Health inspection·December 8, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some recommended for Resident #6 to try and avoid the other resident, and if Resident #6 felt she was being bothered by the other resident, to notify a staff member so they could intervene. 2. Record review of Resident #2's face sheet, dated [DATE], revealed a [AGE] year-old-female with an admission date of [DATE], and a discharge date of [DATE]. Relevant diagnoses included Senile Degeneration of the Brain (progressive deterioration of brain tissue and function), bipolar disorder (a mental health condition characterized by extreme mood swings, including emotional highs and lows), Genetic Related Intellectual Disability (a learning disability significantly influenced by genetic factors), and Severe Intellectual Disabilities (significant limitations in cognitive functioning and adaptive behavior). Record review of Resident #2's Quarterly MDS Assessment, dated [DATE], revealed a BIMS score of 09, moderately impaired cognition. Record review of Resident #2's care plan, initiated [DATE], revealed Resident #2 had a potential to be verbally aggressive (she yelled at other residents and staff). Interventions included: medication review was done by the hospice doctor; urinalysis was done; administer medications as ordered; assess Resident #2's understanding of the situation; allow time for Resident #2 to express self and feelings toward the situation. Another care plan, initiated [DATE], revealed Resident #2 had the potential to be physically aggressive. Interventions included: labs obtained, modify environment (to include adjust room temperature to comfortable level, reduce noise, dim lights, place familiar objects in room, keep door closed), started on antibiotic for urinary tract infection. This care plan was revised on [DATE] to include Resident #2 was involved in a resident-to-resident altercation with a skin tear to Resident #2's left forearm. Record review of the provider investigation report, dated [DATE], in a narrative given by ADON-B, revealed Resident #2 and Resident #6 were involved in a physical altercation in the dining room in which ADON-B stated he observed both residents physically engaging, and both residents were immediately separated by LVN-G. The assessment, completed by LVN-D, revealed Resident #2 was noted to have had a skin tear to the left forearm. Record review of Resident #2's progress note, dated [DATE], revealed resident to resident verbal and physical altercation. Resident #2 voiced Resident #6 was verbally aggressive toward her and grabbed her by her left forearm and pressed her nails into her. A skin tear was noted to left forearm. Resident #2 was upset and crying. 3. Record review of Resident #9's face sheet revealed a [AGE] year-old female initially admitted on [DATE], with diagnoses of Cerebral Infarction due to Embolism of Right Middle Cerebral Artery( a condition were a blood clot travels through the blood to the brain and blocks oxygen and blood flow to blood vessels in the brain, causing tissue damage.), anxiety disorder(a mental health condition characterized by excessive and persistent worry, fear, and nervousness which could interfere with daily life), Post Traumatic Stress Disorder (a mental health condition which could develop after experiencing or witnessing a traumatic event such as a natural disaster, war, violent crime, or serious accident), Schizophrenia (A Chronic mental health condition which affects a person's thoughts, feelings, and behaviors), Major Depressive Disorder (A common mental health condition characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in previously enjoyable activities). Record review of Resident #9's MDS Quarterly dated [DATE] revealed Resident #9 had a BIMS Score of 02-severe problems with thinking and memory classified as severely impaired cognition, suggesting significant cognitive impairment. MDS functional status revealed the resident needed extensive assistance with ADLs. Record review of Resident #9's care plan dated [DATE] revealed Resident #9 used antidepressant medication Vilazodone for depression and her behavior was to be monitored, documented, and reported for adverse reactions to antidepressant therapy. Resident#9 was to be monitored also for changed behavior in mood/cognition, hallucinations/delusions, social isolation, suicidal thoughts, withdrawal and decline in ADL ability. Resident#9 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675785 If continuation sheet Page 2 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dependent on staff for meeting emotional, intellectual, physical, and social needs due to physical limitations. Resident#9 had an ADL self-care performance deficit related to weakness, poor mobility related to hemiplegia affecting the left side. Resident #9 was at risk for a behavior problem related to Major Depressive Disorder, Post-Traumatic Stress Disorder, Anxiety Disorder, Bipolar Disorder, and Insomnia. Resident #9 had potential to be verbally aggressive yells at staff, verbally inappropriate, uses foul language towards staff related to mental and emotional illness, poor impulse control, anxiety, bipolar disorder, Post Traumatic Stress Disorder, major depressive disorder, and insomnia. Resident #9 had