Health inspection·December 9, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure each resident had the right to be free from abuse for five residents (Resident #2, Resident #3, Resident #4, Resident #5, and Resident #6) of 10 residents reviewed for abuse. Resident #2 sustained facial injuries from an altercation with resident #4 on 05/27/25 7:59 PM as they passed each other in the 600 hall. Resident #3 sustained facial injuries from being hit in the face by Resident #2 on 05/19/25 @1:30 PM in Resident #3's room. \Resident #5 was slapped in the face by Resident #6 as she was trying to get by Resident #6. Resident #6 was scratched by resident #5 in retaliation for being slapped in the face by Resident #5 on 06/19/25 @4:39 PM. These failures have the potential to result in serious injury. Findings include: Resident#2 Record Review of Resident#2's face sheet dated 10/21/25 revealed a [AGE] year-old male initially admitted on [DATE] with diagnoses of Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions), Dementia (A group of thinking an social symptoms that interferes with daily functioning), Depression (a group of conditions associated with the elevation or lowering of a person's mood), Bipolar Disorder (A chronic mental health condition characterized by extreme mood swings between mania and depression), Altered Mental Status (a change in a person's Level of consciousness, alertness, and cognitive Function, Hostility (hostile behavior unfriendliness, or opposition), Mood Disorder (A group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood), and unspecified Psychosis not due to a substance or known physiological condition. Record review of Resident #2's MDS dated [DATE] had a BIMS Score of 04-severe cognitive impairment and needed extensive assistance with all ADLs. Behavioral symptoms included other behavioral symptoms not directed toward others like pacing, and rejection of care occurred 1 to 3 days out of the week, and wandering. A record review of Resident #2's Care Plan dated 03/27/25 revealed Resident #2 wandered into another resident's room resulting in discoloration to bilateral hands and abrasion to chin due to altercation with resident. Resident #2's wandered in hall grabbing another resident by arm resulting in altercation with laceration to left lower jaw to resident. Resident #2 has a behavior problem (Wandering) related to Diagnosis of Alzheimer Disease and Dementia. Resident#2 has impaired cognitive function or impaired thought processes related to Alzheimer's Disease and Dementia. Resident #2 has a psychosocial well-being problem (potential) related to Cognitive deficits. Interventions included speaking calmly, moving slowly towards residents, and explained all procedures and why residents were being re-directed at an appropriate date and initiated 05/19/2025. Observe and monitor for signs and symptoms of changes in mental status. Per family, the resident becomes more confused, agitated, or aggressive when he has UTI. Resident #2 was currently on antibiotics for Urinary Tract Infection. Resident #2 was to be redirected positively when seen entering another resident's room. Resident#2 was monitored with a one-to-one care for three days after the incident. Record review of Resident #2's Progress Page 1 of 11 675162 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Notes Dated 04/19/2025 to 06/22/25 revealed on 05/19/25 Nursing staff reported Resident #2 had an altercation with Resident #3 after wandering into Residents #3's room. Resident #2 was to continue on neuro checks; continued follow up for physical aggression towards staffs and new order day 2 Keppra (is anti-seizure medication) that include drowsiness increased to 1000 mg 1 tab take by mouth twice a day and Haldis (a powerful antipsychotic medication with a wide range of potential side effects) 5mg/ml inject 2ml every 12 hours as needed for 5 days. On 05/19/25 Resident #2 was in hallway attempting to grab another resident from arm, when alleged Resident #4 began to get physical towards resident. The staff member was unable to arrive on time, and the other resident was able to strike other residents on the face. Nursing staff immediately separated both residents from each other. Resident #2 was assessed; a laceration was noted to lower left jaw line. The nurse practitioner was called and notified. Per the nurse practitioner the wound was to be cleansed in the area with wound cleanser, and applied a steri-strip, the nurse practitioner will be doing an in-house visit later today. The family member of Resident #2 was called and notified of the incident. and could conducted and a follow-up visit for new order of Haldol Dec increased to 100mg intermuscular daily for 14 days for severe psychosis, orders carried out, nursing care on going. Patient continued a follow up check for post resident-to-resident conflict. Resident #2 required constant redirection throughout this shift to prevent the resident from entering other patients' rooms. Resident #2 continued with new orders to add Zolpidem (sedative-hypnotic medication used for the short-term treatment of insomnia) 10 mg tablets by mouth every night at bedtime and change trazadone to 50mg as needed each morning and 100MG as needed each evening. Resident #2 was to be continued to be monitored and redirected; nursing care was going with no discomfort noted. Record review of Resident #2's Head-to-toe dated 05-19-25 assessment noted