Health inspection·December 29, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few marked by a mix of schizophrenia symptoms, such as hallucinations and delusions, and mood disorder symptoms, such as depression, mania and a milder form of mania called hypomania), Cognitive Communication Deficit, Anxiety (intense, excessive and persistent worry and fear about everyday situations), and Major Depressive Disorder (a persistent feeling of sadness and loss of interest). Record review of Resident #2's Quarterly MDS assessment, dated 10/29/2025, revealed a BIMS score of 00, which indicated severely impaired cognition. The Quarterly MDS assessment also revealed Resident #2 had Non-Traumatic Brain Dysfunction, Non-Alzheimer's Dementia, Schizophrenia (a serious mental health condition which affects how individuals think, feel, and behave), Anxiety, and Depression (a persistent feeling of sadness and loss of interest). The only documented behavior for Resident #2 on the Quarterly MDS assessment dated [DATE] was a behavior of wandering. Record review of Resident #2's care plan, initiated 03/20/2024 and revised on 12/10/2025, revealed Resident #2 had the potential to be physically aggressive related to Dementia and Depression. This care plan listed the following entries: 04/30/2024 altercation with another resident and placed on one-to-one monitoring until psychological evaluation done; 08/17/2024 - hit another resident in the arm; 07/26/2025 - altercation with another resident; 09/29/2025 altercation with another resident; 12/10/2025 - altercation with another resident. Interventions included Resident #2 placed on one-to-one monitoring on 12/10/2025; Administer medications as ordered; Analyze times of day, places, circumstances, triggers, and what de-escalated the behavior and document; Assess and anticipate Resident #2's needs, such as food, thirst, toileting needs, comfort level, body positioning, and pain. Resident #2 was removed from the situation and placed one to one after each incident, except 08/17/2025, in which the intervention included Resident #2 was redirected and kept safe. Record review of Resident #2's progress noted, dated 12/10/2025, revealed LVN-B heard Resident #2 yelling at someone, so she ran around the nurses' station and saw Resident #2 make contact twice with a female resident on her right arm, so she ran toward the residents. The residents were immediately separated, and a head-to-toe assessment was completed with no injuries noted. LVN-B then reported the incident to the Administrator, RP, the DON, and the doctor. Record review of progress notes also revealed multiple psych progress notes over the past two years. In an interview on 12/29/2025 at 10:10 AM LVN-B stated she was documenting at the nurses' station on 12/10/2025 (unsure of the exact time) when she heard Resident #2 yelling, so LVN-B ran around the nurses' station and saw Resident #2 hit Resident #1 twice in the right arm. LVN-B stated she was not sure who started it, or if anything happened prior to her witnessing Resident #2 hit Resident #1. She stated she and the CNA separated both residents, and skin assessments on were done on both residents. LVN-B stated neither resident had any injuries, redness, or bruising. LVN-B attempted to interview both residents after the incident, and neither recalled the incident. She stated Resident #2 was rambling about something which did not make any sense, and Resident #1 responded by saying something about those girls were fighting. LVN-B stated she had never seen Resident #1 be aggressive, other than not wanting others to touch her things. LVN-B also stated Resident #2 was confused and in his own little world all the time, and he did not like to be touched. She stated Resident #2 had multiple behavioral or aggressive outbursts over the past year or so, but he was currently out of the facility at a behavioral health hospital to be evaluated for his behaviors and for any needed medication adjustments, and she was not sure when Resident #2 would be returning. LVN-B stated they are in-serviced over abuse and neglect at least once per month, but usually multiple times a month. She stated the in-services had also included resident to resident aggression or conflict, and she knew in the event of resident-to-resident aggression, she would separate the residents, provide one-to-one monitoring for the aggressive residents. LVN-B would notify her the Administrator and DON regarding the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675494 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/29/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few incident, as well as notify the provider to obtain any needed orders. Then, she would notify the RP. In an interview on 12/29/2025 at 10:22 AM, the DON stated it was reported by LVN-B that she heard loud voices and ran down the hall where she saw Resident #2 making contact with Resident #1 on her arm. LVN-B separated the residents and placed Resident #2 on one-to-one monitoring. The DON stated both Resident #1 and Resident #2 reside in the memory care unit, but Resident #2 was currently at a behavioral health hospital. The DON stated Resident #2 had a history of aggression with other residents and had been sent to a behavioral health hospital previously, and he did good for a while, but then Resident #2 had episodes of aggression again. The DON stated the staff were hyper-vigilant in monitoring Resident #2 and anticipating his needs. The staff tried to get Resident #2 occupied with activities he might have enjoyed, such as music, but he rarely participated in activities. She also stated Resident #2 had multiple medication reviews and adjustments and saw psych services routinely. The DON stated the current steps were not working, and Resident #2 continued to have aggressive moments, so the facility was trying to figure out where to go from there. The facility discussed the issues with the family, and the family stated Resident #2 did well at the previous facility, but the previous facility did not have a memory unit or locked unit, which was one of the reasons he was transferred to a facility with a locked unit. The DON stated they have referred Resident #2 to many facilities, including an all-male facility, but the referrals were declined every time due to his aggressive behaviors, his wandering, and his background of being incarcerated. The DON stated they were still working on finding a facility which would be a good