Inspection·August 31, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was documented twice. Record review of Resident #1's skin/wound note, dated 08/18/25 at 6:08 PM, written by the Treatment Nurse, stated Resident has necrosis (Death of most or all of the cells in an organ or tissue due to disease, injury or failure of the blood supply) to right hand, bilateral feet, and amputation to left hand 3rd, 4th, and 5th digits. [Wound care MD] gave treatment orders. Sx (surgical) site has 12 sutures in place site cleansed with generic wound cleanser, dry with gauze, apply xeroform, cover with dry dressing, secure with tape. Extremities with necrosis, cleanse with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze secure with tape. Resident tolerated treatment well, no complaints of pain or discomfort. Record review of Resident #1's skin assessments, with an effective date of 08/18/25, reflected Resident #1 had arterial wounds to his left dorsum foot, right dorsum foot, left plantar foot, right plantar foot, right palm, right dorsum hand and surgical wound with 12 sutures to left plantar 3rd digit - amputation site, all were marked as present on admission. Record review of Resident #1's order summary report reflected he had no treatment orders for his identified skin impairments when admitted on [DATE] until 08/19/25, which include the following: 1. Cleanse arterial to left dorsum foot with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. as needed for soiled/disloged [SIC] with an order and start date of 08/19/25.2. Cleanse arterial to left dorsum foot with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. one time a day for arterial with an order date of 08/19/25 and a start date of 08/20/25.3. Cleanse arterial to left plantar foot with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. as needed for soiled/dislodged with an order and start date of 08/19/25.4. Cleanse arterial to left plantar foot with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. One time a day for arterial with an order date of 08/19/25 and start date of 08/20/25.5. Cleanse arterial to right dorsum foot with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. as needed for soiled/dislodged with an order and start date of 08/19/25.6. Cleanse arterial to right dorsum foot with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. One time a day for arterial with an order date of 08/19/25 and start date of 08/20/25.7. Cleanse arterial to right plantar foot with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. as needed for soiled/dislodged with an order and start date of 08/19/25.8. Cleanse arterial to right plantar foot with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. One time a day for arterial with an order date of 08/19/25 and start date of 08/20/25.9. Cleanse arterial to right dorsum hand with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. as needed for soiled/dislodged with an order and start date of 08/19/25.10. Cleanse arterial to right dorsum hand with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. One time a day for arterial with an order date of 08/19/25 and start date of 08/20/25.11. Cleanse arterial to right palm with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. as needed for soiled/dislodged with an order and start date of 08/19/25.12. Cleanse arterial to right palm with generic wound cleanser, dry with gauze, apply betadine cast, wrap with rolled gauze, secure with tape. One time a day for arterial with an order date of 08/19/25 and start date of 08/20/25.13. Cleanse left hand amputation of 3rd, 4th, and 5th finger sx (surgical) incision with generic wound cleanser, dry with 4x4 gauze, apply xeroform, cover with dry gauze, secure with tape. as needed for soiled/dislodged with an order and start date of 08/19/25.14. Cleanse left hand amputation of 3rd, 4th, and 5th finger sx (surgical) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676083 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 676083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownsville Nursing and Rehabilitation Center 320 Lorenaly Dr Brownsville, TX 78520 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few incision with generic wound cleanser, dry with 4x4 gauze, apply xeroform, cover with dry gauze, secure with tape. One time a day for amputation sx (surgical) incision with an order date of 08/19/25 and start date of 08/20/25. Record review of Resident #1's August Treatment Administration Record (TAR) reflected Resident #1 was first provided his ordered treatment on 08/19/25. During an interview with Resident #1 on 08/31/25 at 3:15 PM, he stated he did not recall the exact date he most recently came back to the facility from the hospital but stated he knew he arrived in the evening and stated the following day was a weekend and he had not received his wound care for those 2 days. The resident stated someone told him it was because the wound care nurse only worked Monday through Friday. Resident #1 stated he received his wound care on the