Inspection·November 26, 2025

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview and observation on 10/21/25 at 12:14 p.m., MA A, stated she worked at the facility since 2020 and had stepped into the role as a medication aide in March 2025. She worked from 6 a.m. to 2 p.m. and only remembered giving medications to CR#1 twice. She explained when she gave medication, she would verify the orders by checking the resident's name with the picture, asking the resident to verify their first and last name, and making sure the blister pack matched the orders. MA A took the Surveyor to the medication cart and she reviewed CR #1's orders. She stated she saw there was one order to give 1 tab of 300 MG of Gabapentin 3xs a day and another to give 1 tab of 300 MG of Gabapentin 2xs a day. On her shift of 6 a.m. to 2 p.m., she was ordered to give CR#1 2 capsules of Gabapentin. Reviewing the time stamps in the MAR, she administered this medication on 10/16/25 at 10:34 a.m. and on 10/17/25 at 10:22 a.m. She stated although she saw two separate orders in the MAR, she did not feel like it was inputted by accident, and she followed the orders as written. MA A stated she did not notice any adverse effects or any changes in her behavior. She explained that if she suspected there was an overlap in medications or a discrepancy, she would consult with one of the nurses. Inside the medication cart, there was one bottle of Gabapentin 300 MG filled on 10/15/25 for 60 capsules for CR#1. A blister pack was also found for Gabapentin 300 MG filled on 10/16/25 for 70 capsules. MA A recalled that she administered medication from the Gabapentin bottle initially, but she switched over to the blister pack once it was delivered on 10/17/25. MA A counted the amount of medication remaining from both the pack and the bottle that equaled a total of 130 capsules, 8 capsules 300 MG Gabapentin were missing from the count. In an interview with MA B on 10/21/25 at 12:55 p.m., she stated that she had worked at the facility for 1 year and she worked either the 6-2 a.m. shift or the 2-10 p.m. shift. On 10/16/25 and 10/17/25, she worked the 2-10 p.m. shift. She was familiar with CR#1 and after reviewing the MAR, she confirmed that she administered 300 MG of Gabapentin on 10/16/25 at 3:18 p.m. and 9:54 p.m. as well as on 10/17/25 at 3:40 p.m. and 9:02 p.m. She explained that she noticed that there were two orders of 300 MG of Gabapentin, but she figured it was an entry error because she was admitted with the bottle and the blister pack was delivered the next day. She stated that the combined orders of Gabapentin instructed to give CR#1 600 MG in the morning and 600 MG in the evening. She explained that she thought that this was too much and a medication error, so she decided to follow the order that stated to give CR#1 300 MG of Gabapentin 3xs a day and disregard the additional order that instructed this medication also be administered 2xs a day. MA B explained that for CR#1's evening medication passes, she only administered 1 300 MG capsule of Gabapentin and marked that it was given on the other order although she only passed 1 capsule. She stated she did not ask any of the nurses about CR#1's order but she stated that she was supposed to report it to the nurse if there were any kind of suspected medication errors. She stated that the reason she did not report it to a nurse was because she was working both halls and she forgot. In an interview on 10/22/25 at 9:43 a.m. with CR#1 in the hospital, she was in bed wearing her neck brace while she grimaced and moaned in a lot of pain. She stated that while she was in the nursing facility she was given a lot of medication, but she did not remember what it was. She stated she did not feel any pain while she was there, and the nurses were nice to her but was not feeling well enough to answer additional questions. In an interview on 10/22/25 at 4:43 p.m. with the NP, she stated the last time she saw CR#1 was on 10/17/25 and she was demented but alert and oriented x2. She explained she consulted with the facility's pain management team regarding her pain medications. She stated she saw there were two orders of 300 MG of Gabapentin orders in the system where one was to be given 3xs a day and the others was to be given 2xs a day. She stated for both morning and evening administration, CR#1 was to receive 600 MG of Gabapentin. Two orders were documented into the system for the medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675495 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 675495 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel Court 3830 Mustang Road Alvin, TX 77511 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete because sometimes the system made them input each order in separately for it to populate when to administer it in the MAR. She stated these doses of Gabapentin were normal doses and could still be increased if needed. NP stated that she was unaware that CR#1 had not gotten her doses as she had ordered and she did not receive any questions from facility nurses or staff regarding confusion with the two 300 MG Gabapentin orders. She stated that nurses always contacted her if they were confused and no one should ever administer medication unless they have full understanding of the orders. In an interview with the DON on 10/23/25 at 10:55 a.m. she was informed that MA B had not given CR#1 her 300 MG of Gabapentin medication as ordered. She explained if an aide had confusion with the orders, they should have reached out to a nurse for clarification. If the nurse had a question, they should reach out to the physician. All orders were to be followed as documented in the computer. She explained the harm in CR#1 not receiving her medication as ordered would be increased pain for CR#1. Record review of MA B's employee file documented that she was hired at the facility on 08/19/24 as a certified medication aide. Her essential functions in this role were to administer medications as ordered by a physician under the supervision of a licensed nurse in accordance with any state and federal regulations and consistent with facility policy, record the administration of medications appropriately, and demonstrate knowledge of the five rights (right patient, right drug, right dose, right route, and right time). Record review of the facility's policy titled Adverse Consequences and Medication Errors revised April 2014 stated: A medication error is defined as the preparation or administration of drugs or biological which is not in accordance with physician's orders, manufacturer specifications, or accepted professional standards and principles of the professional(s) providing services. Examples of medications errors include: a. Omission - a drug is ordered but not administered; b. Unauthorized drug - a drug is administered without a physician's order; c. Wrong dose (e.g., Dilantin 12 mL ordered, Dilantin 2 mL given); d. Wrong route of administration (e.g., ear drops given in eye); e. Wrong dosage form (e.g., liquid ordered, capsule given); f. Wrong drug (e.g., vibramycin ordered, vancomycin given); g. Wrong time; and/or h. Failure to follow manufacturer instructions and/or accepted professional standards (e.g., failure to shake medication that is labeled shake well, crushing a medication on the d Event ID: Facility ID: 675495 If continuation sheet Page 3 of 3