Health inspection·October 18, 2023

F 0558 severely impaired cognition and required extensive assistance with toileting. Level of Harm - Minimal harm or potential for actual harm Record review of comprehensive care plan dated 9/28/2023 indicated Resident #51 had a risk for falls and needed a safe environment by making sure call light was working and reachable and had ADL self-care deficit and required supervision and assistance with toileting. Residents Affected - Some Record review of facility face sheet dated 10/17/2023 indicated Resident #65 was an [AGE] year-old female admitted to the facility on [DATE] with diagnosis of Alzheimer's (impaired memory). Record review of quarterly MDS dated [DATE] indicated Resident #65 had a BIMS of 03 indicating severely impaired cognition and required extensive assistance with toileting. Record review of comprehensive care plan dated 08/25/2023 indicated Resident #65 had a risk for falls and needed a safe environment with a working and reachable call light and had ADL self-care deficit and to provide supervision and assistance with toileting. During an observation on 10/16/23 at 9:50 am Resident #54 was present in her room and the call light located in the bathroom was wrapped around the grab bar. The call light was pulled from the bottom of the cord and did not activate. During an interview on 10/16/2023 at 9:52 am Resident #54 stated she used the bathroom at times but had not had to use the call light that she could recall. During an observation on 10/16/23 at 10:08 am Resident #51 and Resident #65 resided in the room together and the call light located in the bathroom was wrapped around the grab bar. The call light was pulled from the bottom of the cord and did not activate. Neither resident was in the room during the observation. During an observation on 10/16/23 at 10:15 am Resident #19 was present and sitting up in her wheelchair propelling with her feet. The call light located in the bathroom was wrapped around the grab bar. The call light was pulled from the bottom of the cord and did not activate. During an interview on 10/16/2023 at 10:16 am Resident #19 stated she used toilet in the bathroom but could not recall if she had to ever use the call light. During an interview on 10/16/23 at 12:20 pm family member of Resident #51 stated that both her family member and the roommate both used their bathroom at times. During an observation on 10/16/2023 at 3:50 pm the bathroom call light for Resident's #19, #37, #51 and #65 remained wrapped around grab bar and call lights pulled again and did not activate. During an interview on 10/16/23 at 4:18 pm NA A stated call lights should be in reach for all residents and the cord should not be wrapped around the grab bar because if a resident fell, they could not reach it or it would not go off. She stated if the resident were to fall and be hurt, they would not be able to tell us. She stated that Resident's #19, #37, #51 and #65 all used their bathrooms with assistance and would need to have their call light accessible. During an interview on 10/17/23 at 8:12 am NA B stated the nurse aides were responsible for making sure all call lights were accessible by the resident including the call lights in the bathroom. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 2 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated the call light should not be wrapped around the grab bar because the string would not pull to activate the alarm. She stated if the alarm could not be activated the resident would not get care if they needed it. During an interview on 10/17/23 at 8:20 am LVN C stated she had been a nurse at the facility for 9 months. She stated all staff were responsible for making sure call lights were always accessible. She stated call lights should be checked with each round and the call light cord should not be wrapped around the grab bar. She stated the light would not activate if it was wrapped and the resident would not be able to call for help or care could be delayed. During an interview on 10/17/2023 at 3:35 pm the maintenance supervisor stated he was also an LVN and helped with the nurse aide training program and checkoffs. He stated part of the training included proper placement of call lights in the room and bathroom. He stated the call light in the bathroom should be freely hanging on not wrapped around the grab bar. He stated if the cord was wrapped it could affect the light being activated and cause a delay in resident care. During an interview on 10/18/23 at 4:35 pm the DON stated everyone was responsible to check call lights and staff would be retrained on call lights including ensuring the call light cord in the bathroom was not wrapped around the grab bar. She stated the call light should be in reach so the resident could call for help. During an interview on 10/18/23 at 4:35 pm the administrator stated all staff were responsible for making sure call lights were accessible and the call lights were to be checked every morning on rounds. She stated the maintenance supervisor checked call lights monthly to ensure they were working properly. She stated that a delay in care could occur if a resident could not reach their call light and expected all staff to check the call lights and especially the bathroom lights to ensure they were accessible and not wrapped around the grab bar. Record review of facility policy and procedure titled Call Light/Bell dated 5/2007 indicated, .place the call device within resident's reach . