Health inspection·December 4, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete interview on 12/03/25 at 5:32 PM, the ADON stated it was all staff's responsibility to ensure the residents' call light was within reach in case the resident needed assistance or there was an emergency. The ADON stated Resident #38 has a history of refusing care and medications, but she was unaware if Resident #38 had a history of throwing his call light off the bed. The ADON stated Resident #38 was visually impaired, and staff needed to ensure his call light was always within reach, so the individualized plan of care was being followed. In an interview on 12/04/25 at 8:35 AM, the DON stated call lights should be within reach for all residents so they can call for assistance if needed. The DON stated anybody can make sure the resident has the call light within reach just like anyone can answer the call light. The DON stated it was important to follow Resident #38's plan of care since it was individualized and set to meet the residents' needs. Record review of the facility's Care Plans, Comprehensive Person-Centered policy dated March 2022 reflected: Policy Statement A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident.7. The comprehensive, person-centered care plan: a. includes measurable objectives and timeframes; b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being Record review of the facility's Call System, Resident policy dated September 2022 reflected: Residents are provided with a means to call staff for assistance through a communication system that directly calls a staff member or a centralized work station. Policy Interpretation and Implementation 1. Each resident is provided with a means to call staff directly from assistance for his/her bed, from toileting/bathing facilities and from the floor. 6. Calls for assistance are answered as soon as possible, but no later than 5 minutes. Urgent requests for assistance are addressed immediately. Event ID: Facility ID: 675796 If continuation sheet Page 2 of 10 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 675796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care of Hebbronville 606 W Gruy Hebbronville, TX 78361 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 - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that residents who needed respiratory care were provided such care consistent with professional standards of practice, physicians orders, the comprehensive person-centered care plan, and the resident's goals and preferences for 1 of 5 residents (Resident #9) reviewed for respiratory care. The facility failed to ensure LVN A transcribed a physician's telephone order during her shift for oxygen at 2 Lpm as needed to maintain oxygen levels above 90% into PCC for Resident #9. This deficient practice could place residents at-risk for insufficient or inappropriate care due to other staff not being aware the physician's order existed. The findings include:Record review of Resident #9's face sheet, dated 12/02/25, reflected an [AGE] year-old female with an original admission date of 01/13/19 and a current admission date of 04/02/19. Resident #9's pertinent diagnosis included unspecified dementia without behavior disturbance (a diagnostic term for dementia where the specific type, such as Alzheimer's or vascular dementia, is not yet determined). Record review of Resident #9's Quarterly MDS assessment, dated 11/11/25, reflected a BIMS score of 15 which indicated no cognitive impairment. Further review reflected Resident #9 had not used oxygen in the last 14 days. Record review of Resident #9's comprehensive care plan, dated 12/02/25, reflected it did not include any sections related to oxygen use. Record review of Resident #9's order summary, dated 12/02/25, reflected it contained no orders for oxygen at 2 Lpm as needed to maintain oxygen levels above 90%. Record review of nurse's progress notes reflected a note was created by LVN A on 12/02/25 at 8:14 PM with an effective date of 12/01/25 at 11:15 PM that stated [Resident #9] with complaints of SOB. Residents O2 at 90% [room air] . MD notified. [new order] received for oxygen as needed at 2 lpm via nasal cannula for SOB to maintain O2 sat[uration] above 90%. Rp notified. During an observation of Resident #9 in her room at 10:15 AM on 12/02/25, Resident #9 was laying in bed receiving oxygen via nasal cannula at 2 lpm. In an interview with Resident #9 at 10:15 AM on 12/02/25, Resident #9 stated she had not been on oxygen very long. Resident #9 stated she felt a little short of breath the night before, so the nurse gave her some oxygen. In