Inspection·December 3, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some encourage the resident to use it for assistance as needed, and needs prompt response to all requests for assistance. Review of Resident #1's nursing progress note dated 10/08/2025 reflected the following: LVN A At 2250 [10:50 PM] 10/7/2025 found Resident [Resident #1] on the floor next to his low bed laying on his Rt. side. Noted blood on the floor, noted laceration to Rt. eyebrow with swelling and bleeding, pressure applied. Resident [Resident #1] is alert, unable to say what happened, kept saying thank you God in Spanish. Resident [Resident #1] is confused as he has been since admit [admission] 10/4/25. Aggressive and combative with assessment and Neuros, PERRLA, moves all extremities. No other visible injury noted. Called 911, Resident sent to ER. MD and DON notified. Review of Resident #1's electronic medical record on 12/02/2025 and 12/03/2025 reflected that an incident report was not documented for the un-witnessed fall on 10/07/2025. Review of Resident #1's electronic medical record on 12/02/2025 and 12/03/2025 reflected there was no facility incident report to HHSC for the alleged violation of injury of unknown source on 10/07/2025. Review of Resident #2's admission record dated 12/03/2025 reflected he was admitted to the facility on [DATE]. His diagnoses included heart failure, unspecified (a condition where the heart cannot pump enough blood to meet the body's needs), shortness of breath, repeated falls, other lack of coordination (condition characterized by difficulty controlling voluntary muscle movements, leading to symptoms such as clumsiness and unsteady gait), and muscle wasting and atrophy (is the loss of muscle mass and strength). Review of Resident #2's admission MDS dated [DATE] reflected a BIMS score of 06, indicating severely impaired cognition. It reflected an active diagnosis of repeated falls and that he required partial/moderate assistance with toileting hygiene, sit to stand, chair/bed-to chair transfer, and toilet transfer. Review of Resident #2's care plan dated 10/10/2025 reflected the following: [Resident #2] The resident is at risk for falls r/t SOB, decreased mobility, s/p NSTEMI. The goals were for Resident #2 to be free of falls through the next review date. And interventions included ensuring Resident #1's call light is within reach, encourage the resident to use it for assistance as needed, and needs prompt response to all requests for assistance.Review of Resident #2's un-witnessed fall report dated 11/12/2025 at 2:00 AM reflected: RN A Heard resident [Resident #2] call for help, upon entering room resident [Resident #2] was on the floor on his right side next to his bed. Resident [Resident #2] stated he fell when getting out of bed. Resident [Resident #2] has small hematoma (an abnormal collection of blood outside of a blood vessel) to left cheekbone and has small laceration to left side of eyebrow. RN [RN A] cleansed laceration, applied pressure, bleeding stopped and TAO was applied. RN [RN A] also applied ice pack to left cheekbone hematoma. Resident [Resident #2] is able to move all extremities without difficulty. Denies pain but has discomfort to BLE due to swelling.MD and DON notified. Review of Resident #2's electronic medical record on 12/02/2025 and 12/03/2025 reflected there was no facility incident report to HHSC for the alleged violation of injury of unknown source on 11/12/2025. During an interview on 12/03/2025 at 9:34 AM, CNA C stated she received ANE training in the last month, she was knowledgeable of ANE and Resident Rights and provided examples. She stated the abuse coordinator is the ADM, she has not witnessed ANE, but if she did, she would report it immediately. She stated the impact abuse and neglect would have on a resident would be seclusion, would not eat, not want to be around others, depression, feel like quitting, and crying. She stated she was familiar with Resident #2's care. She stated Resident #1 required extensive care and he is extremely forgetful, and he does ambulate with a walker, or wheelchair. She stated she was not present for his fall, but fall precautions are in place for him. During an interview on 12/03/2025 at 10:40 AM, CNA B stated ANE in-service is every Thursday during nursing meetings and online every 3 months. She was knowledgeable of ANE, provided examples, and stated the abuse coordinator is the ADM. She stated if suspects or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675395 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 675395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Val Verde Nursing and Rehabilitation Center 100 Hermann Dr Del Rio, TX 78840 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some witnesses ANE she would report immediately to the charge nurse, ADON, DON, and ADM. She stated she would report ANE right away. She stated if a resident were abused or neglected it could impact their mental state. During an interview on 12/03/2025 at 11:16 