Health inspection·July 17, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm In an interview on 07/11/23 at 09:48 a.m., CNA A stated the catheter bag was supposed to be covered. CNA A stated with the catheter bag not being covered, it would be a privacy (issue). CNA A stated it was the CNAs responsibility to make sure the catheter bag was covered. Observation on 07/11/23 at 09:55 a.m., CNA A entered Resident #144's room to cover the catheter bag. Residents Affected - Few Observation and interview on 07/11/23 at 09:59 a.m., LVN C stated she just put a new cover on Resident #114's catheter bag. LVN C stated if the catheter bag does not have a cover on the catheter bag, it was infection control. LVN C stated privacy cover was (now) on bag. LVN C, then walked into the Resident #114's room without knocking. LVN C stated she was supposed to knock before entering a resident's room. LVN C said, I knocked the first time I went in. In an interview on 07/14/23 at 02:44 p.m., the DON stated a catheter bag should always be covered. She said it was a dignity issue if it were not covered. The DON stated everyone needed to knock on the residents' doors before entering. The DON stated not knocking would be a resident right issue. In an interview on 07/14/23 at 06:29 p.m., CNA B stated the catheter bag was always to be covered and not touching the floor. CNA B stated if the catheter bag was not covered, it was a privacy issue for the resident, urine can be seen. CNA B stated before entering the room, she knocks first and asks if she can go in. CNA B stated if you do not knock before entering, it was a privacy issue plus you can scare the resident and that was not good. In an interview on 07/14/23 at 06:40 p.m., ADON D stated catheter bag was to be in a privacy bag. ADON D stated they were called dignity bags because they preserve dignity. ADON D stated everyone was to knock before entering a resident's room. ADON D stated this was the resident's home and their privacy so everyone knocks before entering the resident's home. Record review of the facility's Statement of Resident Rights Dated February 2017 Revised 10/2022 documented: Resident/Patient Rights include: 1. To all care necessary for them to have the highest possible level of health; 2. To safe, decent and clean conditions; 3. To be treated with courtesy, consideration and respect; 4. To privacy, including privacy during visits and telephone calls . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 2 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0558 Reasonably accommodate the needs and preferences of each resident. 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 reasonable accommodation of resident needs for two (Resident #54, Resident # 114) of eight residents reviewed for accommodation of needs: Residents Affected - Few 1.Resident #54's restroom inside door was not equipped with an accessible door handle from the inside. 2. Resident #114's call light was placed out of reach and lying on the floor. This failure could place residents who require assistance with their activities of daily living and use of call lights for assistance in maintaining and/or achieving independent functioning, dignity, and well-being. Findings included: 1.Record review of Resident's #54's admission record face sheet, dated 07/14/23 indicated Resident #54 was an 82 -year-old male admitted on [DATE] with dementia (inability to remember, think, or make decisions), dysphagia (inability to swallow), tachycardia (rapid heartbeat), history of falling, chronic kidney disease (gradual loss of kidney function), sepsis (blood poisoning), non-pressure chronic ulcer of right foot with unspecified severity (a perforation of the skin), hypertension (high blood pressure), diabetes (metabolic disorder in which body has high sugar levels for prolonged periods of time and metabolic encephalopathy (brain disease or brain damage) Record review of Resident #54's quarterly MDS dated [DATE] revealed resident -had a BIMS score of 10 with cognition moderately impaired. -required supervision (oversight, encouragement, or cueing) for bed mobility, transfer and eating. - was always urinary continent. -was occasionally bowel incontinent. -required extensive assistance by one person for personal hygiene. -used a wheelchair as mobility device. -had functional limitation in range of motion in lower extremity (hip, knee, ankle, foot). Record review of Resident #54's care plans indicated resident was had an ADL self-care performance deficit r/t impaired balance and generalized body weakness, date initiated 03/09/20. Interventions included for toilet use, the resident requires supervision by (X1) staff for toileting, date initiated, 03/09/20. Observation on 07/12/23 at 11:21 am revealed Resident #54 in his wheelchair in his room, with sleeves on both of his arms to his wrist. Resident #54 said he easily got his arms bruised because his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 3 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few skin was so thin. Resident #54 said he had trouble opening and closing the restroom door when he went to use the toilet himself as he preferred sometimes. Resident #54 said he was having trouble opening the restroom doors both from the outside and from the inside because he could not reach the door handle if he tried to get out facing the door in his wheelchair. He said he had to turn his wheelchair backwards so he could reach the door handle and open it. Resident # 54 said a month ago he had asked a Maintenance A, whose name he did not remember if something could be done to the restroom door handles so he could easily open. Resident #54 told the staff he had trouble turning the door handles, especially the inside restroom door handle. Resident #54 said maintenance staff had come soon after and provided rope