Issue Cited: Free of Accidents/Hazards/Supervision#5 1. Immediate Action Taken On [DATE] Resident #1 had an unwitnessed fall sustained a laceration @ 0330am, first aid rendered was sent to the hospital Facility initiated investigation Reported to Texas Health and Human Services Intake#1021508, physician and RP, [local police department] CNA A suspended on 7/7 and terminated [DATE]. 2. Identification of Residents Affected or Likely to be Affected: On [DATE] the DON/Designee completed an audit on all residents identified as two person-assist; 64 resident were identified in the facility. On [DATE] the DON/Designee completed an audit on all residents identified with air mattress, 46 residents were identified in the facility 3. Actions to Prevent Occurrence/Recurrence: DON reviewed staffing levels on [DATE] to ensure adequate staffing; no changes required DON/designee conducted audit on [DATE] @6:00pm reviewed all residents requiring two-person assist; point of care and care plan (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 10 of 12 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 07/16/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few reviewed for accuracy DON/designee conducted audit on [DATE] @6:00pm identified all residents on air mattress, and review orders against setting for accuracy. On [DATE] DON/designee in-service all staff on Abuse/Neglect Policy completed on [DATE] by 5:00pm, Any new hires by the facility will receive education upon hire. On [DATE] DON/designee in-service all staff on Fall Management completed on [DATE] by 5:00pm, Any new hires by the facility will receive education upon hire. On [DATE] DON/designee in-service all direct care staff on resident Point of Care completed on [DATE]. Any new hires by the facility will receive education upon hire. On [DATE] DON/designee Performed two-person skill validation with return demonstration on all direct care staff, completed on [DATE]. Any new hires by the facility will receive skill validation training Charge nurses with monitoring tool will monitor the point of care for ADL assistance and ensure the CNAs are adhering to the residents' point of care every shift to ensure the designated level of care for each resident is accurate per point of care. Any discrepancies will be corrected immediately, reported to the DON/designee and re-education as needed. S Charge nurse will print out Kardex daily and review with CNAS Charge nurse will conduct walking rounds with CNA and acknowledge S Documented on monitoring sheet, any discrepancies will be reported immediately to DON/ADON DON/designee will review charge nurse monitoring form daily 5 times a week. All findings will be reviewed in morning meeting with IDT and revisions to plan may be made as necessary. DON/designee will do monitoring in random shifts for 3 residents 5x week to ensure the designated level of care for each resident is accurate per point of care. Ad Hoc QAPI conducted on [DATE] @ 2:00pm with Medical Director to review and discuss plan to sustain compliance. 0n [DATE] at 7:30 pm the facility's Administrator notified the Medical Director regarding the Immediate Jeopardy's the facility received related to resident free of accident/hazards/supervision and review plan to sustain compliance. Date Facility Asserts Likelihood for Serious Harm No Longer Exists: ______[DATE]__________ The state surveyor confirmed the facility's Plan of Removal had been implemented sufficiently to remove the Immediate Jeopardy that included: Record Review on [DATE] of facilities immediate actions taken in response to Resident #1's fall reflected LVN B documented Resident #1's fall on a nursing note dated [DATE] which included her being notified of fall, how Resident #1 presented when observed by nurse, vitals, notifications made and orders received. Note dated [DATE] from an on call provider reflected Resident #1's fall and their orders to send Resident #1 out to the emergency department. A post fall evaluation was completed in response to Resident #1's fall with an effective date of [DATE]. Facility initiated neuro checks on [DATE] at 3:30am. Facility generated incident report dated [DATE] that included summary of Resident #1's incident, immediate actions taken, pain scale which reflected a pain level of 7, and the notifications made. Facility initiated investigation into incident that included staff statements, resident skin assessments, and report made to HHSC, police department was contacted however report for incident was not yet completed. Documentation of termination of CNA A's employment reviewed and reflected he was terminated on [DATE]. Record review of staffing list for [DATE] was signed as reviewed by ADON D and identified a total of 2 nurses and 3 aides working on station 1 where Resident #1 was located and 3 nurses and 3 aides working in station 2 for a total of 11 staff that were scheduled and worked on [DATE] at time of Resident #1's fall. Record review of facility audit that identified a total of 64 residents who required 2 person assistance was signed as verified on [DATE]. Record review of facility audit of residents with air mattress included review of order listing report document with list of residents with mattress orders in place with a date of [DATE]. A total of 46 resident were noted to be identified with air mattress orders in place. Record review of staff training dated from [DATE] to [DATE] reflected staff had been trained over abuse and neglect, fall management, POC, with nursing staff completing a 2 person skills (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 11 of 12 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 07/16/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete validation with return demonstration. On [DATE] and [DATE] a total of 10 aides, 8 LVNs, from all shifts 1 ADON and Administrator were interviewed with all staff stating they had recently received training with in the past few day that covered the abuse and neglect policy that included what to report and who to report, the kinds of abuse and the timeline for reporting and fall management that included how to prevent falls, what to do when they occur, who to notify and incident reports, use of wedges, bolsters, mats and low beds and using 2 persons. Staff had been trained over the plan of care and where to find it and how to where to find resident assistant levels and identify how many staff are required for assistance. Nursing staff had also completed a 2 person skill validation that required them to reposition and move a resident in bed with use of 2 people and be checked off by leadership staff. Staff were aware of new procedure of charg e nurses reviewing resident Kardex with aides at start of all shifts and complete walking rounds with the aides to ensure they understand the level of assistance required for residents care. Nursing staff was aware of aides signing on the Kardex to indicate they understood and charge nurses filling out the monitoring sheet that also included if aides required more education and notifying the DON or an ADON if a any discrepancies were noted. to All staff interviewed were able to recall training and procedures they were educated on. ADON E along with charge nurses were aware of review of monitoring sheets daily during the morning meetings, with ADON E stating her and ADON D were to separately monitoring 3 residents 5 times a week on a random shift to ensure residents level of care is accurate. Record review and observation completed by survey reflected 6 sampled residents, Residents #2, #3, #4, #5, #6 and #7 had information on their care plan and Kardex indicating their level of care (2 person assistance) and had orders in place for air mattress which were observed to be on appropriate setting when compared to orders that were in place. The Administrator was informed the Immediate Jeopardy (IJ) was removed on [DATE] at 7:59pm. The facility remained out of compliance at a severity level of actual harm and a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 675044 If continuation sheet Page 12 of 12