Inspection·July 22, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 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 interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs for one resident (Resident #7) of 17 residents whose care plans were reviewed. The facility failed to ensure Resident #7's comprehensive care plan was updated was developed and implemented after starting anticoagulant (blood thinner) medication on 04/26/25. The deficient practice could place residents in the facility at risk of not being provided with the necessary care or services, and the implementation of personalized plan of care developed to address their specific needs. Findings include:Record review of Resident #7's face sheet dating 07/20/25 reflected a [AGE] year-old-male with an original admission date of 1/07/20. Diagnoses included pulmonary fibrosis (lung disease characterized by the scarring and damage of lung tissue), congestive heart failure, high blood pressure, chronic kidney disease, and type two diabetes (insufficient production of insulin in the body). Record review of Resident #7's Physician orders dated 04/26/25 reflected: Eliquis Oral Tablet 5 MG (Apixaban) Give 1 tablet by mouth two times a day related to chronic atrial fibrillation (type pf heart arrhythmia characterized by irregular and often rapid beating of the atria, upper chambers of the heart). Record review of Resident #7's care plan initiated on 01/07/2020 and revised on 06/02/2025 reflected no care plan for anticoagulants. In an interview on 07/22/2025 at 9:41 AM, the MDS Coordinator stated she was unable to find Resident #7's anticoagulant medication in the care plan. The MDS Coordinator stated it should be care planned to ensure the staff are aware of the signs and symptoms such as the risk of bleeding and bruising. The MDS stated it was an oversight, and there was no reason why Resident #7's care plan was not updated. In an interview on 07/22/2025 at 9:48 AM, the DON stated Resident #7's anticoagulants should have been care planned. The DON stated it was important to have any anticoagulants care planned so staff could be aware of what signs and symptoms to look for such as bleeding or bruising. The DON stated that whenever there is a change in condition or new medications for any resident, it would be discussed during morning meetings and the team would go over any revisions of care plans. The DON stated Resident #7's care plan was just overlooked. In an interview on 07/22/25 at 1:28 PM, the ADM stated Medical Records would do a lot of auditing and needed to get with her to see if she was responsible for conducting care plan audits. The ADM stated the facility had ensured Medical Records personnel were nurses so they would be able to assist with this kind of documentation. In an interview on 07/22/2025 at 1:47 PM, Medical Records stated she did not audit resident care plans and was not sure who did. Record review of the facility's Care Plan Revisions Upon Status Change dated 10/24/25 reflected: Policy: The purpose of this procedure is to provide a consistent process for reviewing and revising the care plan for those residents experiencing a status change. Policy Explanation and Compliance Guidelines: 2. Procedure for reviewing and revising the care plan when a resident experiences a status change: a. Upon identification of a change in status, the nurse will notify the MDS Coordinator, the physician, and the resident representative, if applicable. h. The Unit Manager or other designated staff member will conduct an audit on all residents experiencing a change in status, at the time the change in status is identified, to ensure care plans have been updated to reflect current resident needs. Event ID: Facility ID: 675396 If continuation sheet Page 2 of 10 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 07/22/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to ensure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident for 1 of 2 glucometers (device used to measure the amount of glucose in a resident's blood) reviewed for pharmacy services. The facility failed to ensure the glucometer in the nurse cart for halls 100, 200 and 400 were tested for accuracy and recorded in the glucometer logbook on 07/01/25, 07/02/25, 07/07/25, 07/08/25, and 07/21/25 in the month of July. These failures could place residents at risk of receiving either too much insulin or not enough. The findings included:Record review of the glucometer logbook on 07/22/25 at 10:37 AM revealed the test results for the glucometer in the nurse cart for halls 100, 200 and 400 were not recorded on 07/01/25, 07/02/25, 07/07/25, 07/08/25, and 07/21/25. In an interview with the DON on 07/22/25 at 1:11 PM, the DON stated the glucometers were supposed to be tested every day on the night shift