Monday (08/18/25) after he returned to the facility. Resident #1 stated he did not experience any negative impact or outcomes due to not receiving wound care over the weekend for 2 days. During an interview and record review with LVN A on 08/31/25 at 4:00 PM, he stated he was the admitting nurse for Resident #1 on 08/15/25. LVN A stated Resident #1 had gangrene to bilateral hands and feet and some amputation to his left hand and stated he identified this on his initial nursing assessment. LVN A stated he was given wound care orders for Resident #1 over the phone when he received admission report from the hospital. LVN A stated he verified the orders with the PA but did not recall if he discussed his findings with the PA. LVN A stated he did not discuss wound care orders for Resident #1 with the PA. LVN A stated he should have discussed wound care orders with the PA. LVN A reviewed Resident #1's chart and stated he did not see any wound care orders he had put in at admission on [DATE] and he probably forgot. LVN A stated he was trained over verification of orders and inputting orders and he was trained during his orientation in June 2025. LVN A stated their policy and procedure was to get the hospital paperwork and send to the provider and asked if there were any changes they would make and continue with their orders. LVN A stated the order should be input into the system and he was responsible for inputting the order on 08/15/25 for Resident #1. LVN A stated he followed the policy and procedures in this situation. LVN A stated we were not sure but thought the ADONs reviewed the resident charts the following day to ensure residents had the correct orders in place. LVN A stated a resident who did not have wound care orders in place and did not receive wound care and could have a negative outcome of infection. During an interview with RN B on 08/31/25 at 4:45 PM, she stated she was the weekend supervisor on 08/16/25 and 08/17/25. RN B stated it was her responsibility to review new admission charts to ensure they had the appropriate orders. RN B stated she recalled reviewing Resident #1's chart and had just reviewed it again at that time and she did not see any betadine order on Resident #1's chart for 08/16/25 or 08/17/25. RN B stated she saw LVN A's note regarding wound care but did not see any orders for wound care. RN B stated she did not like to go into the chart and put in orders specifically related to treatment because that was the wound care nurses responsibility. RN B stated she spoke to LVN C, who was the wound care nurse on the weekend of 08/16/15 and stated she spoke to him about seeing Resident #1 and she assumed he would see him and put in the related orders. RN B stated it was her responsibility to get clarification on any orders in question and she should have followed up with the provider. RN B stated LVN A should have put in the wound care orders because it's the admitting nurse's responsibility to do so and anything that was in question could have been let in a queue to be confirmed at a later date or report could have been given to the following nurse to get clarification. RN B stated she was trained over reviewing orders, ensuring all the correct orders were input and contacting the MD for any clarification. RN B stated she was recently trained in early August. RN B stated she reviewed Friday admission on Saturday and Saturday admissions on Sunday and on Monday the entire leadership staff would also review all of the admissions as a double check after her. RN B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676083 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 676083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownsville Nursing and Rehabilitation Center 320 Lorenaly Dr Brownsville, TX 78520 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated she felt like she followed her facility policy and procedure in this situation. RN B stated not having wound care orders and not having wound care could negatively impact residents by causing worsening or deteriorating wounds. RN B stated Resident #1 had no deterioration to his wounds that she knew of. Attempted interview on 08/31/25 at 5:05 PM, 5:15 PM and 5:16 PM with LVN C, who was the wound care nurse on 08/16/25 and 08/17/25, were unsuccessful. Voicemails were left with each call, however no communication with LVN C was made. During an interview with the DON on 08/31//25 at 6:55 PM, he stated when a resident was admitted to the facility the nurse should get report from the hospital and ask about any orders or treatment they had and wait for the accompanying orders that came with the resident and then verify those orders and any reports provided by the hospital with the physician. After verification, the nurse should then input the orders. The DON stated the charge nurse who admitted the resident was responsible for ensuring orders were clarified with the provider and input into their chart. The DON stated LVN A was responsible for verification and input of the orders for Resident #1 