Health inspection·September 14, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some impairment, chronic Pain due to Rheumatoid Arthritis/Restless Legs Syndrome/Myasthenia Gravis. She required staff assistance with her ADLs with interventions including Encourage the resident to use the bell to call for assistance. Date Initiated: 06/14/2022 Observation of Resident #18 on 09/12/23 at 1:37 p.m. revealed her call light was wrapped on the left 1/4 rail of the bed. Resident #18's left hand was contracted. Resident #18 could move her right arm to her face. Resident #18 had little to no dexterity and significant tremors in both hands. The call light had no clip on it to secure it. An observation and interview with the DON on 09/12/23 at 1:42 p.m. regarding Resident #18's call light revealed he asked her to press her call light. The DON stated Resident #18 had been able to hold a cup and utensils before her stroke. Resident #18 was observed trying to reach for the call light but could not. The DON stated a few weeks ago was the last time he knew of Resident #18's ability to help herself. The DON stated the staff took direction from him to set up rooms. The DON stated the staff came in every so often to offer water. The DON stated staff should come in every 2 hours at least. Resident # 18 stated she had not seen anyone since lunch at 11:30 a.m. The DON left the room without adjusting the bedside table or the call light. The DON then returned to Resident # 18's room and asked Resident # 18 if she needed any water, which she denied. The DON told the resident to let him know if she needed anything then left the room again without adjusting the resident's call light. Observation of Resident #18's call light placement on 09/13/23 at 3:00 p.m. revealed the call light was on her left side with no clip to secure it. Resident #18 could not reach the call light after trying for 20 seconds. Resident #18's hands were trembling significantly. Observation of Resident #18 and Interviews with the DON and CNC on 09/13/23 at 3:30 p.m. revealed Resident #18's call light was on her left side with no clip to secure it, and she demonstrated she could not reach it after 15-20 seconds of trying. Resident #18's hands were trembling so much, she could not grasp the call light and the call light would move out of her reach because it was not secured. The CNC stated Resident #18 needed a pad-type call light that she could touch to activate it. The CNC stated she would get an order and have therapy assess Resident #18. An Interview with the CNC on 09/14/23 at 8:26 a.m. revealed the facility did not have touch-type call lights and they were going to order some. Interview with CNA A on 09/14/23 at 8:31 a.m. stated she was familiar with Resident # 18 and that Resident #18 had more bad days than good days. CNA A stated on a good day, Resident #18 could use her call light. CNA A stated they did walk-throughs down the hallways to check to make sure the call lights were in place, the residents were positioned properly, and if anyone needed anything. CNA A stated she was not aware of any policy to determine how often the staff were supposed to check on the residents. CNA A stated the hospitality aid walked around and ensured the residents had hydration, needed snacks, answered call lights, made beds, etc. CNA A stated the CNAs documented food on their ADL sheet but they did not document fluid intake. CNA stated everyone was responsible for making sure residents were getting proper hydration. Interview with LVN A on 09/14/23 at 8:51 a.m. stated Resident #18 yelled out because she could not use her call light for about 2 weeks because of her condition. LVN A stated Resident #18 could hardly use her left hand. LVN A stated she knew Resident #18's call light did not have a clip on it. LVN A stated she did not let anyone know about the missing clip. LVN A stated Resident #18 got checked on more than other residents, she was guessing, every 30 minutes or so. LVN A stated we could be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 2 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some there as much as we could for her because emotionally, it's hard on her to be alone and she had to shout if she needed something because she could not use her call light. LVN A stated the CNAs documented meal intake but did not separate fluids. LVN A stated the residents were monitored for intake by the CNAs who would tell the nurses if a resident was not eating or drinking enough. Interview with OTA on 09/14/23 at 9:21 a.m. stated he was familiar with Resident #18, and she was pending an evaluation for OT next Saturday. The OTA stated he was notified about the evaluation yesterday. The OTA stated Resident #18 would struggle with using a call light due to her tremors and confusion. Interview with CNA C on 09/14/23 at 5:26 p.m. stated some of the call lights did not have clips, so they put them on the residents' chest or on the side they can use if they have had a stroke or something. CNA C stated Resident #18's call light should be on her chest since it did not have a clip. CNA C stated the call lights did not really stay if they did not have the clip. CNA C stated Resident #18 had not been able to use her call light for more than 2 weeks which she knew of, since Resident #18 got back from the hospital this last time. CNA C stated Resident #18's call light was on her chest, but it was still hard for her. CNA C stated Resident #18 needed one of those that you can tap. CNA C stated she had seen only one on another resident, and the facility did not keep them there. CNA C stated they check on Resident #18 frequently, so they leave the curtain and door open to her room. A record review of Resident #28's face sheet dated 08/11/22 revealed a [AGE] year-old female with diagnoses including orthopedic aftercare for a left femur (long upper leg (thigh) bone) fracture and right wrist fracture, muscle wasting and weakness, Alzheimer's, stroke, anxiety, and dementia. A record review of Resident #28's MDS dated [DATE] revealed a BIMS of 3, indicating severe cognitive impairment. A record review of Resident #28's care plan dated 11/23/22 revealed Resident #28 had an ADL self-care performance deficit related to Impaired balance and musculoskeletal impairment due to a left femur fracture and right wrist fracture. Date Initiated: 02/17/23. Revision on: 03/10/23. Interventions included Encouraging the resident to use the bell to call for assistance. Date Initiated: 02/17/23. Focus: The resident is at risk for falls related to a history of fracture, vitamin D deficiency, impaired balance, incontinence, and a history of falls. Date initiated 02/17/23. Interventions included Be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response to all requests for assistance. Date Initiated: 02/17/23. Observation of Resident #28 on 09/13/23 at 9:57 am revealed her call light to be behind the bed, on the floor. A record review of Resident #40's face sheet revealed a [AGE] year-old male admitted on [DATE]. Diagnoses included weakness and paralysis of the left side after a stroke, speech, and language deficits, cognitive communication deficits, diabetes, bipolar disorder, and schizophrenia. A record review of Resident #40's MDS dated [DATE] documented a BIMS of 15, indicating intact cognition. A record review of Resident # 40's care plan dated 5/23/2022 documented a focus of an ADL self-care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 3 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some performance deficit related to left-sided weakness, impaired balance, and stroke. Date Initiated: 01/26/2023 with a revision on 03/10/2023. Interventions included: Encourage the resident to use the bell to call for assistance date Initiated: 01/26/2023 with a revision on 01/26/2023. Focus: Resident #40 was at risk for falls r/t o Gait/balance problems, Hypotension, Incontinence, Paralysis, Psychoactive drug use and a history of falls prior to admission. Date Initiated: 01/26/2023. Interventions included: Be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response to all requests for assistance. Date Initiated: 01/26/2023. Observation and interview with Resident #40 on 09/12/23 at 2:22 p.m. revealed he could not locate his call light after searching for it on his bed. Resident # 40's call light was on the floor and did not have a clip to secure it within reach. Resident #40 stated his call light never had a clip on it and did not know what he would do if he needed assistance. A record review of Resident #43's face sheet revealed a [AGE] year-old female admitted on [DATE] with a re-admission on [DATE]. Diagnoses included Alzheimer's, cognitive communication deficit, contractures of both hands, Dementia, and Tremors. A record review of Resident #43's MDS dated [DATE] documented a BIMS of 14, indicating intact cognition. A record review of Resident #43's care plan dated 05/19/21 documented a focus of an ADL self-care performance deficit related to Dementia and Impaired balance date Initiated: 06/13/2022. Interventions included encouraging the resident to use the bell to call for assistance. Date initiated 06/13/22. Focus: Resident #43 has a communication problem related to Dentition problems Date Initiated: 06/13/2022. The interventions included: Ensuring/providing a safe environment: Call light in reach, Adequate low glare light, Bed in lowest position and wheels locked, Avoid isolation. Date Initiated: 06/13/2022. Focus: Resident #43 is a Moderate risk for falls related to Gait/balance problems, Incontinence, Poor communication and comprehension, Psychoactive drug use, Unaware of safety needs, and Vision problems. Date Initiated: 06/13/2022. Interventions included: Be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response to all requests for assistance. Date Initiated: 06/13/2022. Observation and interview with Resident # 43 on 09/12/23 at 2:36 pm revealed she could not locate her call light after searching for it on her bed. Resident # 43's call light was on the floor and did not have a clip to secure it within reach. Resident #43 stated her call light never had a clip on it and did not know what she would do if she needed assistance. Interview with CNA B on 09/14/23 at 5:13 p.m. stated not all of the call lights had little clips on them used to clip on the residents' blanket in front of them so they could see it and for her to use to make sure they (the call lights) were within reach. CNA B stated Resident #18 could not use her call light. CNA B stated they did their rounds about every 2 hours and checked on her. Interview with CNA A on 09/14/23 at 5:53 p.m. stated all residents had call lights. CNA A stated we usually put them at