Inspection·April 6, 2023

F 0561 Record review of Resident #62's Quarterly MDS dated [DATE] revealed a BIMS score of 15 indicating he is cognitively intact . Level of Harm - Minimal harm or potential for actual harm Section G0120. Bathing reflected Residents Affected - Few 2. Physical help limited to transfer only Record review of Resident #62's Care Plan with an edit date of 11/03/22 revealed a problem of: [Resident #62] has an ADL self-care performance deficit r/t MS revealed an intervention of BATHING/SHOWERING: [Resident 62] is totally dependent on staff to provide shower as schedule and as necessary. During the resident council meeting on 04/05/23 at 10:00 AM, Resident #62 reported that he preferred to have his showers daily. He said he was told by the Activities Director and the Social Worker that he would no longer be able to have daily showers. He said he was told they do not have the staff. He said he wore a brief and he preferred to shower daily. He said being told he could not shower daily made him mad and that he did not feel clean if he did not shower every day. He said he could not do things for himself because if he could, he would. During an interview on 04/05/23 at 10:41 AM, the Activity Director said the facility changed from residents having daily showers to scheduled showers because the facility was challenged with staffing. She said a meeting was held with her (Activity Director) and the Administrator in March 2023. She said the options for showers were changed to every other day. She said before the shower schedule change only three residents preferred showers daily but only two had an issue with the change (Resident #62 and Resident #19). However, she said Resident #19 did not like it. She said Resident #19 wanted to shower daily, especially before Sunday's religious service. She said Resident #62 was mad and upset when the change occurred. She said Resident #62 exchanged bad words, but she did not specifically say what was said but that he was not happy with the decision. During an interview that occurred on 04/05/23 at 10:48 AM, Resident #19 said in the past he was allowed to take a shower daily. He said all of a sudden in March 2023 the daily showers stopped. He said the Administrator and Social Worker told him he could no longer take daily showers. He said he was not sure why the decision was made but that it made him feel bad when he could not shower daily. He said that he sweated a lot when he was in bed and that he wore a brief. He said he could not walk and care for himself and depended on staff to help him with daily activities. He said he was always in bed and felt better when clean. He said taking a shower every other day made him feel dirty. He said it made him feel like the staff treated him and the others who could not speak up for themselves like animals. He said they were not animals, but they were humans. He said he understood that he and the other residents were dying, but they were not dead and were human and should be able to shower every day. He said he needed to talk for himself and those who could not speak up. During an interview on 04/05/23 at 10:58 AM, the Social Worker stated the Activities Director was responsible for the shower schedule. She said the facility's process for showers included the Activities Director asking the residents when they wanted to take their showers. She said based on their response, that was when the residents were scheduled to take their showers. She said the change was made because of the lack of staff. She said the directive came from the Administrator after he spoke with the people above him. She said the Administrator explained to the residents they could not fulfill a service they did not have. She said that meant if the facility did not provide daily showers as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 2 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few a daily service, then they would not have to fulfill that service. She said the only options for showers were Monday's, Wednesday's, Friday's, or Tuesday's, Thursday's, and Saturday's. She said no showers were given on Sunday's. She said the potential negative outcome for residents not receiving their daily preferential showers was decreased quality of life and body hygiene. She said that was not a decision that she or the Activity Director made but that they were following the directive given by the Administrator that he received from upper management. During an interview on 04/05/23 at 11:10 AM, the ADM stated the change in showers occurred in March 2023. He said the options that were given to the residents were Monday's, Wednesday's, Friday's, Tuesday's, Thursday's, and Saturday's. He said PRN showers should have been given to any resident that became soiled or if they fell in the mud. He said the cancellation of daily showers is not a directive that came from him but a policy that his company had adopted. When asked why the change was made, he initially stated the change was made because of the lack of resources. When asked about what he meant by lack of resources, he said he did not mean to use the word resources. When asked why the change from daily showers to scheduled showers was made, he said he would have to get back to the investigator. When asked about the potential negative outcome for residents not receiving their preferential daily showers, he said he would have to get back with the investigator. He said when the change was made, he announced the bathing schedule options Resident Council. He said he announced the shower schedule in the resident council meeting. During an interview on 04/05/23 at 11:47 AM, the ADM said with the change in the policy, they tried to accommodate the residents the best they could. When asked which policy he referred to on the implemented change, he said he would get back to the investigator. During an interview on 04/05/23 at 11:49 AM, the DON stated when the change for scheduled showers was implemented, it was because they had a lot of residents. He said if residents wanted a shower after the scheduled showers were completed, the staff should have been given a shower. He said there was no existing policy for the implemented change that he could provide. He said all showers should be documented in the electronic medical system. During an interview with Confidential Staff A, they said they provided showers for the residents in the facility. They said in the past some residents received showers daily, but it was stopped because they were short-staffed. They said the Activity Director was responsible for the shower schedule, and they had been trained to follow the schedule. She said it was their understanding when they are fully staffed again, and they can go back to doing daily showers. They said they were told that the Social Worker and the Administrator talked to the residents about the change. They said no residents reported any issues directly to her, but she had heard that some residents did not like the change. They said a potential negative outcome is that the residents would feel bad. They said outside of the scheduled days for showers, the residents only received a shower before doctor appointments and family visits. They said other than that, the residents should receive a shower every other day regardless of their preference for a daily shower. They said they did not receive formal training but that the shower book was how they knew what residents and what days they shower. During an interview with Confidential Staff B, they said there was a shower book they went by and that was how they knew who was supposed to shower. They said the only time the schedule changes was if the resident changes halls. They said the residents could not have a shower every day because sometimes they were short-staffed. They said that Resident #19 had expressed to them that he would like a shower every day but they had told him that he could not have one daily, which made him mad. They said they had been trained to follow the schedule. They could not think of a potential negative (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 3 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0561 outcome for the resident not being able to choose their shower days. Level of Harm - Minimal harm or potential for actual harm During an interview with Confidential Staff C, they said they had provided residents showers while working. They said they followed the schedule in the binder at the nursing station. They said that Resident #62 had expressed that he would like to shower daily, but they told him that he would not be able to shower daily because he took an hour and a half and they did not have enough staff, so that was why the schedule was put in place. They said Resident #62 would get mad, and they would report to the DON when he was mad. They said when they told the DON he said he would talk to Resident #62. They said they were unaware if the DON had spoken with Resident #62. Residents Affected - Few During an interview with Confidential Staff D, they said they had provided residents with showers. They said they gave residents daily showers if they asked for them in the past, but that had changed as of March 2023. They said they were not sure why it was changed but that they had been short staffed, and they thought this may have been the reason. They said Resident #62 had expressed that he liked to shower daily. They said that the ADM and the Social Worker talked to the residents to let them know about the changes and that the residents could no longer shower daily. They said Resident #62 was mad and upset about the changes. They said they tried to keep him from being so angry, and they would give Resident #62 bed baths and that kept him calm. They said Resident #62 expressed that he felt cleaner and appreciated when that was done. They said if they had time, they would still try to give showers on their unscheduled shower days, but if there was no time, the residents had to wait for their scheduled days. During an interview with Confidential Staff E, they said they provided showers to residents per their schedule and mostly on Saturday's because someone provided showers during the week. They said they knew who to shower by the binder, which was how she had been trained. They said that Resident #19 had expressed that he would like showers daily but that they had told him no because sometimes they were short staffed and the staff would have two halls. They said having two halls made it challenging to shower everyone. They said when they told Resident #19, he would get mad and threatened to call the state. During an interview with the DON on 04/06/23 at 11:24 AM, the DON clarified that the scheduled showers was not a change. He said it was something the company brought up. He said it was an attempt to accommodate everyone. He said the residents were uncomfortable a little bit. He said he was not in the resident council meeting when the announcement was made, so he could not say what was said during that meeting. He said it was his interpretation that they would have scheduled days for residents to shower, but the residents could shower daily if they wanted to. He said Resident #62 received daily baths, but it may be longer than he wants to wait, and Resident #62 would leave. He said he didn't believe there were in-services on the changes. He said he expected everyone to be showered according to the schedule, but they were supposed to provide daily showers if they wanted a shower daily. He said the potential negative outcome could be the same for receiving daily showers and not receiving daily showers. He said the resident could have dry skin and irritation. He said they did not have to train when the changes came because they had always had that schedule. He said no one complained to him about the change. He said the nurses make the shower schedule and revise it weekly to ensure everyone is on there, including new admissions. During an interview with the ADM on 04/06/23 at 11:50 AM he said, We had a change of policy. when he was asked if he gained clarification on why the change in shower schedules was implemented. When (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 4 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few asked was a specific policy that was changed, his response was just a change of policy. When asked for the copy of the Resident Rights Policy that the facility admission packet referenced, the ADM stated there was a copy on the wall, and it was big. The ADM offered to take a picture of the rights. A physical copy was not provided. He said he was aware that the change upset some of the residents and specifically named Resident #19. He said Resident #19 asked if he could get a daily shower, and the ADM said he explained that he had showers on the scheduled days. The ADM said he considered bathing and showering a part of personal care. He said he did not at the time believe having scheduled shower days was a limitation because they told him he would get the shower on the scheduled days and would still shower on the other days. He said during the resident council meeting, they announced the shower schedule, and on the other days that the residents were not scheduled, showers should still occur if the resident fell in the mud or had an event. He said after that meeting, each resident could choose their preferential schedule. When asked how the staff were trained on the new change, the ADM responded, Just by the schedule. He said there was no in-service or documentation to support the change he could provide. He said nursing and activities were responsible for the shower schedule. He said he did not have any additional policies outside of the policies he provided. When asked about the potential negative outcome of the residents not receiving the daily showers, he responded, I do not have one. An observation made on 04/06/23 at 12:30 PM revealed a large poster with nursing facility resident rights: Freedom of Choice: Nursing facility requirements for licensure & Medicaid Certified Centers Residents have a freedom of choice. During an interview with the Activities Director on 04/06/23 at 1:17 PM she said that freedom of choice should have included being able to choose when the residents would shower. During an interview with the DON on 04/06/23 at 1:18 PM he said that freedom of choice should have included being able to choose when the residents would shower. During an interview with the Social Worker on 04/06/23 at 1:19 PM she said that freedom of choice should have included being able to choose when the residents would shower. During an interview with the ADM on 04/06/23 at 1:20 PM she said that freedom of choice should have included being able to choose when the residents would shower. Record Review of the Shower Schedule provided revealed the following: Resident #19 was scheduled for showers during the 6A-2P shift Monday's, Wednesday's and Friday's. Resident #62 was scheduled for showers during the 6A-2P shift Monday's, Wednesday's and Friday's. Record Review of Resident Council Meeting Minutes dated 03/06/23 revealed the following: New Business: Patient Education on the showers ( Monday, Wednesday, Friday or Tuesday, Thursday Saturday) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 5 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure all residents had the right to formulate an advance directive for 6 of 22 residents (Residents #3, #30, #31, #35, #57 and #59) reviewed for advanced directives. Resident #3, #30, #31, #35, #57 and #59 were incorrectly filled out or missing required information. Residents #3, #30, #31, #35, #57, and #59 were listed as a DNR (Do Not Resuscitate) but had Out-of-Hospital Do Not Resuscitate (OOH-DNR) forms that were incorrectly filled out or missing required information. This failure could place residents at risk for not having their end of life wishes honored and incomplete records. Findings included : Resident #3 Record review of Resident #3's dated [DATE] face sheet revealed an [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include covid-19, dementia, type 2 diabetes mellitus and obesity. Record review of Resident #3's physician's order summary dated [DATE] revealed an order ADC: Do Not Resuscitate - DNR dated [DATE]. Record review of Resident #3's care plan, dated [DATE], revealed a care plan for DNR. Record review of Resident #3's Out of Hospital Do Not Resuscitate form dated [DATE] revealed under Physician's Statement, no date or physician's license number noted on the form. Resident #30 Record review of Resident #30's dated [DATE] face sheet revealed a [AGE] year-old-male was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include covid-19, peripheral vascular disease (poor blood circulation) and muscle weakness. Record review of Resident #30's physician's order summary dated [DATE] revealed an order ADC: Do Not Resuscitate - DNR dated [DATE]. Record review of Resident #30's care plan, dated [DATE], revealed a care plan for DNR. Record review of Resident #30's Out of Hospital Do Not Resuscitate form dated [DATE] revealed under Person's full legal name, no signature, date or printed name noted on form. Resident #31 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 6 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0578 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #31's (dated [DATE]) face sheet revealed an [AGE] year-old-male who was admitted to the facility on [DATE] with diagnoses to include cerebral palsy (disorder of movement) Record review of Resident #31's physician's order summary dated [DATE] revealed an order Do Not Resuscitate - DNR dated [DATE]. Residents Affected - Some Record review of Resident #31's care plan, dated [DATE], revealed care plan for Advance Care Plan: No CPR/DNR. Record review of Resident #31's Out of Hospital Do Not Resuscitate form dated [DATE] revealed under Declaration by a legal guardian agent or proxy on behalf of the adult person who is incompetent or otherwise incapable of communication did not reveal how the named person was related. Furthermore, the Physician Statement and the License # and date were blank. Resident #35 Record review of Resident #35's face sheet dated [DATE] revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include primary oseto arthritis, dementia and hypertensive heart disease. Record review of Resident 35's physician's order summary dated for [DATE] revealed an order ADC: Do Not Resuscitate - DNR dated [DATE]. Record review of Resident #39's care plan, dated [DATE], revealed a care plan for DNR started [DATE]. Record review of Resident #35's Out of Hospital Do Not Resuscitate form dated (undated) revealed under the Physician Statement the doctor's printed name, date and the License # was blank. Resident #57 Record review of Resident #57's face sheet dated [DATE] revealed a [AGE] year-old-male was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include traumatic brain injury, hypertensive heart disease, and cirrhosis of liver. Record review of Resident #57's physician's order summary dated [DATE] revealed an order ADC: Do Not Resuscitate - DNR dated [DATE]. Record review of Resident #57's care plan, dated [DATE], revealed a care plan for DNR. Record review of Resident #57's Out of Hospital Do Not Resuscitate form dated [DATE] revealed under Person's full legal name, no date of birth and no indication whether the resident is female or male. Under area for legal guardian, agent or proxy, no date or printed name noted on form. Resident #59 Record review of Resident #59's face sheet dated [DATE] revealed an [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include type 2 diabetes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 7 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0578 Record review of Resident #59's physician's order summary dated [DATE] revealed no order for DNR. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #59's care plan, dated [DATE], revealed a care plan for DNR that started [DATE]. Residents Affected - Some Record review of Resident #59's Out of Hospital Do Not Resuscitate form dated [DATE] revealed under the Physician Statement the doctor's printed name and the License # was blank. During an interview with the Social Worker on [DATE] at 11:01 AM, she said she was responsible for the DNRs. She said the facility process is she would meet with the resident to determine their cognition, complete a social history, and address the advance directive choice. She said if the resident is uncomfortable with the topic, she would use information from the hospital face sheet and the resident's representative. She said a DNR is valid or official when the resident or responsible party has signed it. She said the signature of the doctor makes it valid. She said she had never been questioned on the completion of her DNRs. She said every space applicable needed be completed . She said the potential negative outcome for an incomplete DNR was the nurse staff being first in line and unable to determine if the resident's wish was to be full code or a DNR, which could cause harm to the resident. She said the staff would only be able to provide care or respect the resident's wishes if the DNR was complete d correctly. She said there was no system to review the DNRs outside of her review. She said the medical records staff is responsible for sending the document to the doctor and ensuring that all the doctor's information is there. She said she is responsible for the resident and family portion. She reviewed the following DNRs and reported the following: Resident #35 She said Resident #35's DNR was incomplete because there was no date and no physician license to the doctor . However, she said she did not know why it was incomplete because she gave it to medical records. Resident #31 She said Resident #31's DNR was incomplete because it was missing the doctor's information, and the family member signed in the wrong place. However, she said she was unsure why it was incomplete or incorrect because she was not present during the resident's admission. Resident #59 She said Resident #59 was not correct because the doctor's printed name and license number were missing. She said she was not sure why that was not done. She said her portion was completed. Resident #30 She said Resident #30's DNR was invalid because there was no printed name, and the resident's name was not legible. She said she was not sure why it was done incorrectly . She said the previous Business Office Manager and assistant completed the DNR. She said both of those people no longer worked for the facility. Resident #3 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 8 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some She said Resident #3's is invalid because the doctor's portion has no date or license. However, she said she is not sure why it was not done as it was done before her employment. Resident #57 She said Resident #57's DNR was invalid because the responsible party portion did not have a relationship with the resident. She said she knew the relationship, but all portions should have been completed. She said she was unsure why it was not checked on the form. During an interview with the DON on [DATE] at 11:24 AM he said all staff was responsible for DNRs. He said the DNR process started with Admissions and the Social worker, but ultimately they should all be reviewing the status of the residents. When asked if there is a system to monitor DNRs, he said DNRs were discussed in the daily meetings, but no problems had been identified. The DON said after it is completed, medical records, social services, and the DON and ADON should review it. He said a DNR was complete when the family and doctor had signed the form. He said he expected that all fields on the form be completed, or it may create a discrepancy. He said the potential negative outcome for the resident was their wishes might not be followed. He said he was unaware of a problem with the DNRs, but it was brought to his attention since the surveyors had been in the facility. After reviewing all DNRs, the DON agreed that they were not complete. During an interview with the ADM on [DATE] at 11:50 AM, he said the Social Worker is responsible for completing DNRs. He said the facility process is to ask family and the resident what their advance directive preferences were on admission , and once they are completed, the completed document is uploaded into the system. When asked if there was a system to monitor DNRs, the ADM said they had just completed an audit a week ago and had a few residents with incomplete DNRs; it was his understanding that those had been corrected. He said Medical Records is responsible for audits, which would then be given to the appropriate disciplines to follow up on. When asked what the potential negative outcome was, his response was, We have a potential for a negative outcome. When asked what his expectation for DNRs in his facility, his response was, If there are blanks, then the DNR is not activated. When asked what he meant by the term activated, he clarified and said that it meant that the DNR was not effective or valid. During an interview with Medical Records on [DATE] at 1:31 PM, she said the Social Worker is responsible for the DNRs. She said the process was the Social Worker would complete her portion, then when it would be given to her, and this would be when she would send it to the doctor. She said when it was returned to her, then she would scan it. She said she typically did not review it before she scanned it. She said sometimes she would sign as a witness. She said she believed whoever completes the form is responsible for the form. She said the doctor's signature has to be there for the DNR to be valid. She said if it is not signed, she would send it back and tell the doctor they must sign it. She said if all appropriate areas are not completed, then the form is not valid. She said an incomplete DNR form would mean the resident must be full code against their wishes. She said she was unaware of the issues with incomplete DNRs until the Social worker told her of the issue on the previous date (04/05)23). She said she had not received formal training on completing the form. She said she knew the doctor's signature had to be on the form. She said she could not explain why the DNRs were not complete. Record review of the facility policy, Resident Rights Regarding Treatment and Advance Directives, dated [DATE], revealed the following documentation: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 9 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0578 Review of the policy did not reveal any information regarding the completion of the OOH-DNR Order. Level of Harm - Minimal harm or potential for actual harm Record Review of the Instructions For Issuing An OOH-DNR Order (undated) revealed the following: Residents Affected - Some INSTRUCTIONS FOR ISSUING AN OOH-DNR ORDER PURPOSE: The Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order on reverse side complies with Health and Safety Code (HSC), Chapter 166 for use by qualified persons or their authorized representatives to direct health care professionals to forgo resuscitation attempts and to permit the person to have a natural death with peace and dignity. This Order does NOT affect the provision of other emergency care, including comfort care. APPLICABILITY: This OOH-DNR Order applies to health care professionals in out-of-hospital settings, including physicians' offices, hospital clinics and emergency departments. IMPLEMENTATION: A competent adult person, at least [AGE] years of age, or the person's authorized representative or qualified relative may execute or issue an OOH-DNR Order. The person's attending physician will document existence of the Order in the person's permanent medical record. The OOH-DNR Order may be executed as follows: Section A - If an adult person is competent and at least [AGE] years of age, he/she will sign and date the Order in Section A. Section B - If an adult person is incompetent or otherwise mentally or physically incapable of communication and has either a legal guardian, agent in a medical power of attorney, or proxy in a directive to physicians, the guardian, agent, or proxy may execute the OOH-DNR Order by signing and dating it in Section B. Section C - If the adult person is incompetent or otherwise mentally or physically incapable of communication and does not have a guardian, agent, or proxy, then a qualified relative may execute the OOH-DNR Order by signing and dating it in Section C. Section D - If the person is incompetent and his/her attending physician has seen evidence of the person's previously issued proper directive to physicians or observed the person competently issue an OOH-DNR Order in a nonwritten manner, the physician may execute the Order on behalf of the person by signing and dating it in Section D. Section E - If the person is a minor (less than [AGE] years of age), who has been diagnosed by a physician as suffering from a terminal or irreversible condition, then the minor's parents, legal guardian, or managing conservator may execute the OOH-DNR Order by signing and dating it in Section E. Section F - If an adult person is incompetent or otherwise mentally or physically incapable of communication and does not have a guardian, agent, proxy, or available qualified relative to act on his/her behalf, then the attending physician may execute the OOH-DNR Order by signing and dating it in Section F with concurrence of a second physician (signing it in Section F) who is not involved in the treatment of the person or who is not a representative of the ethics or medical committee of the health care facility in which the person is a patient. In addition, the OOH-DNR Order must be signed and dated by two competent adult witnesses, who have witnessed either the competent adult person making his/her signature in section A, or authorized declarant making his/her signature in either sections B, C, or E, and if applicable, have witnessed a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 10 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete competent adult person making an OOH-DNR Order by nonwritten communication to the attending physician, who must sign in Section D and also the physician's statement section. Optionally, a competent adult person or authorized declarant may sign the OOH-DNR Order in the presence of a notary public. However, a notary cannot acknowledge witnessing the issuance of an OOH-DNR in a nonwritten manner, which must be observed and only can be acknowledged by two qualified witnesses. Witness or notary signatures are not required when two physicians execute the OOH-DNR Order in Section F. Event ID: Facility ID: 675396 If continuation sheet Page 11 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to develop a comprehensive care plan to meet the highest practicable physical, mental, psychosocial well-being for13 of 22 residents (Residents #4, #12, #19, #20, #28, #30, #31, #33, #42, #45, #47, #56, and #59) reviewed for care plans as follows: Resident #4 did not have a care plan for behavior. Resident #12 did not have a care plan for vision and dehydration. Resident #19 did not have a care plan for communication, falls and dehydration. Resident #20 did not have a care plan for vision, communication and dental care. Resident #28 did not have a care plan for dehydration. Resident #30 did not have a care plan for mood and dental care. Resident #31 did not have a care plan for vision and communication. Resident #33 did not have a care plan for vision and pain. Resident #42 did not have a care plan for dehydration. Resident #45 did not have a care plan for vision, communication, activities of daily living, falls and dehydration. Resident #47 did not have a care plan for vision. Resident #56 did not have a care plan for vision and pain. Resident #59 did not have a care plan for vision. This failure could place residents at risk of not receiving the care required to meet their physical, mental, and psychosocial needs to attain or maintain their highest practicable physical, mental, and psychosocial outcome. Findings include: Resident #4 Record review of Resident #4's dated 04/04/23 face sheet revealed a [AGE] year-old-female was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include Alzheimer's disease (memory problems) essential hypertension (high blood pressure) and peripheral vascular disease (poor blood circulation). Record review of Resident #4's Annual Minimum Data Set, dated [DATE], revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 12 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Section C Brief Interview for Mental Status score revealed a score of 0, which indicated the resident's cognition was severely impaired . Level of Harm - Minimal harm or potential for actual harm Section V Care Area Assessment (CAA) Summary: Residents Affected - Some CAA Results: (List the CAA that triggered and not Care Planned) 09. Behavioral Symptoms Section E 1100. Changes in Behavior or Other Symptoms Enter Code: 2 - Worse. Record review of Resident #4's care plan, dated 03/09/23, revealed no care plan for behavior symptoms. Resident #12 Record review of Resident #12's face sheet dated 04/04/23 revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include obstructive pulmonary disease (lung disease) Record review of Resident #12's Comprehensive Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 07, which indicated the resident's cognition was severely impaired . B1000. Vision 1. Impaired Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 03. Visual 14. Dehydration Record review of Resident #12's care plan, dated 02/28/23, revealed no care plan for vision and dehydration. Resident #19 Record review of Resident #19's face sheet dated 04/04/23 revealed a [AGE] year-old-male was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include type 2 diabetes mellitus, paraplegia, generalized anxiety disorder, and muscle weakness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 13 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Record review of Resident #19's Annual Minimum Data Set, dated [DATE], revealed: Level of Harm - Minimal harm or potential for actual harm Section C Brief Interview for Mental Status score revealed a score of 14, which indicated the resident's cognition was cognitively intact. Residents Affected - Some Section B 0700. Makes Self Understood Enter Code: 1 - Usually understood - difficulty communicating some words or finishing thoughts but is able if prompted or given time. Section B 0800. Ability To Understand Others Enter Code: 1 - Usually understands - misses some part/intent of message but comprehends most conversation Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 04. Communication 11. Falls 14. Dehydration Section B 0700. Makes Self Understood Enter Code: 1 - Usually understood - difficulty communicating some words or finishing thoughts but is able if prompted or given time. Section B 0800. Ability To Understand Others Enter Code: 1 - Usually understands - misses some part/intent of message but comprehends most conversation Record review of Resident #19's care plan, dated 02/03/23, revealed no care plan for communication, falls or dehydration. Resident #20 Record review of Resident #20's face sheet dated 04/04/23 revealed an [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include type II diabetes and hypertensive heart disease without heart failure. Record review of Resident #20's Comprehensive Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 6, which indicated the resident's cognition was severely impaired. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 14 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Section V Care Area Assessment (CAA) Summary: Level of Harm - Minimal harm or potential for actual harm CAA Results: (List the CAA that triggered and not Care Planned) 03. Visual Residents Affected - Some 04. Communication 15. Dental Care Record review of Resident #20's care plan, dated 03/28/23, revealed no care plan for vision, communication and dental care. Resident #28 Record review of Resident #28's dated 04/04/23 face sheet revealed a [AGE] year-old-female was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include angina pectoris (chest pain), morbid obesity, anxiety disorder, and essential hypertension (high blood pressure). Record review of Resident #28's Annual Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 15, which indicated the resident's cognition was cognitively intact. Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 14. Dehydration Record review of Resident #28's care plan, dated 11/22/22, revealed no care plan for dehydration. Resident #30 Record review of Resident #30's face sheet dated 04/04/23 revealed a [AGE] year-old-male was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include COVID-19, hemiplegia and hemiparesis following cerebral infarction (disrupted blood flow to the brain) affecting left non-dominate side (left-sided weakness), and peripheral vascular disease (poor blood circulation). Record review of Resident #30's Annual Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 15, which indicated the resident's cognition was cognitively intact. Section D0300 Total Mood Severity Score Enter Score: 04 Section L 0200 Dental. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 15 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Check all that apply Level of Harm - Minimal harm or potential for actual harm B. No natural teeth or tooth fragments. Section V Care Area Assessment (CAA) Summary: Residents Affected - Some CAA Results: (List the CAA that triggered and not Care Planned) 08. Mood 15. Dental Care Record review of Resident #30's care plan, dated 01/23/23, revealed no care plan for mood or dental care. Resident #31 Record review of Resident #31's face sheet dated 04/04/23 revealed an [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include cerebral palsy (movement disorder) Record review of Resident #31's Comprehensive Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 15, which indicated the resident's cognition was intact. Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 03. Visual 04. Communication Record review of Resident #31's care plan, dated 03/07/23, revealed no care plan for vision and communication. Resident #33 Record review of Resident #33's dated 04/04/23 face sheet revealed a [AGE] year-old-female was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses to include hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (right sided weakness), aphasia (language disorder), pressure ulcer of sacral region (wound to buttocks area) and major depressive disorder. Record review of Resident #33's Annual Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 14, which indicated the resident's cognition was cognitively intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 16 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Section B 1000. Vision Level of Harm - Minimal harm or potential for actual harm Enter Code: 2- Moderately Impaired - limited vision; not able to see newspaper headlines but can identify objects Residents Affected - Some Section J 0100. Pain Management A. Enter Code: 1 - Yes, received scheduled pain medication regimen. B. Enter Code: 1 - Yes, received PRN pain medications OR was offered and declined. Section J 0300 Pain Presence Enter Code: 1 - Yes Section J 0400 Pain Frequency Enter Code: 3 - Occasionally Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 03. Visual Function 19. Pain Record review of Resident #33's care plan, dated 01/24/23, revealed no care plan for vision impairment or pain management. Resident #42 Record review of Resident #42's face sheet dated 04/04/23 revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include dementia. Record review of Resident #42's Comprehensive Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 11, which indicated the resident's cognition was moderately impaired. Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 14. dehydration (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 17 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Record review of Resident #42's care plan, dated 01/31/23, revealed no care plan for dehydration. Level of Harm - Minimal harm or potential for actual harm Resident #45 Residents Affected - Some Record review of Resident #45's face sheet dated 04/04/23 revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include pulmonary fibrosis (thickening or scarred tissue in the lungs). Record review of Resident #45's Comprehensive Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 14, which indicated the resident's cognition was intact. B1000. Vision 1. Impaired Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 03. Visual 04. Communication 15. Activities of Daily Living 11. Falls 14. Dehydration Record review of Resident #45's care plan, dated 01/03/23, revealed no care plan for vision, communication, activities of daily living, falls and dehydration. Resident #47 Record review of Resident #47's face sheet 04/04/23 revealed an [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include type II diabetes. Record review of Resident #47's Comprehensive Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 03, which indicated the resident's cognition was severely impaired . B1000. Vision 2. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 18 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Moderately impaired Level of Harm - Minimal harm or potential for actual harm Record review of Resident #47's care plan, dated 01/03/23, revealed no care plan for vision. Resident #56 Residents Affected - Some Record review of Resident #56's dated 04/04/23 face sheet revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include chronic obstructive pulmonary disease (lung disease), generalized anxiety, peripheral vascular disease (poor blood circulation) and pneumonia (lung infection). Record review of Resident #56's Annual Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 14, which indicated the resident's cognition was cognitively intact. Section B 1000. Vision Enter Code: 1 - Impaired - sees large print, but not regular print in newspapers/books. Section J 0100. Pain Management A. Enter Code: 1 - Yes, received scheduled pain medication regimen. B. Enter Code: 1 - Yes, received PRN pain medications OR was offered and declined. Section J 0300 Pain Presence Enter Code: 1 - Yes Section J 0400 Pain Frequency Enter Code: 2 - Frequently Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 03. Visual Function 19. Pain Record review of Resident #56's care plan, dated 03/13/23, revealed no care plan for vision impairment or pain management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 19 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Resident #59 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #59's face sheet 04/04/23 revealed an [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include type II diabetes. Residents Affected - Some Record review of Resident #59's Comprehensive Minimum Data Set, dated [DATE], revealed: Section C Brief Interview for Mental Status score revealed a score of 5, which indicated the resident's cognition was severely impaired. Section V Care Area Assessment (CAA) Summary: CAA Results: (List the CAA that triggered and not Care Planned) 03. Visual B1000. Vision 2. Moderately Impaired Record review of Resident #59's care plan, dated 02/16/22, revealed no care plan for vision. During an interview with MDS Nurse A on 04/06/23 at 9:09 AM, she said everyone was responsible for the care plans. She said anybody could add to the care plan. She said the IDT discussed resident care plans during the morning meeting. She said anyone could add to the resident's goals, problems, and interventions. She said she had training from nursing schools but not company training. She said they received updates from the company but mostly from nursing school was where she learned about care plans. She said a care plan was a problem or an issue that was going on with the resident. She said it must be addressed through goals and interventions. She said the care plan was implemented to avoid or prevent problems. She said everyone used the care plan to care for the residents. She said if staff had a question about the resident , they should have been able to go to the resident charts. She said new staff could also add interventions if they notice things. She said there was no system she knew of for the review of the care plan. She said she does not believe the care plans were reviewed after completion. She said that it was her understanding that the facility expected the care plan to include active diagnoses, medications that contribute and side effects, and the triggered MDS CAAS from section V. She said the resident care plan was also to include things such as the resident's eating habits and behaviors. She reported the following regarding the missing care plans for each resident: Resident #42 She said regarding Resident #42 that she completed the care plan. After reviewing the care plan dated 01/31/23, she confirmed dehydration was not care planned. She said she did not have a reason why she did not complete the care plan for dehydration but that the potential negative outcome for dehydration was the resident could get a urinary tract infection. Resident #12 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 20 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some She said that she completed the care plan and confirmed after looking at the care plan that the resident did not have a care plan for vision and dehydration. She said she did not have a reason for missing it. She said the potential negative outcome for dehydration could be infection, UTI, and regards to vision the resident could be at risk for falls. She said she iwas not sure why it was not care planned. She said a negative outcome could be a UTI for the resident. Regarding vision, she said he has a diagnosis of diabetes, he can develop glaucoma and poor vision as a part of the diagnosis. She said without a care plan staff might not know how to address the resident regarding this issue of vision and dehydration. Resident #47 She said that she was the one who completed the care plan for Resident #47. After reviewing the care plan, she confirmed the resident did not have a care plan for vision. She said vision triggered because of his diagnosis of diabetes, but he did not have a diagnosis related to vision. She said she only typically care planned if there is an actual diagnosis with treatment by the nurse. She confirmed that according to the facility policy, that vision should have been addressed in the care plan. She did not have a reason why it was not done. She said Resident #47 was at risk for poor vision and the lack of a care plan staff may not know how to respond appropriately. Resident #45 She confirmed the care plans for vision, communication, activities of daily living, falls, and dehydration was not included , and she was the nurse that completed the care plan. She does not have a reason as to why they were not done. She said the resident was very independent, so she said she did not care plan the ADLS, but he triggered in the MDS assessment because of the need for set-up assistance. She said the triggered items should have been care planned. Resident #31 She stated she completed the care plan. She confirmed that the care plan was not there for vision, but she did not care plan it because he did not have a diagnosis of vision that needed treatment. She said it triggered because the MDS assessment reflected his impaired vision. Resident #59 She confirmed after looking at the care plan there was no care plan for vision. She said Resident #59 does not have a dx nor treatment for impaired vision. She stated according to the policy, it should have been care planned. She said the resident could potentially fall and that Resident #59 is susceptible to fractures. Resident #20 She said she completed and reviewed the care plan for Resident #20 She confirmed the resident did not have a care plan for vision, communication, or dental care . She said she did not care plan vision because the resident did not have a vision dx that required treatment, but according to the facility policy, it should have been care planned. She said she did not have a reason why the other triggered areas were not care planned. She said no dental care plan could result in weight loss or infection for the resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 21 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Resident #56 Level of Harm - Minimal harm or potential for actual harm She stated she was the person that completed and reviewed the care plan and that vision and pain were not care planned. She said the potential negative outcome for vision is falls and injury or decline in ADL because of the pain for the resident. Residents Affected - Some Resident #30 She confirmed that mood and dental care were not care planned. She did not have a reason why the areas were not care planned. She said that she missed them. She said the potential negative outcomes could be infection and unmet needs for the resident. Resident #28 She confirmed that dehydration was not care planned and the potential negative outcome could be a UTI for the resident. She said she did not have a reason why the care plan was not completed for the resident. Resident #19 She confirmed the resident did not have a care plan for falls and dehydration. She said the potential negative outcome was increased falls. She said the resident had paraplegia and required a mechanical lift with two staff. She said not addressing the triggered dehydration put the resident at risk for a UTI. She said no care plan for communication could lead to the resident's needs not being met because staff may not know how to communicate with the resident. Resident #33 She confirmed there was no care plan for pain. She did not have a reason for not having a care plan, but the resident did not have a diagnosis that required treatment. She said not addressing the triggered pain could cause the resident to decline in activities of daily living because of pain. Resident #4 She confirmed she did not see a care plan for behavior. She said the resident would refuse to eat. She said the staff might not know how to meet her needs and address or communicate with her without the care plan. During an interview with MDS Nurse B on 04/06/23 at 9:30 AM, she said the process had recently changed. She said in the past, she and MDS Nurse A had separate duties regarding assessments and the care plan, but with the change of the new company, they were assigned essentially by halls. She said she had received most of the training from nursing school in general but not specific company training. She said a care plan was the ideal situation that residents had for staff to treat the resident better and to be able to care for them. She said everyone uses the care plan. She said there was no system she knew of to monitor the care plan outside of her and the MDS Nurse completing them. She said she believed the facility expectation was to include active diagnoses, medications that contribute and side effects, and the triggered MDS CAAS from section V. She said eating habits and behaviors would have also been included. In regards to the incomplete care plans, she reported the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 22 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Resident #42 Level of Harm - Minimal harm or potential for actual harm She said that she was the person that completed the care plan for Resident #42. She said the resident did trigger for dehydration, according to the comprehensive care plan dated 05/02/22. She said that she should have been care planned. She said the resident is at risk for UTI without the dehydration care plan. Residents Affected - Some Resident #12 She confirmed after looking at the comprehensive MDS dated [DATE] that the resident was triggered for cognitive loss, vision, and dehydration. She said she would have completed the comprehensive assessment. Resident #47 She confirmed she was the person who completed the MDS assessment dated [DATE] and stated the resident did trigger for vision. She said that should have been care planned. Resident #45 She said she was the person who completed the comprehensive MDS assessment dated [DATE] and confirmed he triggered for vision, communication, ADLs, falls, and dehydration. In general, she said the negative outcome for not care planning these items could be increased falls and UTIs. Resident #31 She said she was the person who completed the MDS assessment dated [DATE] and confirmed he triggered for vision. She said the resident could not see small print, and without staff knowing that, staff may not know that information and provide him with the material he could not see. Resident #59 She completed the comprehensive MDS assessment