Health inspection·November 26, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 10/11/25 at 4:00 PM by LVN B, The resident with no noted bruising nor redness to face nor upper body from altercation on 10/08/25, no c/o of pain voiced denies pain when asked. The resident does not remember anything about the altercation.Created date: 10/16/25 at 5:25 AM; Effective date: 10/11/25 at 8:15 PM by RN C, No evidence of bruising or redness noted to face or upper torso present from altercation on 10/08/25. No indication of pain. Continue plan of care.Created date: 10/15/25 at 4:10 PM; Effective date: 10/12/25 at 1:07 PM by LVN B, The resident does not have any noted bruising nor redness to the face nor upper body from the altercation on 10/08/25, denies pain when asked, no c/o of pain voiced. the resident has no recollection of the altercation.Created date: 10/16/25 at 10:26 PM; Effective date: 10/12/25 at 10:30 PM by RN C, No evidence of bruising or redness noted to face or upper torso present from altercation on 10/08/25. No indication of pain. Continue plan of care.Record review of Resident #2's admission record reflected n [AGE] year-old male admitted to the facility on [DATE]. His relevant diagnoses included Alzheimer's disease with early onset (progressive brain disorder that slowly destroys memory and thinking skills) and unspecified dementia, unspecified severity, with other behavioral disturbance (loss of memory, language, problem solving and other thinking abilities which significantly impair a person's ability to perform daily activities with behavioral disturbances such as depression, agitation, and wandering).Record review of Resident #2's quarterly MDS dated [DATE] reflected a BIMS score of 4 which indicated severe cognitive impairment. Record review of Resident #2's progress notes reflected the following entry:Created date: 10/13/25 at 4:51 PM; Effective date: 10/08/25 at 4:50pm by LVN A, CN was at nurses station and heard the resident in a verbal altercation with another resident in the hallway. CNA stated this resident hit the other resident with a walker in the face as he passed the other resident. CNA separated both residents to de-escalate the situation. When asked what happened the resident stated, I am tired of him cussing at me (in spanish). CN performed a head-to-toe assessment on the resident for any injuries. No visible injuries or pain noted at this time. RP, DON, ADMN and MD were notified. CN call MD's office to request an order for a UA and labs. MD agreed STAT. Labs and urine have been collected. Pending results. Resident was placed on a 1:1 monitoring plan.In an interview on 11/26/25 at 3:25 PM, LVN B stated she was told in report about Resident #1 and Resident #2's altercation. LVN B stated, The nurse heard yelling, and she saw [Resident #2] hit [Resident #1] with his walker. [Resident #1] may have Tourette's because he will just be walking down the hall and say curse words. [Resident #2] is sensitive to other's words, so they keep [Resident #1] and [Resident #2] away from each other. LVN B stated she forgot to document the follow ups on 10/10/25, 10/11/25 and 10/12/25. She stated she was off on 10/13 and 10/14 and documented them on 10/15. LVN B stated she was advised the documentation was not done in morning report on 10/15/25. She stated she did the documentation and also told RN C that it needed to be done during report at shift change that evening. LVN B stated if something was not documented, it did not happen. She stated if things were not documented accurately and timely, it could lead to residents not receiving the care they needed. She stated documentation in-services were conducted at least every 3 months, and the last one was in October. She stated when that type of incident occurred, the nurse did a physical aggression-received report for the victim and physical aggression- initiated report in incident/ risk management reports which gave the steps to follow and progress notes were part of those steps. LVN B stated Resident #2 had not had any other incidents of physical aggression.In an interview on 11/26/25 at 4:18 PM, Resident #1 stated he felt safe in the facility and was not afraid of anyone. Resident #1 could not recall ever being hit by anyone or anything.In an interview on 11/26/25 at 4:24 PM, Resident #2 stated he did not remember hitting Resident #1 with his walker. He stated he was friends with Resident #1 and would never hit him. He stated he felt (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675494 If continuation sheet Page 2 of 3 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 675494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lone Star Ranch Rehabilitaion and Healthcare Cente 316 General Cavazos Blvd Kingsville, TX 78363 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete safe in the facility. In a telephone interview on 11/26/25 at 5:10 PM, LVN A stated she did not see the incident happen. She stated she heard something in the hallway, walked toward it, and asked the hospice CNA that was close by what happened. The hospice CNA told her Resident #1 and Resident #2 had a verbal altercation then Resident #2 picked up his walker and smacked Resident #1 in the face with it. LVN A stated she saw a red mark on Resident #1's face. LVN A stated she did put a progress note in, but she did not sign and lock it because she was told the DON needed to see it first. LVN A stated she was off from 10/10/25 to 10/12/25, and on 10/13/25, she went into her progress notes and signed/locked it so it would show up. She did not lock it on 10/08/25 because she was waiting on the DON to read it and approve it. LVN A stated there were no other issues between Resident #1 and Resident #2. She stated Resident #1 cursed and made inappropriate remarks all the time even with redirection. LVN A stated they automatically did an incident report that showed up in progress notes once it was copy/pasted at the end of the incident report. She stated it was important to document things when they happened so that details would not be forgotten and so that others knew what was going on with the resident. She stated she did not recall the last in-service for documentation.In a telephone interview on 11/26/25 at 5:43 PM, RN C stated she was told by the nurse she relieved (LVN B) to go back and make sure there was documentation of Resident #1's injury assessments from the altercation on 10/08/25. RN C stated she was told there was an altercation between Resident #1 and Resident #2, but was not aware Resident #1 had been hit since he did not have any injuries or any changes in behavior. Resident #1 and Resident #2 had not had any altercations prior to or since that incident and staff made sure they were apart. RN C stated it was important to document things so other staff were aware of what was going on with the resident and could provide appropriate care. In an interview on 11/26/25 at 6:05 PM the ADON stated it was important to document incidents accurately and timely to ensure the resident got the care/treatment necessary. The ADON stated when nurses were initially hired, she did a skills check off with them which included documentation. She stated nurse skills were also done annually and as needed. The ADON stated LVN A saved the initial progress note on 10/08/25 but she did not sign it, so it did not show up in the progress notes for that day. She stated annual evaluations and skills check offs were done quarterly. In an interview on 11/26/25 at 6:39 PM, the MDS nurse (who was acting DON) stated it was important to document things as they happened for the safety of the residents, to note interventions, and so other staff were aware of what was going on with the resident. She stated nurses had been educated and in-serviced that they were to document for 72 hours for any issues/incidents. The MDS nurse stated if things were not documented, the resident was at risk of not getting the care they needed. She stated nurses were in-serviced on documentation upon hire, annually, and as needed.Record review of the facility's Policy for Resident Incident and Visitor Accident Report dated 06/05/25 reflected in part: .3. Pertinent documentation must be completed:. d. Nurse Progress Notes. g. Follow up documentation every shift for 72 hours or more frequently if needed. Event ID: Facility ID: 675494 If continuation sheet Page 3 of 3