straps to attach to the door handles for him to be able to reach the door handles from sitting in his wheelchair. Resident #54 told the staff did not like the rope straps, because they did not work to help him. Resident #54 said maintenance staff never came back with a solution to the problem. Interview on 07/14/23 at 10:16 am with Maintenance A revealed that Resident #54 had told him that he had trouble opening his restroom doors, especially from the inside. Maintenance A said he told his supervisor, Maintenance Supervisor about Resident #54's problems with the restroom doors right after Resident # 54 voiced his concerns to him, which was about a month ago. Maintenance A said they had not found a solution to Resident #54's concerns with the restroom doors. Interview on 07/14/23 at 10:17 am with Maintenance Supervisor said he didn't remember who Resident #54 had informed him about his problems with the restroom door handles and who told him about the resident's concerns with the door handles. Maintenance Supervisor said the restroom handles were already designed for handicap use. Maintenance Supervisor said he told the Director of Maintenance about the concerns, but the Director of Maintenance said he had no other door handles or methods to fix the problem. Maintenance Supervisor said they had placed rope straps on the door handles to provide Resident #54 ease to use the door. Resident #54 said he didn't think that solution would help him. Interview on 07/14/23 at 10:23 am with CNA G revealed Resident #54 had not mentioned he had any problems using the restroom door handles to go in or come back out from restroom. CNA G said Resident #54 used the restroom on his own most of the time and sometimes when he used a laxative, he would ask us to help him. CNA G said if Resident #54 had told her he was having problems with the restroom door handles, she would have told her charge nurse. Interview on 07/14/23 at 1:21 pm with the DON revealed Maintenance H, Maintenance Supervisor or Director of Maintenance had not told nurses or the DON that Resident #54 had problems using his restroom door handles. The DON said these concerns voiced by Resident #54 had not been addressed or resolved by nursing staff since they had not been made aware of the problem. The DON said she had informed Rebab Therapy Department to assess the concern and they had already come up with a solution that worked for the resident as of the day before. The DON said the facility failed to address this concern as needed because Maintenance staff had not informed her, the nursing staff or administrator as they should have so nursing staff could address the concerns. Interview on 7/14/23 at 4:32 pm with Director of Maintenance revealed his staff had told him about #54's concerns with using the restroom door handles and they had gone to him to provide him with some solutions but Resident #54 said they would not work for him. The Director of Maintenance said Maintenance staff did not inform the DON or Administrator of the remaining concern that Resident #54 had using the restroom door handles. Interview and observation on 07/14/23 at 4:58 pm revealed the restroom door handles had rope straps (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 4 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few both on the outside and indoor handles. Inside the restroom door a grab bar was installed on the door to allow Resident #54 to grab the bar and open the inside door. Resident #54 said he could use the door handles better and did not have to use his wheelchair backwards to grab the handle and exit the restroom. 2. Record review of Resident #114's Face sheet dated 7/13/23 documented a [AGE] year-old male, admitted on [DATE]. Diagnoses included sepsis (occurs when chemicals released in the bloodstream to fight an infection trigger inflammation throughout the body that can cause cascade of changes that damage multiple organ systems leading them to fail sometimes even resulting in death), acute kidney failure, and obstructive and reflux uropathy (disorder of the urinary tract that occurs due to obstructed urinary flow). Record review of Resident #114's Significant Change MDS, dated [DATE], revealed a Brief Interview of Mental Status score of 00, had no speech, and had an indwelling catheter. Resident #114 required extensive assistance with 2+ person physical assistance with bed mobility. Resident #114 was totally dependent and required 2+ person assist for transfers, was totally dependent requiring 1 person physical assistance for dressing, eating, toileting, and personal hygiene. Resident #114 was always incontinent of bowel and had a Foley catheter. Record review of Resident #114's care plan, last revised on 07/11/23, revealed Resident #114 had a communication problem related to hearing deficit without use of hearing aids. Interventions included: Ensure/provide a safe environment: Call light in reach. On observation on 07/11/23 at 09:42 a.m., Resident #114's call light lying on the floor at the side of Resident #114's bed. In an interview on 07/11/23 at 09:48 a.m., CNA A stated call light was to be where the resident could reach it. CNA A stated if the call light was not in reach of the resident, the resident could fall or something could happen. CNA A stated it is everybody's responsibility to make sure the call light is within the resident's reach. In an interview on 07/11/23 at 09:59 a.m., LVN C stated the call light was supposed to be beside Resident #114 so he could reach it. LVN C stated Resident #114 could sometimes use the call light and sometimes he was confused (and could not use the call light). LVN C stated if the resident is in need of something, he would be unable to communicate if the call light was not in reach. In an interview on 07/14/23 at 02:44 p.m., DON stated the call light should