purple discolorations to bilateral hand, upon resident-to-resident confrontation, noted during nursing assessment. A new order as follows: cleanse with wound cleanser and apply steri-strips to area; orders carried out. Residen#2 was placed on a one to one for closer observation for 3 days. Record review of Resident #2's dated 05/19/25 Skin assessment revealed Resident#2 had an abrasion to the chin, applied topical antiseptic ointment, resident monitored for discoloration to hands and abrasions to the chin area; and continued to be monitored. Had continued with weekly and as needed skin evaluations. Resident #2 altercation with Resident #3, a skin & wound evaluation was completed and noted with abrasion to left medial jaw & laceration to the left lateral jaw. First aid rendered, orders received for wound care to site from NP orders noted. On 5/26/25 skin evaluation completed, abrasion to the chin area was resolved. Resident monitored for discoloration to hands and abrasions to chin area; skin intact and no signs of infection noted, no drainage noted and no redness around wound area. Record review of Resident #2 incident report dated 05/19/25 conducted by ADON-B On 05/19/2025revealed; Resident #2 (BIMs 4) entered Resident #3 room telling Resident #2 to get out of his room. Resident #3 asked Resident #2 to leave his room. As Resident#2 was leaving, he swung at Resident #3 making contact with his left forehead resulting in skin tear. CNA heard yelling and immediately ran to Resident #3 room separating residents. The charge nurse called to the room and performed a head-to-toe assessment of #3 with noted skin tear to left upper forehead and abrasion to the left eyebrow. The physician advised new orders for Haldol Deaconate 5mg/ml inject 2 ml every 12 hours as needed for 5 days and increase in Keppra to 1000mg 1 tab by mouth at bedtime as ordered. The incident was reported to local authorities. Police report filed and case number was provided. Resident #2 was placed on a one-to-one monitoring. Record review of Resident#2's pain evaluation conducted by the ADON B revealed the Resident #2 had no pain reported by resident at the time of incident. Resident #2 was not observed due to his passing 10/13/2025 in the facility at the time of the investigation not 675162 Page 2 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some related to incident. Resident # 3 Record review of Resident #3's face sheet dated 05/22/25 revealed a 66year-old male initially admitted on [DATE] and readmitted on [DATE] with diagnoses of traumatic hemorrhage of cerebrum (a bleeding within the brain tissue, cerebrum, caused by an injury to the head) and altered mental status (a change in a person's level of consciousness, alertness, and cognitive function.) Resident #3 was not observed due to he no longer resided in the facility at the time of the investigation was discharged [DATE]. Record review of Resident #3's quarterly MDS dated [DATE] indicated a BIMS score of 10- which indicated moderate cognitive impairment and may need extra assistance with activities of daily life. Resident#3 had difficulty focusing and had disorganized thinking no behaviors were noted. Record review of Resident #3's Care Plan revised on 05/19/2025 revealed Resident #3 with a skin tear to the left upper front of forehead as a result of an altercation with another resident entering his room. Monitor left upper forehead for redness swelling further skin breakdown. Resident #4 has potential to be physically aggressive when touched or when another resident comes close to him. When the resident becomes agitated: Engage Calmly in conversation; if response is aggressive, staff to walk calmly away, and approach later. Ask residents whether he wants the door open or closed after any entrance to his room. Record review of Resident #3's progress notes dated 05/19/25 revealed continues on discoloration and swelling to right index finger, no complaint of pain; will continue to monitor any changes throughout all shifts. Resident with follow up for resident-to-resident altercation and with injury with skin tear to left forehead and abrasion to be left eyebrow. No pain or discomfort voiced this shift to staff. Continuing with neuro check, monitoring discoloration and swelling to right index finger no complaint of pain. Patients continue with skin tears to the left of the forehead and abrasion to be left eyebrow. No signs or symptoms of infection. The right index finger continues with purple discoloration swelling resolved. Denies any pain or discomfort. Patients also continue to me monitored for follow up post resident to resident incident. Patients show no signs of pain, distress, or discomfort. Patients demonstrated a good appetite on this shift consuming 75%-100% of his dinner. Will continue to monitor.'' Resident #4 Record review of Resident #4's face sheet dated 05/25/25 revealed a [AGE] year-old male admitted on [DATE] with a diagnoses of Vascular Dementia (a type of dementia caused by damage to the blood vessels in the brain), and bipolar disorder (a chronic mental health condition characterized by extreme mood swings between mania and depression). Record Review of Resident's #4's MDS dated [DATE] revealed a BIMS score of 10 which indicated moderate cognitive impairment and may need extra assistance with activities of daily life. Resident#4 has difficulty focusing and disorganized thinking. Resident #4 was not noted