Health inspection·July 16, 2025

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident will have no evidence of behavior problems by review date. Administer medications as ordered. Monitor/document for side effects andeffectiveness. Anticipate and meet the resident's needs.Explain all procedures to the resident before starting and allow the resident to adjust to changes. Head to toe assessment and labs In an interview on 07/15/25 at 1:38pm, Resident #1 stated on the first day he got to the facility, he was about to take a shower, and he told CNA A he could shower himself but stated CNA A went in the shower room and helped him shower anyways. Resident #1 stated during the shower, CNA A began to give him oral sex. Resident #1 stated me as a man, I liked it. Resident #1 stated this continued for the first two weeks after arriving to the facility. Resident #1 stated he did not report the incident until two weeks later to the ADM. Resident #1 stated he was not scared and enjoyed it at the time. Resident #1 did not elaborate further on alleged incident. Resident #1 stated he asked CNA A for her number, and she gave it to him. Resident #1 stated they began to text, and he asked CNA A for a picture. Resident #1 showed this State Surveyor his phone and the text thread with a picture of what appeared to be a mirror selfie of a female with tattoos located on the arm and leg seen in the picture, no face was visible in the picture as it was covered by the phone. Resident #1 did not state if he knew CNA A prior to being admitted to the facility. Record review of Resident #1's text messages reflected:Resident #1: What's up beautifulAlleged CNA A: Hey, what's up just seeing thisResident #1: Can you send me another picture I deleted the one you sent meAlleged CNA A: It will have to be later I don't have the correct phone with meResident #1: Okay thanksResident #1: It feels good outsideAlleged CNA A: Does it I haven't been outsideAlleged CNA A: HelloResident #1: Sorry I fell asleepResident #1: Send me a picture of youAlleged CNA A: I have to wait till I get homeResident #1: OkayAlleged CNA A dated, Sunday April 27th at 2:35pm: Picture of a female with no face visible wearing a bra and underwear, with visible tattoos on the forearm and leg. In an interview on 7/16/25 at 9:38am, the SW stated she had just arrived to work when Resident #1 came up to her and stated he needed to talk with her. The SW stated Resident #1 reported to her he was getting inappropriate pictures from CNA A, and she was coming on to him. The SW stated Resident #1 stated CNA A tried to kiss him and gave him unwanted advances. The SW stated she immediately informed administration. The SW stated Resident #1 spoke to the ADM and the DON and showed them the inappropriate picture of a female that was texted to him. The SW stated Resident #1 stated she sent multiple pictures but there were no other pictures on the phone and the phone number on the text message was not the same number listed for CNA A. The SW was unable to identify if the female in the picture was CNA A as the face was not visible. The SW stated Resident #1 did not appear fearful, did not appear to be in any distress, and did not verbalize feeling unsafe. The SW stated later, during Resident #1's head-to-toe assessment, Resident #1 reported to the DON and the ADM another story. Resident #1 stated he was receiving oral sex from CNA A; Administration reported the alleged incident to the state survey agency. The SW stated she was not present during the head-to-toe assessment, and she did not know exactly what was said but stated Resident #1 changed his story from CNA A kissing him or trying to kiss him, to receiving oral sex and he did not report it because he is a man, and he couldn't tell her no. The SW stated no other residents came to her or expressed being inappropriately cared for or touched by CNA A or any other staff members. The SW stated the resident stated the advances were happening in his room. In an interview on 07/16/25 at 12:11pm, the DON stated during a morning meeting, the SW came to inform them Resident #1 had made an allegation stating he received inappropriate pictures of CNA A. The DON stated he and the SW went to speak to Resident #1 and showed him a text thread on his phone. The DON stated in the text message, Resident #1 asked for a picture. The DON stated the picture shown was of a female in front of a mirror with the phone partially covering her face and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 2 of 4 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 07/16/2025 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she was in her underwear. The DON stated the resident claimed there were other pictures but he deleted them and was going to ask for more so he could show his lawyer. The DON stated even though in the picture, her face was partially covered by the phone, it could have been CNA A. The DON stated he could not identify the female in the picture by the tattoos. The DON stated the police were called immediately (police report observed). The DON stated while the police were at the facility, that was when Resident #1 insinuated he and CNA A had oral sex by motioning it without saying it. The DON stated Resident #1 stated CNA A touched him, and they kissed in his room and motioned with gestures they had oral sex. The DON stated the resident stated it happened just the one time. The DON stated the police officer saw the picture and recognized the female as possibly being CNA A as CNA A had run ins with the law. The DON stated the phone number used in that text, was later confirmed to be CNA A's phone number. The DON stated the CCS for the facility called the number used in the text and CNA A answered the phone and identified herself by name when asked who she was. The DON stated CNA A denied the allegations between her and Resident #1 and could not answer why Resident #1 had her number or picture. The DON stated no other residents had a concern about the care CNA A provided. In an interview on 7/16/25 at 12:21, the ADM