Inspection·July 10, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few timely and could develop into something worse. During an interview on 07/10/2025 at 03:13 p.m., LPN F revealed she had worked for the facility since around November or December of 2024, but transitioned to the treatment nurse position in late May 2025. She revealed she was not the treatment nurse during the week of 05/09/2025. She stated it was possible Resident #1 was out for an appointment or something, which caused him to miss his skin assessment. She stated the charge nurses were completing the weekly skin assessments between the time the prior full-time treatment nurse left and she transitioned into the position, no more than a week. She revealed since starting the treatment nurse position, she was responsible for completing the weekly skin assessments. She revealed Resident #1 had not experienced any skin issues other than dry skin since she had started completing the weekly skin assessments. During an interview on 07/10/2025 at 03:24 p.m., LPN E revealed she did not recall Resident #1's skin assessment for the week on 05/09/2025. She stated she did not know if the assessment was not done or just not marked as done. She stated that at the time, the system for completing the skin assessments was being changed. She stated the nurses could go to the forms tab in the EMR and see if there were any resident assessments due that day or past due. She stated she was unsure what would have been due on 05/09/2025 or 05/10/2025 for Resident #1. She revealed she was not aware of Resident #1 having had any skin issues. She stated Resident #1 was very independent and would tell the staff if he had any concerns. She stated that if an assessment was missed, the staff would have to go back and assess him to ensure they didn't miss any changes. Record review of facility policy, Skin Assessment, date implemented 04/24/2025, reflected, Policy Explanation and Compliance Guidelines: 1. A full body, or head to toe, skin assessment will be conducted by a licensed or registered nurse upon admission/re-admission and weekly thereafter. 2. Record review of Resident #2's admission Record, dated 07/09/2025, reflected a [AGE] year-old male. He was admitted to the facility on [DATE]. Record review of Resident #2's Medical Diagnosis EMR tab, undated and accessed on 07/09/2025, reflected Resident #2 had diagnoses which included diastolic (congestive) heart failure (CHF; a long-lasting condition resulting from the loss of the heart's ability to relax between heartbeats reducing the amount of blood that can enter the heart), unsteadiness on feet, (osteo)arthritis (OA; a joint disease where the cartilage that cushions the ends of bones wears down over time leading to pain, stiffness, and a loss of flexibility), gout (inflammatory arthritis), polyneuropathy (a disorder that damages the peripheral nerves, which control the movement of the arms and legs), and muscle wasting and atrophy. Record review of Resident #2's Quarterly MDS, dated [DATE], reflected Resident #2 had a BIMS score of 12, which indicated he was mildly cognitively impaired. He was documented as having had no falls since admission/entry or reentry or the prior assessment. Record review of Resident #2's Care Plan, undated and accessed 07/09/2025, reflected Resident #2 had the following focuses and interventions:- [Resident #2] has ADL self-care performance deficit r/t generalized weakness & debility. DX: CHF, OA and Gout. He has poor balance., date initiated 05/10/2024 and revised on 07/06/2025. Interventions included, Monitor/document/report PRN any changes, any potential for improvement, reasons for self-care deficit, expected course, declines in function.- [Resident #2] has limited physical mobility related to weakness and debility. DX: CHF, Gout, Neuropathy & OA. Non-ambulatory., date initiated 05/08/2024 and revised on 07/06/2025. Interventions included, Monitor/document/report PRN any s/sx of immobility: contractures [a permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joints to shorten and become very stiff] forming or worsening, thrombus [blood clots within the blood vessels that reduces blood flow] formation, skin-breakdown, fall related injury, date initiated 05/08/2024. - [Resident #2] is at risk for falls related to impaired cognition, balance and safety awareness. He has impaired vision., date initiated and revised 05/10/2024. His (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675110 If continuation sheet Page 2 of 9 