by the nurses and the results recorded in the logbook. The DON stated night shift nurses were trained to test the glucometers every shift. The DON stated it was the DON and ADON's responsibility to check the logbooks and ensure the night shift nurses were recording the results of the tests. The DON stated he did not think there was an official policy on testing the glucometers every day, but that it was best practices for nursing. The DON stated it was important to test the glucometers to ensure they gave accurate readings. The DON stated if a glucometer gave inaccurate readings a resident may end up receiving insulin when they did not need it, or not receive insulin when they did need it. The DON stated this could impact any resident that received insulin. In an interview with LVN D on 07/22/25 at 2:06 PM, LVN D stated he did not work the night shift. LVN D stated it was the night shift nurse's responsibility to test the glucometers and record the results in the logbook every night. LVN D stated it was important to ensure the glucometers were working so there would not be any mistakes in administering insulin. LVN D stated an inaccurate glucose measurement may result in administering insulin to a resident that did not need it or vice versa. A phone interview was attempted with three different night shift nurses on 07/22/25 between 1:50 PM and 1:57 PM, but none answered the phone or called back. This stated surveyor requested a facility policy from the DON on 07/22/25 at 1:11 PM dictating how often to test the glucometers but none was provided prior to exit. Event ID: Facility ID: 675396 If continuation sheet Page 3 of 10 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 07/22/2025 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 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 observations, interviews and record reviews, the facility failed to ensure all drugs and biologicals were stored in locked compartments and labeled in accordance with currently accepted professional principles reviewed for medications stored in 1 of 1 medication rooms reviewed for medication storage. The facility failed to ensure the medication room was locked at 11:21 AM on 07/20/25 This failure could place residents in the facility at risk of drug diversion or misuse of medications leading to harm. The findings included:During an observation at 11:21 AM on 07/20/25, the medication room door was left slightly ajar, allowing this state surveyor to open the door and gain entrance without any key. No employees were in the medication room at that time. This state surveyor stayed by the entrance to the medication room until the ADM walked by at 11:50 AM and was informed the door was slightly ajar. In an interview with the ADM at 11:50 AM on 07/20/25, the ADM stated the medication room door was supposed to be closed and locked when no one was inside the room. The ADM stated the medication room should be closed and locked to prevent any unauthorized personnel from gaining access to residents' medications. The ADM stated LVN A, CMA C, and RN B all had keys to the medication room and had been working today from 6:00 AM to 2:00 PM. The ADM stated if the door was left open, residents or unauthorized staff could gain access to medications and ingest them or steal them. In an interview with RN B on 07/20/25 at 1:05 PM, RN B stated she had a key to the medication room, and the last time she was in the room today was around 9:30 AM. RN B stated she closed and locked the door behind her when she left. RN B stated it was important to keep the door to the medication room closed and locked, so unauthorized people did not gain access to medications. In an interview with CMA C on 07/20/25 at 1:20 PM, CMA C stated she had a key to the medication room, and the last time she was in the room was around 10:00 AM. CMA C stated she closed and locked the door behind her when she left. CMA C stated it was important to keep the door locked so residents or staff could not go in and out of the room and possible eat or steal medications. In an interview with LVN A on 07/20/25 at 1:35 PM, LVN A stated she had a key to the medication room, and the last time she was in the room was around 10:30 AM. LVN A stated she closed and locked the door behind her after she left. LVN A stated it was important to keep the door closed and locked to keep any unauthorized people from going into the medication room and taking things that did not belong to them. In an interview with the DON on 07/22/25 at 1:11 PM, the DON stated the medication room door should be closed and locked whenever no authorized staff were present in the room. The DON stated the room should be locked to prevent any unauthorized people from getting int the room and ingesting or stealing medications. The DON stated he