Health inspection·July 7, 2022

F 0640 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A for the facility. She said that she began working as the facilities MDS RN A about 2 weeks ago. She said she was the RN who signed the facility MDS' because the DON at the facility did not have the appropriate certification to sign MDS'. When she was shown CR #1's Medicare 5 day MDS dated [DATE] that had her initials, she confirmed those were her initials and that she had been signing the facility MDS' in February of 2022 and had signed that MDS for CR #1. When shown the MDS assessment list for CR #1 she said she also, did not see a discharge MDS and said that CR #1 should have one. She stated Yep, can't argue that it is not there. She said that the previous MDS nurse should have caught that there was no discharge MDS for CR #1, because that was ultimately his job because back in February, she was the Corporate Nurse. She said the Corporate MDS Consultant would have been responsible for oversight of all MDS' at that time. She said that the RAI manual was the policy and procedure they use for the completion of MDS'. Telephone interview with Corporate MDS Consultant on 7/6/22 at 11:49 am who said that with regard to CR #1's discharge MDS assessment, unfortunately we missed it. He said that when he looked at it today and there was no discharge assessment for CR #1 who told MDS RN A to just do one dated for today (7/6/22) because CR #1 was supposed to have one. He said that he was oversight for 7 buildings and that ultimately it was the responsibility of the previous MDS Coordinator at the facility to ensure all MDS' were completed and on time. He said the previous MDS Coordinator left on 6/27/22 and that he had not conducted any audits yet since his departure. He said the facility uses the RAI manual as the policy and procedure for completing MDS'. Record review on 7/6/22 at 2:18pm of CMS Submission Report MDS 3.0 NH Final Validation Report .Submission Date/Time: 07/06/2022 12:58 and had the following warning .Assessment Completed Late:(assessment completion date) is more than 14 days after . (assessment reference date). Record review of CMS's RAI manual version 3.0 dated October 2019 revealed the following: Discharge assessment .MDS Completion Date .No Later Than .discharge date +14 Calendar Days. Transmission Date No Later Than .MDS Completion Date +14 Calendar Days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 2 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0690 Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that a resident who was incontinent of bowel received appropriate treatment and services to prevent fecal impaction for 1of 33 residents (CR # 62) reviewed for incontinent bowel care in that: The facility failed to ensure CR #62 did not develop bowel complications while at the facility that resulted in hospitalization and a fecal impaction. This failure could place residents at risk for developing bowel complications including impaction and hospitalization. Findings included: Record review of CR #62's admission record dated 7/6/22 revealed she was a [AGE] year old female who admitted on [DATE] and readmitted to the facility on [DATE] with diagnoses to included: unspecified hemorrhoids (swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding), atrial fibrillation and flutter (condition in which the heart's upper chambers (atria) beat too quickly), shortness of breath, presence of heart valve replacement, hemiplegia and hemiparesis (paralysis of one side of the body) following a cerebral infarction (disrupted blood flow to the brain due to problems with the blood vessels that supply it, which can cause parts of the brain to die off) affecting left non dominant side. CR #62 discharged from the facility to hospital emergency room on 6/10/22. Record review of CR #62's admission MDS dated [DATE] revealed that her BIMS was 12 out of 15 indicating her cognition was intact with moderate impairment. CR #62 required extensive assistance of one staff for toilet use and had impaired range of motion to one side of her upper and lower extremities and was frequently incontinent of bowel and bladder. Record review of CR #62's admission Care plan dated 05/23/2022, revealed the following: Focus area CR #62 was at risk for alteration on bowel elimination: Constipation related to use of iron supplement, use of pain medication. Goal: CR #62 will establish normal elimination pattern with the ordered intervention in the next 90 days. Interventions: check for fecal impaction in rectal vault as needed. Monitor (sic)med list for any (sic) meds that may cause constipation, medicate as ordered by physician and monitor and report to (sic)md efficacy of (sic) meds. . Focus area CR #62 had pain from her hemorrhoids, bleeding from her rectum. . Goal: CR #62's pain will be managed effectively with the medication ordered by her MD through the next review date. .Interventions: Staff will monitor for pain and bleeding from her rectal area every shift and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 3 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0690 document. Level of Harm - Actual harm Further record review of CR #62's EMR revealed there was no documentation every shift, of CR #62's pain and whether she had any bleeding. There was no documentation of any checks for fecal impaction in rectal vault conducted by staff or physician on CR #62. Residents Affected - Few Record