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 675110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cuero Nursing and Rehabilitation Center 1310 E Broadway Cuero, TX 77954 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete interventions included, Educate the resident/family/caregivers about safety reminders and what to do if a fall occurs., date initiated 05/08/2024. Record review of Resident #2's EMR Forms tab, accessed on 07/09/2025, reflected a Nursing- Fall Risk Evaluation V-1 was due 06/26/2025, with schedule frequency noted as Schedule Completion of Fall Risk- admission / Quarterly. The most recent Nursing- Fall Risk Evaluation V-1 was dated 03/26/2025. Record review of Resident #2's Nursing- Fall Risk Evaluation- V 1, dated effective date 03/26/2025, reflected the reason for the evaluation was quarterly. The resident was categorized as high fall risk with a score of 15. Record review of Resident #2's Progress Notes, created date range 03/26/2025 to 07/09/2025, did not reveal a progress note mentioning Resident #2's fall risks between 06/26/2025 and the last documented progress note, dated 07/02/2025. Attempted interview on 07/10/2025 at 01:33 p.m. Resident #2 was not able to vocalize response, but indicated he did not want to be interviewed. He indicated he did not feel well and wanted to see the nurse. During an interview on 07/10/2025 at 02:53 p.m., the DON revealed the Nursing- Fall Risk Evaluations was to be completed upon admission, re-admission, quarterly, and if there is a significant change or incident, it may trigger to be completed. She stated the schedule for the evaluations was per policy. She stated the evaluations were assigned to the charge nurses, but the MDS nurses may also complete them. She stated the evaluations will automatically populate in the EMR when they are due. She stated the nurses are notified when they have a quarterly assessment to complete. She revealed the impact of a missed assessment or evaluation might be that the staff do not catch a change in the resident's well-being. During an interview on 07/10/2025 at 03:24 p.m., LPN E revealed the nurses are typically notified by the MDS nurses when their resident quarterlies are due, and the notification would include what shift was assigned to do them. She revealed the assignments were separated by shift, so each shift had only so many assessments/evaluations to do during their shift. Record review of facility policy, Fall Prevention Program, date implemented 08/15/2022, reflected, Policy: Each resident will be assessed for fall risk and will receive care and services in accordance with their individualized level of risk to minimize the likelihood of falls.Policy Explanation and Compliance Guidelines: . 4. Low Risk Protocols: . g. Complete a fall risk assessment every 90 days and as indicated when the resident's condition changes. 5. High Risk Protocols: . b. Provide additional interventions as directed by the resident's assessment. Event ID: Facility ID: 675110 If continuation sheet Page 3 of 9 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 675110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cuero Nursing and Rehabilitation Center 1310 E Broadway Cuero, TX 77954 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to provide pharmaceutical services including procedures that assure the accurate dispensing, administering, and timely documentation of medications given, to meet the needs of each resident for 2 of 17 residents (Resident #3 and Resident #4) reviewed for pharmacy services. 1. CMA A failed to ensure medications were signed out as given to Resident #3 after administration, and not before they were given. 2. LPN H failed to reconcile Resident #4's documented penicillin (antibiotic) allergy with the physician's order for amoxicillin (antibiotic) before it was scheduled for administration on 06/29/2025. These failures could place residents at risk for loss of prescribed medications, drug diversion, and not receiving the intended therapeutic effects of prescribed medications or receiving potentially harmful side effects from prescribed medications. Findings included: 1. Record review of Resident #3's admission Record reflected a [AGE] year-old male, with an original admission date of 05/29/2025 and a re-admission date of 06/09/2025. Record review of Resident #3's Medical Diagnosis EMR tab, undated and reviewed on 07/10/2025, reflected Resident #3 had diagnoses including high blood pressure, pain in the right knee, constipation, stiffness in the right knee, and low back