Health inspection·October 16, 2023

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of Resident #39's nursing notes dated 09/23/23 at 1:40PM by RNS revealed she was called by LVN P to Resident #4's room which she shared with Resident #39. RNS's nursing note stated she went to Residents #4 and 39's room and observed Resident #4 was being physically and verbally aggressive with Resident #39 with Resident #4 swinging bed remote at Resident #39's bilateral legs. RNS's nursing note stated a Head to toe assessment was performed with noted dark purple bruising to right forearm, dark purple bruise to left and right hand. Redness noted to right shin, right knee and bite mark to right lateral thigh. Scratch noted to inferior aspect of left eye. Scratch noted to right inner aspect of thigh/knee area. Resident #4 At time of the investigation Resident #4 was no longer in the facility, as per record review of Resident #4's face sheet on 10/15/23 Resident #4 was discharged from facility on 09/27/23 Record review of Resident #4's face sheet, dated 10/15/23, revealed the resident was a [AGE] year-old female who was admitted to the facility on [DATE] and was discharged on 09/27/23 with diagnoses that included: Acute diastolic (occurs when left ventricle muscle becomes stiff or thickened) (congestive) heart failure ( the heart does not pump blood as well as it should ), bipolar disorder (a disorder associated with episodes of mood swings ranging from depressive lows to manic highs), current episode depressed, moderate, dementia (a group of thinking and social symptoms that interferes with daily functioning) in other diseases classified elsewhere, moderate, with mood disturbance, pneumonia (infection that affects one or both lungs), unspecified organism and type 2 diabetes mellitus (high blood sugar) with other specified complication. Record review of Resident #4's 5- day MDS assessment, dated 08/17/23, revealed Resident #4 had a BIMS score of 04, indicating severe cognitive impairment. Record review of Resident #4's care plan did have specific focuses regarding her anti-depressant and anticonvulsant medication but did not address her history of aggression. Resident #4's care plan had a focus of I use anticonvulsant medication as a mood stabilizer related to Dementia with mood disturbances; Bipolar and I require anti-depressant medication related to diagnosis of Depression which had an intervention to Monitor/document/report to MD prn ongoing signs and symptoms of depression unaltered by antidepressant meds: Sad, irritable, anger, never satisfied, crying, shame, worthlessness, guilt, suicidal ideations, neg. mood/comments, slowed movement , agitation, disrupted sleep, fatigue, lethargy, does not enjoy usual activities, changes in cognition, changes in weight/appetite, fear of being alone or with others, unrealistic fears, attention seeking, concern with body functions, anxiety, all which had a created date of 08/24/23 and an initiated date of 10/14/23 Record review of Resident #4's hospital paper work submitted as part of her referral revealed a history of present illness from admission date 07/31/23 stating This lady is a psychiatric patient by all means who requires psychiatric attention. Not too long ago she was admitted for psychiatric treatment after an overdose and several episodes of fights and aggression at home with husband and others who may be there. Last week she was here in the emergency room for the same reason. It also included a hospital progress note for Resident #4 stating there was an open legal case for domestic abuse. Record review of Resident #4's nursing notes dated 09/23/23 at 1:40PM by RNS revealed she was called by LVN P to Resident #4's room which she shared with Resident #39. RNS's nursing note stated she went to Residents #4 and 39's room and observed Resident #4 swinging bed remote at Resident #39 striking him multiple times. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 2 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Immediate jeopardy to resident health or safety Residents Affected - Few During an interview on 10/11/23 at 5:10pm with the DON and ADM they both stated they were not aware of any APS case or Resident #4's behaviors prior to the incident between Resident #4 and #39 on 9/23/23. During an interview with the Admissions Coordinator at the facility on 10/11/23 at 3:25pm she stated Resident #4 had originally sent over paper work for admission months before her recent admission on [DATE] and stated that paperwork did include resident #4's behaviors and aggression towards Resident #39 and stated she was denied admission. The Admissions Coordinator stated when they received referral paper work for Resident #4's recent admission on [DATE] the paper work was submitted under a different name, she stated one of Resident #4's last names had been switched around or removed. The Admissions Coordinator could not provide any documentation of the original paperwork submitted for admission before current admission on [DATE] and stated because it was a denial that paperwork was not uploaded into any chart. During an interview with the responsible party for both Resident #4 and #39 on 10/11/23 at 4:25pm she stated Resident #4 had a history of aggression towards Resident #39 and had previously hit her as well. The responsible party for both Resident #4 and #39 stated the Medical Director knew Resident #4 was aggressive. The responsible party for both Resident #4 and #39 stated 2 or 3 days after Resident #39 was admitted to the facility she went to speak to the Admissions Coordinator at the facility and thought she had told her that Resident #4 was aggressive and that she was scared that Resident #4 would do something to Resident #39. The responsible party for both Resident #4 and #39 stated the Admissions Coordinator told her that Resident #4 and #39 would be fine and that nothing would happen. During an interview with the Admissions Coordinator at the facility on 10/11/23 at 4:50pm she stated there was nothing on Resident #4's records or referral about aggression. The Admissions Coordinator stated family for Resident #4 had not told her about aggression. The Admissions Coordinator stated she was not in communication with the responsible party for both Resident #4 and Resident #39 until Resident #39 was admitted to the facility and stated the only thing the responsible party for both Resident #4 and Resident #39 told her was that Resident #4 and #39 had a very complicated relationship. The Admissions Coordinator at the facility stated the process for reviewing an admission was, that everything was sent to Central Admissions and from there if there was any identified behavior on the paperwork it would be sent to herself, ADM and DON. The Admissions Coordinator stated there were no behaviors identified on either Resident #4 or #39. During an interview with Resident #39 on 10/11/23 at 4:25pm he stated Resident #4 had come to his bed side while he was in his bed and stated Resident #4 started hitting him on the arm with the call light and bit him on the leg after he put his arms up to defend himself. Resident #39 stated he felt fine with Resident #4 until she started to get mad on the day of the incident. During an interview with the Centralized Admissions Nurse on 10/12/23 at 12:08 pm he stated when reviewing referrals, he reviewed the documentation the hospital provides such as physician notes, therapy evaluations, medication records, specific skilled services they were requesting. The Centralized Admissions Nurse stated what he reviewed was documented under Resident #4's chart titled, referral. The Centralized Admissions Nurse stated he had reviewed Resident #4's referral documentation and stated he had concerns regarding history of bipolar disorder, mention of aggressive behavior, and dementia. The Centralized Admissions Nurse stated these concerns would have been sent over to the DON, ADM and the Liaison. The Centralized Admissions Nurse stated the Liaison completed an onsite assessment of Resident #4 on 08/08/23 at the hospital. The Centralized Admissions Nurse stated the Liaisons (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 3 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Immediate jeopardy to resident health or safety Residents Affected - Few onsite included making sure Resident #4 was not on any chemical or physical restraints, was not a 1:1 supervision, speaking with direct care staff and asking about any concerns. The Centralized Admissions Nurse stated during those interviews conducted by the Liaison there were no concerns, and it was identified she was participating with therapy and at that point that decided to move forwards. During an interview with the Liaison 10/12/23 at 12:44pm she stated referrals who are categorized as yellow would require an onsite evaluation on the patient due to concerns of history of behaviors and elopement. The Liaison stated Resident #4 required an onsite evaluation that included her speaking with nurses, attending staff and therapy, she stated through her evaluation she identified Resident #4 was friendly, alert x4, talkative, kind and as per nurse she did have some episodes of confusion but did not with her. The Liaison stated her report was that there were no behaviors and no elopement. The Liaison stated the email from the Centralized Admissions Nurse regarding having her assess Resident #4 for any active behaviors or elopement had also been carbon copied to the ADM, DON, and Admissions Coordinator and stated they were aware of the behaviors being assessed by her. During an interview with the Medical Director on 10/12/23 at 6:21pm he was asked if he was aware of Resident #4's history of aggression towards Resident #39, he stated he had known Resident #4 and #39 for years and stated, this has been going on for years. The Medical Director stated Resident #4 and #39 previously lived together and stated Resident #4 and #39 wanted to be together and did not want to be kept apart so he said it was okay to put them together. When asked if he notified the facility of Resident #4's history of aggression he stated he thought it was written in his discharge summary for Resident #4 and stated the facility was aware that Resident #4 was bipolar. The Medical Director stated Resident #4 was a psych patient and needed to be admitted somewhere she could be monitored, and medication would be given on time and that had a psychologist and psychiatrist available on call to be there for a crisis. The medical director stated Resident #4 was aggressive to those around her by yelling, and would only hit, Resident #39. LVN P was attempted to be reached for telephone interview on 10/13/23 at 9:03am and 9:57am with no answer, voicemail was left however phone call was not returned. During an interview on 10/13/23 at 9:58am with RNS she stated on 9/23/23 she was called over to Resident #4 and #39's by LVN P. RNS stated she observed Resident #4 swinging the bed remote at Resident #39 hitting him on the legs. RNS stated they separated Resident #4 and #39 and checked on Resident #39 who told her Resident #4 had hit him everywhere with both the call light and the bed remote. RNS stated Resident #39 had redness to lower legs and knees and had a bite mark to upper thigh which she stated Resident #4 admitted to doing and Resident #39 confirmed. RNS stated after she separated Resident #4 and Resident #39 she called the doctor to speak with Resident #4 and notify him that she was being aggressive, RNS stated Resident #4 had tried to hit her and slap the phone out of RNS's hand. RNS state Resident #4 cornered her and was able to hit her and stated she believed Resident #4 turned around and had bit and hit LVN P. RNS stated she was not aware of any aggressive behaviors prior to the incident on 9/23/23. RNS stated she spoke to a family member of Resident #4 who stated that was their relationship at home and an APS (Adult Protective Services) worker who was at the building that day had told her that they had previous cases with Resident #4 and #39 for almost 5 years regarding physical arguing. RNS did not provide a name for APS worker. RNS stated Resident #4 had not exhibited similar behaviors towards Resident #39 before incident on 09/23/23. RNS stated Resident #4 only had her moods with refusing medication but that was the only extent of her behaviors. RNS stated she could not recall if Resident #4 had monitoring for behaviors associated with bipolar disorder. RNS stated if a resident had an antipsychotic or antidepressant or anti-convulsant then they would have a monitoring order for sleeplessness, agitation and stated she did not think (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 4 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Immediate jeopardy to resident health or safety Residents Affected - Few it included aggression but more restlessness and insomnia. RNS stated she had done routine checks that included checking on Resident #4 and providing medication. RNS stated she always checked for any behaviors residents demonstrated and would have to notify the appropriate person if any changes were identified. During an interview with the ADM on 10/14/23 at 12:09PM he stated he, and facility staff had been trained over abuse identification and prevention, stating they were trained annually. The ADM stated a fracture, spiral fracture or bruising was considered physical abuse. The ADM stated Resident #4 had struck Resident #39 with the bed remote and had bit Resident #39's thigh. The ADM was asked if he considered the incident between Residents #4 and #39 abuse and he stated it was borderline. The ADM stated