reach, some (residents) had a paralyzed side, so we put them on the side they can use. CNA A stated we have little clips that we clip wherever the call light needs to be. CNA A stated not all of the call lights have the clips, she noticed. CNA A stated she asked HR for a clip this morning and was told the facility did not have any more, and that she would have to order them. CNA A stated they ask HR or MS for the clips if one is missing. CNA A stated she usually put Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 4 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete #18's call light on her chest and she checked on her as much as she could, as she was always up and down the hall. Review of the facility policy titled, Answering the call light revised September 2022 documented Purpose: The purpose of this procedure is to ensure timely responses to the resident's requests and needs. Under General Guidelines, 1. Upon admission and periodically as needed, explain and demonstrate the use of the call light to the resident. 2. Ask the resident to return the demonstration. 5. Ensure the call light is accessible to the resident when in bed . Event ID: Facility ID: 675630 If continuation sheet Page 5 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0692 Provide enough food/fluids to maintain a resident's health. 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 review, the facility failed to offer sufficient fluid intake to maintain sufficient hydration and health for 1 of 8 residents (Resident #18) reviewed for hydration in that: Residents Affected - Few Resident #18 was in her room in her bed without access to fluids. This failure had the potential to affect all residents who depended on the facility to meet their hydration needs by causing dehydration. The findings were: Record review of Resident #18's face sheet dated 05/03/22 with a re-admission on [DATE] revealed a [AGE] year-old female with diagnoses including encephalopathy (damage or disease that affects the brain when there has been a change in the way the brain works or a change in the body that affects the brain that leads to an altered mental state, leaving one confused and not acting like they usually do), muscle wasting and weakness, lack of coordination, stroke, cognitive-communication deficit, liver disease, respiratory failure, paranoia, depression, anxiety, diabetes, myasthenia gravis (a chronic autoimmune, neuromuscular disease that causes weakness in the muscles to allow body movement in the arms and legs and allow for breathing), Restless Legs Syndrome (a condition that causes an uncontrollable urge to move the legs), and rheumatoid arthritis (an autoimmune and inflammatory disease that attacks healthy cells in the body by mistake, causing painful swelling, attacking many joints at once). A record review of Resident #18's MDS dated [DATE] revealed a BIMS of 7, indicating severe cognitive impairment. Resident #18's MDS Section G, Functional Status, ADLs, revealed she required set-up help and one person physical assist to eat. A record review of Resident #18's care plan dated 06/14/23 revealed Resident #18 had an ADL self-care performance deficit related to Activity Intolerance, Fatigue, Impaired balance, Musculoskeletal impairment, chronic Pain due to Rheumatoid Arthritis/Restless Leg Syndrome/Myasthenia Gravis. She required staff assistance with her ADLs with interventions including Encourage the resident to use the bell to call for assistance. Date Initiated: 06/14/2022. Focus: At risk for constipation related to the use of opiates for chronic pain. Date initiated 06/14/22. Interventions included encouraging the intake of fluids. Date initiated 06/14/22. Focus: has potential fluid deficit related to Diuretic for diagnosis of congestive heart failure. Date initiated: 06/14/22. Interventions included Monitor/document/report PRN any s/sx of dehydration: decreased or no urine output . Date initiated 06/14/22. Diagnosis of Rheumatoid arthritis Date initiated 06/14/22. Interventions included encouraging adequate nutrition and hydration. Date initiated 06/14/23. Focus: Potential for pressure ulcer development r/t decreased mobility. Date initiated 06/14/22. Interventions included monitoring nutritional status . monitoring intake and record. Date initiated 06/14/23. Observation of Resident #18 on 09/12/23 at 1:37 p.m. revealed her call light was wrapped on the left 1/4 rail of the bed. Resident #18's left hand was contracted. Resident #18 could move her right arm to her face. Resident #18 had little to no dexterity and significant tremors in both hands. The call light had no clip on it to secure it. Observation of Resident #18 on 09/12/23 at 1:37 p.m. revealed a glass of thickened water on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 6 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0692 bedside table was out of reach. The glass was filled to approximately 1 inch from the top. Level of Harm - Minimal harm or potential for actual harm Observation and Interview with the DON on 09/12/23 at 1:42 pm regarding Resident #18's water revealed the DON stated Resident #18's water was out of reach. The DON stated her setup was the same as she had a few weeks ago. The DON stated a few weeks ago was the last time he knew of Resident #18's ability to help herself. The DON stated the staff took direction from him to