Inspection·March 5, 2025

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few one point 1:1 redirecting, providing snacks, bed low position, and floor mats. He said he did frequent rounding for his residents. He said he recalled receiving in-services for abuse, neglect, and exploitation, and for falls . During an interview on 3/5/25 at 3:15 pm, MDS A said when she ran her Risk Assessment report, it showed Resident #1 had a fall but did not have an injury at the time of the incident. She said she went based on that report. She said Resident #1 was later sent out to the hospital, where they found the fractures. She said the fall with injury should have been updated and coded accurately on the MDS once they learned about the fractures. She said she just missed it. She said if the MDS was not documented accurately, the information that gets automatically transferred to other facilities would be inaccurate. The accepting facility would not be aware that Resident #1 had a prior fall with major injury, and it could cause more injury or harm to the Resident if not communicated. She said she modified the assessment and fixed the issue once she reviewed the documentation from the hospital. During an interview on 3/5/25 at 4:00 pm, the DON said Resident #1 had an unwitnessed fall on 1/30/25, and she was complaining of pain to the head. The DON said due to the fall being unwitnessed, the MD sent her to the hospital for a CT scan. She said in-services were conducted for abuse, neglect, and exploitation which included injury of unknown origin. She said a falls in- service was also conducted once we ensured it was a fall. She said depending on what was involved with a fall, we included transfer training or get the therapist involved. She said Resident #1's fall happened due to self-transferring at night. She said Resident #1 understood when we instructed her on the use of the call light for assistance with transfers, but she would not remember to use the call light due to her diagnosis of dementia, bipolar, and schizophrenia. She said fall in-services were done any time there was an incident, a change of condition that involved an injury, or for a fall and included the reason of what happened to try and improve on the care. The DON said the Risk Assessment report showed no injury due to the head CT scan results were negative for injury, and the initial complaint was related to pain to the head. She said the fall with major injury should have been caught and coded accurately on the MDS. She said the outcome of the coding did not affect the care Resident #1 received when she returned to the facility because the care plan was being followed to provide her care and the MD was aware of her status. During an interview on 3/5/25 at 5:10 pm, the Administrator said Resident #1 had a fall and was sent out to the hospital where they found she had rib fractures. He said we want to ensure our facility was accurate in our reporting for the MDS. He said the fall was reported, we just forgot to include it involved an injury. He said he felt it would not affect the care Resident #1 needed for the fall. He said it was more a technical error. Record review of CMS's RAI Version 3.0 Manual dated 10/2024 reflected section: J1800: Any falls since admission/entry or reentry or Prior to Assessment . Steps for Assessment . 3. Review all available sources for any fall since the last assessment, no matter whether it occurred while out in the community, in an acute hospital, or in the nursing home. Include medical records generated in any health care setting since last assessment. Coding instructions: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675689 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675689 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Village Healthcare and Rehabilitation 615 N Ware Rd McAllen, TX 78501 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 0641 Code 1, yes if the resident has fallen since the last assessment. Continue to number of falls since admission/entry or reentry or prior to assessment. Level of Harm - Minimal harm or potential for actual harm J1900: Any falls since admission/entry or reentry or Prior to Assessment. Residents Affected - Few Coding instructions for J1900C: Code 1, one: if the resident had one major injurious fall since admission/entry or reentry prior assessment . Coding Tip If the level of injury directly related to a fall that occurred during the look-back period is identified after the ARD and is at a different injury level than what was originally coded on an assessment that was submitted to the Internet Quality Improvement and Evaluations System (iQIES), the assessment must be modified to update the level of injury that occurred with that fall. Definitions . Major Injury Includes bone fractures, joint dislocations, closed head injuries with altered consciousness, subdural hematoma. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675689 If continuation sheet Page 3 of 3