Inspection·December 2, 2023

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated the staff helped him put on the back brace if he askedthem to,but he mostly put the back brace on by himself. Interview with (CNA) A on 11/30/23 at 9:13 AM,CNA A stated the staff would assist Resident #200 with the back brace if he asked for help. CNA A could not remember if Resident #200 was admitted to the facility with the back brace or not. CNA A stated Resident #200 was not dependent on staff for all activities of daily living. Interview with (LVN) A on 11/30/23 at 10:13 AM,(LVN A) stated he was not sure if the back brace was in Resident #200's orders.LVN A stated he assumed the back brace was only used as reassurance by the resident. The licensed vocational nurse did not see or understand why a resident would need to be care planned, or have any orders for it if it was only used because the resident wanted it on. Interview with the Director of Nursing on 11/30/23 at 10:46 AM she stated she did not remember if the back brace was brought in upon admission or if maybe a family member had brought in the back brace after the resident was already admitted to the facility. The Director of Nursing stated nobody told her Resident #200 had the back brace. The Director of nursing stated the back brace was something that should be care planned or the resident should have an order.The Director of Nursing stated she must have made a mistake and missed it. The Director of Nursing stated she will get an order for it and add into the care plan immediately.The Director of Nursing stated a resident could be harmed by lack of training of a device, or a resident health could decline from not using the adaptive device . Record review of the facility's policy on Care Plans, effective 11/2017, reflected A comprehensive, person-centered care plan that includes, measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs that have been identified through a comprehensive assessment. The Interdisciplinary Team (IDT) will work in coordination with the resident, the resident's family and responsible party to develop and maintain the comprehensive care plan. The comprehensive care plan is based on a comprehensive assessment which includes. But is not limited to, the MDS, Care Area Assessments, clinical assessments, and data collection forms. Each resident's comprehensive care plan will describe person centered measurable objectives and timeframes that will be used to evaluate progress towards goals. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 2 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that included measurable objectives, and timeframes to meet a residents medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for two of two residents (Resident #198 and Resident #200) reviewed for care plans. 1. The facility failed to develop a care plan to address Resident #198's tracheotomy care needs or address emergency management in the event of a dislodgement. 2. The facility failed to correctly assess/identify/document Resident #200's current physical functioning and the use of a back brace in his initial assessment dated [DATE]. These failures could place resident's at risks of suffocation or death. The findings included: 1. Record review of Resident #198's face sheet, dated 11/29/2023, reflected a [AGE] year old male who was admitted to the facility on [DATE]. Resident #198 had diagnoses which included: Subacute Osteomyelitis of the left ankle (a chronic low-grade infection of bone), peripheral vascular disease (circulation disorder), Diabetes type II (high levels of sugar in the blood), Asthma (a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing), Heart disease, lack of coordination, need for assistance with personal care, tracheostomy (an incision in the windpipe made to relieve an obstruction to breathing) and a history of polio (an infectious viral disease that affects the central nervous system). Record review of Resident #198's Care Plan, dated 11/29/23, reflected Resident #198 has impaired airway clearance as a focus, but has no mention of a tracheostomy or interventions needed for a tracheostomy. Record review of the facility MDS Matrix, dated 11/28/2023 at 9:44 AM, reflected no indication Resident #198 had a tracheostomy. Record review of Resident #198's medical chart reflected he was assessed on 11/27/2023 by Nurse Practitioner A and she indicated Resident #198 had COPD and had orders for Xopenex nebulizer treatments every 6 hours (helps with breathing easier), Singular daily (used for asthma), Duoneb every 2 hours as needed (used to treat COPD) and albuterol every 6 hours (used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma and chronic obstructive pulmonary disease) and budesonide nebulizer treatments twice a day (to prevent symptoms of asthma). Record review of Resident #198's physician's Orders reflected no order for tracheotomy care on 11/29/2023 . Observation of Resident #198 on 11/29/2023 at 8:30 AM revealed he had a tracheostomy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 3 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with Resident #198 on 11/29/2023 at 12:24 PM, he said he had the trach 8 years. He said his wife cleaned the outer trach every two days and it had not been done for the week he was at the facility. Resident #198 said his tracheostomy was a size 6, then it was increased to a size 7 to help him breathe better, but when they put a new one in at the hospital 8 days ago, it was a 6 again and he did not know why. Resident #198 said the facility had not done trach care on him since his arrival. Resident #198 said the hospital did suctioning on him before he left (7 days ago) and he had not been suctioned since then . During an observation of central supply with the ADON on 11/30/2023 at 1:30 PM the ADON was unable to locate an emergency trach kit. During an interview with the DON on 11/30/2023 at 12:25 PM, she said; Now that I have reviewed the procedure, [Resident #198] should have had oxygen, another Shiley (inner tracheostomy tube), a suction machine and a trach emergency kit at his bedside. The DON said she heard Resident #198's family member did the trach care for the resident but had never met the family member and did not know if care had been done. The DON said Resident #198 had not been suctioned since he had been at the facility. The DON said there was no excuse for that not to happen. The DON said the facility would have called 911 if Resident #198's trach came