review of CR #62's undated consolidated physician's order summary report revealed the following orders which CR #62 was receiving: .MiraLAX Powder 17 GM/scoop (Polyethylene Glycol 3350) Give 1 scoop by mouth one time a day for constipation with a start dated 5/24/2022. .Norco tablet 5 325 MG (Hydrocodone Acetaminophen) Give 1 tablet by mouth every 12 hours as needed for pain with a start dated 06/09/2022. .Preparation H Cream 1% (Hydrocortisone) Apply to rectum topically every 8 hours as needed for hemorrhoids with a start dated 5/23/2022. .Preparation H Suppository 0.25 88.44% (Phenylephrine Cocoa Butter) Insert 1 suppository rectally every 12 hours as needed for hemorrhoids .with a start dated 6/07/2022. .Tylenol with Codeine #3 Tablet 300 30MG (Acetaminophen Codeine) Give 1 tablet by mouth every 4 hours as needed for pain. .Ferrous Sulfate tablet 325 (65 Fe) MG Give 1 tablet by mouth one time a day for supplement. Record review of CR #62's TAR dated 6/1/2022 6/30/2022 revealed she received 1 Preparation H Suppository 0.25 88.44% (Phenylephrine Cocoa Butter) Insert 1 suppository rectally every 12 hours as needed for hemorrhoids on 6/9/22 which was documented as being effective. Interview with the DOR on 7/6/22 at 1:04 p.m., said she remembered and had worked with CR #62. The DOR said CR #62 frequently complained of pain to her rectum and CR # 62 did not participate in therapy the way she was supposed to because of painful hemorrhoids. She said she and other therapy staff always reported her complaints and concerns to nursing and it was usually the charge nurse assigned to care for CR #62 on that day. The DOR said she could not recall how many times she notified nursing about CR #62's pain. Record review of nursing progress notes on 7/6/22 at 12:55 p.m., by Former MDS Coordinator revealed the following entry dated 6/10/22: Call placed to CR #62's family member regarding concerns with constipation and pain, call placed with nurse on duty (sic)was explained that during shower this am she had a large bowel elimination and she had just had another bowel elimination and hemorrhoidal suppository had been applied. Family member said that CR #62 had a high tolerance for pain and that if she was unable to get up for therapy, she wanted her transferred to the ER. Attempted to contact nurse who wrote the progress note on 7/6/22 at 1:00pm, but nurse no longer worked for the facility and contact number voicemail box was full. Record review of nursing progress notes on 7/6/22 at 1:03 p.m. by Former MDS Coordinator dated 6/10/2022 . Per family request resident is being sent to hospital ER. 911 in facility to transport (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 4 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0690 resident to ER call placed to hospital ER Triage and report was given to RN. Level of Harm - Actual harm Record review of social services note on 7/6/22 at 1:12 p.m. dated 6/11/2022 Late Entry: Since residents admission writer has talked with family member on many occasions, family member has contacted insurance company and insurance case manager contacted writer about concerns and writer wrote a grievance on family members complaints. CR #62 was (sic)(Draft)refusing therapy and writer and DOR went to her room to talk to her bout needing to participate CR #62 states she had concerns with her hemorrhoids .it was reported to writer that CR #62's family member was bringing medication from home to give to CR #62 Family member continued to complain about no one assisting with CR #62's hemorrhoids and the pain she is going through. Physician A had been notified several times and saw the resident several times. Residents Affected - Few Interview on 7/6/22 at 1:11 p.m., the SW said she remembered CR #62 and the resident frequently had pain and was not participating in therapy. She said she wanted to transfer or go to a facility with a higher level of care for therapy, but it was difficult to forward records for acceptance because she was not participating and was refusing. She said CR #62 told her about painful hemorrhoids and she would tell the charge nurse and had also notified the DON and the Corporate Nurse about CR #62's concerns. SW said she spoke with CR #62's family members frequently and was trying to help because the family said they could not take the resident home and the resident was not well enough to go back to living on her own. Record review of CR #62's hospital records dated 6/10/2022 6/20/2022 revealed the following: CT ABDOMEN PELVIS W CONTRAST Result Date: 6/10/2022 Impression: 1. Severe rectal fecal impaction . HOSPITAL COURSE: General Surgery consulted and performed bedside disimpaction . (Use of finger to remove stool from rectum). Telephone interview on 7/7/22 at 2:01 p.m., Physician A said he was the physician for CR #62 and completed physical examinations on the resident during her stay at the facility. He said that CR #62 was having loose stools and got a laxative and oral stimulant and had a history of hemorrhoids. He said when he examined CR #62, she did not exhibit any signs/symptoms of bowel or rectal perforation or impaction. He said he was aware that the resident did have a fecal impaction after the June 10, 2022 admission to the hospital but did not think there was anything additional, he should have prescribed or done for the resident. He said that he felt like the staff cared for CR #62 appropriately and per his orders. Record review of the facility policy titled Bowel (Lower Gastrointestinal Tract) Clinical Protocol dated 2001 MED PASS, Inc (Revised September 2017) read in part: Assessment and Recognition .1. As part of the initial assessment, the staff and physician will help identify individuals with previously identified lower gastrointestinal tract conditions and symptoms. 