Health inspection·August 3, 2023

F 0550 with other residents and observed holding out her hand with feces without any verbal comments. Level of Harm - Minimal harm or potential for actual harm Interview on 08/02/23 at 10:05 with LVN G revealed Resident #202 did have feces all over her right hand while sitting in the dining room. LVN G said she would take Resident #202 to the room to get her cleaned up. LVN G said Resident #202 did have behaviors of placing her hand inside her brief and pulling out feces in her hand. LVN G said the staff had not noticed the feces in her hand. Residents Affected - Few Interview on 08/02/23 at 10:15 am with CNA A revealed hospice staff had come and bathed Resident #202 earlier in the morning. After Resident #202 was showered someone brought the resident to the dining room for activities. CNA A said Resident #202 was in the dining room about forty minutes, with the Activity Aide providing activities to the residents. CNA A said staff had to be checking Resident #202 regularly because she did have the behavior of reaching into her brief and pulling out feces. Interview on 08/02/23 at 10:13 am with Activity Aide revealed her responsibility was to monitor and supervise the residents when they were in the dining room with activities. Activity Aide said Resident #202 did not participate in the activities in the dining room due to her cognitive impairment. The Activity Aide said she was aware of Resident #202's behavior of reaching into her brief and grabbing her feces. The Activity Aide said she was not aware Resident #202 had feces in her hand while she was in the dining room. Interview on 08/03/23 at 8:50 am with the DON revealed that hospice had come and bathed Resident #202 earlier in the morning and then CNAs had taken the resident to the dining room. The DON said CNAs did go and help the Activity Aide with the residents but unfortunately Resident #202 had an episode of getting her feces on her hands and was not observed by any staff. The Activity Aide does ask staff for help if she saw any situation that needed the nurse's attention. Resident #202 is not aware she has this behavior but Resident #202 needs to be monitored so she is not sitting with feces in her hands at any time, especially when Resident #202 was out in the common area. Interview on 08/03/23 at 8:55 am with LVN F revealed Resident #202 had been placed in the dining room on 08/02/23. LVN F said she didn't know who had taken Resident #202 to the dining room. Resident #202 was placed in the dining room to be with other residents. LVN F said there had been several residents in the dining room. LVN F said that the Activity Aide had enough time to monitor all residents for incidents. LVN F said Resident #202's hand had been with feces and there were other residents around her. Record review of facility policy titled Promoting/Maintaining Resident Dignity dated 1/13/23 reflected policy; It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, that maintains or enhances resident's quality of life by recognizing each resident's individuality. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675606 If continuation sheet Page 2 of 9 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 675606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harlingen Nursing and Rehabilitation Center 3810 Hale St Harlingen, TX 78550 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities for 1 of 6 residents (Resident #151) reviewed for activities in that: Residents Affected - Few The facility failed to provide Resident #151 activities designed to meet his interests and promote physical, mental, and psychosocial well-being. This deficient practice could affect residents at the facility who require assistance to activities to decline in mental acuity due to lack of stimulation, boredom, and depression. The findings included: Record review of Resident #151's Order Summary Report dated 08/03/23 reflected Resident #151 was a [AGE] year-old male admitted to facility on 06/28/23 with the diagnosis of major depressive disorder (characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), alcohol dependence with alcohol inducing dementia (damage to the brain, caused by regularly drinking too much alcohol over many years), and anxiety disorder (feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities). Record review of Resident 151's Quarterly MDS assessment dated [DATE] reflected Resident #151 -had unclear speech, -was rarely understood by others -rarely understood others, -severe cognitive impairment and, -required extensive assistance of two plus persons for activities of daily living. Record review of Resident #151's care plan dated 07/06/22 revealed -Resident #151 is dependent on staff for meeting emotional, intellectual, physical, and social needs r/t cognitive deficits. Interventions included: -Establish and record the resident's prior level of activity involvement and interests by talking with the resident, caregivers, and family on admission and as necessary. -Invite the resident to scheduled activities. -Thank resident for attendance at activity function. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675606 If continuation sheet Page 3 of 9 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 675606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harlingen Nursing and Rehabilitation Center 3810 Hale St Harlingen, TX 78550 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 0679 -The resident needs assistance/escort to activity functions. Level of Harm - Minimal harm or potential for actual harm Observation on 08/01/23 at 04:45 PM revealed Resident #151 in the dining room. Resident #151 sitting in his wheelchair, did not respond to greeting, has his head back, grabbing the bottom of his shirt with both hands and staring up at the ceiling. Residents Affected - Few Interview on 08/02/23 at 9:28 AM Activity Director said Resident #151 was in the memory unit but was taken out of the memory unit because he does not pose a threat for elopement. AD said Resident #151was walking when he was first admitted to the unit. The AD said Resident #151 does not talk and needs assistance for all his ADLs. The staff assist him with feeding. The AD said Resident #151 does not participate in activities, so he is not taken to activities. The AD said they will play music for him or sit him in the hall or by the nurse's station so he can see people go by. Observation on 08/02/23 at 10: 10 am revealed Resident #151 in the dining room sitting in his wheelchair with a family member. Family member was sitting next to Resident #151 and patting his hand and rubbing his arm. In an interview on 08/02/23 at 10:13 am the Family Member said she would have liked the facility to provide activities to Resident #151 because he would sit in the dining room alone or out in the hall and does not have any sensory stimulation. Observation on 08/02/23 at 10:30 am revealed the AD placing residents in a circle in the dining room and passing out different colored balloons to residents in the circle. Resident #151 saw the balloons and pointed to the balloons. Resident #151 laughed and then said, [NAME], [NAME] (look, look)! Resident #151's family member moved Resident #151 closer to the group. In an interview on 08/03/23 at 9:37 am CNA H said Resident #151 would walk but would not talk, he would only say several words when he was admitted . CNA H said Resident #151 would participate in activities when he first arrived. CNA H said he would dance when they played music, or he would hit the ball or balloon when he first arrived in the unit. Resident declined and stopped participating in the activities. Interview on 08/03/23 at 10:00 am CNA I said Resident #151 would walk in the unit occasionally. Resident #151 was moved to the general population because he could not walk anymore. Resident would participate in activities sometimes. Resident #151 only liked the activity when they passed the balloon and the toy cars that his family member would bring him. Interview on 08/03/23 at 10:37 am CNA J said Resident #151 was walking when he was admitted to the memory unit. CNA said Resident #151 would wander up and down the hall and would go into other resident rooms. Resident would play with his cars and would participate in activities with music or food. Resident declined and stopped playing with his cars, he will only hold the toy car. Observation on 08/03/23 at 12:01 pm revealed Resident #151 at lunch time. Resident #151 was sitting in his wheelchair and a CNA was assisting resident to eat. In an interview on 08/03/23 at 4:00 pm LVN K said Resident #151 is not independent for his ADLs and does not have the strength to move independently. LVN said the Activity Director provides activities to the residents such as Loteria. The Activity Director will call out the cards and that will provide auditory stimulation for residents that are not able to actively participate. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675606 If continuation sheet Page 4 of 9 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 675606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harlingen Nursing and Rehabilitation Center 3810 Hale St Harlingen, TX 78550 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 0679 Level of Harm - Minimal harm or potential for actual harm In an interview on 08/03/23 at 5:58 PM the Administrator said the Activity Director provides activities to resident #151 such as playing music for him and assisting resident to activities held in the dining room. The Administrator said a family member also brings Resident #151 toy cars because Resident #151 used to like cars. Residents Affected - Few Record review of facility's revised Activity Policy dated 09/2014 reflected: Policy The facility has an on-going program of activities designed to meet the interests and the physical, mental, spiritual, and psychosocial well-being of each resident in accordance with his/her comprehensive assessment. Policy Interpretation and Implementation All residents, particularly bedfast and those residents unable to participate in group activities will be visited by Activity Director, Activity Assistant, and/or volunteers at least 3 times a week. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675606 If continuation sheet Page 5 of 9 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 675606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harlingen Nursing and Rehabilitation Center 3810 Hale St Harlingen, TX 78550 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 0880 Provide and implement an infection prevention and control program. 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 establish and maintain an infection prevention and control program, designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, for two residents (Resident #105 and Resident #209) of twenty-four residents observed for infection control, in that: Residents Affected - Few 1.The facility failed to post Droplet Precautions sign on Resident #105's door when Resident #105 was in isolation due to being COVID-19 positive. 2. CNA A did not use one wipe per swipe on Resident #209's buttocks during incontinent care. This failure could place residents at risk for infections and cross contamination. The findings included: 1.Record review of Resident #105's Face Sheet dated 08/02/23 reflected an [AGE] year old female admitted to the facility on [DATE], with diagnoses that included heart failure, dementia (progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change resulting from organic disease of the brain), type 2 diabetes mellitus, chronic kidney disease stage 3, dependence on dialysis Record review of Resident #105's Quarterly MDS dated [DATE] reflected Resident #105's cognitive status was moderately impaired, she required extensive assistance with two-person assistance for bed mobility, transfers, dressing, toilet use, and personal hygiene, at risk of developing ulcers/injuries, and was occasionally incontinent of bowel and frequently incontinent of bladder. Record review of Physician's Orders dated 08/01/23 reflected, Droplet isolation x 10 days related to COVID-19, Precautions. Every shift for 10 days. Record review of Resident 105's care plan dated 11/05/22, revised 08/01/23 reflected, (Resident 105) was at risk for deterioration of medical condition related to possible exposure to other COVID-19 positive individuals. Date Initiated: 08/01/2023 Revision on: 08/01/2023 GOALS: Resident will remain free from significant adverse effects related to COVID-19 positive test, including hospitalization, through next review. Date Initiated: 08/01/2023 Target Date: 10/12/2023. Record review of nurse's progress note dated 08/01/23 revealed, Resident (#105) initiated on droplet precautions x 10 days d/t (due to) COVID 19 exposures. No s/s (signs/symptoms) of COVID at this time. Resident (#105) stable. Tested negative. RP (Responsible Party) notified. MD (Medical Doctor) made aware. DON (name) notified. Observation on 08/02/23 at 08:45 a.m., Resident #105's door to room did not have a Droplet Precautions sign on it. Interview on 08/02/23 at 02:41 p.m., LVN C stated (Resident #105) is on precautions due to exposure. LVN C stated that everyone who was COVID+ or had exposure to COVID has PPE (Personal Protective (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675606 If continuation sheet Page 6 of 9 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 675606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harlingen Nursing and Rehabilitation Center 3810 Hale St Harlingen, TX 78550 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Equipment) outside their doors and signs of Droplet Precautions on the door. LVN C stated (ADON E) is responsible for putting the Droplet Precautions signs on the door of residents who are in isolation. LVN C stated if a LVN noticed the PPE or the signs were not on the doors, the LVN stated they would notify ADON E. In an interview on 08/02/23 at 02:47 p.m., ADON E stated she is responsible for putting the signage on the doors of residents in isolation. ADON E stated housekeeping helps putting the PPE outside the isolation rooms. ADON E walked to (Resident #105's room) and stated she did not know what happened to the sign that was on the door. ADON E stated this morning she had some people removed the signs off the doors of the residents who had come off isolation and they must have removed (Resident #105's door) signage by mistake. ADON E stated she would get the signage right away. In an interview on 08/02/23 at 02:55 p.m., DON stated usually (ADON E) is the one who is responsible for putting the isolation signs on the door. DON stated, Yesterday y'all came in and it was hectic, and we forgot to put the sign up on (Resident #105)'s door. DON stated other staff are responsible for looking and checking to make sure everything is there at the isolation rooms. DON stated the negative outcome for not having a sign on the door of a resident who was exposed to COVID and in isolation could be someone going in the room and being exposed also. Surveyor asked for policy concerning signage on rooms on TBP (Transmission Based Precautions). Review of Regency Integrated Health Services, LLC Isolation Notices Policy dated Revised 04/2015 reflected, Policy Statement Appropriate isolation notices should be used to alert staff of the implementation of isolation precautions, while protecting to privacy of the resident. Policy Interpretation and Implementation 1. When isolation precautions are implemented, an appropriate isolation sign should be posted and placed at the entrance/doorway of the resident's room. 2. Categories of isolation are outlined in a separate policy entitled Categories of Infection Precautions. 