be within reach (of residents) so if the resident needed assistance, the resident could put on their light. In an interview on 07/14/23 at 06:29 p.m., CNA B stated the call light is supposed to be close to Resident #114's hand that he uses. CNA B stated if the call light is on the floor it needs to be picked up and placed by the resident's hand. CNA B stated if the call light is not in reach, the resident may need something, and they cannot get help because they cannot put the light on. In an interview on 07/14/23 at 06:40 p.m., ADON D stated the call light is supposed to be close to the resident when in the resident is in bed or near the bed. ADON D stated the negative would be no one would know if the resident needed assistance if the call light was not within reach. Record review of the facility policy titled Accommodating Resident Needs dated 10/2022, indicated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 5 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0558 Each resident has the right to reside and receive services and reasonable accommodation of individual needs and preferences. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 6 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to develop and implement a comprehensive person-centered care plan that included measurable objectives and time frames to meet a resident's mental, nursing, and psychosocial needs for 1 of 5 residents (Resident #1) reviewed for care plans. The facility failed to fully develop a comprehensive person-centered care plan that was specific for Resident #1 to address his smoking needs. This failure could affect residents in the facility by placing them at risk of not being provided with necessary care or services and not having personalized plans developed to address their specific needs. The findings were: A record review of Resident #1's Face Sheet dated 07/17/23 documented a [AGE] year-old male, admitted on [DATE] with diagnoses including diabetes, diabetic ulcer of the left foot, high blood pressure, COPD, congestive heart failure, muscle weakness, obstructive sleep apnea, a-fib, depression, morbid obesity, and osteomyelitis (bone infection). Record review of Resident #1's MDS dated [DATE] documented a BIMS of 13, indicating he was cognitively intact. Further review revealed, Resident #1's level of assistance with Activities of Daily Living (ADLs) of walking in his room or corridor, eating, and toilet use at a supervised level with set-up help only. For bed mobility, transfers, locomotion on the unit, and personal hygiene at a level of limited assistance with one person's physical assistance. Locomotion off the unit and dressing at a level of extensive assistance with one person's physical assistance. Record review of Resident #1's Care Plan dated 03/31/23 did not include or address his smoking. Observation and interview with Resident #1 on 07/11/23 at 11:32 am revealed he had an open pack of cigarettes in his left shirt pocket. He stated he carried his own lighter. He stated he smoked 4-6 cigarettes a day, he said there was a schedule, but he could go whenever he wanted to, and no one had to go with him. Resident #1 stated, he Used to get his cigarettes and lighter from the nurses at the nurse's station. I asked them if I could have my own for convenience to me and them. Resident #1 stated, They said I could have them as long as I didn't burn anything down, then laughed and stated, I would never do anything like that. Resident #1 could not identify which nurse allowed him to have his own cigarettes and lighter. An interview with LVN-A on 07/14/23 at 11:18 am stated Resident #1's smoking should be in his care plan. In an interview with RN-A on 07/14/23 at 11:08 am, RN-A stated smoking should be in the resident's care plan. Interviews with the DON and ADON on 07/14/23 at 04:15 pm both stated smoking should definitely be part of the care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 7 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0656 Record review of facility policy, Care Plans dated 02/2017 documented: The comprehensive care plan is developed within seven days of the completion of the comprehensive assessment . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 8 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide adequate supervision for four Residents (Resident #76, Resident #93 ) of eight residents whose records were reviewed for elopement and supervision. 1.The facility failed to ensure Resident #76, and Resident #93 received adequate supervision. Resident #76 eloped from the facility memory unit on 10/22/2022 & 12/19/22. Resident #93 eloped on 1/30/23. The non-compliance was identified as Past Non Compliance. The Immediate Jeopardy (IJ) began on 12/18/22 and ended on 2/13/23. The facility corrected the non-compliance before the survey began. These failures could place the residents with exit seeking behaviors at risk for injury or death and could place residents at risk for smoking-related injuries. Findings were: 1. Record review of R#76's Order Summary Report dated 7/14/23 revealed an [AGE] year-old male with diagnoses of ST Elevation Myocardial Infraction Involving (STEMI) other coronary artery of inferior wall (most severe type of heart attack), Essential (Primary) Hypertension (pressure in blood vessels is too high), Unspecified dementia (loss of thinking, remembering, reasoning) Unspecified severity with other behavioral disturbance, and Peripheral vascular disease (slow circulation disorder). Record review of R#76's MDS Section C dated 4/27/23 revealed resident had a BIMS Score of 00 (Severely Impaired Cognition). Resident is able to ambulate with no assistive devices. Record review of R#76's Care Plan dated 11/14/22 revealed: Focus: I am exit seeking impaired safety awareness. Interventions: - arrange furniture placement