2. Examples of lower gastrointestinal tract conditions and symptoms include: b. Fecal incontinence; d. pain with defecation; f. Alteration in bowel movements; h. Residents taking antidiarrheal medications or medications related to bowel motility. 3. In addition, the nurse shall assess and document/report the following: b. Quantitative and qualitative description of diarrhea (how many episodes in what period, amount, consistency, etc.); d. Presence of fecal impaction; f. Abdominal assessment; g. Digital rectal examination .5. The staff and physician will characterize symptoms related to bowel function; for example, location and radiation of abdominal pain, time relationship to meals, presence or cramps or bloating, etc6. Check for diffuse or localized tenderness and listen for bowel sounds in area of suspected ileus or obstruction FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 5 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that the facility provided pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 out of 14 residents (Resident #110) reviewed for pharmacy services. The facility failed to ensure that Resident #110's Hydromorphine (Dilaudid) pain medication was ordered from the pharmacy and received timely. This failure could place residents whose medications were supervised by the facility at risk of experiencing serious side effects from possible interruptions to their medication regimen. Findings Included: Record review of Resident #110's face sheet revealed she was a [AGE] year old female who was admitted to the facility on [DATE]. She was diagnosed with pain, scoliosis (a sideway curvature of the spine), fusion of spine (surgery to permanently connect two or more vertebrae in the spine, eliminating motion between them) and osteoporosis (a condition in which bones become weak and brittle). Record review of Resident #110's MDS dated [DATE], revealed she had a BIMS of 15 (cognitively intact); she did not exhibit any symptoms of psychosis or behaviors; she required limited assistance from one staff for bed mobility, transfers, dressing, toilet use, and personal hygiene; Resident #110 was occasionally incontinent of bowel and bladder. The resident reported her worst pain over the last five days was eight. Record review of Resident #110's baseline care plan dated 06/28/2022 revealed she was on opioids (documented), she had a presence of back pain, and the resident had post surgical wounds. Record review of Resident #110's Physician's Order Summary Report for July 2022 revealed: Hydromorphine tablet: 4 Mg. every four hours for pain management for seven days. Start Date: 07/01/2022, End Date 07/08/2022. Record review of Resident #110s MAR for July 2022 revealed: Hydromorphine tablet 4 Mg Give one tablet by mouth every four hours for pain management for seven days. Start Date 07/01/2022. Hold 07/03/2022 at 1949 (7:49 PM). Further review of the record revealed the medication was not administered on 07/03/2022 at: 3:00 AM, 7:00 AM, 11:00 AM, 3:00 PM and 7:00PM. Record review of Resident #110's Nurses Progress Notes revealed: 07/03/2022 at 5:57 AM, LVN J wrote Completely out of Dilaudid, 07/03/2022 at 10:29 AM and 5:15 PM, LVN F wrote Hydromorphine 4 Mg pending pharmacy, 07/03/2022 at 6:22PM, LVN L wrote physician notified resident did not have Dilaudid available. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 6 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0755 Level of Harm - Minimal harm or potential for actual harm Observation and interview on 07/05/2022 at 11:56 AM, revealed Resident #110 was sitting up in bed awake, alert, and oriented. The resident had healing abdominal and back surgical wounds. The resident stated she had surgery on June 7 and June 10, 2022. Her level of pain was five out of ten. Resident #110 reported she was getting her scheduled Dilaudid the first few days she was here then it ran out and it was not available. The resident reported she had been receiving Tylenol with Codeine and Morphine. Residents Affected - Some In an interview on 07/06/22 at 07:15 AM, LVN S stated she worked on an as needed basis. She stated the first time she worked with Resident #110 her Dilaudid was here then when she came back to work the next time, she heard the medication was not available. LVN S stated to prevent a medication from running out the nurse was to notify the physician and pharmacy to refill the medication order. It did take longer to refill Dilaudid due to having to get the triplicate prescription. The medication was to be refilled prior to it running out, but she was not sure how close to the end it should be refilled. LVN S stated the resident received Tylenol with codeine along with Morphine to cover her pain until the Dilaudid was received. All nurses who work on the cart and care for the resident were responsible for making sure there was enough medications available. The risk was the resident's pain may not be covered, she said it happened because it was not filled timely before it ran out. In a phone interview on 07/06/2022 at 01:01 PM, a facility pharmacist stated the