AM, CNA A stated she received ANE training online, she was knowledgeable of ANE, provided examples and stated the abuse coordinator is the ADM. She stated she has not witnessed or suspected ANE. She stated residents who are abused or neglected can have a negative impact and they may refuse care, cause depression, or may not want to do anything, not want to shower, and would feel like a burden. During an interview on 12/03/2025 at 11:45 AM, RN B stated she has received ANE training online, she was knowledgeable and provided examples of ANE. She stated the abuse coordinator is the ADM and any ANE suspected or witnessed is expected or to be reported immediately. She stated the impact ANE would have on residents includes secluding self, weight loss, and decline in health. She stated the post-fall procedures are to notify the DON and ADM regardless of if witnessed or un-witnessed fall. She stated witnessed and un-witnessed falls follow the same process for notification. She stated she was not familiar with Resident #1's care, but she was familiar with Resident #2's care. RN B stated Resident #2 needs partial standby assistance, but lately he has been declining, sometimes he uses a walker and wheelchair, he requires reminders for the restroom, and he is very forgetful. During an interview on 12/03/2025 at 1:15 PM, the DON stated she in-serviced her staff on ANE following a recent fall report to the State in November. She stated she educates herself by constantly reviewing the ANE policy. She stated the abuse coordinator is the ADM. She stated the facility ANE policy is to think of the resident's safety first, remove anyone suspected of ANE, notify the ADM and then notify upper management, and submit a self-report. She stated the nursing staff are expected to report ANE immediately - day or night. She stated all falls witnessed and unwitnessed requires a call to her and ADM. She stated she would have spoken to Resident #2 after the un-witnessed fall on 11/12/2025. She stated he's alert, he needs assistance and reminders with walking. She stated Resident #1 would have been receiving PT services, he has short term memory, requires minimal assistance and no behaviors. She stated she was not sure why there are no ANE reports to the state regarding the unwitnessed falls for Resident #1 on 10/7/2025 and Resident #2 on 11/12/2025. DON stated she believes ANE report was not submitted to the state because Resident #1 and Resident #2 have high BIMS, and she interviewed them after the falls, and they explained why they fell. She stated she does not keep documentation on post-fall interviews, and she does not chart it in their electronic medical record. After she was informed of Resident #2's BIMS score of 06 signifies severe cognitive impairment she stated she would have to review his electronic medical record and get back to me. No additional information was received prior to exit. During an interview on 12/03/2025 at 1:58 PM, the ADM stated the last ANE training conducted was in November following a fall incident that was reported to HHSC. She stated the nursing staff are required to report any allegations of ANE to her immediately. She stated the fall protocol is to ensure when a resident is found to have fallen to make sure there are no injuries, the charge nurse conducts an assessment of the resident and notifies the DON, ADM, RP, and MD. She stated if there is no injury the management team will talk about it in the morning meeting the following day, give screening referral to therapy staff and talk about interventions. ADM stated if there is an injury with the fall there is a whole investigation process, this entails completing an incident report, conducting all the interviews with staff present, resident interview, and documenting timeframes of what occurred to report it to the state. She stated if the fall protocol is not followed it could impact the resident and serious injuries would go unreported. She stated that she has 2 hours after she is notified of the allegation to report to the state. She stated that if allegation with serious injury, unknown injury, resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675395 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 675395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Val Verde Nursing and Rehabilitation Center 100 Hermann Dr Del Rio, TX 78840 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some cannot tell her what happened, no witnesses, or unexplainable injury she is to report to the state within 2 hours. She stated she does not recall the 11/12/2025 un-witnessed fall incident involving Resident #2 and stated the management team usually discusses incidents in the morning meeting. She stated she may have been notified the following morning of Resident #2's un-witnessed fall incident, but she is not sure. She stated because the resident can tell them what occurred even if unwitnessed, this is not suspicious or unknown and this would not rise to the level of a reportable incident to the