dated [DATE] and confirmed that he triggered for vision. Resident #20 She confirmed the resident triggered for vision, communication, and dental care after reviewing the comprehensive MDS Assessment that she completed on 12/13/22. She said the lack of communication could result in him being unable to voice his needs and needs not being met. Resident #56 She confirmed she completed the comprehensive MDS Assessment on 12/13/22, and he triggered for vision and pain. She said lack of care planning those items could result in injury and discomfort for the resident. Resident #30 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 23 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Level of Harm - Minimal harm or potential for actual harm She said she completed the comprehensive MDS assessment dated [DATE] and that the resident had triggered for mood and dental care. She said failure to care plan those items would have had a potential negative outcome of his needs not being met for dental, and there was a possibility for infections. Resident #28 Residents Affected - Some She said she completed the comprehensive MDS dated [DATE]. She confirmed the resident triggered for dehydration. She said the lack of care planning could result in UTIs for the resident. Resident #19 She said she completed the comprehensive MDS assessment dated [DATE] and confirmed the resident triggered for communication, falls, and dehydration. She said the potential negative outcome for communication would be the staff's inability to meet the resident's needs. In addition, she said the resident could have increased falls and is at risk for UTIs. Resident #33 She said she completed the comprehensive MDS assessment dated [DATE] and confirmed the resident triggered for vision and pain. She said the resident's potential negative outcome would be injuries, falls, and increased pain. Resident #4 She said that she completed the comprehensive MDS assessment dated [DATE] and confirmed the resident triggered for behavior. She said the resident would refuse to eat. She said without a care plan, staff would not know how to meet her needs and address or communicate with her. During an interview with the DON on 04/06/23 at 11:24 AM, he said both MDS nurses, ADON, and DON were responsible for care plans. He said he had been trained regarding care plans, but it has been about four years and mostly on the job training. He stated he had not had any formal training regarding care plans. He said a care plan was a plan of care for a resident stay. He said everybody used the care plan, which was how the staff guided themselves when caring for the resident. He said it was what they would do for the resident during their stay at the facility. When asked if there was a system to monitor the completion of care plans, he said they have daily meetings and go over new admissions, readmits, and change of conditions. He said those residents are the focus. He said they try to review as many care plans as they could but their meeting in the mornings was only an hour long. He said they track and continue the process each morning and they are able to work on the ones they had not seen during the previous meetings. He said he expected the care plan to include the resident's activities of daily living, any difficulties they may have, assistance, or information the resident needs during meals, medications, and wounds, if applicable. He said he is unfamiliar with the CAAs generated from the MDS assessment, but that is where MDS nurses would address that portion. He said he was unaware that some residents were missing care plans. He said the only reason areas would not be care planned would be because it was not brought to the attention of the nursing staff. He said a potential negative outcome for care areas not being care planned would be a decline in status in the area not care planned. He said the resident could end up in the hospital with other issues. During an interview with the ADM on 04/06/23 at 11:50 AM, he said the nurses are responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 24 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some care plans for the residents in the facility. He said he had care management people that updated care plans. He said the care management people are the MDS nurses in the facility. He said he knew what a care plan was, but as an ADM, he had limited practice with them. He said he had some care plan training in the past. He said a care plan was a plan that helped them take care of the resident while the resident was at the facility. He said the IDT and nurse aides used the care plan. He said the nurses also use the care plan. When asked if there is a system to monitor care plans after the MDS workers completed them, he said care plans are reviewed in the morning meetings and he was unaware of any issues before the surveyors entrance. He said his expectation was for the care plan to support the resident being taken of. He said he had looked at his care policy but that clinical was more familiar and that the question of the expectation was more of a clinical question. He said he is responsible for all activity in the facility as the administrator. When asked what the potential negative outcome of not care planning triggered care areas from the comprehensive MDS assessment was, his response was, If they are not care planning something that is triggered, the resident could have a negative outcome. That is my answer. Record review of the facility policy Care Plans, Comprehensive Care Plans, implemented 10/24/22, revealed the following documentation: Policy: It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. Definitions: Person-centered care means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives. Policy Explanation and Compliance Guidelines: 1. The care planning process will include an assessment of the resident's strengths and needs and will incorporate the resident's personal and cultural preferences in developing goals of care. Services provided or arranged by the facility, as outlined by the comprehensive care plan, shall be culturally competent and trauma-informed. 2. The comprehensive care plan will be developed within 7 days after the completion of the comprehensive MDS assessment. All Care Assessment Areas (CAAs) triggered by the MDS will be considered in developing the plan of care. Other factors identified by the interdisciplinary team, or in accordance with the resident's preferences, will also be addressed in the plan of care. The facility's rationale for deciding whether to proceed with care planning will be evidenced in the clinical record. 3. The comprehensive care plan will describe, at a minimum, the following: a. The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. b. Any services that would otherwise be furnished but are not provided due to the resident's exercise of his or her right to refuse treatment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 25 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some c. Any specialized services or specialized rehabilitation services the nursing facility will provide as a result of PASARR recommendations. d. The resident's goals for admission, desired outcomes, and preferences for future discharge. f. Resident specific interventions that reflect the resident's needs and preferences and align with the resident's cultural identity, as indicated. If the resident is non-English speaking, the facility will identify how communication will occur with the resident. The care plan will identify the language spoken and tools used to communicate. g. Individualized interventions for trauma survivors that recognizes the interrelation between trauma and symptoms of trauma, as indicated. Trigger-specific interventions will be used to identify ways to decrease the resident's exposure to triggers which re-traumatize the resident, as well as identify ways to mitigate or decrease the effect of the trigger on the resident. 6. The comprehensive care plan will include measurable objectives and timeframes to meet the resident's needs as identified in the resident's comprehensive assessment. The objectives will be utilized to monitor the resident's progress. Alternative interventions will be documented, as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 26 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to, based on a resident's comprehensive assessment, ensure that a resident who is fed by enteral means receives the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers for 2 of 5 residents with gastrostomy tubes (Residents #53 and #57); in that: 1) (Resident #53 and #57 had G-tube feedings that were not administered according to physician's orders, and 2) G-tube flushing equipment (flushing syringes) was not stored in a sanitary manner after use (Residents #53 and #57). These problems could result in the residents on feeding tubes experiencing feeding tube associated complications which could include aspiration pneumonia, discomfort, and inadequate nutrition. The findings include: Resident #53: Record review of the Order Summary Report dated 4/6/23 for female Resident #53 revealed the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses listed as dysphasia (swallowing disorder) following other cerebral vascular disease (heart disease), encounter for attention to gastrostomy (g-tube), unspecified dementia, adult failure to thrive, unspecified, protein-calorie malnutrition (inadequate nutrition), Type 2 diabetes mellitus with hyperglycemia (elevated blood sugar). Further record review of the Orders Summary Report revealed the following physician's orders: Enteral Feed Order every shift flush tube with 125 mls of water every six hours. Order Date 12/31/22. Start date 12/31/22 . Enteral Feed Order every shift Glucerna 1.2 at 50 MLS x 18 hours via peg-tube stationary pump. Downtime 7A-1 P (May substitute with Nestlé's Diabetisource 1.2) Ordered Date 2/21/23. Start date 2/21/23 Record review of the annual MDS for Resident #53, dated 7/13/22, documented that the resident had a Nutritional Approach which included parenteral/IV feeding while not a resident. It was also documented that the resident had a feeding tube while not a resident and while being a resident. The resident was identified as having diagnoses that included cerebral vascular accident/stroke, dementia, and malnutrition. The resident had no BIMS score and was identified as being severely impaired cognitively. Record review of the quarterly MDS dated [DATE] for Resident #53 documented the resident had a Nutritional Approach that included having a feeding tube while a resident. The resident was identified as having diagnoses that included cerebral vascular accident/stroke, dementia, and malnutrition. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 27 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0693 resident had no BIMS score and was identified being severely impaired cognitively. Level of Harm - Minimal harm or potential for actual harm Record review of the current undated care plan for Resident #53 revealed the following Problem (Resident) requires tube feeding R/T dysphasia. Date initiated: 7/30/21. Revision on: 9/17/21. Interventions listed revealed the following: (Resident) is total dependent with tube feeding and water flushes. See MD orders for current feeding orders. Date initiated: 7/31/21. Revision on: 7/8/22 . Observe/document/report PRN any S/SX of: aspiration . Date initiated: 7/30/21 .Water flushes as ordered. Date initiated: 2/17/22. Revision on: 10/2/22 Residents Affected - Few On 4/04/23 at 11:18 AM Resident #53, was observed in a lower air bed, and had a G-tube feeding labeled On at 1 PM off at 7 AM. 50 mL/hr, Glucerna Carbready 1.2 Cal and the level was at 550ml. The flush/water bag for the G-tube was at a level of approximately 700ml. It was labeled 125 mL (flush). The pump was off. On 4/4/23 at 1:18 PM an interview was conducted with LVN A, charge nurse for hall 200 regarding her residents. She stated the following: Resident #53's G-tube was continuous and off from 7 AM to 1 PM. On 4/5/23 at 9:22 AM Resident #53 was observed in bed on an air bed. She was awake and confused. The G-tube pump was turned off and the feeding was Glucerna 1.2 at 950 mL level. The flush/water bag was at 800ml level. The head of bed had a slight elevation. The resident's flushing syringe, for the G-Tube, had the plunger stored in the barrel and stored together in a bag. The syringe was dirty and had a white substance in the tip. On 4/6/23 at 8:57 AM Resident #53 was observed in bed asleep. The G-tube pump was on. The flushing/water bag was labeled On at 1 PM and off at 7 AM. The feeding rate was documented at 50 ml/hour flush 125 mls every six hours on the display on the pump. The Glucerna 1.2cal feeding bottle was labeled 4/6/23 On at 1 PM off at 7 AM. The resident's head of bed was elevated. Observation on 4/6/23 at 9:06 AM revealed the G-tube pump for Resident #53 was still on. On 4/6/23 at 9:38 AM Resident #53 was observed in bed. The resident's flushing syringe, for the G-Tube, had the plunger stored in the barrel and stored together in a bag. The syringe was dirty and had a white substance in the tip. The bag was dated 3/6/23. The g-tube pump was off. Resident #57: Record review of the Order Summer Summary Report for male Resident #57 dated 4/6/23 revealed the resident was admitted to the facility on [DATE] and was [AGE] years old. The diagnoses listed for the resident were: post COVID-19 condition, unspecified, unspecified, cirrhosis of the liver (liver damage), unspecified, severe protein - calorie malnutrition (inadequate nutrition), gastrointestinal hemorrhage, unspecified (intestinal bleeding), encounter for attention to gastrostomy (g-tube), hemiplegia and hemiparesis following cerebral infarction (heart attack), affected right dominant side (paralysis), and dysphasia following cerebral infarction (swallowing disorder). Further record review of the Order Summary revealed the following orders: Enteral Feed Order every shift - observe for signs of intolerance, i.e., Diarrhea, nausea and vomiting, constipation, abdominal distention/cramping, dehydration, fluid overload, aspiration, increased (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 28 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0693 Level of Harm - Minimal harm or potential for actual harm gastric residual, or hypo/hyper glycemia (low or high blood sugar). Order date 12/11/22. Start date 12/11/22 . Enteral Feed Order every shift. Enteral 1. - Feeding: administer Glucerna, 1.5 per peg tube via pump. Rate: 65 MLS/hour, for 18 hours/day. On at 1 PM stop 7A. Order Date 12/11/22. Start Date 12/11/22 . Residents Affected - Few Enteral Feed Order every shift for hydration bolus with 350 ML of water every six hours for hydration and tube patency. Order Date 12/11/22. Start Date 12/11/22 . Record review of the significant change MDS for Resident #57 dated 5/16/22 documented the resident had a BIMS score of four indicating that the resident was cognitively impaired. Further documentation of the significant change MDS revealed that the resident's primary medical condition was a stroke. Other diagnosis documented was aphasia (language disorder), hemiplegia (paralysis), and malnutrition. Further documentation on this MDS revealed that the resident had a Nutritional Approach that included parenteral/IV feedings while not a resident and feeding tube while not a resident and while a resident. Record review of the quarterly MDS dated [DATE] documented that Resident #57 had a primary medical condition of a stroke. Other diagnoses documented was aphasia (language disorder), hemiplegia (paralysis), and malnutrition. Further documentation on this MDS revealed that the resident had a Nutritional Approach that included parenteral/IV feedings while not a resident and feeding tube while not a resident and while a resident. The resident had a BIMS score of six indicating that the resident was cognitively impaired. Record review of the current undated care plan for Resident #57 documented the following Problem, (Resident) requires tube feeding related to dysphagia. Date initiated: 5/12/22. Revision on: 5/16/22. Goals listed revealed the following: (Resident) will be free of aspiration through the review date. Date initiated: 5/16/22. Revision on: 5/26/22. Target date: 6/16/23. (Resident) will remain free of side effects or complications related to tube feeding through review date. Date initiated: 5/16/22. Revision on: 5/26/22. Target date: 6/16/23 . Interventions listed included: Bolus of water as ordered for hydration and tube patency. Date initiated: 5/19/22. Revision on: 3/30/23 .Formula feeding as ordered. Date initiated: 5/19/22. Revision on: 12/23/22. Further record review of the current undated care plan for Resident #57 revealed a Problem reflecting, (Resident) is at risk for malnutrition related to alcohol abuse and cirrhosis of the liver. Date initiated: 3/17/22. Revision on: 3/17/22. Interventions included, Formula feeding via peg tube as ordered. Date initiated: 9/26/22. Revision on 12/23/22 On 4/04/23 at 11:13 AM Resident #57 was observed. The resident had a G-tube and the feeding was Glucerna 1.5 cal and it was at a level of 1000 cc. The G-Tube was turned off. The rate reflected on the feeding was 65 ml/hour. It was also labeled that the start time was 700 (7:00 AM), 4/4/23. The flushing/water bag was labeled continuous 350ml rate Q6 hours. The level on the water bag was 1000 mls. The resident was verbal but appeared confused. On 4/4/23 at 1:18 PM an interview was conducted with LVN A charge nurse for hall 200 regarding her residents. She stated the following: Resident #57 had a G-Tube, continuous. Off from 7 AM to 1 PM. The resident also consumed food orally. He had no weight loss and she was unsure if he was confused. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 29 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0693 Level of Harm - Minimal harm or potential for actual harm On 4/5/23 at 9:12 AM Resident #57 was observed in bed asleep, and the G-tube pump/feeding was off. The flushing syringe for the G-tube was stored in a bag and had been used. The plunger was stored in the barrel. There was a white substance in the tip of the syringe. The resident had Glucerna 1.5 Cal at approximately 550 mls level and the flushing/water bag was at 1000 mL level. The resident's head of bed was elevated. Residents Affected - Few On 4/6/23 at 8:51 AM Resident #57 was observed awake with the head of bed elevated. The resident's G-Tube was on and running. The Glucerna 1.5 cal bottle was labeled On 1pm off at 7 AM. Hung at 5 AM 4/6/23, 65 ml/hour. The flushing/water bag level was at 950ml. It was also observed that the plunger was stored inside the flushing syringe barrel. The syringe was soiled with a white substance. On 4/6/23 at 9:03 AM, while in Resident #57's room, an interview was conducted with the ADON (acting charge nurse for hall 200) regarding why the G-tubes were still running for Resident #53 and #57. He stated he was not sure why and was getting report from the night nurse who had been in charge of the hall, (RN A). On 4/6/23 at 9:06 AM observation of the G-tube pump for Resident #57 revealed it was still on. On 4/6/23 at 9:36 AM Resident #57 was observed, and his flushing syringe had the plunger stored in the barrel and wet with a white substance in the tip. The bag was dated 4/5. The pump was off. On 4/6/23 at 9:10 AM an interview was conducted with RN A who was the charge nurse for hall 200 on the night shift and had stayed into the day shift as charge nurse due to a staff call-in. She stated she did not see or check the G-tubes at 7:00 AM because she was checking on resident safety and oxygen needs. She added that a lot of things were going on at 6:45 AM such as day shift staff coming in that she did not know. She stated she wanted to keep residents safe and peaceful. She stated she should have known to check the G-tubes but was worried about safety and went into triage mode. She added there were two nurses and three CNAs on duty during the night shifts. She further stated she should call the residents' doctors about the G-tube feedings not being administered as ordered and should adjust the feeding two hours back and check the residual. Regarding what could result from a G-tube not being administered according to physician's orders and running too long, she stated she felt safe for Resident #53, who she had checked on, but residents could regurgitate from having too much feeding. Regarding her training/orientation at the facility, she stated she did several trainings, but could not recall which ones. She further stated she had worked in nursing homes for six years and worked at the facility six months. On 4/6/23 at 9:58 AM an interview was conducted with the DON regarding the G-tubes being left running and not according to the physician's order. Regarding why the G-tubes were left on, he state, staff told him RN A was behind on her work. He stated he told RN A to call the doctor and wait for a further response regarding the G-tubes. Regarding any competency checks for the nurses, he stated competency was checked on nurses. He added the facility had nurses go through a checklist and check off their competencies. The DON stated the nurse would identify what they were not competent on, and they were offered training by nurse management. He further stated that new employees received one to two weeks of orientation. Regarding whom was responsible to ensure that staff follow G-tube orders, he stated the nurses bring problems to nurse management, and the problems were addressed by the DON, ADON and sometimes the MDS nurse. He stated residents could experience dehydration and malnutrition if they do not get enough of the feeding as ordered or aspiration if it the G-tube feeding went on too long. Regarding care and storage of the flushing syringes, he stated when finished use, staff should clean it, and store the plunger and barrel separately and dry. He stated bacterial growth could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 30 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few result from storing the plunger and barrel together and dirty. Regarding why he thought the g-tube issues occurred, he stated people overlook things; staff habits. The DON stated nursing management needed to make more rounds and ensure staff were conducting care properly. On 4/6/23 at 1:15 PM an interview was conducted with the DON regarding the competency evaluation for RN A. He stated the old management company had a form about competencies, but RN A was hired after the transition to the new management company. He added RN A would have the current competency/orientation sheet. He further stated he was not sure where her current competency/orientation sheet was for RN A. Record review of the facility's current undated ORIENTATION form for RN/LPN revealed that the Topics/Essential Job Function, included prevention and control of infections, but did not specifically address G-tube care. On 4/6/23 at 12:54 PM an interview was conducted with Administrator regarding G-tube issues. He stated there was a potential for a negative outcome for residents if g-tube feedings were not administered according to physician's orders and flushing syringes were improperly stored. On 4/6/23 at 1:52 PM the DON was interviewed about G-tube in-services. He stated he was hired in October 2022, and had not conducted any in-services regarding G-tubes. Record review of the facility policy, titled Care and Treatment of Feeding Tubes, copyright 2022, revealed the following documentation, Policy: It is the policy of this facility to utilize feeding tubes in accordance with current clinical standards of practice, with interventions to prevent complications to the extent possible. Policy Explanation and Compliance Guidelines: 1. Feeding tubes will be utilized according to physician orders, which typically include: the kind of feeding, and its caloric value, volume, duration, mechanism of administration, and frequency of flush. 7. Direction for staff on how to provide the following care will be provided. d. Use of infection control precautions, and related techniques to minimize the risk of contamination. f. Ensuring that the administration of enteral nutrition is consistent with and follows the practitioner's orders. 10. The facility will notify and involve the physician or designated practitioner of any complications, and in evaluating and managing care to address the complications and risk factors. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 31 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure PRN orders for psychotropic drugs were limited to 14 days unless the attending physician or prescribing practitioner believed, and documented, that it was appropriate for the PRN order to be extended beyond 14 days, in that two of seven residents (Resident #4 and Resident #58) continued to receive psychotropic medications PRN for more than 14 days without a physician addressing the continued use of the medication: - Resident #4 continued to have a PRN order for Lorazepam(anti-anxiety) 0.5mg after 14 days without an evaluation by the physician for continued treatment. - Resident #58 continued to have a PRN order for Lorazepam(anti-anxiety) 0.5mg after 14 days without an evaluation by the physician for continued treatment. This failure could result in residents receiving psychotropic and antipsychotic medications when contraindicated and could also result in residents experiencing adverse drug reactions. The findings include: Resident #4 Record review of Resident #4's face sheet, dated 04/04/23, revealed a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses: Alzheimer's disease (memory disease), type 2 diabetes mellitus and lack of coordination. Record review of Resident #4's physician orders, dated 04/04/23, revealed an order for Lorazepam 0.5 mg 1 tablet by mouth every 4 hours as needed for increased agitation/anxiety with a start date of 03/07/23 and no end date. Record review of Resident #4's quarterly MDS, dated [DATE], revealed Section N - Medication Section

N0410 - Medications Received: B - Antianxiety - Given 0 out of 7 days. Record review of Resident #1's MAR from March 2023 revealed Lorazepam 0.5mg give 1 tablet by mouth every 4 hrs. as needed for anxiety with a start date of 03/07/23. Record review of the pharmacy consultant book from January 2023 to March 2023 revealed no pharmacy recommendations related to Resident #4's PRN Lorazepam. Record review of progress notes for Resident #1 revealed no documentation or rationale for the extended PRN Lorazepam order. Resident #58 Record review of Resident #58's face sheet, dated 3/23/23, revealed a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses: malignant neoplasm of liver (liver cancer) and traumatic brain injury. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 32 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0758 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #58's physician orders, dated 04/04/23, revealed an order for Lorazepam 0.5mg 1 tablet by mouth PRN every 4 hours as needed for anxiety with a start date of 03/17/23 and no end date. Record review of Resident #58's quarterly MDS, dated [DATE], revealed Section N - Medication Section

N0410 - Medications Received: B - Antianxiety - Given 0 out of 7 days. Residents Affected - Few Record review of Resident #58's MAR from March 2023 revealed Alprazolam 0.5mg 1 tab PO PRN was currently ordered with a start date of 03/17/23 and an indefinite end date. Record review of the pharmacy consultant book from January 2023 to March 2023 revealed no pharmacy recommendations related to Resident #58's PRN Lorazepam. Record review of progress notes for Resident #58 revealed no documentation or rationale for the extended PRN Lorazepam order. Interview on 04/05/23 at 12:18 PM, the DON stated that he was responsible for ensuring PRN antipsychotic medications were not extended beyond 14 days. The DON stated that both residents were on hospice services and the orders were just looked over. The DON stated he was not sure the last time medications were checked for PRN antipsychotic medications. The DON stated the residents had an increased risk for sedation and over-medication due to an extended PRN antipsychotic medication order. Interview on 04/06/23 at 11:26 AM, the ADM stated it was the responsibility of the DON to check on PRN psychotropic medications. The ADM stated he does not know how this failure occurred and believes the orders were overlooked due to the residents being on hospice. The ADM stated that the residents were at risk of over sedation related to the psychotropic PRN medications. Record review of facility policy titled, Psychotropic Medication with a date of 08/15/22 reflected the following: Policy: Residents are not given psychotropic drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record, and the medication is beneficial to the resident, as demonstrated by monitoring and documentation of the residents response to the medication(s). Policy Explanation and Compliance Guidelines: .9. PRN orders for all psychotropic drugs shall be used only when the medication in necessary to treat a diagnosed specific condition that is documented in the clinical record, and for a limited duration (i.e. 14 days) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 33 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review, the facility failed to store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys, in that: One of one medication rooms was unlocked and unattended on four different occasions. LVN A left medications on storage cart unlocked and unattended in the hallway. These failures could result in the theft or misuse of medications. The findings include: 4/4/23 at 8:39 AM an observation was made of the hall 300 medication room entrance door. The door was ajar unlocked, and the room was unattended. 4/4/23 at 12:24 PM, an observation was made of the hall 300 medication room unlocked and unattended. 4/4/23 at 1:59 PM an observation was made of the hall 300 medication room, and the door was a jar, unlocked, and the room was unattended. 4/4/23 at 2:07 PM an observation was made of the hall 300 medication room, and the door was still ajar and the room was unattended. During an observation of medication pass on 4/5/23, LVN A left medications on top of the cart unlocked and unattended while she administered medications in the resident's room. Interview on 4/5/23 at 12:22 PM, LVN A stated she should not have left medications on the cart unlocked and unattended. LVN A stated one of the resident's could have taken the medications. LVN A stated she has been trained to keep the medications locked in the cart but doesn't remember the last time she was trained. Interview on 4/6/23 at 10:15 AM, the DON stated that the medication room should be locked at all times and the medications should never be left on the medication cart unlocked and unattended. The DON stated the medications being accessible is a risk for misplaced or mishandled medications. Record review of the facility policy titled, Medication Administration, with a revised date of 10/01/19 reflected the following: Procedure: 2. The medication cart is locked at all times when not in use. 3. Do not leave the medication cart unlocked or unattended in the resident care areas FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 34 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide food that was palatable, attractive and at a safe and appetizing temperature for 3 of 3 meals. Residents Affected - Some 1) The facility failed to provide food that was palatable for 3 of 3 meal observed (4/04/23, lunch and dinner) and 4/05/23, lunch). These failures could place residents at risk of decreased food intake, hunger, and unwanted weight loss. The findings include: During the Resident Council Meeting on 4/05/23 at 10:00 AM, residents were confidentially interviewed about food palatability. Two of 6 residents voiced concerns about the temperature and flavor of the food served. One resident stated the food was always cold. The resident further stated he ate in his room and the tortillas were not cooked well and were soggy. Another resident stated the food was always cold; all meals were cold. - The following observations were made, and interviews conducted during a kitchen tour on 4/4/23 that began at 11:50 AM and concluded at 12:58 PM: On 4/4/23 at 12:18 PM temperatures were taken on the service line by Dietary Staff B. Purée meat/Carne Guisada was 135°F and had a coarse/grainy appearance Puréed potato tots were 124°F and had a coarse/ grainy appearance Puréed mixed vegetables were 140°Fand had a coarse/ grainy appearance On 4/4/23 at 12:50 PM puréed foods were sampled. The results of the test were as follows: The puréed potato tots were coarse and chunky. The puréed, mixed vegetables were grainy, coarse, and had bits of whole vegetable. The puréed Carne Guisada/ground beef was grainy, coarse and had bits of gristle. On 4/4/23 at 12:52 PM an interview was conducted with Dietary Staff B regarding training she received related to puréed foods. She stated she was told it should be like pudding and a spoon should stand up in it. On 4/4/23 at 1:08 PM an observation was made in the dining room. Three residents received puréed foods and were being fed by staff. Residents #18, #11, and #43 were seated at the same table and served a purée diet. They received pureed bread, pureed mix vegetables, puréed meat/carne guisada and puréed potato tots. On all three trays the puréed vegetables were visibly coarse with strings and grainy. The purée meat was coarse and grainy. The purée tots were visibly coarse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 35 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of the Order Summary Report dated 4/5/23 for female Resident #43 revealed the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses listed as muscle wasting, not elsewhere classified, unspecified, Alzheimer's disease (dementia disorder), unspecified and dysphasia, unspecified (swallowing disorder) and unspecified proteins - calorie malnutrition (lack of proper nutrition). Further record review of the orders revealed that the resident had an order of, Regular diet, puréed texture, regular liquids consistency for diet. Order date 6/10/20. Start date 6/10/20. Record review of the Order Summary Report for female Resident #11, dated 4/5/23, revealed the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses of: chronic kidney disease, stage three unspecified, unspecified, Alzheimer's disease, unspecified (dementia disorder), abnormal weight loss, and primary open angle, glaucoma, left eye, moderate stage (vision disorder). Further record review of the Order Summary Report revealed a diet order of, Regular diet, puréed texture, regular liquid consistency, prune juice with meals, encourage fluid intake. Order date, 9/20/22. Start date 9/20/22. An additional order documented, SPEECH THERAPY: 92610 Dysphagia Evaluation and Treat. Prescriber Written Active 11/03/2021. Order Date 11/03/21 Record review of the Order Summary Report for female Resident #18 dated 4/5/23 revealed the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses of bipolar disorder, unspecified (mental disorder), Type 2 diabetes