pain. Record review of Resident #3's MDS dated [DATE] documented a BIMS score of 12 out of 15, which suggested a moderate cognitive impairment (some trouble with memory, thinking issues, and making decisions that affected daily life). Record review of Resident #3's Care, undated and assessed on 07/10/2025, reflected the following focus, The resident has an AOL self-care, initiated on 05/30/2025 and revised on 06/25/2025. The interventions included staff assistance with showering, dressing, transferring, and monitoring for any changes. Record review of Resident #3's Order Summary Report dated 07/09/2025 reflected the following orders: Baclofen Oral Tablet (Baclofen) Give 20 mg by mouth three times a day for muscle spasm, dated 06/09/2025. Docusate Sodium Oral Capsule 100 MG (Docusate Sodium) Give 1 capsule by mouth two times a day forConstipation dated 06/09/2025. Gabapentin Oral Tablet 600 MG (Gabapentin) Give 1 tablet by mouth three times a day for NERVE PAIN, dated 06/09/2025. hydrALAZINE HCI Oral Tablet 100 MG (Hydralazlne HCI) Give 1 tablet by mouth three times a day related to ESSENTIAL (PRIMARY) HYPERTENSION (110) **Give 2-50mg tablets to equal 100mg until supplyexhaust**, dated 06/12/2025. oxyCODONE HCI Oral Tablet 20 MG (Oxycodone HCI) Give 1 tablet by mouth every 6 hours for PAIN, dated 06/09/2025. During an observation on 07/08/2025 at 05:00 p.m., CMA A pulled and poured Resident #3's medications, . CMA A then proceeded to sign out all medications as given, which turned each medication color on the electronic medication administration record from yellow to green, CMA A then went into Resident #3's room where he took all of the medications. During an interview on 07/08/2025 at 05:10 p.m., CMA A stated that she administered Resident #3's and indicated she signed the medications out as given before Resident #3 took them and that she was trained that way two years ago by a CMA who no longer worked in the facility and had not had any training since that time. CMA A revealed that when it was time for medications to be given, the color on the screen appeared yellow, and that when they were signed as given the medications turned green. Record review of the facility's policy titled Medication Administration dated 10/01/2019, reflected that for Documentation (including electronic) A. The individual who administers the medication dose records the administration on the resident's MAR directly after the medication is given. 2. Record review of Resident #4's admission Record, dated 07/09/2025, reflected an [AGE] year-old female. She was originally admitted to the facility on [DATE] and re-admitted on [DATE]. Record review of Resident #4's Medical Diagnosis EMR tab, undated and accessed on 07/09/2025, reflected Resident #4 had diagnoses which included vascular dementia (brain damage (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675110 If continuation sheet Page 4 of 9 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 675110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cuero Nursing and Rehabilitation Center 1310 E Broadway Cuero, TX 77954 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few typically caused by multiple strokes), cerebral infarction (a disruption in the brain's blood flow), and type 2 diabetes mellitus (a condition that develops with the way the body regulates and uses sugar as fuel) with hyperglycemia (high sugar levels in the blood). Record review of Resident #4's Quarterly MDS, dated [DATE] with observation end date of 07/02/2025, reflected Resident #4 had a BIMS score of 8, which indicated she was mildly cognitively impaired. She was documented as having taken an antibiotic during the last 7 days or since admission/entry or reentry if less than 7 days. Record review of Resident #4's EMR Allergy tab, accessed on 07/09/2025, reflected Resident #2 had an allergy to Penicillin, dated 11/18/2019, with unknown severity. Record review of Resident #4's Care Plan, undated and accessed 07/09/2025, reflected the following focus, [Resident #4] is at risk for allergic reaction as she is allergic to: PENICILLIN & SULFA ANTIBIOTICS, date initiated 12/07/2024 and revised 02/05/2025. The interventions included, [NAME] chart with allergies, Notify MD of any accidental ingestions of medications/foods on allergy list, and Notify pharmacy of allergies, all initiated on 12/07/2024. Record review of Resident #4's Order Audit Report, dated 07/09/2025, reflected Amoxicillin Oral Tablet 500 MG (Amoxicillin) Give 1 tablet by mouth two times a day for UTI for 5 