impaired cognitive function or impaired thought processes related to difficulty making decisions. Record review of Resident #9's progress notes dated [DATE] to [DATE] revealed on [DATE] Resident #9 went to the nurses station and stated another resident had hit her with his electric wheelchair. Resident #9 stated she got lost and went into Resident #10's room where the incident occurred. Resident #9 stated Resident #10 hit her on the right shin with his electric wheelchair attempting to push her out of his room at the same time resident attempted to move back causing a skin tear to her left calf. A complete head to toe assessment was done, head clear of bumps, abrasion or pain, face asymmetrical due to Cerebrovascular accident (stroke) and missing dentition. Skin tear to left shin measured 1.5cm X 0.3cm according to the nurse's head to toe assessment. 4. Record review of Resident#10 face sheet revealed an [AGE] year-old male initially admitted on [DATE], with diagnosis of Quadriplegia (A medical condition characterized by the partial or complete loss of movement and sensation in all four limbs), muscle wasting atrophy (a condition which causes a progressive loss of muscle mass, strength and power), acute embolism(an obstructions of an artery typically by a blood clot or other material) and thrombosis (the formation of a blood clot inside a blood vessel obstructing the flow of blood through the circulatory system), Bradycardia(a slow heart rate, where the heart beats at a rate below the normal range). Record review of Resident #10's MDS Quarterly dated [DATE] revealed Resident #10 had a BIMS Score of 15 which indicated a resident's cognition was intact, meaning they had very little mental impairment. The MDS revealed functional limitations in range of motion on both sides. The MDS indicated Resident #10 used a motorized wheelchair and was dependent on staff to help in all daily activities. Record review of Resident #10's Care Plan date [DATE] revealed Resident #10 was independent for meeting emotional, intellectual, and social needs related to activities. Resident #10 could decide whether he wanted to participate in an activity. Resident #10 enjoys spending social time on the patio in the mornings, chatting and smoking with other residents. Resident #10 enjoyed participating in group activities such as recreational bingo in the afternoons, celebrations with music and snacks and only when he preferred, the outings for Walmart. Resident #10 was alert and independent and able to move around in his power wheelchair but due to the limitations of his hands, he required activities without much physical or cognitive effort. Resident #10 had an ADL self-care performance deficit related to functional quadriplegia and bilateral hand contractures. Resident #10 had limited physical mobility related to quadriplegia. Resident #10 required supervision by staff for locomotion when he used his personal motorized wheelchair. Resident #10 had potential to be physically aggressively related to poor impulse control and was triggered for physical aggression with poor impulse control. Resident #10's behaviors were de-escalated by redirection. Record review of Resident #10's progress notes dated [DATE] to [DATE] revealed on [DATE] at 12:00 AM Resident #10 stated to LVN Resident #9 went inside his room and as he used his electric wheelchair to push Resident #9 out of his room it caused a skin tear to Resident #9's lower leg. Resident #10 was checked for injuries, denied pain or discomforts. Administrator, DON, MD, and family notified of incident occurrence between both residents. In an observation and interview on [DATE] at 3:17 PM with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675785 If continuation sheet Page 3 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #9 revealed the resident was sitting in her wheelchair in her room talking with the CNA who had just brought her into the room. Resident #9 was upset as she spoke to CNA-A about her mother and how her visit was with her mother. The State Surveyor asked Resident #9 about the incident with Resident #10, and she stated she could not remember the incident or having received a wound from the wheelchair of Resident #10. Resident #9 then began to state her home had been robbed by someone named [NAME] and she needed help to find her stuff. The Surveyor discontinued the interview as the resident became upset while she spoke of the robbery. CNA-A stated she gets confused often. In an observation and interview on [DATE] 3:43 PM with Resident #10 revealed the resident was in bed watching television. Resident #10 was alert and agreed to discuss the incident between Resident #9 and himself. Resident # 10 stated he was in his chair watching TV when suddenly Resident #9 rolled in on her wheelchair and said she thought it was her room and for him to leave. Resident #10 stated she was confused and was in the wrong room, so she tried to wheel herself out and she got caught up between the bed and wall. Resident #10 stated he then rolled over to her to help her and accidentally scratched her leg. Resident #10 stated he was only trying to help her get unstuck, and he did not intend to harm her leg. In an interview on [DATE] at 3:30 PM, LVN-D stated Resident #2, had an issue