an interview with LVN A at 4:51 PM on 12/03/25, LVN A stated Resident #9 complained of shortness of breath at around 11:15 PM on 12/01/25, so she called the physician. LVN A stated the physician gave her an order over the telephone for oxygen at 2 lpm as needed to maintain oxygen saturation over 90%. LVN A stated she got busy after that and forgot to put the order into PCC. LVN A stated it was important to put orders into PCC (computer charting system for resident medical records) when they were received from the physician so other nurses were up to date on the proper care for residents. In an interview with the DON at 8:25 AM on 12/04/25, the DON stated any telephone orders from the physician should have been immediately entered into PCC. The DON stated it was important to enter new orders into PCC quickly so the oncoming nurse would know what was going on with the resident. The DON stated LVN A should have put the order from the physician into PCC right after she got off the phone with him at around 11:15 PM on 12/01/25. Record review of the facility's policy Telephone Orders, dated February 2014, reflected the following policy: .1.Orders must be reduced to writing, by the person receiving the order, and recorded in the resident's medical record.2. The entry must contain the instructions from the physician, date, time and the signature and title of the person transcribing the information. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675796 If continuation sheet Page 3 of 10 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 675796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care of Hebbronville 606 W Gruy Hebbronville, TX 78361 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were free from any significant medication errors for one of five residents (Resident #5) reviewed for medication errors. 1. The facility failed to hold Resident #5's losartan (blood pressure medication) when Resident #5's blood pressure was outside of physician's parameters on November 6th and 26th of 2025. 2. The facility failed to hold Resident #5's hydralazine (blood pressure medication) when Resident #5's blood pressure was outside of physician's parameters on November 2nd, 6th, 17th, and 26th of 2025. This failure could place residents at risk for complications such as increased blood pressure, exacerbation of symptoms, and potential hospitalization.The findings include:Record review of Resident #5's face sheet, dated 12/02/25, reflected an [AGE] year-old male with an original admission date of 06/11/14 and a current admission date of 11/10/20. Resident #5's pertinent diagnosis included essential hypertension (high blood pressure with no single identifiable cause, developing gradually from a mix of genetics, age, and lifestyle factors like poor diet, obesity, inactivity, and stress). Record review of Resident #5's Quarterly MDS assessment, dated 11/10/25, reflected a BIMS score of 0 which indicated severe cognitive impairment. Record review of Resident #5's comprehensive care plan, dated 12/02/25, reflected the focus [Resident #5] has a history of CVA (a sudden disruption of blood flow to the brain, causing brain cells to die from lack of oxygen, leading to potential disability or death) and bradycardia (slow heart rate). An intervention listed for the focus included Administer medications as prescribed. Record review of Resident #5's order summary reflected an active order for Losartan Potassium Tablet 100 MG. Give 1 tablet via G-tube one time a day related to essential (primary) hypertension. Hold if SBP less than 120 or DBP less than 60 initiated on 05/02/25. Further review reflected an active order for hydralazine HCL Oral Tablet 25 MG. Give 1 tablet via G-tube two times a day related to essential (primary) hypertension. Hold if SPB less than 110 or DBP less than 60 initiated on 07/16/25. Record review of Resident #5's MAR for November 2025 reflected losartan and hydralazine were administered by RN C on 11/06/25 and 11/26/25 with blood pressures 155/55 and 117/50 respectively. Further review reflected hydralazine was administered by RN F on 11/02/25 and 11/17/25 with blood pressures 91/56 and 111/59 respectively. In an interview with RN C at 3:54 PM on 12/03/25, RN C stated she always checked a resident's blood pressure before administering medications designed to raise or lower their blood pressure. RN C stated administering blood pressure medications outside of physician's parameters could lead to hypotension (low blood pressure), causing excessive sweating or clammy skin. RN C stated she did not remember the specific instances on 11/06/25 or 