set up rooms. The DON stated the staff came in every so often to offer water. The DON stated staff should come in every 2 hours at least. The DON stated he relied on staff to to check on the residents. The DON stated he did not monitor them (staff). Resident #18 stated she had not seen anyone since lunch at 11:30 a.m. The DON left the room without adjusting the bedside table. The DON then returned to Resident #18's room and asked Resident # 18 if she needed any water, which she denied. The DON told the resident to let him know if she needed anything then left the room again without adjusting the resident's bedside table. The DON stated he was unaware of any facility policy for hydration. The DON stated he was responsible for ensuring staff were aware of facility policies. Residents Affected - Few Observation of Resident #18's bedside table and water placement on 09/13/23 at 3:00 p.m. revealed the glass of water was out of reach on the bedside table. The glass was filled to approximately 1 inch from the top. Resident #18 could not move the bedside table after trying for 20 seconds. Resident #18's hands were trembling significantly. Observation of Resident #18 and Interviews with the DON and CNC on 09/13/23 at 3:30 p.m. revealed Resident #18's bedside table was on the right side of the bed with a glass of thickened water on the far end of the table. Resident #18 demonstrated she could not move the table closer to her to reach the glass. Resident #18 stated it was the same glass from yesterday. The glass was filled to approximately 1 inch from the top. The CNC stated Resident # 18 needed a weighted glass with handles that she could pick up easier because of the tremors in her hands. The CNC stated it was nursing staff who were responsible for assessing the residents and therapy was responsible for ensuring residents had the equipment they needed as far as adaptive equipment. Observation of Resident #18's bedside table on 09/14/23 at 8:16 a.m. revealed it was out of reach and a glass of thickened water was on it. The glass was filled to approximately 1 inch from the top. Observation of Resident #18 on 09/14/23 at 12:16 p.m. revealed a CNA assisting her to eat and drink. An Interview with the CNC on 09/14/23 at 8:26 a.m. revealed she had therapy come in yesterday to try a cup with a handle for Resident #18. The CNC stated Resident #18 was unable to hold the cup with a handle and the cup was not a weighted cup. Interview with CNA A on 09/14/23 at 8:31 a.m. stated she was familiar with Resident # 18 and that Resident #18 had more bad days than good days. CNA A stated on a good day, Resident #18 could hold a cup and drink from it. She stated Resident #18 shook a lot, so she spilled it all over herself. CNA A stated Resident #18 could not hydrate herself. CNA A stated they (staff) did walk-throughs down the hallways to check to make sure the call lights were in place, the residents were positioned properly, and if anyone needed anything. CNA A stated she was not aware of any policy to determine how often the staff were supposed to check on the residents. CNA A stated the hospitality aid walked around and ensured the residents had hydration, needed snacks, answered call lights, made beds, etc. CNA A stated the CNAs documented food on their ADL sheet, but they did not document fluid intake. CNA A stated everyone was responsible for making sure residents were getting proper hydration. CNA A stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 7 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0692 she was unaware of any facility policy for hydration. Level of Harm - Minimal harm or potential for actual harm An interview with LVN A on 09/14/23 at 8:51 a.m. stated Resident #18 needed help holding a cup. LVN A stated Resident #18 would probably drink more if she could reach it and drink herself. LVN A stated she had never seen any adaptive appliances at Resident #18's bedside. LVN A stated she was unaware of any facility policy for hydration. Residents Affected - Few Interview with OTA on 09/14/23 at 9:21 a.m. stated he was familiar with Resident #18, and she was pending an evaluation for OT next Saturday. The OTA stated he was notified about the evaluation yesterday. The OTA stated Resident #18 would need assistance eating and holding a cup to drink. The OTA stated previously that Resident #18 could either do it or not-she would have good days and bad days (holding a cup to drink on her own). The OTA stated Resident #18 was never evaluated for weighted utensils and cups before her last hospitalization about a month ago because she was able to hold cups and utensils. The OTA stated adaptive equipment would have to be ordered because the facility did not have any. Interview with CNA B on 09/14/23 at 5:13 p.m. stated the residents got beverages when they did rounds, and for the ones that could not do for themselves, they offered them water. CNA B stated one of the residents (could not recall the name) was shaky, but they had to help him because he would spill it all over himself if they did not. CNA B stated he did not have a special cup, and he fed himself, but he did not have special utensils to eat with. CNA B stated there was another resident (could not recall) who was also shaky and had a special cup and utensils and they worked for him. CNA B stated Resident #18 required eating and