out. The DON said all direct care staff completed a competency checklist for tracheostomies upon hire, so staff should know where to look for an emergency trach kit. The DON said an emergency trach kit did not need to be in the crash cart. The DON said the emergency trach kit was kept in central supply . During an interview with the DON on 12/2/2023 at 4:44 PM, she said there should have been a care plan for a tracheostomy when Resident #198 first got to the facility. The DON said she did not know why the admitting nurse did not make one specific for a trach. The DON said they needed a Drs order to put a suction machine in the room, and then said well you could put it in there, but you would need an order to suction the person that has a tracheostomy. The DON said the nurses who admitted the resident did the initial care plan, and then after 14 days the LVN Resident Assessment Instrument (MDS) did it. The DON said the resident only had his initial care plan. The DON said Resident #198 was admitted using information from the care plan received from the hospital along with his admission diagnosis that was acquired from the hospital medical records. The DON said the facility knew his tracheostomy was listed on his admitting diagnosis when he was admitted . The DON related the admitting nurse said the hospital told her it was an established tracheostomy and did not need care. The DON said it was not true that he did not need care for his tracheostomy. The DON said it should have been automatic that the facility put emergency equipment in his room, and they did not. 2.) Record review of Resident #200's face sheet, dated 11/28/23, documented an 63- year-old male who was admitted to the facility on [DATE]. Resident #200 had with the diagnoses ofwhich included: spinal stenosis (pressure on the spinal cord and the nerves within the spine), lumbar region without neurogenic claudication(m48.061) (compression of the spinal nerves in the lumbar [(lower]) spine, encounter for surgical aftercare following surgery on the nervous system. Record review of Resident #200's Quarterly MDS, dated [DATE], reflected: The resident was at risk for falls related to impaired mobility and experienced pain. Resident #200 had an alteration in musculoskeletal status. Resident #200 had an ADL Self Care Performance Deficit related to impaired mobility . Review of R #200's Quarterly Minimum Data Set (MDS) dated [DATE] revealed he: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 4 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0656 -is at risk for falls related to impaired mobility Level of Harm - Minimal harm or potential for actual harm -is experiencing pain. -has an alteration in musculoskeletal status. Residents Affected - Few -has an ADL Self Care Performance Deficit related to impaired mobility Review of R #200's Physician's Order dated 11/28/23 did not reveal a back brace included. Record review of Resident #200's Comprehensive Care Plan, completed on 11/21/23, did not include the back brace and how the facility would implement the back brace for R #200the resident. Observation of Resident #200 on 11/28/23 at 10:13 AM this investigator entered and revealed the resident leaning on his left side while sitting on his bed. This investigator noticed that There was a back brace that was set upon a wheelchair on the left side of the bed. This investigator asked Resident #200 if stated that was his back brace and R #200 responded saying yes it was. This investigator asked Resident #200 When he uses the back brace, and R #200 stated that he uses used it the back brace when he is was sitting down. This investigator asked Resident #200 stated if the staff help him to put on the back brace and R #200 stated that the staff will would help him with his back brace if he asks asked them to, but he mostly puts the back brace on by himself. Interviewed Certified Nurse Aide (CNA) A on 11/30/23 at 9:13 AM. The CNA A stated that the staff will assist R #200 with the back brace if he asks for help. CNA A could not remember if R #200 was admitted into the facility with the back brace or not. CNA A stated that R #200 is not dependent on staff for all activities of daily living (adl). Interviewed licensed vocational nurse (LVN) A on 11/30/23 at 10:13 AM. Upon interview with LVN A, the licensed vocational nurse, he stated that he was not sure if the back brace was in his orders. LVN A stated that he assumed the back brace was only used as reassurance by the resident. The licensed vocational nurse did not see or understand why a resident would need to be care planned or have any orders for it if it was only used because the resident wanted it on. Interview DON on 11/30/23 at 10:46 AM. Upon interview with the DON, she stated that she did not remember if the back brace was brought in upon admission or if maybe a family member had brought in the back brace after he was already admitted into the facility. This investigator asked the DON if she had been told by any of the staff that R #200 had the back brace and she stated that nobody had mentioned it to her. This investigator asked the DON if the back brace is something that should be care planned or have an order for, and the Director of nursing replied by stating yes, that is something that should be care planned, and she must have made a mistake and missed it. The DON also added that she will get an order for it and added into the care plan immediately. This investigator asked the Director of Nursing what could potentially happen if adaptive equipment is missed or not care planned? The DON stated that a resident could be harmed by lack of training of a device, or a resident health could decline from not using the adaptive device. The facility failed to do a proper observation of the items and devices that R #200 uses as assistance. The facility failed to get orders and do a proper comprehensive care plan for the resident. The facility did not care plan R#200's back brace when he was admitted into the facility. The facility did not care plan the back brace if it was an assistive device that was brought in after admission. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 5 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0656 The facility did not get orders, nor did they create goals and interventions for this back brace. Level of Harm - Minimal harm or potential for actual harm Record review of facility's policy on Care Plans, effective 11/2017, reflected A comprehensive, person-centered care plan that includes, measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs that have been identified through a comprehensive assessment. Residents Affected - Few The Interdisciplinary Team (IDT) will work in coordination with the resident, the resident's family and responsible party to develop and maintain the comprehensive care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 6 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents with limited range of motion received appropriate treatment and services to increase range of motion and/or prevent further decrease in range of motion for two residents (R #159 and R #200) reviewed for restorative care. The facility failed to apply knee immobilizer to Resident #159's knee to reduce the risk of further loss of range of motion. The facility failed to back immobilizer to Resident #200's back to reduce the risk of further loss of range of motion. This failure placed residents on restorative nursing care at risk for decline in range of motion, and decreased mobility. The findings: Record review of R 159's #'s Face Sheet dated 11/28/2023, documented a [AGE] year-old female admitted [DATE], with the diagnoses of, fracture of the left patella (knee fracture), heart failure, Diabetes type 2 (insufficient production of insulin in the body), and malignant neoplasm of the breast (breast cancer). Record review of R #159's physician orders 11/16/2023 specified, knee brace on at all times. Frequent ice packs to left knee to reduce pain and swelling. Do not allow left knee to bend if brace is opened up. Record review of R #159's MDS revealed a BIMs score of 7 (Severe Impairment). Record review of R #159's Care Plan dated 11/16/2023 revealed R #159 had an alteration in musculoskeletal status r/t fracture of patella (knee) and interventions were, knee brace to be worn daily as tolerated by patient. Observation on 11/28/23 at 01:29 PM, R # 159's knee immobilizer observed on left knee and was not secured and slid down and knee immobilizer was touching the floor as R #159 sat in wheelchair. Observation on 11/28/23 at 02:11 PM. R # 159's knee immobilizer observed on left knee and was not secured and slid down and knee immobilizer was touching the floor as R #159 sat in wheelchair. Observation on 11/28/23 at 03:05 PM. R # 159's knee immobilizer observed on left knee and was not secured and slid down and knee immobilizer was touching the floor as R #159 sat in wheelchair and knee immobilizer turned backwards. Interview with the DON on 12/02/23 at 02:44 PM stated R #159's knee immobilizer should be kept secure and stated the knee immobilizer is probably too big for R # 159 as she is short and stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 7 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some OT (occupational therapy) was working with resident on 11/28/2023 at 1:14PM and maybe it slid off after therapy. The DON stated R #159 came in with that knee brace from hospital and unsure if it was a good fit for R # 159. The DON stated while R # 159 was lying in bed, the knee immobilizer had stayed secured, but when R # 159 would possibly be sitting down, the knee immobilizer could have slid down. The DON stated that if the knee immobilizer is not worn as ordered, it could cause R # 159 to have further complications or possibly reinjury the affected area. On 12/02/23 at 03:03 PM, this surveyor and the DON went into R # 159's room. The DON asked R # 159 if she could show us her knee immobilizer. When R # 159 removed blanket, R # 159 was not wearing knee immobilizer. Resident stated that the knee immobilizer kept sliding down so she decided not to wear it. The DON stated that she would order and new knee immobilizer for the R # 159 after speaking with MD. R # 159 refused to knee immobilizer back on and denied having any pain at that time. 2.)Review of R #200's Face Sheet dated 11/28/23 documented an [AGE] year-old male admitted on [DATE] with the diagnoses of: SPINAL STENOSIS (pressure on the spinal cord and the nerves within the spine), LUMBAR REGION WITHOUT NEUROGENIC CLAUDICATION(M48.061) (Compression of the spinal nerves in the lumbar (lower) spine, ENCOUNTER FOR SURGICAL AFTERCARE FOLLOWING SURGERY ON THE NERVOUS SYSTEM(Z48.811). Review of R #200's Quarterly Minimum Data Set (MDS) dated [DATE] revealed: -is at risk for falls related to impaired mobility -is experiencing pain. -has an alteration in musculoskeletal status. -has an ADL Self Care Performance Deficit related to impaired mobility Review of R #200's Physician's Order dated 11/28/23 did not reveal a back brace included. Review of R #200's Comprehensive Care Plan completed on 11/21/23 did not include the back brace and how the facility would implement the back brace for R #200. Observation of R #200 on 11/28/23 at 10:13 AM this investigator entered and revealed the resident leaning on his left side while sitting on his bed. This investigator noticed that there was a back brace that was set upon a wheelchair on the left side of the bed. This investigator asked R #200 if that was his back brace and R #200 responded saying yes it was. This investigator asked R #200 When he uses the back brace, and R #200 stated that he uses it when he is sitting down. This investigator asked R #200 if the staff help him to put on the back brace and R #200 stated that the staff will help him if he asks them to, but he mostly puts the back brace on by himself. Interviewed Certified Nurse Aide (CNA) A on 11/30/23 at 9:13 AM. The CNA A stated that the staff will assist R #200 with the back brace if he asks for help. CNA A could not remember if R #200 was admitted into the facility with the back brace or not. CNA A stated that R #200 is not dependent on staff for all activities of daily living (ADL). Interviewed licensed vocational nurse (LVN) A on 11/30/23 at 10:13 AM. Upon interview with Licensed Vocational Nurse A (LVN A), the licensed vocational nurse, he stated that he was not sure if the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 8 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some back brace was in his orders. The licensed vocational nurse stated that he assumed the back brace was only used as reassurance by the resident. The licensed vocational nurse did not see or understand why a resident would need to be care planned or have any orders for it if it was only used because the resident wanted it on. Interview the DON on 1130 at 10:46 AM. Upon interview with the DON, stated that she did not remember if the