state. ADM reviewed Resident #1's nurse's progress notes for 10/07/2025 un-witnessed fall and stated she would need to review the documentation further for this one. She stated there was no severe bodily injury, no suspicion, would have to look at documentation, but believed he was alert and may have had a history of being combative, but she doesn't recall and would need to coordinate with management team to provide the un-witnessed fall report that would provide additional details to the progress note. No additional information was provided prior to exit.Review of the facility document dated 11/03/2025, titled In-Service Training Report reflected the following: Topic: Fall Precautions and contents include call bell in reach, answer promptly, assist post fall care, toilet as often as needed, equipment, and documentation. Review of the facility policy dated 8/15/2022, titled Incidents and Accidents reflected the following: Policy: It is the policy of this facility for staff to report, investigate, and review any accidents or incidents that occur or allegedly occur, on facility property and may involve or allegedly involve a resident. Definitions: Accident refers to any unexpected or unintentional incident, which results or may result in injury or illness to a resident.Policy Explanation: The purpose of incident reporting can include: Alert administration of occurrences that could result in reporting requirements. Meeting regulatory requirements for analysis and reporting of incidents and accidents. Compliance Guidelines: Incidents that rise to the level of abuse, misappropriation, or neglect, will be managed and reported according to the facility's abuse prevention policy. Review of the facility policy undated, titled Fall Prevention Program reflected the following: Falls can cause people to restrict their activities, lead to depression, helplessness, social isolation, loss of confidence in independent mobility, injuries and even death. Most falls occur as a result of multiple intrinsic and extrinsic factors. Review of the facility policy dated 8/15/2025, titled Abuse, Neglect and Exploitation reflected the following: 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 property. Neglect means failure of the facility, its employees, or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Alleged Violation is a situation or occurrence that is observed or reported by staff, resident, relative, visitor or others but has not yet been investigated and, if verified, could be indication of noncompliance with the Federal requirements related to mistreatment, exploitation, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property. Policy Explanation and Compliance Guidelines: 1. The facility will develop and implement written policies and procedures that: a. Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property; b. Establish policies and procedures to investigate any such allegations; and c. Include training for new and existing staff on activities that constitute abuse, neglect, exploitation, and misappropriate of resident property, reporting procedures, and dementia management and resident abuse prevention; and IV. Identification of Abuse, Neglect and Exploitation A. The facility will have written procedures to assist staff in identifying the different types of abuse - mental/verbal abuse, sexual abuse, physical abuse, and the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675395 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 675395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Val Verde Nursing and Rehabilitation Center 100 Hermann Dr Del Rio, TX 78840 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete deprivation by an individual of goods and services. This includes staff to resident abuse and certain resident to resident altercations. 3. Physical injury of a resident, of unknown source. V. Investigation of Alleged Abuse, Neglect and Exploitation A. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur. B. Written procedures for investigations include: 1. Identifying staff responsible for the investigation; 2. Exercising caution in handling evidence that could be used in a criminal investigation (e.g., not tampering or destroying evidence); 3. Investigating different types of alleged violations; 4. Identifying and interviewing all involved persons, including the alleged victim, alleged perpetrator, witnesses, and others who might have knowledge of the allegations; 5. Focusing the investigation on determining if abuse, neglect, exploitation, and/or mistreatment has occurred, the extent, and cause; and 6. Providing complete and thorough documentation of the investigation. VII. Reporting/Response A. The facility will have written procedures that include: 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. 