drinking assistance because she was too shaky and did not have a special cup or special utensils. CNA B stated the shaky residents would probably benefit from adaptive equipment. CNA B stated she was unaware of any facility policy for hydration. Interview with CNA C on 09/14/23 at 5:26 p.m. stated they had to give water to Resident #18 because she could not do it herself. CNA C stated Resident #18 could not hold the cup, and they also had to feed her because she could not hold utensils. CNA C stated Resident #18 could only get water when we gave it to her. CNA C stated she felt bad for Resident #18 because she could get thirsty, but she would have to wait for someone to bring it to her. CNA C stated Resident #18 got nectar-thick fluids either from the kitchen with meals or nursing staff could mix it. CNA C stated the CNAs did not document fluid intake, only percentages of meals. CNA C stated the nurses routinely asked the CNAs how much the residents eat and drink. CNA C stated she was unaware of any facility policy for hydration. Interview with CNA A on 09/14/23 at 5:53 p.m. stated Resident #18 got beverages throughout the day only from staff by checking on her and asking if she needed water. CNA A stated Resident #18 could not hold a cup because she shook a lot when she was holding it. CNA A stated Resident #18 did not have a special cup. CNA A stated she was unaware if they had tried a special cup for Resident #18. CNA A stated Resident #18 could not feed herself and shook too much to hold a fork or anything else. CNA A stated the shaking got worse and worse every time Resident #18 came back from the hospital. CNA A stated they had not tried the built-up utensils for Resident #18. CNA A stated Resident #18 was able to hold a spoon, but she just shook too much to use it. CNA A stated she was not sure how often Resident #18 received fluids. CNA A again stated, she was unaware of any facility policy for hydration. Record reviewof physician orders dated 08/01/23 revealed an order for Furosemide ( a diuretic-medicines that help reduce fluid buildup in the body and increases the flow of urine. Commonly used for high blood pressure, edema, and congestive heart failure. Diuretics can impact your hydration level). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 8 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Oral Tablet 40mg to be given 1 tablet by mouth one time a day for CHF (congestive heart failure-a condition that develops when your heart does not pump enough blood for your body's needs. This can happen if your heart cannot fill up with enough blood). Record review of the facility policy, Hydration Management, indicated all residents will be provided with sufficient fluid intake to maintain proper hydration and nutritional status. 2. Residents identified with potential/actual dehydration, will be evaluated for contributing factors. 5. Risk factors for dehydration may include .medications such as diuretics .6. Notify caregivers of residents at risk for dehydration and ensure proper hydration measures are implemented. 7. Fluid intake will be monitored per facility protocol and care plan goals. Page 2. Facility Hydration Program: All residents will have their fluid needs met via the facility hydration program unless noted otherwise in their plan of care. The hydration program will consist of the following measures: Staff awareness of the need to offer fluids, Hydration passes 3 times a day (approximately 10 am, 2 pm, and 7 pm) whereby all residents will be offered beverages .Total cc's of fluids offered during hydration pass = 360 cc's. Fluids offered with each meal are broken down as follows: Breakfast = 840 cc's Lunch = 480 cc's, Dinner = 480 cc's. Total cc's of fluids offered during meals = 1800 cc's. Approximately 120 cc's of fluids are offered during each medication administration. If a resident received medications 3 times a day, Total cc's of fluids offered during medication pass would be = 360 cc's. Total cc's of fluids offered within a 24-hour period would be approximately 2500 cc's. Staff is encouraged to offer residents beverages all through the day. Water pitchers will be placed at the bedside unless otherwise indicated. If the resident had a beverage of choice that is noted in the plan of care and those beverages are offered to the resident. For residents who are on thickened liquids, the kitchen will send out pre-thickened liquids with meals and during hydration passes. During all other times, the nursing staff will offer liquids thickened to the desired consistency. Bedside thickened liquids will be provided. Any resident needing variation from the above fluid plan will be assessed and have a specific plan of care to meet those needs. Page 3 outlined Intake and output monitoring. Page 4 outlined Measuring fluid intake-1. Fluid taken in by the resident is monitored and documented per shift .Measuring Fluid Output 1.