with maybe 1 or 2 residents which were on the 100 and 300 hall, but it was mostly the other residents picking on Resident #2. She stated Resident #6 used to pick on Resident #2 because she was jealous of Resident #2 talking to her boyfriend. Resident #6 would call Resident #2 names. LVN-D stated she did not recall a specific incident in which she did a skin assessment on Resident #2 or Resident #6, but she could have. She also did not recall having to intervene between Resident #2 and Resident #6 during any of their physical altercations, but she did remember one of the physical altercations because she was at the nurses' station getting report and heard both Resident #2 and Resident #6 yelling at each other. LVN-D did not go into the dining room to assist because she was counting narcotics, and the other staff had already assisted and separated the residents. She stated Resident #2 had scratches on her arm from the physical altercation. LVN-D stated after the incident, Resident #2 was moved to the 300 hall first, then Resident #2 was moved to the 200 hall after another incident. LVN-D stated Resident #2 was moved multiple times in the facility's attempt to keep her and Resident #6 from having any verbal or physical altercations. In an interview on [DATE] at 3:55 PM, MA-E stated Resident #2 was moved to multiple rooms while she was here. MA-E stated Resident #2 would yell at everyone. It was not that she was yelling, but it was Resident #2's way of communicating because she talked very loudly. MA-E stated most of the incidents were in the dining room because Resident #2 followed Resident #6 and her boyfriend because she liked Resident #6's boyfriend. Resident #6 would get jealous and get verbally aggressive with Resident #2. MA-E stated she was there when one of the physical altercations occurred but did not remember the exact date. MA-E stated by the time she had gotten to the dining room, both residents had already been pulled apart. Resident #6 stated her hair was pulled, but MA-E had not seen any redness to the area or missing hair, and Resident #2 had a scratch to one of her arms. MA-E stated both residents used to taunt each other. In an interview on [DATE] at 4:53 PM, the DON stated Resident #2 was pleasant, not aggressive. She was loud sometimes, but it was normal for Resident #2 to be loud. Other residents may have taken it the wrong way if they had not known or understood Resident #2, but she was not the type to have gone up to anyone and started an argument or started an altercation. The DON stated Resident #2 had an intellectual disability, but she was able to answer simple questions and give simple answers, but she would get confused very easily. The DON stated Resident #6 could be very disrespectful and call other residents names and make fun of them or make faces at them. She stated they tried to explain to Resident #6 about Resident #2's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675785 If continuation sheet Page 4 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete cognitive status, but she still instigated things, made noises at her, and called her names, and it would upset Resident #2 who then lashed out. The DON stated staff tried to always keep the two residents separated from each other, but it did not always work because when Resident #6 would say something, Resident #2 would turn around to make a face at her or went back to her. The DON stated Resident #2 had lorazepam (a medication used to treat anxiety) ordered because she was under hospice services, and it would sometimes help with her anxiety or agitation. Then, hospice ordered the Ativan/Benadryl/Haldol (ABH) Gel (a medication used for agitation, anxiety, and hospice patients) after the second incident, and it seemed to help as well. The DON stated Resident #2 was moved from the facility and transferred to a different facility, even though Resident #6 was the one who instigated things. In an interview on [DATE] at 5:05 PM, CNA-I stated she had taken care of Resident #9 and said Resident #9 was always lost and went into other residents' rooms. CNA-I stated Resident #9 was always confused and made-up stories about residents or staff members in the facility. CNA-I stated Resident #9 had made phone calls to police claiming she had been hurt and robbed by other residents and that did not occur. CNA-I stated earlier today Resident #9 told her about visiting her mother and the resident's mother had been deceased for several years. CNA-I stated every incident Resident #9 had been a part of had been investigated by the facility. CNA-I stated the resident was removed from the same hall as Resident #10, so the incident did not occur again. CNA-I stated last Abuse and Neglect training was about 2 weeks ago and was able to state the steps for reporting physical/sexual, mental and verbal abuse seen in the facility. In an interview on [DATE] 5:30 PM, LVN-C stated she had completed a head-to-toe assessment on Resident #9 but could not remember the location or describe how the scratch looked. LVN-C stated she remembered the incident and remembered the resident crying and trying to calm her down. LVN-C stated Resident #9 was an emotional person and was very sensitive and always thought other residents and staff members