Inspection·February 4, 2026

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some have made him unsteady on his feet, but he was already a high fall risk with a long history of falls and behaviors. During an interview on 2/3/2026 at 3:24 pm, LVN A stated she had worked on 12/17/2025 and gave Resident #1 his Lorazepam at 8pm. She stated she gave him a 1 mg tablet and signed off on the narcotic sheet that she gave a 1 mg tablet. LVN A denied wasting any part of the medication. She stated she signed off in the MAR that she gave Resident #1 0.5 mg, but she gave him 1.0 mg of Lorazepam. She stated she did not follow the order for the 0.5 mg tablet of Lorazepam. During an interview on 2/3/2026 at 4:04 pm, LVN B stated he had worked 12/18/2025 and gave Resident #1 his Lorazepam at 8:00 am. He stated Resident #1 ran out of his scheduled 0.5 mg tablet of Lorazepam, so he came him the 1 mg tablet of Lorazepam and signed it off in the MAR under his 0.5 mg tablet. LVN B denied wasting any part of the medication. LVN B stated he did not follow the order for the scheduled 0.5 mg tablet of Lorazepam. During an intervie w on 2/3/2026 at 4:18 pm, LVN C stated she had worked on 12/16/2025 and gave Resident #1 his AM dose of Lorazepam. She stated if she signed out on the narcotic sheet that she gave a 1 mg tablet, then that's what she gave the resident. She denied wasting any medication and stated if she had wasted any part of the medication she would have noted it in the narcotic count sheet and had another nurse witness the wasting. She stated she did not follow the order for the 0.5 mg Lorazepam that was scheduled.During an interview on 2/3/2026 at 4:36 pm, LVN D stated she had worked on 12/17/2025 and gave Resident #1 his AM dose of Lorazepam. She stated if I signed it [narcotic count sheet] , I'm assuming I gave it. She stated the 0.5 mg tablet was not there, so she gave the 1 mg tablet instead. She wanted resident #1 to have something for his anxiety. She stated later I realized I had signed off the MAR on the 0.5 mg order, and it was wrong, but I didn't get a chance to go back and check and fix it. LVN D denied wasting any medication and stated she gave Resident #1 the 1 mg tablet.An attempt was made to contact LVN E on 2/3/2026, but the call was not returned.During an interview on 2/4/2026 at 11:46 am, the pharmacy nurse stated she was aware of the issue with Resident #1's Lorazepam. She stated she had talked to the nurses (LVN A, B, C, D, E) and they said they were taking the 1 mg PRN tablet and administering half of it and the nurses just hadn't put that they had wasted half of the tablet on the narcotic count sheet. She stated, no one gave her a sufficient answer as to why they didn't document the wasting and she did not ask any of the nurses if they had had a witness when they wasted the medication. She stated Resident #1 was out of his scheduled 0.5 mg Lorazepam due to a lack of communication, so the nurses were using the PRN 1 mg dose instead.During an interview on 2/4/2026 at 3:06 pm, the ADM stated he was aware of the issues with Resident #1's Lorazepam medication. He stated his expectation was that staff will followed physician orders and they should not be signing them out on the narc sheet and not documenting appropriately in the MAR. He stated his concerns would be that we don't know if the patient actually got them - possible diversion.During an interview on 2/4/2026 at 3:14 pm, the DON stated her expectations are that staff will administer medications as ordered and they are supposed to document that way. She stated if staff was wasting medications, they should be doing that with another nurse as a witness and documenting this on the narcotic count sheet including the date and signature of the person that witnessed and the nurse giving the medication. She stated if medications were not documented correctly in the MAR, we don't know if residents got the medication as ordered - medication is not therapeutic as it's supposed to be.Review of the facility's policy Administering Medications, revision April 2019, reflected the following: Policy Statement Medications are administered in a safe and timely manner, and as prescribed.Policy Interpretation and Implementation4. Medications are administered in accordance with prescriber orders, including any required time frame.22. The individual administering the medication initials the resident's MAR on the appropriate line after giving each medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675857 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675857 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE William R Courtney Texas State Veterans Home 1424 Martin Luther King Jr LN Temple, TX 76504 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete and before administering the next ones.23. As required or indicated for a medication, the individual administering the medication records in the resident's medical record:a. the date and time the medication was administered;b. the dosage;c. the route of administration;d. the injection site (if applicable);e. any complaints or symptoms for which the drug was administered;f. any results achieved and when those results were observed; andg. the signature and title of the person administering the drug.Review of Facility Policy Controlled Substances, revision November 2022 reflected the following: Policy Statement The facility complies with all laws, regulations, and other requirements related to handling. storage, disposal. and documentation of controlled medications (listed as Schedule 11-V of the Comprehensive Drug Abuse Prevention and Control Act of 1976). Policy Interpretation and ImplementationDispensing and Reconciling Controlled Substances2. The system of reconciling the receipt, dispensing and disposition of controlled substances includes the following:a. Records of personnel access and usage;b. Medication administration records;c. Declining inventory records; and d. Destruction, waste and return to pharmacy records. Event ID: Facility ID: 675857 If continuation sheet Page 3 of 3