Health inspection·March 22, 2023

F 0655 BASELINE CARE PLAN POLICY DATED: NOVEMBER 2017 Level of Harm - Minimal harm or potential for actual harm Policy: The facility will develop and implement a baseline care plan for each resident in order to provide effective and person-centered care of the resident. Residents Affected - Few Responsibility: Licensed Nurse Purpose: To provide an interdisciplinary resident centered care plan to meet the initial needs of the resident involving the resident and/or representative. Procedure: 1. The baseline care plan will: a. Be developed within 24 hours of the residents' s admission b. Include the minimum healthcare information necessary to properly care for a resident including but not limited to: i. Initial goals based on admission orders ii. Physicians orders iii. Dietary orders iv. Therapy services v. Social Services vi. PASARR recommendation, if applicable 2. The facility must provide the resident and/or their representative with a copy of the baseline care plan that includes but is not limited to: a. The initial goals of the resident b. A copy of the resident's medications, dietary orders and other services or treatments to be administered. c. Any services and treatments to be administered by the facility and personnel acting on behalf of the facility d. Any updated information based on the details of the comprehensive care plan, as necessary. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 2 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan that included measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs for 1 resident (Resident #300) reviewed for care plans in that: Residents #300 care plans did not implement a person-centered individualized care plan in that: a. Resident #300 diagnosis of Acute Kidney Disease was not addressed in the care plan. b. Resident #300 received pain medications with pain not addressed in the care plan. c. Resident #300's diagnosis of Urinary Tract Infection was not addressed in the care plan. d. Resident #300's care plan did not address the use of Foley Catheter. e. Resident #300's care plan did not address Benign Prostatic hyperplasia This failure could place resident at risk of receiving inadequate interventions not individualized to their care needs. Findings included: During an interview on 3/22/2023 at 10:45AM. the DON stated Resident #300's Comprehensive Care Plan was not done and should have been done within 24 hours of admission, she said the Resident #300 was admitted on a Sunday and the RN supervisor was to do the Care Plan, then the DON said she went on vacation and did not follow up on care plansto see if Care plans were done nor updated. She was asked how you normally catch this, the DON said she has a check list to check that nursing has entered their plan and she failed to follow up. The DON said this was bottom line her responsibility to make sure this was completed. Record Review of Resident #300's admission record revealed an admission date of 02/26/2023 with a principal diagnoses of: Benign Prostatic hyperplasia with lower Urinary tract symptoms, personal History of Urinary tract infections, and Acute Kidney Injury. Record review of Resident #300's MDS assessment dated [DATE] revealed a BIMS Summary Score of 00 (severely impaired cognition). Record review of Resident #300's medical record revealed Resident #300 did not have a Comprehensive care plan. Record Review of the facillity: BASELINE CARE PLAN POLICY DATED: NOVEMBER 2017 Policy: The facility will develop and implement a baseline care plan for each resident in order to provide effective and person-centered care of the resident. Responsibility: Licensed Nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 3 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0656 Purpose: To provide an interdisciplinary resident centered care plan to meet the initial needs of the resident involving the resident and/or representative. Level of Harm - Minimal harm or potential for actual harm Procedure: Residents Affected - Few 1. The baseline care plan will: a. Be developed within 24 hours of the residents' s admission b. Include the minimum healthcare information necessary to properly care for a resident including but not limited to: i. Initial goals based on admission orders ii. Physicians orders iii. Dietary orders iv. Therapy services v. Social Services vi. PASARR recommendation, if applicable 2. The facility must provide the resident and/or their representative with a copy of the baseline care plan that includes but is not limited to: a. The initial goals of the resident b. A copy of the resident's medications, dietary orders and other services or treatments to be administered. c. Any services and treatments to be administered by the facility and personnel acting on behalf of the facility d. Any updated information based on the details of the comprehensive care plan, as necessary. Record review