such as tables positioned in the dining room area to distract from exit doors in that area. -Increased and /or frequent monitoring to validate safety -Sleep pattern on resident to be established -Promote activity and exercise during day so that I can rest at night. Record review of the facility's incident report dated 10/22/22 at approximately 6:41am revealed R#76 eloped from facility through the library window in the Memory Care Unit. An open window to the Memory Care Unit library was observed by CNA T. Resident #76 was found by police almost two miles from the facility. Speed limit at 30 mph (miles per hour). Resident #76 was taken to ER by police then returned to facility. Physical injuries sustained to face were skin laceration to right eyebrow and laceration to nose bridge, skin abrasion to right shoulder, skin discoloration noted to right elbow, skin abrasion to right knee. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 9 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0689 Record review of the facility's incident report dated 12/19/22 revealed Resident #76 Level of Harm - Immediate jeopardy to resident health or safety eloped again on 12/18/22 at approximately 11:48 p.m. He was seen on camera eloping from facility through the dining room door in the Memory Care Unit. LVN P heard the door alarm, went to look, saw nothing, the door alarm turned off, and the nurse went back to her station. At approximately 12:00 am, Police called to notify facility they had taken Resident #76 to ER for evaluation. Resident #76 returned to facility from ER with no skin discolorations, skin tears, cuts, abrasions or any injuries. Residents Affected - Some Record review of Police Department Incident Report dated 12/18/22 stated the temperature outside at the time was at 53 degrees. -In an interview with LVN P on 7/13/23 at 3:30 pm revealed that on 12/18/22 at 11:48 pm an alarm went off, LVN P said she heard the alarm from the dining area but as she approached the area, the alarm turned off. She said she looked outside but did not go check outside. She said she knew she was supposed to check outside and knew the procedure for elopement but did not follow it. She stated she received in services and trainings on resident elopements after the incident and also have monthly in services after incident with Resident #76. -In an interview on 7/13/23 at 9:52 p.m. CNA P said stated he received in services and trainings on resident elopements after the incident with Resident #76 and also have monthly in services. - In an interview on 7/13/23 at 10:35 am LVN X stated he received in services and trainings on resident elopements after the incident with Resident #76 and also have monthly in services. Record review of R#93's admission Record dated 7/17/23 revealed an [AGE] year-old male with an initial admission date of 5/11/21. His diagnoses included Type 2 diabetes mellitus without complications (chronic condition that affects the way the body processes blood sugar), Essential (Primary) Hypertension (pressure in blood vessels is too high), Unspecified dementia (loss of thinking, remembering, reasoning) Unspecified severity without behavioral disturbance, Muscle wasting & atrophy not elsewhere classified Unspecified site. Record review of R#93's Care plan revealed; Focus: I am exit seeking, I am at risk for elopement and/or wandering with unsafe boundaries r/t: Dementia Interventions/Tasks: - Distract me from exit seeking by offering pleasant diversions, structured activities, food, conversation, television, book. Record review of the facility's incident report dated 1/30/23 revealed Resident #93 eloped through exit door on 01/30/2023 at approximately 7:35 am, alarm sounded in 400 hall. Two employees went towards exit door where alarm had been set off. They looked outside through the window but did not see Resident #93 outside. RN L proceeded to disengage the alarm. Resident #93 was found by another staff member outside the facility near the facility sidewalk. Resident #93 was unharmed. -On 7/11/23 at 11:25 am observation of resident sitting in wheelchair in living room area of secure unit. Resident residing in room [ROOM NUMBER] - A in secure unit as a result of elopement incident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 10 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some In an interview on 7/14/23 at 8:24 am the DON stated that the employees who responded to the elopement of Resident #93 were both terminated due to not following elopement procedures. According to DON, RN L and Floor Tech D responded to an alarm on 1/30/23, they walked towards the exit doors but did not go outside to check for residents. As per DON, RN L then proceeded to turn off the alarm. DON also stated that both Floor Tech D and RN L were terminated as the result of the investigation on Resident #93's elopement. DON also stated, the facility placed a white affixed box with a keypad outside the DON's office. The box contains keys to turn off alarms when alarms are activated. The DON and Administrator were the only ones who had the code to open the box. The staff must follow elopement protocol before they can request the keys from DON/Administrator to turn off alarm. -Record review of in-services dated 12/19/22 revealed; All staff were in-serviced for Door Alarms/Missing person protocol, how to identify residents at risk for elopement, how to supervise, monitor, and redirect residents, at risk for elopement. Additionally, staff were in-serviced post elopement policy and the facility elopement book and elopement drills are being conducted monthly. - On 7/14/23 at 11:35 am a white box with keypad was observed outside the office of DON's office. -Resident #93 was reassessed for placement in the memory care support unit, pending IDT evaluation of status and continued need for