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 3 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 provide the necessary services to maintain personal hygiene for 2 of 16 residents reviewed for ADLs (Residents #53 and Resident #6) Residents Affected - Few The facility failed to ensure Resident #53 received timely incontinent care. The facility did not clean or trim Resident #6 fingernails. These failures could place residents who required assistance from staff for ADLs at risk of not receiving care and services to meet their needs which could result in poor care, risk for skin breakdown, feelings of poor self-esteem, lack of dignity and health. Findings included: 1.Record review of facility face sheet dated 10/17/2023 indicated Resident # 53 was an [AGE] year-old male admitted to the facility on [DATE] with diagnosis of hypertension (high blood pressure). Record review of Quarterly MDS dated [DATE] indicated Resident #53 had a BIMS of 10 indicating moderate cognitive deficit and required total assistance times two persons for toileting. Record review of comprehensive care plan dated 09/28/2023 indicated Resident #53 had a potential for altered skin integrity related to incontinence of bowel and bladder and to provide incontinent care every 2 hours and as needed, required use of disposable brief, and incontinent checks, had an ADL self-care deficit and to assist with toileting, and had a potential for pressure ulcer development and to provide incontinent care every 2 hours and as needed. During an observation on 10/16/2023 at 9:22 am Resident # 53 was lying in bed and lifted his blanket to reveal his shirt was wet from the bottom up to his mid back, under pad was wet with two dark ring rings around him and his brief was wet and puffy. During an interview on 10/16/2023 at 9:24 am Resident #53 stated he had to wait to get changed several times a week and could not remember when they changed him last but thought it was at least 4 hours ago or maybe longer. He stated he had not called for assistance and was just waiting for someone to come in and do it. During an interview on 10/16/2023 at 9:42 am NA E stated she had been at the facility 2 months and was assigned to Resident #53. NA E stated Resident #53 required total care for all ADL's and was to receive incontinent care every 2 hours. NA E stated Resident #53 was changed around 6:00 am or 6:30 am and he was due to be changed but was busy passing ice. NA E stated she was trained on timely incontinent care. NA E stated if a resident was left wet and unchanged it could cause skin breakdown. Record review of certificate of achievement dated 10/11/2023 indicated NA E had completed the NATCEP (Nurse Aide Training and Competency Evaluation Program) and met all criteria for the clinical competency skills checklist on 10/09/2023. During an interview 10/16/2023 at 4:18 pm NA A stated Resident #53 required total care for incontinence and required incontinent care every 2 hours. NA A stated if a resident was not changed timely, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 4 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 0677 it could cause an infection or skin breakdown. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/17/2023 at 8:06 am CNA D stated resident care needs are in the facility computer program on the resident's care plan including bowel and bladder needs. She stated if a resident was total care for ADL's they should be checked and changed every 2 hours and if they are not changed skin breakdown could occur. Residents Affected - Few During an interview on 10/17/2023 at 8:20 am LVN C stated she had been a nurse at the facility for 9 months and all dependent residents were to be checked and changed every 2 hours. She stated the LVN assigned to the resident was responsible for overseeing resident care and that the CNA's were providing care appropriately. She stated a resident left wet could cause skin breakdown and infections. 2. Record review of an admission Record dated 10/18/2023 for Resident #6 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of Type 2 diabetes, dementia (loss of memory, language and problem solving), generalized anxiety disorder (extremely worried or nervous more frequently) and hypertension (high blood pressure). Record review of a physician order summary report dated 10/18/2023 for Resident #6 indicated an order for diabetic nail care by licensed nurse every day shift every Saturday related to type 2 diabetes with a start date of 9/30/2023. Record review of a care plan dated 10/18/2023 for Resident #6 indicated she had a history of scratching the inside of brief and in perineal area causing nails to become soiled with interventions to avoid scratching and keep hand and body parts from excessive moisture. Keep fingernails short. She was at risk for ADL Self Care Performance Deficit related to poor coordination, weakness, decreased cognition and required assist with personal hygiene. Interventions included to clean nails with showers as needed. Nails to be trimmed by licensed nurse