stated Resident #1 informed the SW CNA A was having an inappropriate relationship with him. When the ADM spoke to Resident #1, he stated CNA A was sucking his dick. The ADM stated Resident #1 was not fearful. The ADM stated the resident reported to the SW kissing was going on in his room and CNA A was sending him pictures but did not report about the oral sex. The ADM stated the police were called, CNA A was immediately suspended, and an investigation was conducted. The ADM stated no other residents stated they were abused or inappropriately touched by CNA A or any staff member. CNA A was terminated an no longer employed by the facility. In a phone interview on 7/16/25 at 12:31pm, the CCS stated she was contacted by the facility and informed about the situation with Resident #1 and CNA A. The CCS stated the ADM stated there was an allegation of emotional distress. The CCS stated the number used in the text messages where the picture was found was not a number the facility had listed for CNA A. The CCS stated since the picture did not show a face, the staff were unable to positively identify the female in the picture was CNA A. The CCS stated however, she called the number on the text thread and when the person answered the phone, they identified themselves as CNA A. The CCS stated she did not know what CNA A looked like and could not identify her as the female in the picture. In an in anonymous interview, CNA A seemed flirtatious with the male residents and giggly with the female residents. CNA A was not professional, and CNA A would present herself different with the male residents like the boundary wasn't there for her. They reported CNA A's behavior to many people including the ADON and was not sure what came about it and could not identify who they told or when the complaints were made. They felt CNA A was doing stuff she was not supposed to be doing. CNA A would sometimes take a long time with Resident #1. When they would check on what was taking CNA A so long, she would be in the room combing Resident #1's hair or CNA A stated she was just providing care. In an interview on 7/16/25 at 1:59pm the ADON stated CNA A was an okay employee and stated Resident #1 claimed she was a good CNA. The ADON stated staff never came to her about concerns with CNA A and the care she provided. The ADON stated CNA A would take a long time when providing care to residents but could not say if it was with male or female residents but believed CNA A was just slow because she was new to the facility. The ADON stated she did not work closely with CNA A and could not say if she was inappropriate with residents. The ADON stated Resident #1 claimed CNA A was sending him inappropriate text messages or pictures. The ADON stated she could not see the face in the picture and could not positively identify if it was CNA A. The ADON stated she could not recall if Resident #1 stated it happened once or not. The ADON stated no other (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675630 If continuation sheet Page 3 of 4 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 07/16/2025 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete residents expressed concern or complained about CNA A's care. In a second anonymous interview revealed CNA A seemed to be flirtatious with Resident #1. CNA A's behavior was reported to multiple nurses which included the ADON but did not know if anything was ever done. CNA A would take hours on Resident #1 and CNA A would say she was either combing their hair or providing some kind of care. CNA A would brag about getting texts from Resident #1, but CNA A never stated she had a sexual relationship with Resident #1 and denied any inappropriate behavior. Information about CNA A texting Resident #1 was not reported. In a phone interview on 7/16/25 at 2:51pm, CNA A stated she remembered Resident #1 and stated he would request her to provide care to him because she cared for him the right way and would bathe him right. CNA A stated she never sent text messages or pictures to any resident, CNA A denied any inappropriate behavior and stated she did have tattoos but did not identify them. Attempted interview with the local authorities on 07/16/25 at 4:04pm, 07/16/25 at 4:08pm, and 07/16/25 at 4:40pm were unsuccessful. Record review of the Police Report dated 4/29/25, reflected the call log confirmed the phone number in Resident #1's text message belonged to CNA A. Record review of the facility's Abuse Prohibition Policy dated 06/02/25 reflected: IntentEach resident has the right to be free from abuse, mistreatment, neglect, corporal punishment, involuntary seclusion and financial abuse. Sexual abuse includes, but is not limited to, rape, sexual harassment, sexual coercion or sexual assault.Identifying Sexual Abuse and Capacity to ConsentA resident's consent to sexual activity is not valid if obtained from a resident who lacks the capacity to consent, or if the consent was obtained through intimidation, fear or coercion. 1. Sexual abuse is non-consensual sexual contact of any type with a resident, as defined at 42 CFR S483.5. Sexual abuse includes, but is not limited to:a. unwanted intimate touching of any kind especially of breasts or perineal area;b. all types of sexual assault or battery, such as rape, sodomy, and coerced nudity;c. forced observation of masturbation and/or pornography; andd. taking sexually explicit photographs and/or audio/video recordings of a resident(s) and maintaining and/or distributing them (e.g. posting on social media). This wouldinclude, but is not limited to, nudity, fondling, and/or intercourse involving a resident.2. Generally, sexual contact is nonconsensual if the resident either:a. appears to want the contact to occur, but lacks the cognitive ability to consent; orb. does not want the contact to occur.4. Any forced, coerced or extorted sexual activity with a resident, regardless of the existence of a pre-existing or current sexual relationship, is considered to be sexualabuse. Event ID: Facility ID: 675630 If continuation sheet Page 4 of 4