Resident #39 had a bite to thigh and bruising to left arm. The ADM stated nobody had made him aware of Resident #4's history of aggressive behaviors before the incident. The ADM stated he was made aware of Resident #4's behaviors after the incident when APS spoke to him and told him stories of incidents in the home setting. The ADM stated he was able to review the resident chart but did not review Resident #4's referral documents in that detail because the Central admission nurse handled that. The ADM stated he did not think there was an indication that Resident #4 had aggressive behaviors. The ADM stated the Medical Director had worked with Resident #4 and #39 previously and stated he could only speculate he was aware of Resident #4's history of aggressive behaviors but could not speak for him. The ADM stated, the Central Admissions nurse had not notified him of Resident #4 having violent behavior. The ADM stated Resident #39 was not scared of Resident #4. The ADM was not aware of Resident #4's care plan information, stating Resident #4 had no behaviors. The ADM stated nurses monitored Resident #4 stated they were with her every day stating any indication of behaviors they would have flagged. The ADM stated Resident #4 had a history of aggressive behaviors, but he was not aware. The ADM stated to ensure residents are free from abuse while in the facility they completed assessments, reviewed data from the physician and any other sources. The ADM stated the data did not indicate the actual violence that occurred, stating he did not know the extent of the aggression because there was not any indication of actual injury. The ADM stated their abuse policy stated they are to keep residents from abuse, he stated the policy was followed in this situation because Resident #39 did not indicate any fear and wanted to be with Resident #4. The ADM stated not identifying residents with history of aggressive behavior could cause a negative impact to other residents such as injury or death. During an interview with the DON on 10/14/23 at 2:35pm she stated her, and facility staff had been trained over abuse identification and prevention, stating training were completed 2 times a month. The DON stated hitting would be considered physical abuse. The DON stated she was notified that Resident #4 had started hitting Resident #39, the DON stated the incident between Resident #4 and #39 was considered physical abuse . The DON stated Resident #39 had purple discoloration of right forearm, left and right hand with redness noted to shin, and right knee. The DON stated Resident #39 was not scared of Resident #4 and wanted to be with her. The DON stated Resident #4 had no exhibited any aggressive behaviors before this incident on 09/23/23. The DON stated to ensure residents are free from abuse while in the facility she made sure that nobody with current aggressive behaviors were paired with anybody else, the DON stated it was effective in the situation with Resident #4 and #39 stating they moved Resident #4 and #39 . The DON stated not identifying residents with history of aggressive behaviors could impact residents because they could potentially be paired with somebody with behaviors who could potentially hurt their neighbors. During an interview with Resident #39 on 10/11/23 at 4:25pm he stated Resident #4 had come to his bed side while he was in his bed and stated Resident #4 started hitting him on the arm with the call light and bit him on the leg after he put his arms up to defend himself. Resident #39 stated he felt (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 5 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 fine with Resident #4 until she started to get mad on the day of the incident. Level of Harm - Immediate jeopardy to resident health or safety Record review of facility's policy titled, Abuse Guidance: Preventing, Identifying and Reporting with an implemented dated of February 2017 and a review date of 10/2022 stated, Every resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation. Residents should not be subjected to abuse by anyone, including, but not limited to, community team members, other residents, consultants, or volunteers, staff of other agencies serving the resident, family members or legal guardians, friends, or other individuals. And The community conducts the following steps to protect the residents, patients and veterans served . Residents should be screened upon referral to ensure that the current staffing patterns and staff expertise are suitable to provide the necessary care that the prospective resident requires, without the possibility of acts of abuse and neglect towards other residents Residents Affected - Few The Administrator and DON were notified of an IJ on 10/13/23 at 3:53PM and were given a copy of the IJ Template and a Plan of Removal (POR) was requested. The Plan of Removal was accepted on 10/14/23 at 4:00pm and included the following: Immediate Plan of Removal for:

F656 Develop/Implement Comprehensive Plan of Care

F600 Freedom from Abuse, Neglect, and Exploitation Immediate Response: Resident #4 was immediately assessed by nursing, medical care provided, and IDT continued to monitored resident to ensure his wellbeing. Resident # 39 was immediately assessed by the nurse and placed on 1:1 for monitoring and discharged for evaluation and treatment. Risk Response: All newly admitted residents who are admitted with historical aggressive behaviors may have been potentially affected. Director of Nursing/Designee will conduct an audit of all recent admissions hospital records to identify any concerns with aggressive behaviors towards others and will review the plan of care to ensure it appropriately reflects potential behavioral risks and/or will update the plan of care as indicated. Date completed: 10-14-23. Administrator/Social Worker/Director of Nursing/Designee will conduct staff and resident interviews to identify any concerns of aggressive behaviors towards others. If identified the IDT will review the plan of care and/or will update the plan of care as indicated in order to ensure it appropriately reflects potential behavioral risks. Date completed: 10-15-23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 6 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Immediate jeopardy to resident health or safety Regional Nurse conducted re-educated to the Director of Nursing and Administrator regarding the Abuse and Neglect Preventing, Identifying and Preventing, admission process to include identifying potential behavioral risks; thus, having the identified risk identified on the plan of care and to ensure appropriate monitoring and supportive interventions are in place. Date completed: 10-14-23. Residents Affected - Few Regional Nurse conducted re-educated to the Director of Nursing and Administrator regarding the RAI process to include but not limited to completion of a resident centered comprehensive care plan on each resident regarding services to attain or maintain the resident's highest practical level of physical, mental, and psychosocial well-being. Date completed: 10-14-23. System Response: Director of Nursing / Assistant Director of Nursing conducted re-educated to the IDT and all licensed nurses regarding the admission process and assessing residents to include identifying potential risks to include but not limited to behavioral risks, such as aggression or aggressive behaviors; thus, ensuring the identified risk is identified on the plan of care to ensure appropriate monitoring and supportive interventions are in place. Date completed: 10-15-23. Director of Nursing / Assistant Director of Nursing conducted re-educated to the IDT and all licensed nurses regarding the RAI process to include but not limited to completion of a resident centered comprehensive care plan on each resident regarding services to attain or maintain the resident's highest practical level of physical, mental, and psychosocial well-being. Date completed: 10-15-23. Education was provided to all staff regarding the process for monitoring, observing, and reporting all behavioral concerns to the licensed nurse in effort to provide needed care, protect the safety and well-being of all residents, to meet the resident's needs, have accurate documentation reflected in clinical record and to ensure appropriate interventions are in place as per facility's expected practices. Date completed: 10-15-23. Regional Nurse conducted re-educated to the Director of Nursing, Administrator admission Coordinator and Centralized Admissions Nurse regarding facility's updated referral/admission protocol effective immediately to implement a mandatory admission acceptance to ensure that all referrals with known physical aggression/aggressive behaviors are cleared by the Director of Nursing and/or Administrator prior to accepting the referral for admission. Date Completed: 10-14-23. Facility has updated its referral/admission protocol effective immediately to implement a mandatory admission acceptance to ensure that all referrals with known physical aggression/aggressive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 7 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 behaviors are cleared by the Director of Nursing and/or Administrator prior to accepting the referral for admission. Level of Harm - Immediate jeopardy to resident health or safety Date Completed: 10-13-2023. Residents Affected - Few Director of Nursing / Designee to conduct retraining for all team members prior to assuming next shift regarding: o Preventing, Identifying and Reporting Abuse and Neglect. Date Completed:10-15-23. Ad Hoc QAPI held with Administrator, Director of Nursing and Medical Director to review the concerns and plan of removal implemented. Date Completed: 10-15-2023. Monitoring Response: ADMIN/DNS/SW/ Designee will conduct random daily rounds 3-7 days a week, on various shifts to validate the safety and well-being of our residents. Director of Nursing/Designee will conduct random weekly audits of 1-3 new admission and/or readmissions' initial care plans and comprehensive care plans in order to validate the accuracy of the care plan by ensuring identified aggressive behavioral or known physical aggression are noted in the plan of care and appropriate interventions are in place. Director of Nursing/Designee will audit and review progress notes, changes in conditions, risk management reports and the nursing 24 hr. report daily 5-7 days per week during the morning clinical meeting in order to validate appropriate follow up and necessary interventions are in place accordingly. This plan will remain in place for the next 3 months and findings will be reported to the QAPI committee during monthly meeting for the next 3 months. The QAPI committee will then determine compliance or identify a need for additional training. The surveyor verification of the Plan of Removal on 10/15/23 and 10/16/23 was as follows: Record review of facility services revealed the DON, MDS and ADM had been trained over the new referral /admission protocol, RAI (Resident Assessment Instrument) process, identifying and preventing abuse and neglect, the admission process to include identifying potential behavior risks and risks that should be care planned and the importance of monitoring of supportive interventions. Record review of facility services revealed the Central Admissions nurse, Liaison, and the Admissions Coordinator, had been trained over the new referral/admission protocol. Record review of facility in services revealed 23 staff members that included nurses and the IDT (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 8 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Immediate jeopardy to resident health or safety Residents Affected - Few (interdisciplinary team) were trained over the RAI process and the admission process to include assessing residents for behavioral risks and care planning the risks and supportive interventions. Record review of in services dated 10/13/23 revealed 90 team members were in serviced over, monitoring/observing/reporting behavioral concerns. Identifying and preventing abuse, neglect and exploitation. The importance of immediately completing the admission assessment/evaluation and exit seeking tool. Identifying exit seeking/elopement risk for all new admission/re-admission and utilizing a wander guard device if the person is identified as an elopement risk and what to o or response to a missing/unaccounted for resident/patient as per community process. Record review on 10/16/23 of resident charts and facility plan of removal revealed facility had identified 4 residents with behaviors, none of which were aggression. Record review of impacted 4 residents revealed all care plans were updated appropriately. A total of 47 staff members were interviewed on 10/15/23 and 10/16/23 across 3 separate shifts, from 6am-2pm, 2pm-10pm and 10pm-6am. Interviewed staff included both direct care and non-direct care staff. All staff members stated they had recently been trained over behaviors, documentation, facility procedures and abuse and neglect. All staff members interviewed were aware of what to do when identifying behaviors, who to report to and where to document identified behaviors. Staff were able to define abuse and neglect, staff gave examples of abuse and neglect, identify abuse and neglect, staff were aware of what to do when abuse and neglect was suspected and who to report to. In addition, nurses and leadership were aware of the admission process and RAI process. During an interview with the DON on 10/15/23 at 12:16pm she stated through audits and staff interviews the facility had identified residents with behaviors and had updated care plans appropriately. The DON stated they would be monitoring residents on a daily basis during morning meetings, through clinical reviews that would include reviewing the 24-hour report that would state any behaviors or changes. The DON stated residents care plans would be updated immediately in the morning meeting if needed. During an interview with the DON on 10/16/23 at around 9:00AM she stated they had identified 4 residents with behaviors however none of the behaviors identified were aggression. The DON stated care plans had been updated to reflect identified behaviors. During an interview with the Medical Director on 10/16/23 at 4:13pm he stated he was a part of a meeting over the weekend (10/14/23-10/15/23) with the facility that covered elopement, door alarms, strategies to monitor the doors, monitoring patients, behaviors and training of the staff to be aware and facility procedures. During an interview on 10/16/23 at 3:50PM with the Central Admissions nurse he stated he had been trained over the new referral/admission protocol and was aware of needing DON and/or ADM approval for approval/denial for new admissions. An IJ was identified on 10/13/23. The IJ template was provided to the facility on [DATE] at 3:53pm. While the IJ was removed on 10/16/23, the facility remained out of compliance at a scope of isolated and a severity level of actual harm. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 9 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were free from abuse for 2 of 8 residents (Residents #39 and #4) reviewed for abuse. Residents Affected - Few The facility did not take measures to prevent physical abuse between R#4 and R#39; R#39 was bit on the upper thigh and struck with a bed remote and call light by R#4. This failure could place residents at risk of physical harm, mental anguish, or emotional distress. An IJ was identified on 10/13/23. The IJ template was provided to the facility on [DATE] at 3:53pm. While the IJ was removed on 10/16/23, the facility remained out of compliance at a scope of isolated and a severity level of actual harm. The findings were: Resident #39: Record review of Resident #39's face sheet, dated 10/15/23, revealed the resident was a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses that included: cardiomegaly (an enlarged heart), essential (primary) hypertension (high blood pressure), cerebral ischemia (results from impaired blood flow to the brain), anxiety disorder, unspecified ( a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), cognitive communication deficit (difficulty with thinking and how someone uses language). Record review of Resident #39's MDS assessment, dated 09/29/23, revealed Resident #39 had a BIMS score of 14, indicating intact cognition. Record review of Resident #39's care plan revealed a focus of, I have impaired cognitive function/or impaired though process related to cerebral ischemia. Record review of Resident #39's skin: abrasion/bruise/edema/mole/rash document dated 09/23/23 completed by RNS revealed Resident #39 had dark purple bruise to left and right hand, dark purple bruising to right forearm, a scratch noted to inferior aspect of left eye, redness to right shin and right knee and a bite mark to right lateral thigh and a scratch noted to right inner aspect of thigh/knee area. Record review of Resident #39's nursing notes dated 09/23/23 at 1:40PM by RNS revealed she was called by LVN P to Resident #4's room which she shared with Resident #39. RNS's nursing note stated she went to Residents #4 and 39's room and observed Resident #4 was being physically and verbally aggressive with Resident #39 with Resident #4 swinging bed remote at Resident #39's bilateral legs. RNS's nursing note stated a Head to toe assessment was performed with noted dark purple bruising to right forearm, dark purple bruise to left and right hand. Redness noted to right shin, right knee and bite mark to right lateral thigh. Scratch noted to inferior aspect of left eye. Scratch noted to right inner aspect of thigh/knee area. Resident #4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 10 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of Resident #4's face sheet, dated 10/15/23, revealed the resident was a [AGE] year-old female who was admitted to the facility on [DATE] and was discharged on 09/27/23 with diagnoses that included: Acute diastolic (occurs when left ventricle muscle becomes stiff or thickened) (congestive) heart failure ( the heart does not pump blood as well as it should ), bipolar disorder (a disorder associated with episodes of mood swings ranging from depressive lows to manic highs), current episode depressed, moderate, dementia (a group of thinking and social symptoms that interferes with daily functioning) in other diseases classified elsewhere, moderate, with mood disturbance, pneumonia (infection that affects one or both lungs), unspecified organism and type 2 diabetes mellitus (high blood sugar) with other specified complication. Record review of Resident #4's 5- day MDS assessment, dated 08/17/23, revealed Resident #4 had a BIMS score of 04, indicating severe cognitive impairment. Record review of Resident #4's care plan did have specific focuses regarding her anti-depressant and anticonvulsant medication but did not address her history of aggression. Resident #4's care plan had a focus of I use anticonvulsant medication as a mood stabilizer related to Dementia with mood disturbances; Bipolar and I require anti-depressant medication related to diagnosis of Depression which had an intervention to Monitor/document/report to MD prn ongoing signs and symptoms of depression unaltered by antidepressant meds: Sad, irritable, anger, never satisfied, crying, shame, worthlessness, guilt, suicidal ideations, neg. mood/comments, slowed movement , agitation, disrupted sleep, fatigue, lethargy, does not enjoy usual activities, changes in cognition, changes in weight/appetite, fear of being alone or with others, unrealistic fears, attention seeking, concern with body functions, anxiety, all which had a created date of 08/24/23 and an initiated date of 10/14/23 Record review of Resident #4's hospital paper work submitted as part of her referral revealed a history of present illness from admission date 07/31/23 stating This lady is a psychiatric patient by all means who requires psychiatric attention. Not too long ago she was admitted for psychiatric treatment after an overdose and several episodes of fights and aggression at home with husband and others who may be there. Last week she was here in the emergency room for the same reason. It also included a hospital progress note for Resident #4 stating there was an open legal case for domestic abuse. Record review of Resident #4's nursing notes dated 09/23/23 at 1:40PM by RNS revealed she was called by LVN P to Resident #4's room which she shared with Resident #39. RNS's nursing note stated she went to Residents #4 and 39's room and observed Resident #4 swinging bed remote at Resident #39 striking him multiple times. During an interview on 10/11/23 at 5:10pm with the DON and ADM they both stated they were not aware of any APS case or Resident #4's behaviors prior to the incident between Resident #4 and #39 on 9/23/23. During an interview with the Admissions Coordinator at the facility on 10/11/23 at 3:25pm she stated Resident #4 had originally sent over paper work for admission months before her recent admission on [DATE] and stated that paperwork did include resident #4's behaviors and aggression towards Resident #39 and stated she was denied admission. The Admissions Coordinator stated when they received referral paper work for Resident #4's recent admission on [DATE] the paper work was submitted under a different name, she stated one of Resident #4's last names had been switched around or removed. The Admissions Coordinator could not provide any documentation of the original paperwork submitted for admission before current admission on [DATE] and stated because it was a denial that paperwork was not uploaded into any chart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 11 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few During an interview with the responsible party for both Resident #4 and #39 on 10/11/23 at 4:25pm she stated Resident #4 had a history of aggression towards Resident #39 and had previously hit her as well. The responsible party for both Resident #4 and #39 stated the Medical Director knew Resident #4 was aggressive. The responsible party for both Resident #4 and #39 stated 2 or 3 days after Resident #39 was admitted to the facility she went to speak to the Admissions Coordinator at the facility and thought she had told her that Resident #4 was aggressive and that she was scared that Resident #4 would do something to Resident #39. The responsible party for both Resident #4 and #39 stated the Admissions Coordinator told her that Resident #4 and #39 would be fine and that nothing would happen. During an interview with the Admissions Coordinator at the facility on 10/11/23 at 4:50pm she stated there was nothing on Resident #4's records or referral about aggression. The Admissions Coordinator stated family for Resident #4 had not told her about aggression. The Admissions Coordinator stated she was not in communication with the responsible party for both Resident #4 and Resident #39 until Resident #39 was admitted to the facility and stated the only thing the responsible party for both Resident #4 and Resident #39 told her was that Resident #4 and #39 had a very complicated relationship. The Admissions Coordinator at the facility stated the process for reviewing an admission was, that everything was sent to Central Admissions and from there if there was any identified behavior on the paperwork it would be sent to herself, ADM and DON. The Admissions Coordinator stated there were no behaviors identified on either Resident #4 or #39. During an interview with Resident #39 on 10/11/23 at 4:25pm he stated Resident #4 had come to his bed side while he was in his bed and stated Resident #4 started hitting him on the arm with the call light and bit him on the leg after he put his arms up to defend himself. Resident #39 stated he felt fine with Resident #4 until she started to get mad on the day of the incident. During an interview with the Centralized Admissions Nurse on 10/12/23 at 12:08 pm he stated when reviewing referrals, he reviewed the documentation the hospital provides such as physician notes, therapy evaluations, medication records, specific skilled services they were requesting. The Centralized Admissions Nurse stated what he reviewed was documented under Resident #4's chart titled, referral. The Centralized Admissions Nurse stated he had reviewed Resident #4's referral documentation and stated he had concerns regarding history of bipolar disorder, mention of aggressive behavior, and dementia. The Centralized Admissions Nurse stated these concerns would have been sent over to the DON, ADM and the Liaison. The Centralized Admissions Nurse stated the Liaison completed an onsite assessment of Resident #4 on 08/08/23 at the hospital. The Centralized Admissions Nurse stated the Liaisons onsite included making sure Resident #4 was not on any chemical or physical restraints, was not a 1:1 supervision, speaking with direct care staff and asking about any concerns. The Centralized Admissions Nurse stated during those interviews conducted by the Liaison there were no concerns, and it was identified she was participating with therapy and at that point that decided to move forwards. During an interview with the Liaison 10/12/23 at 12:44pm she stated referrals who are categorized as yellow would require an onsite evaluation on the patient due to concerns of history of behaviors and elopement. The Liaison stated Resident #4 required an onsite evaluation that included her speaking with nurses, attending staff and therapy, she stated through her evaluation she identified Resident #4 was friendly, alert x4, talkative, kind and as per nurse she did have some episodes of confusion but did not with her. The Liaison stated her report was that there were no behaviors and no elopement. The Liaison stated the email from the Centralized Admissions Nurse regarding having her assess Resident #4 for any active behaviors or elopement had also been carbon copied to the ADM, DON, and Admissions Coordinator and stated they were aware of the behaviors being assessed by her. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 12 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few During an interview with the Medical Director on 10/12/23 at 6:21pm he was asked if he was aware of Resident #4's history of aggression towards Resident #39, he stated he had known Resident #4 and #39 for years and stated, this has been going on for years. The Medical Director stated Resident #4 and #39 previously lived together and stated Resident #4 and #39 wanted to be together and did not want to be kept apart so he said it was okay to put them together. When asked if he notified the facility of Resident #4's history of aggression he stated he thought it was written in his discharge summary for Resident #4 and stated the facility was aware that Resident #4 was bipolar. The Medical Director stated Resident #4 was a psych patient and needed to be admitted somewhere she could be monitored, and medication would be given on time and that had a psychologist and psychiatrist available on call to be there for a crisis. The medical director stated Resident #4 was aggressive to those around her by yelling, and would only hit, Resident #39. LVN P was attempted to be reached for telephone interview on 10/13/23 at 9:03am and 9:57am with no answer, voicemail was left however phone call was not returned. During an interview on 10/13/23 at 9:58am with RNS she stated on 9/23/23 she was called over to Resident #4 and #39's by LVN P. RNS stated she observed Resident #4 swinging the bed remote at Resident #39 hitting him on the legs. RNS stated they separated Resident #4 and #39 and checked on Resident #39 who told her Resident #4 had hit him everywhere with both the call light and the bed remote. RNS stated Resident #39 had redness to lower legs and knees and had a bite mark to upper thigh which she stated Resident #4 admitted to doing and Resident #39 confirmed. RNS stated after she separated Resident #4 and Resident #39 she called the doctor to speak with Resident #4 and notify him that she was being aggressive, RNS stated Resident #4 had tried to hit her and slap the phone out of RNS's hand. RNS state Resident #4 cornered her and was able to hit her and stated she believed Resident #4 turned around and had bit and hit LVN P. RNS stated she was not aware of any aggressive behaviors prior to the incident on 9/23/23. RNS stated she spoke to a family member of Resident #4 who stated that was their relationship at home and an APS (Adult Protective Services) worker who was at the building that day had told her that they had previous cases with Resident #4 and #39 for almost 5 years regarding physical arguing. RNS did not provide a name for APS worker. RNS stated Resident #4 had not exhibited similar behaviors towards Resident #39 before incident on 09/23/23. RNS stated Resident #4 only had her moods with refusing medication but that was the only extent of her behaviors. RNS stated she could not recall if Resident #4 had monitoring for behaviors associated with bipolar disorder. RNS stated if a resident had an antipsychotic or antidepressant or anti-convulsant then they would have a monitoring order for sleeplessness, agitation and stated she did not think it included aggression but more restlessness and insomnia. RNS stated she had done routine checks that included checking on Resident #4 and providing medication. RNS stated she always checked for any behaviors residents demonstrated and would have to notify the appropriate person if any changes were identified. During an interview with the ADM on 10/14/23 at 12:09PM he stated he, and facility staff had been trained over abuse identification and prevention, stating they were trained annually. The ADM stated a fracture, spiral fracture or bruising was considered physical abuse. The ADM stated Resident #4 had struck Resident #39 with the bed remote and had bit Resident #39's thigh. The ADM was asked if he considered the incident between Residents #4 and #39 abuse and he stated it was borderline. The ADM stated Resident #39 had a bite to thigh and bruising to left arm. The ADM stated nobody had made him aware of Resident #4's history of aggressive behaviors before the incident. The ADM stated he was made aware of Resident #4's behaviors after the incident when APS spoke to him and told him stories of incidents in the home setting. The ADM stated he was able to review the resident chart but did not review Resident #4's referral documents in that detail because the Central (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 13 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few admission nurse handled that. The ADM stated he did not think there was an indication that Resident #4 had aggressive behaviors. The ADM stated the Medical Director had worked with Resident #4 and #39 previously and stated he could only speculate he was aware of Resident #4's history of aggressive behaviors but could not speak for him. The ADM stated, the Central Admissions nurse had not notified him of Resident #4 having violent behavior. The ADM stated Resident #39 was not scared of Resident #4. The ADM was not aware of Resident #4's care plan information, stating Resident #4 had no behaviors. The ADM stated nurses monitored Resident #4 stated they were with her every day stating any indication of behaviors they would have flagged. The ADM stated Resident #4 had a history of aggressive behaviors, but he was not aware. The ADM stated to ensure residents are free from abuse while in the facility they completed assessments, reviewed data from the physician and any other sources. The ADM stated the data did not indicate the actual violence that occurred, stating he did not know the extent of the aggression because there was not any indication of actual injury. The ADM stated their abuse policy stated they are to keep residents from abuse, he stated the policy was followed in this situation because Resident #39 did not indicate any fear and wanted to be with Resident #4. The ADM stated not identifying residents with history of aggressive behavior could cause a negative impact to other residents such as injury or death. During an interview with the DON on 10/14/23 at 2:35pm she stated her, and facility staff had been trained over abuse identification and prevention, stating training were completed 2 times a month. The DON stated hitting would be considered physical abuse. The DON stated she was notified that Resident #4 had started hitting Resident #39, the DON stated the incident between Resident #4 and #39 was considered physical abuse . The DON stated Resident #39 had purple discoloration of right forearm, left and right hand with redness noted to shin, and right knee. The DON stated Resident #39 was not scared of Resident #4 and wanted to be with her. The DON stated Resident #4 had no exhibited any aggressive behaviors before this incident on 09/23/23. The DON stated to ensure residents are free from abuse while in the facility she made sure that nobody with current aggressive behaviors were paired with anybody else, the DON stated it was effective in the situation with Resident #4 and #39 stating they moved Resident #4 and #39 . The DON stated not identifying residents with history of aggressive behaviors could impact residents because they could potentially be paired with somebody with behaviors who could potentially hurt their neighbors. During an interview with Resident #39 on 10/11/23 at 4:25pm he stated Resident #4 had come to his bed side while he was in his bed and stated Resident #4 started hitting him on the arm with the call light and bit him on the leg after he put his arms up to defend himself. Resident #39 stated he felt fine with Resident #4 until she started to get mad on the day of the incident. Record review of facility's policy titled, Abuse Guidance: Preventing, Identifying and Reporting with an implemented dated of February 2017 and a review date of 10/2022 stated, Every resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation. Residents should not be subjected to abuse by anyone, including, but not limited to, community team members, other residents, consultants, or volunteers, staff of other agencies serving the resident, family members or legal guardians, friends, or other individuals. And The community conducts the following steps to protect the residents, patients and veterans served . Residents should be screened upon referral to ensure that the current staffing patterns and staff expertise are suitable to provide the necessary care that the prospective resident requires, without the possibility of acts of abuse and neglect towards other residents The Administrator and DON were notified of an IJ on 10/13/23 at 3:53PM and were given a copy of the IJ Template and a Plan of Removal (POR) was requested. The Plan of Removal was accepted on 10/14/23 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 14 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 at 4:00pm and included the following: Level of Harm - Immediate jeopardy to resident health or safety Immediate Plan of Removal for: Residents Affected - Few

F600 Freedom from Abuse, Neglect, and Exploitation

F656 Develop/Implement Comprehensive Plan of Care Immediate Response: Resident #4 was immediately assessed by nursing, medical care provided, and IDT continued to monitored resident to ensure his wellbeing. Resident # 39 was immediately assessed by the nurse and placed on 1:1 for monitoring and discharged for evaluation and treatment. Risk Response: All newly admitted residents who are admitted with historical aggressive behaviors may have been potentially affected. Director of Nursing/Designee will conduct an audit of all recent admissions hospital records to identify any concerns with aggressive behaviors towards others and will review the plan of care to ensure it appropriately reflects potential behavioral risks and/or will update the plan of care as indicated. Date completed: 10-14-23. Administrator/Social Worker/Director of Nursing/Designee will conduct staff and resident interviews to identify any concerns of aggressive behaviors towards others. If identified the IDT will review the plan of care and/or will update the plan of care as indicated in order to ensure it appropriately reflects potential behavioral risks. Date completed: 10-15-23. Regional Nurse conducted re-educated to the Director of Nursing and Administrator regarding the Abuse and Neglect Preventing, Identifying and Preventing, admission process to include identifying potential behavioral risks; thus, having the identified risk identified on the plan of care and to ensure appropriate monitoring and supportive interventions are in place. Date completed: 10-14-23. Regional Nurse conducted re-educated to the Director of Nursing and Administrator regarding the RAI process to include but not limited to completion of a resident centered comprehensive care plan on each resident regarding services to attain or maintain the resident's highest practical level of physical, mental, and psychosocial well-being. Date completed: 10-14-23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 15 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 System Response: Level of Harm - Immediate jeopardy to resident health or safety Director of Nursing / Assistant Director of Nursing conducted re-educated to the IDT and all licensed nurses regarding the admission process and assessing residents to include identifying potential risks to include but not limited to behavioral risks, such as aggression or aggressive behaviors; thus, ensuring the identified risk is identified on the plan of care to ensure appropriate monitoring and supportive interventions are in place. Residents Affected - Few Date completed: 10-15-23. Director of Nursing / Assistant Director of Nursing conducted re-educated to the IDT and all licensed nurses regarding the RAI process to include but not limited to completion of a resident centered comprehensive care plan on each resident regarding services to attain or maintain the resident's highest practical level of physical, mental, and psychosocial well-being. Date completed: 10-15-23. Education was provided to all staff regarding the process for monitoring, observing, and reporting all behavioral concerns to the licensed nurse in effort to provide needed care, protect the safety and well-being of all residents, to meet the resident's needs, have accurate documentation reflected in clinical record and to ensure appropriate interventions are in place as per facility's expected practices. Date completed: 10-15-23. Regional Nurse conducted re-educated to the Director of Nursing, Administrator admission Coordinator and Centralized Admissions Nurse regarding facility's updated referral/admission protocol effective immediately to implement a mandatory admission acceptance to ensure that all referrals with known physical aggression/aggressive behaviors are cleared by the Director of Nursing and/or Administrator prior to accepting the referral for admission. Date Completed: 10-14-23. Facility has updated its referral/admission protocol effective immediately to implement a mandatory admission acceptance to ensure that all referrals with known physical aggression/aggressive behaviors are cleared by the Director of Nursing and/or Administrator prior to accepting the referral for admission. Date Completed: 10-13-2023. Director of Nursing / Designee to conduct retraining for all team members prior to assuming next shift regarding: o Preventing, Identifying and Reporting Abuse and Neglect. Date Completed:10-15-23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 16 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Ad Hoc QAPI held with Administrator, Director of Nursing and Medical Director to review the concerns and plan of removal implemented. Date Completed: 10-15-2023. Monitoring Response: Residents Affected - Few ADMIN/DNS/SW/ Designee will conduct random daily rounds 3-7 days a week, on various shifts to validate the safety and well-being of our residents. Director of Nursing/Designee will conduct random weekly audits of 1-3 new admission and/or readmissions' initial care plans and comprehensive care plans in order to validate the accuracy of the care plan by ensuring identified aggressive behavioral or known physical aggression are noted in the plan of care and appropriate interventions are in place. Director of Nursing/Designee will audit and review progress notes, changes in conditions, risk management reports and the nursing 24 hr. report daily 5-7 days per week during the morning clinical meeting in order to validate appropriate follow up and necessary interventions are in place accordingly. This plan will remain in place for the next 3 months and findings will be reported to the QAPI committee during monthly meeting for the next 3 months. The QAPI committee will then determine compliance or identify a need for additional training. The surveyor verification of the Plan of Removal on 10/15/23 and 10/16/23 was as follows: Record review of facility services revealed the DON, MDS and ADM had been trained over the new referral /admission protocol, RAI (Resident Assessment Instrument) process, identifying and preventing abuse and neglect, the admission process to include identifying potential behavior risks and risks that should be care planned and the importance of monitoring of supportive interventions. Record review of facility services revealed the Central Admissions nurse, Liaison, and the Admissions Coordinator, had been trained over the new referral/admission protocol. Record review of facility in services revealed 23 staff members that included nurses and the IDT (interdisciplinary team) were trained over the RAI process and the admission process to include assessing residents for behavioral risks and care planning the risks and supportive interventions. Record review of in services dated 10/13/23 revealed 90 team members were in serviced over, monitoring/observing/reporting behavioral concerns. Identifying and preventing abuse, neglect and exploitation. The importance of immediately completing the admission assessment/evaluation and exit seeking tool. Identifying exit seeking/elopement risk for all new admission/re-admission and utilizing a wander guard device if the person is identified as an elopement risk and what to o or response to a missing/unaccounted for resident/patient as per community process. Record review on 10/16/23 of resident charts and facility plan of removal revealed facility had identified 4 residents with behaviors, none of which were aggression. Record review of impacted 4 residents revealed all care plans were updated appropriately. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 17 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few A total of 47 staff members were interviewed on 10/15/23 and 10/16/23 across 3 separate shifts, from 6am-2pm, 2pm-10pm and 10pm-6am. Interviewed staff included both direct care and non-direct care staff. All staff members stated they had recently been trained over behaviors, documentation, facility procedures and abuse and neglect. All staff members interviewed were aware of what to do when identifying behaviors, who to report to and where to document identified behaviors. Staff were able to define abuse and neglect, staff gave examples of abuse and neglect, identify abuse and neglect, staff were aware of what to do when abuse and neglect was suspected and who to report to. In addition, nurses and leadership were aware of the admission process and RAI process. During an interview with the DON on 10/15/23 at 12:16pm she stated through audits and staff interviews the facility had identified residents with behaviors and had updated care plans appropriately. The DON stated they would be monitoring residents on a daily basis during morning meetings, through clinical reviews that would include reviewing the 24-hour report that would state any behaviors or changes. The DON stated residents care plans would be updated immediately in the morning meeting if needed. During an interview with the DON on 10/16/23 at around 9:00AM she stated they had identified 4 residents with behaviors however none of the behaviors identified were aggression. The DON stated care plans had been updated to reflect identified behaviors. During an interview with the Medical Director on 10/16/23 at 4:13pm he stated he was a part of a meeting over the weekend (10/14/23-10/15/23) with the facility that covered elopement, door alarms, strategies to monitor the doors, monitoring patients, behaviors and training of the staff to be aware and facility procedures. During an interview on 10/16/23 at 3:50PM with the Central Admissions nurse he stated he had been trained over the new referral/admission protocol and was aware of needing DON and/or ADM approval for approval/denial for new admissions. An IJ was identified on 10/13/23. The IJ template was provided to the facility on [DATE] at 3:53pm. While the IJ was removed on 10/16/23, the facility remained out of compliance at a scope of isolated and a severity level of actual harm FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 18 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property were reported immediately, but not later than 2 hours after the allegation was made, if the alleged violation involved abuse or resulted in serious bodily injury, to the administrator of the facility and to other officials (which included to the State Survey Agency) in accordance with State law through established procedures for 1 of 8 residents (Resident #5) reviewed for reporting alleged allegation of abuse. The facility did not report, within 2 hours, when Resident #5's responsible party reported on 06/23/23 to the Social Worker (SW) that LVN M had been rude to Resident #5 on 06/22/23. This failure could place residents at risk for undetected abuse, neglect and/or decline in feelings of safety and well-being. The findings included: Record review of Resident #5's face sheet, dated 10/14/23, revealed an [AGE] year-old male with an admission date of 06/21/23 and discharge date of 6/23/23 with diagnoses which included: essential (primary) hypertension (high blood pressure), type 2 diabetes mellitus with other specified complication (high blood sugar), Parkinson's disease (a disorder of the central nervous system that affects movement), end stage renal disease (when kidney function that has declined and can no longer function on their own) and other Alzheimer disease ( a progressive disease that destroys memory and other important mental functions). Record review of Resident #5's Medicare 5-day MDS assessment dated [DATE] revealed a BIMS was not conducted due to resident rarely/never understood. Record Review of TULIP (Health and Human Services Commission online incident reporting application) on 10/10/23 at 5:00p.m., revealed the facility made a self-reported incident on 06/26/23 at 4:09PM in regard to facility Liaison being notified by hospital case manager that Resident #5's responsible party had stated Resident #5 was hit by LVN M while at the facility. Record review of grievances revealed a grievance report dated 6/26/23 regarding an incident on 6/22/23 filled out by the DON. The grievance concern was regarding LVN M talking to Resident #5 in a strong tone as if she was mad. Record review of in-service training reports revealed a training dated 06/26/23 and titled caring for residents with dementia that covered how to respond to aggression in residents with dementia signed by LVN M and given by the Director of Education. Record review of in-service training reports revealed a training dated 06/26/23 and titled Customer service that covered quality treatment/care, being courteous and respectful signed by LVN M and given by the Director of Education. During an interview with Resident #5's responsible party on 10/10/23 at 4:43pm she stated when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 19 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #5 arrived to the facility at midnight on 6/22/23 she observed LVN M yelling at Resident #5 and began recording the encounter. The responsible party for Resident #5 refused to share video evidence for review. Resident #5's responsible party stated later that same day she had told many staff members at the facility about her encounter with LVN M yelling at Resident #5 but could not remember the names of the staff members she spoke to; and stated she stated somebody from the state had met with her at the hospital regarding allegation of LVN M yelling at Resident #5. During an interview on 10/11/23 at 12:35pm with LVN M she stated her interaction with Resident #5 only involved her telling him to calm down because he was going to fall and was throwing his hands, trying to remove his peg tube and was very restless. LVN M stated she did not speak rudely to Resident #5. LVN M stated she had been trained over identifying, preventing and reporting abuse and neglect within the previous 2 months and sated staff were given in services almost monthly. During an interview with the DON on 10/12/23 at 10:00am she stated she was made aware of allegation involving LVN M and Resident #5 by the Liaison after Resident #5's responsible party made a complaint at the hospital. The DON stated she completed the grievance the same day she got report from the Liaison on 6/26/23. The DON stated nobody had made her aware of the allegation before this. The DON stated staff should report allegations directly to her when made aware. During an interview with Resident #5's responsible party on 10/13/23 at 9:10pm she stated she felt the interaction between LVN M and Resident #5 was abuse. During an interview with the SW on 10/14/23 at 8:14am she stated Resident #5's responsible party made an allegation about a nurse being rude to Resident #5. The SW stated she could not recall the exact date Resident #5 's responsible party made her aware of allegation but stated it was the day Resident #5 had pulled out his peg tube. Record review identified Resident #5 was admitted to the hospital due to peg tube being dislodged on 6/23/23. The SW stated she did not think she suspected abuse and did not know if it was an allegation of abuse stating Resident #5's responsible party had stated a nurse was talking to Resident #5 in a rude way and she had not seen anything else. The SW stated when a resident or responsible party made an allegation of abuse she had to immediately report it to the ADM. The SW stated she reported the allegation but did not recall to who. The SW stated the ADM was responsible for reporting allegation of abuse and stated she had been previously trained over reporting allegations of abuse. The SW stated the appropriate time frame to report allegations of abuse to state agencies was within 2 hours. The SW stated she was not aware if a self-report was completed within that 2-hour time frame. The SW stated her, and facility leadership ensured allegations of abuse were reported appropriately by having discussions during their morning meetings and contacting the ADM or DON immediately with any emergencies. The SW stated the facility policy regarding reporting allegations of abuse was to report it, stating its an obligation. The SW stated she followed the facility policy on reporting allegations of abuse because she told somebody. The SW stated not appropriately reporting allegations of abuse could negatively affect the residents because they would be neglecting the residents and ignoring the situation and could put the resident's life in danger. During an interview with the ADM on 10/14/23 at 11:23am he stated he was responsible for reporting any allegations of abuse. The ADM stated he and his staff had been trained over reporting requirements for allegations of abuse recently and very frequently, he stated during those trainings they went over policy and procedures that the facility followed and used data from HHSC (Health and Human Services Commission), the ADM did not specify what data. The ADM also stated he and his staff got trained through an online training program. The ADM stated he was not made aware by the SW of the allegation Resident #5's responsible party made of a staff member being rude to Resident #5 on 06/22/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 20 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The ADM stated he was made aware when he got a message from the marketer at the hospital after Resident #5's responsible party made a comment to the case manager at the hospital. The ADM stated if there was an allegation of abuse the SW should have reported the allegation to him. The ADM stated being rude or making a comment could be considered abuse and would warrant an investigation. The ADM stated he always suspects abuse until an investigation completed. The ADM stated the appropriate time frame for staff to report allegations of abuse was immediately. The ADM stated that in talking with the SW there was no allegation of abuse and that was why she did not report it to him. The ADM stated the facility policy regarding allegations of abuse was to report to the abuse coordinator immediately and report to state by their time criteria's. The ADM stated based on the information he had he did follow the facility policy. The ADM stated leadership ensures allegations of abuse are reported appropriately by in-servicing staff that any allegations or suspicions need to be reported at any time. The ADM stated the 24-hour reports were reviewed in the morning meeting and stated that's when he would start to question and look into things. The ADM stated not appropriately reporting allegations of abuse can negatively affect the residents because if it was not reported and there was actual abuse or neglect them it will continue and can lead to other issues not just with the resident with others. Record review of facility policy titled Abuse Guidance: Preventing, Identifying and reporting with an implementation date of February 2017 and a reviewed date of 10/2022 stated under section Reporting allegation or Suspicions of Abuse reads, Report any alleged or suspicions of abuse to HHSC (Health and Human Services Commission) by telephone reporting or via TULIP (HHSC online incident reporting application)reporting within the designated time frames in accordance with HHS's (Health and Human Services) PL (Provider Letter) 19-17 (Replaces PL 17-18). Are reported immediately, But not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, Or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 21 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0635 Provide doctor's orders for the resident's immediate care at the time the resident was admitted. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure for 1 of 11 residents (Resident 13) was admitted with physician order for thier care reviewed for admission orders. Residents Affected - Few 1.There were no physician orders for R #13 to receive dialysis treatment. This deficient practice could affect residents and place them at risk of not receiving the care and services to meet their needs. Findings include: Record review of R #13's Face Sheet revealed a [AGE] year-old female, with an original admission date of 04/25/2019 and a readmission date of 09/08/2023. Diagnoses included type two diabetes (condition resulting from insufficient production of insulin) with polyneuropathy (general degeneration of peripheral nerve that spreads toward the center of the body), congestive heart failure (impairment of the heart's blood pumping function), myocardial infarction (heart attack), muscle wasting and atrophy (loss or decrease of muscle mass), end stage renal failure ( kidney failure), and acute osteomyelitis (infection of bone) of the right foot and ankle. Record review of R #13's Quarterly Minimum Data Set, dated [DATE] revealed R #13 had a BIMS (Brief Interview Mental Status) of 14 (Cognition Intact) and requires Extensive Assistance with, bed mobility, transfers, dressing, toilet use and personal hygiene. Record review of R #13's Care Plan dated 09/27/2023 revealed R #13 had ESRD (End Stage Renal Disease) and require dialysis treatments and at risk for increased S.O.B., chest pains, increase or decrease of blood pressure, itchy skin, nausea\vomiting, loose stools, dehydration and infected/mal-functioning access site. Record Review of R #13's physician orders did not state an order for dialysis but did have the following orders: Dated 9/8/2023 Check Shunt Site for Thrill & Bruit Q Shift and PRN; if not present, notify physician every shift and as needed. Dated 9/8/2023 Check Shunt Site for bleeding Q Shift and PRN; if bleeding present apply pressure to site and notify physician. Dated 9/8/2023 Check site to ensure dressing dry & intact Q shift; if not, reinforce dressing with occlusive pressure dressing- to be schedule for dialysis days only. Interview on 10/13/23 at 10:44 AM the DON stated R #13's orders do not state R #13 was ordered to receive dialysis, but there were orders to monitor for s/s (signs and symptoms) of any dialysis complication, but there should be a physician order. The DON stated there was no specific reason why the order was missed and the ADON and the DON oversee that physician orders are updated and correct. DON stated physician orders were needed to make sure resident orders are in place to reflect current treatment and so other healthcare professionals (hospital, doctors, nurses, etc.) can be aware of R #13's treatments and current orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 22 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with R #13 on 10/11/2023 at 10:53AM stated she did recieve dialysis treatment and the facility trasports her to and from treatments on Tuesday's, Thursday's, and Saturday's. Record review of Professional Standard of Care Policy dated 2017 stated; The community provides services that meet professional standards of quality and are provided by appropriately qualified persons. d) When a licensed nurse takes a verbal or telephone order from a physician, podiatrist, or dentist, the nurse must sign the order. The community must obtain the physician's, podiatrist's, or dentist's signature on the order and return it to the clinical record in a timely manner. e) Nurses must enter, or approve and sign, nurse's notes in the following instances 1) at least monthly. Routine charting for residents must reflect the recipient's ability as assessed on the way he performs his activities of daily living at least 60% of the time; and 2. at the time of any physical complaints, accidents, incidents, change in condition or diagnosis, and progress. All of these situations must be promptly recorded as exceptions and included in the clinical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 23 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Some 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 observation, interview, and record review, the facility failed to develop and implement a person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 3 of 8 residents (Resident #'s 4, #13, and #17) reviewed for comprehensive care plans in that: 1. The facility did not identify or implement interventions for Resident #4's history of aggression. 2. The facility did not implement the comprehensive person-centered care plan set forth for R #13 (care plan did not state R #13 was on a renal diet). 3. R #17's code status was not updated in the care plan to reflect current physician orders. This deficient practice could place residents at risk for not receiving appropriate treatment and services. The findings were: Record review of Resident #4's face sheet, dated 10/15/23, revealed the resident was a [AGE] year-old female who was admitted to the facility on [DATE] and was discharged on 09/27/23 with diagnoses that included: Acute diastolic (occurs when left ventricle muscle becomes stiff or thickened) (congestive) heart failure ( the heart does not pump blood as well as it should ), bipolar disorder (a disorder associated with episodes of mood swings ranging from depressive lows to manic highs), current episode depressed, moderate, dementia (a group of thinking and social symptoms that interferes with daily functioning) in other diseases classified elsewhere, moderate, with mood disturbance, pneumonia (infection that affects one or both lungs), unspecified organism and type 2 diabetes mellitus (high blood sugar) with other specified complication. Record review of Resident #4's 5- day MDS assessment, dated 08/17/23, revealed Resident #4 had a BIMS score of 04, indicating severe cognitive impairment. Record review of Resident #4's care plan did have specific focuses regarding her anti-depressant and anticonvulsant medication but did not address her history of aggression. Resident #4's care plan had a focus of I use anticonvulsant medication as a mood stabilizer related to Dementia with mood disturbances; Bipolar and I require anti-depressant medication related to diagnosis of Depression which had an intervention to Monitor/document/report to MD prn ongoing signs and symptoms of depression unaltered by antidepressant meds: Sad, irritable, anger, never satisfied, crying, shame, worthlessness, guilt, suicidal ideations, neg. mood/comments, slowed movement , agitation, disrupted sleep, fatigue, lethargy, does not enjoy usual activities, changes in cognition, changes in weight/appetite, fear of being alone or with others, unrealistic fears, attention seeking, concern with body functions, anxiety, all which had a created date of 08/24/23 and an initiated date of 10/14/23 Record review of Resident #4's hospital paper work submitted as part of her referral revealed a history of present illness from admission date 07/31/23 stating This lady is a psychiatric patient by all means who requires psychiatric attention. Not too long ago she was admitted for psychiatric (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 24 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Some treatment after an overdose and several episodes of fights and aggression at home with husband and others who may be there. Last week she was here in the emergency room for the same reason. Record review of Resident #4's nursing notes dated 09/23/23 at 1:40PM by RNS revealed she was called by LVN P to Resident #4's room which she shared with her husband Resident #39. RNS's nursing note stated she went to Resident #4 and 39's room and observed Resident #4 swinging bed remote at Resident #39 striking him multiple times. During an interview on 10/11/23 at 5:10pm with the DON and ADM they both stated they were not aware of any APS case or Resident #4's behaviors prior to the incident between Resident #4 and #39 on 9/23/23. During an interview with the Admissions Coordinator at the facility on 10/11/23 at 3:25pm she stated Resident #4 had originally sent over paper work for admission months before her recent admission on [DATE] and stated that paperwork did include resident behaviors and aggression towards her husband. The Admissions Coordinator at the facility stated Resident #4's original referral was denied. The Admissions Coordinator stated when they received referral paper work for Resident #4's recent admission on [DATE] the paper work was submitted under a different name, she stated one of Resident #4's last names had been switched around or removed. The Admissions Coordinator could not provide any documentation of the original paperwork submitted for admission before current admission on [DATE] and stated because it was a denial that paperwork was not uploaded into any chart. During an interview with the responsible party for both Resident #4 and #39 on 10/11/23 at 4:25pm she sated Resident #4 had a history of aggression towards Resident #39 and had previously hit her as well. The responsible party for both Resident #4 and #39 stated the Medical Director knew Resident #4 was aggressive. The responsible party for both Resident #4 and #39 stated 2 or 3 days after Resident #39 was admitted to the facility she went to speak to the Admissions Coordinator at the facility and thought she had told her that Resident #4 was aggressive and that she was scared that Resident #4 would do something to Resident #39. The responsible party for both Resident #4 and #39 stated the Admissions Coordinator told her that Resident #4 and #39 would be fie and that nothing would happen. During an interview with the Admissions Coordinator at the facility on 10/11/23 at 4:50pm she stated there was nothing on Resident #4's records or referral about aggression. The Admissions Coordinator stated family for Resident #4 had not told her about aggression. The Admissions Coordinator stated she was not in communication with the responsible party for both Resident #4 and Resident #39 until Resident #39 was admitted to the facility and stated only thing the responsible party for both Resident #4 and Resident #39 told her was that Resident #4 and #39 had a very complicated relationship. The Admissions Coordinator at the facility stated process for review got admission was that everything got sent to Central Admissions and from there if he identified any behavior on the paperwork it would be sent to herself, ADM and DON. The Admissions Coordinator stated there were no behaviors identified on neither Resident #4 or #39. During an interview with the Centralized Admissions Nurse on 10/12/23 at 12:08 pm he stated when reviewing referrals, he reviews the documentation the hospital provides such as physician notes, therapy evaluations, medication records, specific skilled services they were requesting. The Centralized Admissions Nurse stated what he reviewed was documented under Resident #4's chart titled, referral. The Centralized Admissions Nurse stated he had reviewed Resident #4's referral documentation and stated he had concerns regarding history of bipolar disorder, mention of aggressive behavior, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 25 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Some dementia. The Centralized Admissions Nurse stated these concerns would have been sent over to the DON, ADM and the Liaison. The Centralized Admissions Nurse stated the Liaison completed an onsite assessment of Resident #4 on 08/08/23 at the hospital. The Centralized Admissions Nurse stated the Liaisons onsite included making sure Resident #4 was not on any chemical or physical restraints, was not a 1:1 supervision, speaking with direct care staff and asking about any concerns. The Centralized Admissions Nurse stated during those interviews conducted by the Liaison there were no concerns, and it was identified she was participating with therapy and at that point that decided to move forwards. During an interview with the Liaison 10/12/23 at 12:44pm she stated referrals who are categorized as yellow would require an onsite evaluation on the patient due to concerns of history of behaviors and elopement. The Liaison stated Resident #4 required an onsite evaluation that included her speaking with nurses, attending staff and therapy, she stated through her evaluation she identified Resident #4 was friendly, alert x4, talkative, kind and as per nurse she did have some episodes of confusion but did not with her. The Liaison stated her report was that there were no behaviors and no elopement. The Liaison stated the email from the Centralized Admissions Nurse regarding having her assess Resident #4 for any active behaviors or elopement had also been carbon copied to the ADM, DON, and Admissions Coordinator and stated they were aware of the behaviors being assessed by her. During a interview with the Medical Director on 10/12/23 at 6:21pm he was asked if he was aware of Resident #4's history of aggression towards Resident #39, he stated he had known Resident #4 and #39 for years and stated, this has been going on for years. The Medical Director stated Resident #4 and #39 previously lived together and stated Resident #4 and #39 wanted to be together and did not want to be kept apart so he said it was okay to put them