fit for Resident #2, but until it happened, Resident #2 would continue his stay at the behavioral health hospital, continue to have medication reviews, remain on the memory unit when he returned, and the staff would continue to keep a close eye on him, redirect him as needed, and try to anticipate his needs. In an interview on 12/29/2025 at 10:54 AM, the SS stated she followed up with both residents after the incident, and neither remembered the incident. The SS stated she sent a referral to the behavioral health hospital for Resident #2 because he usually did good, at least for a while, when he came back from behavioral health. The SS stated Resident #2 had been referred to the behavioral health hospital probably 3-4 times previously. She stated she had also tried to get him into an all-male facility, and other facilities, but none would accept him due to his history. The SS stated they (the facility) tried all the recommendations from the family and Ombudsman such as one-to-one monitoring, a locked unit, referrals to behavioral health, but none of the recommendations have worked. The SS stated she was still working on finding placement for Resident #2 in a facility where he might be a better fit. In an interview on 12/29/2025 at 1:11 PM, the Administrator stated LVN-B saw Resident #2 hit Resident #1 in the arm. He stated he was not sure what triggered Resident #2 prior to the incident. He also stated he was not sure what triggered Resident #2 prior to every aggressive outburst or behavior he had. The Administrator stated they have tried to figure out what triggered Resident #2, or what sets him off, but they could not determine any one thing which caused his aggressive outbursts. The Administrator stated Resident #2 was incarcerated previously, and he was not sure if he still had the mindset of being in prison since he was confused most of the time. The Administrator stated they have discussed progressive behaviors and outbursts with the family, as well as have tried to find placement in another facility, but the facility had no luck with finding anywhere to accept his referral. The Administrator stated they always followed any recommendations made by the Psych doctor, as well as his primary doctor, such as medication reviews, one-to-one monitoring with frequent or severe aggression, as well as educated staff to anticipate Resident #2's needs and assess for unmet needs. In an interview on 12/29/2025 at 2:31 PM, Resident #1 stated she lived in the facility so they would take care of her feet. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675494 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/29/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete denied remembering any incident or altercation with any other residents. She denied experiencing any abuse by staff or residents. She was pleasantly confused. Record review of the facility's Abuse Prohibition Policy, revised 10/2022, revealed Each resident has the right to be free from abuse, mistreatment, neglect, corporal punishment, involuntary seclusion and financial abuse. Abuse means the willful infliction of injury, withholding or misappropriating property or money, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Event ID: Facility ID: 675494 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675494 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/29/2025 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 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 observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments for 1 of 4 treatment and medication carts (main treatment cart) reviewed for labeling and storage. The facility failed to ensure the main treatment cart belonging to RN-A was locked and secured. This failure could place the residents at risk of gaining access to unlocked medical supplies and medications which were not prescribed to them and could cause them harm.The findings included: Observation on 12/29/2025 at 8:19 AM revealed an unlocked treatment cart belonging to RN-A parked in the A Hall with no nurses or other staff around it. RN-A was in a room with a resident. There were residents noted to be ambulating in and down the halls. The main treatment cart lock was popped out, and all drawers were able to be opened and accessed. The main treatment cart was full of treatment supplies and treatment medications, to include scissors, needles, multiple containers of liquids, as well as a medication cup filled with a thick, white substance with a wooden spoon in it. Attempted to interview RN-A multiple times on 12/29/2025. She was performing treatments on residents at time the unlocked treatment cart was identified. RN-A left work early, as it was not her normal day or hours to work. Attempted to call RN-A multiple times on 12/29/2025 (called at 12:55 PM, texted at 12:56 PM, called at 5:01 PM) with no returned call or text from RN-A. In an interview on 12/29/2025 at 10:22 AM, the DON stated it was RN-A who worked on the main treatment cart today and did the resident treatments, and it was RN-A who left the main treatment cart unlocked. The DON stated all treatment carts and medication carts were to be locked for Resident safety if the nurse's step away from them. She stated if the carts were left unlocked residents could have gotten a hold of medications or supplies which could have caused them harm. She stated the last in-service for the nurses regarding medication carts was in November of 2024, so she went ahead and started an in-service today. In an interview on 12/29/2025 at 1:11 PM, the Administrator stated treatment and medication carts were supposed to be locked when not in use, and the nurses were responsible for their own medication and treatment carts. The cart was the responsibility of the nurse that was in control of it for that shift. He stated this was done for the residents' safety so they did not have access to medications or supplies which could harm them. The Administrator stated the DON had already started an in-service regarding this. Record review of the facility's Medication Storage Policy, dated 06/24/2025, revealed 1. Drugs and biologicals used in the facility are stored in locked compartments under proper temperature, light and humidity controls. 8. Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biologicals are locked when not in use. 9. Unlocked medication carts are not left unattended. Event ID: Facility ID: 675494 If continuation sheet Page 5 of 5