as needed. Record review of a Quarterly MDS Assessment for Resident #6 dated 9/22/2023 indicated she had severe impairment in thinking with a BIMS score of 0. She was totally dependent with personal hygiene with two person assist. During an observation on 10/16/2023 at 9:48 AM, Resident #6 was lying in her bed awake unable to speak. Her hands were positioned on her chest and her fingernails were medium length with a black substance underneath them. During an observation on 10/17/2023 at 4:45 PM, Resident #6 was lying in her bed with eyes open and unable to speak. Her fingernails were still long and had a black substance underneath them. During an observation and interview on 10/18/2023 at 9:35 AM in Resident #6's room. Resident #6 was lying in bed and NA G said she was assigned to work hall f today where Resident #6 resided. She said nail care was something that activities did for the residents but for diabetic residents the nurses were responsible for providing nail care. She said she did not think Resident #6 was diabetic, but her nails were long and dirty with a black substance underneath them. She said Resident #6 scratched herself a lot and it had been reported to LVN F. She said sometimes the residents could become combative when staff tried to perform nail care and if she was not sure about a resident, she would ask the nurse. She said today was only her third day to work with Resident #6 and did not know much about her. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 5 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 0677 Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 10/18/2023 at 9:40 AM, in the room of Resident #6 who was lying in bed resting. LVN F said the nurses were responsible for nail care if the residents were diabetic and trimmed their nails weekly as needed. She said Resident #6 scratched herself at times and she had black stuff under her nails, and they were long. She said most times Resident #6 would not allow staff to trim her nails or provide nail care. Residents Affected - Few During an interview on 10/18/23 at 4:35 pm the DON stated all nursing staff were responsible for making sure the residents were receiving care timely. She stated she would retrain staff on timely ADL care. She states if ADL care was not provided timely skin breakdown could occur and expected all resident needs were met. She said nail care should be done weekly and trimmed if the resident requested. She said activities had nail care that they provided to the residents, and they cleaned and painted their nails. She said diabetic residents were to be done by the nurses. She said normally residents received nail on their shower days and Resident #6 was known to scratch her skin all the time. During an interview on 10/18/23 at 4:45 pm the administrator stated she was responsible all things in the facility. She stated the nursing staff were to be rounding and ensuring timely ADL care and expected all residents to receive timely ADL care to prevent an adverse event. Record review of policy and procedure undated titled Incontinence Care indicated, .facility to provide incontinence care for those residents requiring assistance with bladder and/or bowel incontinence . Record review of a facility policy titled Care of Fingernails/Toenails with a revised date of October 2010 indicated, .The purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections. General Guidelines: 1. Proper nail care can aid in the prevention of skin problems around the nail bed. 2. Unless otherwise permitted, do not trim the nails of diabetic residents or residents with circulatory impairments . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 6 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 0759 Ensure medication error rates are not 5 percent or greater. 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 a medication error rate of less than 5 percent. There were 5 errors out of 31 opportunities, resulting in an 16.13% percent medication error involving 1 of 5 residents reviewed for medication pass. (Resident #20) Residents Affected - Some MA H failed to administer Protonix 40 mg delayed release (treats acid reflux), Metoprolol 25 mg extended release (for high blood pressure), Depakote 250 mg delayed release (to treat bipolar), Potassium 8 meq extended release (supplement) and Venlafaxine 225 mg extended release (for increased restlessness and irritability) medications as ordered that indicated do not crush. This failure could place residents at risk for inaccurate drug administration resulting in decline in health and decreased quality of life. Findings included: Record review of an admission Record dated 10/17/2023 for Resident #20 indicated he admitted to the facility on [DATE] and was [AGE] years old with diagnoses of dementia (loss of memory, language and problem solving), COPD (a group of lung diseases that cause breathing problems), depression, schizoaffective disorder (a mental illness that can affect your thoughts, mood and behavior), bipolar type (extreme mood swings), and unspecified convulsions (uncontrollable contractions of muscles) and atherosclerotic heart disease (buildup of fats and cholesterol in the arteries). Record review of an active physician order summary report dated 10/17/2023 