liked to pull on the door handle whenever he walked by the room just to be sure it was closed. Record review of the facility policy titled Medication Carts and Supplies for Administering Meds revealed the following: .The following equipment and supplies are acquired and maintained by the facility for the proper storage, preparation, and administration of medications: 1. Lockable medication carts, cabinets, drawers, and/or rooms with well-lit medication preparation areas. Event ID: Facility ID: 675396 If continuation sheet Page 4 of 10 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 07/22/2025 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, interviews, and record reviews, the facility failed to store, prepare, distribute, and serve food per professional standards for food service safety for 1 of 1 kitchen reviewed for storage, preparation, and sanitation.The facility failed to ensure dishes were cleaned after washing and not used for service.The facility failed to ensure the utensils were in good condition.The facility failed to ensure personal items were not in the prep areas.The facility failed to ensure a cabinet door was safe to open.The facility failed to ensure table scraps were disposed of properly.The facility failed to ensure personal items were separated from leftovers in refrigerator #D2.The facility failed to ensure food items in refrigerators #A1, and #D2, and freezers #B3, #C3, and #D2 were labeled, dated, and stored properly.The facility failed to ensure the dry storage area was free from fruit and dented cans.The facility failed to ensure food items in the dry storage area were properly sealed, labeled, and dated. The facility failed to properly maintain temperature logs in refrigerators #A1, and #D2, and freezers #B3, #C3, and #D2.The facility failed to maintain dishwasher temperature and sanitation logs. The facility failed to ensure all staff were properly trained in removing dishes from meal trays and serving residents seated at the same table at the same time. The facility failed to ensure all kitchen staff were using the designated handwashing sink and not the prep sink for handwashing.These failures could place residents who received meals and/or snacks from the kitchen and satellite kitchens at risk for food contamination and foodborne illness.Findings included:Observation and initial tour of the kitchen on 07/20/25 at 10:45 am revealed 13 of 26 coffee cups on the coffee cart were scratched and stained inside, and some had food stuck to the inside. The coffee maker on the coffee cart was leaking coffee. There were 20 of 78 juice glasses on the clean rack with a partially removable white substance in the bottoms and up the sides. There was a serving ladle stacked in another ladle in a clean drawer that had a sticky, red substance in it. When moved, the ladle beneath it had a sticky, red substance on its bottom, and inside the drawer. There was a large rubber spatula hanging from the pot rack with chips missing from the sides. There was a Styrofoam cup with foil over it and a personal cup next to the mixer on a prep table, both unlabeled and undated. There was a cabinet door above a prep area with an unscrewed hinge at the bottom that fell sharply when it opened. The DW was using an open trash bag on the floor to scrape food scraps into it. Refrigerator #D2 had a sign on the outside of the door that read, Kitchen Staff Only Refrigerator. One of the drawers inside refrigerator #D2 had a sign on it that read, This area is exclusive for employees and was full of what appeared to be jalapeno peppers. The peppers were loose in the drawer. Inside refrigerator #D2, there was an open Styrofoam cup without a lid that was 1/2 full of red liquid, unlabeled and undated. There were food items (later identified by the CK as leftovers for residents) stored in 5, 2-quart containers. Three of the containers were dated 07/16/25. There was a 1-gallon bag of what appeared to be 6 egg rolls unlabeled and undated; a partially empty 1-pint bottle of red liquid unlabeled and undated; 7 small sausages in a wrinkled, open piece of foil; a 1-gallon bag labeled turkey, but had no dates on it; a 1-gallon bag of a brown/red substance (later identified by the CK as left over beans) unlabeled and dated 07/16/25 inside refrigerator #D2. Refrigerator #A1 and freezer #s B3 and C3 had several unlabeled and undated trays of desserts inside. There was a 1/2-pint carton of milk open to air, unlabeled and undated in refrigerator #B3. There was a small juice glass filled with a white substance next to the open carton that was also not labeled or dated. There was a large bag of frozen ravioli in freezer #C3 dated 01/12/25. The ravioli was covered in frost and discolored. There were 3 resident pitchers open to air, 1/2 full of ice, undated