back brace was brought in upon admission or if maybe a family member had brought in the back brace after he was already admitted into the facility. The investigator asked the DON if she had been told by any of the staff that R #200 had the back brace and she stated that nobody had mentioned it to her. This investigator asked the DON if the back brace is something that should be care planned or have an order for, and the DON replied by stating yes, that is something that should be care planned, and she must have made a mistake and missed it. The DON also added that she will get an order for it and added into the care plan immediately. This investigator asked the DON what could potentially happen if adaptive equipment is missed or not care planned? The DON stated that a resident could be harmed by lack of training of a device, or a resident health could decline from not using the adaptive device. The facility failed to do a proper observation of the items and devices that R #200 uses as assistance. The facility failed to get orders and do a proper comprehensive care plan for the resident. The facility did not care plan R#200's back brace when he was admitted into the facility. The facility did not care plan the back brace if it was an assistive device that was brought in after admission. The facility did not get orders, nor did they create goals and interventions for this back brace. Record review of Assisted Devices and Equipment dated January 2020 stated; Policy statement Our facility maintains and supervises the use of assistive devices and equipment for residents. 3. Recommendations for the use of devices and equipment are based on the comprehensive assessment and documented in the resident care plan. 4. Staff and volunteers are trained on the use of devices and equipment prior to assisting or supervising residents. 5. Residents, family, and visitors are trained, as indicated, on the safe use of equipment and devices. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 9 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who needed respiratory care, including tracheostomy care and tracheal suctioning, was provided, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents' goals and preferences for one of one resident (Resident #198) reviewed for tracheostomy care . Residents Affected - Few 1. The facility failed to ensure Resident #198 had suction equipment, emergency supplies, a spare trach or a care plan specific for tracheostomy care. 2. The facility failed to ensure staff could describe steps to take in the event of an emergency dislodgement of Resident #198's trach. 3. The facility failed to ensure staff were competent in trach care and knowledgeable of equipment needed. These failures could place residents at risk for suffocation and death. The facility Administrator and DON were notified on 11/29/23 at 5:32 PM, that an Immediate Jeopardy situation had been identified due to the above failures. While the IJ was removed on 12/02/23 at 6:08 pm, the facility remained out of compliance at a scope of isolation and a severity level of no actual harm with potential for more than minimal harm. The findings included: Record review of Resident #198's face sheet, dated 11/29/2023, reflected a [AGE] year old male who was admitted to the facility on [DATE]. Resident #198 had diagnoses which included: Subacute Osteomyelitis of the left ankle (a chronic low-grade infection of bone), peripheral vascular disease (circulation disorder), Diabetes type II (high levels of sugar in the blood), Asthma (a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing), Heart disease, lack of coordination, need for assistance with personal care, tracheostomy (an incision in the windpipe made to relieve an obstruction to breathing) and a history of polio (an infectious viral disease that affects the central nervous system). Record review of Resident #198's Care Plan, dated 11/29/23, reflected Resident #198 has impaired airway clearance as a focus, but did not mention a tracheostomy or interventions needed for a tracheostomy. Record review of the facility MDS Matrix, dated 11/28/2023 at 9:44 AM, reflected no indication Resident #198 had a tracheostomy. Record review of Resident #198's medical chart indicated he was assessed on 11/27/2023 by Nurse Practitioner A and she indicated Resident #198 had COPD and had orders for Xopenex nebulizer treatments every 6 hours (helps with breathing easier), Singular daily (used for asthma), Duoneb every 2 hours as needed (used to treat COPD) and albuterol every 6 hours (used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma and chronic obstructive pulmonary disease) and budesonide nebulizer treatments twice a day (to prevent symptoms of asthma). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 10 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0695 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Observation of Resident #198 on 11/29/2023 at 9:30 AM revealed LVN G gave a breathing treatment to Resident #198. LVN G attempted to place a mask over Resident #198's mouth and nose for an Albuterol breathing treatment. (Albuterol is a medication that treats lung diseases, such as asthma, where the airways in the lungs narrow, causing breathing troubles or wheezing [bronchospasm]. Observation of Resident #198's room on 11/29/2023 at 9:30 AM revealed no emergency equipment present for tracheostomy care and no equipment present for routine tracheostomy maintenance. During an observation of central supply with the ADON on 11/30/2023 at 1:30 PM the ADON was unable to locate an emergency trach kit. During an interview with LVN G on 11/29/2023 at 8:30 AM, she said she would not have a suction machine available for Resident # 198 unless the Dr. ordered it. LVN G was aware that Resident #198 had a tracheostomy. During an interview with LVN G on 11/29/2023 at 9:15 AM she said she was not trained for tracheostomy care. LVN G said the facility would probably send Resident #198 out if there was an emergency . During an interview with the DON on 12/02/203 at 4:44 PM, she said there should have been a care plan for a tracheostomy when Resident #198 first got to the facility. The DON said she did not know why the admitting nurse did not make one specific for a trach . The DON said they needed a Drs order to put a suction machine in the room, and then said well you could put it in there, but you would need an order to suction the person that has a tracheostomy . The DON said the nurse that