for Resident #20 indicated he had medication orders for: pantoprazole 40 mg delayed release give one tablet by mouth one time a day with a start date of 6/9/2023. divalproex 250 mg delayed release give one tablet by mouth one time a day with a start date of 5/30/2023. metoprolol 25 mg extended release give one tablet by mouth one time a day for hypertension, do not crush, with a start date of 5/30/2023. potassium chloride 8 meq extended release, give one capsule by mouth one time a day, do not crush, with a start date of 1/4/2023. venlafaxine 225 mg extended release given one tablet by mouth one time a day, with a start date of 11/22/2022. Record review of a Quarterly MDS assessment dated [DATE] for Resident #20 indicated he did not have any impairment in thinking with a BIMS score of 14. Record review of a Swallowing Precautions note revised 7/20/2023 for Resident #20 indicated his diet was regular texture with thin liquids, should receive a Mighty Shake on all meal trays. There was no indication that his medications were to be crushed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 7 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of a care plan for Resident #20 dated 11/22/2022 indicated he had the potential for mood problem related to admission, disease process and medication side effects with interventions to administer medications as ordered, monitor/document for side effects and effectiveness. During an observation on 10/17/2023 at 7:49 AM, MA H administered medications to Resident #20. Prior to administering medications to Resident #20, she checked his blood pressure which was in parameters. She sanitized and placed gloves on her hands and opened the capsule of protonix 40 mg delayed release and emptied the contents into a medication cup along with medications that indicated do not crush on the blister pack which included: metoprolol 25 mg extended release (do not crush), Depakote 250 mg delayed release (do not crush or chew), potassium 8 meq extended release (do not crush) and venlafaxine 225 mg extended release. MA H placed levothyroxine 100 mcg 1 tablet, amlodipine 10 mg 1 tablet, Buspar 7.5 mg 1 tablet, docusate 100 mg 1 tablet, furosemide 20 mg 1 tablet, gabapentin 100 mg 1 tablet, sennasides 8.6 mg 1 tablet, vitamin d3 125 mcg 1 tablet, Zyrtec 10 mg 1 tablet, crushed the medications and mixed them with magic shake (a pudding texture that contains extra calories) and administered them to Resident #20. During an interview on 10/18/2023 at 8:30 AM, MA H said she had been employed at the facility for 10 months on the 6am-2pm shift and worked all over the facility and was not assigned to a specific hall. She said she had been a medication aide for 10 years. She said Resident # 20 had been receiving all of his medications crushed. She said all of his medications were caplets except for his protonix and it was a capsule. She said on yesterday 10/17/2023 she opened the capsule of protonix and poured it into the plastic medicine cup to be administered along with all of the other medications that were scheduled and she crushed all of them and mixed it with magic shake. She said Resident #20 had swallowing precautions and there was a sheet in the binder that was on the cart that indicated his medications needed to be crushed. She said therapy told her that his medications needed to be crushed. She said all staff had been crushing his medications when they administered to him. She said the hall that Resident #20 resided on was a new hall to her. She said she always made sure to double check the orders and the medication to be sure it was correct. She said she also used the binder that indicated if residents required their medications to be crushed or not. She said a resident could be at risk of getting an instant effect from the medications if they were delayed release or extended release. Record review of a Skills Checklist-Med Pass dated 1/4/2023 for MA H indicated she demonstrated competency and followed the six rights of medication administration. During an interview on 10/18/2023 at 2:50 PM, ADON N said she had been employed at the facility for over a year. She said pharmacy conducted check offs with nursing and medication aides when they visited the facility monthly. She said staff should be able to tell if a resident had medications that could be crushed or not because it would tell them on the MAR. She said she guessed it depended on the medications and what could happen if a medicine was crushed that should not have been. She said the pharmacy consultant visited the facility in September but did not provide a copy of the audit that was conducted at that time. During an interview on10/18/2023 at 3:05 PM, the DON said staff should be utilizing the ten medication rights. She said the DON, pharmacy consultant, and ADON's observed staff with medication pass often. She said with Resident #20 they completed a medication error report following the incident on 10/17/2023 after MA H crushed his medications that indicated to not crush. She said they contacted the physician and placed the resident on 72-hour checks and the physician did not want any labs ordered at this time. She said the pharmacy consultant would be at the facility later this week and would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 8 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some conduct a medication pass observation with MA H. She said staff should review the medications and the orders one by one before administering. She said MA H received verbal instruction on 10/16/2023. She said MA H had been assigned more online training on medication administration. She said the risk depended on the medications and what could happen if a medicine was crushed that should not have been. Record review of a facility policy titled Oral Medication Administration undated indicated, .To administer oral medications in a safe, accurate, and effective manner. Special Considerations: 1. Refer to crushing guidelines prior to crushing any medication for assurance that it can be pulverized. 