Health inspection·November 20, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the report taken by officer. R#2 would continue to be monitored for any pain or change in condition. Staff would continue to monitor and meet residents' needs. Record review of R #2's MDS Quarterly dated 10/29/25 revealed R#2 had a BIMS Score of 06 which indicated that a resident's cognition was severely impaired dad significant difficulty with cognitive tasks and may require increased staff support for daily living activities. The MDS revealed no change in cognitive, or behaviors. R#2's Mood indicated to rarely feel isolated. not indicated to be present at time of assessment. The MDS indicated Resident #2 used a wheelchair and is dependent on staff to help in some daily activities. Resident #3 Record review of R #3 face sheet revealed a [AGE] year-old female initially admitted on [DATE], with diagnosis of Cerebral Infarction due to Embolism of Right Middle Cerebral Artery( a condition were a blood clot travels through the blood to the brain and blocks oxygen and blood flow to blood vessels in the brain, causing tissue damage.), Dementia (a group of thinking an social symptoms that interferes with daily functioning), Unspecified Psychosis (a diagnostic category for a patient experiencing psychotic symptoms like delusions or hallucinations, but where there is not enough information to make a specific diagnosis, or the symptoms don't meet the criteria for another disorder), Delusional disorders ( a serious mental illness characterized by one or more non-bizarre, false beliefs that persist for at least one month, despite evidence to the contrary) and Alzheimer's Disease with late on set (a progressive disease that destroys memory and other important mental functions). Record review of Resident #3's MDS Quarterly dated 09/23/25 revealed Resident #3 had a BIMS Score of 09-moderate cognitive impairment a notable change for normal cognitive abilities and could signal a need for further assessment, as it suggests problems with thinking and memory. The MDS revealed no cognitive patterns present. The resident mood assessment reveals rare feelings of loneliness. The MDS revealed R#3 had no behaviors present indicating psychosis, rejection of care or wandering. Functional abilities revealed she had upper and lower extremity limitation on one side and used a wheelchair. R #3's functional abilities revealed she needed partial to substantial help with hygiene and toileting but minimal help in repositioning in bed and feeding herself. Record review of Resident #3's progress notes dated 10/15/2025 the CNA reported R #3 hit another resident while they passed each other in the hallway, staff member immediately separated and reported the incident to LVN F. LVN F assessed both residents, and no complaints of pain was voiced at that time. R #3 was able to move all extremities without difficulty and no redness or bruising was noted at the time. The incident was reported to the nurse practitioner for further instructions. On 10/15/25 the social worker was informed R#3 was involved in a physical altercation with a R#2. R#3 explained when she was wheeling herself down the hall going towards her room R#3 made a flirty sexual comment towards her. R#3 explained how she asked for R#2 to stop, and he wouldn't. R#3 voiced she felt as if R#2 was going to hit her because of how he looked at her, so she struck R#2 and R#2 struck at her back on her chest and collar bone area. Video surveillance was reviewed, and it was noted that R#3 was out in the hall wheeling herself towards the nurses' station and R#2 was also heading towards the nurses' station when R#2 pulled up next to R#3 and R#3 was seen striking R#2 in the left shoulder area multiple times. R#2 struck R#3 and the pair were separated by a staff member immediately. R#3 was assessed by the charge nurse and had no signs of discoloration and did not voice any pain at that time. R#3 has been placed on a 1 to 1 for the safety of herself and others. The social worker was instructed to have resident moved due to resident's history of physical aggression and physically hitting a male resident several times. A referral had been sent to a local behavioral hospital and acceptance was pending due to pending medical clearance. The social worker was instructed to send R#3 to ER to be medically cleared and assessed for inpatient behavioral services. On 10/20/25 R#3 was cleared and released by local (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 2 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few hospital to return to the facility. Record review of R #3's care plan dated 10/20/24 revealed R #3 used psychotropic medications (antidepressants) related to dx of labile moods, delusional disorder, depression, mood disorder, insomnia, and psychosis behavior was to be monitored, documented, and reported for adverse reactions to antidepressant therapy. R#3 is to have been monitored, record and report to physician side effects and adverse reactions of psychoactive medication such as unsteady gait, tardive dyskinesia(a disorder of involuntary, repetitive movements ,often affecting the face, limbs and trunk caused by long-term use of certain medications, particular antipsychotics), Extra Pyramidal Symptoms (shuffling gait, rigid muscles, shaking), frequent falls, refusal to eat, difficulty swallowing, dry mouth, depression, suicidal ideations, social isolation, blurred vision, diarrhea, fatigue, insomnia, loss of appetite, weight loss, muscle cramps nausea, vomiting, behavior symptoms not usual to the person. R#3 has impaired cognition and is at risk for a further decline in cognitive and functional abilities related to dementia and CVA (cerebrovascular accident), memory deficit related to CVA, symptoms and signs involving cognitive function following CVA related to Alzheimer's diagnosis. R#3 has an ADL Self Care Performance Deficit and is at risk for not having their needs met in a timely manner. Performance deficits are related to severe weakness, hemiplegia left side from CVA, history of left radius fracture, Osteoarthritis, right shoulder rotator cuff tear, lack of