11/26/25. RN C stated, based on the MAR, it did look like she administered blood pressure medications to Resident #5 outside of parameters. In an interview with RN F at 6:02 PM on 12/03/25, RN F stated he always checked a resident's blood pressure before administering medications designed to raise or lower their blood pressure. RN F stated if a resident's blood pressure dropped too low it could cause the resident to become unresponsive. RN F stated, based on the MAR, it looked like he administered hydralazine to Resident #5 on 11/02/25 and 11/17/25 outside of parameters. RN F stated he thought he made an error in recording the information because he would have held the medications based on Resident #5's blood pressure at the time. In an interview with the DON at 8:25 AM on 12/04/25, the DON stated a resident's blood pressure should be checked before administering blood pressure altering medications to them. The DON stated hypotension could cause dizziness, light-headedness, and cause the resident to faint. The DON stated blood pressure medications should not have been administered outside of parameters unless the nurse was given specific instructions by the physician. Record review of the facility's policy Administering Oral Medications, dated Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675796 If continuation sheet Page 4 of 10 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 675796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care of Hebbronville 606 W Gruy Hebbronville, TX 78361 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 0760 October 2010, reflected the following policies: .1. Verify that there is a physician's medication order for this procedure.6. Check the label on the medication and confirm the medication name and dose with the MAR. 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: 675796 If continuation sheet Page 5 of 10 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 675796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care of Hebbronville 606 W Gruy Hebbronville, TX 78361 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 - Some 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, interview and record review, the facility failed to maintain medical records on each resident that were complete and accurately documented in accordance with accepted professional standards and practices for 2 of 5 residents (Resident #13 and Resident #36) reviewed for documentation. The facility failed to ensure LVN A documented relevant information (redness/rash to abdomen) and did not document incorrect information (dependence on staff for eating due to tube feeding) on Resident #13's admission Nursing Assessment form dated 11/26/25. The facility failed to ensure LVN B documented relevant information (presence of arterial ulcers, pressure ulcer, abrasion, and redness/rash to abdomen) and did not document incorrect information (reason for skilled services: PEG tube, the presence of an IV and enteral (tube) feeding, and dependence on staff for eating due to tube feeding) on Resident #13's Daily Skilled Nurses Notes form dated 11/27/25, 12/02/25, and 12/03/25. The facility failed to ensure RN C documented relevant information (presence of arterial ulcers, pressure ulcer, abrasion, and redness/rash to abdomen) and did not document incorrect information (reason for skilled services: PEG tube, the presence of an IV and enteral (tube) feeding, and dependence on staff for eating due to tube feeding) on Resident #13's Daily Skilled Nurses Notes form dated 11/28/25. The facility failed to ensure LVN D documented relevant information (presence of arterial ulcers, pressure ulcer, abrasion, and redness/rash to abdomen) and did not document incorrect information (reason for skilled services: PEG tube, the presence of an IV and enteral (tube) feeding, and dependence on staff for eating due to tube feeding) on Resident #13's Daily Skilled Nurses Notes form dated 11/29/25. The facility failed to ensure Resident #36's blood pressures were taken as ordered for the month of November 2025. These failures could place residents at risk for errors in care and treatment and not receiving the services needed to attain or maintain their highest practicable physical well-being. Record review of Resident #13's face sheet dated 12/03/25 reflected a [AGE] year-old male originally admitted to the facility on [DATE]. Diagnoses included gastrostomy infection (infection of the opening where a tube used to provide nutrition, hydration, and medication was surgically implanted through the abdomen into the stomach), dementia (progressive loss of