would talk badly about her. The LVN stated Resident #9 had made accusations against the facility even by calling police and when police showed up she would tell them to leave. The LVN stated Resident #10 was found to have had no injuries when assessed. Resident #9 was moved to another hall away from Resident #10 so future incidents do not occur between them. In an interview on [DATE] at 9:38 AM, CNA-F stated he heard a female scream and quickly went toward the room of Resident #10's room and found Resident #9 near the doorway making her way out of Resident 10's room. CNA-F called the charge nurse, and a head-to-toe assessment was administered and the only injury found was the scratch to her lower leg. The CNA stated Resident #9 wanders into other residents' rooms and the staff monitored her when she scooted around the halls in her wheelchair. Record review of the facility's policy Abuse, Neglect and Exploitation, implemented [DATE], it revealed It is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, which can include staff to resident abuse and certain resident to resident altercations. 1. B. Prospective residents will be screened to determine whether the facility has the capability and capacity to provide necessary care and service for each resident admitted to the facility. Event ID: Facility ID: 675785 If continuation sheet Page 5 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews the facility failed to ensure the assessment accurately reflected the resident's status for 1 (Resident #5) of 5 residents reviewed for MDS assessment. Resident #5's MDS admission assessment dated [DATE] failed to indicate Resident #5 had a fall that resulted in major injury. This deficient practice could place residents at risk for inadequate care and services to meet their needs based on inaccurate MDS assessments. Findings included:Record review of Resident #5's admission assessment reflected an [AGE] year-old female initially admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included displaced intertrochanteric fracture of left femur (a break in the top of the thigh bone), history of falling, cognitive communication deficit (difficulty with communication), vascular dementia (problems with thought processes and memory caused by brain damage from impaired blood flow), hyperlipidemia (high cholesterol), atherosclerotic heart disease (buildup of fats and other substances in and on the artery walls of the heart causing decreased blood flow and/or clots), non-ST elevation myocardial infarction (a type of heart attack characterized by a partial artery blockage in the heart), hypertension (high blood pressure), and unspecified osteoarthritis (degenerative joint disease that results from breakdown of joint cartilage and underlying bone). Record review of Resident #5's previous hospital records dated 04/29/25 to 05/10/25 reflected an orthopedic consultation dated 05/02/25 which stated in part: History of Present Illness: [AGE] year-old female who was admitted after sustaining a ground level fall. Resident #5 was complaining of knee pain but did not require surgery during that hospital stay. Record review of the facility's provider investigation report dated 07/03/25 reflected Resident #5 had an unwitnessed fall in her room on 06/27/25 that resulted in a cut to the back of her head and complaints of left hip and leg pain. Resident #5 was transferred to the hospital and underwent surgery on 06/28/25 to repair her left hip fracture that was sustained as a result of the fall. Record review of Resident #5's admission MDS dated [DATE] and electronically signed by the MDS nurse on 07/17/25 reflected it was a reentry into the facility on [DATE] from a short-term general hospital and a BIMS score of 5 which indicated severe cognitive impairment. Section I- Active Diagnoses reflected Resident #5 had a hip fracture. Section J 1700- Fall History on Admission/Entry or Reentry reflected the MDS nurse answered, No, Resident #5 did not have a fall any time in the last month or in the last 2 to 6 months, and Resident #5 did not have any fracture related to a fall in the 6 months prior to admission/entry or reentry. Section J 2100- Recent Surgery Requiring Active SNF Care reflected Resident #5 had a major surgical procedure (repair of a fracture of the pelvis, hip, leg, knee, or ankle) during the prior inpatient hospital stay that required active care during the SNF stay. Section M 1040- Other Ulcers, Wounds, and Skin Problems reflected Resident #5 had a surgical wound that required surgical wound care. In an interview on 10/08/25 at 2:44pm, the MDS nurse stated she coded the fall with major injury on the resident's discharge MDS dated [DATE], so she did not answer yes to those questions on the reentry MDS. She stated the questions about the falls should have been answered yes instead of no. The MDS nurse stated Resident #5's falls were on the care plan even though they were not on the MDS but if falls were not triggered on the MDS for a new resident, it did not show up on the care plan as high risk. The MDS nurse stated it was the responsibility of the MDS nurses to ensure resident assessments were accurate. A policy for accuracy of MDS assessments was requested from the facility, however they did not have one and stated they referred to the RAI for whichever section is being answered. Record review of CMS's RAI Version 3.0 Manual, CH 3: MDS Items J effective 10/01/25 reflected in part: Steps for Assessment The period of review is 180 days (6 months) prior to admission, looking back from the resident's entry date (A1600). 