Health inspection·March 14, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some well as pull her up because she was wet. Resident #8 also stated she was told by CNA X to just ring the bell once, we cannot continue to come in here. Resident #8 also relayed that she had woken up wet and CNA X was pissed and told her Now I have to change the whole bed. Resident #8 also relayed to the DON that when CNA X came in the room to address her roommate (unknown), she used vulgar language. The DON asked Resident #8 if she knew CNA X and Resident #8 told her she was a heavy set hispanic female with very short, white hair. The DON asked if Resident #8 felt afraid and Resident #8 stated stated she was afraid of CNA X but did not want her in the room with her ever again. Resident #8 stated she was not afraid that CNA X would come in and hurt her, but she felt she may retaliate.The undated resolution of the grievance was: Employee has been terminated from her employment. Resident is satisfied with solution. Record review of Resident Abuse Interviews dated 02/27/24 revealed 2 other residents having problems with CNA X.: Record review of Resident #22's admission record revealed a [AGE] year-old female admitted on [DATE]. Her diagnoses included diabetes, kidney failure, high blood pressure, stroke, and need for assistance with personal care. Record review of Resident #22's MDS dated [DATE] indicated a BIMS of 7 (moderate cognitive impairment), had no mood disorders or behaviors, was weak on one side due to the stroke, and was dependent on staff for toileting and lower body dressing. Resident #22 required partial/moderate assistance with mobility, standing, and transferring. Record review of Resident #22's care plan dated 02/16/24 had a focus of ADL self-care performance deficit r/t debility and weakness with interventions including total assist with bed mobility, bathing/showering, turning and repositioning in bed, personal hygiene and oral care, and toileting. Resident #22 required a mechanical lift for transfers and encourage to use bell to call for assistance. Another focus was at risk for falls r/t decreased safety awareness and weakness. Interventions included anticipate and meet the resident's needs, call light within reach and encourage to use it for assistance as needed, the resident needs prompt response to all requests for assistance. Another focus was bladder prolapse, urinary incontinence with interventions including, provide peri care after each incontinent episode dated 02/16/24. Record review of Resident Abuse Interviews dated 02/27/24 revealed Resident #22 wrote that she told CNA X she needed to be changed and CNA X told her she was busy and would come back but never did. She rang again and CNA X came in, turned the light off and left without saying anything. Resident #23 wrote that she activated her call light because she needed to be changed and the CNA with really short white hair came in and said she was busy and would return but never did. She called again, the same lady came in, turned the light off and left without saying anything. Record review of Resident #23's admission record revealed a [AGE] year-old female admitted on [DATE]. Her diagnoses included diabetes, ESRD (end stage renal disease), dialysis dependent, high blood pressure, right leg below-the-knee amputation, and need for assistance with personal care. Record review of Resident #23's MDS dated [DATE] indicated a BIMS of 15 (no cognitive impairment), had no mood disorders or behaviors, and was dependent on staff for toileting and showering. Resident #23 required partial/moderate assistance with dressing and oral care, and substantial/maximal assistance with transferring. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #23's care plan dated 02/02/24 had a focus of ADL self-care performance deficit r/t amputation of the right leg with interventions including moderate assist with bed mobility, bathing/showering, turning and repositioning in bed, personal hygiene and oral care, and toileting and encouraged to use bell to call for assistance. Another focus was at risk for falls r/t amputation. Interventions included anticipate and meet the resident's needs, call light within reach and encourage to use it for assistance as needed, the resident needs prompt response to all requests for assistance. Another focus was bowel incontinence with interventions including provide peri care after each incontinent episode dated 02/02/24. Record review of Resident Abuse Interviews dated 02/27/24 revealed Resident #23 wrote she activated her call light because she needed to be changed and the CNA with really short white hair came in and said she was busy and would return but never did. She called again, the same lady came in, turned the light off and left without saying anything. During an interview with the DON on 03/14/24 at 9:27 am stated CNA X was suspended then terminated. The DON stated CNA X was pulled immediately from the floor and suspended and CNA X never returned after the suspension. The DON stated CNA X told her she wasn't the only CNA working on 02/26/24, but Resident #8 described her. The DON stated CNA X said she would put it (her side of the story) in writing but never did. The DON stated CNA X had other write-ups about her attitude, so they were going to term her, but she quit instead. The DON stated Resident #8 was with it and she believed her. The DON stated Resident #8 said she could use the restroom but required assistance due to fear of falling and was weak. The DON stated Resident #8 described CNA X as a heavy-set Hispanic with very short white hair, she was not afraid of her, but never wanted her in her room again and felt she may retaliate. The DON stated Resident #8 discharged