Health inspection·January 8, 2024

F 0635 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few altered cardiovascular status r/t Hypertension, CAD, AFIB. Goal: Resident #3 will be free from complications of cardiac problems through the review date. Assess for chest pain every (specify). Enforce the need to call for assistance is pain. Assess for shortness of breath and cyanosis (bluish or grayish color of skin, nails, lips or around the eyes) every (specify) Medications as ordered by MD for Hypertension and AFIB. Monitor/document/report PRN any changes in lung sounds on auscultation (i.e. crackles), edema and changes in weight. Monitor/document/report PRN any s/sx of CAD: chest pain or pressure especially with activity, heartburn, nausea and vomiting, shortness of breath, excessive sweating, dependent edema, changes in capillary refill, color/warmth of extremities. Record review of Resident #3's hospital discharge medication reconciliation list dated 11/16/2023 at 3:24PM, [hospital] discharged Resident #3 with a finalized Discharge Medication list that documented to continue Hydralazine 50mg Q8hr, Metoprolol tartrate 50mg Q12hr, Isosorbide dinitrate 20mg daily and Nifedipine 20mg Q8hr Record review of Resident #3's physician orders documented: From 11/16/2023-11/24/2023, none of the listed medications were reordered. -Isosorbide Dinitrate 20mg tablet PO for heart failure state date: 11/07/2023 d/c date:11/15/2023 -Nifedipine ER 30mg tablet PO Daily state date: 11/13/2023 d/c date: 11/15/2023 -Metoprolol tartrate 50mg tablet Q12hr for hypertension start date: 11/06/2023 d/c date: 11/15/2023. -Hydralazine HCL 50mg tablet PO Q8hr for hypertension start date: 11/07/2023 d/c date: 11/15/2023. Record review of Resident #3's blood pressure on: 11/16/2023 No blood pressure reading available. 11/17/2023 at 12:47AM: 160/81, 7:17PM: 180/75 11/18/2023 at 1:56AM 173/80, 12:37PM:172/85, 7:53PM 169/84 11/19/2023 at 2:02AM:155/80, 1:42PM 150/78 Record review of Resident #3's progress note dated 11/23/2023 at 9:14PM, LVN C documented patient complained of chest pain she was given one sublingual tablet of nitroglycerin (used to treat chest pain) that was effective. Record review of Resident #3's progress note dated 11/24/2023 at 7:55PM, LVN D documented received call from dialysis sending resident to [hospital] emergency room diagnosis atrial fibrillation. Called RP made aware and DON. Record review of Resident #3's progress note dated 11/28/2023, ADON B documented notified by case manager at hospital that resident's family member had concerns over whether BP meds were given while resident was in facility, conducted a review of admission orders and determined medication reconciliation had inconsistencies. Medication reconciliation completed with inconsistencies. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 2 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 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 0635 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of Resident #3's [hospital] discharge report on 11/24/2023 Resident #3 was admitted to [hospital] for NSTEMI type 2 (heart attack), Atrial fibrillation (irregular often rapid heart rate), encephalopathy (a brain disease that alters the brain's function), severe hyperkalemia (high potassium level), normocytic anemia (codition in which blood does not have enough red blood cells). Resident #3 was discharged from [hospital] on 11/30/2023. During an observation and interview on 01/05/2024 at 2:01PM, Resident #3 was ambulating within her room. Resident #3 stated she was preparing to leave for her appointment to a dialysis center. Resident #3 stated she recalled while she was at her dialysis session on 11/24/2023, she began to feel a pain in her chest, and notified the staff at the dialysis center. Resident #3 stated the pain she felt was not unusual and felt like the chest pains she usually got. Resident #3 stated she recalled being hospitalized on [DATE] for heart issues but does not recall the specifics of her hospitalization. Resident #3 stated she felt fine and did not verbalize any concerns. During an interview on 01/06/2024 at 12:29PM the NP stated she was not made aware by the nursing facility of Resident #3's lack of cardiac medications during the period of 11/16/2023-11/24/2023 but was notified by the facility later of Resident #3's hospitalization on 11/24/2023. The NP stated the medication reconciliation process when a resident is being admitted is for the receiving facility staff member to notify either the NP, Doctor, or on-call physician, and verify which orders to continue. The NP stated she could not recall going over medication reconciliation for Resident #3 but did recall Resident #3 had a history of cardiac issues. The NP stated she oversees many residents and relies on staff personnel to advocate on a resident's behalf. The NP stated Metoprolol is used for blood pressure and atrial fibrillation, and without proper management could affect a resident's well-being detrimentally, especially if the resident does not receive proper management which would include medication administration. The NP stated she does not recall reconciling medication for Resident #3 upon her admittance into the nursing facility on 11/16/2023 and stated she would expect the nursing facility to do their due diligence and ensure and advocate for the well-being of all residents within their care. The NP stated the usual process for medication reconciliation is during the admission/readmission process nurses will call either her, the Doctor, or on-call physician, and review all hospital orders and whilst on the phone the medical professional will verbalize to either continue/discontinue the nursing facility or hospital orders. The NP stated she was under the impression that either the DON or ADONs would follow up on orders however was not fully knowledgeable of the process of order follow ups. The NP stated the process for acquiring orders is identical to medication reconciliation, the nurses will call either her, the Doctor, or on-call physician and advocate/request orders. The NP stated during the period of 11/16/2023-11/24/2023 she was not contacted for new or continuing orders regarding cardiac medications for Resident #3. The NP stated this instance regarding Resident #3's lack of cardiac medication management/administration may have been her oversight during medication reconciliation on Resident #3's readmittance on 11/16/2023, but stated her expectation is for the facility to follow up and ensure accuracy/advocacy for each resident and stated this was overlooked by the facility. The NP stated Resident #3's hospitalization on 11/24/2023 could potentially have been caused by Resident #3 not receiving her cardiac medications for 8 days and stated Resident #3 could have exhibited signs of uncontrolled atrial fibrillation like chest pains, or palpitation as well as signs of high blood pressure which would be indicative within vital sign results. The NP stated atrial fibrillation could potentially have led to blood clots which would negatively affect any resident's health. During an interview on 01/06/2024 at 12:53PM, LVN C (Charge Nurse) stated she has worked with Resident #3 consistently prior to 11/16/2023. LVN C stated she