1. Ask the resident and Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675785 If continuation sheet Page 6 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete family or significant other about a history of falls in the month prior to admission and in the 6 months prior to admission. This would include any fall, no matter where it occurred. 2. Review inter-facility transfer information (if the resident is being admitted from another facility) for evidence of falls. 3. Review all relevant medical records received from facilities where the resident resided during the previous 6 months; also review any other medical records received for evidence of one or more falls. Coding Instructions for J1700A, Did the Resident Have a Fall Any Time in the Last Month Prior to Admission/Entry or Reentry? Code 0, no: if resident and family report no falls and transfer records and medical records do not document a fall in the month preceding the resident's entry date item (A1600). Code 1, yes: if resident or family report or transfer records or medical records document a fall in the month preceding the resident's entry date item (A1600). Coding Instructions for J1700B, Did the Resident Have a Fall Any Time in the Last 2-6 Months prior to Admission/Entry or Reentry? Code 0, no: if resident and family report no falls and transfer records and medical records do not document a fall in the 2-6 months prior to the resident's entry date item (A1600). Code 1, yes: if resident or family report or transfer records or medical records document a fall in the 2-6 months prior to the resident's entry date item (A1600). Coding Instructions for J1700C. Did the Resident Have Any Fracture Related to a Fall in the 6 Months prior to Admission/Entry or Reentry? Code 0, no: if resident and family report no fractures related to falls and transfer records and medical records do not document a fracture related to fall in the 6 months (0-180 days) preceding the resident's entry date item (A1600). Code 1, yes: if resident or family report or transfer records or medical records document a fracture related to fall in the 6 months (0-180 days) preceding the resident's entry date item (A1600). Event ID: Facility ID: 675785 If continuation sheet Page 7 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 - Some 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 interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and time frames to meet a resident's medical, nursing, mental, and psychosocial needs for 3 of 5 residents (Resident #6, Resident #2, and Resident #5) reviewed for care plans. The facility failed to develop care plans for Resident #6 and Resident #2 to include previous verbal altercations in the months leading up to when the physical altercations began between Resident #6 and Resident #2. The facility failed to include wound care for Resident #5's care plan for her surgical wound. These failures could place residents at risk of not receiving person-centered care and/or services to meet their physical and/or psychosocial needs. Findings included: 1. Record review of Resident #6's face sheet, dated 10/08/2025, revealed a [AGE] year-old-female with an admission date of 01/15/2023. Pertinent diagnoses included Cerebral Infarction (most common form of stroke) and Altered Mental Status (a change in cognitive function). Record review of Resident #6's Quarterly MDS Assessment, dated 04/17/2025, revealed a BIMS score of 15, intact cognition. Record review of Resident #6's care plan, initiated 06/02/2025, revealed Resident #6 had a potential to be physically aggressive as evidenced by striking another resident in the arm related to poor impulse control. Interventions included assessing for contributing sensory deficits, assessing Resident #6's needs, and lab work. This care plan was revised on 06/11/2025 to include Resident #6 was involved in a physical altercation with another female resident. There was no care plan which addressed Resident #6's verbal altercations with Resident #2 which began in April 2025 (according to interviews and incident and accident reports). Record review of Resident #6's progress note, dated 04/06/2025, revealed resident to resident verbal altercation. Both residents became increasingly verbally aggressive. Residents were separated and no physical altercation occurred. Record review of the provider investigation report, dated 06/02/2025, in a narrative given by LVN-F, revealed Resident #2 and Resident #6 were involved in a physical altercation in which Resident #2 looked at Resident #6 ugly, so in response, Resident #6 made a noise to scare her away. Then, Resident #2 grabbed Resident #6 by the arms causing a small skin tear to Resident #6's hand. The Provider Investigation report revealed the Administrator confirmed the incident with both residents, however, both residents blame the other for instigating the altercation. Record review of Resident #6's progress note, dated 04/06/2025, revealed resident