Dilaudid required a triplicate prescription or e script and it cannot be ordered for more than 30 days at a time. To prevent the resident from running out the required prescription needed to be reordered prior to the medication running out. The pharmacist stated she was on call over the weekend and the nurses made multiple requests to get the medication and the physician was notified for the need to refill the order. She stated the process was to stock the Omnicell (a medication dispensing machine) and replenish as needed until the total that was ordered had been provided then a new order must be received as required. An unsuccessful attempt was made to contact LVN J by phone on 07/06/2022 at 12:42 PM and 4:24 PM. In a phone interview on 07/06/2022 at 04:35 PM, LVN F stated when she worked on 7/3/2022 Resident #110's Dilaudid was out each time it was due to be given. She stated she documented on the number nine on the MAR and a blank space for comments came up. LVN F stated she documented pending pharmacy meaning pending pharmacy delivery of the Dilaudid. She stated as soon as she saw the medication was out she called the physician and pharmacy but the pharmacy did not fill it. LVN F stated she believed this occurred because the medication was not refilled before it ran out and it could have been prevented if it was reordered before it got low especially over a holiday weekend. She continued and stated everyone working on the cart and with the resident's medication was responsible for making sure there was enough medication available. Running out had a big risk of not managing a resident's pain. In a phone interview on 07/07/2022 at 09:52 AM, the Physician stated the interruption with Resident #110's Dilaudid was because he was attempting to wean her off the Dilaudid back to the medication she was on prior to her surgery. He stated he was in communication with her pain specialist, and they managed her pain with Tylenol #3 and with Morphine orally. He stated Resident #110 was not at risk of not having her pain uncontrolled. The physician stated his physical exam of the resident did not reveal that her pain was not in control. In an interview on 07/07/2022 at 10:31 AM, the DON stated she knew there was an interruption in the Dilaudid on 07/03/22. She stated on 07/01/22 the physician gave a verbal order to the nurse to discontinue the Dilaudid but the nurse did not follow through and write the order. Since the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 7 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some discontinuation order for the Dilaudid was never followed through and entered into the system there was still a current active Dilaudid order for the resident and the medication was not available to give. She said we did Performance Improvement and took it to our Quality Assurance Performance Improvement so this will not occur again. She said we are having all verbal orders go through me so I can follow up and make sure the orders were followed. The resident did not have any risk because she was having her pain controlled with other medications for pain. The DON stated she will make sure all medications are available on Friday going forward to help ensure this does not occur again. In an interview on 07/07/2022 at 11:00 AM, the Administrator stated the medication issue was going to Quality Assurance Performance Improvement. She stated she agreed the DON will make sure the residents have their medications every Friday. The administrator also said every day in the morning they will run an order listing report to monitor medication availability to prevent this from occurring again. Record review of, Administering Medication, Revised April 2019 revealed, Policy Statement Medications are administered in a safe and timely manner, and as prescribed. 4. Medications are administered in accordance with prescriber orders, including any required time frame . Record review of, Medication Orders, Revised November 2014 revealed, Purpose The purpose of this procedure is to establish uniform guidelines in the receiving and recording of medication orders . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 8 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure each resident's drug regimen was free from the administration of unnecessary drugs (in the presence of adverse consequences which indicate the dose should be reduced or discontinued/for excessive duration/without adequate indications for use/duplicate therapy), for 1 of 3 residents (Resident #8) reviewed for unnecessary psychotropic medications. Residents Affected - Few Resident #8 was receiving antidepressant, Sertraline (Zoloft), for diagnosis of depression without adequate indications for continuing the same dose. The deficient practice could place the resident at risk for complications resulting from receiving unnecessary medication. Findings included: Resident #8 Record review of the admission sheet for Resident #8 revealed an [AGE] year old[AGE] year old female that who admitted to the facility on [DATE]. Her diagnosis included depression, hyperlipidemia, insomnia, dementia, hypertension, congestive heart failure, venous insufficiency, acute kidney failure, malaise, localized edema, and reduced mobility. Record Review of Resident #8's comprehensive MDS assessment dated [DATE] revealed the resident has a moderate cognitive impairment with a BIMS score 8 out of 15. Record Review of Resident #8's most recent