for any behaviors. Review of Resident #4's care plan dated 08/25/25 revealed Resident #4 was involved in a resident-to-resident altercation in which he struck the other resident. Interventions included monitoring and a visit with the social worker, and no distress was noted or voiced. Resident #4 has potential to be physically aggressive when touched. When another resident comes to close to him. Record review of Resident #4's progress notes dated 05/27/25 revealed Resident #4 was involved in a resident-to-resident altercation in which he struck the other resident. Following the altercation, the charge nurse performed a head-to-toe assessment. No skin tears or bruising was noted. On 05/27/25 to 05/29/25 Resident #4 was monitored, and no distress nor latent injuries were noted. No previous incidents of aggression or altercations were noted to have occurred. Record review of Resident #4's Incident Report dated 5/27/2025 conducted by ADON B revealed, Incident Description: On 05/27/25 both residents were ambulating down the hallway Resident #2 attempted to grab Resident #4 by the arm to ask a question. At that time Resident #4 pushed him away. The CNA attempted to verbally redirect both residents and simultaneously tried to physically intervene. During this interaction, Resident #2 675162 Page 3 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some attempted to grab Resident #4's arm. In response, Resident #4 kicked and struck Resident #2 on the left lower jaw line. Resident #5 Record review of Resident#5's face sheet dated 05/27/25 revealed a [AGE] year-old female initially admitted on [DATE] with diagnoses of Alzheimer's Disease with late on set (a progressive disease that destroys memory and other important mental functions), Dementia (A group of thinking an social symptoms that interferes with daily functioning), Mood Disorder (A group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood), and Major Depressive Disorder (A common mental health condition characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in previously enjoyable activities). Record review of Resident #5's MDS Quarterly dated 08/27/2025 revealed Resident #05 had a BIMS Score of 01 which indicated -severe cognitive impairment and needed extensive assistance with all ADLs. Behaviors included hallucinations, delusions, and pacing which occurred 4 to 6 days but less than daily. Rejection of care occurred 1 to 3 days and wandering 4 to 6 days, but less than daily. Record review of Resident #5's care plan dated 03-19-25 revealed she used antipsychotic medications to Abilify for Aggression/Agitation Date Behaviors included hallucinations, delusions, and pacing which occurred 4 to 6 days but less than daily. Rejection of care occurred 1 to 3 days and wandering 4 to 6 days, but less than daily Initiated: 03/12/2025. Record review of Resident #5's progress note dated 06/19/25 revealed Resident approached another resident while trying to ambulate with walker, this resident scream at other resident and slap her on the face, other resident responded scratching this resident in right arm. Resident restless and pacing hall crying, Pain medication administered Tylenol 325mg 2tabs as needed for pain. Cleanse abrasion made to right arm with Normal Saline, apply topical antibiotic ointment only. Residents was on a 1:1 supervision for aggressive behavior. Record review of Resident #5's incident report dated 06/19/25 revealed 06/19/25 at 4:39 PM, Resident#5 exhibited a sudden episode of agitation, approached another resident in an aggressive manner, and struck her in the face with an open hand. In response, the other resident stuck back and caused a scratch to Resident #5's right arm. Local police were contacted, and a report was made. Record review of Resident #5's Skin and Wound assessment dated [DATE] revealed An abrasion located on the right inner forearm was acquired in house. Measurements of the wound were documented as 0.4 cm x1.6 cm X 0.4 cm. treatment included to cleanse with normal saline. Resident #6 Record review of Resident#6's face sheet dated 05/22/25 revealed an [AGE] year-old female initially admitted on [DATE], and readmitted on [DATE] with diagnoses of Depression (a group of conditions associated with the elevation or lowering of a person's mood), Vascular Dementia (a type of dementia caused by damage to the blood vessels in the brain), Altered Mental Status (a change in a person's Level of consciousness, alertness, and cognitive function). Resident #6 was not observed due to he no longer resided in the facility at the time of the investigation and was discharged [DATE] to another facility. Record review of Resident #6's MDS Quarterly dated 06/06/2025 revealed Resident #6 had a BIMS Score of 03 which indicated -severe cognitive impairment and needed extensive assistance with all ADLs. Cognitive patterns of inattention and disorganized thinking were present behaviors. Residents' mood revealed feelings of feeling down, depressed or hopeless. Behaviors of hallucinations and delusions were present and behaviors hitting scratching and self-pacing were noted. Functional abilities revealed Residents #6 needed supervision for touching and partial to moderate supervision needed for activities of daily life. Record review of Resident #6's care plan dated 06/19/25 revealed Resident #6 is an elopement risk; wanderer related to impaired safety awareness due to her Dementia. The resident was in