to resident verbal altercation. Both residents became increasingly verbally aggressive. Residents were separated and no physical altercation occurred. Record review of Resident #6's progress note, dated 06/02/2025, revealed Resident #6 was heard arguing with another resident. Upon visualization of Resident #6 and Resident #2, LVN-F saw both residents throwing their hands up in the air and on their arms. LVN-F got in the middle of the altercation and separated both residents. This incident occurred in the hallway outside of the dining room. Only a small nail imprint, 0.25 cm, on the right wrist visualized on Resident #6. A progress note dated 06/11/2025 revealed Resident #6 was seen with her hands on another resident in a physically aggressive manner. Resident #6 stated the other resident started it. Record review or Resident #6's care plan note, dated 06/12/2025, revealed it was discussed with Resident #6 the other resident had intellectual disabilities, and these altercations could be considered mental abuse. It was recommended for Resident #6 to try and avoid the other resident, and if Resident #6 felt she was being bothered by the other resident, to notify a staff member so they could intervene. 2. Record review of Resident #2's face sheet, dated 10/07/2025, revealed a [AGE] year-old-female with an admission date of 02/09/2025, and a discharge date of 06/19/2025. Relevant diagnoses included Senile Degeneration of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675785 If continuation sheet Page 8 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 - Some Brain (progressive deterioration of brain tissue and function), bipolar disorder (a mental health condition characterized by extreme mood swings, including emotional highs and lows), Genetic Related Intellectual Disability (a learning disability significantly influenced by genetic factors), and Severe Intellectual Disabilities (significant limitations in cognitive functioning and adaptive behavior). Record review of Resident #2's Quarterly MDS Assessment, dated 05/17/2025, revealed a BIMS score of 09, moderately impaired cognition. Record review of Resident #2's care plan, initiated 05/19/2025, revealed Resident #2 had a potential to be verbally aggressive (she yelled at other residents and staff). Interventions included: medication review was done by the hospice doctor; urinalysis was done; administer medications as ordered; assess Resident #2's understanding of the situation; allow time for Resident #2 to express self and feelings toward the situation. Another care plan, initiated 06/02/2025, revealed Resident #2 had the potential to be physically aggressive. Interventions included: labs obtained, modify environment (to include adjust room temperature to comfortable level, reduce noise, dim lights, place familiar objects in room, keep door closed), started on an antibiotic for a urinary tract infection. This care plan was revised on 06/11/2025 to include Resident #2 was involved in a resident-to-resident altercation with a skin tear to Resident #2's left forearm. There was no care plan which addressed Resident #2's verbal altercations with Resident #6 which began in April 2025. Record review of Resident #2's progress note, dated 04/06/2025, revealed resident to resident verbal altercation. Resident #2 stated the other resident was being mean and dismissive to her. Anxiety medication was offered, and labs were ordered. Resident #2's room assignment was changed in an effort to avoid further altercations. Record review of Resident #2's progress note, dated 05/11/2025, revealed a resident-to-resident verbal altercation in the dining room with Resident #6. Resident #2 stated gave her the middle finger. Record review of Resident #2's progress note, dated 06/02/2025, revealed a resident-to-resident verbal and physical altercation in which both residents were witnessed throwing their hands up in the air, and Resident #2 then hit Resident #6, and dug her nails into the back of Resident #6's hand. Record review of the provider investigation report, dated 06/11/2025, in a narrative given by ADON-B, revealed Resident #2 and Resident #6 were involved in a physical altercation in the dining room in which ADON-B stated he observed both residents physically engaging, and both residents were immediately separated by LVN-G. The assessment, completed by LVN-D, revealed Resident #2 was noted to have had a skin tear to the left forearm. Record review of Resident #2's progress note, dated 06/11/2025, revealed a resident-to-resident verbal and physical altercation. Resident #2 voiced Resident #6 was verbally aggressive toward her and grabbed her by her left forearm and pressed her nails into her. A skin tear was noted to the left forearm. Resident #2 was upset and crying. Record review of the facility's incidents and accidents from 04/01/2025 - 06/23/2025 revealed a resident-to-resident altercation between Resident #6 and Resident #2 on 04/06/2025 (verbal), 05/11/2025 (verbal), 06/02/2025 (physical), and 06/11/2025 (physical). 