Health inspection·February 27, 2026

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Note: The nursing home is disputing this citation. Orders handwritten on it and what looked to be initials or a signature. Record review of Resident #1's progress notes written by ADON C, dated [DATE], reflected .Resident bmp CBC and phenytoin labs reviewed by NP NNO given at this time. Record review of Resident #1's Medication Regimen Review, dated [DATE], reflected .Routine lab monitoring.order Dilantin oral capsule 100 mg (phenytoin sodium extended) give 2 capsules by mouth one time a day for seizures. Order date [DATE]. Level 5.6 on [DATE], 23.4 on [DATE] (reference range 10.0 to 20.0 ug/ml). Recommendation: Dose was decreased from 250 mg to 200 mg after the elevated level but is now low can we redraw and if still off adjust dose? . Physician Response Section: (the box was checked next to the following statement) I agree with this recommendation.physician signature present and dated [DATE]. Record review of Resident #1's order summary report, printed [DATE], reflected .Phenytoin | CBC w/Auto Diff | Basic Metabolic Panel ** SCHEDULED [DATE]; Auto-Send [DATE] 2:00 AM ** one time only Phone Active order date [DATE], start date [DATE]. Record review of Resident #1's progress notes between [DATE] and [DATE] did not reveal any other documentation related to this hospitalization and lab value. No documentation of any signs or symptoms of seizures. Record review of Resident #1's medication administration record for February 2026 reflected .Dilantin Oral Capsule 100 MG (Phenytoin Sodium Extended) Give 2 capsule by mouth one time a day for Seizures. There was a check mark showing the medication was given February 1st through February 23rd of 2026. Record review of Resident #1's progress notes written by LVN D, dated [DATE], reflected .Transfer notification.Resident #1 was transferred to a hospital on [DATE] 12:00 AM related to Screaming in severe pain. Record review or Resident #1's hospital records, printed [DATE], reflected [DATE] - ED to Hosp-admission (Current).Chief complaint Altered Mental Status.Hospital Problems.Status epilepticus.epilepsy.History.anoxic brain injury seizures apparently noncompliant with his Dilantin (phenytoin) checked out to me to load with Dilantin DC back to group home.Medical Decision Making.with seizures and apparent noncompliance with Dilantin as level was undetectable loaded with Dilantin here patient had another seizure gave Ativan (acute seizure medication). Diagnoses.subtherapeutic serum Dilantin level.his Dilantin level was low very low.positive for seizures.labs phenytoin less than 1.8. During an observation on [DATE] at 10:30 a.m., Resident #1 was at the hospital in his bed. An attempt to interview was made, but he was not interviewable and continued to fall asleep off and on. During an interview with FM #1 on [DATE] at 10:40 a.m., she stated the hospital neurologist told her he can't be taken off medications like that in that way. The hospitalization was all caused by the decrease in his medication. This was preventable. She stated he seemed to be doing better and was no longer having seizures. During an interview with FM #2 on [DATE] at 11:27 a.m., she stated the neurologist said this was preventable. She said the phenytoin levels were too low, critical level in December. She stated he was sent out in the middle of the night screaming. The ER said his levels were less than 1.8. She stated he hadn't had a seizure in 12 years. She stated she was told when he had these kinds of seizures brain cells died and did damage to his heart. She stated his phenytoin level was 5.6 in December, and they did nothing at that point. During an interview with the DON on [DATE] at 1:01 p.m., she stated Resident #1's [DATE] labs had 23.4 for his phenytoin level. MD B decreased his dosage from 250 mg to 200 mg in [DATE] and increased lab draws from every three months to every two months. She stated the next set of labs had a level of 5.6 and that was low. The NP reviewed the labs and gave no new orders. She stated it was a little behind because of the holidays. During an interview with the NP on [DATE] at 1:41 p.m., she stated I am at a loss I don't know what happened. I looked yesterday when I heard about it. She was unable to recall everything exactly. She stated she knew she signed it, but she missed it somehow. She stated if she had caught it, for labs sensitive like that, normally she would ask for a replacement lab that day. By that time, the lab (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676108 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 676108 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vidor Health & Rehabilitation Center 470 Moore Dr Vidor, TX 77662 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Note: The nursing home is disputing this citation. value was two weeks old. Then adjust medications and redraw them two weeks later. She stated with his history of seizures and his levels being low like that, she definitely would have ordered to redraw labs. She