cared for Resident #3 during the period of 11/16/202311/24/2023 and recalled some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 3 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 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 0635 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few of Resident #3 diagnosis history. LVN C stated she was the admitting nurse for Resident #3 on 11/16/2023. LVN C stated she recalled receiving the hospital's medication reconciliation list for Resident #3 and does recall notifying an on-call physician of Resident #3's arrival into the facility on [DATE]. LVN C stated on 11/16/2023, while speaking to the unknown on-call physician, she advocated for the on-call physician to continue Resident #3's Nitroglycerin sublingual tablet due to Resident #3's history of chest pain. LVN C stated she failed to advocate for a continuation of Resident #3's additional cardiac medication admission orders due to her not seeing page 2 of Resident #3's hospital's discharge medication reconciliation form dated 11/16/2023. LVN C stated she takes some responsibility for the mistake, however to her knowledge, no other shift (day/evening/night) from 11/16/2023-11/24/2023, made any inquiry to advocate for Resident #3's medications. LVN C stated Resident #3 went without her cardiac medications for 8 days. LVN C stated she should have been more diligent while going through the hospital medication reconciliation list, however stated it is not just her fault, but the fault of the facility for not doing double checks. LVN C stated when she held an ADON position previously within the facility, she would perform double checks for all admitting/readmitting resident. LVN C stated double checks are when once the admitting nurse uploads the physician's orders upon any admission/readmission, she would follow up the following day to ensure accuracy and verification of all orders. LVN C stated since she withdrew herself from the ADON position, no one has maintained the continuation of the order accuracy/verification process. LVN C stated she does not want to throw anyone under the bus but felt the facility also failed Resident #3 due to not double-checking orders, and stated had the facility double checked orders, the medication error would have been caught. LVN C stated Metoprolol is important for management of blood pressure and used to increase the strength and contractility of the heart's beat, as well as assist with rhythmic abnormalities like atrial fibrillation, and is a very important to the well-being of Resident #3. LVN C stated Hydralazine also assists with the management of blood pressure and is a very important medication because Resident #3 has a history of high blood pressure. LVN C stated if Resident #3's blood pressure was not managed Resident #3 could potentially have a stroke and worst-case scenario could be fatal. LVN C stated collectively as a care team, should have ensured all of Resident #3's medications orders were accurate and active, as well as taken the time to update oneself on the Resident #3's hospitalization as well as advocate for residents in general when a nurse notices irregularities in physician orders. LVN C stated she did not recall noticing any irregularities on Resident 3's orders, but wishes she was more diligent during the admitting medication reconciliation process and stated Resident #3's hospitalization potentially could have been avoided. LVN C stated a sign of uncontrolled atrial fibrillation could be chest pain and recalled on 11/23/2023 notifying the on-call physician of Resident #3's complaint of chest pain, but does not recall who she spoke to, however does recall the physician instructed her to maintain a three pill protocol (administer 1 nitroglycerin pill, assess after 5 minutes, if chest pain persists, administer another nitroglycerin pill, wait assess after 5minutes, if chest pain persists, administer 1 more nitroglycerin pill, after the third pill send out to EMS) state after she administered Resident #3's first nitroglycerin tablet, Resident #3 verbalized no additional concerns for chest pain. LVN C stated she was in-serviced on medication reconciliation, medication error/transcription error process, notification to medical director for verification/clarification of medications upon admission/readmission, as well as correctly verbalized her directive to ensure any admission/readmission of any resident is secondly notified to the ADONs. During an interview on 01/06/2024 at 1:54PM, LVN D stated she has been taking care of Resident #3 for at least a year. LVN D stated the process when admitting/readmitting a resident is to perform a head-to-toe (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 4 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 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 0635 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few assessment, vital signs, verify medications with the doctor and ask if they want to continue medications, as well as interact and learn as much history from the resident. LVN D stated she recalled Resident #3 began dialysis recently, as well as had a history of hypertension, early dementia, and diabetes. LVN D stated she recalled Resident #3 had cardiac issues as well as a history of stroke or heart attack and recalled Resident #3's heart was not in good condition. LVN D stated a generalized statement that during Resident #3's several hospitalizations, the hospitals would administration many medications and stated the hospitals did not think about the long-term effects for Resident #3. LVN D stated she theorized that even if Resident #3 was given the cardiac medications during the 8-day period between 11/16/2023-11/24/2023, the outcome of hospitalization, would have been the same due to Resident #3's cardiac issues. LVN D stated chest pain could have been indicative of cardiac issues. LVN D stated the process of medication reconciliation is for the admitting nurse to verify with the doctor/NP which orders they want for each resident. LVN D stated the process to attain orders is the same as medication reconciliation, the nurse will call the Doctor/NP to acquire orders. LVN D stated she wished and should have advocated for Resident #3 cardiac medications. LVN D stated she did not call Doctor or NP for cardiac medication orders for Resident #3 during those 8 days because she believed all medication reconciliation orders for Resident #3 had been taken care of and did not think much about it because she believed all orders had been taken care of. LVN D stated she felt terrible that the lack of advocacy for Resident #3 results in Resident #3's hospitalization. LVN D stated everyone at the facility was at fault for not advocating for Resident #3, and stated this medication error could have been caught, and should have been caught, but was not. LVN D stated this failure could have jeopardized the well-being and health of Resident #3. LVN D stated she attended multiple in-services on 11/28/2023 and 11/29/2023, and correctly verbalized the process for medication reconciliation/ medication error/transcriptions, as well as verbalized her directive to notify ADONs as part of a double check, of all admission/readmissions of residents to ensure accuracy of all