intellectual functioning, thinking, remembering, and reasoning skills), type 2 diabetes (chronic condition that happens when blood sugar levels are persistently high), Parkinson's disease (a brain condition that causes problems with movement, mental health, sleep, pain and other health issues), dysphagia (difficulty swallowing), and moderate protein-calorie malnutrition ((an imbalance between the nutrients needed to function and the nutrients received). Record review of Resident #13's quarterly MDS dated [DATE] reflected a BIMS score of 15 which indicated he was cognitively intact, and he had a feeding tube and a mechanically altered therapeutic diet. Record review of Resident #13's hospital record dated 11/24/25 reflected he was admitted to the hospital on [DATE] and his gastrostomy (feeding) tube was removed on 11/23/25 while he was in the hospital. Record review of Resident #13's Weekly Skin assessment dated [DATE] reflected he had abrasions to his nose with small red scabs, 2 arterial ulcers (painful deep sores caused by poor circulation) to the back of his left lower leg, and an arterial ulcer to his left heel.Record review of Resident #13's Order Summary Report dated 12/03/25 reflected an order that stated, Stage 2 to sacrum: cleanse with wound cleanser, pat dry with 4x4 (gauze), apply {skin barrier cream] and collagen powder and secure with bordered dressing every day shift for treatment. Record review of Resident #13's progress notes dated 11/03/25 to 12/03/25 reflected he returned to the facility on [DATE] at 7:30 PM. Record review of Resident #13's admission Nursing assessment dated [DATE] at 7:30 PM by LVN A reflected in Section C: Skin Integrity: LVN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675796 If continuation sheet Page 6 of 10 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 675796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care of Hebbronville 606 W Gruy Hebbronville, TX 78361 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 - Some A did not document Resident #13's redness/rash on his abdomen and in comments she stated: PEG tube removed at hospital. Resident with clean and dry dressing in place. LVN A documented Resident #13 was dependent (he needed total assistance with eating) and did not mark he was on a mechanically altered diet and had a pressure ulcer present in Section D: Oral/Nutrition. Record review of Resident #13's assessments reflected the following: Daily Skilled Nurses Notes dated 11/27/25 at 9:56 AM and 11/30/25 at 10:10 AM, LVN B documented (incorrect information) or failed to document (relevant information): Section 2. Medicare Diagnosis: 1. Document reason resident is on Medicare Skilled Services: PEG TUBE, PARKINSONS (Incorrect information) 5. Devices and Treatments: Enteral Feeding and IV were checked as active. (Incorrect information)Section 3. Functional Status: SELF PERFORMANCE- Eating (how resident ate and drank/ if resident was on a g-tube), LVN B marked Total Dependence (FULL staff performance/ NO help from resident) and on staff support provided, LVN B marked 1-person physical assist. (Incorrect information) Section 8a- Skin issues, LVN B failed to document any of Resident #13's 3 arterial ulcers, stage 2 pressure ulcer (a shallow wound with a pink or red base with skin loss, abrasions, and blisters possible), abrasion to his nose, or redness/rash to his abdomen. (Relevant information)Section 8cGastrointestinal, LVN B marked yes; Resident #13 had a feeding tube. (Incorrect information)Section 10Additional Notes, LVN B documented, Resident up to wheelchair in therapy no acute distress and no complaints pain or SOB. Resident continues on 02 per nasal cannula. Resident continues with 3+ edema to lower extremities. Resident is able to voice needs effectively. He requires extensive assistance with ADLS and transfers. Resident eating well. G- tube patent and flushing well. Bolus if intake less than 50%. Will continue to monitor for any changes in condition. [sic] (Contains incorrect information) Daily Skilled Nurses Notes dated 11/28/25 at 9:36 AM, RN C documented or failed to document all the same information as LVN B on 11/27/25 except for: Section 10- Additional Notes, RN C documented, Resident up to wheelchair, in no acute distress. no complaints of discomfort or pain. Continues on 02 per nasal cannula, and edema to lower extremities. Resident is able to voice needs effectively. He requires extensive assistance with ADLS and transfers. Resident eating well. G- tube patent and flushing well. Bolus if intake less than 50%. Will continue to monitor for any changes in condition. [sic] (Contains