3. For solid medications: b) Crush medications, if indicated by prescriber's order for this resident, only after checking the Medication Crushing Guidelines . Record review of a facility policy titled Medication Errors and Adverse Reactions with a revision dated of 1/2022 indicated, .It is the policy of this facility that medication errors and adverse drug reactions must be reported to the resident's attending physician. Medication Error means the observed or identified preparation or administration of medications or biologicals which is not in accordance with: The prescriber's order, Manufacturer's specifications (not recommendations) regarding the preparation and administration of the medication or biological . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 9 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 observation, interview, and record review, the facility failed to ensure residents were free from significant medication errors for 1 of 4 residents (Resident #20) reviewed for significant medication errors. Residents Affected - Few MA H failed to administer Metoprolol 25 mg extended release (for high blood pressure) and Depakote 250 mg delayed release (to treat bipolar) medications as ordered that indicated do not crush. This failure could place residents at risk for inaccurate drug administration resulting in decline in health and decreased quality of life. Findings included: Record review of an admission Record dated 10/17/2023 for Resident #20 indicated he admitted to the facility on [DATE] and was [AGE] years old with diagnoses of dementia (loss of memory, language and problem solving), COPD (a group of lung diseases that cause breathing problems), depression, schizoaffective disorder (a mental illness that can affect your thoughts, mood and behavior), bipolar type (extreme mood swings), and unspecified convulsions (uncontrollable contractions of muscles) and atherosclerotic heart disease (buildup of fats and cholesterol in the arteries). Record review of an active physician order summary report dated 10/17/2023 for Resident #20 indicated he had medication orders for: divalproex 250 mg delayed release give one tablet by mouth one time a day with a start date of 5/30/2023. metoprolol 25 mg extended release give one tablet by mouth one time a day for hypertension, do not crush, with a start date of 5/30/2023. Record review of a Quarterly MDS assessment dated [DATE] for Resident #20 indicated he did not have any impairment in thinking with a BIMS score of 14. Record review of a Swallowing Precautions note revised 7/20/2023 for Resident #20 indicated his diet was regular texture with thin liquids, should receive a Mighty Shake on all meal trays. There was no indication that his medications were to be crushed. Record review of a care plan for Resident #20 dated 11/22/2022 indicated he had the potential for mood problem related to admission, disease process and medication side effects with interventions to administer medications as ordered, monitor/document for side effects and effectiveness. During an observation on 10/17/2023 at 7:49 AM, MA H administered medications to Resident #20. Prior to administering medications to Resident #20, she checked his blood pressure which was in parameters. She sanitized and placed gloves on her hands and opened the capsule of protonix 40 mg delayed release and emptied the contents into a medication cup along with medications that indicated do not crush on the blister pack which included: metoprolol 25 mg extended release (do not crush), Depakote 250 mg delayed release (do not crush or chew), potassium 8 meq extended release (do not crush) and venlafaxine 225 mg extended release. MA H placed levothyroxine 100 mcg 1 tablet, amlodipine 10 mg 1 tablet, Buspar 7.5 mg 1 tablet, docusate 100 mg 1 tablet, furosemide 20 mg 1 tablet, gabapentin 100 mg (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 10 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 1 tablet, sennasides 8.6 mg 1 tablet, vitamin d3 125 mcg 1 tablet, Zyrtec 10 mg 1 tablet, crushed the medications and mixed them with magic shake (a pudding texture that contains extra calories) and administered them to Resident #20. During an interview on 10/18/2023 at 8:30 AM, MA H said she had been employed at the facility for 10 months on the 6am-2pm shift and worked all over the facility and was not assigned to a specific hall. She said she had been a medication aide for 10 years. She said Resident # 20 had been receiving all of