2. Record review of Resident #209's Face Sheet dated 08/03/23 reflected a [AGE] year old male admitted to the facility on [DATE], with diagnoses that included Guillain-Barre Syndrome (a disorder of the peripheral nerves, often preceded by a virus infection, usually beginning in the lower limbs and resulting in abnormal sensation and muscle weakness or paralysis), quadriplegia (a symptom of paralysis that affects all a person's limbs and body from the neck down), type 2 diabetes mellitus Record review of Resident #209's Quarterly MDS dated [DATE] reflected Resident #209's cognitive status was not impaired, he required extensive assistance with two person assistance for bed mobility and dressing, he was totally dependent with two person assistance for transfers, toilet use, and personal hygiene, was totally dependent with one person physical assistance for eating, was occasionally incontinent of bowel and frequently incontinent of bladder, and had a stage 3 pressure ulcer on left gluteal fold. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675606 If continuation sheet Page 7 of 9 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 675606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harlingen Nursing and Rehabilitation Center 3810 Hale St Harlingen, TX 78550 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 0880 Record review of Physician's Orders dated 08/01/23 revealed, wound care Level of Harm - Minimal harm or potential for actual harm orders for Stage 3 left gluteal pressure ulcer. Residents Affected - Few Record review of Wound Care assessment dated [DATE] revealed, Stage 3 Gluteal Pressure Ulcer measurements of 3.3cm x 3.1cm x 0.2cm. Observation during incontinent care on 08/03/23 at 02:24 p.m. CNA A. CNA A used one wipe per swipe on buttock area wiping front to back. Scant bowel movement. CNA used one wipe wiping front to back on anal area. CNA A rewiped anal area using the same wipe wiping front to back. CNA A removed gloves, used hand sanitizer, and put on clean gloves. In an interview on 08/03/23 at 02:49 p.m., CNA A stated she was to use one wipe per swipe. CNA A stated she was nervous and did not remember wiping twice. CNA A stated infection could occur from using the same wipe on the same area twice. In an interview on 08/03/23 at 02:53 p.m., CNA B stated she was to use one wipe for each swipe. CNA B stated infection could occur when using the same wipe twice on the same area. In an interview on 08/03/23 at 03:20 p.m., WCN stated one wipe was to be used for each swipe during incontinent care. WCN stated infection could occur when using a wipe over the same area more than twice. WCN stated they are in-serviced on infection control all the time by the ADON E or DON. In an interview on 08/03/23 at 03:22 p.m., ADON E stated one wipe was to be used per each swipe during incontinent care. ADON E stated infection or cross-contamination could occur using the same wipe for more than one swipe. ADON E stated she was the one who does in-servicing on incontinent care, infection control, droplet, etc. She said she and the other ADON do in-services along with the DON. In an interview on 08/03/23 at 03:26 p.m., DON stated a wipe is to only be used once for each swipe during incontinent care. DON stated infection could occur if the same wipe is used over the same area for more than one wipe during incontinent care. DON stated the CNAs were in-serviced at least weekly on incontinent care. DON stated the two CNAs (CNA A and CNA B) who did the incontinent care have been with her for years and she did not think there would be any problems. Regency Integrated Health Services Perineal Care policy dated 10/24/22 reflected: Policy: It is the practice of this facility to provide perineal care to all incontinent residents during routine bath and as needed in order to promote cleanliness and comfort, prevent infection to the extent possible, and to prevent and assess for skin breakdown. Policy Explanation and Compliance Guidelines: 9. If perineum is grossly soiled, turn resident on side, remove any fecal material with toilet paper, then remove and discard. a. Cleanse buttocks and anus, front to back; vagina to anus in females, scrotum to anus in males, using a separate washcloth or wipes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675606 If continuation sheet Page 8 of 9 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 675606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harlingen Nursing and Rehabilitation Center 3810 Hale St Harlingen, TX 78550 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 0880 b. Thoroughly dry. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675606 If continuation sheet Page 9 of 9