Health inspection·February 3, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident's prescribed diet, oral care, monitoring for aspiration and offering substitutes if the resident ate less than 50% of meals. Further review of the resident's care plans revealed there was not a care plan that addressed the specific goal and interventions and services provided by hospice. In an interview on 2/2/2023 at 3:38 p.m. with RN/MDS E revealed she worked for the facility about a month. RN/MDS E reported care plans were created to address resident care to know what the resident needed. RN/MDS E reported a hospice care plan should note the resident was on hospice services and that basic needs were addressed. RN/MDS E revealed she knew what to care plan by looking at the face sheet diagnoses, orders, the Resident Assessment Instrument (RAI) and any records from a hospital. RN/MDS E reported she would normally care plan hospice as a problem on its own, and provide goals and interventions related to hospice services and not combine it in another care plan. RN/MDS E reported care plans were necessary for staff to do care the residents needed and to know who was on hospice services. Record review of the facility policy titled, Comprehensive Care Plans revised 5/12/2015 revealed, The care plan must describe the following: a. Services/interventions that are to be furnished to attain and maintain the resident's highest practicable physical, mental, and psychosocial well-being.Review of the facility policy titled, Comprehensive Care Plans revised 5/12/2015 revealed, The care plan must describe the following: a. Services/interventions that are to be furnished to attain and maintain the resident's highest practicable physical, mental, and psychosocial well being. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 2 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the comprehensive assessment of a resident, the facility must ensure that a resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 of 2 residents (Resident #35) reviewed for pressure sores, in that: Residents Affected - Few LVN D failed to sanitize her hands between glove changes while providing wound care to Resident #35. This failure could place residents at risk for infections and cross contamination. The findings were: Record review of Resident #35's Face sheet, dated 02/03/23, revealed an admission date of 01/04/23, with a diagnosis which included: unspecified urinary incontinence, vascular dementia and dementia with behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (A group of symptoms that affects memory, thinking and interferes with daily life), muscle wasting and atrophy (muscle weakness), and poisoning by local antifungal, anti-infective and anti-inflammatory drugs, intentional self-harm. Rcord review of the Quarterly MDS dated [DATE] for Resident #35 revealed a BIMS of 02 which indicated the resident had severe impaired cognition. Under section G functional status for toilet use revealed total dependence on staff. Under section H bladder and bowel revealed the resident was always incontinent. Record review of Resident #35's Care Plan dated 01.12.23 revealed alterations in ADL self-performance and mobility related to weakness. Resident #35 required x1 assist with personal hygiene. Record review of Resident #35's Physician order summary, dated 02/03/23, revealed an order for nystatin powder; 100,000 unit/gram topical apply to peri wound to left buttock, left groin, and right groin, with a start date of 01/23/23 and no end date. Record review of Resident #35's Physician order summary, dated 02/03/23, revealed an order for buttocks clean wound with wound cleanser, pat dry, apply collagen powder and calcium alginate and cover with gauze, with a start date of 01/30/23 and no end date. Record review of Resident #35's Physician order summary, dated 02/03/23, revealed an order for right and left groin clean area with wound cleanser, pat dry, apply collagen powder and calcium alginate cover with dry dressing twice a day, with a start date of 01/30/23 and no end date. During an observation on 02/01/23 at 4:33 p.m. revealed LVN D provided wound care to Resident #35's left and right groin area and buttocks area. LVN D did not sanitize her hands in between glove changes during the wound care treatment. LVN D changed her gloves approximately 6 times with out sanitizing her hands between glove changes. During an interview on 02/01/23 at 4:57 p.m. LVN D stated she should sanitize her hands between glove changes during wound care. She stated she did not have any hand sanitizer on her tray during (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 3 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few wound care to use. She stated she did have some in the nurse treatment cart, but she forgot it. She stated she should sanitize her hands for infection control. During an interview on 02/01/23 at 5:01 p.m. the DON stated staff were expected to sanitize their hands between glove changes to prevent infections during wound care. She stated they had bottles of hand sanitizer available for them to use. She stated they should also wash their hands with soap and water after they were done with wound care. Record review of the Facility's Policy titled Clean Dressing Change, dated 01/27/21, stated Intent: it is the policy of the facility to ensure change dressings in accordance with state and federal regulations, and national guidelines. Procedure: 1. Verify and review physician's order before procedure 2. Perform hand hygiene and assemble equipment and supplies needed for dressing change .5. Put on gloves. adjust bedside table to waste off. Clean bedside table with germicide disposable cloth. Establish a clean field . 