women's secured unit the resident had the potential to be verbally aggressive, and the intervention was to analyze key times, places circumstances, triggers and what deescalates behavior and 675162 Page 4 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some document. Needed to be in a structured environment in secure unit related to cognitive deficit. The resident was resistive to care; refused to be rendered ADL care, toileting, incontinent care, showers, medication, treatments, nail care. The resident had a behavior problem; many at times exhibit behaviors such as labile moods, remove brief, urinates on the floor, restlessness, aggression, yelling, irritability, sundowning. The intervention was to discuss behavior with the residents and explain also reinforce why this behavior is inappropriate and unacceptable. Record review of Resident #6's progress notes dated 06/19/25 while this resident was trying to ambulate with walker, another resident approached and slapped her, this resident responder scratched other resident in right arm. Pain was assessed and the resident denied any pain and skin was intact. This Social worker followed up with Resident #6 due to resident-to-resident altercation. The residents had no recollection of events with another resident. Day 1 after 06/20/25 resident to resident altercation Resident #6 was noted with no pain and no injuries was calm with no emotional distress. Day 2 06/21/25 after resident-to-resident altercation Resident #6 was noted with no pain and no injuries. Resident #6 was calm with no emotional distress. Resident#6 was discharged to another facility on 06/23/25. Record review of Resident #6's incident report revealed on 06/19/25 at 4:39pm. Resident #5 exhibited a sudden episode of agitation, approached Resident #6 in an aggressive manner, and struck her in the face with an open hand. In response, the other Resident #6 struck back and caused a scratch to Resident #5's right arm. The police were contacted, and a report was made. Observation on 10/22/25 at 11:41 AM of Resident #4 revealed he was located inside the 600 Hall men locked unit sitting in a chair and had a drink. Resident #4 stated he could not remember any incident and did not want to talk to the state surveyor. Observation and attempted interview with Resident #5 revealed she was sitting with her family member asleep on his shoulder in the front lobby of the facility. The family member stated she could not talk and did not have a good memory and would not be able to say or remember what happened. Resident #5 woke up and seemed incoherent and confused. Resident #5 could not speak, made mumbling sounds. The surveyor attempted to ask Resident #5 if she remembered the incident and Resident #5 did not make eye contact and did not say a word. The state surveyor discontinued the interview at that time. In an interview on 10/22/25 at 8:54 AM with CNA C she said when she arrived at the altercation with Resident #2 and Resident #3 both residents were already separated inside Resident #3's room. CNA C said she saw Resident #3 at the door and heard him screaming to get Resident #2 out of his room. CNA C said Resident#3 had blood and a scratch to his forehead with slight bleeding. CNA C said Resident #2 hit him in the face. CNA C said Resident #2 had no injuries noticed at the time of the altercation. CNA C said Resident #2 thought he was in his room then realized it wasn't his room and wanted to leave to his room. CNA C said Resident #2 was always going into other Residents rooms thinking it was his room. CNA C said Resident #2 was put on a 1 to 1 monitoring for 3 days. CNA C said Resident #3 was not an aggressive person and did not want to get in trouble and just wanted to go home. Resident #3 felt that he was defending himself. CNA C said no other altercation occurred between Resident#2 and Resident #3 or with any other residents. CNA C said her last training was this week on abuse and neglect and had one right after the incident with Resident #2 and Resident#3. CNA C stated the administrator is the abuse coordinator and could state all types of abuse physical, mental, sexual, and verbal. In an interview on 10/22/25 at 10:18 AM with the SW she said Resident #3 was in his room and Resident #2 had entered his room and Resident #3 asked him to leave. The SW said Resident#2 struck Resident#3 causing an injury to Resident#3's forehead. The SW said she had done a follow up with both residents several days following the incident, and Resident#2 had a medication review to adjust his medication that helped with his mental status at the time. The SW said she could not recall many 675162 Page 5 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some details about this incident. The SW stated she did not have many notes, so she could not recall what interventions had been put in place for either resident. The SW said she did recall both residents were wandering residents, and the facility had plenty of intervention for those types of residents in the facility. In an interview on 10/22/25 at 11:37 AM with CNA D said she did not witness the altercation between Resident #2 and Resident #3 but did assist in keeping them apart by staying at the nurse's station to monitor other residents out of their rooms as other staff went to assist in the altercation. CNA D said she worked in hall 600 and was familiar with Resident #2 he always wandered the hall and often went into