physician orders. During an interview on 01/08/2024 at 10:47AM, ADON A stated the admission/readmission process is for the admitting nurse to verify orders with doctor and confirm what orders the physician wants to maintain or implement. ADON A stated during the admitting/readmitting verification process the nurse will ensure accuracy of specific order parameters and should be diligent and thorough when reviewing the medication reconciliation with MD. ADON A stated prior to Resident #3's 11/16/2023 medication reconciliation incident, she was unaware of ADONs tasked to check/verify medication reconciliation admission/readmission orders. ADON A stated she does not recall being notified of any medication irregularities regarding Resident #3 during 11/16/2023-11/24/2023. ADON A stated the expectation of the facility is for all nurses to do their due diligence and double check all orders especially when confirming hospital orders with physicians. ADON A stated on 11/16/2023, LVN C may have reviewed Resident #3's medication reconciliation with physician quickly which could have led to LVN C overlooking page 2 on Resident #3's hospital's 11/16/2023 medication reconciliation form. ADON A stated LVN C should have taken her time and thoroughly reviewed each page with the MD, which could have potentially eliminated Resident #3's 11/24/2023 hospitalization. ADON A stated if Resident #3's atrial fibrillation was uncontrolled, Resident #3's well-being could have jeopardized, due to the lack of rhythmic medication management, which potentially could have been fatal. ADON A stated similarly, if Resident #3's blood pressure was high and uncontrolled by medication management, the well-being of Resident #3 could have been negatively impacted. ADON A stated she attended several in-services on 11/28/2023 and 11/29/2023 and verbalized the correct procedures of her role to thoroughly verify all physician orders upon admission/readmission within a 24hr period. During an interview on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 5 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 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 0635 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 01/08/2024 at 11:15AM, MA A stated he knew Resident #3 well. MA A stated he recalled Resident #3 had taken scheduled oral cardiac medications prior to 11/16/2023. MA A stated one thing that he recognized on 11/17/2023 was that Resident #3's blood pressure medications were not on Resident #3's MAR and recalled inquiring to LVN C about Resident #3's cardiac medications. MA A stated LVN C stated Resident #3 was newly on dialysis and that would assist with Resident #3's blood pressure issue but gave no definitive answer if Resident #3 would resume/begin with any blood pressure medications, and believed LVN C would follow up on MA A's concern. MA A stated from work experience did not believe dialysis would solely fix the problem for Resident #3's blood pressure but was confident that LVN C would advocate for Resident #3. MA A stated he still took Resident #3's blood pressure vital signs during 11/17/2023-11/24/2023. MA A stated the following day on 11/18/2023, he notified RN A about Resident #3's high blood pressure readings, and that RN A stated she would give Resident #3 Clonidine PRN. MA A stated he asked/notified RN A about his concern, that Resident #3 did not have her previous blood pressure medications on the MAR but was not given a definitive answer on how to proceed. MA A stated he notified LVN D of Resident #3's blood pressure reading on 11/19/2023 but again was not given a definitive answer. MA A stated he felt within those 3 days LVN C, LVN D, and RN A did not hear/act upon his concern. MA A stated he continued to take Resident #3's blood pressure even though Resident #3 was not receiving blood pressure medications, as his attempt to advocate for Resident #3. MA A stated he takes pride in his work because resident lives are in staff's hands. MA A stated when speaking to the three nurses he did not feel heard, and that staff cannot pick and choose what parts of care to do and not do. MA A stated he did not believe the facility neglected Resident #3. MA A stated he attended in-services on 11/28/2023 and 11/29/2023, and correctly verbalized the procedures of notifying licensed nurse, charge nurse, ADON, or DON with any concerns or discrepancies regarding medications. During an interview on 01/08/2024 at 11:53AM, RN A stated on 11/17/2023, during the day shift, she reviewed Resident #3 hospitalization record dated 11/16/2023, as well as reviewed Resident #3's medication reconciliation form also dated 11/16/2023. RN A stated on 11/17/2023, she noticed several discrepancies regarding Resident #3's blood pressure medications while she was comparing Resident #3's facility chart to the hospital medication reconciliation form. RN A stated she noticed that Resident #3's blood pressure medications were not active in the Resident #3's MAR. RN A stated once she realized the discrepancies, she took the concern to ADONs. RN A stated the ADONs told her that the medications would have to be reviewed and confirmed by the admitting nurse and MD. RN A stated originally, she assumed the ADONs would verify and solve the issue, and stated she did not want to call and clarify/bother the admitting nurse. RN A stated she could have called the MD and wishes she did now. RN A stated she was knowledgeable of the process to attain physician orders, but did not attempt to contact the MD, NP, or on-call physician because she believed the ADONs would take care of Resident #3's blood pressure medication issue. RN A stated she should have advocated for continuation of cardiac medications for Resident #3 and wishes she did. RN A stated Resident #3 was under her care on 11/17/2023 and 11/18/2023 but was never notified of any staff regarding blood pressure abnormalities for Resident #3. RN A stated if high blood pressure is not managed properly, high blood pressure could lead to heart attack, stroke, as well as if high blood pressure is uncontrolled, it could have affected Resident #3 in a negative way, and worst-case scenario be fatal. RN A stated she attended several in-services on 11/28/2023 and 11/29/2023, and correctly verbalized the procedures regarding medication error/transcription error, medication reconciliation and order entries for admission/readmission, clarification of medication and for any concerns or discrepancies of medication and must notify DON and immediately call the MD in charge of resident to clarify. RN A stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 6 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 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 0635 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few within the in-services on 11/28/2023 and 11/29/2023, she was directed to notify ADONs of any admission/readmissions and the ADONs are tasked to follow up and verify. During an interview on 01/08/2024 at 1:13PM, the interim DON stated she has been positioned at the facility for the past three weeks and was not present during the incident regarding Resident #3's failed medication reconciliation post hospitalization of 11/16/2023. The interim DON stated she did familiar herself with