7. Remove gloves and perform hand hygiene .12. Remove dressing and place in the residence trash can. 13. Remove gloves and perform hand hygiene. 14. Put on clean gloves. 15. Clean wound with gauze and prescribed cleaning solutions using single outward strokes. Use separate guys for each cleansing wipe .17. Remove gloves and perform hand hygiene. 18. Put on clean gloves. 19. Apply clean dressing as ordered and ensure the dressing is dated. 20. Remove gloves and perform hand hygiene . Record review of the Facility's policy titled Fundamentals of Infection Control Precautions, dated 02/14/02, stated a variety of infection control measures are used for decreasing the risk of transmission of microorganisms in the LTCF. These measures make up the fundamentals of infection control precautions. 1. Hand washing and gloving, 1. hand washing is the most important measure to reduce the risk of transmitting organisms from one person to another or from one site to another on the same resident. 2 . in addition to hand washing gloves play an important role in reducing the risk of transmission of microorganisms. C. gloves are worn for three important reasons .4. Wearing gloves does not replace the need for hand washing because gloves may have small and inapparent defect or be torn during use, and hands can become contaminated during removal of gloves . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 4 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as was possible for 2 of 22 residents (Residents #18 and #35) reviewed for accidents and hazards in that: The facility failed to ensure Residents #18 and #35 did not have two disposable razors in their rooms. This failure could place residents at risk of harm or injury and contribute to avoidable accidents. The findings were: 1. Record review of Resident #18's Face sheet, dated 02/03/23, revealed an admission date of 09/28/22 and readmission date of 01/02/23 with diagnoses which included seizures (Sudden, uncontrolled electrical disturbance in the brain which can cause changes in behavior, movements, feelings, and consciousness), lack of coordination, and unspecified dementia with behavioral disturbances (Dementia is a term used to describe a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life). Record review of for Resident #18's Quarterly MDS dated [DATE] revealed the resident had a BIMS of 4 which indicated severe impaired cognition. Record review of Resident #18's Care Plan dated 02/01/23 revealed the resident experienced wandering moved with no rational purpose, seemingly oblivious to needs or safety, with a goal for the Resident to wander safely within specified boundaries. Wander-guard in place (a device that is worn by residents designed for Alzheimer's and dementia patients allowing them to have freedom within their resident facilities and will alert staff if they go beyond allowed boundaries). Record review of Resident #18's Physician order summary, dated 02/03/23, revealed an order for a wander guard to the right lower extremity, with a start date of 01/05/23 and an end date of 01/07/23. 2. Record review of Resident #35's Face sheet, dated 02/03/23, revealed an admission date of 01/04/23, with a diagnoses which included: vascular dementia and dementia with behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (A group of symptoms that affects memory, thinking and interferes with daily life), muscle wasting and atrophy (muscle weakness), poisoning by local antifungal, anti-infective and anti-inflammatory drugs, and other lack of coordination. Record review of Resident #35's Quarterly MDS dated [DATE] revealed a BIMS of 02 which indicated the resident had severe impaired cognition. Record review of Resident #35's Care Plan dated 01/12/23 revealed alterations in ADL self-performance and mobility related to weakness. Resident #35 required x1 assist with personal hygiene. During an observation on 02/01/23 at 10:37 a.m., Resident #18 and Resident #35 had a basket of toiletries on top of a counter next to the sink in their shared room. The basket contained two disposable razors. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 5 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 0689 A second observation on 02/02/23 at 2:13 p.m. revealed the basket still contained two disposable razors. Level of Harm - Minimal harm or potential for actual harm During an interview on 02/07/23 at 4:01 p.m. LVN A stated there was a list of items that were prohibited in residents' rooms. She stated razors were not allowed in the residents' rooms. She stated she knew of one resident, Resident #37, who was allowed to shave themselves. LVN A stated the CNAs watched Resident #37 while shaving and removed the razor when the resident was done shaving. LVN A stated staff should not leave any razors in resident rooms and razors were locked up in the central supply closet. Residents Affected - Few During an interview on 02/02/23 at 4:30 p.m. the DON stated Residents #18 and #35 were shaved by the CNAs. The DON confirmed there were two razors in Resident #18 and #35's room at that time. The DON removed the razors from the room at that time. The