Days, was verbally ordered by MD D on 06/29/2025 at 04:59 p.m. The order was created by LPN H on 06/29/2025 at 05:01 p.m. The Signature Type was noted as Pending. The order was last revised on 06/29/2025 at 07:34 p.m. The Administrative Order Summary noted LPN E documented the order was discontinued on 06/30/2025 at 07:48 a.m. by MD C with the reason DC MEDICATION D/T ALLERGIC REACTION. Record review of Resident #4's MAR (Medication Administration Record), dated 06/01/2025 - 06/30/2025 and printed on 07/09/2025, reflected: Amoxicillin Oral Tablet 500 MG (Amoxicillin) Give 1 tablet by mouth two times a day for UTI for 5 Days, start date 06/29/2025 at 06:00 p.m. and d/c date 06/30/2025 at 07:48 a.m., was administered one time, on 06/29/2025 at *6p-1, by LPN G. Record review of Resident #4's Progress Notes, created date range 06/26/2025 to 07/09/2025 and printed on 07/09/2025, reflected: - a NURSING Nurse Note, dated 06/29/2025 at 05:01 p.m., by LPN H reflected This nurse notified [MD D] of the UA and C&S results, and he ordered Amoxicillin Oral Tablet 500 MG [sic] Give 1 tablet by mouth two times a day for UTI for 5 Days.- a NURSING Nurse Note, dated 06/29/2025 at 05:01 p.m., by LPN H reflected The system has identified a possible drug allergy for the following order: Amoxicillin Oral Tablet 500 MG (Amoxicillin) [sic] Give 1 tablet by mouth two times a day for UTI for 5 Days.- a NURSING Nurse Note, dated 06/30/2025 at 01:22 a.m., by LPN G reflected INITIAL DOSE OF ABT AMOXICILLIN 500MG 1 TAB PO BID X5 DAYS FOR UTI, RES TOLERATED MEDICAITON WELL. ENCOURAGED RESIDENT TO OMCREASE [sic] WATER INTAKE. NO CONCERNS VOICED.- a NURSING Nurse Note, dated 06/30/2025 at 07:43 a.m., by LPN E reflected RESIDENT IS PRESCRIBED PO AMOXCILLIN [sic] 500MG 1 TAB BID X 5 DAYS FOR UTI, WITH INITIAL DOSED [sic] OF ADMINISTRATION LAST NIGHT; HOWEVER, RESIDENT HAS ALLERGIES TO PENICILLIN. RES AOX 4, ABLE TO ANSWER QUESTIONS CLEAR AND APPROPRIATELY. V/S OBTAINED.NO S/S OF ANY ADVERSE REACTION OR COC. NO VERBAL CONCERNS MENTIONED.MORNING DOSE OF ABT IS HELD. NOTIFIED [MD C], GIVEN NEW ORDER TO DC PO AMOXICILLIN.NOTIFIED [Resident #4's Representative].- a Change of Condition, dated 06/30/2025 at 07:43 a.m., by LPN E reflected MED ERROR: PO AMOXICILLIN GIVEN, WHOM HAS ALLERGIES TO PENICILLIN, started 06/30/2025, since started it has gotten: [response not selected]. - a NURSING- Nurse Note, dated 07/01/2025 at 02:32 a.m., by LPN I reflected Day 1 F/U med error receiving ABT Amoxicillin x 1 dose. Resident is allergic to ABT. No adverse reactions noted. No redness, rash or swelling noted. Resident is able to voice needs.- a NURSING- Nurse Note, dated 07/01/2025 at 06:41 a.m., by LPN E reflected DAY 1 F/U MED ERROR OF RECEIVING ABT AMOXCILLIN [sic] X 1.NO S/S OF ANY ADVERSE REACTION NOTED. NO VERBAL CONCERNS MENTIONED. - a NURSING- Nurse Note, dated 07/02/2025 at 02:35 a.m., by LPN I reflected Day 2 F/U FOR med error received ABT resident has an allergy to. No adverse reactions noted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675110 If continuation sheet Page 5 of 9 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 675110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cuero Nursing and Rehabilitation Center 1310 E Broadway Cuero, TX 77954 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete No complaints of discomfort voiced.- a NURSING- Nurse Note, dated 07/02/2025 at 07:09 p.m., by LPN J reflected DAY 2 F/U FOR MED ERROR OF RECEIVING ABT AMOXCILLIN [sic]. NO ADVERSE REACTIONS NOTED. NO C/O PAIN OR DISCOMFORT NOTED. - a NURSING- Nurse Note, dated 07/03/2025 at 11:28 a.m., by LPN J reflected DAY 3 F/U FOR MED ERROR OF RECEIVING ABT AMOXCILLIN [sic]. NO ADVERSE REACTIONS NOTED. NO C/O PAIN OR DISCOMFORT NOTED. Record review of facility report, Incidents By Incident Type, date range 04/08/2025 to 07/08/2025 and printed 07/08/2025, reflected Resident #4 noted under Medication Error Incidents on 06/30/2025 at 07:43 a.m. During an interview on 07/10/2025 at 11:10 a.m., Resident #4 revealed she was aware the facility changed her antibiotic order after 1 dose of the oral antibiotic to an antibiotic given intravenously, through her vein. She revealed she had not experienced any rashes, upset stomach, or other side effects from the oral antibiotic medication. Resident #4 did not mention a prior allergic reaction to the oral antibiotic. During an interview on 07/10/2025 at 12:17 p.m., MD C revealed he was the facility medical director. He revealed he believed the amoxicillin was ordered after