his medications crushed. She said all of his medications were caplets except for his protonix and it was a capsule. She said on yesterday 10/17/2023 she opened the capsule of protonix and poured it into the plastic medicine cup to be administered along with all of the other medications that were scheduled and she crushed all of them and mixed it with magic shake. She said Resident #20 had swallowing precautions and there was a sheet in the binder that was on the cart that indicated his medications needed to be crushed. She said therapy told her that his medications needed to be crushed. She said all staff had been crushing his medications when they administered to him. She said the hall that Resident #20 resided on was a new hall to her. She said she always made sure to double check the orders and the medication to be sure it was correct. She said she also used the binder that indicated if residents required their medications to be crushed or not. She said a resident could be at risk of getting an instant effect from the medications if they were delayed release or extended release. Record review of a Skills Checklist-Med Pass dated 1/4/2023 for MA H indicated she demonstrated competency and followed the six rights of medication administration. During an interview on 10/18/2023 at 2:50 PM, ADON N said she had been employed at the facility for over a year. She said pharmacy conducted check offs with nursing and medication aides when they visited the facility monthly. She said staff should be able to tell if a resident had medications that could be crushed or not because it would tell them on the MAR. She said she guessed it depended on the medications and what could happen if a medicine was crushed that should not have been. She said the pharmacy consultant visited the facility in September but did not provide a copy of the audit that was conducted at that time. During an interview on10/18/2023 at 3:05 PM, the DON said staff should be utilizing the ten medication rights. She said the DON, pharmacy consultant, and ADON's observed staff with medication pass often. She said with Resident #20 they completed a medication error report following the incident on 10/17/2023 after MA H crushed his medications that indicated to not crush. She said they contacted the physician and placed the resident on 72-hour checks and the physician did not want any labs ordered at this time. She said the pharmacy consultant would be at the facility later this week and would conduct a medication pass observation with MA H. She said staff should review the medications and the orders one by one before administering. She said MA H received verbal instruction on 10/16/2023. She said MA H had been assigned more online training on medication administration. She said the risk depended on the medications and what could happen if a medicine was crushed that should not have been. Record review of a facility policy titled Oral Medication Administration undated indicated, .To administer oral medications in a safe, accurate, and effective manner. Special Considerations: 1. Refer to crushing guidelines prior to crushing any medication for assurance that it can be pulverized. 3. For solid medications: b) Crush medications, if indicated by prescriber's order for this resident, only after checking the Medication Crushing Guidelines . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 11 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of a facility policy titled Medication Errors and Adverse Reactions with a revision dated of 1/2022 indicated, .It is the policy of this facility that medication errors and adverse drug reactions must be reported to the resident's attending physician. Medication Error means the observed or identified preparation or administration of medications or biologicals which is not in accordance with: The prescriber's order, Manufacturer's specifications (not recommendations) regarding the preparation and administration of the medication or biological . Event ID: Facility ID: 675962 If continuation sheet Page 12 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 7 staff (CNA D, NA M and ADON N) and 3 of 8 residents (Resident #57, Resident #12, and Resident #17) reviewed for infection control. Residents Affected - Some CNA D did not wash or sanitize her hands when changing gloves while performing incontinent care to Resident #57. ADON did not wash or sanitize her hands when changing gloves while performing incontinent care to Resident #12. NA M wiped Resident #12, a female resident from back to front while performing incontinent care. The facility failed to ensure the urinary catheter bag for Resident #17 did not touch the floor. These failures could place residents at risk of exposure to communicable diseases and infections. Findings Included: 1. Record review of facility face sheet dated 10/17/2023 indicated Resident #57 was an [AGE] year-old female readmitted to the facility on [DATE] for diagnosis of heart disease. Record review of quarterly MDS dated [DATE] indicated Resident #57 had a BIMS of 13 indicating intact cognition and required total dependence in toileting. Record review of comprehensive care plan dated 10/11/2023 indicated Resident #57 had bowel and bladder incontinence and to provide pericare