the same incorrect information) Daily Skilled Nurses Notes dated 11/29/25 at 3:57 PM, LVN D documented or failed to document all the same information as RN C on 11/28/25 including Section 10- Additional Notes. Daily Skilled Nurses Notes dated 12/01/25 at 12:43 PM, LVN E documented or failed to document all the same information as LVN B on 11/27/25 except for Section 10- Additional Notes Daily Skilled Nurses Notes dated 12/02/25 at 3:09 PM and 12/03/25 at 12:44 PM, LVN B documented or failed to document all the same information as LVN E on 12/01/25 including Section 10- Additional Notes. Observation and interview of Resident #13 on 12/03/25 reflected resident sitting in his wheelchair in his room with a rolling table in front of him. Resident #13 was eating graham crackers and drinking water without difficulty. Resident #13 stated his feeding tube was removed while he was at the hospital on [DATE] because it had not been used in about 6 months and there was an infection on his abdomen where it was at. Resident #13 stated he had open sores on his lower left leg, left heel, and his sacrum and redness and rash to his abdomen where his feeding tube had been and where the gauze was at. In a telephone interview on 12/03/25 at 4:55 PM, LVN A stated the admission Assessment was a blank form that was not pre-filled with information. LVN A stated she marked dependent for nutrition by accident because Resident #13 ate by himself. LVN A stated the Daily Skilled Nurses Notes assessment auto- populated when the form was opened. In an interview on 12/03/25 at 3:51 PM, RN C stated Resident #13 did not still have a feeding tube, and it was removed while he was in the hospital. RN C stated the Daily Skilled Nurses Notes form was a new note each (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675796 If continuation sheet Page 7 of 10 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 675796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care of Hebbronville 606 W Gruy Hebbronville, TX 78361 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 - Some time, and she pulled up another screen to copy the previous note. She stated she overlooked the feeding tube and the IV check boxes, and they should not have been checked. She stated the comments were her own comments and not copy/pasted, but she did follow the notes from the previous note. She stated it was important to not use information from anyone else's notes because that was her assessment of the resident, and the previous information could have been incorrect. She stated she did not document any of his wounds on the Daily Skilled Nurses Notes form because she did not have specific measurements of them. RN C stated in-services on documentation and skills were done upon hire and annually. She did not recall the last in-service for documentation. In an interview on 12/03/25 at 2:32 PM, LVN B stated Resident #13 went to the hospital for an infection to his feeding tube site and was on antibiotics by mouth while in the hospital for 4 days then continued on antibiotics when he returned to the facility. LVN B stated the feeding tube was removed because it had not been used for several months. When asked why he documented peg tube and Parkinson's as the reason for skilled assessment, LVN B stated he probably just did not look at it again. LVN B stated the Daily Skilled Nurses Notes form auto-populated when it was opened. LVN B stated Resident #13 had an IV, a long time ago. LVN B stated he went through all the check boxes when he opened the form, but he probably just went through it fast and did not catch those boxes that should have been unchecked. LVN B stated he noticed on 11/30/25 that his comments were not correct but did not catch the check boxes. He stated if things were just copied/pasted, important information could be missed. LVN B stated he believed the ADON and DON audited the Daily Skilled Nurses Notes to ensure they were accurate, but it was the nurse's responsibility to ensure they were documented correctly. In an interview on 12/03/25 at 5:43 PM, the ADON stated the Daily Skilled Nurses Notes had an option to copy the previous note to a new note. The ADON stated Resident #13's feeding tube was removed while he was at the hospital due to infection at the insertion site. She stated she thought the MDS coordinator would review those notes on skilled residents, but she and the DON did not review them. She stated it was important the information was correct because it was a full assessment of the resident. If the information was not correct, a nurse that was not familiar with the resident would