Health inspection·July 14, 2022

F 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few should be dated. LVN H said the IV site should be changed every 3 days . LVN H said he did not put that IV in, and was unsure who did. Record review of Resident #15's Order Summary Report dated 07/11/22, revealed Resident #15 was a [AGE] year old female, who was admitted to the facility on [DATE], diagnoses included: essential hypertension (abnormally high blood pressure), muscle weakness, and vascular dementia without behavioral disturbance (changes to memory, thinking, and behavior resulting from conditions that affect the blood vessels in the brain). Record review of Resident #15's Quarterly MDS dated [DATE], revealed Resident #15 had a BIMS of 15 (cognitively intact), and limited assistance by one staff for dressing, toilet use and personal hygiene. Record review of Resident #15's care plan, date initiated 07/08/22, and revision on 07/08/22, revealed Resident #15 was on IV medications r/t medication Merrem Solution Reconstituted 500MG, interventions included: Monitor/document/report to MD PRN s/sx of infection at the site: drainage, inflammation, swelling, redness, warmth. Record review of Resident #15's physician's order dated 7/07/22 indicated the resident was to receive Merrer Solution Reconstituted 500MG (meropenem-antibiotic), use 500mg intravenously two times a day for ESBL to urine for 13 administrations. There were no orders for monitoring of an IV catheter. Observation on 07/11/22 at 2:21 PM, revealed Resident #15 laying in bed, with an IV site to her left hand, no date of insertion was visible. The IV was not in use. Observation and interview with LVN G on 07/11/22 at 3:17 PM, revealed Resident #15 was lying in bed, with the IV site undated. LVN G said the IV site was not dated, and it should be. LVN G said she was not sure about any orders regarding monitoring of the IV site, but you do want to observe for any redness to the site. In an interview on 07/12/22 at 7:40 AM, the DON said the date must have fallen off the IV site. The DON said there are orders that are inputted into PCC (electronic system used for the resident's records), to monitor for any redness to the IV site. The DON said the orders are probably still on paper, and have not been inputted yet. In a phone interview, on 07/13/22 at 1:43 PM, the facility Medical Director said you want to monitor the IV site, to make sure there was no redness, or infiltration to the IV site. Record review of facility policy titled Nursing Services, Section: Quality of Care Subejct: Administration of Medications and Fluids, Intravenous, last revised on 12/2019 revealed: It is the policy of this facility that medications and/or fluids shall be administered as prescribed by the attending physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676042 If continuation sheet Page 2 of 5 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 676042 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McAllen Transitional Care Center 2109 South K St MC Allen, TX 78503 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 - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, administration of all drugs and biologicals to meet the needs of each resident for 1 of 5 residents (Resident #26) reviewed for pharmaceutical services, in that: The facility applied a topical treatment Resident #26's groin without a physician's order. This failure could affect residents receiving medications and could lead to decline in health. The findings include: Record review of Resident #26's Order Summary Report, dated 07/14/22, revealed Resident #26 was a [AGE] year old male, who was admitted to the facility on [DATE], diagnoses included: peripheral vascular disease (circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), hemiplegia (paralysis of partial or total body function on one side of the body), and hemiparesis (weakness on one side of the body) following cerebral infarction affecting right dominant side and , and dementia without behavioral disturbance (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning). Further review, revealed there was no orders for any ointments to apply to Resident #26's groin area. Record review of Resident #26's Significant Change MDS, dated [DATE], revealed Resident #26 had a BIMS of 11 (moderately impaired), and required extensive assistance by one staff for transfers, dressing, toilet use, and personal hygiene. Further review revealed Resident #26 was always incontinent of bowel and bladder. Observation of incontinent care on 07/13/22 at 2:44 PM, revealed CNA B and CNA C provided incontinent care to Resident #26. Resident #26 had a white ointment to his groin area. When the ointment was wiped off with the wipes, Resident #26's groin area, was a pink/red to his groin. Attempted to interview Resident #26, Resident #26 unable to keep eyes open, and unable to answer questions. Interview on 07/13/22 at 3:10 PM, CNA B said Resident #26 has had the redness to his groin area for about 2 days. CNA B said the treatment nurse applies zinc oxide to Resident #26's groin. Observation and interview on 07/13/22 at 3:25 PM, Wound care nurse accompanied by surveyor assessed Resident #26 groin area. Wound