the room of Resident #3 thinking it was his room. CNA D said Resident #3 was quiet and reserved, who mainly kept to himself. Resident #2 was more aggressive and was always confused about where his room was located. CNA D did not see Resident #3 afterward and did not know of injuries that he had sustained. CNA D could only say she heard the shouting from Resident #3's Room. CNA D stated Resident#2 was always going to Resident #3 room and never had an altercation before this one. CNA D said Resident#2 was put on a 1 to 1 and after the incident occurred. CNA D said the staff became more aware of Resident #2's whereabouts in the hall and redirected him away from other residents' rooms. CNA D said no other altercations occurred between Resident #2 and Resident #3 or with any other resident. CNA D stated she had just received training on abuse, neglect, and the next day after the incident between Resident #2 and Resident #3 occurred. CNA D stated any verbal, physical, sexual, and mental abuse occurrence must be reported immediately to the abuse coordinator and charge nurse. In an interview with ADON-B on 10/22/25 at 9:31 AM she said the incident between Resident #2 and Resident #3 occurred on 05/27/25 at 7:59 AM in the 600 hallway. ADON B stated the Resident#2 and Resident #4 were walking in the hallway and Resident #2 tried to grab the arm of Resident #4. ADON B said Resident #4 pushed Resident #2 away and Resident #2 tried again to grab Resident #4's arm and Resident #4 punched and kicked Resident #2. ADON B stated both residents did not need to be sent out for their injuries and were taken care of in-house. Resident #2 sustained a laceration to the left jaw and an abrasion to left middle jaw. ADON B said Resident#2 was monitored for 3 days on a 1 to 1 and Resident #4 was monitored for the same number of days by the staff on duty at every shift. Resident #2 was under psych eval since 04/25, and his medications and care plan were reviewed and modified by his nurse practitioner and physician. ADON B said a meeting was set up with family to discuss individual activities and redirections. ADON B stated the nurse practitioners' orders were to monitor injury sight for changes and notify him of any changes in behavior. ADON B said the residents were not moved to different rooms as the altercation happened in the hallway. When asked why the incident between Resident #2 and Resident #4 was not reported to local authorities, ADON B said the altercation was not considered abuse because it was a witnessed altercation. ADON B said reportable abuse incidents are on a case-by-case basis. ADON B said an abuse incident had to be suspicious, or something out of the ordinary like misappropriation of property and Injury of unknown origin. ADON B could not remember if the incident was reported, and there were no notes to show it had been reported. ADON B said because the incident was witnessed, the incident was not questionable and not considered abuse. ADON B said this incident was not considered an incident of abuse. ADON B stated the incident between resident #3 and Resident #4 was a willful act. ADON B would not say that this incident was a willful act as Resident #4 was defending himself and only reacted. In an interview with 10/22/25 at 10:27 AM LVN E stated Resident #2 was required to be on a 1 to 1 because of aggressive behavior with residents and staff members. LVN E said Resident #4 was grabbed by Resident#2, and he was pushed, hit, and kicked by Resident #4. Resident #2 was very confused and always going into the outer residents' rooms. The LVN said Resident #2 was also inappropriate with female staff members at 675162 Page 6 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some times. LVN E said the incident occurred in the hallway as Resident #4 was coming out of his room and Resident #2 had grabbed Resident by the arm then Resident #4 then hit Resident #2 in the face. LVN E said it was a busy time for the staff members around the time the incident occurred as staff were attending to residents with breakfast and getting residents out of bed. LVN E said RN F had done the skin assessments and Resident #2 had a small wound to the lower cheek and a small laceration, but it not swollen. LVN E said Resident#4 was put on a 1 to 1 along with Resident #2. LVN E said Resident #2 was monitored more thoroughly after the 1 to 1 was over her shift and Resident #4 never got near Resident #2 after altercation. LVN E stated staff received abuse, neglect, and dementia care in service after the altercation between Resident #2 and Resident #4. LVN stated the most current in service on abuse and neglect was last week. In an interview on 10/22/25 at 8:30 AM with RN F, she said she conducted the skin assessment for the incident between Resident#2 and Resident #4. RN F said Resident #2 was wandering down the hall and got too close to Resident #4. RN F said then Resident #4 threw a punch as he was reacting to Resident #2 who got too close to him. RN F said Resident #2 had a small laceration to the cheek area and an abrasion and had done wound care. RN F got orders from the physican for a steri-strip to help the wound heal because it had minimal bleeding. RN F said Resident #4 had a bruise on his hand and could not recall any x-rays being done. RN F said both residents were wandering around the hallway that morning. RN F said Resident #4 did not like anybody in his personal space. RN F