placement. Record review of the Missing Resident/Elopement Facility Policy dated 5/23/22 stated; When an elopement occurs; All team members will be alerted to search in the community or grounds as soon as there is an awareness of the resident missing If the resident is not quickly located in the community or on the grounds a point person is designated to make the notifications to staff. Observation of the locked box in a med cart in the nurse's station on the memory care unit and interview with RN-A on 07/14/23 at 11:08 am, RN-A stated the process for residents to smoke was for them to collect their smoking materials at the nurse's station and a staff or family member would take the lighter and light the residents' cigarettes. RN-A stated he was unsure of the smoking times, and only one or two residents in the memory care unit smoked. A review of an undated list of residents who smoke provided by the facility on 07/12/23 revealed five residents in the facility that smoked cigarettes. Record review of the facility Smoking Guidelines-Residents revised 05/11/12 documented .A smoking assessment shall be completed on admission and updated quarterly and more frequently as deemed necessary .Resident smoking materials shall be turned in to the charge nurse. No resident shall be allowed to keep cigarette lighters, matches, or smoking materials in any other area than the nursing station . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 11 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that all drugs and medical devices used in the facility were labeled in accordance with professional standards, including expiration dates for 2 of 2 medication rooms reviewed for expired medications in that: -24 Acetaminophen suppositories were expired -A 100 ml bag of intravenous fluid was expired This failure could place residents at risk of being administered medications that were ineffective. The findings were: Observation of the Medication Room Skilled Side on 07/12/23 at 03:08 PM revealed: -24 Acetaminophen suppositories 650mg expired 06/2023. Observation of the Medication Room Memory Skilled Unit on 07/12/23 at 03:30 pm revealed: - A 100ml bag of 5% Dextrose expired [DATE]. An interview with the DON on 07/12/23 at 2:55 pm stated RN B was responsible for checking the medication rooms for expired medications. Interview with RN B on 07/12/23 at 03:16 pm stated, The medication rooms were checked constantly by himself, the nurses, and med aids. RN B stated, The resident's medications were checked for expiration when they were admitted to the facility and prior to administration, and any time between receiving the drug to administration, and any time we go through a drawer. RN B stated, It's very important not to have expired medications because the manufacturer can't guarantee the effectiveness of the drug or that it is safe to administer after the expiration date-the possibilities are endless; ineffective, a reaction could happen and cause harm to the resident in that an expired drug could react with other medications and make them sicker. RN B said all expired medications were logged and kept in a seperate container in the locked medication room until pharmacy arrived monthly to do medication destruction. RN B had nothing to say when informed of the expired medications in the medication's rooms. Record Review of Facility Policy, Storage and Expiration of Medications, Biologicals, Syringes, and Needles revised 01/01/13 documented: 15. Facility should ensure that medications and biologicals for expired or discharged residents are stored separately, away from use, until destroyed or returned to the provider . 17. Facility personnel should inspect nursing station storage areas for proper storage compliance on a regularly scheduled basis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 12 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the FDA website, https://www.fda.gov on 07/14/23 revealed drug expiration dates reflect the time period during which the product is known to remain stable, which means it retains its strength, quality, and purity when it is stored according to its labeled storage conditions. If a drug has degraded, it might not provide the patient with the intended benefit because it has a lower strength than intended. In addition, when a drug degrades it may yield toxic compounds that could cause consumers to experience unintended side effects. Sterility may be compromised after the expiration date on medical devices such as IV tubing, catheters, and other sterilized products. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 13 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review 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 residents (Resident #114, Resident #66, and Resident # 100) of 25 residents observed in that: Residents Affected - Few CNA A did not perform hand hygiene after picking call light up off the floor and placing it next to Resident #114. CNA C and CNA D did not perform hand hygiene between glove changes while providing Resident #66 and Resident #100 with incontinent care. These failures could place residents at risk for infections and cross contamination. The findings were: 1 Record review of Resident #114's Face sheet dated 7/13/23 documented a [AGE] year-old male, admitted on [DATE]. His diagnoses included sepsis (occurs when chemicals released in the bloodstream to fight an infection trigger inflammation throughout the body that can cause cascade of changes that damage multiple organ systems leading them to fail sometimes even resulting in death), acute kidney failure, and obstructive and reflux uropathy (disorder of the urinary tract that occurs due to obstructed urinary flow). Record review of Resident #114's Significant Change MDS, dated [DATE], revealed a Brief Interview of Mental Status score of 00, indicating