admitted the resident did the initial care plan, and then after 14 days the LVN Resident Assessment Instrument (MDS) did it. The DON said the resident only had his initial care plan. The DON said Resident #198 was admitted using information from the care plan received from the hospital along with his admission diagnosis that was acquired from the hospital medical records. The DON said the facility knew his tracheostomy was on his admitting diagnosis when he was admitted . The DON related the admitting nurse said the hospital told her it was an established tracheostomy and did not need care. The DON said it was not true that he did not need care for his tracheostomy. The DON said it should have been automatic that the facility put emergency equipment in his room, and they did not. During an interview with Resident #198 on 11/29/2023 at 12:24 PM, he said he had the trach 8 years. He said his family member cleaned the outer trach every two days and it had not been done for the week he had been at the facility. Resident #198 said his tracheostomy was a size 6, then it was increased to a size 7 to help him breathe better, but when they put a new one in at the hospital 8 days ago, it was a 6 again and he did not know why. Resident #198 said the facility had not done trach care on him since his arrival. Resident #198 said the hospital did suctioning on him before he left (7 days ago) and he had not been suctioned since then . During an interview with the DON on 11/29/2023 at 12:45 PM, she said the facility clinical liaison told her Resident #198 did not need any tracheostomy care. The DON said the trach size was a 7 (it is a size 6). The DON said Resident #198 went back and forth between a 6 and a 7. The DON said there was supposed to be an extra trach available, and there was not an extra one at the facility (there was supposed to be an extra trach and one of the next smallest size available). The DON said she did not hear Resident #198's family member took care of Resident #198's trach until 11/29/2023. The DON said Resident #198 had not been suctioned since his arrival. The DON said any of the nurses could suction him . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 11 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0695 Level of Harm - Immediate jeopardy to resident health or safety During a phone interview with the attending physician on 11/29/2023 at 1:02 PM, he said he was aware Resident #198 had a tracheostomy. The attending physician said he did not know what the procedures were for admitting tracheostomy patients to the facility . The attending physician said there were not many, if any facilities that would accept a patient with a trach, and if there was an emergency and no one was well trained at the facility, the resident would have to be hospitalized . The physician said he did not know if the facility had any knowledge of the resident's care and needs. Residents Affected - Few During an interview with Resident #198's nurse practitioner on 11/29/2023 at 1:30 PM, she said there should have been trach supplies at the bedside, even for an old trach, as old trachs could have issues such as getting plugged with mucus and other emergencies. The NP stated she saw the resident twice and did not recall seeing any trach supplies such as oxygen, suctioning or a trach kit in resident's room. The NP stated Resident #198 should have some trach care being performed but the NP was seeing Resident #198 for his primary issues which was a diabetic ulcer on his foot. The NP stated she was not aware Residents #198's family member was managing his trach as she had never seen the resident's family member at the facility and was not aware the facility did not have the correct size Shiley in case of an emergency. A Shiley (Trademark) disposable inner canula helps provide convenient and safe tracheostomy care and maintenance to patients in medical and home care settings. During an interview with the DON on 11/30/2023 at 12:25 PM, she said; Now that I have reviewed the procedure, Resident #198 should have had oxygen , another Shiley (inner tracheostomy tube), a suction machine and a trach emergency kit at his bedside. The resident was not receiving oxygen. The DON said she heard Resident #198's family member did the trach care for the resident but had never met the wife and did not know if care had been done. The DON said Resident #198 had not been suctioned since he had been at the facility. The DON said there was no excuse for that not to happen. The DON said the facility would have called 911 if Resident #198's trach had come out. The DON said all direct care staff completed a competency checklist for tracheostomies upon hire, so staff should know where to look for an emergency trach kit. The DON said an emergency trach kit did not need to be in the crash cart. The DON said the emergency trach kit was kept in central supply. During an interview with the Activity Assistant on 11/29/2023 at 10:25 AM, she said she did not remember getting training for trach care. She did not know what could happen if a trach came out . During an interview with RN A on 11/29/2023 at 10:30 AM, he said he had training for tracheostomies in nursing school 8 years ago. He said a suction machine should probably be in the resident's room and probably an ambu bag and emergency kit. RN A said an extra trach should be somewhere known to staff. During an interview with the physical therapist on 11/29/2023 at 10:35 AM, she said residents with tracheotomies did not need a suction machine in their room. She said she did not know if an emergency kit should be in the room. During an interview with LVN B on 11/29/2023 at 10:40 AM, she said she did not get training for trach care at the facility. She said she would put another trach in if the resident's trach came out, and it depended on where the trach was stored. She said sometimes they were stored in the room, or in central supply. During an interview with ADON (LVN) on 11/29/2023 at 10:27 AM, she said she would replace a trach if it came out. The ADON said a suction machine should be in the resident's room. The ADON said there was an ambu bag available in the crash cart and a trach emergency kit was always available. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 12 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0695 ADON said there was training when staff were hired for trach care. Level of Harm - Immediate jeopardy to resident health or safety During an interview with CNA C on 11/29/2023 at 10:44 AM, she said she did not believe a resident with a trach needed a suction machine in their room. She said she would have to ask where an emergency trach kit was located. Residents Affected - Few During an interview with the Speech Therapist on 11/29/2023 at 10:45 AM, she said she did not think a resident needed an ambubag or emergency kit in their room if they had a trach. She said she had trach training 13 years ago when she was a student. During an interview with LVN A on 11/29/2023 at 8:30 AM, she said maybe a resident needed a suction machine and emergency trach kit in their room if they had a trach. She said she had no training for trach care from the facility. During an interview with the DON on 11/29/2023 at 12:45 PM, she said the facility did not have a policy for admitting a resident with a tracheostomy . A record review of the facility Tracheostomy Replacement Competency, dated 2/2020, indicated equipment needed: 1 an appropriate size tracheostomy 2 lubricant 3 Velcro tracheostomy sties 4 scissors 5 gloves 6 ambu bag 7 suction supplies 8 towel 9 syringe Skills described the procedure to safely replace a tracheostomy. A record review of the facility's Tracheostomy Care and Suctioning Competency, dated 2/2020, indicated equipment needed: 1 Tracheal cleaning tray 2 Sterile gloves 3 Suction equipment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 13 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0695 4 Complete tracheal tube set (for emergency use) Level of Harm - Immediate jeopardy to resident health or safety 5 disposable inner cannula of same size Residents Affected - Few 7 Sterile nonraveling presplit dressing 6 Sterile normal saline 8 Clean tracheal ties Skills described the procedure to safely care for a resident with a tracheotomy. A record review of the facility's Suctioning Competency, dated 2/2020, indicated equipment needed: 1 Sterile suction catheter kit 2 Sterile drape 3 Sterile cup 4 Sterile gloves 5 #10 to #16 French catheter 6 Sterile gauze 7 Towel 8 (8) 100 cc sterile saline or sterile water 9 Resuscitation (Ambu) bag with supplemental oxygen 10 PPE Skills described the procedure to safely suction a resident with a tracheotomy. Record review of LVN A's training since hire: indication of tracheostomy care for suctioning (verbal), tracheostomy care and suctioning, and tracheostomy care replacement (verbal). 6/6/2023 A record review of the facility Charge Nurse Skills Checklist, dated 1/2022, indicated each charge nurse upon hire, and at a minimum annually thereafter should complete training for Tracheostomy care and suctioning and Tracheostomy Care Replacement. The facility Administrator and DON were notified on 11/29/23 at 5:32 PM, that an Immediate Jeopardy situation had been identified due to the above failures. On 12/1/2023 at 9:53 PM, the facility was notified of the acceptance of the Plan of Removal (POR). The facility's Plan of Removal documented: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 14 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0695 Verification phase: Level of Harm - Immediate jeopardy to resident health or safety Resident #198 no longer resided at the facility at the time of the verification phase. No other tracheostomy residents reside at the facility. A total of 34 staff members from various shifts and departments were interviewed on the process of emergency tracheostomy care and tracheostomy care beginning on 12/2/2023 at 10:00 AM. All staff members were able to identify the proper procedures for emergency tracheostomy care and tracheostomy care. Residents Affected - Few -On 11/29/23 a respiratory assessment was completed by the Assistant Director of Clinical Services (ADCS) for resident# 198. RP notified by LVN G. MD notified by director of clinical services. The director of clinical services notifed the healthcare supplier of equipment needed. - Verified on 11/29/23 the ADCS observed resident# 198 demonstrate tracheostomy care utilizing appropriate technique and was able to do return demonstration. - Verified on 11/29/23 the following supplies wer e in Resident 198's room: l).suction machine 2). Replacement Shiley size of the 3) tracheostomy kits, 4) oxygen tank and concentrator,5) Ambu bag, 6)Passy-Muir valve) suction kits 8). - Verified on 11/29/23 a licensed nurse obtained an order for tracheostomy care and revised the care plan for Resident #198. - Verified on 11/29/23 the [NAME] President, Divisional Field Sales and Marketing re-educated the Healthcare Liaison on completing the preadmission screen and verification that tracheostomy supplies are available. - Verified on 11/29/2023 Clinical Services (RDCS) re-educated the DCS and Healthcare Liaison on the admission process, continuity of care related to tracheostomy care, availability of supplies, and potential outcomes. - Verified on 11/29/23 the admitting nurses received re-education from the DCS and ADCS on performing skin assessments and completing orders in the medical record for trach care and supplies (See Attachment A)required at bedside. - Verified on 11/29/23 and 11/30/23 the DCS or designee completed re- education to all licensed nurses on procedures for trach care including emergency interventions such as trach dislodgement, occlusion or respiratory distress, trach supplies (see checklists) and location and placement of orders. See guidelines. On 12/01/23, the DCS or designee observed licensed nurses performing return demonstration for an occlusion, respiratory distress, and dislodgement. Remaining licensed nurses will be trained prior to next shift and upon hire. - Verified on 11/29/23 trach orders will include trach size and trach care. - Verified on 11/29/23 the Central Supply Clerk placed supplies (see Attachment B) for tracheostomy in the respiratory storage room. This will be maintained by the Central Supply Clerk or designee. - Observed on 11/30/23 a third party Respiratory Therapist provided additional training to licensed nurses and the DCS and ADCS. All Licensed Nurses completed this training. Licensed Nurses (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 15 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0695 Level of Harm - Immediate jeopardy to resident health or safety that were unavailable to attend the Respiratory Therapist training will be trained by the DCS, ADCS, or designee prior to working their next shift and upon hire. - Verified on 11/29/23 and 11/30/23, the Healthcare Administrator (HCA), DCS, or designee