stated the seizures could have been prevented. During an interview with MD B on [DATE] at 2:36 p.m., he stated he lowered the dosage due to a critically high phenytoin level. He stated he did not decrease it that much. He changed phenytoin from 250 mg to 200 mg which is 1/3 of the dosage and he stated it should have minimal change. He increased lab draws from every three months to every two months. He stated, The first recheck was 5 something. He stated it was on the low side. It should be somewhere around 10. He stated the NP missed the lab; he was not sure how that happened. MD B stated the seizures could have any other cause such as stress or a urinary tract infection. He did not recall if he was notified about this specific lab value. He stated the levels could be off due to timing of the labs. He stated there was no reason to do anything else at the time because there were no symptoms. He stated he wouldn't just chase the numbers. During an interview on [DATE] at 3:19 p.m., ADON C stated when the NP came to the building, she rounded at that time. She pulled all the labs that have not been reviewed. She stated she did not specifically look at each lab herself. She printed them and gave them to the NP. The NP read through them while she was standing there, signed them, and gave them back to her. ADON C documented any orders or if there were no orders in the EHR, then the signed labs were given to medical records to be scanned and uploaded into the EHR. This was part of the normal lab practice for all the labs that came into the entire facility. During an interview on [DATE] at 3:26 p.m., LVN D stated she notified the NP of the lab results. She did not confirm or deny that she informed the NP specifically about the phenytoin level. She stated she knew she would notify the doctor if any lab values were off. She stated she received a text back, no new orders from the NP. She stated she knew she put in the progress notes that she contacted the NP regarding the labs. During an interview on [DATE] at 9:15 a.m., the DON stated the lab value was low, not critical. The DON stated the NP was contacted twice regarding the labs. The Administrator was present during this interview, she added the NP was contacted twice, what else are we supposed to do? The Administrator asked, Isn't it the NP's responsibility to let the doctor know? She stated, the NP was under his license, so she should do that. The DON stated it was beyond the nurse's scope to question the NP's response. She stated we followed the orders, drew the labs, and contacted the NP and followed her recommendations. She stated she would not answer any other questions until she contacted her VP. An attempt to interview the hospital neurologist on [DATE] at 9:26 a.m. was made, no return call was received. During an interview on [DATE] at 1:08 p.m., MD F stated the phenytoin lab was at 5.6, which is low, it can change quickly. He stated all doctors should probably schedule labs monthly if they are changing something (like medication dosages) or if the lab value was changing rapidly, the labs should be drawn weekly. He stated, oh no, can't make changes based off old labs. He stated new labs should have been done, before changes to the medications were made, lab draws should be within a couple days. He stated the lab values were subtherapeutic, you can't say for sure. (it caused seizures) but it didn't help. The DON was emailed regarding a related lab policy on [DATE], she replied at 1:30 p.m., there was no specific policy for labs, they followed the doctor's orders. Review of the facility's policy, Notifying the Physician of Changes in Status, no date, reflected The nurse should not hesitate to contact the physician at any time when an assessment and their professional judgment deem it necessary for immediate medical attention. This facility utilizes the INTERACT tool, Change in Condition - When to Notify the MD/NP/PA to review resident conditions and guide the nurse when to notify the physician. This tool informs the nurse if the resident condition requires immediate notification of the physician or non-immediate/Report on Next Work day notification of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676108 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 676108 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vidor Health & Rehabilitation Center 470 Moore Dr Vidor, TX 77662 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Note: The nursing home is disputing this citation. physician. 1. The nurse will notify the physician or their delegated nurse practitioner or physician assistant with change in status. The nurse will document signs and symptoms of significant change, time/date of callto physician, and interventions that were implemented in the resident's clinical record. 