coordination, pain, muscle weakness, abnormalities of gait and mobility, contracture left hand, contracture, history of falls. R#3 was dependent on staff for meeting emotional, intellectual, physical, and social needs due to physical limitations. R#3 had an ADL self-care performance deficit related to weakness, poor mobility related to hemiplegia affecting the left side. R #3 has a behavior problem as evidenced of fluctuating thoughts of suicidal ideations, refuses care, meds, makes false accusations of staff members, she consistently changes her stories. R#3 was seen for counseling. Prefers female staff, two staff members at all times. Attempts to self-transfer without assistance. Attempting to strike other residents, aggressive towards other residents and staff, hit another resident. In an observation and interview on 11/18/2025 at 5:03 PM of R #3 reveal she was in her wheelchair sitting out in the hall. R #3 stated R#2 like to tell her he loved her and flirted with her. R#3 told to R#2 to leave her alone because she was married and her husband was very jealous. R#3 stated she did not remember very well how the incident occurred. R#3 stated she was not fearful of any staff or other resident in the facility. R #3 stated she had not seen or had another altercation with R#2. In an observation and interview on 11/18/25 at 5:17 P.M. with Resident #2 he was in bed watching television waiting for his dinner tray to be brought to him. R#2's deminer was anxious and he stated he was looking for his shoes. R#2 recalled the incident and stated he was in the dining room and R#3 told him a bad word, so he pulled her hair and then R#3 hit him. R #2 stated he was sore afterward but not too painful. R#2 stated he had never had an issue with R #3 this was the first time he had an altercation with R #3. R#2 stated he was not fearful of any staff or other residents. R#2 stated he stays away from R#3 and had not had any contact with R#3. In an interview on 11/18/25 5:25 P.M. with CNA A she stated resident # 2 can be aggressive sometimes with staff but the incident with R #2 was the first time she was aggressive with a resident. CNA A stated R # 2 has not been aggressive with her the resident is always pleasant when she provides care. She was not present when the incident occurred but was told to keep the two residents apart from each other. In an interview on 11/18/25 at 5:42 PM the Social Worker (SW) stated what was seen on the camera was both were going to their rooms when R#2 pulled up next to R#3 then R#3 started to hit R #2 and then R #2 began hit R #3 back. The SW Could not tell if R #2 made contact with R #3. The SW stated when she spoke with R #3 she stated R #2 made flirty comments to R #3 and she got upset and swung at R #2. The incident occurred in the hallway (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 3 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few as they were going to their rooms in two different halls. R #3 was sent to be evaluated for the aggressive behavior and placed on a 1 to 1 monitor. R #2 had followed up visits and monitored for his injury. They did three days of evaluations for each resident to monitor any aggressive behaviors the following 3 days. R#3 had another incident with another resident where she was the victim and R #2 had no other incidents. The SW stated the abuse coordinator is the Administrator and was able to verbalize the different types of abuse. When an abuse incident was reported to her and she would call the Administrator so the investigation could begin, and responsible party was notified along with doctor and the Administrator/Abuse the coordinator. The SW stated the in-services are to be conducted and interventions are put into place to prevent abuse incidents. The Abuse Coordinator is responsible for making sure the policy and procedure for abuse is done correctly, because if the proper preventions are not implemented correctly the incidents can recur. In an interview on 11/18/25 at 5:57 PM CNA D stated a few days after R #3 was moved from 700 to 200 she was feeling angry and said if she ever saw R #2 again she would want to smack him. CNA D said R#3 had no aggressive behavior with residents or staff members in the new hall she was placed in. CNA D stated R #3 would become confused and would tell the staff to help her look for her car but she does not own a car. CNA D stated R #2 did show signs of aggression as one day R #2 became aggressive because he could not get to his bed and the CNA could not help him right away and he had to wait till the CNA could help him. CNA D stated R #3 was aggressive the day of the incident and was yelling so she was sent to the hospital for an evaluation. CNA D said the administrator was the abuse coordinator and was able to distinguish different types of abuse. CNA D said last week was the last training for abuse. In an interview on 11/19/25 at 9:27 AM CNA E stated she was an as needed nursing staff member and worked on 10/15/25 when the incident occurred. CNA E stated she was picking up the breakfast trays in the 100 hall when she saw both residents striking each other. CNA E stated she immediately separated the residents, called for help, and wheeled R #3 to nurses' station #2. CNA E stated the charge nurse did the head-to-toe assessment on R#2 but could not say if the charge nurse did the assessment on R#3. CNA E stated she did not see any marks or discolorations on R #2. CNA E stated she did not know of any other altercations between R #2 and R #3. CNA E stated she did not know of any altercations with other residents or staff. CNA E stated the last training she received was 2 months ago because she only worker as needed at night. CNA E stated the administrator was the abuse coordinator and was able to verbalize the different types of abuse. In an interview on 11/19/25 at 5:23 PM LVN C stated R #2 has never been aggressive with her or seen him be aggressive with other residents or staff. LVN C said she began working in September and has not had too much contact with either resident. LVN C had no problems with R #3 being aggressive or refusing care from her. LVN C said the abuse coordinator was