re-educated all Licensed Nurses and C.N.A's on potential outcomes; those Licensed Nurses and C.N.A's that were not available by 11/30/23 will receive the re-education prior to their next scheduled shift. Residents Affected - Few - Verified on 11/29/23 and 11/30/23 the ADCS or designee completed re-education to all Certified Nursing Assistants (C.N.A's) and Licensed Nurses on trach care, trach supplies ( see Attachment A) and interventions for dislodgement, occlusion and respiratory distress; those associates not available by 11/30/23 will receive the re-education prior to their next scheduled shift. - Verified on 11/30/23 the DCS created a checklist of trach supplies (see Attachment A) that are kept at bedside for residents that have tracheostomy tubes. The checklist was placed in the nurse's information book - Verified On 12/01/23 the DCS added the emergency tracheostomy checklist (see Attachment B) to the emergency checklist binder to include tracheostomy supplies. - Upon new admissions with tracheostomy tubes will be reviewed the next business day by the Interdisciplinary Team (IDT) (the IDT may include, but not limited to the DCS, ADCS, RAI Coordinator, HCA, Resident Programs and Social Services). This review includes the medical record and verification of tracheostomy orders. Licensed nurse will notify Healthcare Provider as needed for orders. - All Licensed Nurses will complete the Tracheostomy Care re-education and Post Test by 11/30/23; those Licensed Nurses not available on 11/30/23 will receive the re-education and Post Test prior to their next scheduled shift. This re-education will be completed by the DCS, ADCS, or designee. - Verified on 11/30/23 the DCS or designee provided re-education to all skilled Administration, Dining, Housekeeping, Therapists, Maintenance, Resident Programs and C.N.A's on emergency process including signs and symptoms of respiratory distress and when to call for assistance. Those associates not available by 11/30/23 will receive the re-education prior to their next shift. - Verified through record review on 11/29/23 an Impromptu Quality Assurance Performance Improvement (QAPI) meeting was held with the Medical Director, Executive Director, HCA, RDCS, Regional Director of Operations, District Director of Clinical Services and Healthcare Liaison. On 12/22/23 at 6:08 PM, the Administrator and DON were informed the IJ was removed. However, the facility remained out of compliance at a scope isolation and a severity level of no actual harm with potential for more than minimal harm after the IJ immediacy was removed due to the facility's need to monitor and evaluate the effectiveness of the corrective systems. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 16 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for of two of five medication carts (200 and 300 Hall 2nd floor Medication Cart) reviewed for medication storage The facility failed to ensure, 200 and 300 hall medication carts were locked when unattended. This deficient practice could place residents at risk of misappropriation of medications or harm due to accidental ingestion of unprescribed mediations. Findings include: Observation on 11/28/2023 at 1:08 pm revealed two medication carts unlocked. The Charge nurse was observed to be behind the nurses' station. The State Surveyor walked towards the medication carts and was able to open drawers and pull out a variety of medications. Interview on 11/28/2023 at 1:23 pm revealed LVN A took ownership of the unlocked medication cart and went to the nurses' station to work on other tasks she had and forgot to lock the medication cart. LVN A stated if the medication cart should not be unlocked, and all medication carts should be locked at all times when not in use so unauthorize people did not have access to medications located inside the medication cart. LVN A stated she could not remember the last time an in-service was conducted on locking medication cart, but administration was always rounding and making sure medication carts were locked at all times when not in use. Interview with the DON on 11/28/2023 at 1:23 pm revealed medication carts are supposed to be locked at all times as per facility protocol when not in use. Observation and interview on 11/30/23 at 1:30 PM revealed 1 of 3 medication carts unlocked at the entrance of hall 100. There were no residents close to the medication cart or in the hallway, but there were visitors entering and exiting the elevator 4 feet away from where the elevator was parked while unlocked. Five minutes later, LVN A came out from the nurses' station LVN A stated it was her medication cart and was interviewed again about what could happen with medication carts being unlocked. The Licensed Vocational nurseLVN A stated that residents and others could could go into the carts and take things from the cart that do did not belong to them. Interview with the Director of Nursing on 11/30/23 at 1:35 PM the Director of Nursing stated she would do another in-service with the Licensed Vocational Nurse and she understood how dangerous it was to have a medication cart unlocked and forgotten to be locked. Record review of the facility's Medication Cart Use and Storage Policy dated 10/01/2019 reflected: Guidelines Security Line 1. The medication cart and its storage bins are kept locked until the specified time of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 17 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 0761 medication administration. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 18 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to maintain and ensure safe and sanitary storage of residents' food plates. Residents Affected - Some 1. Upon two separate visits to the 4th floor satellite kitchen revealed a worn, distressed looking temperature log binder being placed to lean against the food plates that are served to the residents for their meals every day. This failure could place residents at risk for cross-contamination and food-borne illnesses. 