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, or b. Not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury. B. The Administrator will follow up with government agencies, during business hours, to confirm the initial report was received, and to report the results of the investigation when final within 5 working days of the incident, as required by state agencies. Event ID: Facility ID: 675395 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 675395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Val Verde Nursing and Rehabilitation Center 100 Hermann Dr Del Rio, TX 78840 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to have evidence all allegations of abuse, neglect, or mistreatment were thoroughly investigated and documented for 2 of 10 residents (Resident #1 and Resident #2) reviewed for a fall injury. The facility failed to have evidence that a thorough investigation was conducted following the allegation Resident #1 had an unwitnessed fall with injury on 10/07/2025 and Resident #2 had an unwitnessed fall with injury on 11/12/2025. These failures could place residents at risk for abuse and neglect by not investigating injuries of unknown origin. The findings included: Review of Resident #1's admission record dated 12/03/2025 reflected he was admitted to the facility on [DATE], readmitted on [DATE], and discharged on 11/18/2025. His diagnoses included acute respiratory failure with hypoxia (a condition when the respiratory system fails to maintain adequate oxygen levels in the blood), dementia (a condition characterized by a decline in cognitive function), muscle wasting and atrophy (is the loss of muscle mass and strength), sepsis, unspecified organism (condition when the body's immune system reacts severely to an infection, leading to widespread inflammation), and other lack of coordination (condition characterized by difficulty controlling voluntary muscle movements, leading to symptoms such as clumsiness, unsteady gait). Review of Resident #1's discharge MDS dated [DATE] reflected a BIMS score of 11, indicating moderately impaired cognition. It reflected that he required substantial/maximal assistance with sit to stand, chair/bed-to-chair transfer, toilet transfer and required the use of a manual wheelchair. Review of Resident #1's care plan dated 10/10/2025 reflected the following: [Resident #1] The resident is at risk for falls r/t decreased mobility d/t respiratory failure, CHF, Dementia, muscle wasting. The goals were for Resident #1 to be free of falls through the next review date. And interventions included ensuring Resident #1's call light is within reach, encourage the resident to use it for assistance as needed, and needs prompt response to all requests for assistance. Review of Resident #1's nursing progress note dated 10/08/2025 reflected the following: LVN A At 2250 [10:50 PM] 10/7/2025 found Resident [Resident #1] on the floor next to his low bed laying on his Rt. side. Noted blood on the floor, noted laceration to Rt. eyebrow with swelling and bleeding, pressure applied. Resident [Resident #1] is alert, unable to say what happened, kept saying thank you God in Spanish. Resident [Resident #1] is confused as he has been since admit [admission] 10/4/25. Aggressive and combative with assessment and Neuros, PEARLA, moves all extremities. No other visible injury noted. Called 911, Resident sent to ER. MD and DON notified. Review of Resident #1's electronic medical record on 12/02/2025 and 12/03/2025 reflected that an incident report was not documented for the un-witnessed fall on 10/07/2025. Review of Resident #1's electronic medical record on 12/02/2025 and 12/03/2025 reflected there was no facility incident report to HHSC for the alleged violation of injury of unknown source on 10/07/2025. Review of Resident #2's admission record dated 12/03/2025 reflected he was admitted to the facility on [DATE]. His diagnoses included heart failure, unspecified (a condition where the heart cannot pump enough blood to meet the body's needs), shortness of breath, repeated falls, other lack of coordination (condition characterized by difficulty controlling voluntary muscle movements, leading to symptoms such as clumsiness and unsteady gait), and muscle wasting and atrophy (is the loss of muscle mass and strength). Review of Resident #2's admission MDS dated [DATE] reflected a BIMS score of 06, indicating severely impaired cognition. It reflected an active diagnosis of repeated falls and that he required partial/moderate assistance with toileting hygiene, sit to stand, chair/bed-to chair transfer, and toilet transfer. Review of Resident #2's care plan dated 10/10/2025 reflected the following: [Resident #2] The resident is at risk for falls r/t SOB, decreased mobility, s/p NSTEMI. The goals were for Resident #2 to be free of falls through the next Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675395 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 675395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Val Verde Nursing and Rehabilitation Center 100 Hermann Dr Del Rio, TX 78840 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some review date. And interventions included ensuring Resident #1's call light is within