and unlabeled in freezer #B3. There were 5, 6-pound dented (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 5 of 10 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 07/22/2025 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 cans on the use shelf in the dry storage room. The bin labeled Do Not Use Damaged Food Cans was empty. There was an uncut melon on the shelf in the dry storage room. There was a 1-gallon bag of bread and 8 slices of bread in a partially closed bag and a large, loosely closed bag of tortillas unlabeled and undated in the dry storage room. Refrigerator #A1 had an outer digital thermometer that read 36F even when the doors were opened for several minutes. The internal thermometers read 42F-45F with the doors open. The daily freezer and refrigerator temperature logs were missing data. The low-temp dishwasher temp and sanitation logs had the same numbers logged every day. There was one tray cart that had no covering on the sides or top. There were four regular push carts near the open tray cart.Observations and interview with the DW on 07/20/25 at 10:55 am, he said the low temp dishwasher temperature should be 120F, but it read 115F. He said he did not know how long the dishwasher water temperature had been low. He said he did not know what the sanitation level should be. [Chem strip container numbers and colors were scaled 0-light yellow, 100-light green, etc.] The DW demonstrated using a chem strip during the rinse cycle and he said the activated chem strip should be on the 100 of the chem strip container. The chem strip read 0. The DW said the chem strip was closer to zero than to 100. The DW said he was not sure what the level of sanitation was. He said the dishwasher temperature and sanitation log might not be accurate, as all the numbers were the exact same and did not reflect the temperatures or the sanitation level that had been documented. The DW said if the dishes were not getting sanitized in the dishwasher, it could cause cross-contamination and make residents sick. The DW said he did not know why he was not using a trash bin with a removable lid and the garbage bag inside to remove food from the dishes. Regarding the unhinged cabinet door, the DW said he had verbally told the maintenance man multiple times and wrote it in the log at the nurse's station but did not use the facility's electronic maintenance system. There was no log at the nurse's station. The DW said the kitchen staff never used the designated handwashing sink. He said kitchen staff used the prep sink for handwashing. He said he did not know why it mattered which sink they used for handwashing.Observation of dinner service in the dining room on 07/21/25 at 5:05 pm revealed CNA E was observed grabbing multiple resident cups and bowls by the top rim during meal service. Several tables with seated residents were not served at the same time. In an interview with the CK on 07/20/25 at 11:00 am, she said the coffee maker had been leaking badly for about 3 months and she told the FPM about it. She said they were not supposed to be using the leaking coffee maker. She said they liked it better than the thermoses they were supposed to be using. The CK said the food in refrigerator #D2 was leftovers for the residents. She said staff items should not be in there. She said all food should be labeled and dated. She said food should be thrown out after 3 days. She said she did not know who was responsible for making sure expired food in the refrigerators was removed. She said all kitchen staff were responsible for making sure food in the refrigerators and freezers was labeled and dated so everyone knew what it was and when to get rid of it. She said the kitchen staff were supposed to be using the designated handwashing sink for handwashing, and she never used the prep sink for handwashing. She said the dietary aides were responsible for logging the refrigerator and freezer temperatures. The FPM was unavailable for interview at this time.In an interview with the FPM (food protection manager) and the RD on 07/21/25 at 2:58 pm, the FPM said the DW did not know how to take the temperature of the dishwashing machine because he was nervous about it and the chem strips. She said he had been trained and should have known. She said the DW was responsible for making sure dishes were clean before placing them on the clean rack. She said the CNAs were responsible for the stains and stuck-on food in the coffee cups because it was easy for them to put oatmeal in the cups for the residents to eat from. The FPM and RD both said the residents used metal spoons to eat from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 6 of 10 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 07/22/2025 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 