-10. Assessment and Evaluation. Event ID: Facility ID: 675630 If continuation sheet Page 9 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 Based on observation, interview, and record review, the facility failed to establish and maintain an infection prevention program to provide a safe and sanitary environment for 1 of 1 laundry room, and 1 of 1 facility reviewed for infection control, in that: Residents Affected - Many The facility failed to maintain an infection and prevention control program that included, at a minimum, a system for preventing and controlling Legionella through a program that identifies areas in the water system where Legionella can grow and spread by not testing for Legionella and not implementing a system for doing so. The facility failed to ensure laundry was disinfected properly by failing to sort garments before washing to prevent cross-contamination These failures could place all residents of the facility at risk for airborne infection and cross-contamination. The findings included: Observation of the washing machine in the laundry on 09/14/23 at 3:15 p.m. revealed blankets, sheets, towels, and gowns in the same load. There were two manufacturer posters on the wall in the laundry directly across from the washers. One of the posters was titled, Linen Handling Procedures which addressed sorting soiled linen, loading washers, avoiding overloading, and keeping all equipment clean. The other poster was titled, Laundry System Process Information, which had 3 sections: Linen Typessheets, towels, blankets, rags/mops, bed pads, personal, reclaim, and isolation. The section, Wash Program, had numbers listed for each linen type,1-8 to enter into the washing machine. Section Machine # was a list of numbers to push on the washers for dispensing the proper amount and type of chemicals for that load. There was another section, Wash Procedures which listed 1. Sort soiled linens 2. Shake out each piece to remove any items or trash 3. Separate stained items for pretreatment 4. Do not overload/underload the washer 5. Check the supply of laundry chemicals 6. Unload washed linens .7.place in dryer as soon as possible .8. Remove from dryer .9. Clean, folded linen should be stored for 24 hours for best overall results. Interviews with LAU (laundry) and HKS (housekeeping supervisor) on 09/14/23 at 3:37 p.m. regarding the sorting of linens, washer operation, and temperatures revealed that LAU stated she sorted the laundry according to the color of the clothing. LAU stated she sorted blankets, sheets, gowns, and towels to be washed separately. The LAU stated she put the load of blankets, sheets, gowns, and towels in the washer because it was the last load of the day, and it was a small load. The LAU could not state why it was important to separate the laundry. The LAU did not know what temperature the washer should be. The HKS stated the laundry staff, including herself, had never had any training or in-services on the washers, only to put the numbers in for the loads and chemicals. The HKS stated she was new at the facility and did not know who was responsible for training on laundry functioning. An interview with ICP on 09/14/23 at 3:40 p.m. stated laundry should be sorted and washed at certain temperatures to kill any germs but could not think of what those temperatures should be. The ICP stated she did not know who was responsible for for training laundry staff. The ICP stated she did not know how laundry staff were monitored to ensure handling of the laundry was within guidelines. An interview with the ADM on 09/14/23 at 3:53 p.m. stated the laundry should be sorted according to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 10 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 - Many the manufacturer list (on the wall). The ADM stated sheets, blankets, and gowns should not be in the same load because there was cross-contamination with linens that may be more heavily soiled with body fluids as opposed to clothing that may not be more heavily soiled with body fluids. The ADM stated every garment should be washed at the proper temperature of 140-160F to kill germs according to the manufacturer. The ADM stated the automatic chemical dispensing was designed to dispense the proper amount of chemicals according to the load selected by the person sorting the laundry. The ADM stated laundry personnel were responsible for sorting and knowing the temperature garments should be washed. The ADM stated the facility tested for Legionella but did not know they had to send it to a lab. The ADM stated the facility used ph chem strips for testing Legionella. The ADM stated the MS was responsible for all water testing, including Legionella. The ADM stated he was not sure if the facility was testing for Legionnaires according to their policy. The ADM stated he was unaware the laundry was not being monitored, or who trained laundry staff. The ADM stated resident's, especially the elderly, could get very sick from cross-contaminated laundry because their immune systems were vulnerable. A record review of the facility Environment of Care Policy and Procedure Manual (2003) indicated that the water temperatures of the laundry and kitchen areas should be maintained at a temperature of 140 degrees F. An interview with the MS on 09/14/23 at 3:10 pm revealed he did not know what Legionnaire's (a serious type of pneumonia (lung infection) caused by Legionella bacteria. People can get sick when they breathe in small droplets of water or accidentally swallow water containing Legionella into the lungs) was, he had never tested for it and was unaware of the repercussions if Legionnaire's was to infect the building. The MS was also unaware of the facility policy, Legionella Water Management Program reviewed 03/28/23. A record review of the