DON stated razors were kept locked up because they could be a danger to residents who got a hold of them and were not competent to be using a sharp object. The DON stated the only resident she was aware of that shaved by themselves was Resident #37. The DON stated staff should be checking the rooms for items that were not allowed. Record review of an undated document titled Nursing Home List of Items Not Allowed in Resident Rooms, stated the following is a list of items which are either specifically controlled by code, standards, regulations or have been determined by this facility as having an adverse effect on the health and safety of our residents. upon removal of any of these non-allowed items from the resident's room, family will be notified, and the item will be held until the family claims them . safety hazard . aerosol cans: of any product are combustible, glass items: which can be broken and cost cut, razors and blades: these must be left at the nurses station . Record review of the Facility's policy, undated, titled Free of Accident Hazards/Supervision/Devices, stated Intent: it is the policy of the facility to ensure it identifies and provides needed care and services that are resident centered, in accordance with each resident's preferences, goals for care and professional standards of practice that will meet each resident's physical, mental, and psychosocial needs. Procedure: 1. the facility must ensure that: a. the resident environment remains as free of accident hazards as is possible; and b. each resident receives adequate supervision and assistance devices to prevent accident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 6 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure each resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and restore continence to the extent possible, for 1 of 1 Residents (Resident #35) reviewed for perineal/incontinent care, in that: The facility failed to ensure CNA B provided proper incontinent care to Resident #35. This deficient practice could place residents at risk of increased urinary tract infections due to improper care. The findings were: Record review of Resident #35's Face sheet, dated 02/03/23, revealed an admission date of 01/04/23. Resident #35 had diagnoses which included unspecified urinary incontinence, vascular dementia and dementia with behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (A group of symptoms that affects memory, thinking and interferes with daily life), muscle wasting and atrophy (muscle weakness), and other lack of coordination. Record review of Resident #35's Quarterly MDS dated [DATE] revealed a BIMS of 02 which indicated the resident had severe impaired cognition. Under section G functional status for toilet use revealed total dependence on staff. Under section H bladder and bowel revealed the resident was always incontinent. Record review of Resident #35's Care Plan dated 01/12/23 revealed alterations in ADL self-performance and mobility related to weakness. Resident #35 required x1 assist with personal hygiene. During an observation on 02/01/23 at 4:12 p.m. CNA B provided incontinent care to Resident #35 in the order of in between the residents thighs, scrotum, buttocks, and then penis. During an interview on 02/01/23 at 4:30 p.m. CNA B stated she should have cleaned Resident #35 penis instead of his bottom first. She stated she was taught to clean in the order of groin area, then penis, then the bottom. She stated she messed up and forgot to wash the penis and moved on to clean his bottom then came back to wash his penis. She stated she should clean from an area of clean to dirtiest to prevent a urinary tract infection for the resident. During an interview on 02/01/23 at 5:01 p.m. the DON stated incontinent care for a male resident should be done in the order of the penis, scrotum, and back area. She stated if the CNA cleaned the buttocks area and then the penis this would not be the correct order. She stated they should clean from the front to back, cleanest to dirtiest because you did not want to move the germs to the clean area. Record review of the, undated, facility document of a check off list revealed an area titled Peri care- male and stated Help resident flex knees and spread legs apart, wash upper thighs using one stroke method, washing down leg towards knee, gently grasp shaft of penis & if uncircumcised retract foreskin, wash tip of penis at urethral meatus (the opening of the urethra) first. Using circular (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 7 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 0690 Level of Harm - Minimal harm or potential for actual harm motion, cleanse from meatus outward & down shaft. One stroke method. Gently cleanse scrotum, lift carefully & wash underlining skin folds & groin, change gloves & pat dry, lower legs & resume side lying position, wash by wiping from front towards anus with one stroke. Repeat using clean wipe, change gloves, dry area using one stroke method. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 8 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to establish a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation for 3 of 10 residents (Residents #24, #40, and #50) reviewed for medication administration in that: The facility failed to ensure the Station 2 medication cart contained an accurate narcotic log for Residents #25, #40, and #50. This deficient practice could place residents at risk of inaccurate care due to improper procedures. The findings were: 1. Record review of Resident #25's Face sheet, dated 02/03/23, revealed an admission date of 09/05/22, and a readmission date of 10/19/22, with diagnoses which included epilepsy (A neurological disorder that causes seizures or unusual sensations and behaviors). Record review of Resident #25's Physician orders, dated 02/03/23, revealed an order for lacosamide (a controlled substance used to prevent and control seizures) 200 mg tablet oral twice a day at 9:00 a.m. and 9:00 p.m. with an order date of 04/18/22 and no end date. Record review of Resident #25's MAR, dated 02/03/23, revealed lacosamide was administered on 02/02/23 at 9:00 a.m. by MA C. Record review of a document titled individual Patient's Antibiotic/Narcotic Record , dated 01/17/23, revealed 1 tab of lacosamide 200 mg tabs were last administered on 02/01/23 at 8:00 p.m. with a quantity of 36 remaining in the package. During an observation on 02/02/23 at 10:13 a.m. revealed a blister pack contained 35 pills of lacosamide 200 mg tablets for Resident #25. 2. Record review of Resident #40's Face sheet, dated 02/03/22, revealed the resident was admitted to the facility on [DATE], with diagnoses which included anxiety (mind and body's reaction to stressful, dangerous, or unfamiliar situations, it's the sense of uneasiness, distress, or dread you feel) and bipolar disorder (condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression)). Record review of Resident #40's Physician orders, dated 02/03/23, revealed an order for lorazepam (a controlled substance used to treat anxiety) 1 mg tab oral give 30 or 60 minutes before dialysis on Monday, Wednesday, and Friday at 9:00 a.m. with an order date 08/08/22 and no end date. Record review of Resident #40's MAR, dated 02/03/23, revealed lorazepam was not available to be administered on 02/02/23. It was only to be administered on Mondays, Wednesdays, and Fridays before dialysis. 02/02/23 was a Thursday. Record review of a document titled individual Patient's Antibiotic/Narcotic Record , dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 9 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 01/14/23, revealed 1 tablet of lorazepam 1 mg tablets was administered on 02/02/23 at 8:49 a.m. with a quantity of 6 remaining in the package. MA C initialed the log. During an observation on 02/02/23 at 10:13 a.m. revealed a blister pack contained 7 pills of lorazepam 1 mg tablets for Resident #40. Residents Affected - Some 3. Record review of Resident #50's admission Record, dated 02/03/23, revealed an admission date of 12/07/22 and a readmission date of 12/29/22, with diagnoses which included epilepsy (A neurological disorder that causes seizures or unusual sensations and behaviors). Record review of Resident #50's Physician orders for September 2022 revealed an order for phenobarbital (a controlled used to prevent and control seizures) 64.6 mg tab 2 orally once a day at 7:00 a.m., with an order date 12/29/22 and no end date. Record review of Resident #50's MAR, dated 02/03/23, revealed 2 tabs of phenobarbital were administered on 02/02/23 at 7:00 a.m. by MA C. A note was added by MA C on 02/02/23 at 8:08 a.m. which stated, late administration: charted late. Record review of a document titled individual Patient's Antibiotic/Narcotic Record , dated 01/28/23, revealed 2 tablets of phenobarbital 64.8 mg tablets were administered on 02/01/23 at 7:00 a.m. with a quantity of 24 remaining in the package. During an observation on 02/02/23 at 10:13 a.m. revealed a blister pack contained 22 pills of phenobarbital 64.8 mg tablets for Resident #50. During an interview on 02/03/23 at 10:33 a.m. MA C stated she should have documented the removal of medications from the packages right after they were administered. She stated because it was a narcotic, they must document it right away. She stated if the count was off on the narcotic log they must investigate where the medication went. She stated she accidentally documented she gave one medication on another Resident's log and that was why 2 of the logs were incorrect. She stated she would go find someone to help her correct them at that time. During an interview on 02/02/23 at 4:39 p.m. the DON stated when a narcotic medication was popped out of the blister package it should be documented in the narcotic log at that time. The DON stated even if the medication was not administered and was refused by the resident later it should be documented at the time it was removed from the package. She stated the logs were checked between shifts to make sure no one was taking the medications and to prevent drug diversion. The DON stated the residents were at risk of missing a medication dose or being over dosed if medications were not documented properly in the narcotic log. Record review of the facility's policy titled Storage and documentation of schedule II controlled medications, dated 2003, stated all schedule two controlled medication will be stored under double lock and checked for accountability at each change of shift by the nurse going off duty and the nurse coming on duty. Documentation of the audit will be completed on the appropriate form . disposition of controlled substance is maintained on a sheet supplied by the pharmacy with each scheduled to controlled substance, and the controlled substance in schedule III and IV provided in counters. Entries are to be made in pen each time it controlled substances used. Then the nurse administering the medication will record the following information: date and time drug is administered, amount of drug administered, remaining balance of drug, and signature of the nurse administering drug . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 10 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 - Some 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 1 of 1 kitchen reviewed for food handling sanitation. 1. The facility failed to ensure the kitchen ice machine was clean. 2. The facility failed to ensure the kitchen handwashing sink was supplied with hot water. These failures could place residents at risk for cross-contamination and foodborne illnesses. The findings include: Observation on 01/31/23 at 1:42 PM revealed the designated handwashing sink within the kitchen to only provide cold water. Observation on 02/01/23 at 11:14 AM revealed several large black spots along the inside of the ice machine. Interview on 02/01/23 at 11:21 AM, the DS stated the ice maker was serviced approximately 1 month ago (January 2023) and should have been cleaned thoroughly. The DS stated the black substance observed was mold. The DS stated the protocol for maintaining the cleanliness of the ice maker was to observe the ice maker from the inside on a regular basis and submit a work order to the MS when they observed it needed to be cleaned. The DS stated the ice maker was cleaned regularly by a third-party vendor. The DS stated she did not know the frequency of cleaning and approximated quarterly. The DS stated the reason the ice maker was not currently free of mold was due to an incomplete work order by the third-party vendor. The DS additionally stated the designated handwashing sink did not have cold water, so staff would use the 3-compartment sink. The DS stated staff were not able to use the 3-compartment sink when it was in operation to wash their hands. The DS stated she submitted a work request to fix the handwashing sink approximately 3 months ago (November 2022) but the problem had not been corrected. Interview on 02/02/23 at 12:19 PM, the Maintenance Supervisor stated a request to look at the hot water in the handwashing sink was submitted to him when he started in his position about 4 months ago (October 2022). The MS stated he knew hot water was operating in the 3-compartment sink but was not aware of the handwashing sink. The MS stated he was trying to fix the handwashing sink himself without the help of a vendor. The MS stated the previous MS tried to fix the handwashing sink and completed the repair improperly. The MS stated he attempted to clean the ice maker by himself by cleaning the front face of the unit and cleaning the filters. The MS stated a vendor came to work on the ice maker about a month ago (January 2023) to clean the ice maker by emptying the ice, defrost, and cleaned the inside of the unit. The MS stated he did not check the ice maker after the vendor completed the work and had not cleaned the inside of the unit himself. The MS stated ensuring the cleanliness of the ice maker was the responsibility of the dietary staff. Interview on 1/02/2023 at 3:15 PM, the DON stated it was her expectation food provided to the residents was prepared in accordance with professional standards. The DON stated it her expectation for the ice maker that provided ice to the residents was clean and free of mold. The DON stated it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 11 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 - Some her expectation that staff who prepared food for the residents washed their hands properly while in the kitchen. The DON stated a risk of the ice maker containing mold and dietary staff not washing their hands properly would be the residents could contract foodborne illness. Interview on 2/03/2023 at 9:39 AM, the ADM stated she was not aware the ice maker had not been cleaned or the designated handwashing sink was not operating properly. The ADM stated it was her expectation food provided to the residents was prepared in accordance with professional standards. The ADM stated it was her expectation for the ice maker that provided ice to the residents was cleaned and free of mold. The ADM stated it was her expectation that staff who prepared food for the residents washed their hands properly while in the kitchen. The ADM stated a risk of the ice maker containing mold and dietary staff not washing their hands properly would be the residents could contract foodborne illness. Record review of the facility's, undated, policy titled Cleaning Schedulereflected ice maker to be listed within the section Weekly (Thorough Cleaning). Record review of the facility's, undated, policy titled Sanitizing Ice Machine and Scoops reflected Sanitize inside [with] clean saturated with sanitizing solution. Record review of facility's, undated, policy titled Handwashingreflected wet hands with warm running water. Record review of the US Food Code, dated 2017, revealed 5-202.12 Handwashing Sink, Installation. (A) A HANDWASHING SINK shall be equipped to provide water at a temperature of at least 38oC (100oF) through a mixing valve or combination faucet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 12 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure, in accordance with professional standards and practices, medical records were maintained for each resident that were complete and accurately documented for 2 of 22 residents (Resident #33 and Resident #104) reviewed for accurate and complete medical records, in that: 1. The facility failed to ensure Resident #33's dietary orders were correct in the resident's clinical record. 