of the facility's policy titled Comprehensive Care Plans dated June 2019 revealed: Care Plan Comprehensive Policy: 1. To develop a comprehensive resident person centered care plan. Responsibility: Licensed Nurses. Purpose: To develop an interdisciplinary resident centered comprehensive care plan to meet the individual needs of each resident. Procedure: 1. An interdisciplinary team develops and maintains a comprehensive care plan for each resident 2. The comprehensive care plan has been designed to: a. Identify care needs that include resident's strengths, history, and preferences (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 4 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0656 b. Incorporate risk factors Level of Harm - Minimal harm or potential for actual harm c. Establish goals in measurable outcomes d. Include individualized approaches to meet residents' goals Residents Affected - Few 3. The resident comprehensive care plan is developed within seven (7) days after the completion of the MDS assessment. New residents will have a comprehensive care plan within seven (7) days after the completions of the MDS assessment, not to exceed (21) days from the date of admission a. Care plans are revised as changes are indicated b. Review of the care plan is made with each comprehensive and quarterly assessment. 4. The facility supports the residents' right to be informed of and participate in their care plan with the resident and/or representative. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 5 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility's interdisciplinary team failed to review and revise all residents' care plans after each comprehensive and quarterly review assessments for one (Resident #300) of four residents reviewed for comprehensive care plans. The facility failed to revise Resident #300's care plan to reflect the Foley Catheter. This deficient practice could place the residents at risk of not receiving the care and services required. The findings included: Record review of Resident #300's care plan dated 2/23/2023, did not reveal in part, [Resident #300 any evidence of Resident #300 having a Foley catheter. Record Review of Resident #300's admission record revealed an admission date of 02/26/2022 with principal diagnoses of: Benign Prostatic hyperplasia with lower Urinary tract symptoms, personal History of Urinary tract infections, Acute Kidney Injury. Record review of Resident #300's MDS assessment dated [DATE] revealed a BIMS Summary Score of 00 (severely impaired cognition). Record review of Resident #300's physician order dated 3/10/2023 revealed orders for Foley catheter care with perineal wipes and/or soap and water Q SHIFT and PRN, Empty Foley catheter and record urine output q shift Observation on 3/20/2023 at10:40 AM, revealed Resident #300 was observed in his room with Foley Catheter bag in his lap. Observation on 3/21/2023 at 9:15 AM Resident #300 was observed in bed with Foley Catheter Bag attached to side of his bed. Observation on 3/22/2023 at 10:35 AM resident had been transferred to ER local hospital on 3/21/2023 at 19:55 PM for change in condition. During an interview on 3/21/2023 at 1:55 PM., the MDS Coordinator, stated Resident #300's admission care plan was not done and stated she would check with the DON to make sure it was not completed. During an interview on 3/21/2023 at 2:10 PM, the MDS Coordinator stated she checked with the DON and was confirmed that the admission care plan was not done, when asked who is responsible for doing that care plan, she said the admission RN During an interview on 3/22/2023 at 10:45AM. the DON stated Resident #300's Comprehensive Care Plan was not done. She said the Resident #300 was admitted on a Sunday and the RN supervisor was to do the admission Care Plan, then the DON said she went on vacation and did not follow up on care plans. She was asked how she normally caught missed care plans , the DON said she has a check list to check (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 6 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0657 that nursing has entered their plans which are to be completed in 7 days. Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy titled Comprehensive Care Plans dated June 2019 revealed: Care Plan Comprehensive Residents Affected - Few Policy: To develop a comprehensive resident person centered care plan. Responsibility: Licensed Nurses. Purpose: To develop an interdisciplinary resident centered comprehensive care plan to meet the individual needs of each resident. Procedure: 1. An interdisciplinary team develops and maintains a comprehensive care plan for each resident 2. The comprehensive care plan has been designed to : a. Identify care needs that include resident's strengths, history, and preferences b. Incorporate risk factors c. Establish goals in measurable outcomes d. Include individualized approaches to meet residents' goals 3. The resident comprehensive care plan is developed within seven (7) days after the completion of the MDS assessment. New residents will have a comprehensive care plan within seven (7) days after the completions of the MDS assessment, not to exceed (21) days from the date of admission a. Care plans are revised as changes are indicated b. Review of the care plan is made with each comprehensive and quarterly assessment. 