facility's Legionella Water Management Program Policy Interpretation and Implementation reviewed 03/28/23 indicated the water management program included the following elements: 5. b. A detailed description and diagram of the water system in the facility, including the following: 1. Receiving 2. Cold water distribution 3. Heating 4. Hot water distribution 5. Waste 5. c. The identification of areas in the water system that could encourage the growth and spread of Legionella or other waterborne bacteria, including storage tanks, water heaters, filters, aerators, showerheads and hoses, misters, atomizers, air washers and humidifiers, hot tubs, fountains and medical devices such as CPAP machines, hydrotherapy equipment etc. 5. d. The identification of situations that can lead to Legionella growth, such as: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 11 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 1. Construction Level of Harm - Minimal harm or potential for actual harm 2. Water main breaks 3. Changes in municipal water quality Residents Affected - Many 4. The presence of biofilm, scale, or sediments 5. Water temperature fluctuations 6. Water pressure changes 7. Water stagnation 8. Inadequate disinfection 5. e. Specific measures used to control the introduction and/or spread of legionella (e.g., temperature, disinfectants) 5. f. The control limits or parameters that are acceptable and that are monitored 5. g. A diagram of where the control measures are in place 5. h. A system to monitor control limits and the effectiveness of control measures 5. i. A plan for when control limits are not met or not effective 5. j. Documentation of the program FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 12 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0940 Develop, implement, and/or maintain an effective training program for all new and existing staff members. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to develop, implement, and maintain annually an effective training program for individuals providing services under a contractual arrangement, consistent with their expected roles for 3 of 3 contract employees (physical therapy, occupational therapy and speech therapy working) reviewed for training. Residents Affected - Few The facility failed to ensure required trainings were provided for physical therapy, occupational therapy and speech therapy working in the therapy departments at the facility under a contractual agreement for the review period of September 2022 to September 2023. This failure could place residents at risk of being cared for by staff who have been insufficiently trained. The findings were: During a record review of personnel records provided by the HR Manager for the facility occupational therapist it was revealed restraints training was last completed on 7/18/2022. During a record review of personnel records provided by the HR Manager for the facility physical therapist it was revealed restraints training was last completed on 7/18/2022. During a record review of personnel records provided by the HR Manager for the facility speech therapist it was revealed falls training was last completed on 8/16/2022. During an interview with the DON on 9/14/2023 at 4:20 PM he said it is possible staff without restraint training might put someone in a restraint that could result in injury. The DON said the facility has a no restraint policy. During an interview with the occupational therapist on 9/14/2023 at 4:30 PM he said residents could get injured without restraint training. The occupational therapist said the facility is restraint free, and training is done through HR. During an interview with the occupational therapist on 9/14/2023 at 4:30 PM he said the physical therapist was unavailable for an interview. During an interview with the occupational therapist on 9/14/2023 at 4:30 PM he said The speech therapist was called as needed and was not unavailable for an interview. During an interview with the Administrator on 9/14/2023 at 4:45 PM he said that if staff weren't trained in restraints, residents could have an accidental injury. The administrator said when he did training, an example that was shown included a resident strangled by the bed rail. He said residents might become injured. The administrator said if staff were not trained in falls, then staff members, visitors or residents might slip and fall and could become injured. Training was tracked and monitored by Human Resources and included 2 hours per quarter to include HIV, Restraints, Falls and Dementia. Record review of the facility's policy titled, In-Service Training, All Staff dated September 2022, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 13 of 14 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 675630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gulf Shores Rehabilitation & Healthcare Center 1301 S Terrell St Falfurrias, TX 78355 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 0940 revealed, Level of Harm - Minimal harm or potential for actual harm 1 All staff are required to participate in regular in-service education. Residents Affected - Few 2 For the purposes of this policy, staff means all new and existing personnel, individuals providing services under contractual agreement, and volunteers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 14 of 14