mellitus without complications (blood sugar disorder), mild proteins - calorie malnutrition (lack of proper nutrition), Alzheimer's disease (dementia), unspecified. Further record review of the Order Summary Report revealed the resident had a diet order of NAS (no added salt) diet puréed texture, regular liquid consistency, lactose free. Order date 10/2/22. Start date 10/2/22. On 4/6/23 at 12:23 PM an interview was conducted with the DON regarding the reason Resident #18 was on a purée diet. He stated the resident rolled food in her mouth with any other texture of food, other than puree. - The following observations were made during a kitchen tour on 4/04/23 that began at 3:43 PM and concluded at 5:33 PM: On 4/4/23 at 5:02 PM temperatures were taken on the service line by Dietary Staff C. Puréed, macaroni cheese and ham dish was 110°F and ham bits were visible On 4/4/23 at 5:26 PM the surveyor requested to sample the puréed foods of the puréed macaroni cheese and ham dish. The puréed macaroni cheese and ham dish had whole pieces of diced ham and was coarse in texture. The purée was shown to the Visiting Dietary Manager. On 4/4/23 at 5:41 PM an observation was made of the dining room and the same three residents, Residents #11, #18 and #43 were seated together and fed by staff. All three received a puréed diet which included puree carrots, puree bread and purée macaroni cheese and ham dish. Observation of the pureed macaroni cheese and ham dish revealed that bits of ham were visible. - The following observations were made, and interviews conducted during a kitchen tour on 4/05/23 that began at 11:35 AM and concluded at 1:22 PM: On 4/05/23 at 11:35 AM the Dietary Manager was informed that a test tray would be requested from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 36 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0804 dining room service and corridor service. Level of Harm - Minimal harm or potential for actual harm On 4/05/23 at 12:12 PM observations were made of foods on the steam table and of Dietary Staff B taking temperatures with the following results: Residents Affected - Some The puréed chicken was 163°F. The mashed potatoes was 140.4°F. The puréed green beans was 157°F. There were bits of a brown substance observed in the food and it appeared coarse. The mechanically altered chicken was 159.5°F. The green beans were 180°F The regular tarragon chicken was 175°F. The diced potatoes were 150°F. The mashed potatoes were192°F. The baked Fish was 132°F and then was later reheated. No temperature was taken. The brown gravy was 153°F. The puréed bread on the counter at the service line at room temperature and not on any source of heating or cooling. No temperature was taken. Observation on 4/5/23 at 12:40 PM the meal tray for Resident #37 was observed being prepared. She received puréed chicken, mashed potatoes with gravy, purée bread, and puréed green beans. The pureed green beans had visible hulls/bits and skins. Record review of the Order Summary Report for female Resident #37, dated 4/5/23, revealed that the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses of functional quadriplegia (paralysis), dysphasia (swallowing disorder), following other cerebrovascular disease (heart disease), and Alzheimer's disease (dementia), unspecified. Further record review of the Order Summary Report revealed a diet order of, NAS (no added salt) diet, purée texture, regular liquid consistency. Order date 10/21/22. Start date 10/21/22. Observation on 4/5/23 at 12:56 PM the meal tray for Resident #49 was observed being prepared. She received puréed chicken, mashed potatoes with gravy, purée bread, and puréed green beans. The pureed green beans had visible hulls/bits and skins. Record review of the Order Summary Report for male Resident #49 dated 4/5/23 revealed that the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses of epilepsy, unspecified, not intractable, without status epilepticus (convulsions), dehydration (reduced hydration), dysphasia, following cerebral infarction (swallowing disorder), and muscle wasting and atrophy. Further record review of the Order Summary Report revealed a diet order of, Regular diet, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 37 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0804 puréed texture, regular liquids consistency. Order date 2/3/23. Start date 2/3/23. Level of Harm - Minimal harm or potential for actual harm The last dining room tray was served at 12:55 PM. The test tray preparation began at 12:55 PM. The test tray prep was completed at 12:59 PM and left the kitchen at this time. Residents Affected - Some - On 4/05/23 at 1:02 PM, surveyors tested the test trays with the following results: The mashed potatoes were 116°F, lukewarm and bland. The puréed chicken was 120°F, lukewarm and coarse. The puréed beans were 120°F, had a tart flavor and had hulls/skins. The diced potatoes were lukewarm and 98°F. The green beans were bland, cold, and 111.2°F. The fish was 104°F, tough, salty/spicy and cold. The roll was burned and hard. Testing ended at 1:10 PM. Observation of the Hall 100 tray prep revealed it began at 1:13 PM. The last tray for hall 100 was prepared at 1:18 PM. The test tray prep for hall 100 began at 1:19 PM and the hall 100 cart left the dining room at 1:22 PM. The cart arrived on the unit at 1:23 PM. The last tray was served on hall 100 at 1:29 PM. One staff member was serving trays on the hall. - On 4/05/23 at 1:31 PM, surveyors tested the test trays with the following results: The fish was 100°F, cool and tough. The roll was hard and burned. The puréed chicken was 128°F, warm but coarse. It needed to be chewed. The mashed potatoes were 111°F, lukewarm and bland. The green beans were 110°F, bland and lukewarm. The diced potatoes were 113°F and bland The puréed green beans were 116°F, coarse with hulls, skins, and strings The mechanical altered chicken was cool, bland and 104.7°F. The testing ended at 1:39 PM. On 4/4/23 at 9:46 AM an interview was conducted with Dietary staff B. Regarding training, she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 38 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated that she had worked in the facility three weeks. She added she shadowed another cook for three or four days and then slowly she was allowed to work by herself. On 4/5/23 at 2:24 PM an interview was conducted with Dietary staff B regarding observations in the kitchen. Regarding food palatability and purées for all three meals, she stated she thought the tater tot skins were a problem and she should have use mashed potatoes. She added the vegetables were hard to purée, and one vegetable dish contained broccoli. She further stated beef was hard to purée. She stated residents who consumed improperly pureed foods could choke on it. She added that staff watched for chunks in the food. On 4/5/23 at 4:49 PM an interview was conducted with a Dietary staff C regarding issues in the kitchen. She stated she started working as a cook approximately two weeks ago, and she worked as a dishwasher since November 2022. Regarding puréed food and food palatability, she stated staff were trained that puréed food should not be too soggy or watery. Dietary staff C stated a spoon should stand up in it and it should be pudding consistency. Regarding the pureed foods served, she stated it was possible staff did not puree the food long enough, or it might be a problem with the processor blades. She stated residents who consumed improperly pureed foods could choke. On 4/6/23 at 11:00 AM an interview was conducted with a Dietary Manager regarding issues found in the dietary department. Regarding food palatability and puree preparation, she stated the processor may have been a faulty blade. She added staff puréed long and some vegetables were not good to purée. Regarding training related to pureeing, she stated she had not given any formal training for puréed foods. The Dietary Manager stated staff did not sign an in-service form and it was a verbal training only. She stated she instructs staff that pureed foods should be like baby food; smooth, not dry, not too wet. She added if a spatula is used, it should stand in the food. She stated she and the cook were responsible to ensure that purées were produced correctly. She further stated residents could choke as a result of improperly pureed foods. Regarding food palatability related to the test trays, she stated maybe the facility needed a warmer, but there was no space for a warmer. She added that staff serve as fast as they can. She further stated she tells staff to season the food. She added that when she cooks vegetables seasonings were used. She stated she was responsible to ensure that the food was palatable. She added that residents would not eat the food and could get angry if foods were not palatable. Regarding resident communication related to palatability of the foods, she stated if residents were happy the resident care aides tell the dietary staff. She stated she had attended three or four resident council meetings since being hired. On 4/6/23 at 12:54 PM an interview was conducted with Administrator regarding dietary department issues. Regarding food palatability and puree issues in the dietary department, he stated residents may not eat foods that were not palatable. He added that he sampled the food in the facility. Record review of the facility's guidelines, titled National Dysphasia Diet Level 1: Purée, dated July 14, 2021, revealed the following documentation, The Level 1: Purée diet follows the regular diet menu items whenever possible with the modification of puréeing the food item. Foods are modified to a consistency that is pudding like. Considerations for specific food items. Fried potatoes and potatoes with peels - the potato peel is restricted and smooth mashed or puréed potatoes without any lumps are served as the substitute. Food Groups. Proteins Foods. Avoid. Tough, dry, whole, or ground, red meat, (beef, pork, lamb). Tough, dry, whole or ground poultry, (chicken and turkey). Record review of the facility policy, titled, Policy: Menu Planning, Policy Number: 01.002, Date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 39 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0804 Level of Harm - Minimal harm or potential for actual harm revised: June 1, 2019, revealed the following documentation, Policy: the facility believes that nutrition is an important part of maintaining the well-being and health of its residents, and is committed to providing a menu that is well-balanced, nutritious and meets the preferences of the resident population. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 40 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure each resident received and the facility provided food prepared in a form designed to meet individual needs, for 3 of 3 meals observed for 5 of 5 residents with orders for pureed diets (Residents #11, 18, 37, 43 and 49); in that: 1) The facility failed to provide food that was in a form to meet resident needs during 3 of 3 meal observed (4/04/23, lunch and dinner) and 4/05/23, lunch) for 5 of 5 residents with orders for pureed diets (Residents #11, 18, 37, 43 and 49). These failures could place residents at risk of decreased food intake and choking. The findings include: - The following observations were made, and interviews conducted during a kitchen tour on 4/4/23 that began at 11:50 AM and concluded at 12:58 PM: On 4/4/23 at 12:18 PM temperatures were taken on the service line by Dietary Staff B. Purée meat/Carne Guisada was 135°F and had a coarse/grainy appearance Puréed potato tots were 124°F and had a coarse/ grainy appearance Puréed mixed vegetables were 140°Fand had a coarse/ grainy appearance On 4/4/23 at 12:50 PM puréed foods were sampled. The results of the test were as follows: The puréed potato tots were coarse and chunky. The puréed, mixed vegetables were grainy, coarse, and had bits of whole vegetable. The puréed Carne Guisada/ground beef was grainy, coarse and had bits of gristle. On 4/4/23 at 12:52 PM an interview was conducted with Dietary Staff B regarding training she received related to puréed foods. She stated she was told it should be like pudding and a spoon should stand up in it. On 4/4/23 at 1:08 PM an observation was made in the dining room. Three residents received puréed foods and were being fed by staff. Residents #18, #11, and #43 were seated at the same table and served a purée diet. They received pureed bread, pureed mix vegetables, puréed meat/carne guisada and puréed potato tots. On all three trays the puréed vegetables were visibly coarse with strings and grainy. The purée meat was coarse and grainy. The purée tots were visibly coarse. Record review of the Order Summary Report dated 4/5/23 for female Resident #43 revealed the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses listed as muscle wasting, not elsewhere classified, unspecified, Alzheimer's disease (dementia disorder), (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 41 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some unspecified and dysphasia, unspecified (swallowing disorder) and unspecified proteins - calorie malnutrition (lack of proper nutrition). Further record review of the orders revealed that the resident had an order of, Regular diet, puréed texture, regular liquids consistency for diet. Order date 6/10/20. Start date 6/10/20. Record review of the Order Summary Report for female Resident #11, dated 4/5/23, revealed the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses of: chronic kidney disease, stage three unspecified, unspecified, Alzheimer's disease, unspecified (dementia disorder), abnormal weight loss, and primary open angle, glaucoma, left eye, moderate stage (vision disorder). Further record review of the Order Summary Report revealed a diet order of, Regular diet, puréed texture, regular liquid consistency, prune juice with meals, encourage fluid intake. Order date, 9/20/22. Start date 9/20/22. An additional order documented, SPEECH THERAPY: 92610 Dysphagia Evaluation and Treat. Prescriber Written Active 11/03/2021. Order Date 11/03/21 Record review of the Order Summary Report for female Resident #18 dated 4/5/23 revealed the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses of bipolar disorder, unspecified (mental disorder), Type 2 diabetes mellitus without complications (blood sugar disorder), mild proteins - calorie malnutrition (lack of proper nutrition), Alzheimer's disease (dementia), unspecified. Further record review of the Order Summary Report revealed the resident had a diet order of NAS (no added salt) diet puréed texture, regular liquid consistency, lactose free. Order date 10/2/22. Start date 10/2/22. On 4/6/23 at 12:23 PM an interview was conducted with the DON regarding the reason Resident #18 was on a purée diet. He stated the resident rolled food in her mouth with any other texture of food, other than puree. - The following observations were made during a kitchen tour on 4/04/23 that began at 3:43 PM and concluded at 5:33 PM: On 4/4/23 at 5:02 PM temperatures were taken on the service line by Dietary Staff C. Puréed, macaroni cheese and ham dish was 110°F and ham bits were visible On 4/4/23 at 5:26 PM the surveyor requested to sample the puréed foods of the puréed macaroni cheese and ham dish. The puréed macaroni cheese and ham dish had whole pieces of diced ham and was coarse in texture. The purée was shown to the Visiting Dietary Manager. On 4/4/23 at 5:41 PM an observation was made of the dining room and the same three residents, Residents #11, #18 and #43 were seated together and fed by staff. All three received a puréed diet which included puree carrots, puree bread and purée macaroni cheese and ham dish. Observation of the pureed macaroni cheese and ham dish revealed that bits of ham were visible. - The following observations were made, and interviews conducted during a kitchen tour on 4/05/23 that began at 11:35 AM and concluded at 1:22 PM: On 4/05/23 at 11:35 AM the Dietary Manager was informed that a test tray would be requested from dining room service and corridor service. On 4/05/23 at 12:12 PM observations were made of foods on the steam table and of Dietary Staff B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 42 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0805 taking temperatures with the following results: Level of Harm - Minimal harm or potential for actual harm The puréed chicken was 163°F. The mashed potatoes was 140.4°F. Residents Affected - Some The puréed green beans was 157°F. There were bits of a brown substance observed in the food and it appeared coarse. Observation on 4/5/23 at 12:40 PM the meal tray for Resident #37 was observed being prepared. She received puréed chicken, mashed potatoes with gravy, purée bread, and puréed green beans. The pureed green beans had visible hulls/bits and skins. Record review of the Order Summary Report for female Resident #37, dated 4/5/23, revealed that the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses of functional quadriplegia (paralysis), dysphasia (swallowing disorder), following other cerebrovascular disease (heart disease), and Alzheimer's disease (dementia), unspecified. Further record review of the Order Summary Report revealed a diet order of, NAS (no added salt) diet, purée texture, regular liquid consistency. Order date 10/21/22. Start date 10/21/22. Observation on 4/5/23 at 12:56 PM the meal tray for Resident #49 was observed being prepared. She received puréed chicken, mashed potatoes with gravy, purée bread, and puréed green beans. The pureed green beans had visible hulls/bits and skins. Record review of the