said they were kept separated and could not recall if either one was on a 1 to 1. RN F said no other incident occurred between Resident#2 and Resident #4. RN F said the abuse and neglect were given at least annually as incidents occurred. RN F said the Abuse Coordinator was The Administrator. In an interview on 08/22/25 1:30 PM with LVN I said she did the head-to-toe assessment for Resident #5, and she just had a scratch on her hand with slight blood. Resident # 5 did not have any marks on her face and could not remember any of the incident. LVN I said there were follow-ups for the next couple of days, and neither resident could remember what had happened. Resident#6 did not have a history of aggression towards others. LVN I said Resident #5 was aggressive at the beginning of her stay in the facility and now she just slightly poked staff and other residents in their stomachs. LVN I said Resident #5 did this playing around meaning no harm. LVN I said before this incident Resident 5 nor Resident #6 had any other altercation with each other or any other residents in the facility. No other incidents occurred between Resident #5 and Resident #6 before or after this incident. In an interview with ADON H 10/22/25 2:16 PM she said when she followed up with Resident #2, he could respond but he was not comprehensive. ADON H said Resident #4 was able to recall the incident, and she gave resident #4 council on what not to do to other residents while out of his room. ADON H said Resident #2 had never been aggressive with other residents but did have other incidents with staff members which was sexual in nature often touching female staff members. ADON H said he would often confuse female staff members as his wife and gabbed when in a sexual manner. ADON H said the incident between Resident#2 and Resident #3 occurred in a locked unit in the hallway and could only remember speaking to them days after the incident. ADON H said Resident #2 had received social services with the SW and the SW did follow up visits for a few days after. ADON H said Resident #2 was put on 1:1; medication was reviewed and reeducated on behaviors. ADON H said Resident #4 was reeducated on behavior outside of his room with other residents. ADON H said she did not think this was abuse case Resident #4 was just reacting to Resident #2. ADON H said after the definition of willful and abuse was given to her to read she agreed the right to be free from abuse was violated and the incident was considered abuse. ADON H said the Administrator is the Abuse Coordinator and said they were provided with training last week on abuse and neglect. In an interview on 10/22/25 at 2:36 PM 675162 Page 7 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with ADON H she said Resident #5 and Resident #6 were in a resident-to-resident altercation where Resident #6 was slapped by Resident #5. ADON H said Resident #5 struggled trying to get by Resident #6's walker and Resident #5 got frustrated and slapped Resident #6. ADON H said Resident#6 in turn scratched the hand of Resident#5. Resident #5 was put on a 1 to 1 and Resident #6 was to be monitored with supervision from staff. ADON H said there was a charge nurse, and 2 CNA's who were witnesses to the altercation. The Incident was reported to police by the abuse coordinator. ADON H, she said they had dementia care and abuse, neglect, and dementia care in services last week. In an interview on 10/22/25 at 3:30 PM with the Administrator/ Abuse coordinator she said all altercations were taken seriously and were reported immediately to state and local authorities if the altercation was considered a crime like theft, sexual in nature or if injury occurred to any party involved in the incident. The Administrator said these types of incidents must be reported within the proper time allowed, which is 2 hours. The Administrator stated every resident has the right to be free from all forms of abuse, and that was the main concern when any type of alteration occurs with a resident in the facility. The administrator said interventions should be put in place immediately after an incident of abuse occurred, residents are to be monitored with a 1 to 1 for three days minimum, medication should be reevaluated so that the behavior of the resident could be controlled. The administrator said residents seen wandering and entering a room that was not theirs's should be redirected by all staff members. 675162 Page 8 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation were reported immediately, but not later than two hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, to the administrator of the facility and to other officials, including to the State Agency, in accordance with State Law through established procedures for 2 out of 10 residents (Resident #1 and Resident #2) reviewed for reporting of abuse/neglect. 1. The facility failed to report to the local law enforcement agency a resident-to-resident physical altercation involving Resident #2 and Resident #4 resulting in minor injuries that occurred on 05/27/25. 