reach, encourage the resident to use it for assistance as needed, and needs prompt response to all requests for assistance.Review of Resident #2's un-witnessed fall report dated 11/12/2025 at 2:00 AM reflected: RN A Heard resident [Resident #2] call for help, upon entering room resident [Resident #2] was on the floor on his right side next to his bed. Resident [Resident #2] stated he fell when getting out of bed. Resident [Resident #2] has small hematoma (an abnormal collection of blood outside of a blood vessel) to left cheekbone and has small laceration to left side of eyebrow. RN [RN A] cleansed laceration, applied pressure, bleeding stopped and TAO was applied. RN [RN A] also applied ice pack to left cheekbone hematoma. Resident [Resident #2] is able to move all extremities without difficulty. Denies pain but has discomfort to BLE due to swelling.MD and DON notified. Review of Resident #2's electronic medical record on 12/02/2025 and 12/03/2025 reflected there was no facility incident report to HHSC for the alleged violation of injury of unknown source on 11/12/2025. During an interview on 12/03/2025 at 1:15 PM, the DON stated she in-serviced her staff on ANE following a recent fall report to the State in November. She stated she educates herself by constantly reviewing the ANE policy. She stated the abuse coordinator is the ADM. She stated the facility ANE policy is to think of the resident's safety first, remove anyone suspected of ANE, notify the ADM and then notify upper management, and submit a self-report. She stated the nursing staff are expected to report ANE immediately - day or night. She stated all falls witnessed and unwitnessed requires a call to her and ADM. She stated she would have spoken to Resident #2 after the un-witnessed fall on 11/12/2025. She stated he's alert, he needs assistance and reminders with walking. She stated Resident #1 would have been receiving PT services, he has short term memory, requires minimal assistance and no behaviors. She stated she was not sure why there are no ANE reports to the state regarding the unwitnessed falls for Resident #1 on 10/7/2025 and Resident #2 on 11/12/2025. DON stated she believes ANE report was not submitted to the state because Resident #1 and Resident #2 have high BIMS, and she interviewed them after the falls, and they explained why they fell. She stated she does not keep documentation on post-fall interviews, and she does not chart it in their electronic medical record. After she was informed of Resident #2's BIMS score of 06 signifies severe cognitive impairment she stated she would have to review his electronic medical record and get back to me. No additional information was received prior to exit. During an interview on 12/03/2025 at 1:58 PM, the ADM stated the last ANE training conducted was in November following a fall incident that was reported to HHSC. She stated the nursing staff are required to report any allegations of ANE to her immediately. She stated the fall protocol is to ensure when a resident is found to have fallen to make sure there are no injuries, the charge nurse conducts an assessment of the resident and notifies the DON, ADM, RP, and MD. She stated if there is no injury the management team will talk about it in the morning meeting the following day, give screening referral to therapy staff and talk about interventions. ADM stated if there is an injury with the fall there is a whole investigation process, this entails completing an incident report, conducting all the interviews with staff present, resident interview, and documenting timeframes of what occurred to report it to the state. She stated if the fall protocol is not followed it could impact the resident and serious injuries would go unreported. She stated that she has 2 hours after she is notified of the allegation to report to the state. She stated that if allegation with serious injury, unknown injury, resident cannot tell her what happened, no witnesses, or unexplainable injury she is to report to the state within 2 hours. She stated she does not recall the 11/12/2025 un-witnessed fall incident involving Resident #2 and stated the management team usually discusses incidents in the morning meeting. She stated she may have been notified the following morning of Resident #2's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675395 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 675395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Val Verde Nursing and Rehabilitation Center 100 Hermann Dr Del Rio, TX 78840 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some un-witnessed fall incident, but she is not sure. She stated because the resident can tell them what occurred even if unwitnessed, this is not suspicious or unknown and this would not rise to the level of a reportable incident to the state. ADM reviewed Resident #1's nurse's progress notes for 10/07/2025 un-witnessed fall and stated she would need to review the documentation further for this one. She stated there was no