Inspection·December 21, 2023

F 0695 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #23's physician order report dated 12/01/2023-12/31/2023 revealed there was no oxygen order. During an observation on 12/19/2023 at 9:00 AM revealed Resident #23 was in bed with oxygen at 3 liters per minute by nasal cannula. Residents Affected - Few During an observation and interview on 12/21/2023 at 11:30 AM revealed Resident # 23 was in bed with oxygen by nasal cannula. Resident #23 stated she used her oxygen and kept it on all the time. During an observation and interview on 12/21/2023 at 12:22 PM revealed LVN S observed Resident #23's oxygen. LVN S stated Resident #23 had oxygen on at 3 liters per minute continuous since she returned from the hospital on [DATE]. As the interview continued LVN S reviewed Resident #23's physician's orders. LVN S stated she did not see any physician's order for the oxygen or the oxygen flow rate. LVN S stated the nurse was responsible for monitoring the resident's physicians' orders and oxygen . During an interview and record review on 12/21/2023 at 12:38 PM the Facility Regulatory Specialist reviewed Resident #23's physician's orders. The regulatory specialist stated she did not see any physician's order for oxygen for the resident. She stated the risk for the resident was she could get too much oxygen and have elevated CO2 ) (end product of respirations caused headache, drowsiness, rapid breathing, mental confusion). During an interview and record review on 12/21/2023 at 12:51 PM the DON reviewed Resident #23's physician's orders. The DON stated she did not see any physician's order for oxygen administration. The DON stated the nurse who readmitted the resident from the hospital on [DATE] was responsible for ensuring there was a physician's order for the oxygen. The DON stated each nurse who cared for the resident after her readmission was responsible for monitoring to ensure there was a physician's order for the O2 liter flow. The DON stated the risk of no physician's order for her oxygen was the resident could get too much oxygen. During an interview on 12/21/2023 at 1:36 PM the Administrator stated she expected residents on oxygen to have a physician's order for the oxygen and how many liters it was set to run. The Administrator stated the importance of a physician order was to ensure the oxygen was administered properly. The Administrator stated the nursing staff was responsible for monitoring resident's oxygen and physician's orders. The administrator stated the risk to the resident was respiratory illnesses such as COPD could be made worse. The Administrator state to prevent this in the future we will do chart audits. Interview on 12/21/2023 at approximately 3:00 PM The regulatory specialist provided the Lippincott Nursing Procedures 9th Editions dated 2023 titled oxygen administration. The regulatory specialist stated that was what the facility used for the oxygen policy and procedure. Record review of the Lippincott Nursing Procedures 9th Edition dated 2023 titled Oxygen Administration reflected in part . Implementation verify the practitioner's order for the oxygen therapy, because oxygen is considered a medication or therapy and should be prescribed . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 2 of 5 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation. The facility failed to ensure that expired food products were discarded. The facility failed to ensure that the oven vent above the cooking stove was free of grease buildup. These failures could place residents at risk for food-borne illness. Findings Included: Observation and interview of the kitchen on 12/12/23 at 9:00AM, revealed the oven vent hood above one of one cooking stove had grease buildup on the vent hood. The Dietary Manager said she would call the servicing company for cleaning. She looked at the vent hood and said the last time it was clean was June of 2023. Observation 12/12/23 at 9:05 AM of the dry good s storage revealed 6 cartons of 48 oz of thicken sweetened tea with manufactured date of used by 12/09/23. The Dietary Manager said she had just received the products from the food supply company. She took all 6 expired products out of the food pantry. In an interview with the Dietary Manager on 12/19/23 at 1:00 PM, the Dietary Manager said the grease buildup could be a fire hazard and the expired food products could lead to food poison and food borne illness. Review of the facility policy dated July 2024 titled Nutrition Policies and procedures reflected in part .Subject: Cleaning Vent hoods and filters .Monthly: clean vent hood to prevent accumulation of dirt and grease . And continued review of policy revealed no information on expired dry goods. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 3 of 5 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 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 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for 23 (100- hall) of 59 residents reviewed for environmental concerns in that: Residents Affected - Few The facility failed to provide a clean shower on 100-hall for the residents. This failure placed residents at risk of living in an unsafe, unsanitary, and uncomfortable environment. Findings included: Observation on 12/21/2023 at 3:11p.m., revealed CNA B used a code to open the door to the shower room on hall 100. Observation on 12/21/2023 at 3:12p.m., revealed black substance that resembled mold, along the walls at the bottom of the shower. There was black substance at the bottom of the wall near the bathroom door. There was rust on the shower rails. The shower floors were filled with dirt. In an interview on 12/21/2023 at 3:15p.m. CNA D said housekeeping was responsible for cleaning the showers. She said there were no showers in the resident's rooms. She said the shower did not look clean. She said she never told anyone the shower was dirty because she did not think to tell anyone about it. She said the shower was the residents' hygiene and that was how they kept clean. She said she would not want to take a shower in a dirty bathroom so why would the residents. She said housekeeping was at the facility in the morning and the evening. She said having black substance at the bottom of the shower could cause the residents to get sick. In an interview on 12/21/2023 at 1:29p.m. Housekeeping A said she cleaned the restrooms every day. She said 12/20/2023 she noticed the black substance on the floor. She said she started 11/1/2023 and saw the mold on the floor when she started. She said she sprayed Clorox bleach on it. She said Clorox was not the right product to clean mold. She said she needed mold remover. She said she told the Housekeeping Supervisor about the mold, and she told her she would order mold cleaner. She said it was important to remove the mold because it can make the residents sick. She said she cleaned the showers after the CNAs have cleaned the showers. She said CNAs are responsible for cleaning the showers. She said a resident had not complained to her about the showers. She said they need rust remover, but she did not tell the supervisor. She said she did not know why she had not shared that with them. She said for now on they will clean the showers every day. She said when the residents get out of the showers, she will go behind them and clean. In an interview on 12/21/23 at 1:43p.m., the Housekeeping Supervisor said her job duties in housekeeping were to monitor the housekeepers. She said she also participated in cleaning as well. She said she sweeps, mop, clean bathrooms, and the toilets. She said she was recently informed about the black substance in the shower, and the dirtiness of the shower. She said maybe she could have used Tilex which is a bleach cleaner, to get what is possibly mold under control. She said she normally check on the cleanliness of the restrooms a couple of times a day. She said she mainly work on hall 300. She said she checked the restroom this morning, but it had been a day in half since she checked. She said she did not notice the mold the other day. She said infection control and residents being sick (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 4 of 5 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 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 0921 could happen because of the mold. She said she would not want to use a dirty restroom. Level of Harm - Minimal harm or potential for actual harm In an interview on 12/21/23 at 1:50p.m., the Maintenance Director said he did maintenance supplies for housekeeping, he maintained the grounds, worked in laundry, completed temperature checks and more. He said there is a check list for the rooms that they have cleaned and will check over what they have completed to make sure staff is doing their job. He said he has not been in the shower room lately. He said there is no excuse, but he usually does not check the showers that often. He said no one has reported to him about the mold or the restroom being dirty. He said he did not notice the rusted shower rail. He said the employees in housekeeping, or the nurses are responsible for reporting to him about cleanliness and mold issues and they did not report the mold or the rusting rails in the restroom. He said sanitation and infection control is important so that it cannot spread bacteria or diseases. Residents Affected - Few Record Review of the facility's policy titled Shower and Tub Room Cleaning revised on 03/2006 read in part . This procedure will remove soap scum, dirt and debris from these areas providing a safe and sanitary place for the patients/residents to bathe. This is a daily routine cleaning procedure. Clean, safe and odor free shower rooms and fixtures. Equipment: small bucket, mop bucket, wringers, brush (1X1 nylon w/handle), measuring cup, putty knife, cleaning cloths, broom, wet mop, and wet floor signs. Supplies: quaternary disinfectant cleaner, spray bottle of diluted disinfectant, glass cleaner, general purpose cleaner, tube/tile cleaner, trash can liners, soap, toilet tissue, and paper towels . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 5 of 5