after each incontinent episode. During an observation of incontinent care on 10/17/2023 at 12:25 pm NA B and CNA D washed their hands and applied gloves. CNA D opened and pulled down Resident #57's soiled brief and provided pericare using wipes. NA B turned Resident #57 to her right side and CNA D cleaned her buttocks using wipes and removed soiled brief. CNA D removed her soiled glove from her right hand and applied a new glove without hand hygiene. CNA D used her right gloved hand to apply a skin barrier cream to Resident #57. CNA D removed both gloves and sanitized her hands. NA B applied a new brief, removed her gloves, and sanitized her hands. During an interview on 10/17/2023 at 12:30 pm CNA D stated she should have removed both gloves when going from dirty to clean, sanitized her hands, and then reapplied gloves. She stated she changed only the right glove because she did not have enough gloves on hand. She stated she had been trained on incontinent care and maintaining infection control including hand washing and changing gloves. She stated by not following infection control measures could cause a resident to get sick. During an interview on 10/17/2023 at 12:40 pm the treatment nurse stated she was responsible for CNA competency and training. She stated CNA D had been properly trained on infection control and incontinent care. She stated she would begin retraining staff on infection control measures. She stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 13 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 by not following proper infection control measures could cause a resident to get an infection. Level of Harm - Minimal harm or potential for actual harm Record review of certificate of Achievement dated 10/10/2023 for NA B indicated she had completed the NATCEP (Nurse Aide Training and Competency Evaluation Program) and met all criteria for clinical competency skills checklist. Residents Affected - Some Record review of CNA competency skills checklist dated 06/01/2023 indicated CNA D had met criteria for incontinent care and hand hygiene. 2. Record review of an admission Record dated 10/17/2023 for Resident #12 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of dementia (loss of memory, language and problem solving), alcoholic cirrhosis of liver (liver disease that causes the liver to become stiff, swollen and unable to do its job), bipolar (extreme mood swings), and Alzheimer's disease (a progressive disease that leads to memory loss). Record review of a Quarterly MDS Assessment for Resident #12 dated 7/21/2023 indicated she had severe impairment in thinking with a BIMS score of 1. She required extensive assistance with ADL's with two person assist. She was always incontinent of bowel and bladder. Record review of a care plan for Resident #12 with a revision date of 3/31/2016 indicated she had bowel/bladder incontinence with impaired mobility that included interventions to check as required for incontinence. Wash, rinse, and dry perineum. During an observation on 10/16/2023 at 11:50 AM in the Room of Resident #12, ADON L and NA M were present to provide incontinent care. Resident #12 was sitting up on the side of the bed being assisted by NA M who had visible feces noted on the draw sheet and her brief. NA M sanitized her hands and applied gloves. ADON L applied gloves to her hands without washing or sanitizing them. Resident #12 was positioned in bed and her brief was pulled down between her legs. ADON L removed wipes from the container and wiped Resident #12's perineal area from front to back using multiple wipes and placed them in the trash. Resident #12 was rolled onto her right side by NA M. ADON L removed the soiled brief and placed it in the trash. ADON L placed her gloves in the trash and put on clean gloves without washing or sanitizing her hands. NA M was given wipes by ADON L and NA M wiped Resident #12's rectal area from back to front two times. NA M placed the wipes in the trash along with her gloves and sanitized her hands. NA M applied clean gloves to her hands. ADON L removed the draw sheet and linens from the bed and placed them in a plastic bag. ADON L placed a clean brief underneath Resident #12's buttocks and resident was repositioned and the brief secured. ADON L removed her gloves and placed them in the trash and washed her hands. ADON L placed clean gloves on her hands and assisted NA M with transferring Resident #12 from her bed to the wheelchair. Both removed gloves and placed them in the trash. During an interview on 10/16/2023 at 12:05 PM, NA M said she had been employed at the facility since February 2023. She said she was a nurse aide in training and had completed all of the required hours but was waiting to schedule to take her certification test. She said during the incontinent care provided to Resident #12 she should have wiped her from front to back and not from back to front. She said she received training and had been checked off multiple times by staff in the facility. She said residents could be at risk for UTI's or yeast infection if staff did not wipe properly. Record review of a Skills Checklist-Incontinence Care dated 3/3/2023 for NA M indicated she demonstrated competency with incontinent care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 