severe bodily injury, no suspicion, would have to look at documentation, but believed he was alert and may have had a history of being combative, but she doesn't recall and would need to coordinate with management team to provide the un-witnessed fall report that would provide additional details to the progress note. No additional information was provided prior to exit.Review of the facility document dated 11/03/2025, titled In-Service Training Report reflected the following: Topic: Fall Precautions and contents include call bell in reach, answer promptly, assist post fall care, toilet as often as needed, equipment, and documentation. Review of the facility policy dated 8/15/2022, titled Incidents and Accidents reflected the following: Policy: It is the policy of this facility for staff to report, investigate, and review any accidents or incidents that occur or allegedly occur, on facility property and may involve or allegedly involve a resident. Definitions: Accident refers to any unexpected or unintentional incident, which results or may result in injury or illness to a resident.Policy Explanation: The purpose of incident reporting can include: Alert administration of occurrences that could result in reporting requirements. Meeting regulatory requirements for analysis and reporting of incidents and accidents. Compliance Guidelines: Incidents that rise to the level of abuse, misappropriation, or neglect, will be managed and reported according to the facility's abuse prevention policy. Review of the facility policy undated, titled Fall Prevention Program reflected the following: Falls can cause people to restrict their activities, lead to depression, helplessness, social isolation, loss of confidence in independent mobility, injuries and even death. Most falls occur as a result of multiple intrinsic and extrinsic factors. Review of the facility policy dated 8/15/2025, titled Abuse, Neglect and Exploitation reflected the following: 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 property. Neglect means failure of the facility, its employees, or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Alleged Violation is a situation or occurrence that is observed or reported by staff, resident, relative, visitor or others but has not yet been investigated and, if verified, could be indication of noncompliance with the Federal requirements related to mistreatment, exploitation, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property. Policy Explanation and Compliance Guidelines: 1. The facility will develop and implement written policies and procedures that: a. Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property; b. Establish policies and procedures to investigate any such allegations; and c. Include training for new and existing staff on activities that constitute abuse, neglect, exploitation, and misappropriate of resident property, reporting procedures, and dementia management and resident abuse prevention; and IV. Identification of Abuse, Neglect and Exploitation A. The facility will have written procedures to assist staff in identifying the different types of abuse - mental/verbal abuse, sexual abuse, physical abuse, and the deprivation by an individual of goods and services. This includes staff to resident abuse and certain resident to resident altercations. 3. Physical injury of a resident, of unknown source. V. Investigation of Alleged Abuse, Neglect and Exploitation A. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675395 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 675395 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Val Verde Nursing and Rehabilitation Center 100 Hermann Dr Del Rio, TX 78840 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete or exploitation occur. B. Written procedures for investigations include: 1. Identifying staff responsible for the investigation; 2. Exercising caution in handling evidence that could be used in a criminal investigation (e.g., not tampering or destroying evidence); 3. Investigating different types of alleged violations; 4. Identifying and interviewing all involved persons, including the alleged victim, alleged perpetrator, witnesses, and others who might have knowledge of the allegations; 5. Focusing the investigation on determining if abuse, neglect, exploitation, and/or mistreatment has occurred, the extent, and cause; and 6. Providing complete and thorough documentation of the investigation. VII. Reporting/Response A. The facility will have written procedures that include: 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. 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, or b. Not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury. B. The Administrator will follow up with government agencies, during business hours, to confirm the initial report was received, and to report the results of the investigation when final within 5 working days of the incident, as required by state agencies. Event ID: Facility ID: 675395 If continuation sheet Page 9 of 9