the 11/28/2023 in-service regarding medication reconciliation and stated the facility's expectation for medication reconciliation process, is that ADONs are to verify reconciled medications and ensure accuracy during daily clinical morning meetings. During the daily morning clinical meetings, the managerial team will review all new admission/readmissions that happened 24 hours prior. The interim DON stated blood pressure medications are important to the well-being of any resident experiencing high blood pressure. The interim DON stated if blood pressure is not managed properly, blood pressure can increase and lead to stroke. The interim DON stated in worst-case scenario blood pressure can lead to stroke, which can then be fatal. The interim stated she was briefed about the incident regarding Resident #3 and was told that the clinical nursing staff did not realize that Resident #3 was without cardiac medications. The interim DON stated it is the expectation that post the initial medication reconciliation, ADONs are verifying orders 24hr after admission/readmissions to ensure accuracy and verification of all physician orders. The interim DON stated the nursing staff (day/evening/night shift) during the 8-day period of 11/16/2023-11/24/2023, should have reviewed Resident #3's chart/orders/hospitalization record to familiarize themselves with the most updated plan of care, and in doing so may have uncovered the medication discrepancy which potentially could have kept Resident #3 from being hospitalized . The interim DON stated had the nursing staff realized the medication discrepancy, they should have advocated for cardiac medications for Resident #3. Prior to entrance on 01/04/2024, the facility conducted the following training: Record review of the facility's 11/28/2023 Inservice: Medication Error/Transcription Error: All Medication errors identified must notify MD, DON immediately. Record review of the facility's 11/28/2023 Inservice: Notification to MD/ verification/clarification of Meds upon admit/re-admit: Return from ER med and document upon any admission/readmit all medications and orders to be verified by Dr. if NP on call Dr. and correctly entered into PCC Nurses to document on any D/C or readmit time where admit/d/c to and notify DON. Record review of the facility's 11/28/2023 Inservice: Medication reconciliation and order entry for admission/readmission from ER. Nurses to ensure all medications and orders upon admit/readmit have been checked with Doctor/FNP/On-call Drs. And correctly entered into PCC. Record review of the facility's 11/29/2023 Inservice Clarification of medications: For any concerns or discrepancies of medications, licensed nurse must notify DON and immediately call the MD in charge of resident to clarify. Record review of the facility's 11/29/2023 Inservice: Medication Review (orders): 1. Review resident orders or admission/readmission/ER (emergency room) visits during the morning clinical meeting to ensure orders are transcribed correctly. 2. New orders will be reviewed in the morning clinical meeting by the DON to ensure orders are written correctly. Observation of medication pass beginning on 01/08/2024 at 9:34AM of Resident's #4 and #5 revealed no identified concerns. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 7 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 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 0635 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of the facility's Medication Reconciliation policy and procedure dated 04/10/2023 revealed, this facility reconciles medication frequently throughout a resident's stay to ensure that the resident is free of any significant medication errors, and that the facility's medication error rate is less than 5 percent. 4. admission process b. Compare orders to hospital records, etc. Obtain clarification order as needed. c. Transcribe orders in accordance with procedures for admission orders. e. Verify medications received match the medication orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 8 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to ensure residents were free of any significant medication errors for 1 (Resident #3) of11 residents reviewed for pharmacy services, in that:. Residents Affected - Some LVN C failed to accurately reconcile Resident #3's heart medications of: Hydralazine 50mg Q8hr, Metoprolol 50mg Q12hr, Isosorbide dinitrate 20mg daily, or Nifedipine 20mg Q8hr was not acquired and administered from 11/16/2023-11/24/2023 (8days). Resident #3 was admitted to the hospital from dialysis with diagnoses including NSTEMI type 2 (heart attack), Atrial fibrillation. The noncompliance was identified as PNC. The IJ began on 11/16/23 and ended on 11/28/23. The facility had corrected the noncompliance before the survey began. This deficient practice could place residents who receive blood pressure/heart medications at an increased risk for complications such as decreased blood pressure, decrease pulse, an exacerbation of symptoms and disease process, and potential hospitalization. Findings include: Record review of Resident #3's face sheet dated 01/05/2024 documented an [AGE] year-old female with a diagnosis of hyperlipidemia (high cholesterol), hypertension (high blood pressure), atherosclerotic heart disease (damage or disease in the heart's major blood vessels), atrial fibrillation (irregular heart rhythm), chronic kidney disease (kidney damage), transient ischemic attack (stroke, mini stroke) and cerebral infarction (stroke). Record review of Resident #3's MDS dated [DATE] documented Resident #3's BIMS score of 12/15 indicating moderate cognitive impairment, as well as coded Resident #3 with atrial fibrillation or other dysrhythmias (abnormality in the rhythm in the activity of the brain or the heart), coronary artery disease (damange or disease in the heart's major blood vessels), hypertension (high blood pressure), and renal insufficiency/renal failure or end-stage renal disease. Record review of Resident #3's care plan date initiated on 08/02/2023 documented, Resident #3 has HAD transient ischemic attacks (TIA)(stroke) r/t Atrial fibrillation. Goal: Resident #3 will be free from s/sx of complications r/t TIA through the review date. Interventions: Address resident by name, introduce self and explain what you are going to do with each interaction. Educate resident/family/caregivers about the importance of seeking medical consultation to determine cause of TIA even though the symptoms resolve in order to prevent potential problems such as major stroke. Monitor for and document any s/sx of ineffective cerebral perfusion: Altered mental status, Dysphasia (inability to produce or understand spoken language), pupil changes, abnormal speech patterns or aphasia, weakness or paralysis of an extremity, behavioral changes, any changes in motor responses. Record review of Resident #3's care plan date initiated on 08/02/2023 documented, Resident #3 has altered cardiovascular status r/t Hypertension, CAD, AFIB. Goal: Resident #3 will be free from complications of cardiac problems through the review date. Assess for chest pain every (specify). Enforce the need to call for assistance is pain. Assess for shortness of breath and cyanosis (bluish or grayish color of skin, nails, lips or around the eyes) every (specify) Medications as ordered by MD for Hypertension and AFIB. Monitor/document/report PRN any changes in lung sounds on auscultation (i.e. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 9 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some crackles), edema and changes in weight. Monitor/document/report PRN any s/sx of CAD: chest pain or pressure especially with activity, heartburn, nausea and vomiting, shortness of breath, excessive sweating, dependent edema, changes in capillary refill, color/warmth of extremities. Record review of Resident #3's hospital discharge medication reconciliation list dated 11/16/2023 at 3:24PM, [hospital] discharged Resident #3 with a finalized Discharge Medication list that documented to continue Hydralazine 50mg Q8hr, Metoprolol tartrate 50mg Q12hr, Isosorbide dinitrate 20mg daily and Nifedipine 20mg Q8hr Record review of Resident #3's physician orders documented: From 11/16/2023-11/24/2023, none of the listed medications were reordered. -Isosorbide Dinitrate 20mg tablet PO for heart failure state date: 11/07/2023 d/c date:11/15/2023 -Nifedipine ER 30mg tablet PO Daily state date: 11/13/2023 d/c date: 11/15/2023 -Metoprolol tartrate 50mg tablet Q12hr for hypertension start date: 11/06/2023 d/c date: 11/15/2023. -Hydralazine HCL 50mg tablet PO Q8hr for hypertension start date: 11/07/2023 d/c date: 11/15/2023. Record review of Resident #3's blood pressure on: 11/16/2023 No blood pressure reading available. 11/17/2023 at 12:47AM: 160/81, 7:17PM: 180/75 11/18/2023 at 1:56AM 173/80, 12:37PM:172/85, 7:53PM 169/84 11/19/2023 at 2:02AM:155/80, 1:42PM 150/78 Record review of Resident #3's progress note dated 11/23/2023 at 9:14PM, LVN C documented patient complained of chest pain she was given one sublingual tablet of nitroglycerin that was effective. Record review of Resident #3's progress note dated 11/24/2023 at 7:55PM, LVN D documented received call from dialysis sending resident to [hospital] emergency room diagnosis atrial fibrillation. Called RP made aware and DON. Record review of Resident #3's progress note dated 11/28/2023, ADON B documented notified by case manager at hospital that resident's family member had concerns over whether BP meds were given while resident was in facility, conducted a review of admission orders and determined medication reconciliation had inconsistencies. Medication reconciliation completed with inconsistencies. Record review of Resident #3's [hospital] discharge report on 11/24/2023 Resident #3 was admitted to [hospital] for NSTEMI type 2 (heart attack), Atrial fibrillation (irregular often rapid heart rate), encephalopathy (a brain disease that alters the brain's function), severe hyperkalemia (high potassium level), normocytic anemia (codition in which blood does not have enough red blood cells). Resident #3 was discharged from [hospital] on 11/30/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 10 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an observation and interview on 01/05/2024 at 2:01PM, Resident #3 was ambulating within her room. Resident #3 stated she was preparing to leave for her appointment to a dialysis center. Resident #3 stated she recalled while she was at her dialysis session on 11/24/2023, she began to feel a pain in her chest, and notified the staff at the dialysis center. Resident #3 stated the pain she felt was not unusual and felt like the chest pains she usually got. Resident #3 stated she recalled being hospitalized on [DATE] for heart issues but does not recall the specifics of her hospitalization. Resident #3 stated she felt fine and did not verbalize any concerns. During an interview on 01/06/2024 at 12:29PM the NP stated she was not made aware by the nursing facility of Resident #3's lack of cardiac medications during the period of 11/16/2023-11/24/2023 but was notified by the facility later of Resident #3's hospitalization on 11/24/2023. The NP stated the medication reconciliation process when a resident is being admitted is for the receiving facility staff member to notify either the NP, Doctor, or on-call physician, and verify which orders to continue. The NP stated she could not recall going over medication reconciliation for Resident #3 but did recall Resident #3 had a history of cardiac issues. The NP stated she oversees many residents and relies on staff personnel to advocate on a resident's behalf. The NP stated Metoprolol is used for blood pressure and atrial fibrillation, and without proper management could affect a resident's well-being detrimentally, especially if the resident does not receive proper management which would include medication administration. The NP stated she does not recall reconciling medication for Resident #3 upon her admittance into the nursing facility on 11/16/2023 and stated she would expect the nursing facility to do their due diligence and ensure and advocate for the well-being of all residents within their care. The NP stated the usual process for medication reconciliation is during the admission/readmission process nurses will call either her, the Doctor, or on-call physician, and review all hospital orders and whilst on the phone the medical professional will verbalize to either continue/discontinue the nursing facility or hospital orders. The NP stated she was under the impression that either the DON or ADONs would follow up on orders however was not fully knowledgeable of the process of order follow ups. The NP stated the process for acquiring orders is identical to medication reconciliation, the nurses will call either her, the Doctor, or on-call physician and advocate/request orders. The NP stated during the period of 11/16/2023-11/24/2023 she was not contacted for new or continuing orders regarding cardiac medications for Resident #3. The NP stated this instance regarding Resident #3's lack of cardiac medication management/administration may have been her oversight during medication reconciliation on Resident #3's readmittance on 11/16/2023, but stated her expectation is for the facility to follow up and ensure accuracy/advocacy for each resident and stated this was overlooked by the facility. The NP stated Resident #3's hospitalization on 11/24/2023 could potentially have been caused by Resident #3 not receiving her cardiac medications for 8 days and stated Resident #3 could have exhibited signs of uncontrolled atrial fibrillation like chest pains, or palpitation as well as signs of high blood pressure which would be indicative within vital sign results. The NP stated atrial fibrillation could potentially have led to blood clots which would negatively affect any resident's health. During an interview on 01/06/2024 at 12:53PM, LVN C (Charge Nurse) stated she had worked with Resident #3 consistently prior to 11/16/2023. LVN C stated she cared for Resident #3 during the period of 11/16/202311/24/2023 and recalled some of Resident #3 diagnosis history. LVN C stated she was the admitting nurse for Resident #3 on 11/16/2023. LVN C stated she recalled receiving the hospital's medication reconciliation list for Resident #3 and does recall notifying an on-call physician of Resident #3's arrival into the facility on [DATE]. LVN C stated on 11/16/2023, while speaking to