4. The facility supports the residents' right to be informed of and participate in their care plan with the resident and/or representative BASELINE CARE PLAN POLICY DATED: NOVEMBER 2017 Policy: The facility will develop and implement a baseline care plan for each resident in order to provide effective and person-centered care of the resident. Responsibility: Licensed Nurse Purpose: To provide an interdisciplinary resident centered care plan to meet the initial needs of the resident involving the resident and/or representative. Procedure: 1. The baseline care plan will: a. Be developed within 24 hours of the residents' s admission b. Include the minimum healthcare information necessary to properly care for a resident including (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 7 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0657 but not limited to: Level of Harm - Minimal harm or potential for actual harm i. Initial goals based on admission orders ii. Physicians orders Residents Affected - Few iii. Dietary orders iv. Therapy services v. Social Services vi. PASRR recommendation, if applicable 2. The facility must provide the resident and/or their representative with a copy of the baseline care plan that includes but is not limited to: a. The initial goals of the resident b. A copy of the resident's medications, dietary orders and other services or treatments to be administered. c. Any services and treatments to be administered by the facility and personnel acting on behalf of the facility d. Any updated information based on the details of the comprehensive care plan, as necessary. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 8 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure 1 of 4 residents reviewed for gastrostomy tubes (Resident # 59) received proper tube care during administration of medications. The facility failed to follow their policy for administering medications via gastrostomy tube and used an unauthorized instrument to de-clog a feeding tube. This failure could place the resident at risk for not receiving his medication dose as ordered and at risk for a punctured gastrostomy tube and possible leakage of medications, formula, and/or water into the abdominal cavity. Findings included: During observation of medication administration and interview on 03/21/2023 at 11:35 AM, LVN A used a 60 cc (centimeter) syringe to aspirate a scant amount of stomach contents from Resident # 59's gastrotomy tube and then gently push it back into the stomach. LVN A did not auscultate the abdomen for bowel sounds nor did she check placement by auscultating the abdomen while instilling air into the tubing prior to aspiration of stomach contents. LVN A disconnected the syringe from the tubing port, pulled 30 ccs of water into the syringe, inserted the syringe tip into the tube port, and using the syringe plunger, pushed the water into the tube. LVN A disconnected the syringe from the tube port, removed the plunger from the syringe, and re-inserted the syringe tip into the tube port. The nurse then poured the medication (gabapentin 6 ccs) mixed with a small amount of water into the syringe. The liquid did not drain from the syringe, indicating the gastric tube was clogged. After several attempts of repositioning and massaging the tube, LVN A said, If this doesn't work, I'll get the de-clogger. The nurse separated the syringe from the tube, spilling some of its liquid content and then emptied the liquid remaining in the syringe into a medicine cup. LVN A walked over to Resident # 59's locked medication storage cabinet and obtained a sealed package containing an enteral feeding tube de-clogger. LVN A inserted the de-clogger into the feeding tube, rotated it in a back and forth and up and down motion several times and then removed the tool from the tube. LVN A then inserted the open syringe into the tube port, poured the medication mixture into the tube and followed it with 30 ccs water. By gravity flow, the medicine and water drained from the syringe into the stomach. During an interview on 03/21/2023 at 11:42, LVN A said the nurses use the de-clogger tool when repositioning or massaging the tube does not unclog the tube. A review of Resident #59's progress notes for the month of March 2023 indicated no documentation of any difficulty with administering medications, formula, or water via the gastric tube, nor if the physician was aware of any difficulty, nor of use of a de-clogger tool. A review of