she had no response to any questions, had no speech, and had an indwelling catheter. Observation on 07/11/23 at 09:42 a.m., in Resident #114's room, call light was noted on the floor on the right side of Resident #114's bed and urinary catheter bag was not in a privacy cover. Observation on 07/11/23 at 09:48 a.m., CNA A did not use hand sanitizer after picking up the call light on the floor. CNA A then walked out the door. In an interview on 07/14/23 at 02:44 p.m., the DON stated when staff touches a resident or their items, they need to wash their hands before leaving the room. DON said not washing their hands could cause cross contamination. In an interview on 07/14/23 at 06:29 p.m., CNA B stated after touching a resident's items like call light or catheter bag, everyone should wash their hands before leaving the room. CNA stated washing your hands before leaving the room helps prevent cross contamination. In an interview on 07/14/23 at 06:40 p.m., ADON D stated after touching items in the resident's room, you wash your hands. ADON D stated if you did not wash your hands, it would be cross contamination and an infection control. Review of the Handwashing/Hand Hygiene Policy Revised August 2015 revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 14 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 Policy Statement Level of Harm - Minimal harm or potential for actual harm This facility considers hand hygiene the primary means to prevent the spread of infections. Residents Affected - Few 1.All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections. 7.Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: b. Before and after direct contact with residents; l. After contact with objects (e.g., medical equipment) in the immediate vicinity of the resident . 2 Record review of Resident #66's Face Sheet dated 07/17/23 documented a [AGE] year-old female admitted on [DATE] with diagnoses including Alzheimer's dementia, high blood pressure, high cholesterol, difficulty swallowing, and stroke. A record review of Resident #66's MDS dated [DATE] documented a BIMS of 99, indicating she had no response to any questions. Observation of Resident #66 on 07/11/23 at 02:34 pm revealed she could not move or speak. CNAs C and D were in the process of changing Resident #66's soiled brief. Both CNAs had gloves on. CNA C swiped Resident #66's front peri area, twice, from front to back, utilizing new wipes each time. The CNAs turned Resident #66 to her right side. CNA D removed the soiled brief and swiped from front to back x2 with new wipes each time. The wipes were not removed from the container prior to beginning peri care. The CNAs positioned Resident #66 to her left side and CNA D placed a clean brief on Resident #66. Both CNAs removed their gloves into a trash can. CNA C washed her hands for less than 30 seconds. CNA D washed her hands for more than 30 seconds. CNA C put on clean gloves after placing the container of wipes on the patient's shelf. CNA D put on gloves and the two CNAs removed Resident #66's top and placed a clean gown on Resident #66, as well as offloaded her heels. Neither CNA changed gloves nor used hand sanitizer prior to repositioning Resident #66, nor before touching the new, clean brief. 3. Record review of Resident #100's Face Sheet documented an [AGE] year-old female admitted on [DATE] with diagnoses including heart failure, a-fib, diabetes, high blood pressure, kidney disease and failure, reflux, failure to thrive, anxiety, dementia, depression, Alzheimer's, high cholesterol, and suicide attempts. A record review of Resident #100's MDS dated [DATE] documented a BIMS of 14, indicating she was cognitively intact. Observation of Resident #100 on 07/11/23 at 02:58 pm revealed LVN B turned off tube feeds so CNAs C and D could change Resident #100's soiled brief. Both CNAs did not wash their hands prior to putting gloves on. CNA C swiped Resident #100's front peri area, twice, from top to bottom, utilizing new wipes each time while CNA D held the resident in position on her left side. The CNAs turned Resident #100 to her right side. CNA D removed the soiled brief and swiped from front to back x2 with new wipes each time. The wipes were not removed from the container prior to beginning peri care. The CNAs positioned Resident #100 back to her left side and CNA D placed a clean brief on Resident #100. CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 15 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few C put on clean gloves after placing the container of wipes on the patient's shelf. Both CNAs removed their gloves into a trash can. CNA C washed her hands for less than 30 seconds. CNA D washed her hands for more than 30 seconds. Neither CNA changed gloves nor used hand sanitizer prior to repositioning Resident #100, nor before touching the new, clean brief. Interview with CNA C on 07/14/23 at 04:02 pm stated, I know I messed up as soon as I touched Resident #66. She stated she should have washed her hands before leaving the room and should have changed gloves after cleaning the resident, use ABHR then put on new gloves. She stated she had ABHR in her pocket at the time. CNA C stated, It was important to change our gloves because they are contaminated, and the resident could get sick and pick up whatever we had on our gloves. She stated she just got nervous. She stated she got training at the CNA course 2 years ago and here, they got checked off she thought two months ago, but she wasn't sure. Interviews with the DON and the ADON on 07/14/23 at 04:11 pm, they stated that CNAs were trained via annual competencies, and also infection control via in-services and return demonstrations, but neither could say when the last training was. They stated when they did rounds, they watched the CNAs providing care and made sure they were providing privacy, putting trash in the trash can, not the floor, washing their hands, and changing their gloves. They stated changing gloves properly and hand washing was important because if it was not being done it could cause infection. The DON stated, she tells them (staff) when they remove dirty, their gloves are dirty, and they need to throw them (in the trash). Record review of the facility policy, Handwashing/Hand Hygiene revised 08/2015 documented in the statement, This facility considers hand hygiene the primary means to prevent the spread of infections .2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors .7. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap and water for the following situations: b. Before and after direct contact with residents g. Before handling clean or soiled dressings, gauze pads, etc. h. Before moving from a contaminated body site to a clean body site during resident care. i. After contact with a resident's intact skin j. After contact with blood or bodily fluids m. After removing gloves . Applying and Removing Gloves 1. Perform hand hygiene before applying non-sterile gloves. Record review of the facility policy, Infection Control, Standard Precautions revised 2011 . Policy Interpretations and Implementation: 1. Hand washing . b. Wash hands immediately after gloves are removed, between resident contacts, and when otherwise indicated to avoid transfer of microorganisms to other residents or environments. Wash hands between tasks and procedures on the same resident to prevent cross-contamination of different body sites . 2. Gloves .c. Change gloves between tasks and procedures on the same resident after contact with material that may contain a high concentration of microorganisms. D. Remove gloves after use, before touching non-contaminated items and environmental surfaces, and before going to another resident. Wash hands to avoid transfer of microorganisms to other residents or environments. Record review of In-services: 06/15/23 and 07/13/23 Hand Washing, 07/10/23 Caring for patients with C-Diff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 16 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0926 Have policies on smoking. 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 follow their established smoking policy regarding smoking safety for 2 of 6 residents reviewed for safe smoking. (Resident #1 Resident #30) Residents Affected - Few 1. Resident #1 had a package of cigarettes in his shirt pocket and a lighter. 2. Resident #30 was smoking unsupervised. These failures could place the residents with exit seeking behaviors at risk for injury or death and could place residents at risk for smoking-related injuries. Findings were: 1. Record review of Resident #1's Face Sheet dated 03/29/23 documented a [AGE] year-old male with diagnoses including diabetes, diabetic ulcer of the left foot, high blood pressure, COPD, congestive heart failure, muscle weakness, obstructive sleep apnea, a-fib, depression, morbid obesity, and osteomyelitis (bone infection). Resident #1's MDS dated [DATE] documented a BIMS of 13, indicating he was cognitively intact. Further, Resident #1's level of assistance with Activities of Daily Living (ADLs) of walking in his room or corridor, eating, and toilet use at a supervised level with set-up help only. Bed mobility, transfers, locomotion on the unit, and personal hygiene at a level of limited assistance with one person's physical assistance. Locomotion off the unit and dressing at a level of extensive assistance with one person's physical assistance. A record review of Resident #1's Care Plan dated 03/31/23 had no information about his smoking. A record review of Resident #1's Smoking assessment dated [DATE] documented under AA. he preferred cigarettes, A. his short-term memory, long-term memory, recall, and decision-making were intact, he was alert and oriented and consistently performed safe smoking techniques, B. he had no vision or hearing deficits, his communication was effective, and he could understand others, C. his smoking ability documented he had fine motor skills to securely handle the smoking device, he could light his own cigarette and had adequate posture to safely smoke. D1. Documented he did not use oxygen, could tolerate smoking without oxygen, and could smoke safely. E. he had no safe smoking needs, and E. 1., d able to smoke independently, was not checked off, F. Smoking Plan of care included I am a cigarette smoker, I am able to light/hold my own cigarette, conduct safety checks as needed, related to smoking materials and ensuring the safety and well-being of others, explain safe smoking procedures, such as the assessment, schedule, and safe storage, provide a reasonable routine smoking schedule, smoking materials at the nurse's station in a designated area, and smoking of any type should take place in the designated areas to smoke and educate the resident as indicated to this assigned area for safety. Record review of the facility Smoking Guidelines-Residents revised 05/11/12 documented .A smoking assessment shall be completed on admission and updated quarterly and more frequently as deemed necessary .Resident smoking materials shall be turned in to the charge nurse. No resident shall be allowed to keep cigarette lighters, matches, or smoking materials in any other area than the nursing station . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 17 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0926 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. A record review of resident #30's Face sheet dated 05/05/17 and the re-admission date of 05/11/23 documented an [AGE] year-old male with diagnoses including diabetes, reflux, kidney disease, stroke, cataracts, hearing loss, high blood pressure, depression, insomnia, hemiplegia on the right dominant side (paralysis on one side of the body, usually after a stroke) and muscle wasting. A record review of Resident #30's MDS dated [DATE] documented a BIMS of 10, indicating moderate cognitive impairment. Further, the resident's level with ADLs of bed mobility, transfers, and toilet use was at an independent level with one-person physical assistance. Dressing and personal hygiene were at a level of extensive assistance with one-person physical assistance. A record review of Resident #30's Care Plan initiated and revised on 05/11/23, documented a focus area of I have a hearing problem that may affect my ability to understand others due to a diagnosis of conductive hearing loss to both ears and interventions that included, speak to me in an appropriate tone; avoid talking too fast or too loud and remember to face me when talking to me. An additional focus area was initiated and revised on 05/11/23 I am a smoker I prefer to smoke cigarettes with the goal of I will smoke safely and will not experience any harm/injury related to my choice to smoke. Interventions initiated on 05/11/23 included, I am able to light/hold my own cigarette, conduct safety checks as needed, related to smoking materials, and ensuring the safety and well-being of others, explain safe smoking procedures, such as the assessment, schedule and safe storage, provide a reasonable, routine smoking schedule, and safe smoking assessments/evaluation to be completed as indicated. A record review of Resident #30's most current smoking assessment dated [DATE] documented under A. his short-term memory, long-term memory, recall, and decision-making was intact, he was alert and oriented, and consistently performed safe smoking techniques, B. he had no vision or hearing deficits with or without aid, his communication was effective, and he could understand others, C. his smoking ability documented he had fine motor skills to securely handle the smoking device, he could not light his own cigarette, he was balanced while sitting or standing, and had a total range of motion of both arms and legs. D. he smoked 2-5 cigarettes a day and liked to smoke in the morning, afternoon, and evening. D1 1. He was able to communicate why oxygen must always be shut off prior to lighting a cigarette, 2. the risks associated with smoking, 3. Held lighter securely and safely without bringing flame close to face, 4. The resident smokes safely; remains alert and aware, does not fall asleep, endangers self or others, burns furniture, skin, clothing, or others. Turns off oxygen prior to lighting cigarettes and smoked in designated areas. 5. Used ashtray safely and properly 6. Able to extinguish cigarettes safely and completely when finished. E. Safety; assistance level independent. Observation and interview with Resident #1 on 07/11/23 at 11:32 am revealed he had an open pack of cigarettes in his left shirt pocket. He stated he carried his own lighter. He stated he smoked 4-6 cigarettes a day, there was a schedule, but he could go whenever he wanted to, and no one had to go with him. Resident #1 stated, he Used to get his cigarettes and lighter from the nurses at the nurse's station. I asked them if I could have my own for convenience to me and them. Resident #1 stated, They said I could have them as long as I didn't burn anything down, then laughed and stated, I would never do anything like that. Resident #1 could not identify which nurse allowed him to have his own cigarettes and lighter. Observation and interview with Resident #30 on 07/14/23 at 10:45 am he stated he got his cigarettes and lighter from the nurse at the nurse's station and returned them when he was finished smoking. He stated usually, no one came with him to smoke. Resident #30 was sitting outside in a designated smoking area by himself. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 18 of 19 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 676063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alfredo Gonzalez Texas State Veterans Home 301 E Yuma Ave McAllen, 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 0926 Level of Harm - Minimal harm or potential for actual harm Observation of the locked box in a med cart in the nurse's station on the memory care unit and interview with RN-A on 07/14/23 at 11:08 am, RN-A stated the process for residents to smoke was for them to collect their smoking materials at the nurse's station and a staff or family member would take the lighter and light the residents' cigarettes. RN-A stated he was unsure of the smoking times, and only one or two residents in the memory care unit smoked. Residents Affected - Few An interview with LVN-A on 07/14/23 at 11:18 am stated Resident #1's cigarettes were in the locked med cart's locked drawer. LVN-A stated Resident #1 gave them to the nurse last night. LVN-A stated she was not sure who the nurse was. LVN-A was not sure of the smoking times and thought it was posted somewhere. Interview with Resident #1 on 07/14/23 at 11:28 am stated he turned in his lighter and cigarettes last night because he wanted to be monitored with his smoking and for staff to only give him one at a time, otherwise, he would smoke two, and he wanted to cut down. A review of an undated list of residents who smoke provided by the facility on 07/12/23 revealed five residents in the facility that smoked cigarettes. Record review of the facility Smoking Guidelines-Residents revised 05/11/12 documented .A smoking assessment shall be completed on admission and updated quarterly and more frequently as deemed necessary .Resident smoking materials shall be turned in to the charge nurse. No resident shall be allowed to keep cigarette lighters, matches, or smoking materials in any other area than the nursing station . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676063 If continuation sheet Page 19 of 19