the bacteria culture result was received and relayed to the on-call physician, MD D. He revealed MD D ordered the amoxicillin, but MD C stated he was not sure if the nurse that relayed the culture result to MD D saw the allergy note on Resident #4's record or relayed the allergy information to MD D. He stated he would say that the allergy information should have been relayed. MD C stated the EMR would have required the nurse to bypass the allergy notification when putting in the order. MD C stated he did not have any concerns regarding Resident #4's impact of the error because Resident #4 had only received one dosage and the facility notified him that she had not experienced any adverse effects. Attempted to interview LPN H on 07/10/2025 at 01:02 p.m., 02:50 p.m., and 05:00 p.m. Missed LPN H's return call on 07/10/2025 at 04:19 p.m. During an interview on 07/10/2025 at 02:53 p.m., the DON revealed the nurse took the amoxicillin order from the doctor and administered the medication without verifying allergies. The DON stated the allergy concern was identified in the morning, the doctor and family were notified, and Resident #4 was put on a 72-hour observation. The DON stated she did not believe Resident #4 was impacted by the error because the resident did not have an adverse reaction to the antibiotic and the doctor changed the antibiotic the next day. The DON stated she was not sure who received the order and did not know if the nurse had discussed the allergy information with the physician. The DON stated the facility medication administration training did cover medication allergies. During an interview on 07/10/2025 at 02:38 p.m., LPN G revealed she did not put in the amoxicillin order for Resident #4 but did administer the medication. She revealed she did not call the physician about the order because she assumed that the staff member that entered the order in the EMR had called the doctor and discussed the order. She revealed she was not aware Resident #4 had any allergies until the next day; however, she did check on Resident #4 during the night and Resident #4 did not have any type of reaction. LPN G revealed part of the facility procedure for receiving and documenting a new medication order was to alert the family and resident about the new medication, and to make sure there were not any adverse reactions to the medication. Record review of facility policy, Medication Administration, date devised 10/01/2019, reflected under Procedure, 1. Preparation.D. 10 Rights of Medication Administration- .10. Right EvaluationMake sure you check for drug allergies and interactions between different medications. Doctors and pharmacists don't always catch them [sic] and we need to be a third set of eyes. Event ID: Facility ID: 675110 If continuation sheet Page 6 of 9 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 675110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cuero Nursing and Rehabilitation Center 1310 E Broadway Cuero, TX 77954 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 interviews and record reviews, the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained on each resident that were complete and accurately documented for 2 of 4 residents (Resident #1 and Resident #4) reviewed for clinical records.?? ? 1. CMA A failed to document a progress note following the entry of chart code 5= Hold/See Progress Notes on 06/16/2025 for Resident #1's Metoprolol Tartrate (a blood pressure medication) order. 2. CMA A failed to document progress notes following the entry of chart code 9= Other/See Progress Notes on 07/02/2025 and 07/03/2025 for Resident #5's Olmesartan Medoxomil-HCTZ (a blood pressure medication) order. ? This failure could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records.? ? Findings included:? 1. Record review of Resident #1's admission Record, dated 07/08/2025, reflected a [AGE] year-old male. He was admitted to the facility on [DATE]. Record review of Resident #1's Medical Diagnosis EMR tab, undated and accessed on 07/08/2025, reflected Resident #1 had diagnoses which included alcohol dependence with alcohol-induced persisting dementia (a general term for impaired ability to remember, think, or make decisions), hypertension (condition of high pressure in the vessels that carry blood from the heart to the rest of the body), and muscle wasting and atrophy (shrinking of muscle or nerve tissue). Record review of Resident #1's Quarterly MDS, dated [DATE], reflected Resident #1 had a BIMS score of 12, which indicated he was mildly