be reading the wrong information on the resident. The ADON stated when the Daily Skilled Nurses Notes contained all the same wrong information, it told her the nurses were not reading what they documented on the assessment and possibly meant the nurses were not assessing the resident. The ADON stated billing for Medicare and Medicaid may have been done from the Daily Skilled Nurses Notes. She stated in-services on documentation were quarterly, and she was unsure of when the last one was. In an interview on 12/04/25 at 8:25 AM, the DON stated the Daily Skilled Nurses Notes form was a head-to-toe assessment of how the resident did during that shift, and the nurse was supposed to assess the resident before documenting the daily skilled note. The DON stated the daily skilled note was reviewed by the MDS nurse daily, who should have caught the errors. She stated it was also reviewed by the regional MDS nurse. The DON stated the MDS information came from the Daily Skilled Nurses Notes, and it was also used during a RUG (Resource Utilization Groups) review for Medicare. She stated it was important the forms were accurate so the information could be followed through. The DON stated when the nurse entered a new Daily Skilled Nurses Note, there was a button to be able to copy an old one and put that information into the new note. In an interview on 12/04/25 at 9:01AM, the MDS nurse stated the Daily Skilled Nurses Notes assessment was used for Resident #13 because he was also a VA patient and the VA requested daily skilled notes. She stated it was important for those notes to be accurate because she reviewed them when she completed the MDS. The MDS nurse stated Resident #13's quarterly MDS would be completed today because it was due yesterday. The MDS nurse stated she reviewed the daily skilled notes when she was ready to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675796 If continuation sheet Page 8 of 10 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 675796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care of Hebbronville 606 W Gruy Hebbronville, TX 78361 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 - Some do the MDS, but she saw the resident daily and if she found incorrect information after seeing the resident, she would let the nurses know. She stated she reviewed the functional abilities daily for 3 days when the resident was admitted or readmitted and for the 3 days look back when the MDS was due. The MDS nurse stated if the MDS was submitted with the wrong information, she would have to submit a correction and she would know if there was an error because she did audits of them every 2-3 weeks that covered the previous 30 days. The MDS nurse stated the purpose of the MDS, was to maintain and improve the resident's level of function, and you had to know your resident so it gave State and CMS an accurate view of the resident. She stated CMS based the PDPM (Patient Driven Payment Model; how the facility got paid for Medicare residents) off the MDS and if it was inaccurate, the facility had to repay/ refund the money paid by Medicare. The MDS nurse stated CMS had OIG audits every 2 years to ensure facilities were not being paid fraudulently. She stated she looked at the CNA tasks daily to see what they were documenting in terms of ADL assistance needed and if she saw something that was not accurate, she would talk to them about documenting it correctly. In an interview on 12/04/25 at 9:35 AM, the Adm stated the MDS had to be accurate to be able to take care of the resident appropriately and for billing purposes. She stated the MDS was looked at to see how Medicare/Medicare was going to reimburse for the resident's care based on the level of care needed. The Adm stated if the MDS was not accurate, the facility could be underpaid, overpaid, or lose all reimbursement. Record review of Resident #36's face sheet dated 12/03/25 reflected an [AGE] year-old female with an original admission date of 11/27/23. Diagnoses included dementia (progressive loss of intellectual functioning, thinking, remembering, and reasoning skills) and high blood pressure. Record review of Resident #36's quarterly MDS dated [DATE] reflected a BIMS of 13 (cognition intact) and an active diagnosis of high blood pressure. Record review of Resident d#36's care plan dated 05/20/25 reflected: Resident #36 received medication to treat a diagnosis of hypertension (high blood pressure). Resident #36's blood pressure would be stable during and until the next quarterly review. Report any significant abnormal results to the MD. Medication to treat hypertension per the MD