2. The facility failed to ensure Resident #104's EHR reflected the correct code status. These failures could place residents at risk for errors in care and treatment. Findings included: 1. Record review of Resident #33's face sheet, dated 2/2/2023, revealed the resident was admitted to the facility on [DATE] and had diagnoses which included end stage renal disease (the kidneys no longer filter wastes and excess fluids from the blood), Hemiplegia (partial or total paralysis on one side of the body) and hemiparesis (weakness on one side of the body) following cerebrovascular infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it which can cause parts of the brain to die), essential hypertension (a type of blood pressure that has no clearly identifiable cause, but thought to be linked to genetics, poor diet, lack of exercise and obesity) and dysphagia (swallowing difficulties). Record review of Resident #33's Quarterly MDS dated [DATE], revealed the resident had a Brief Interview for Mental Status (BIMS) score of 12, which indicated mild cognitive loss. Record review of Resident #33's physician orders, with a start date of 11/19/2022 and revised 1/21/2023, revealed he had an order for a Liberal Renal Diet, with no salt on tray, limit citrus fruit, bananas, chocolate, potatoes, beans and tomatoes, breakfast taco for every breakfast meal. Further review of Resident #33's medical record revealed he had an order for NPO (nothing by mouth) with a start date of 12/5/2021. Record review of Resident #33's care plan dated 6/2/2021 revealed the resident had a care plan to provide diet as ordered and monitor intake. In an observation on 2/1/2023 at 12:20 p.m. revealed an unidentified CNA took Resident #33 a meal tray, into his room, then exited his room and reported to the nurse the resident's mother was going to bring him lunch today. Further observation revealed the resident did not eat his meal served by the facility . In an interview on 2/1/2023 at 9:58 a.m., during initial rounds, Resident #33 reported the food at the facility did not taste good. In an interview on 2/02/2023 at 11:52 a.m. with LVN F revealed Resident #33 received Bolus feedings (a type of feeding where a syringe is used to send formula through a feeding tube) if he ate less (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 13 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 than 50% of his meal. The LVN stated the resident was NPO a while back and was on a feeding pump (an electronic medical device that controls the timing and amount of nutrition delivered to a resident during enteral feeding by feeding tube), but now Resident #33 received a tray and bolus feeding, if needed. The LVN reported the physician or Speech Therapist usually wrote orders if a resident was to be NPO or not . In an interview on 2/2/2023 at 12:00 p.m. with the DON revealed both she and RN E reviewed the resident's physician orders for accuracy. The DON reported Resident #33 received a diet tray from the kitchen and received feedings via gastrostomy tube (a surgical placed device used to give direct access to the stomach for supplemental feeding) if the resident consumed less than 50% of his meal. In an interview on 2/2/2023 at 12:08 p.m. with RN E revealed Resident #33 was on a renal diet (a diet aimed at keeping levels of fluids, electrolytes, and minerals balanced in the body in individuals with chronic kidney disease) and received a meal tray from the kitchen. The RN revealed the resident was not NPO and the NPO order should have been removed. The RN stated if a nurse had seen both orders and was confused about whether to give the resident a meal tray or not the RN stated she, hoped the nurse would check with the doctor and just not let him have food. The RN stated Resident #33 was particular about his food, so his mother frequently brought him food. 2. Record review of Resident #104's physician's orders dated 12/9/2021 reflected an active order which indicated Full Code. Record review of Resident #104's comprehensive care plan dated 1/29/23 reflected a care goal of DNR. Record review of Resident #104's DNR revealed the form was signed by the resident, witnesses and physician. Interview on 02/02/23 at 11:41 AM LVN F stated Resident #104 did have an active DNR but it might not have been uploaded to the EHR. LVN F stated the DNR was in the paper file for Resident #104. LVN F stated medical records uploaded the DNR forms into the EHR for new admissions but the medical records staff member was on leave for the last several weeks. LVN F stated she was not aware of what staff member took over the role of medical records while she was on leave. LVN F stated the physician's orders for Resident #104 must reflect the will of the resident and must be a mistake as the resident wished to not be resuscitated in that instance. Interview on 02/02/23 at 01:49 PM, the DON stated Resident #104's EHR should reflect she had an active DNR and requested to not be resuscitated. The DON stated she was not sure why the EHR was inconsistent for Resident #104 or why the physician's orders reflected a Full Code order. The DON stated the concern and risk with having conflicting information related to the code status for a resident would be staff would potentially not respect the resident's wishes in the instance of a code. Interview on 2/03/2023 at 9:39 AM, the ADM stated she was not aware of Resident #104's EHR reflecting a Full Code physician order while Resident #104 had a completed and executed DNR. The ADM stated it was her expectation resident's EHR's reflected the will of the resident the same as their paper records for all residents. The ADM stated the risk associated with having inconsistent records for resident's code status could cause the resident's rights to not be respected during the instance of a code. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 14 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 0908 Keep all essential equipment working safely. 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 ensure residents had the right to a safe, clean, comfortable, and homelike environment which included but not limited to receiving treatment and supports for daily living for 2 of 5 resident rooms (Rooms #809 and #811) reviewed for environmental conditions and for 2 of 8 Residents (Residents #16 and #49) reviewed for safe and clean environment in that: Residents Affected - Few 1. The facility failed to ensure Resident #16's bed was not broken. 2. The facility failed to ensure Resident #49's bed was not broken. These failures could place residents at risk of living in an unsafe, unclean, uncomfortable, and un-homelike environment. Findings include: 1. Record review of Resident #16's face sheet dated 2/1/2023 revealed the resident was admitted on [DATE] and had diagnoses which included essential hypertension (a type of high blood pressure that has no clearly identifiable cause), cerebral infarction (a disrupted blood flow to the brain due to problems with the blood vessels that supply it, which can cause parts of the brain to die), hemiplegia (paralysis on one side of the body) and hemiparesis (weakness on one side of the body) following cerebral infarction affecting of left non-dominant side, and cognitive communication deficit. Record review of Resident #16's Quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident had a Brief Interview for Mental Status (BIMS) score of 11 which indicated the resident had moderate impaired cognitive status and required extensive assistance of 2 staff for bed mobility, transfers, dressing and toileting. Observation on 2/1/2023 at 9:10 a.m. reflected Resident #16 in his room in Bed A, the bed was by the door, and there was another bed, Bed B, that was in the room but was unoccupied. Further observation of Bed B revealed there was a sign on the bed that read, Maintenance with a picture of a wrench and hammer on the sign. 2. Record review of Resident #49's face sheet dated 2/2/2023 revealed the resident was admitted to the facility on [DATE] and had diagnoses which included dementia (a progressive loss of intellectual functioning, especially with impaired memory and abstract thinking, resulting from organic disease of the brain) with anxiety, essential hypertension (high blood pressure that does not have a known secondary cause), chronic obstructive pulmonary disease (a type of progressive characterized by long-term respiratory symptoms and airflow limitation), and other chronic pain. Record review of Resident #49's admission MDS dated [DATE] revealed the resident had a BIMS score of 14 which indicated the resident was cognitively intact, and required extensive assistance of 1 staff member for bed mobility, transfers, dressing, toileting, and personal hygiene. Observation on 2/1/2023 at 9:15 a.m. reflected Resident #49 occupied Bed B in his room, by the window and bed A, by the door, was unoccupied. Further observation of Bed A revealed there was a sign on the bed that read, Maintenance with a picture of a wrench and hammer on the sign. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 15 of 16 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 675532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Uvalde Healthcare and Rehabilitation Center 535 N Park St Uvalde, TX 78801 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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 2/2/2023 at 9:55 p.m. with the Maintenance Director he reported the signs were on the beds because the beds were broken, and he was waiting for parts. The Maintenance Director stated the beds were power beds and used hydraulics to raise and lower the bed. He stated parts to the hydraulics needed to be replaced and were on back order. He stated he left the broken beds in the room because that was where they were when they broke. He said there was no other reason why he did not move the broken beds out of the rooms. In an interview on 2/3/2023 at 12:40 p.m. with the Administrator, she reported she asked the Maintenance Director to put the signs on the beds because they kept assigning residents to them. Record review of the facility policy entitled, Homelike Environment, revised February 2021, revealed, 3. The facility staff and management minimize, to the extent possible, the characteristics of the facility that reflect a depersonalized, institutional setting. These characteristics included: c. institutional signage (for example, labeled storage closets and work rooms in common areas). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675532 If continuation sheet Page 16 of 16