cognitively impaired. Record review of Resident #1's Order Recap Report, order date: 06/01/2025- 07/31/2025 and printed on 07/08/2025, reflected Metoprolol Tartrate Oral Tablet 25 MG (Metoprolol Tartrate) Give 1 tablet by mouth one time a day related to ESSENTIAL (PRIMARY) HYPERTENSION (I10) hold for sbp<100 dbp< 60 hr <60, order date 11/13/2024, start date 11/14/2024, and end date 07/02/2025. Record review of Resident #1's MAR, dated 06/01/2025 - 06/30/2025 and printed on 07/08/2025, reflected: Metoprolol Tartrate Oral Tablet 25 MG (Metoprolol Tartrate) Give 1 tablet by mouth one time a day related to ESSENTIAL (PRIMARY) HYPERTENSION (I10) hold for sbp<100 dbp< 60 HR <60, start date 11/14/2024 at 06:00 p.m. and d/c date 07/02/2025 at 01:12 p.m., was coded as 5 on 06/16/2025 by CMA A. Vitals entered on 06/16/2025 reflect a blood pressure of 94/62 and pulse of 67. Chart Codes reflect 4=BS/VS Outside of Parameters for Admin and 5=Hold/See Progress Notes. Record review of Resident #1's Progress Notes, dated 06/11/2025 to 06/25/2025, did not reveal a progress note mentioning medication administration or blood pressure values. During an interview on 07/10/2025 at 11:09 a.m., Resident #1 revealed he had received his medications on time and had not observed any issues with his medication administration. He revealed the staff check his blood pressure twice a day and he knew his blood pressure values go up and down due to his heart issues. He stated he had not had any issues with his blood pressures or blood pressure medication. 2. Record review of Resident #5's admission Record, dated 07/08/2025, reflected an [AGE] year-old female. She was admitted to the facility on [DATE] and readmitted on [DATE]. Record review of Resident #5's Medical Diagnosis EMR tab, undated and accessed on 07/08/2025, reflected Resident #5 had diagnoses which included unspecified dementia, polyneuropathy, and hypertension. Record review of Resident #5's Annual MDS, dated [DATE], reflected Resident #5 had a BIMS score of 9, which indicated she was mildly cognitively impaired. Record review of Resident #5's Order Summary Report, dated on 07/08/2025, reflected Olmesartan Medoxomil-HCTZ Oral Tablet 40-12.5 MG (Olmesartan Medoxomil-Hydrochlorothiazide) Give 1 tablet by mouth one time a day related to ESSENTIAL (PRIMARY) HYPERTENSION (I10), order date 07/01/2025 and start date 07/02/2025. Record review of Resident #5's MAR, dated 07/01/2025 - 07/31/2025 and printed on 07/08/2025, reflected: Olmesartan (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675110 If continuation sheet Page 7 of 9 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 675110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cuero Nursing and Rehabilitation Center 1310 E Broadway Cuero, TX 77954 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Medoxomil-HCTZ Oral Tablet 40-12.5 MG (Olmesartan Medoxomil-Hydrochlorothiazide) Give 1 tablet by mouth one time a day related to ESSENTIAL (PRIMARY) HYPERTENSION (I10), start date 07/02/2025 at 08:00 a.m., was coded as 9 on 07/02/2025 and 07/03/2025 by CMA A. Chart Codes reflect 9=Other / See Progress Notes. Chart Codes did not reflect a code description for On order. Record review of Resident #5's Progress Notes, printed on 07/08/2025 and dated effective date range: 06/08/2025 to 09/09/2025 and created date range: all created; did not reveal a progress note entered after 07/01/2025. During an interview on 07/10/2025 at 02:13 p.m., Resident #5 revealed she was administered her medications generally at the same time each day. She stated she took medication for blood pressure and the staff checked her blood pressure twice a day. She stated her blood pressure was different at different times a day. During an interview on 07/10/2025 at 12:51 p.m., CMA A revealed she did not recall entering a code for Resident #1's blood pressure medication on 06/16/2025, but thought she most likely held his medication because his blood pressure was outside of parameters. She stated she would have entered an out of parameters code in the MAR if Resident #1's blood pressure values were outside the order's hold parameters. CMA A revealed she did recall Resident #5's blood pressure medication not being in stock when the order started. She stated the nurse told her they (the nursing staff) would start administering the medication once the medication was in stock. She revealed she recalled putting an on order code in the eMAR. She stated when she clicked No for administered, the computer will provide prompts, and she