home with no home health on 03/10/24. Observation and interview with Resident #22 on 03/14/24 at 9:35 am stated she remembered a CNA with short white hair wouldn't change her sometimes. Resident #22 stated she could not recall how many times or when, but it was not too long ago. She stated she felt safe at the facility now because she had not seen that person in a long time. Resident #22 stated she remembered because she felt humilitated. Interviews beginning on 03/12/24 at 1:40 pm through 03/14/24 with the AD, CNA A, LVN A, CNA B, SW, and DON all identified the ADM as the Abuse coordinator, were able to identify all types of abuse and verbalized mandatory reporting of abuse was within 2 hours. Record review of CNA X's personnel file revealed: Senate [NAME] 9 Statement dated 06/03/21 containing CNA X's signature. Remember our policy that all residents of this nursing facility are to be treated with dignity and respect at all times under all circumstances. Mistreatment or abuse of any Nature will not be tolerated. Any employee guilty of abusing a resident is subject to immediate discharge. Local authorities will be notified immediately, and criminal charges may be filed against any employee guilty of abuse. I understand the criminal liability and sign this policy and explanation after having the forgoing provisions fully explained to me. On 02/29/24, CNA X received an employee counseling report for a level 3 offense that included dishonest, disrespectful or threatening behavior toward a resident and neglect of the care of residents. The Performance Improvement Plan was: Employee suspended x3 days pending investigations. After 3 days and at the end of investigations, employee terminated from her duties. Record review of CNA X's personnel file revealed: One on one in-service dated 09/29/22 for excessive absences on 7/16, 7/18, 7/19, 8/9, 8/10, 8/11, 9/8, 9/14, and 9/20. The return demonstration was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the employee will be at work for her scheduled shifts for the next 30 days. The document contained CNA X's signature. One on one in-service dated 09/20/23 for excessive absences and call-ins on 9/4 2-10 and 10-6 shift,9/15 2-10 and 10-6 shift, and 9/16 2-10 and 10-6 shift. The return demonstration was the employee will be at work for her scheduled shifts for the next 30 days. One on one in-service dated 11/20/23 for reporting allegations of abuse timely-for any allegation of abuse that you learn of you must report immediately. The document contained CNA X's signature. One on one in-service dated 01/10/24 for attitude and customer service. The return demonstration was the employee will be courteous and respectful to resident's and families. When families request assistance, employee will provide without attitude or poor body language. The document contained CNA X's signature. Record review of the facility policy, Abuse, Neglect, and Exploitation dated 08/15/22: Policy: It is the policy of this facility to provide protections for the health, welfare, and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, xploitation and mispprporiation of resident property. Abuse .abuse includes the deprivation by an indivdual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being . Neglect means failure of the facility, its employees, or service providers to provide goods and services to a resident taht are necessary to avoid physical harm, pain, mental anguish, or emotional distress. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 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 676107 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 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 0727 Level of Harm - Minimal harm or potential for actual harm Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 4 of 74 days reviewed for RN coverage. Residents Affected - Some The facility failed to ensure they had an RN on duty on Sunday, 02/11/24, Sunday, 02/25/24, Saturday, 03/09/24, and Sunday, 03/10/24. This failure could place residents at risk of missed nursing assessments, interventions, and treatment. Findings included: Review of RN staffing for all shifts dated 01/01/24-03/14/24 revealed zero hours worked by an RN on Sunday, 02/11/24, Sunday, 02/25/24, Saturday, 03/09/24, and Sunday, 03/10/24. During an interview with the DON on 03/14/24 at 8:20 am she stated every building had staffing problems, the nurses and herself were working the floors. They were constantly recruiting and hiring, but they (the hires) may come in for one day and never show up again or just never show up at all. The DON stated staffing, recruiting, and retention was also part of their QAPI plan-HR was the lead. The DON stated the facility had recruiting activities and corporate would come in to help with that. The DON stated, We are not short every shift. After reviewing the schedules, the DON stated there was no RN on the shifts mentioned. The DON stated she checked the time sheets. The DON stated she was not sure how that happened. The DON stated not having an RN on duty could possibly affect the care and assessments of the residents, as well as the rest of the staff if they needed an RN's expertise. The DON did not provide a policy on staffing. During an interview with the ADM on 03/14/24 at 3:20 pm he stated he was unaware of not having RN coverage daily. The ADM stated the facility was supposed to have RN coverage every day. The ADM stated daily RN coverage was important because the RN was the resource, especially on weekends. The ADM stated he would speak with the DON. A policy on the requirement for RN coveraage was requested but not provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676107 If continuation sheet Page 5 of 5