3. Record review of Resident #5's admission assessment reflected an [AGE] year-old female initially admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included displaced intertrochanteric fracture of left femur (a break in the top of the thigh bone), history of falling, cognitive communication deficit (difficulty with communication), vascular dementia (problems with thought processes and memory caused by brain damage from impaired blood flow), and unspecified osteoarthritis (degenerative joint disease that results from breakdown of joint cartilage and underlying bone).Record review of Resident #5's admission MDS dated [DATE] and electronically signed by the MDS nurse on 07/17/25 reflected it was a reentry into the facility on [DATE] from a short-term general hospital and a BIMS score of 5 which indicated severe cognitive impairment. Section I- Active Diagnoses reflected Resident #5 had a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675785 If continuation sheet Page 9 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete hip fracture. Section J 2100- Recent Surgery Requiring Active SNF Care reflected Resident #5 had a major surgical procedure (repair of a fracture of the pelvis, hip, leg, knee, or ankle) during the prior inpatient hospital stay that required active care during the SNF stay. Section M 1040- Other Ulcers, Wounds, and Skin Problems reflected Resident #5 had a surgical wound that required surgical wound care. Record review of Resident #5's order summary report as of 07/12/25 reflected the order, Cleanse left hip surgical incision with wound cleanser, pat dry, paint with povidone iodine, leave open to air QD and PRN every day shift for surgical incision with staples in place. Record review of Resident #5's care plan dated 05/11/25 reflected the problem, alteration in musculoskeletal status r/t fracture of the left hip s/p ORIF initiated 07/17/25 with goal, the resident's wound will heal and progress without complications through the review date. Interventions included, Follow MD orders for weight bearing status; see MD orders and/or PT treatment plan, give analgesics as ordered by the physician, monitor for fatigue, monitor/ document for risk for falls, monitor/ document/ report PRN s/sx or complications related to arthritis. This care plan also reflected the problem, [Resident #5] has surgical incision to left hip r/t s/p surgery, initiated on 07/10/25 with goal, resident will have no complications from left hip surgical incision through the review date. Interventions included, Administer medication as ordered, avoid scratching and keep hands and body parts from excessive moisture, do not use harsh detergents, soaps, fragrances, or other irritating substances, and increase out of bed activity as tolerated. Interventions for wound care and monitor/ document/ report signs and symptoms of infection were not included. In an interview on 10/08/25 at 2:44pm, the MDS nurse stated wound care should have been an intervention on the care plan for either the musculoskeletal or the surgical site problems. She stated the care plan started with the admission nurse then she finished it when she did the assessment. She stated she did not know why wound care was not on the care plan. In an interview on 10/08/25 at 3:09 pm, the DON stated if things were not care planned, it could cause a break in communication regarding the care of the resident and wound care should have been in the interventions for the surgical wound. The DON stated the goal for the problem, alteration in musculoskeletal status should not have been about the wound. She stated it was everyone's responsibility to ensure the care plan was correct. In an interview on 10/08/25 at 4:47pm, the WCN stated it was important that wound care was on the care plan because everything should match. She stated wound care would be on the interventions for whichever wound was being addressed and if wound care was not on the care plan for a resident that received wound care, she would add it. The WCN stated the MDS nurse was ultimately responsible for making sure that interventions were added to the care plan and if something was not on a care plan it could cause the residents to not receive the best quality of care. She stated care plans were to be reviewed daily in case there were changes in residents' conditions and she found out about new residents/ changes in care in morning report. The WCN stated she was involved in care plan meetings if wound care was addressed. Record review of the facility's policy Comprehensive Care Plans, implemented 10/24/2022, revealed It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. 3. The comprehensive care plan will describe, at minimum, the following: A. The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. F. Resident specific interventions that reflect the resident's needs and preferences and align with the resident's cultural identity, as indicated. Event ID: Facility ID: 675785 If continuation sheet Page 10 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to maintain clinical records in accordance with accepted professional standards and practices complete and accurately documented medical records for 1 (Resident #7) of 10 residents whose records were reviewed. Clinical medical staff failed to ensure that Resident #7 suprapubic catheter output log was accurately documented as order by her physician. This failure could place residents of having incomplete and inaccurate records which could impact their treatment and