the administrator and could verbalize different types of abuse. LVN C said last month was the last training she received on abuse. In an interview on 11/19/25 at 10:41 AM with LVN B she said R#2 does good in the halls never show aggression towards other residents and never bothers anyone. Resident #2 is quiet, keeps to himself, and mainly stays in his room. LVN B said she could not really say much about R #3 because she did not have too much contact with her. LVN B stated she did not know of any altercations with R #2 other than the one With R #3. LVN B was able to describe what a willful act was but felt the mental condition of the residents made a difference in the determination of the act being willful or not. LVN B was able to state several types of abuse, and the administrator was the abuse coordinator. LVN B stated the there was enough staff for the facility to monitor residents with behavior problems to prevent other incidents from happening. The last abuse in-service was two weeks ago. In an interview on 11/19/25 at 11:01 AM with LVN F stated she did the assessment for R #3 and R #3 told her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 4 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she hit R #2 because of what he told her. LVN F stated the residents had a previous relationship with R #2. LVN F stated R #2 tended to be a little spicy with the female residents. LVN F stated R #2 did not like to be told to what to do by females in general. LVN F stated there were no visible marks on the left arm area of R#2 and both residents were separated from each other right away. LVN F said the head-to-toe assessments revealed no injuries or marks on either resident. LVN F stated R#3 can be outspoken as well as her family and the family did not want meds for R#3's behaviors. LVN F stated R#2 did not have any behavior medication at the time the incident occurred. LVN F stated R#3 was sent out for a psychiatric evaluation at the local hospital. LVN F stated R #3 had a urinary tract infection, but the resident denied treatment for it. LVN F stated R #2 and his family refused medication to help with his aggressive behaviors. LVN F stated the incident between R#2 and R#3 was a willful act of abuse by R#3. LVN F stated R#2's right to be free from abuse was violated by R#3. LVN F stated the abuse coordinator was the administrator and was able to verbalize the different forms of abuse. In an interview on 11/20/25 at 1:05 PM with DON she stated both residents were friends before and maybe had a relationship on the day of the incident R #2 told R #3 something to provoked her and R #3 hit him. The DON said this was the first time they had a physical altercation but could not say if they exchanged words in the past. The family of R #2 was wanting to press charges but changed their mind, but a police report was done. R #3 was moved to another hall away from R#2 when they stopped being friends so that no altercations could occur. After the altercation R #3 was moves farther away to the other side of the facility so that no other incidents could occur. R #3 was placed on a 1 to 1 monitor until she was sent to ER for a psych eval for aggressive behavior and a medication change if needed. The DON stated personally she did not see this as a willful act because she was defending herself from R #2 advances. The right of R #2 was not violated because of the cognitive impairment of R #3. In an interview on 11/20/25 at 2:06 PM with the Administrator (admin)/ Abuse Coordinator stated there was a video of the incident but could not say if the facility still had the video available. The admin recalled in the video R #3 had reached out and touched R #2. The admin stated a CNA was helping a resident and heard loud voices and went out to the hallway and saw R #2 and R #3 in an altercation and called for help as she separated R #2 and R #3. The admin stated when the nurse and the CNA separated R#2 and R #3, and a head-to-toe assessment was done on both residents and R#3 was placed on a 1 to 1 monitor and was sent to a hospital so a psych eval could be done. The admin stated R#3 was released to return to the facility. The admin stated interventions for both residents are still in place with the residents moved far apart from each other and no interaction between them can occur. The admin stated R#2 and R#3 were still being monitored for interaction with each other. The admin stated the facilities policies and procedures are monitored for the effectiveness by the DON and ADON. The admin stated the SW also does follow up visits with residents and the facility doctor or psychiatric clinic ensure medication does not need to be adjusted or changed. The admin stated she has nurses do follow up visits then random spot checks on resident to monitor behaviors. The admin stated the DON meets with resident see how they are doing and the admin and SW also do spot checks after the resident returns from an admission to the hospital for an evaluation by the psychiatric unit. The administrator and DON are responsible for ensuring the policy and procedures are implemented correctly. The DON stated the abuse and neglect trainings and in-services are to be monitored monthly to ensure all policy and procedure are done correctly. The admin stated in services are consistently monitored by the DON and ADONS to ensure the facility is in compliance with the state. In Record review of the facilities Abuse Policy and Procedures dated 09/06/24 it states the policy of this facility is to provide protections for the health, welfare, and rights of each resident by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675044 If continuation sheet Page 5 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, and exploitation and misappropriation of resident property. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, which can include staff to resident abuse and certain resident to resident altercations. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental and psychosocial physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through eh use of technology Event ID: Facility ID: 675044 If continuation sheet Page 6 of 6