the unknown on-call physician, she advocated for the on-call physician to continue Resident #3's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 11 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Nitroglycerin sublingual tablet due to Resident #3's history of chest pain. LVN C stated she failed to advocate for a continuation of Resident #3's additional cardiac medication admission orders due to her not seeing page 2 of Resident #3's hospital's discharge medication reconciliation form dated 11/16/2023. LVN C stated she takes some responsibility for the mistake, however to her knowledge, no other shift (day/evening/night) from 11/16/2023-11/24/2023, made any inquiry to advocate for Resident #3's medications. LVN C stated Resident #3 went without her cardiac medications for 8 days. LVN C stated she should have been more diligent while going through the hospital medication reconciliation list, however stated it is not just her fault, but the fault of the facility for not doing double checks. LVN C stated when she held an ADON position previously within the facility, she would perform double checks for all admitting/readmitting resident. LVN C stated double checks are when once the admitting nurse uploads the physician's orders upon any admission/readmission, she would follow up the following day to ensure accuracy and verification of all orders. LVN C stated since she withdrew herself from the ADON position, no one has maintained the continuation of the order accuracy/verification process. LVN C stated she does not want to throw anyone under the bus but felt the facility also failed Resident #3 due to not double-checking orders, and stated had the facility double checked orders, the medication error would have been caught. LVN C stated Metoprolol is important for management of blood pressure and used to increase the strength and contractility of the heart's beat, as well as assist with rhythmic abnormalities like atrial fibrillation, and is a very important to the well-being of Resident #3. LVN C stated Hydralazine also assists with the management of blood pressure and is a very important medication because Resident #3 has a history of high blood pressure. LVN C stated if Resident #3's blood pressure was not managed Resident #3 could potentially have a stroke and worst-case scenario could be fatal. LVN C stated collectively as a care team, should have ensured all of Resident #3's medications orders were accurate and active, as well as taken the time to update oneself on the Resident #3's hospitalization as well as advocate for residents in general when a nurse notices irregularities in physician orders. LVN C stated she did not recall noticing any irregularities on Resident 3's orders, but wishes she was more diligent during the admitting medication reconciliation process and stated Resident #3's hospitalization potentially could have been avoided. LVN C stated a sign of uncontrolled atrial fibrillation could be chest pain and recalled on 11/23/2023 notifying the on-call physician of Resident #3's complaint of chest pain, but does not recall who she spoke to, however does recall the physician instructed her to maintain a three pill protocol (administer 1 nitroglycerin pill, assess after 5 minutes, if chest pain persists, administer another nitroglycerin pill, wait assess after 5minutes, if chest pain persists, administer 1 more nitroglycerin pill, after the third pill send out to EMS) state after she administered Resident #3's first nitroglycerin tablet, Resident #3 verbalized no additional concerns for chest pain. LVN C stated she was in-serviced on medication reconciliation, medication error/transcription error process, notification to medical director for verification/clarification of medications upon admission/readmission, as well as correctly verbalized her directive to ensure any admission/readmission of any resident is secondly notified to the ADONs. During an interview on 01/06/2024 at 1:54PM, LVN D stated she had been taking care of Resident #3 for at least a year. LVN D stated the process when admitting/readmitting a resident is to perform a head-to-toe assessment, vital signs, verify medications with the doctor and ask if they want to continue medications, as well as interact and learn as much history from the resident. LVN D stated she recalled Resident #3 began dialysis recently, as well as had a history of hypertension, early dementia, and diabetes. LVN D stated she recalled Resident #3 had cardiac issues as well as a history of stroke or heart attack and recalled Resident #3's heart was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 12 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some in good condition. LVN D stated a generalized statement that during Resident #3's several hospitalizations, the hospitals would administer many medications and stated the hospitals did not think about the long-term effects for Resident #3. LVN D stated she theorized that even if Resident #3 was given the cardiac medications during the 8-day period between 11/16/2023-11/24/2023, the outcome of hospitalization, would have been the same due to Resident #3's cardiac issues. LVN D stated chest pain could have been indicative of cardiac issues. LVN D stated the process of medication reconciliation is for the admitting nurse to verify with the doctor/NP which orders they want for each resident. LVN D stated the process to attain orders is the same as medication reconciliation, the nurse will call the Doctor/NP to acquire orders. LVN D stated she wished and should have advocated for Resident #3 cardiac medications. LVN D stated she did not call Doctor or NP for cardiac medication orders for Resident #3 during those 8 days because she believed all medication reconciliation orders for Resident #3 had been taken care of and did not think much about it because she believed all orders had been taken care of. LVN D stated she felt terrible that the lack of advocacy for Resident #3 results in Resident #3's hospitalization. LVN D stated everyone at the facility was at fault for not advocating for Resident #3, and stated this medication error could have been caught, and should have been caught, but was not. LVN D stated this failure could have jeopardized the well-being and health of Resident #3. LVN D stated she attended multiple in-services on 11/28/2023 and 11/29/2023, and correctly verbalized the process for medication reconciliation/ medication error/transcriptions, as well as verbalized her directive to notify ADONs as part of a double check, of all admission/readmissions of residents to ensure accuracy of all physician orders. During an interview on 01/08/2024 at 10:47AM, ADON A stated the admission/readmission process is for the admitting nurse to verify orders with doctor and confirm what orders the physician wants to maintain or implement. ADON A stated during the admitting/readmitting verification process the nurse will ensure accuracy of specific order parameters and should be diligent and thorough when reviewing the medication reconciliation with MD. ADON A stated prior to Resident #3's 11/16/2023 medication reconciliation incident, she was unaware of ADONs tasked to check/verify medication reconciliation admission/readmission orders. ADON A stated she does not