health when receiving suprapubic catheter care. The findings include: Record review of Resident #7's face sheet revealed a [AGE] year-old-female initially admitted on [DATE] with diagnoses of Neuromuscular dysfunction of bladder (the nerves that carry messages back and forth between the bladder and the spinal cord and brain don't work the way they should.), chronic combined systolic and diastolic congestive heart failure (Systolic heart failure, heart isn't contracting well during heartbeats. While diastolic heart failure, by contrast, is when heart can't relax normally between beats), Type 2 diabetes mellitus without complications (body does not use insulin properly with, but it has not resulted in further health problems, such as nerve damage or stroke). Record review of Resident #7's MDS readmit date d 05/19/25 revealed BIMS score 11 indicated moderate cognitive impairment and requires prompt care plan modification. Functional abilities revealed Resident #7 needed substantial maximal assistance with activities of daily living. The MDS revealed Resident #7 has and suprapubic catheter and colostomy bag due to bowel and urine incontinence. Record review of Resident#7's care plan dated 04/04/25 revealed Resident #7 had a suprapubic Catheter related to Neuromuscular dysfunction of bladder. Interventions included administer medication Oxybutynin Chloride as ordered by MD. Monitor for effectiveness and side effects initiated 04/04/2025. Change catheter monthly 20 French catheter(a catheter sized using the French scale) 30ml foley initiated 04/04/25. Check the foley catheter and document urine output every shift. Use leg strap to secure foley in place initiated 05/07/2025. Check tubing for kinks each shift date initiated 04/04/2025. Record review of Resident #7's physician orders dated 04/26/25 indicated Check Foley catheter and document output every shift. The physician orders indicated suprapubic cath. Care every shift and as needed. The physician orders indicated monitor that collection bag is off the floor and hung below bladder level. The physician orders indicated Check suprapubic catheter every shift. Record Review of Resident #7's MAR for the month of May 2025 indicated no documentation of urine output for 4 days, May 1st through 4th, while Resident #7 stayed in the facility. In an interview and observation on 10/07/25 at 3:36 of Resident #7 she stated she has a huge hernia in her lower abdominal area which presses down on her bladder make it difficult to urinate, so she now has a suprapubic catheter to help her void her bladder. She stated that the catheter needed to be changed often but at times it can last for a couple of weeks. Resident #7 stated she still leaks at times from her urethra, so she had a pad to collect any leaked urine. Resident #7 stated her urine output was different everyday but usually voids frequently and a lot. The resident stated that when there was not a lot of output, she knows the catheter is blocked or migrated and needs to be changed. In an interview on 10/08/25 4:35PM with ADON B he stated all staff was responsible for documenting the output of urine if the bag is emptied by he or she. ADON B stated if the hospice nurse empties the urine bag the amount of urine was to be reported to a CNA or nurse. The ADON stated the amount of urine voided is to be documented both in the progress notes and MAR. ADON B could not explain why the amount were not documented on the days in question. In an interview 10/09/25 at 4:40 PM with the DON she stated no documentation could be found in either progress notes or MAR for the urine output for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675785 If continuation sheet Page 11 of 12 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 675785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edinburg Nursing and Rehabilitation Center 5215 S Sugar Rd Edinburg, TX 78539 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident#7. The DON could not explain why no documentation was not done for the 4 days in question. The DON stated not having accurate documentation of urine output could put the resident at risk for the bladder to rupture or urosepsis. The DON stated the facility did not have its own policy and procedure but followed the Lippincott Manual of Nursing Practice 11th Edition for procedure and treatment of residents with catheters and suprapubic catheters. In an interview on 10/0925 at 6:18pm CNA J stated she could not say why the amounts of urine voided was not documented. CNA J stated she could not remember that far back to explain why the amounts were not documented. CNA J stated she takes care of Resident #7 frequently and knows Resident #7 has large amounts of urine output about 700ml to 1000ml in her bag. CNA stated she knew to report to the nurse if Resident #7 amounts of urine during were smaller or different in color and clearness. Record of an In-Service dated 05/05/25 revealed an in-service was completed with the objective of: Suprapubic catheter change and personal protective equipment. The training did not mention any discussion or training on the importance of documentation of urine voided by residents each time the urine bag is emptied. Event ID: Facility ID: 675785 If continuation sheet Page 12 of 12