and RN B, who was the weekend supervisor, was also responsible for reviewing the orders and chart to ensure the appropriate orders were in place for treatment and LVN C who was the wound care nurse should have also verified. The DON stated during the weekday, he, the ADONs and the Treatment nurse were responsible for ensuring the orders were clarified and input into resident charts. The DON stated as far as he knew LVN A did verify the orders with a provider. The DON stated he reviewed Resident #1's chart and saw LVN A documented a progress note regarding wound care orders but it was not under his physician orders. The DON stated these orders should have been input by LVN A and according to LVN A he forgot to put them in. The DON stated was not able to get a hold of LVN C who was the wound care nurse on the weekend on 08/16/25 to see if he provided Resident #1 wound care on 08/16/25 and 08/17/25. The DON stated it was his understanding now that Resident #1 had not received wound care on those 2 days. The DON stated he spoke to Resident #1 who stated he did not get wound on the day in question. The DON stated RN B should have gotten clarification on Resident #1's wound care orders and he did not know why RN B did not get clarification on the orders and RN B told him she told LVN C to make sure to check on Resident #1. The DON stated as per their policy any time they got a physician order they had to input the order and had to verify all orders. The DON stated staff had not followed this policy and LVN A, RN B and LVN C had been trained multiple times over getting clarification for orders and inputting the orders by himself, the ADONs and their Regional. The DON stated Resident #1 went without wound care for 2 days. The DON stated the negative impact if inputting orders and not getting wound care would depend on the wound, the order and the extent of the wound and Resident #1 had no negative outcome or deterioration. During an interview with the Wound Care Physician on 08/31/25 at 7:37 PM, he stated Resident #1 would not have any negative outcome for not having wound care for a weekend on 08/16/25 and 08/17/25. The Wound Care Physician stated the treatment was just to maintain the areas of necrosis as dry and contained as possible. The Wound Care Physician stated no intervention would has been able to resolve his case and Resident #1 had severe peripheral artery disease (condition were plaque narrows arteries reducing blood flow to the arms, legs and abdomen). The Wound Care Physician stated the plan for Resident #1 was to at some point have more amputations. The Wound Care Physician stated he was following Resident #1 at the nursing home and would continue to see him when he returned to the hospital. The Wound Care Physician stated the orders on 08/15/25 were to continue the same treatment from the hospital which was betadine. The Wound Care Physician stated the order should have been sent from the hospital but sometimes orders got lost. The Wound Care Physician stated he thought he told them the orders verbally on the day of discharge from the hospital but did recall who he spoke to.,Record review of the facility's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676083 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 676083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownsville Nursing and Rehabilitation Center 320 Lorenaly Dr Brownsville, TX 78520 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Inservice training report dated 07/01/25, revealed LVN A, RN B and LVN C were trained on charge nurse must follow the admission process and can use admission binder at nurses station to input an confirm orders for all residents from new admissions to new order for PCP which included but not limited to phone services. Record review of the facility's policy, with an implementation date of 04/10/23, and titled Medication Reconciliation included section titled, Policy Explanation and Compliance Guidelines: which stated, .4. admission Processes:Verify resident identifiers on the information received.Compare orders to hospital records, etc. Obtain clarification orders as needed.Transcribe orders in accordance with procedures for admission orders.Order medications from pharmacy in accordance with facility procedures for ordering medications.Verify medications received match the medication orders.5. Daily Processes:a. Address any clinically significant medication irregularities reported by pharmacy consultant.Verify medication labels match physician orders and consider rights of medication administration each time a medication is given.Obtain and transcribe any new orders in accordance with facility procedures. Obtain clarification as needed.Order medications from pharmacy in accordance with facility procedures for ordering medications.Verify medications received match the medication orders. During an interview with ADON D on 08/31/25 at 8:31pm he stated they did not have a policy related to wounds. Event ID: Facility ID: 676083 If continuation sheet Page 5 of 5