recall being notified of any medication irregularities regarding Resident #3 during 11/16/2023-11/24/2023. ADON A stated the expectation of the facility is for all nurses to do their due diligence and double check all orders especially when confirming hospital orders with physicians. ADON A stated on 11/16/2023, LVN C may have reviewed Resident #3's medication reconciliation with physician quickly which could have led to LVN C overlooking page 2 on Resident #3's hospital's 11/16/2023 medication reconciliation form. ADON A stated LVN C should have taken her time and thoroughly reviewed each page with the MD, which could have potentially eliminated Resident #3's 11/24/2023 hospitalization. ADON A stated if Resident #3's atrial fibrillation was uncontrolled, Resident #3's well-being could have jeopardized, due to the lack of rhythmic medication management, which potentially could have been fatal. ADON A stated similarly, if Resident #3's blood pressure was high and uncontrolled by medication management, the well-being of Resident #3 could have been negatively impacted. ADON A stated she attended several in-services on 11/28/2023 and 11/29/2023 and verbalized the correct procedures of her role to thoroughly verify all physician orders upon admission/readmission within a 24hr period. During an interview on 01/08/2024 at 11:15AM, MA A stated he knew Resident #3 well. MA A stated he recalled Resident #3 had taken scheduled oral cardiac medications prior to 11/16/2023. MA A stated one thing that he recognized on 11/17/2023 was that Resident #3's blood pressure medications were not on Resident #3's MAR and recalled inquiring to LVN C about Resident #3's cardiac medications. MA A stated LVN C stated Resident #3 was newly on dialysis and that would assist with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 13 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Resident #3's blood pressure issue but gave no definitive answer if Resident #3 would resume/begin with any blood pressure medications, and believed LVN C would follow up on MA A's concern. MA A stated from work experience he did not believe dialysis would solely fix the problem for Resident #3's blood pressure but was confident that LVN C would advocate for Resident #3. MA A stated he still took Resident #3's blood pressure vital signs during 11/17/2023-11/24/2023. MA A stated the following day on 11/18/2023, he notified RN A about Resident #3's high blood pressure readings, and that RN A stated she would give Resident #3 Clonidine PRN. MA A stated he asked/notified RN A about his concern, that Resident #3 did not have her previous blood pressure medications on the MAR but was not given a definitive answer on how to proceed. MA A stated he notified LVN D of Resident #3's blood pressure reading on 11/19/2023 but again was not given a definitive answer. MA A stated he felt within those 3 days LVN C, LVN D, and RN A did not hear/act upon his concern. MA A stated he continued to take Resident #3's blood pressure even though Resident #3 was not receiving blood pressure medications, as his attempt to advocate for Resident #3. MA A stated he took pride in his work because resident lives are in staff's hands. MA A stated when speaking to the three nurses he did not feel heard, and that staff cannot pick and choose what parts of care to do and not do. MA A stated he did not believe the facility neglected Resident #3. MA A stated he attended in-services on 11/28/2023 and 11/29/2023, and correctly verbalized the procedures of notifying licensed nurse, charge nurse, ADON, or DON with any concerns or discrepancies regarding medications. During an interview on 01/08/2024 at 11:53AM, RN A stated on 11/17/2023, during the day shift, she reviewed Resident #3 hospitalization record dated 11/16/2023, as well as reviewed Resident #3's medication reconciliation form also dated 11/16/2023. RN A stated on 11/17/2023, she noticed several discrepancies regarding Resident #3's blood pressure medications while she was comparing Resident #3's facility chart to the hospital medication reconciliation form. RN A stated she noticed that Resident #3's blood pressure medications were not active in the Resident #3's MAR. RN A stated once she realized the discrepancies, she took the concern to ADONs. RN A stated the ADONs told her that the medications would have to be reviewed and confirmed by the admitting nurse and MD. RN A stated originally, she assumed the ADONs would verify and solve the issue, and stated she did not want to call and clarify/bother the admitting nurse. RN A stated she could have called the MD and wishes she did now. RN A stated she was knowledgeable of the process to attain physician orders, but did not attempt to contact the MD, NP, or on-call physician because she believed the ADONs would take care of Resident #3's blood pressure medication issue. RN A stated she should have advocated for continuation of cardiac medications for Resident #3 and wishes she did. RN A stated Resident #3 was under her care on 11/17/2023 and 11/18/2023 but was never notified of any staff regarding blood pressure abnormalities for Resident #3. RN A stated if high blood pressure is not managed properly, high blood pressure could lead to heart attack, stroke, as well as if high blood pressure is uncontrolled, it could have affected Resident #3 in a negative way, and worst-case scenario be fatal. RN A stated she attended several in-services on 11/28/2023 and 11/29/2023, and correctly verbalized the procedures regarding medication error/transcription error, medication reconciliation and order entries for admission/readmission, clarification of medication and for any concerns or discrepancies of medication and must notify DON and immediately call the MD in charge of resident to clarify. RN A stated within the in-services on 11/28/2023 and 11/29/2023, she was directed to notify ADONs of any admission/readmissions and the ADONs are tasked to follow up and verify. During an interview on 01/08/2024 at 1:13PM, the interim DON stated she has been positioned at the facility for the past three weeks and was not present during the incident regarding Resident #3's failed medication reconciliation post hospitalization of 11/16/2023. The interim DON stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 14 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some she did familiarize herself with the 11/28/2023 in-service regarding medication reconciliation and stated the facility's expectation for medication reconciliation process, is that ADONs are to verify reconciled medications and ensure accuracy during daily clinical morning meetings. During the daily morning clinical meetings, the managerial team will review all new admission/readmissions that happened 24 hours prior. The interim DON stated blood pressure medications are important to the well-being of any resident experiencing high blood pressure. The interim DON stated if blood pressure is not managed properly, blood pressure can increase and lead to stroke. The interim DON stated in worst-case scenario blood pressure can lead to stroke, which can then be fatal. The interim stated she was briefed about the incident regarding Resident #3 and was told that the clinical nursing staff did not realize that Resident #3 was without cardiac medications. The interim DON stated it is the expectation that post the initial medication reconciliation, ADONs are verifying orders 24hr after admission/readmissions to ensure accuracy and verification of all physician orders. The interim DON stated the nursing staff (day/evening/night shift) during the 8-day period of 11/16/2023-11/24/2023, should have reviewed Resident #3's chart/orders/hospitalization record to familiarize themselves with the most updated plan of care, and in doing so may have uncovered the medication discrepancy which potentially could have kept Resident #3 from being hospitalized . The interim DON stated had the nursing staff realized the medication discrepancy, they should have advocated for cardiac medications for Resident #3. Prior to entrance on 01/04/2024, the facility conducted the following training: Record review of the facility's 11/28/2023 Inservice: Medication Error/Transcription Error: All Medication errors identified must notify MD, DON immediately. Record review of the facility's 11/28/2023 Inservice: Notification to MD/ verification/clarification of Meds upon admit/re-admit: Return from ER med and document upon any admission/readmit all medications and orders to be verified by Dr. if NP on call Dr. and correctly entered into PCC Nurses to document on any D/C or readmit time where admit/d/c to and notify DON. Record review of the facility's 11/28/2023 Inservice: Medication reconciliation and order entry for admission/readmission from ER. Nurses to ensure all medications and orders upon admit/readmit have been checked with Doctor/FNP/On-call Drs. And correctly entered into PCC. Record review of the facility's 11/29/2023 Inservice Clarification of medications: For any concerns or discrepancies of medications, licensed nurse must notify DON and immediately call the MD in charge of resident to clarify. Record review of the facility's 11/29/2023 Inservice: Medication Review (orders): 1. Review resident orders or admission/readmission/ER (emergency room) visits during the morning clinical meeting to ensure orders are transcribed correctly. 2. New orders will be reviewed in the morning clinical meeting by the DON to ensure orders are written correctly. Observation of medication pass beginning on 01/08/2024 at 9:34AM of Resident's #4 and #5 revealed no identified concerns. Record review of the facility's Medication Reconciliation policy and procedure dated 04/10/2023 revealed, this facility reconciles medication frequently throughout a resident's stay to ensure that the resident is free of any significant medication errors, and that the facility's medication error rate is less than 5 percent. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 15 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 4. admission process Level of Harm - Immediate jeopardy to resident health or safety b. Compare orders to hospital records, etc. Obtain clarification order as needed. Residents Affected - Some e. Verify medications received match the medication orders. FORM CMS-2567 (02/99) Previous Versions Obsolete c. Transcribe orders in accordance with procedures for admission orders. Event ID: Facility ID: 676107 If continuation sheet Page 16 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 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 - Some 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. Based on observation, and interview, the facility failed to ensure that drugs and biologicals used in the facility were secured properly for one of two nurse medication carts (Hall 300 nurse medication cart) and one of one wound care treatment carts (Hall 300) reviewed for drug storage. -Nurse medication cart on Hall 300 was left unlocked and unattended. -Wound Care Treatment cart on Hall 300 was left unlocked and unattended. These deficient practices could place residents at risk for harm to unauthorized people and place the facility at risk for possible drug diversion. Findings include: 1.) Observation on 1/5/2024 at 2:36PM revealed an unlocked and unattended medication cart in the 300 hall for approximately 6 minutes. This surveyor opened the top drawer recognizing the cart being unlocked. A variety of multiple medications in bulk bottles and blister packs were easily assessable for removal. Interview on 1/5/2024 at 2:43PM LVN A stated she had become distracted when she went to assist a resident in the bathroom. LVN A stated all medication carts should be locked at all times as residents, staff, visitors, and any unauthorized people could get into the medication cart and have access to medications that do not belong to them. LVN A stated staff are reminded by administration every shift to have medication carts locked when not in use and while she was preparing to administer a medication, she got distracted and forgot to lock the medication cart. Interview on 1/5/2024 at 4:10PM ADON B she usually conducted rounds each shift to make sure all medication carts are locked but did not conduct a round for the current shift. ADON B stated medications carts should be locked at all times due to residents, staff, and family members could get into the medications and could cause a drug diversion. ADON B stated staff are reminded daily per shift to keep medication carts locked and staff are in-serviced on locking medication carts during all staff meetings and monthly reminders. 2.) Observation on 01/05/2024 at 01:17PM. This surveyor observed the 300 hall Wound Care Treatment cart unlocked. Wound Care nurse noted to be in a resident's room performing wound care. This surveyor was able to open multiple drawers and pull out a variety of medications and supplies from the wound care treatment cart. Interview on 01/05/2024 at 01:28PM. While opening wound care treatment cart drawers, this surveyor asked, who oversees this medication cart. Wound Care nurse took ownership of the unlocked wound care treatment cart and stated she was in a resident's room performing wound care and forgot to lock the medication cart. Wound Care nurse stated all carts should be locked at all times when not in use so unauthorize people do not have access to medications and supplies located inside the wound care treatment cart. Wound Care nurse stated she could not remember the last time she was in-serviced on locking carts, but stated, administration is always rounding and making sure medication carts are locked at all times when not in use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 17 of 18 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corpus Christi Nursing and Rehabilitation Center 2735 Airline Rd Corpus Christi, TX 78414 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 Interview on 01/05/2024 at 04:07PM with ADON B, this surveyor asked what the facilities policy on locked wound care treatment carts was and, ADON B stated, all medication and wound care treatment carts are to be locked at all times as per facility protocol when not in use. Record review of the facility's Medication Cart Use and Storage Policy dated 07/15/2022 stated; Residents Affected - Some Guidelines Security 1. The medication cart and its storage bins are kept locked until the specified time of medication administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 18 of 18