the cups and to stir their coffee. She said the chemicals in the dishwasher were not strong enough to wash everything. She said the chem strip should be at 100ppm and thought they were using the correct test strips for the low temperature dishwasher. She said the water may not have been hot enough to clean the dishes. She said the dishwasher company did not come to check the (low temperature) dishwasher, even though the ADM called them. The RD said cross contamination from dirty dishes could make residents sick and affect their health. The RD said they could start using plastic spoons or wooden stirrers to prevent the plastic cups from becoming scratched and harboring bacteria. The FPM said leftover food was good for 3 days only and all food should be labeled and dated in the refrigerators, freezer, and dry storage area to prevent contamination. She said she had been trying to replace the coffee maker for 3 months and had let the ADM know. She said the ADM told her he was trying to see if another facility had a replacement. She said personal items were never allowed in the prep areas, but sometimes kitchen staff ate or drank inside the kitchen anyway. She said staff had been trained and should not have personal items in the kitchen. She said she was unaware of the broken cabinet door. She said she did not know why the DW was not using the trash bin for table scraps. She said refrigerator #1 was for residents only. She said she was unaware the staff was using refrigerator #1 for personal items. The FPM said the dry storage area had a bin for dented cans and did not know why the dented cans were on the shelf with the good cans. She said the dented cans were not to be used because the inside would go bad and could make residents very sick. She said a shipment came in last Thursday (07/17/25) and she was out that day for medical reasons. She said nothing when asked why the other kitchen staff did not place the dented cans in the dented can bin. She said temperatures for refrigerators should be 41F or less, or the food would go bad and must be thrown away. She said the temperatures of refrigerators and freezer were checked twice a day. She said no one was monitoring the logs for accuracy. The FPM said she did not know if kitchen staff were using the prep sink to wash their hands because the handwashing sink was easier to get to. She said the open tray cart and the four open push carts were how trays were delivered to residents who received their meals in their rooms.Refrigerator and Freezer Daily Temperature logs, Dishwasher Temperature and Sanitation Logs, Trainings/In-Services from May 2025 to present, and policies for Dishwasher Temperature and Sanitation, Food Storage, Refrigerator and Freezer Temperatures and Logs, and Personal Items in the kitchen were requested at this time. In an interview with CNA A on 07/21/25 at 5:29 pm, she said there was no reason why she was grabbing the resident cups from the lids. CNA A stated she just forgot to grab from the side. She said she had been trained on proper service but could not say when. CNA A stated it was important not to grab resident cups from the top due to cross contamination. She said she could be spreading germs and could make the residents sick. In an interview with the RD on 07/21/25 at 5:32 pm, she said she passes by the dining room when she was at the facility for her monthly visits. She said she had to help the FPM because she was new at her job and was coming in 2-3 times a month for the past month, then she said she had been coming in 2-3 times a month since May 2025. (The FPM hire date was 06/30/23). She said she was involved with training the kitchen staff monthly on various topics including serving from trays, but not nursing staff. She said cups and bowls should be handled by staff by the sides, not the top. She said tables should be served at the same time. The RD said she observed dining on the days she came to the facility and did not train nursing staff on how to pass out meal trays. The RD stated if she saw something wrong with the CNAs, she would let the DON know so further education could be provided. The RD said she did not know if residents who received meals in their rooms complained of the food being cold. She said she did tastings but could not elaborate timing or frequency. She said she was aware of the tray delivery system (open tray cart (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 7 of 10 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 07/22/2025 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 and open push carts). A test tray was requested at this time.Test tray received on 07/21/25 at 5:43 pm-temperatures were within range. The ADM and RD were present with the survey team. Ham, sweet potatoes, and green beans, along with a