2. The facility failed to ensure staff did not store their personal drinks in the preparation area of the facility kitchen. Findings were: 1. In an observation on 11/28/23 at 10:18 a.m. revealed a refrigerator temperature log binder leaning on top of plates that are used to serve the residents on the 4th floor. In an observation on 11/30/23 at 10:38 a.m. the temperature log binder remained leaning against the plates that are utilized to serve the residents on the 4th floor. In an interview on 11/30/23 at 10:42 a.m. with the Dietary Manager revealed that the binder should not be leaning on the plates and it should be placed in the designated basket at the entrance of the kitchen area. The investigator asked the Dietary Manager what those plates that the binder is leaning on are utilized for. The Dietary Manager responded They are used to serve the residents. I can see the problem with that. I will move it immediately. When the investigator asked where the binder belongs, the Dietary Manager followed by stating There is a basket at the entrance of the kitchen where we are supposed to put it. Record review of the facility's policy Food Receiving & Storage Policy Statement revealed, All food, chemicals, and supplies should be received and stored in a manner that ensures quality and maximizes safety of the food served. 2. Observation on 11/29/23 at 10:47 a.m. revealed in the satellite kitchen, located on the 4th floor of the facility a staff personal item placed on top of the counter in the kitchen by the food warmer . Observation on 11/30/23 at 10:34 a.m. revealed, in the main kitchen, two personal drinks placed on the cutting boards of where the kitchen staff cut and prepared food. In an interview on 11/30/23 at 10:25 a.m., the Dietary Manager said items had a designated area that was sectioned and labeled for the residents to place their items at the main kitchen on the 2nd floor. The kitchen on the 4th floor did not have an area for personal items and the dietary manager stated he would create an area for the staff to place their items that would not interfere with a safe and sanitary environment to prepare food for the residents of the facility. Facility's Foods Brought by Family/Visitors policy dated July 2023 reflected: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 19 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Policy Interpretation & Implementation Level of Harm - Minimal harm or potential for actual harm 5. No items will be stored next to the plate warmer(i.e binders, clipboards). Food storage, plateware, utensils will remain free of debris and unsanitary conditions for the kitchen and food service equipment. Residents Affected - Some Record review of the facility's policy reflected Personal Items in Kitchen, dated October 2017, revealed: It is the policy of this facility that any food or personal items that are brought to the kitchen by staff must be directed to an area that does not come into contact with the food and the area that is preparing food for the residents. Procedures: .2. Staff need to be aware that if personal items are being placed in areas of the kitchen that are used for handling the food that is prepared for the residents it is not sanitary and could result in sickness. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 20 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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, and interview, 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 Resident #160 of 55 residents reviewed for infection control. Residents Affected - Few 1. LVN C did not perform hand hygiene for 20 seconds or greater while performing wound care on Resident #160. These failures could place residents at risk for infection through cross contamination of pathogens. The findings include: 1.) Record review of Resident #160's face sheet, dated 12/1/2023, documented a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #160 had diagnoses which included atrial fibrillation (hearts upper chambers beat out of coordination with the lower chambers), displacement of cardiac pulse generator (battery) subsequent encounter for surgical aftercare following surgery on the circulatory system disruption of external operation surgical wound, and multiple sclerosis (a chronic typically progressive disease involving damage to the sheaths of the nerve cells in the brain and spinal cord). Record review of Resident #160's physicians orders, dated 11/22/2023, specified, cleanse surgical wound to left chest, with normal saline and 4x4 gauze, pat dry with 4x4 gauze, apply medihoney to wound bed, cover with calcium alginate, secure with allevyn dressing daily. Record review of Resident #160's, MSD reflected a BIM's score of 12, which indicated Moderate Impairment. Record review of Resident #160's Care Plan, dated 11/14/2023, reflected Resident #160's had actual impairment to skin integrity r/t surgical wound to the left chest which has dehisced (vessels, cut or wound, gaped, or burst opened). Interventions included surgical wound to left chest, cleanse with normal saline and four by four gauze, pat dry with four by 4 gauze, apply medihoney to wound bed, cover with calcium alginate, secure with allevyn dressing daily. Observation on 12/01/23 at 10:47 AM, revealed LVN C perform hand hygiene for approximately 14 seconds prior to performing wound care on Resident # 160 . Interview with LVN C on 12/01/23 at 11:05 AM, LVN C stated hand washing should be performed for 20 seconds or more. LVN C stated she did not count as she was washing hands and possible negative outcomes could lead to Resident # 160's wound getting infected or not healing properly. LVN C stated the last infection control in-service was recently but could not remember when. Interview with the DON on 12/01/23 at 01:06 PM, the DON stated hand washing should be at least 20 seconds or greater of friction with soap and water. The DON stated possible negative outcomes would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 21 of 22 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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 be cross contamination and spread of infection to residents. The DON stated the last infection control In-service was within the last few months but would conduct a Hand Washing and Infection Control in-service immediately. Record review of the facility's Hand Washing Procedure, revised 10/2018, reflected: Residents Affected - Few Handwashing Procedure .: 3. Apply soap to palm of hand; join hands, palm to palm, working up a lather on hands, wrists, and forearms for at least 20 seconds. Washing Hands Procedure Vigorously lather hands with soap and rub them together, creating friction to all surfaces, for a minimum of 20 seconds (or longer) under a moderate stream of running water, at a comfortable temperature. Hot water is unnecessarily rough on hands. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675773 If continuation sheet Page 22 of 22