14 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 10/16/2023 at 12:15 PM, ADON L said she had been employed at the facility for 2 years. She said during the incontinent care provided to Resident #12 she should have sanitized her hands more with every glove change and she did not. She said she helped to oversee the nurse aides in training along with the DON and Administrative nurses. She said residents could be at risk for UTI's or could get septic if staff did not wash or sanitize their hand with gloves changes and if staff did not wipe female residents from front to back with incontinent care. Record review of a Skills Checklist-Incontinence Care dated 2/16/2023 for ADON [NAME] indicated she demonstrated competency with incontinent care. 3. Record review of an admission Record dated 10/17/2023 for Resident #17 indicated she was [AGE] years old with diagnoses of major depressive disorder (persistent feeling of sadness and loss of interest) , obstructive and reflux uropathy (occurs when urine cannot drain through the urinary tract), COPD (a group of lung disease that affect breathing) and acute diastolic congestive heart failure (heart's inability to pump effectively). Record review of a physician order summary report dated 10/17/2023 for Resident #17 indicated an order with a start date of 5/13/2021 to secure catheter with a leg strap/leg band to minimize catheter related injury and accidental removal or obstruction or urine flow. Record review of a Quarterly MDS assessment dated [DATE] for Resident #17 indicated she did not have any impairment in thinking with a BIMS score of 15. She required extensive assistance with ADL's with one-person physical assist. She had an indwelling catheter and an ostomy. Record review of a care plan with a revision date of 8/24/2023 indicated she had an indwelling foley catheter related to obstructive reflux uropathy/sacral wound with interventions that included to secure catheter to facilitate flow of urine, prevent kinking of tubing, and accidental removal. During an observation and interview on 10/16/23 at 9:53 AM, Resident #17 was lying in bed. She said she had been at the facility for 4 years. She said she has had the foley catheter for a long time. Her foley catheter drainage bag was noted lying on the floor with a privacy bag covering it. During an observation and interview on 10/16/23 at 3:19 PM, Resident #17's foley catheter drainage was lying on the floor with a privacy bag covering it. Resident #17 said that the staff do not change the catheter as often as they did before because it was too hard to put back in last time. She said she was aware of the foley drainage bag being on the floor because she told the staff to put it there so it could drain. She said she did not want the bag sitting on the bed because it would back up and not drain properly. During an observation on 10/17/2023 at 3:14 PM, Resident #17's foley catheter drainage bag was on the floor. During an interview on 10/18/23 at 2:50 PM, ADON N said she had been employed at the facility for over a year. She along with the ADON and DON they were responsible for conducting some of the check offs with the nurses and aides. She said they also conducted random checks with staff on hand washing and hand hygiene. She said staff should be washing and sanitizing their hands with glove changes. She said when incontinent care was provided to female residents, staff should be wiping them from front to back. She said foley catheters should be positioned below the bladder and not on the floor. She said all had a risk for infections. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 15 of 16 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 10/18/2023 at 3:05 PM, the DON said she had several people that checked off staff in the facility on infection control with hand washing/hygiene that included the ADON, DON, MDS and the treatment nurse. She said staff were supposed to wash or sanitize their hands between glove changes. She said foley catheters should not be on the floor. She said residents could be at risk of infection with all. Record review of a facility policy titled Incontinence Care undated indicated .It is the policy of this facility to provide incontinence care for those residents requiring assistance with bladder and/or bowel incontinence. Staff providing incontinence care will do so while maintaining the dignity of the residents and providing care in a respectful manner. 1. Staff will wash their hands and don a clean pair of gloves. 4. Wash peri-area from front to back strokes, rinse, pat dry. 6. Remove gloves and wash hands . Record review of facility policy and procedure titled Hand Hygiene dated 10/2022 indicated, .2. use an alcohol-based hand rub, soap, and water for the following situations: m. after removing gloves . Record review of a facility policy titled Catheter Drainage Bag with a revision date of 1/2022 indicated, .It is the policy of the facility to maintain continuously closed urinary drainage system whenever possible and provide a receptacle for urine and to accurately measure output of urine. 12. Position the drainage bag below the level of the resident's bladder. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675962 If continuation sheet Page 16 of 16