roll, matched the menu. The green beans were tasty and had a good texture. Everyone agreed the ham and sweet potatoes were not tasty. The ADM looked up the recipe and discovered it called for lemon juice and orange juice for both the ham and sweet potatoes. Everyone agreed with the ADM who said the texture was ok for the ham, but the sweet potato texture was not identifiable as potato and the flavor of the ham and sweet potatoes was not right and did not taste good. The ADM told the RD she should oversee the recipes.In an interview with the ADM on 07/22/25 at 1:00 pm, he said, the kitchen staff had a thermos to put coffee in. He said the coffee maker worked, but it leaked. He said he got a new coffee maker, but the temperature of the coffee was too hot, so they stopped using it and purchased the thermoses. He said the leaking coffee maker was supposed to have been thrown out. He said the leaking coffee maker was used on Sunday (07/20/25) out of convenience. He said he did not know why kitchen staff preferred wiping up the mess the leaking coffee maker made over the thermoses. He said he called the dishwasher maintenance guy on Sunday (07/20/25) but he did not come to the facility. He said the dishwasher maintenance guy did some trouble shooting over the phone with him instead. He said he checked the hot water heater, and the temperature of the water was 140F. He said he checked the sanitizer lines for blockages and kinks, and they were in good shape. He said the chem strips were correct for the machine. He said there was no excuse why the temperatures of the refrigerators and freezer were being documented by the external digital temp reading. He said the FPM did training on it. He said he did not know why the DW was scraping trash into a bag on the floor-that was not their process. He said their process was for trash to go into a bag inside the trash can with a lid. He said he told the entire team they had a process for getting repairs done through their electronic maintenance system. He said the cabinet door had been fixed several weeks ago, or so he thought. He said the cabinet was fixed yesterday and he uploaded a photo of the cabinet on 07/21/25. (Verified) He said the spatula looked melted and it should not be in use. He said there was more training to be done with kitchen staff to resolve these issues. He said more oversight was necessary, and the RD was coming out every other week, as well as her back-up. He said the RD performed dietary sanitation reviews monthly. He said the RD had her own system for food tasting but he did not know what it was nor if she watched service delivery. He said the RD could train staff on serving and seating arrangements, so the residents at the same table received their trays at the same time and not have to watch the others at the same table eat while they were waiting.Record review of the facility's Dish Machine Temperature and Sanitizing Logs revealed the following out-of-range findings for morning (a.m.), noon, and evening (p.m.) wash temps, final rinse temps, and sanitizer ppm: May 2025- a.m. wash temps 100F on five days, 110F on 3 days. Final Rinse temps were within range. Sanitizer ppm logged at 100ppm on 24 days and 50ppm seven days. Noon wash temps 100F on 12 days, 110F on 11 days. Final Rinse temps 110F on 2 days and 115F on 2 days. Sanitizer ppm logged at 200ppm on 4 days and 50ppm 1 day. p.m. wash at 100F on 8 days. Final Rinse 100F on 3 days, 110F on 4 days. Sanitizer logged at 100ppm each day.June 2025 (31 days logged)- had no outstanding numbers but had 4 days marked out for an unknown reason.July 1-22 2025 (the 19th was missing all data) a.m. Final rinse 110F for 6 days, 115F for 1 day. Sanitizer 110ppm. Noon wash temp 100F for 5 days. Final Rinse 100F for 12 days and 110F for 3 days. Sanitizer had no outstanding numbers. p.m. wash temps 100F for 4 days, Final rinse 100F for 13 days and 110F for 2 days. Sanitizer logged at 100ppm each day.Record review of the facility's Refrigerators and freezer temperature logs for May, June, and July 2025 revealed Refrigerator #A1 was 40F, and freezer #B3 was 0 degrees F for all a.m. and p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 8 of 10 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 07/22/2025 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 dates in May. Refrigerator #D2 was 40F for all days in June. Refrigerator #A1 was missing data for the mornings of July 15 and 22, and evenings of July 1 and 21. All July temperatures recorded were 36F. Freezer #B3 was missing data for the mornings of July 15 and 22, and evenings of July 1 and 21. Temperatures were out of range (above 0 degrees F) for 5 p.m. days. There was no documentation of reporting the out-of-range temperatures. Freezer #C3 was missing data for mornings of