care nurse said Resident #26 had some redness to his groin area. Wound care nurse said when he did Resident #26's head to toe assessment on Monday (07/11/22), Resident #26's skin was intact. Wound care nurse said you need an order to apply zinc oxide. Wound care nurse said the family was probably the one applying the ointment to Resident #26. In an interview on 07/13/22 at 3:42 PM, FM E said Resident #26 had a rash to the groin area, and sometimes it bleeds, due to Resident #26 scratching the area. FM E said the redness to his groin has been an ongoing issues since about March. FM E took out a bottle of skin lotion from the bedside dresser, and said she only applies it to Resident #26's arms. FM E said she does not apply anything to Resident #26's private areas. FM E said she tells the staff when Resident #26 has any redness to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676042 If continuation sheet Page 3 of 5 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 676042 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McAllen Transitional Care Center 2109 South K St MC Allen, TX 78503 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 groin, and staff bring and apply a white cream. FM E said she was unsure which staff members it was, or what their title is. In an interview on 07/13/22 at 3:48 PM, LVN F said the CNAs do not have access to zinc oxide, it was kept in the nurses or wound care cart. Residents Affected - Few In an interview on 07/13/22 at 4:00 PM, the DON said Resident #26 needed an order for zinc oxide. DON said she would assess Resident #26. In an interview on 07/14/22 at 9:47 AM, Wound care nurse said yesterday (07/13/22) the doctor was called, and was unable to come into the facility, but did a tele-visit with Resident #26, and diagnosed Resident #26's groin area, as hyperpigmentation (darkening of an area of skin). Wound care nurse said an order for zinc oxide to the groin area was also prescribed. In an interview on 07/14/22 at 11:20 AM, the DON said the doctor was called, and came to assess Resident #26, and diagnosed the area as hyperpigmentation. The DON said zinc oxide was also ordered for Resident #26's groin. The DON said Resident #26's groin looked discolored, not red. The DON said the CNAs use a barrier cream, that was non medicated, and maybe that was what Resident #26 had to his groin. The DON took out a bottle of barrier cream, and surveyor asked the DON to put on surveyor's hand. Surveyor rubbed the barrier cream ointment on, and barrier cream ointment went on clear. Surveyor explained to DON, the barrier cream ointment on Resident #26's groin, was white. DON said she is not sure what that could be. Record review of the facility's policy Pharmacy Services -Physician orders, revised 05/2007 revealed: It is the policy of this facility that drugs shall be administered only upon the written order of a person duly licensed and authorized to prescribe such drugs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676042 If continuation sheet Page 4 of 5 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 676042 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McAllen Transitional Care Center 2109 South K St MC Allen, TX 78503 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 Based on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program, designed to provide safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections, for one (Resident #17) of two residents reviewed during incontinent care for infection control, in that: Residents Affected - Few CNA A did not perform hand hygiene three times, when changing gloves during incontinent care for Resident #17. This failure could place residents at risk of infections and cross contamination. The findings included: Observation of incontinent care on 07/13/22 at 2:17 PM, CNA A cleansed Resident #17's penis, around the penis, and inner thighs, with gloved hands. CNA A removed her gloves, donned (put on) clean gloves, and continued to wipe Resident #17's buttocks. CNA A removed her gloves, donned clean gloves, and continued to apply a clean brief. In an interview on 07/13/22 at 2:26 PM, CNA A said she was supposed to sanitize or wash her hands after glove changes, for infection control purposes. In an interview on 07/13/22 at 3:12 PM, the DON said staff are to perform hand hygiene for infection control, between glove changes or going from dirty to clean. In an interview on 07/13/22 at 3:45 PM, CNA A approached surveyor, with a bottle of hand sanitizer, and said the reason she did not sanitize her hands was because she forgot her hand sanitizer in her bag. In an interview on 07/14/22 at 10:10 AM, the DON said the CNAs do a skills check off in March and April and upon hire, on incontinent care and handwashing. Record review of the facility's policy, Hand Washing dated 6/2016, revealed: It is the policy of this community to cleanse hands to prevent transmission of possible infectious material and to provide a clean, healthy environment for residents and staff. Hand washing is considered the most important single procedure for preventing the spreading of infections. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676042 If continuation sheet Page 5 of 5