could select on order. She stated she selected on order for those days. During an interview on 07/10/2025 at 02:53 p.m., the DON revealed she believed the MAR had a code for when a medication was not available. She revealed the staff were to go to the nurse when a medication was not available, and the nurse was to order the medication or take it out of the facility's medication inventory. The DON stated she believed the eMAR was supposed to generate a progress note when a staff member selects see progress note, and the staff were to put specifics of the medication administration into the progress note. The DON stated she was unsure why there would not have been corresponding progress notes to see progress note codes in the MAR. The DON stated the impact of not having the corresponding progress note would be that the nurse managers would have to search for the information and/or speak directly with the staff member that entered the see progress note to determine what meds were not given and why. Record review of facility policy, Medication Administration, date devised 10/01/2019, reflected under Procedure, 4. Documentation (including electronic) . F. If a dose of regularly scheduled medication is withheld, refused, not available, or given at a time other than the scheduled time.An explanatory note is entered.G. If an electronic MAR system is used, specific procedures required for.documentation of administration, refusal, holding of doses, and dosing parameters such as vital signs and lab values are described in the system's user manual. Record review of facility policy, Documentation in Medical Record, date implemented 10/24/2022, reflected under Policy Explanation and Compliance Guidelines: . 3. Principles of documentation include, [sic] but are not limited to: .b. Documentation shall be accurate, relevant, and complete, containing sufficient details about the resident's care and/or responses to care. Event ID: Facility ID: 675110 If continuation sheet Page 8 of 9 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 675110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cuero Nursing and Rehabilitation Center 1310 E Broadway Cuero, TX 77954 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 Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of infections involving 1 of 3 staff (CMA B) reviewed for infection control, in that: The facility failed to ensure CMA B cleaned the blood pressure cuff between Resident #6 and Resident #7. These deficient practices could place residents at-risk for infections. The findings included: During an observation on 07/09/2025 at 02:36 p.m., CMA B was observed taking Resident #6's blood pressure prior to administering medications to the resident. CMA B returned to her medication cart and placed the blood pressure cuff on the cart. CMA B did not sanitize the blood pressure cuff. CMA B then went and took Resident #7's blood pressure with the same cuff. CMA B again returned to her medication cart and placed the blood pressure on top of her cart. CMA B again did not sanitize the blood pressure cuff. During an interview on 07/09/2025 at 02:49 p.m., CMA B stated she knew she was forgetting something during her medication administration observation. She revealed she was supposed to wipe the blood pressure cuff after and between each resident. She stated the nursing facility had provided training that reviewed these procedures. She stated wiping the cuff between residents was for sanitation reasons, to stop the spread of germs. During an interview on 07/10/2025 at 02:53 p.m., the DON revealed staff were to take blood pressure readings prior to administering blood pressure medications and the staff were to disinfect the blood pressure cuff between each resident. She stated disinfecting the cuff was for infection control purposes. Record review of facility policy, Infection Prevention and Control Program, date implemented 05/13/2023, reflected under Policy Explanation and Compliance Guidelines, 4. Standard Precautions: a. All staff shall assume that all residents are potentially infected or colonized with an organism that could be transmitted during the course of providing resident care services. and 10. Equipment Protocol: a. All reusable items and equipment requiring special cleaning, disinfection, or sterilization shall be cleaned in accordance with our current procedures governing the cleaning and sterilization of soiled or contaminated equipment. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675110 If continuation sheet Page 9 of 9