physician orders revealed orders dated 11/27/2021 for Sertraline HCL (Zoloft) Tablet 25mg, Anti depressants Behavior Monitoring, and Antidepressant Medication Side Effects Monitoring daily. Record review of Resident #8's Medication Administration Record (MAR) from 06/01/2022 07/06/2022 revealed that Resident #8 was administered Sertraline HCL(Zoloft) Tablet 25mg daily. Record review of Resident #8 Treatment Administration Record (TAR) from 06/01/2022 07/06/2022 revealed that Resident #8 received anti depressants behavior monitoring, and antidepressant medication side effects monitoring daily. Record review of Resident #8's care plan dated on 06/05/2022 revealed the following: Focus: Potential for complications RT depression. Required the use of antidepressant medication. Goal: Will show decreased episodes of depression through the next review date. Intervention: Give antidepressant medication ordered by physician. Monitor/document side effects and effectiveness of antidepressant. Monitor/document/report to MD PRN ongoing s/sx of depression unaltered by antidepressant meds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 9 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0757 Level of Harm - Minimal harm or potential for actual harm Record Rreview of the Medication Regimen Review (MRR) completed by consultant pharmacist on 06/21/2022 revealed Resident #8 was reviewed for psycho active drug, Sertraline HCL(Zoloft), antidepressant. A summary of the pharmacist's recommendation was for a gradual does reduction attempt for Zoloft 25mg. The consultant pharmacist communication to physician document was not available upon record review. Residents Affected - Few In an interview on 07/06/2022 at 12:10 p.m., with the DON revealed that the MRR was completed by the consultant pharmacist on 06/21/2022. She stated that the Consultant Pharmacist communication to physician document was left for Physician B to review on 06/22/2022, but the Physician B had not been to the facility to complete the document. She stated that, she had not contacted Physician B because she had over 100 to follow up on, she had not got to them yet, and the review was just completed on the 22nd. She stated that with the fourth of July holiday, she planned to follow up with Physician B on 07/05/2022, but she was delayed due to the survey. She agreed to provide a copy of the consultant pharmacist communication to physician document that was left for the Physician B. She stated that the SW was responsible for ensuring that Gradual Dose Reduction (GDR) were completed. In an interview on 07/06/2022 at 12:47 p.m., with the SW revealed that she was not the oversite for GDR, and she only assist with scheduling the meeting once she is notified the meeting is needed. She stated that the last GDR she scheduled was in October of 2021 to address Resident #8's Seroquel. In an interview and observation on 07/07/2022 at 09:10 a.m., with Resident #8, revealed that Resident was alert and oriented, . Sshe stated that she is given her medications daily. She stated that she takes medication for a few reasons, but she could not name her diagnosis or medications. Record review of the consultant pharmacist communication to physician document revealed that it was printed and dated on 06/22/2022 for Resident #8's antidepressant gradual dose reduction attempt for Zoloft 25mg daily. The document was viewed to be incomplete and had not been signed by a Physician B. Record review of a policy for Psychoactive Medications with no date provided revealed a policy statement: All physicians' orders will be screened to determine if they have an order for antidepressant, antipsychotic, antianxiety, hypnotic or medication ordered to alter a behavior. E. The designee will review, at least quarterly on all residents on psychoactive medications. 1. Gradual dosage reduction or discontinuation will be recommended by the physician/psychologist/psychiatrist/nurse practitioner and the pharmacy consultant. Record review of the policy dated April 2007 for Medication Therapy revealed a policy statement: 1. Each residents' medication regimen shall include only those medications necessary to treat existing conditions and address significant risks. 2. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 10 of 11 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 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 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 0757 Medication use shall be consistent with an individual's condition, prognosis, values, whishes, and responses. Level of Harm - Minimal harm or potential for actual harm 3. Residents Affected - Few All medication orders will be supported by appropriate care processes and practices. The policy interpretation and implementation revealed: 4. Periodically, and when circumstances are present that represent a greater risk for medication related complications, the staff and practitioner will review the medication regimen for continued indications, proper dosage and duration, and possible adverse consequences. 5. The physician will identify situations where medications should be tapered, discontinued, or changed to another medication. 8. On monthly basis the Medical Director and Consultant Pharmacist shall collaborate to address issues of medication prescribing and monitoring with the practitioners and staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676260 If continuation sheet Page 11 of 11