orders. Monitor blood pressure as ordered and notify MD if results are high or low. Record review of Resident #36's blood pressure reading log and documentation for the month of November 2025 reflected: 11/25/2025 12:22 P.M.118 / 70 mmHg 11/25/2025 02:40 P.M. 118 / 70 mmHg 11/25/2025 09:05 A.M. 118 / 70 mmHg 11/24/2025 12:50 P.M. 112 / 66 mmHg 11/24/2025 09:51 A.M. 112 / 66 mmHg 11/22/2025 10:43 A.M. 121 / 73 mmHg 11/22/2025 09:18 A.M. 121 / 73 mmHg 11/21/2025 01:13 P.M. 127 / 71 mmHg 11/21/2025 08:01 A.M. 127 / 71 mmHg 11/19/2025 10:05 A.M. 124 / 59 mmHg 11/19/2025 08:28 A.M. 124 / 59 mmHg 11/18/2025 08:57 A.M. 100 / 66 mmHg 11/18/2025 08:07 A.M. 100 / 66 mmHg 11/15/2025 02:33 P.M. 117 / 68 mmHg 11/15/2025 01:53 P.M. 117 / 68 mmHg 11/13/2025 09:23 A.M. 123 / 68 mmHg 11/13/2025 08:18 A.M. 123 / 68 mmHg 11/11/2025 12:06 P.M. 127 / 63 mmHg 11/11/2025 08:04 A.M. 127 / 63 mmHg 11/10/2025 09:50 A.M. 122 / 64 mmHg 11/10/2025 08:34 A.M. 122 / 64 mmHg 11/2/2025 10:01 A.M. 118 / 70 mmHg 11/2/2025 08:58 A.M. 118 / 70 mmHg In an interview on 12/03/25 at 09:56 AM, Resident #36 stated she has not had any problems with her blood pressure that she could remember, and staff takes her blood pressure every day. In an interview on 12/03/25 at 2:46 PM, LVN B stated that at times the same blood pressure reading was reused for Resident #36. LVN B explained Resident #36 often had her blood pressure taken in the morning and then again shortly after, for her scheduled blood-pressure-altering medication. LVN B stated the facility system used to document blood pressures included a recall button that allowed the previous readings to be pulled up, and at times, those previous readings were used if Resident #36's blood pressure had been recently taken. LVN acknowledged that previous blood pressure readings should not be reused as blood pressures can change from the original time it was taken. LVN B stated it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675796 If continuation sheet Page 9 of 10 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 675796 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care of Hebbronville 606 W Gruy Hebbronville, TX 78361 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete important to obtain and document accurate blood pressure measurements to ensure Resident #36's medication needs were met and properly tracked and trended for any abnormalities. In an interview on 12/03/25 at 5:41 PM, the ADON stated that the same or previous blood pressure readings should not be reused on any residents. The ADON stated by doing so, staff would not be aware of any potential changes in the residents' condition if the blood pressure had changed. The ADON stated accurate blood pressure measurements should be taken and recorded each time to ensure the resident was receiving the necessary dose of the medication and to also track and trend any patterns the resident may be experiencing. In an interview on 12/04/2025 at 8:37 AM, the DON stated staff should not be reusing any blood pressure reading since blood pressure readings can fluctuate throughout the day. The DON stated when she spoke to some of the nursing staff about the reused blood pressure readings, nursing staff stated it was because Resident #36 had a blood pressure altering medication scheduled for the morning and an order to also assess vitals every shift and those blood pressures were done closely together so they were reused. The DON stated she informed nursing staff that all blood pressure readings should be documented accurately and taken each time regardless of the time taken. The DON stated it was important to accurately document Resident #36's and all residents' vitals to track and trend any abnormalities and to ensure the medication was given as prescribed. Record review of facility's Charting and Documentation policy dated July 2017 reflected: Policy Statement All services provided to the resident, progress toward the care plan goals, or any changes in the resident's medical, physical, functional or psychosocial condition, shall be documented in the resident's medical record. The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care. Policy Interpretation and Implementation 3. Documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate. 7. Documentation of procedures and treatments will include care-specific details, including: a. the date and time the procedure/treatment was provided; c. the assessment data and/or any unusual findings obtained during the procedure/treatment; d. changes in the resident's condition; Event ID: Facility ID: 675796 If continuation sheet Page 10 of 10