Order Summary Report for male Resident #49 dated 4/5/23 revealed that the resident was admitted to the facility on [DATE] and was [AGE] years old. The resident had diagnoses of epilepsy, unspecified, not intractable, without status epilepticus (convulsions), dehydration (reduced hydration), dysphasia, following cerebral infarction (swallowing disorder), and muscle wasting and atrophy. Further record review of the Order Summary Report revealed a diet order of, Regular diet, puréed texture, regular liquids consistency. Order date 2/3/23. Start date 2/3/23. The last dining room tray was served at 12:55 PM. The test tray preparation began at 12:55 PM. The test tray prep was completed at 12:59 PM and left the kitchen at this time. - On 4/05/23 at 1:02 PM, surveyors tested the test trays with the following results: The puréed chicken was 120°F, coarse and needed to be chewed. The puréed beans were 120°F, had hulls/skins. Testing ended at 1:10 PM. Observation of the Hall 100 tray prep revealed it began at 1:13 PM. The last tray for hall 100 was prepared at 1:18 PM. The test tray prep for hall 100 began at 1:19 PM and the hall 100 cart left the dining room at 1:22 PM. The cart arrived on the unit at 1:23 PM. The last tray was served on hall 100 at 1:29 PM. One staff member was serving trays on the hall. - On 4/05/23 at 1:31 PM, surveyors tested the test trays with the following results: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 43 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 0805 The puréed chicken was 128°F, coarse. It needed to be chewed. Level of Harm - Minimal harm or potential for actual harm The puréed green beans were 116°F, coarse with hulls, skins, and strings The testing ended at 1:39 PM. Residents Affected - Some On 4/4/23 at 9:46 AM an interview was conducted with Dietary staff B. Regarding training, she stated that she had worked in the facility three weeks. She added she shadowed another cook for three or four days and then slowly she was allowed to work by herself. On 4/5/23 at 2:24 PM an interview was conducted with Dietary staff B regarding observations in the kitchen. Regarding food purées for all three meals, she stated she thought the tater tot skins were a problem and she should have use mashed potatoes. She added the vegetables were hard to purée, and one vegetable dish contained broccoli. She further stated beef was hard to purée. She stated residents who consumed improperly pureed foods could choke on it. She added that staff watched for chunks in the food. On 4/5/23 at 4:49 PM an interview was conducted with a Dietary staff C regarding issues in the kitchen. She stated she started working as a cook approximately two weeks ago, and she worked as a dishwasher since November 2022. Regarding puréed food, she stated staff were trained that puréed food should not be too soggy or watery. Dietary staff C stated a spoon should stand up in it and it should be pudding consistency. Regarding the pureed foods served, she stated it was possible staff did not puree the food long enough, or it might be a problem with the processor blades. She stated residents who consumed improperly pureed foods could choke. On 4/6/23 at 11:00 AM an interview was conducted with a Dietary Manager regarding issues found in the dietary department. Regarding puree preparation, she stated the processor may have been a faulty blade. She added staff puréed long and some vegetables were not good to purée. Regarding training related to pureeing, she stated she had not given any formal training for puréed foods. The Dietary Manager stated staff did not sign an in-service form and it was a verbal training only. She stated she instructs staff that pureed foods should be like baby food; smooth, not dry, not too wet. She added if a spatula is used, it should stand in the food. She stated she and the cook were responsible to ensure that purées were produced correctly. She further stated residents could choke as a result of improperly pureed foods. She stated she was responsible to ensure that the food was palatable and in the correct form. She added that residents would not eat the food and could get angry if foods were not palatable. On 4/6/23 at 12:54 PM an interview was conducted with Administrator regarding dietary department issues. Regarding food palatability and puree issues in the dietary department, he stated residents may not eat foods that were not palatable. He added that he sampled the food in the facility. Record review of the facility's guidelines, titled National Dysphasia Diet Level 1: Purée, dated July 14, 2021, revealed the following documentation, The Level 1: Purée diet follows the regular diet menu items whenever possible with the modification of puréeing the food item. Foods are modified to a consistency that is pudding like. Considerations for specific food items. Fried potatoes and potatoes with peels - the potato peel is restricted and smooth mashed or puréed potatoes without any lumps are served as the substitute. Food Groups. Proteins Foods. Avoid. Tough, dry, whole, or ground, red meat, (beef, pork, lamb). Tough, dry, whole or ground poultry, (chicken and turkey). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 44 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for 5 of 5 staff (Dietary staff A, B, C, D and E) and 1 of 1 kitchen, in that: 1) Dietary staff failed to store, serve or process foods in a manner to prevent contamination, 2) Dietary staff failed to handle food contact equipment in a manner to prevent contamination, 3) Dietary staff failed to ensure food contact surfaces were clean, 4) Dietary staff failed to perform sanitary handwashing between the handling of soiled and clean food equipment during dishwashing, 5) Dietary staff failed to use good hygienic practices, including incorrect handwashing techniques, 6) TCS/PHF foods were not maintained at 41 degrees F and below or 135 degrees F or above 7) The dial probe thermometers were not accurate 8) Wiping cloth quaternary sanitizer solutions were not at required levels and was not tested correctly 9) Food contact equipment storage areas were not maintained in a clean and sanitary manner 10) Dietary staff restroom did not have a functioning hand sink 11) Staff failed to effectively prevent the entry of pests/flies in the kitchen 12) Foods were spoiled and past their recommended expiration/use dates 13) Food preparation area nonfood contact surfaces were not clean, and 14) Foods were not thawed in a safe manner. These failures could place residents at risk for food contamination and foodborne illness. The findings include: - The following observations were made, and interviews conducted during a kitchen tour on 4/4/23 that began at 9:25 AM and concluded at 10:45 AM: Dietary staff B was observed washing her hands in the two-compartment sink. Dietary staff A was observed touching the trashcan lid and then handling clean trays. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 45 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 There was one of two sets of lights that were unshielded in the dishwasher area. Level of Harm - Minimal harm or potential for actual harm The dishwashing area refrigerator had an opened zip top bag of three bean salad and an opened zip top bag of mixed vegetables. Both opened to air. Residents Affected - Many The oven area walls were dirty with a heavy accumulation of dried spills and the kitchen return air vents had a buildup of grease. Observation and interview on 4/04/23 at 9:40 AM there were 2 wiping cloth buckets observed near the kitchen 2 compartment sink, one was green, and one was red. There were cloths in both. Dietary staff B took a chlorine test strip and tested the liquid in the red bucket. The results was 0 ppm. Regarding the contents of the red bucket, she stated at this time she did not know what solution was in it, and that other staff set up the buckets for them. Observation of the lower wooden kitchen cabinetry revealed that the shelving was scarred and had peeling paint. The doors and exterior of the cabinetry had a buildup of encrusted dried food and dirt. On 4/4/23 at 9:46 AM an interview was conducted with Dietary staff B. She stated she had worked at the facility three weeks and shadowed another cook for three or four days. Dietary staff B stated staff slowly allowed her to work alone. The hand sink in the kitchen employee's restroom was lying on the floor. On 4/4/23 at 9:49 AM an interview was conducted with Dietary staff A regarding the broken restroom hand sink. She stated, the hand sink fell off the wall on Sunday (4/02/23). She further stated they would have to wait until the Maintenance Supervisor came back to get it repaired. She added the Maintenance Supervisor would be off duty this week. Dietary staff A was observed handling soiled dishes, then washed her hands in the dishwasher area two compartment sink at the same time Dietary staff B was washing a colander in the same two compartment sink. Dietary staff B then washed her hands in the two-compartment sink in the dishwasher area which had dirty pans in it. After washing her hands, she disposed of the paper towel on top of a large trashcan. There was a large tube of frozen hamburger in a pan on a counter at the kitchen two compartment sink. There was a small amount of water in the pan, but the hamburger was not submerged in the standing water. The lower shelf of the stove area prep table was heavily soiled with grease buildup. The kitchen's three door refrigerator had a half a block of margarine that was uncovered exposed to air. There was also a zip top bag of small peppers that had six of the peppers that were molded and black. The zip top bag was labeled 1/11/23. There was also a 32-ounce container of Dannon yogurt that was labeled by the facility Use by 3/6/23. The manufacturer's label on the yogurt reflected, Best if used by December 26, 2022. Observation of the metal cabinetry drawers and bins revealed the scoop and ladle storage drawers were lined with heavily soiled paper. There were dried spills and scarring on the exterior of the drawers and bins of the cabinetry. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 46 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 In the pantry there was a large bag of brown sugar and a box of lentils that was open exposed to air. There was one 4-ounce container of Imperial Thickened Apple Juice from Concentrate that was stored on a shelf with current foods. The container's manufacture's label reflected Used by 2/02/23. The interior flashing of the icemaker had dried spills/smears. Residents Affected - Many On 4/4/23 at 10:13 AM the large tube of frozen hamburger was now on a pan with no water in the pan at the kitchen two compartment sink. On 4/4/23 at 10:18 AM an interview was conducted with Dietary staff B regarding the frozen hamburger. She state, the hamburger would be used to make Carne Guisada for the noon meal. Dietary staff A was observed washing her hands in the two-compartment sink in the dishwasher area. She turned off the water with her bare hands She then dried her hands with a paper towel. Next, she handled clean dishes and put them away. On 4/4/23 at 10:22 AM Dietary staff B was about to prepare the puréed mixed vegetables. At that time the surveyor asked to see the interior of the processor and the blade before the food was added. The blade was dirty and had puréed beans on the lid. The lid stirrer was also dirty. Dietary staff B then took the processor back to the two-compartment sink and washed the lid with water only. She then placed it on the processor wet, placed the mixed vegetables in the processor pot and puréed them. Dietary staff A opened the kitchen exit door to the outside and left it open as a visitor was standing in the doorway. This action could allow flies/insects to enter the kitchen. Dietary staff B was washing her hands at the two-compartment sink and then she turned off the sink water with a paper towel. She then continued to dry her hands with the same paper towel. - The following observations were made, and interviews conducted during a kitchen tour on 4/04/23 that began at 11:50 AM and concluded at 12:58 PM: On 4/4/23 at 11:57 AM Dietary staff C and Dietary staff D were standing in the opened kitchen doorway to the outside entrance. They stood there from 11:57 AM to 11:59 AM. At that time a fly was observed, landing on uncovered bowls of peaches in the kitchen. Dietary staff D entered the kitchen and washed his hands in the two-compartment sink in the dishwasher area. He turned off the water then dried his hands with a paper towel. Next, he continued dietary duties. There were also soiled dishes in that two-compartment sink at the time. On 4/4/23 at 12:18 PM temperatures were taken on the service line by Dietary staff B. She used a dial probe thermometer. At this time, she stated, she was not sure how often the thermometer was calibrated for accuracy. The following were the temperatures taken: The mixed vegetables were 150°F. The potato tots were 142°F. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 47 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 The carne guisada was 140°F. Level of Harm - Minimal harm or potential for actual harm The purée meat/Carne guisada was 135°F. The puréed potato tots were 124°F. Residents Affected - Many The puréed mixed vegetables were 140°F. The puréed bread was 90°F and had been placed on the kitchen prep table at room temperature and not on any heat or cooling source since 11:50 AM when first observed by the surveyor. The breaded pork patty was 126°F and was not reheated to 165°F or maintained at 135°F. prior to meal service. On 4/04/23 at 12:25 PM, an interview was conducted with Dietary staff B regarding the preparation of the pureed bread. She stated she prepared the pureed bread using bread and milk. On 4/4/23 at 12:35 PM, the calibration on the facility's dial thermometer was checked with Dietary staff B. The surveyor's and the facility's thermometer were placed in ice water and the facility dial thermometer read 25°F and the surveyor's digital thermometer read 32.7°F. - The following observations were made, and interviews conducted during a kitchen tour on 4/04/23 that began at 3:43 PM and concluded at 5:33 PM: On 4/04/23 at 3:43 PM the puréed bread was in a container at room temperature on the counter near the steam table and not on any heating or cooling source. Dietary staff D was handling soiled dishes at the dishwasher and then washed his hands at the dishwasher area two compartment sink and then put away clean dishes. There were pots in the sink basin where he washed his hands. Dietary staff D handled soil dishes at the dishwasher and then handled clean dishes and insulated lids and did not wash his hands between the soiled and clean duties. Dietary staff C placed macaroni and cheese and ham in the processor pot. The surveyor intervened and pointed out that the lid to the processor and scraper/stirrer had a buildup of food. At this time the Visiting Dietary Manager took the lid and washed it, but it still had food debris on it. The Visiting Dietary Manager then washed it again and it was clean. On 4/4/23 at 4:00 PM an interview was conducted with Dietary staff C regarding the puréed bread. She stated she made the pureed bread with bread, milk, and cinnamon. On 4/4/23 at 4:09 PM an interview was conducted with the Visiting Dietary Manager regarding the green bucket and the red bucket that had wet wiping cloths in them. She stated the green bucket contained soap, and the red bucket contained sanitizer. At that time she tested the red bucket for quaternary sanitizer (Autochlor Solution QA) with quaternary test strips. The level of quaternary sanitizer was 0 ppm. The Visiting Dietary Manager changed out the sanitizer and it was 200 ppm. Observation and record review of the label of Auto Chlor System Solution Q A Sanitizer revealed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 48 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 following documentation, . Sanitizing Food Contact Surfaces: . 200 ppm, active of this product for sanitizing and cleaning of equipment and utensils in restaurants, bars, and institutional kitchens. Level of Harm - Minimal harm or potential for actual harm There was a live fly in the kitchen area. Residents Affected - Many On 4/4/23 at 5:02 PM temperatures were taken on the service line as follows: The macaroni cheese and ham dish was 165°F at the time Dietary staff C wiped the probe of the thermometer with a wet paper towel between each food. The carrots were165F°. The puréed macaroni cheese and ham dish was 110°F and reheated to 175 degrees F. The puréed carrots were 120°F and reheated to 167°F. The puree bread was at room temperature on the counter and was 80°F. The puréed macaroni and ham without cheese was 165°F. The regular ham and macaroni dish without cheese was 163°F. On 4/4/23 at 5:05 PM Dietary staff C was interviewed regarding her use of a wet paper towel to clean the thermometer probe between foods. She stated the paper towel only had water on it. Dietary staff C was observed grasping and touching the stove area preparation tabletop and edge with both hands. She then took one bare hand and flipped flour tortillas on a small skillet on the stove. - The following observations were made, and interviews conducted during a kitchen tour on 4/05/23 that began at 11:35 AM and concluded at 1:10 PM: Two of 2 drink guns had a buildup of syrup and debrison the spout. The walls in the oven area and two compartment sink area in the kitchen were dirty with splatter and dried spills and the return air vents were thick with dust and dirt. The dishwasher area had one of two sets of lights unshielded. The kitchen employee's restroom sink was off the wall and on the floor. Flies and gnats were observed in the kitchen area. There was a large bag of brown sugar that was open in the pantry and exposed to air. Observation of the kitchen area metal cabinetry revealed that there was peeling, and chipping paint and the interior of the drawers were lined with dirty paper. The icemaker interior flashing had dried spills. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 49 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 The lower wooden storage cabinets had doors and shelving that were scraped, had peeling paint, dirt buildup and dried spills. On 4/5/23 at 12:05 PM Dietary staff C was standing in an open exit door to the kitchen, and it was not closed until 12:06 PM. Residents Affected - Many A fly was landing on an uncovered tray of marshmallow and chocolate pudding desserts. On 4/5/23 at 12:12 PM the service line temperatures were taken with a digital thermometer . The Puréed bread was on the counter at the service line at room temperature and not on any heating or cooling source. No temperature was taken. On 4/5/23 at 12:37 PM an interview was conducted with Dietary staff B, regarding how she made the puréed bread. She stated she used bread, milk, and cinnamon. On 4/5/23 at 2:24 PM an interview was conducted with Dietary staff B regarding observations in the kitchen. Regarding dietary sanitation she stated she had not been trained on testing sanitizer. She stated she had been told that the green bucket contained soap and the red contained sanitizer. She stated staff did not specify what type of sanitizer and said to change it every two hours. Regarding handwashing, she stated staff usually washed their hands at the kitchen hand sink. Regarding cleaning of the walls and cabinetry, she stated the cabinets doors and walls were cleaned after lunch. Regarding the thawing techniques, she stated staff tried to place the foods in the refrigerator to thaw. She stated she was not on duty the day before 4/04/23. She added to quick thaw food the foods were usually placed under running water in the (2 compartment) large sink, but the large sink was full of food equipment. Regarding the soiled processor blade, she stated she usually used the processor and then placed it in the dishwasher. She added that she was nervous due to the survey. Regarding potentially hazardous foods not at the proper temperature, she stated, the (pureed) bread should be at room temperature by lunchtime. Regarding calibrating thermometers, she stated she was not trained to calibrate thermometers. She added that the digital thermometer used today was a personal one that belonged to Dietary staff A. Regarding what could result from the dietary sanitation issues that occurred, she stated she did not want residents to be sick and foods off temperature (between 41 degrees F and 135 degrees F) could make residents sick. Regarding why these dietary sanitation issues occurred, she state, she was not prepared after having days off. On 4/5/23 at 4:49 PM, an interview was conducted with a Dietary staff C regarding issues in the kitchen. Regarding staff use of the two-compartment sink for handwashing purposes, she stated there's no reason why it was done. She stated that staff had not received any in-service training on correct handwashing procedures. Regarding the door left open to the outside she stated staff had been told to close the door and not leave it open for long periods of time. Regarding the puréed bread, she state, she was told to have puréed bread at room temperature. Regarding cleaning of the thermometer probe, she stated the facility had sanitizer wipes to clean them, but she could not find them. She stated staff were told to check the cleanliness of the processor and processor parts. Regarding bare hand contact while cooking/warming the flour tortillas, she stated staff were never told not to turn tortillas with their bare hands. She further stated that she started working as a cook approximately two weeks ago, and she worked as a dishwasher in the facility since November 2022. On 4/5/23 at 4:41 PM an interview was conducted with Dietary staff D. He stated he had been working in the facility approximately two weeks. Regarding handwashing in the two-compartment sink, he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 50 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 stated staff had not been instructed not to use the two-compartment sink to wash their hands. He stated he had been told just to wash his hands. He further stated he had not been taught the correct handwashing procedure. Regarding his training for the dietary department, he stated it lasted two or three days. He stated each day he was shown new things. He stated residents could get sick if staff washed their hands incorrectly. Residents Affected - Many - The following observations were made, and interviews were conducted during a kitchen tour on 4/06/23 that began at 10:48 AM and concluded at 11:46 AM: On 4/06/23 at 10:48 AM the Dietary Manager stated the only employees using the kitchen restroom were kitchen staff. Dietary staff E was observed preparing to pureed beans. She placed the beans in the processor which was wet on the interior. On 4/6/23 at 10:52 AM Dietary staff A was interviewed regarding handwashing in the 2-compartment dishwasher area hand sink. She stated staff did not want to bring germs into the kitchen, so they washed at the dishwasher area 2 compartment sink. On 4/4/23 at 12:04 PM an interview was conducted with Dietary staff A. She stated she had been employed in the facility since 12/01/21. Observation of the three-door refrigerator revealed that the zip top bag of sliced ham was labeled by the facility Use by 3/23/23. Dietary staff E was observed washing the processor in the 2-compartment sink. Observation of the lid, after washing, revealed that it had food debris on the scraper/stirrer and the processor pot had food debris. The surveyor intervened, and Dietary staff E washed the lid again. Observation of the lid revealed that it was still dirty with food in places on the processor and lid. The surveyor intervened again, and the processor and lid were washed again. On 4/6/23 at 11:00 AM an interview was conducted with a Dietary Manager regarding issues found in the dietary department regarding the cleanliness of walls and cabinets. She stated she had been hired on 5/28/22 and the walls and cabinetry were in the same condition as now. She added that staff had tried to clean it, but the surface came off the wall. Regarding the timetable when walls and cabinetry were cleaned, she stated staff had not scrub them because they did not have the time. She stated staff applied some degreaser on the walls and cabinets and wiped it off. Regarding the soiled processor parts and processing foods when the processor was wet, she stated she had told staff to let it dry, but the dietary department did not have enough help. Regarding the soiled interior of the icemaker, she stated staff cleaned it every six months. Regarding the identification and incorrect level of quaternary sanitizer in the red bucket, she stated she had always told staff it contained the sanitizer in the red bucket. She stated the label had come off the red bucket and the sanitizer level should be 150 to 200 ppm. Regarding the exit door to the outside being left open, she stated the flies had entered the kitchen even with the zapper (electronic insect exterminator). Observation during this interview with the Dietary Manager revealed that Dietary staff E was washing her hands in the 2-compartment sink at the same time. When it was pointed out to the Dietary Manager, she stated staff should have wash their hands in the (kitchen) hand sink. She stated she knew staff used the two-compartment sink for handwashing. She further stated that she believed the staff had seen the soap and paper towel dispensers installed at the 2-compartment sink and were prompted to use it as a hand (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 51 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 - Many sink. Regarding handwashing in the two-compartment sink, she stated it had been easier for staff to wash their hands at the hand sink located in the kitchen, but staff will not do it since it is too far away. Regarding incorrect handwashing technique, she stated she had told staff to dry their hands, using the paper towel, and then turn off the water and dispose of the paper towel in the trashcan. Regarding staff not washing their hands between soiled and clean dishwashing duties, she stated she had told staff when they handle the soiled dishes, they need to wash their hands, then handle the clean. Regarding the broken hand sink in the restroom, she stated she had been aware of it and reported it through the facility's online maintenance reporting system. She stated she did not know how it happened or when the facility would have it repaired. Regarding bare hand contact with food, she stated she had told staff they should turn tortillas with tongs or a spatula. Regarding outdated foods, she stated the cook would be in charge when the Dietary Manager was absent, and they should check food dates and dented cans. She stated that was the responsibility of the Dietary Manager when present. Regarding thermometer accuracy, she stated, she had calibration instructions posted on the wall at the sink. She stated the dial thermometer was the one used by staff. Regarding cleaning thermometers, she stated staff should have cleaned the thermometer probe with sanitizer wipes. Regarding the improper thawing techniques, she stated she had told staff to thaw foods in the refrigerator in a pan on a lower shelf the day before use. She further stated she had not reviewed with staff any faster methods of thawing such as under running water. Regarding potentially hazardous food/TCS foods not maintained at 41 degrees F or below or 135 degrees F or above, she stated she preferred to make pureed bread with water and did not know why staff used milk. Regarding why all these dietary issues occurred, she stated it had been a lack of training and staff needed more monitoring due to her increased job duties. She stated she had conducted in-services within the past 3 months with one addressing dishwashing. She stated the Dietary Manager, and the cook were responsible to ensure that all functions in the kitchen were performed correctly. She further stated the dietary department did not have enough staff. Regarding what could result from the issues observed in the dietary department regarding dietary sanitation, she stated residents could get sick, especially with incorrect handwashing and temperatures. On 4/6/23 at 12:54 PM an interview was conducted with Administrator regarding issues in dietary. Regarding dietary sanitation, he stated the restroom hand sink broke recently, and he fixed it today. He stated he had no excuse for the delay in repairing the hand sink. He stated there could be a negative outcome as a result of the issues in the dietary department regarding dietary sanitation. On 4/6/23 at 2:13 PM an interview was conducted with the Dietary Manager regarding the repair of the kitchen restroom hand sink. She stated it was repaired at approximately 12:30 PM today. Observation, at this time of the hand sink in the kitchen restroom revealed that it had been repaired. Record review of the dietary in-services held from December 2022 thru April 2023 revealed there were only two. On 12/15/22 the Dietary Manager held an in-service on Handwashing. Dietary staff A and C attended. On 1/20/23 the Dietary Manager held an in-service on Use of Gloves. Dietary staff A, B, C and E attended. Record review of the facility policy titled Policy: Cabinets, Drawers, And Shelving, Policy Number: 04.008, Date Approved: October 1, 2018, revealed the following documentation, Policy: The facility will maintain cabinets, drawers and shelving free of food particles and dirt, to minimize the risk of food hazards. Cabinets, drawers, and shelving will be cleaned a minimum of every week or as needed. Procedure . 6. Do not use shelf liners in drawers, cabinets or shelving. Record review of the facility policy titled Policy: Employee Sanitation, Policy Number: 03.0 4.001, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 52 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 Date Approved: 12/01/11, revealed the following documentation, Policy: The consultant dietitian will monitor each facility to ensure that the facility uses good sanitation practices in accordance with the state and federal food codes. Guidelines . 6. Handwashing. Residents Affected - Many a. Employees wash their hands and exposed portions of their arms at designated handwashing facilities at the following times: . 2. After using the toilet room. 4. Immediately before engaging in food preparation, including working with exposed food, clean equipment and utensils, and unwrapped, single service, and single used articles. 5. During food preparation, as often is necessary to remove soil, and contamination, and prevent cross-contamination when changing tasks. 7. After engaging in other activities that contaminate the hands. Record review of the facility policy titled Policy: Handwashing, Policy Number: 04.002, Date Approved: October 1, 2018, revealed the following documentation, Policy: The facility recognizes that foodborne illness has the potential to harm elderly and frail residents. All nutrition and food service employees will practice good handwashing practices in order to minimize the risk of infection and foodborne illness. Procedure: 1. Handwashing stations. b. Make sure there are handwashing stations in all areas that employee's hands may become contaminated, including food preparation areas, service areas, dishwashing areas, and restrooms. d. Sinks used for food preparation or washing utensils, or a service sink or curbed cleaning facility used to dispose of mop water or similar waste cannot be used as a handwashing station. 2. Hands should be washed after the following occurrences: a. Using the restroom. k. Touching unsanitized equipment, work surfaces are washcloth. 3. Hand washing steps. a. Wet hands and exposed arms with hot water at least 100°F. b. Apply soap. c. Scrub hands, expose arms and fingernails for a minimum of 20 seconds being sure to apply a vigorous friction. d. Rinse hands and expose arms thoroughly under hot running water. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 53 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 e. Dry hands and arms with a paper towel. Level of Harm - Minimal harm or potential for actual harm f. Turn off the faucet with a paper towel to avoid contaminating hands and discard the towel. Residents Affected - Many Record review of the facility policy titled Policy: Food Holding, And Service, Policy Number: 03.005, Date Revised: June 1, 2019, review in the following documentation, Policy: To ensure that all food served by the facility is a good quality and safe for consumption, all food will be held and served according to the state and US Food Codes and HACCP guidelines. Procedure: 1. Serve all hot foods at a temperature of 135°F or greater and all cold food at 41°F or less. 4. If hot food drops below 135°F, reheat to 165°F for a minimum of 15 seconds. 5. Take cold food items from the refrigerator only as needed. Ice down milk for use at meal services Record review of the facility policy titled Policy: Food Storage, Policy Number: 03.003, Date Revised: June 1, 2019, review of the following documentation, Policy: To ensure that all food served by the facility is of good quality and safe for consumption, all food will be stored according to the state, federal and US Food Codes and HACCP guidelines. Procedure: 1. Dry storage rooms. d. To ensure freshness, store opened and bulk items in tightly covered containers. All containers must be labeled and dated. 2. Refrigerators . d. Date, label and tightly seal all refrigerated foods, using clean, nonabsorbent, covered containers, that are approved for food storage. Record review of the facility, policy, titled Policy: Food Preparation and Handling, Policy Number: 03.004, Date Revised: June 1, 2019, revealed the following documentation, Policy: To ensure that all food served by the facility is of good quality and safe for consumption, all food will be prepared and handle according to the state and US Food Codes and HACCP guidelines. Procedure: 1. General guidelines. a. Use clean, sanitize surfaces, equipment, and utensils. b. Wash hands properly before beginning food preparation. c. Prepare food with the least manual contact possible. Do not allow bare hands to touch raw food directly. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 54 of 55 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 675396 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo South Nursing and Rehabilitation Center 1100 Galveston Laredo, TX 78040 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 2. Thawing foods. a. Thaw meat, poultry, and fish in a refrigerator at 41°F or less. Level of Harm - Minimal harm or potential for actual harm b. Foods may be thawed using the following procedures: Residents Affected - Many i. Completely submerged under running water at a temperature of 70°F or below with sufficient water velocity to agitate and float off loosened food particles into the overflow. ii. In a microwave oven using the defrost mode and immediately transferred to a conventional cooking equipment with no interruption in the process. iii. As part of the cooking process. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 55 of 55