2. The facility failed to report an allegation of abuse of Resident #1 within 2 hours that occurred on 04/12/25 at around 1:00 PM. These failures could place residents at risk for potential abuse. The findings included:1. Record Review of Resident#2's face sheet dated 10/21/25 revealed a [AGE] year-old male initially admitted on [DATE] with the diagnoses of Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions), Dementia (A group of thinking an social symptoms that interferes with daily functioning), Depression (a group of conditions associated with the elevation or lowering of a person's mood), Bipolar Disorder (A chronic mental health condition characterized by extreme mood swings between mania and depression), Altered Mental Status (a change in a person's Level of consciousness, alertness, and cognitive Function, Hostility (hostile behavior unfriendliness, or opposition), Mood Disorder (A group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood), and unspecified Psychosis not due to a substance or known physiological condition. Record review of Resident #2's MDS dated [DATE] had a BIMS Score of 04-severe cognitive impairment and needed extensive assistance with all ADLs. Record review of Resident #2's Care Plan dated 03/27/25 revealed Resident #2 wandered into another resident's room resulting with discoloration to bilateral hands and abrasion to chin d/t altercation with resident. Resident #2 wandering in hall grabbing another resident by arm resulting in altercation with laceration to left lower jaw to resident. Resident #2 has a behavior problem (Wandering) related to Diagnosis of Alzheimer Disease and Dementia. Resident#2 has impaired cognitive function or impaired thought processes related to Alzheimer's Disease and Dementia. Resident #2 has a psychosocial well-being problem (potential) related to Cognitive deficits. Interventions included to speak calmly, to move slowly towards resident, and explain all procedures and why resident was being re-directed when appropriate date and initiated 05/19/2025. Observe and monitor for signs and symptoms of changes in mental status. Per family, the resident becomes more confused, agitated, or aggressive when he has a urinary tract infection Resident #2 was currently on antibiotics for Urinary Tract Infection. Resident #2 was to be redirected positively when seen entering another resident's room. Resident#2 was monitored with a 1:1 care for three days after the incident. Record review of Resident #2's Progress Notes dated 04/19/2025 to 06/22/25 indicated Nursing staff report Resident #2 had an altercation with Resident #3 after wandering into Residents #3's room. The head-to-toe assessment noted purple discolorations to bilateral hand., upon resident-to-resident confrontation, noted during nursing assessment. The Nurse practitioner and daughter were called and notified. A new order as follows: cleanse with wound cleanser and apply steri-strips to area; orders carried out. Resident #2 was placed on a one-to-one for closer observation for 3 days. Resident#2 had an abrasion to the chin, applied topical antiseptic ointment, and continued to be monitored. Resident monitored for discoloration to hands and abrasions to chin area; continued on neuro checks; continued follow up for physical aggression towards 675162 Page 9 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few staffs and new order day 2 Keppra increased to 1000 mg 1 tab take by mouth twice a day and Haldo 5mg/ml inject 2ml every 12 hours as needed for 5 days. 05/26/25 Skin evaluation completed, abrasion to chin area resolved, skin intact, no signs of infection noted, no drainage noted and no redness around wound area. On 05/27/25 Resident#2 in hallway attempting to grab another resident from arm, when alleged Resident#4 began to get physical towards resident. The staff member was unable to reach the residents in time to prevent the altercation. Record review of Resident #4's face sheet dated 10/22/25 revealed a [AGE] year-old male admitted on [DATE] with a diagnosis of Vascular Dementia (a type of dementia caused by damage to the blood vessels in the brain), and bipolar disorder (A chronic mental health condition characterized by extreme mood swings between mania and depression). Record Review of Resident #4 quarterly MDS revealed a BIMS score of 10 indicates moderate cognitive impairment and may need extra assistance with activities of daily life. Resident#4 had difficulty focusing and disorganized thinking. Review of Resident #4 care plan dated 08/25/25 revealed Resident #4 was in a resident-to-resident altercation in which he struck the other resident. Interventions included monitoring and a visit with the social worker. Resident #4 did not have any previous resident to resident altercations Record review of Resident #4's progress notes dated 05/27/25 revealed Resident #4 was involved in a resident-to-resident altercation in which he struck the other resident. Following the altercation, the charge nurse performed a head-to-toe assessment. No skin tears or bruising was noted. On 05/27/25 to 05/29/25 Resident #4 was monitored, and no distress nor latent injuries were noted. Resident #2 was not observed due to his passing 10/13/2025 in the facility at the time of the investigation. Record review of Resident #4's incident report dated 5/27/2025 conducted by ADON B revealed, Incident Description: On 05/27/25 both residents were ambulating down the hallway. Resident #2 attempted to grab Resident #4 by the arm to ask a question. At that time Resident #4 pushed him away. The CNA attempted to verbally redirect both residents and simultaneously tried to physically intervene. During this interaction, Resident #2 attempted to grab Resident #4. In response, Resident #4 kicked and struck Resident #2 on the left lower