2. Before the physician is contacted, the nurse will gather and organize resident information. Applicable information will include current medications, vital signs, signs and symptoms initiating call, current laboratory information, and interventions that have currently been implemented.4. If the physician does not return the call within a reasonable amount of time, the nurse will attempt to contact the physician a second time. If the situation is an emergency, and the physician does not callback within a reasonable amount of time, the nurse will contact the Medical Director or the nearest ambulance service for assistance. The nurse will document all attempts to contact the physician in the resident's clinical record.11. Abnormal lab, x-ray and other diagnostic reports require physician notification. An IJ was identified on [DATE]. The Administrator and the DON were notified of the IJ on [DATE] at 11:20 a.m. and a plan of removal to remove the immediacy was requested at that time. Review of the facility's Plan of Removal, dated [DATE], reflected the following: Date: 2.26.26Plan of Removal: F684 - Quality of CareThe facility failed to follow up after notifying the NP twice regarding Resident #1's phenytoin lab value of 5.6 on [DATE] and no intervention or assessments were put in place.Interventions:Resident #1 was transferred to the hospital on [DATE] for treatment of status epilepticus and subtherapeutic Dilantin level. The resident remains in the hospital as of 2.26.26. On 2.26.26 DON, ADON, or Designee completed a 100% audit of: anticonvulsant to ensure therapeutic lab values. Any abnormal findings will be communicated to the Attending Physician. Completed 2.26.26. One abnormal lab on resident, provider notified, awaiting for any new orders. Resident has no s/s of symptoms of seizures. The DON and ADON were in-serviced 1:1 by the Regional Compliance Nurse on the following in-services. Completed 2.26.26.Provider notification of abnormal labs values to include the NP, MD, and Medical Director. The charge nurse will notify the provider and document communication and orders.Documentation of provider notification for changes of condition including changes in condition as a result of abnormal lab values.Escalation: when the charge nurse notices that the NP doesn't address non-therapeutic labs values, then the nurse will call the attending physician. if the attending physician doesn't address non-therapeutic labs values, then the charge nurse will call the medical director.Abuse and neglect- Failure to intervene on abnormal lab values could be considered neglect. The Medical Director was notified of the Immediate Jeopardy on 2.26.26 by the DON. An ADHOC QAPI meeting was completed by the interdisciplinary team to include the Medical Director on 2.26.26 In-services:The following in-services were initiated on [DATE] for all charge nurses by the DON, ADON, and/or Regional Compliance Nurse in person and/or via phone. All staff not present for in-servicing will not be permitted to work their assignment until in-serviced. All new hires will be in-serviced during facility orientation. All agency staff will be in-serviced prior to working their floor assignment. Completed [DATE].Provider notification of abnormal labs values to include the NP, MD, and Medical Director. The charge nurse will notify the provider and document communication and orders.Documentation of provider notification for changes of condition including changes in condition as a result of abnormal lab values.Escalation: when the charge nurse notices that the NP doesn't address non-therapeutic labs values, then the nurse will call the attending physician. if the attending physician doesn't address non-therapeutic labs values, then the charge nurse will call the medical director.Abuse and neglect- Failure to intervene on abnormal lab values could be considered neglect. On [DATE] the facility wide anti-convulsant audit was reviewed, the documentation of Resident #2's follow up to their abnormal lab was reviewed, and the in-service documentation for the ADON, DON, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676108 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 676108 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vidor Health & Rehabilitation Center 470 Moore Dr Vidor, TX 77662 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete and all staff were reviewed. Any in-services that have not bee completed, will be done before their next shift. On [DATE] individual staff interviews were conducted with LVN A, ADON C, RN G, LVN H, LVN I, LVN J, LVN K, LVN L, LVN M, and LVN N from 9:15 a.m. to 12:00 p.m. Staff represented all three shifts including weekends and PRN staff. Staff were asked to describe the training they had received. All employees interviewed were able to correctly answer questions and described all types of lab results that would be reported to the DON, MD, and family. On [DATE] at 12:00 p.m. the Administrator was informed the IJ was removed. While the IJ was removed the facility remained out of compliance at a severity level of no actual harm that was not Immediate Jeopardy with a scope of isolated due to the facility continuing to monitor to ensure the implementation and effectiveness of their plan of removal. Event ID: Facility ID: 676108 If continuation sheet Page 5 of 5