July 4, 15, and 22, and evenings of July 1, 12, 13, and 21. Temperatures were out of range (above 0 degrees F) for 7 a.m. days and 15 p.m. days. There was no documentation of reporting the out-of-range temperatures.Refrigerator #D2 was missing data for the mornings of July 12, 13, 14, 15, and 22, and evenings of July 1, 2, 5, and 21. All recorded temperatures were 40F. Freezer #D2 was missing data for the mornings of July 12, 13, 14, 15, and 22, and evenings of July 1, 22, and 21. All recorded temperatures were 0 degrees F except 4 a.m. days which were 36F, 38F, 40F, and 5F. One of the p.m. temperatures was recorded as 10F. There was no documentation of reporting the out-of-range temperatures.Record review of the facility's kitchen in-services: 04/17/25 For future dietary manager on how to access tray cards and diet orders. 07/21/25 Labeling and Dating, Food storage Guidelines, Temperature Logging, Cleaning, Sanitation, and Food Service Equipment Conditions. 07/22/25 Personal Items and Employee Sanitation.Record review of the facility policy titled, Employee Sanitation approved 10/01/18 reflected, Policy: The nutrition and foodservice employees of the facility will practice good sanitation practices in accordance with the state and US Food Codes in order to minimize the risk of infections and food borne illness. Procedure: 3e. Employees will not eat or drink in food storage and preparation areas, or in areas containing exposed food or unwrapped utensils, or where utensils are cleaned or stored. 4b. Cups, glasses, and bowls must be handled so that fingers or thumbs do not contact inside surfaces or lip-contact outer surfaces.Record review of the facility policy titled, Mechanical Cleaning and Sanitizing of Utensil and Portable Equipment approved 10/01/18 reflected, Policy: The facility will follow the cleaning and sanitizing requirements of the state and US Food Codes for mechanical cleaning in order to ensure all utensils and equipment are thoroughly cleaned and sanitized to minimize the risk of food hazards. Procedure: 7. If a machine that uses chemicals for sanitizing is in use, follow these guidelines: a. The temperature of the wash water must be at least 120F. e. The chemical sanitizing rinse water temperature must be at least or no less than the temperature specified by the machine's manufacturer. f. A test kit or other device that accurately measures the parts per million concentrations of the solution must be available and used. Record review of the facility policy titled, Food Storage approved 10/01/18 reflected, 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: 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 a. Keep fresh meat, poultry, seafood, dairy products, and most fresh fruit and vegetables in the refrigerator at an internal temperature of 41F or less. c.Do not overstock the refrigerators and leave space between items to further improve air circulation. d. Date, label, and tightly seal all refrigerated foods using clean, nonabsorbent, covered containers that are approved for food storage. e. Use all leftovers within 72 hours. Discard items that are over 72 hours old. h. Place a thermometer inside refrigerators near the door where the temperature is warmest. Check the temperature of all refrigerators using the internal thermometer to make sure the temperature stays at 41F or below. Temperatures should be checked each morning and again on the PM shift. Record the temperatures on a log that is kept near the refrigerator. 3. Freezers h. Place a thermometer inside freezers near the door where the temperature is warmest. Check the temperature of all (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675396 If continuation sheet Page 9 of 10 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 07/22/2025 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 FORM CMS-2567 (02/99) Previous Versions Obsolete freezers using the internal thermometer to make sure the temperature stays at 0F or below. Temperatures should be checked each morning and again on the PM shift. Record the temperatures on a log that is kept near the freezer. Record review of the manufacturer specification for the dishwashing machine indicated for low-temperature models: Wash and rinse at temperatures between 120F and 140F, relying on chemical sanitizing agents with the wash water. Use test strip to ensure sanitizer levels is at least 50ppm and no more than 200ppm. Test strips are most accurate at 120F. Higher temperatures may distort reading. If this occurs, use a clean glass to dip water from inside the machine and let cool to 120F before testing. Contact your service representative if you still have trouble verifying sanitizer levels. References: https://www.autochlor.net Event ID: Facility ID: 675396 If continuation sheet Page 10 of 10