jaw line. Observation on 10/22/25 at 11:41 AM of resident #4 revealed he was located inside the 600 Hall men's locked unit sitting in a chair and had a drink. Resident #2 stated he could not remember any incident and did not want to talk to the state surveyor. In an interview on 10/22/25 at 9:30 AM with ADON B, she said abuse cases were reported to local authorities on a case-by-case basis. ADON B said if she suspected something out of the ordinary, she would have reported it to local authorities. ADON B said she could not remember if she had reported the incident to the local authorities, and there was no case number to show it had been reported. ADON B said the incident altercation between Resident #2 and Resident #4 was not an abuse case because it was witnessed, and it was not a questionable incident. ADON B said she had not considered this incident to meet the definition of abuse because Resident #4 was defending himself. ADON B said this was not a willful act because both residents had mental i ADON illnesses. ADON B stated she did not report this incident to the local authority because the two residents had mental illness and dementia and the altercation was not a will full act. In an interview with the Administrator/ Abuse Coordinator 10/22/25 at 3:27 PM she said all altercations were taken seriously and were reported immediately to state and local authorities if the altercation is considered a crime like theft, sexual in nature or if injury occurred to any party involved in the incident. The Administrator stated these types of incidents must be reported within the proper time allowed, which is 2 hours. The Administrator stated every resident has the right to be free from all forms of abuse, and that is the main concern when any type of alteration occurs with a resident in the facility. The Administrator said all altercations in the facility are to be reported immediately to the charge nurse and the abuse 675162 Page 10 of 11 675162 12/09/2025 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few coordinator. 2. Record review of Resident #1's face sheet dated 10/22/25 revealed a [AGE] year-old female with an original admission date of 03/29/12 and a current admission date of 01/01/20. Resident #1's pertinent diagnosis included hemiplegia (paralysis of one side of the body). Record review of Resident #1's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 15 which indicated her cognition was intact. Record review of Resident #1's comprehensive care plan dated 10/22/25 did not reveal any instructions related to reporting of alleged abuse. In an interview with CNA A on 10/21/25 at 1:35 PM, CNA A stated she observed NA L make comments to Resident #1 asking if she was a lesbian at around 1:00 PM on 04/12/25. CNA A stated she observed NA L tell Resident #1 that she was too heavy. CNA A stated she did not report this immediately to the administrator because LVN G was in the room as well and she thought he would report it. CNA A stated she was not the one that reported this incident to the administrator. CNA A stated it was important to report any possible abuse to the administrator to keep the residents safe. In an interview with Resident #1 on 10/21/25 at 4:14 PM, Resident #1 stated one employee did call her fat around April 12th, 2025. Resident #1 stated CNA A stated she should go and report NA L's behavior. Resident #1 stated her feelings were not hurt she NA L called her fat, and that it went in one ear and out the other. In an interview with the DON on 10/22/25 at 9:59 AM, the DON stated CNA A should have reported the incident to the administrator immediately after the incident on 04/12/25. The DON stated she did not hear about the incident until the ombudsman told her a few days later. The DON stated it was important to report instances of suspected abuse immediately to keep the residents safe. In an interview with the ADM on 10/22/25 at 10:24 AM, the ADM stated CNA A should have called her immediately after she witnessed possible abuse on 04/12/25. The ADM stated if an employee had any doubt that abuse or neglect may have occurred they should report it to her. The ADM stated it was important to report all abuse allegations to HHSC within 2 hours to ensure residents were protected. The ADM stated both staff members involved in this incident were no longer employed at the facility. The ADM stated the incident was reported to the HHSC on 04/15/25, after the ombudsman interviewed Resident #1 and reported the allegation to the facility. In an interview with LVN G on 10/23/25 at 9:32 AM, LVN G stated he was not in the room during the alleged abuse. LVN G stated he had been in their earlier, but he did not witness any staff member say Resident #1 was fat or ask if she was a lesbian. LVN G stated he did not know why CNA A thought he was in the room at the time of the incident. LVN G stated if he had witnessed any possible abuse he would have reported it to the administrator immediately. An interview was attempted with NA L on 10/22/25 at 2:49 PM but she did not answer the phone call. Record review of the facility's Abuse and Neglect and Exploitation Policy and Procedure dated 07/11/2025 indicated Policy: it is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation, and misappropriation of resident properties. 1. 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. a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury. 675162 Page 11 of 11