Resident #59's face sheet and physician orders dated 06/24/2021 indicated the resident was admitted to the facility on [DATE] with diagnoses including stroke and gastrostomy tube placement. A review of Resident #59's physician's orders dated March 2023 included an order written on 06/24/2021 for the gastric tube to be checked every shift by auscultation prior to meds, formula, and water flushes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 9 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of Resident #59's consolidated physician orders dated March 2023 indicated there was no physician's order for use of a de-clogger tool to open a clogged enteral feeding tube. During an interview on 03/22/2023 at 10:55 AM, the RN Consultant stated the facility did not have a policy regarding use of a gastric tube de-clogger tool. She said, We are not supposed to be using them. She said she did not know how the de-clogger tools had come to be present at the facility and the facility was removing the tool from the medical supply formulary. During an interview on 03/22/2023 at 04:22 PM, LVN B said she would roll the gastric tube between her fingers to unclog it and if that did not work, we have a de-clogger we can use. During the exit conference on 03/22/23, the DON said the de-clogger tools had been removed from the facility and were no longer available for use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 10 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview and record review the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals for 1 of 2 medication carts (B-House Nurse medication cart) and 1 of 10 medication storage rooms (Resident #84's room) reviewed for labeling and storage. The facility failed to remove expired Lorazepam 0.5 mg tablets with an expiration date 02/27/23 from the nurse medication cart in B-House and expired Valsartan 80 mg tablets with an expiration date 11/10/22 from Resident #84's locked medication storage cabinet in her room. This deficient practice could place residents at risk for receiving outdated medications and could result in residents not receiving the intended therapeutic effects of their medications causing a health decline. Findings include: During an observation and interview on 03/21/23 at 2:31 p.m., the B-House nurse medication cart had a bubble packaged card of Lorazepam 0.5 mg tablets (11 tablets) with an expiration date of 02/27/23 inside the narcotic box for Resident #40. LVN C said the medication was expired and should have been removed from the medication cart by the nurse and DON since the medication was narcotic. LVN C said she would contact the DON. LVN C said nurses are responsible for checking medication expiration dates and removing them from the medication cart. LVN C said a residents who are administered expired medications were at risk of not receiving the intended therapeutic effect or having an adverse reaction from it. During an observation and interview on 03/22/23 at 11:17 a.m., Resident #84's locked medication storage cabinet in her room had a bottle of Valsartan 160 mg tablets with an expiration date of 11/10/22. LVN C said the medication was expired and should have been removed from Resident #84's storage cabinet. LVN C said she did not think to check the expiration date because Resident #84 received the medication at bedtime during the evening shift. During an interview on 03/22/23 at 2:34 p.m., the DON said the nurses were responsible for checking every medication's expiration date before administering them to the residents. The DON said she was unaware there was expired Lorazepam on the medication cart for Resident #40 and expired Valsartan in Resident #84's locked medication storage cabinet. The DON said she expected the nurses to remove all expired medications and contact her when the medication is a narcotic so she could remove it for drug destruction. The DON said residents who are administered expired medications were at risk of not receiving the intended therapeutic effect or having an adverse reaction from it. Record review of the facility's Storage and Expiration Dating of Medications, Biologicals revised 01/01/22 indicated, .4. Facility should ensure that medications and biologicals that: (1.) have an expired date on the label .are stored separate from other medications until destroyed or returned to the pharmacy or supplier . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 11 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to ensure residents who use psychotropic drugs receive gradual dose reductions in an effort to discontinue these drugs for 1 of 6 (Resident #58) reviewed for unnecessary medications. The facility failed to ensure Resident #58 received a gradual dose reduction of his anti-anxiety medication. This failure could place residents at risk for receiving unnecessary psychotropic medications and an increased risk for adverse effects from psychotropic medications. The findings included: Record review of Resident #58's face sheet, dated 03/22/23, revealed he was a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses of Alzheimer's disease (brain disease that affects memory, thinking and behavior), dementia (affects the brain's ability to think, remember, and function normally), and anxiety disorder (the mind and body's reaction to stressful, dangerous, or unfamiliar situations characterized by the sense of uneasiness, distress, or dread before a significant event). Record review of Resident #58's MDS assessment, dated 01/17/23, indicated he had a BIMS score of 03, which indicated severe cognitive impairment. Resident #58 felt tired or little energy nearly every day and had a mood score of 6, which indicated mild depression. Resident #58 received antianxiety medication during the last 7 days. Record review of Resident #58's comprehensive care plan, last revised 05/02/22, indicated Resident #58 had anxiety and was on antianxiety medication (lorazepam). Interventions included: administer medications as ordered, psychoactive medication evaluation as facility protocol and routine pharmacy consults. Record review of Resident #58's physician's order summary report, dated 03/22/23, revealed an order for lorazepam 0.25 mg by mouth one time a day for anxiety and lorazepam 0.5 mg by mouth one time a day for anxiety both ordered on 07/22/22. Record review of a pharmacy consultation report dated 01/23/23 indicated Resident #58 had been receiving Lorazepam 0.25 mg in the morning and 0.5 mg at bedtime since 07/22/22. The pharmacist recommended a gradual dose reduction of Lorazepam to 0.25 mg by mouth twice a day. The Nurse Practitioner agreed with recommendation. The pharmacy consultation report was signed and dated by the Nurse Practitioner on 02/10/23. Record review of Resident #58's medication administration record for February 2023 and March 2023, indicated he received 0.5 mg at bedtime on 02/10/23 through 03/21/23. During an interview on 03/22/23 at 2:34 PM, the DON said the charge nurse was responsible for putting medication orders in the electronic charting system. The DON said the nurse practitioner signed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 12 of 13 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 676311 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watkins-Logan-Garrison Texas State Veteran's Home 11466 Honor Lane Tyler, TX 75708 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and approved the pharmacist's recommendation to decrease Resident #58's Lorazepam. The DON said Resident #58's Lorazepam order was not entered into the electronic charting system and placed him at risk for receiving unnecessary medications. The DON said the pharmacy consultation reports are kept in the pharmacy binder and were reviewed by the ADON, medication nurse, and herself. The DON said she did not review Resident #58's pharmacy consultation report and was unsure if the ADON or medication nurse had. The DON said she was unsure why the order did not get entered and to prevent this from again the ADON, medication nurse and herself will be responsible for entering in any new approved pharmacist recommendations. The DON said she would enter and change Resident #58's order to decrease his Lorazepam and notify the charge nurse of the change. The DON said she would complete a full audit of the pharmacy consult reports for the past two months to ensure all approved recommendations have been ordered. Record review of the facility's Antipsychotic Drugs policy revised 10/2022 indicated, .Purpose: To ensure each resident's drug regimen is free from unnecessary drugs, including unnecessary antipsychotic drugs. Procedure: The facility will adhere to antipsychotic drug guidelines related to the following: .Antipsychotic gradual dose reduction (GDR)- Dose reductions will occur in modest increments over adequate periods of time to minimize withdrawal symptoms and to monitor symptom recurrence unless clinically contraindicated . Record review of the facility's Antipsychotic Drug Guidelines revised 06/2016 indicated, .3. Antipsychotic drug dose reduction A. Residents who use antipsychotic drugs will receive gradual dose reduction, unless clinically contraindicated, in an effort to discontinue use of these drugs .D. Each resident will receive the lowest possible dose and for the shortest period of time necessary for treating his or her condition .4. With the physician as the leader, and in collaboration with a pharmacist and other members of the interdisciplinary team, each resident's drug regimen will be reviewed on an ongoing basis, taking into consideration the following elements: Dose, Duration of use, Presence of adverse consequences which indicate the dose should be reduced or discontinued . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676311 If continuation sheet Page 13 of 13