together. When asked if he notified the facility of Resident #4's history of aggression he stated he thought it was written in his discharge summary for Resident #4 and stated facility was aware that Resident #4 was bipolar. The Medical Director stated Resident #4 was a psych patient and needed to be admitted somewhere she could be monitored, and medication would be given on time and that had a psychologist and psychiatrist available on call to be there for a crisis. The medical director stated Resident #4 was aggressive to those around her by yelling, and would only hit her husband, Resident #39. LVN P was attempted to be reached for telephone interview on 10/13/23 at 9:03am and 9:57am with no answer, voicemail was left however phone call was not returned. During an interview on 10/13/23 at 9:58am with RNS she stated on 9/23/23 she was called over to Resident #4 and #39's by LVN P. RNS stated she observed Resident #4 swinging the bed remote at Resident #39 hitting him on the legs. RNS stated they separate Resident #4 and #39 and checked on Resident #39 who told her Resident #4 had hit him everywhere with both the call light and the bed remote. RNS stated Resident #39 had redness to lower legs and knees and had a bite mark to upper thigh which she stated Resident #4 admitted to doing and Resident #39 confirmed. RNS stated after she separated Resident #4 and Resident #39 she called the doctor to speak with Resident #4 and notify him that she was being aggressive, RNS stated Resident #4 had tried to hit her and slap the phone out of RNS's hand. RNS state Resident #4 cornered her and was able to hit her and stated she believed Resident #4 turned around and had bit and hit LVN P. RNS stated she was not aware of any aggressive behaviors prior to the incident on 9/23/23. RNS stated she spoke to a family member of Resident #4 who stated that was their relationship at home and an APS (Adult Protective Services) worker who was at the building that day had told her that they had previous cases with Resident #4 and #39 for almost 5 years regarding physical arguing. RNS did not provide a name for APS worker. RNS stated Resident #4 had not exhibited similar behaviors towards her husband before incident on 09/23/23. RNS stated Resident #4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 26 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 - Some only had her moods with refusing medication but that was the only extent of her behaviors. RNS stated she could not recall if Resident #4 had monitoring for behaviors associated with bipolar disorder. RNS stated if a resident had an antipsychotic or antidepressant or anti-convulsant then they would have a monitoring order for sleeplessness, agitation and stated she did not think it included aggression but more restlessness and insomnia. RNS stated she had done routine checks that included checking on Resident #4 and providing medication. RNS stated she always checked for any behaviors residents demonstrated and would have to notify the appropriate person if any changes were identified. During an interview with the DON on 10/14/23 at 2:17pm she stated the Central Admissions nurse had identified concerns related to history of aggressive behaviors, diagnoses of bipolar and dementia for Resident #4. The DON stated she had rereviewed the admission documentation that was uploaded under referral' on Resident #4's chart. The DON was asked if her and leadership staff were aware of Resident #4's history of aggressive behaviors and she stated they were made aware of Resident #4 having behaviors at home and that there was an APS case but stated they were not aware of the extent of either. The DON stated The MDS Coordinator was responsible for developing the residents care plans. The DON stated they monitored for behaviors especially if taking medication, the DON stated they were monitoring Resident #4 for the behaviors that were on her care plan. The DON stated not developing care plans to include history of aggressive behaviors could impact the residents because it would not show that they had to monitor for a specific behavior. During an interview with MDS Coordinator on 10/14/23 at 2:47pm she stated she was responsible for developing the comprehensive care plan for residents. MDS Coordinator stated she does not care plan the history of behaviors and only care planed what occurred in house and stated Resident #4's history of aggressive behaviors was not care planned stating the only behaviors care planned were the ones she had happened in house. MDS Coordinator stated she was not aware of Resident #4's history of aggressive behaviors and stated the Central Admissions nurse had not made her aware. MDS Coordinator stated she had not reviewed Resident #4's referral until Resident #4 was already at the facility. MDS Coordinator was asked how not developing care plans to include history of aggressive behaviors could impact the residents and she stated she did know how to answer that because she care planed from the hospital stay to the facility and stated based on the hospital work Resident #4 was stable and was stable at the facility until incident with Resident #39 on 9/23/23. Record review of facility's policy titled, Care Plans with an implemented dated of February 2017 and a review date of March 2022 stated, the community develops a comprehensive care plan for each resident that includes measurable objectives ad timetables to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. The Care plan will describe: The services to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. 2. Record review of R #13's Face Sheet revealed a [AGE] year-old female, with an original admission date of 04/25/2019 and a readmission date of 09/08/2023. Diagnoses included type two diabetes (condition resulting from insufficient production of insulin) with polyneuropathy (general degeneration of peripheral nerve that spreads toward the center of the body), congestive heart failure (impairment of the heart's blood pumping function), myocardial infarction (heart attack), muscle wasting and atrophy (loss or decrease of muscle mass), end stage renal failure, and acute osteomyelitis (infection of bone) of the right foot and ankle. Record review of R #13's Quarterly Minimum Data Set, dated [DATE] revealed R #13 had a BIMS (Brief Interview Mental Status) of 14 (Cognition Intact) and requires extensive assistance with, bed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 27 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 mobility, transfers, dressing, toilet use and personal hygiene. Level of Harm - Minimal harm or potential for actual harm Record review of R #13's Care Plan dated 09/27/2023 revealed R #13 was on a regular texture, regular thin liquid diet. Record review did not indicate a renal diet as ordered. Residents Affected - Some Record Review of R #13's physician orders stated: Dated 9/8/2023 Renal diet, Regular texture, thin/regular consistency. Interview on 10/13/23 at 10:44 AM the DON, stated, the care plan does not state R #13 was on a renal diet and the care plan can be more specific and was more generalized. The DON stated that she was not sure if the system allowed MDS Coordinator to be specific when care planning as it was a new system. The DON stated R #13's care plan should reflect physician orders as it can cause R #13 to not receive the proper plan of care. The DON stated R #13's renal diet is shown on the main chart and in physician orders. Interview on 10/13/23 at 02:35 PM the MDS Coordinator stated, R #13's diet was entered incorrectly, and R #13 could potentially receive the wrong dietary order, however, R #13's renal diet order was on the physician orders, on all tray cards, and on the main resident chart. The MDS Coordinator stated, she is responisble to ensure care plans are up to date and correct. Record review of the dietary checklist and tray cards does confirm that R #13 was on and received a renal diet. 3. Record review of R #17's Face Sheet revealed a [AGE] year-old female, with an original admission date of 11/14/2020 and a readmission date of 09/14/2023. Diagnoses included cachexia (wasting syndrome), contraction of right lower leg, right knee, and right thigh, muscle wasting and atrophy, dementia (loss of cognitive function that interferes with a person's daily life and activities), malnutrition, dysphagia (difficulty swallowing), edema (fluid retention in the body's tissue), and depressive episodes. Record review of R #17's Quarterly Minimum Data Set, dated [DATE] revealed R #17 requires extensive assistance with, bed mobility, transfers, dressing, toilet use and limited assistance with eating, and personal hygiene. Record review of R # 17's care plan dated 5/8/2023 states, resident/family/RP does not have advance directives and elects Full Code. Record review of Out of Hospital Do-Not-Resuscitate Order signed by family on 9/4/2023. Record review of R #17's physician orders states; Dated 9/14/2023 DNR. Interview on 10/13/23 at 10:37 AM the DON stated the care plan for R #17 should have been updated to reflect current code status. The DON stated, the DON, nurses, and MDS Coordinator make changes for resident charts and care plans as needed. DON stated there was no reason why R #17's code status was not updated in the care plan. The DON stated usually there are morning meetings held about code status changes and usually code status is updated immediately. The DON stated since R #17's code (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 28 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 status was not updated on the care plan, staff would not be able to see the current code status, and if R #17 ended up declining, staff would have seen a full code status in the care plan instead of the current DNR code status. The DON stated, however, R #17's chart (profile screen) is the first place staff looks at to see code status and makes sure the orders are in place to adhere to correct code status. Residents Affected - Some Record review of R #17's chart (profile screen) does reflect a DNR status. Interview on 10/13/23 at 02:21 PM the MDS Coordinator stated R #17's code status was not updated due to human error and was overlooked. MDS Coordinator stated not updating R #17's code status could potentially cause the wrong plan of care for the resident since the plan of care is person centered. The MDS Coordinator stated she was out sick that week when R #17's code status change occurred and usually when there are changes to a resident's care plan, changes are reviewed in morning meetings and care plans are updated in real time. The MDS Coordinator stated when she is out of the facility, the Regional MDS Coordinator is notified and coverage from a remote worker is used to fill the position. The MDS Coordinator stated sometimes there could be a traveling MDS coordinator that will go to the facilities but, during that time, one could not fill in at the facility and the [NAME] MDS coordinator was notified and filled the position. Interview on 10/13/23 at 02:25 PM the Regional MDS stated staff knew that R #17 was a DNR code status as it comes up on R #17's main chart. The Regional MDS Coordinator stated with major resident updates such as code status, they are usually updated in real time and R #17's was potentially missed due to the MDS Coordinator being out sick at the time. The Regional MDS Coordinator stated he manages 8 other facilities, and it was human error R #17's code status update was missed. Record review of Care Plan Policy dated 2/2017 and revised on 3/2022 stated: The community develops a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment. Record review of Care Plan Policy dated 2/2017 and revised on 3/2022 stated: The community develops a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment. The care plan reflects intermediate steps for each outcome objective if they will enhance the resident's ability to meet his or her objectives. Team members use these objectives to monitor resident progress. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 29 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure each resident received adequate supervision to prevent accidents for 1 of 8 residents (Resident #100) reviewed for accidents and hazards: Residents Affected - Few The facility failed to develop and implement interventions to prevent Resident #100's elopement from the facility. Resident #100 eloped from the facility and was found by the road having sustained abrasions, lacerations and a hematoma. An IJ was identified on 10/13/23. The IJ template was provided to the facility on [DATE] at 3:53pm. While the IJ was removed on 10/16/23, the facility remained out of compliance at a scope of isolated and a severity level of actual harm. This deficient practice could place the residents at risk for harm, serious injury or death. The findings were: Review of Resident #100's face sheet dated 10/15/23 reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including, other specified arthritis (inflammation or swelling of joints), multiple sites, unspecified dementia (a group of thinking and social symptoms that interfere with daily functioning), moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, other unspecified depressive episodes ( feeling sad, irritable, empty). cognitive communication deficit (difficulty with thinking and how someone uses language) and unsteadiness on feet. Resident #100 was not identified as her own responsible party. Review of Resident #100's MDS, dated [DATE], reflected a BIMS of 05, indicating severe cognitive impairment. It further reflected that Resident #10 did not require any mobility devices and when walking up to 150 feet required supervision or touching assistance. Resident #100's MDS reflect a 0 when asked is Has the resident wandered?, a 0 indicated wandering behavior had not been exhibited. Resident #100's MDS reflected she used a wander/elopement alarm daily. Record review of Resident #100's comprehensive care plan revealed Resident #100 had impaired cognitive function or impaired though processes related dementia with a created and initiated date of 09/12/23. Resident #100's care plan stated, I am exit seeking, I am at risk for elopement and/or wandering with unsafe boundaries related to dementia 9/30 elopement with a created and initiated date of 09/15/23 and a revision date of 10/05/23. Interventions included, 9/30 out to ER(emergency room) for check up; room change provided; with an initiation date of 10/05/23 and Assess my continued need for the wander guard use as indicated . Distract me from exit seeking by offering pleasant diversions, structured activities, food, conversation, television, book. I prefer the following: . I wear a wander guard device; confirm functioning of device & change device as indicated . Identify pattern of exit seeking: Intervene as appropriate in efforts to minimize behavior . Provide planned and engaging activities as well as activities to meet my needs such as toileting efforts and addressing thirst and hunger needs to prevent/minimize wandering and/or exit seeking attempts because the behavior may be related to a need that cannot be stated. All with an initiation date of 09/15/23. Record review of Resident #100's physician orders revealed an order to check functionality and visualization of wander guard/exit management system through wand or alarmed door QS (every shift) with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 30 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 a start date of 09/14/23 and that was active with no end date noted. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #100 September 2023 licensed nurse administration record revealed order had been completed and documented for every shift in September 2023 as ordered. Residents Affected - Few Record review of Resident #100's exit seeking risk tool dated 09/15/23 completed by the DON revealed Resident #100 exhibited wandering and/or confused behavior, verbalized the need and /or desire to go home or to another location and has the ability to act on that verbalization, has a medical diagnosis associated with confusion which may indicate future likelihood for wandering and was physically able to exit on foot or by wheelchair. Wandering assessment identified Resident #100 did not display exit seeking behavior further stating, NO EXIT SEEKING AT THIS TIME, ONLY WANDERING BEHAVIOR. Record review of Resident #100's nursing notes with an effective date of 09/30/23 and 2:47pm written by RNS revealed she was called to 400 hall by NAIT L due to an activated door alarm. RNS stated her and LVN N went to reset the alarm and looked outside but did not see anyone. RNS stated she completed a resident check and noted Resident #100 was not in her room and went back outside and checked again but did not find the resident. RNS stated she searched inside the facility again and asked other nurses if they had seen Resident #100 but Resident #100 was not located. RNS stated her and LVN N went outside to check again and went down the street when someone was calling out behind her, she turned back and saw what appeared to be a person on the floor with people around and cars on the street. RNS ran to Resident #100 with LVN N and saw Resident #100 sitting on the curb past a vacant lot near offices who when asked where she was going stated she had left to go to the store. RNS identified Resident #100 was actively bleeding from nose and mouth, had a hematoma noted to right side of her forehead above the eyebrow, redness to nose, abrasion to left knee and laceration to the lower lip, Resident #100 was conscious and able to recall a family members phone number. 911 was activated at 3:00pm. Resident #100 was noted with good range of motion to all extremities and denied pain. Record review of Resident #100's hospital records dated 9/30/23 revealed a diagnosis of, contusion to left knee, contusion to right knee, facial abrasion, facial contusion, fall, traumatic hematoma of forehead and wrist sprain. Prescriptions given included acetaminophen 325mg (milligrams) with instructions of 650 MG by mouth every 4 hours as needed for pain for 5 days. Bacitracin/neomycin/polymyxin pramoxine top (triple antibiotics plus topical ointment) for 1 application to be applied topically 2 times for 3 days. Imaging results stated as pending. Record review of Resident #100's nursing noted completed by RNS on 09/30/23 at 6:33pm stated RNS received a call from hospital nurse who stated Resident #100 would be returning to facility and stated Resident #100 had cervical and facial CT scan, x-rays of left knee, left wrist which were all negative. Only finding was soft tissue swelling. New orders to be send for Tylenol 650MG PRN (as needed) and triple antibiotic ointment to be applied to abrasions. Record review of Resident #100's nursing noted completed by RNS on 09/30/23 at 7:37pm stated Resident #100 arrived back to facility after emergency room visit and was able to get out of family members truck and ambulate to her room, RNS completed a head to assessment that noted abrasion to nose, upper lip, left knee, left hand knuckle and right aspect of forehead. A Hematoma was noted to the right aspect of forehead and a laceration to inner lower lip. Resident #100 denied pain and could not recall falling or eloping. Resident #100 was placed on 15-minute monitoring and neuro check (assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired.) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 31 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of Resident #100's document titled Skin: Abrasion/Bruise/Edema/Mole/Rash dated 09/30/23 and signed by RNS on 10/01/23 revealed Resident #100 had abrasion to left hand knuckles, abrasion to left knee and a hematoma to right aspect of forehead, abrasion to nose, upper lip and laceration to inner aspect of lower lip that was first observed on 09/30/23. Record review of Resident #100's document titled Skin & Wound - Total Body Skin Assessment with an effective date of 09/30/23 at 7:37pm and signed by RNS on 10/01/23 revealed a total of 9 new wounds. During an interview an observation with the Maintenance Director on 10/11/23 between 9:52am and 10:15am noted a total of 9 doors, 2 doors identified as the service door and front door were equipped with similar alarm systems that required the alarm to be turned off at the door and at the nurse's station. All other 7 doors were equipment with a different type of alarm. Doors were tested with and without wander guard, all doors opened after a 15 second egress regardless of if using a wander guard or not. During an interview with the ADM on 10/11/23 at 10:12am he stated the front door and service door were equipped with a wander guard alarm while all other doors were equipped with a sound alarm. The ADM stated the service door and the front door were high traffic areas and that was why they were equipped those 2 doors with a wander guard alarm. It was identified through this information that the door Resident #100 eloped from in hall 400 door was equipped with a 15 second delayed egress and a stop alarm (manual annunciator) Record review of maintenance logbook documentation stating Resident Monitoring System: check operation of door monitors and patient wandering system. Marked done on time by (Maintenance supervisor) on September 22, 2023. Revealed 9 doors were tested and alert and alarm system are in working condition. Record Review of TULIP (HHSC online incident reporting application) on 10/10/23 at 5:00PM revealed the facility made a self-reported incident on 10/02/23 at 2:01pm regarding Resident #100's elopement. Record review of facility elopement training/in services completed prior to Resident #100's elopement revealed the facility had a training over elopement on 09/25/23 at 1:40pm. NAIT L was not on identified on attendance record. Record Review of facility elopement training/in services revealed NAIT L had not previously been trained before Resident #100's elopement on 09/30/23. Observation on 10/13/23 at 9:00am of surrounding streets revealed a 2-way street with a turning lane with a speed limit of 30 miles per hour. Observation of Resident #100 on 10/10/23 at 9:32am revealed scab to left knee, bruising under bilateral eyes, bruising to right side of forehead, bubbled skin tear area inside lower lip with scabbing noted on lower lip. Resident #100 was noted with a wander guard in place. During an interview on 10/10/23 at 9:32am with Resident #100 she stated she had a fall when she went alone to cross the street to go to the store. Resident #100 was unable to recall what happened after she was helped up but stated she had pain inside her lip. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 32 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few During an interview on 10/10/23 at 12:17 pm with NAIT L she stated on 09/30/23 she heard the alarm go off in the 400 hall back side door, she stated she went to put in the code to the key pad because normally a resident would click there but not go out. NAIT L stated she attempted to put in the code, but it did not work. NAIT L stated she proceeded to notify RNS and LVN N who both went to the door. NAIT L stated RNS fixed the door alarm, did a head count and checked every room in every hall but did not find Resident #100. NAIT L stated everyone went outside to search for Resident #100. NAIT L stated she did not look outside the door when responding to the door alarm because she is used to residents in the wheelchair just pushing the door. NAIT L stated she had been trained over elopement procedures and should have gone outside to check but stated she forgot and got the nurse instead, NAIT L stated she looked through the window. NAIT L stated everybody including herself was responsible for supervision of Resident #100 on 09/30/23. NAIT L stated Resident #100 had a wander guard in place at the time of elopement and stated everyone was responsible for ensuring it was in place and working. NAIT L stated door alarms were working on 09/30/23. NAIT L stated she was not aware where Resident #100 was found. NAIT L stated residents eloping could negatively impact them because they could get ran over or something even worse than that. During an interview with RNS on 10/10/23 at 1:16pm she stated when a door alarm goes off they need to check surroundings by the door and check if anybody is walking outside and if nobody is found they proceed to do a head count and check in rooms and have other nurses check residents who are elopement risks. RNS stated she went to Resident #100's room and did not see her, RNS stated she ran outside with a nurse and went towards a vacant lot in the back and towards the street and checked the sides and did not find anyone. RNS stated she went back into facility and searched again but stated no one saw Resident #100. RNS stated they began to search outside again and decided to go down the street because Resident #100 always said she wanted to go home and to her family members house who RNS stated lived close by. RNS stated she heard someone behind her saying, over here, over here and stated she saw a car in the middle of the street and a lady in the middle of the street. RNS stated once she got to the location, Resident #100 was sitting at the side the street. RNS stated Resident #100 told her she was just going to the store nearby. RNS stated she assessed Resident #100 and identified an abrasion to left knee, a hematoma to right upper forehead, laceration to inner lower lip, redness to nose and was bleeding from her nose and mouth. RNS stated Resident #100 was able to recall family members phone number which RNS stated she called but stated the call was not picked up. RNS stated she called 911. RNS stated there was 1 car that had pulled over and 1 that was on the side. RNS stated there were 2 ladies who were there with Resident #100 with 1 stating they did not see anything and the other stating she had only seen Resident #100 crawling on the street when she was turning. RNS stated the street where Resident #100 was found was accessible by cars with both coming and going lanes. RNS stated she had been previously trained over elopement and stated when they hear an alarm they had to go right aware and check surroundings and count residents and complete a walk through. RNS stated the alarm was working on 9/30/23 because they did hear the alarm. RNS stated when the alarm went off they had positive COVID (coronavirus disease) residents and had the double doors shut and stated the alarm did not sound as loud, stating she did not hear it right away. RNS stated NAIT L stated she had heard the alarm, but RNS was not sure if NAIT L had went outside. RNS stated once NAIT L called her that's when they went to check. RNS stated she was not too sure on what time Resident #100 exited the facility but stated she started going towards the alarm at 2:47pm and had found Resident #100 at 2:55pm with the ambulance arriving at 3:18pm. RNS stated everyone on the floor including nurses and aides were responsible for supervising Resident #100 on 09/30/23. RNS stated Resident #100 had a wander guard in place at time of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 33 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few elopement on 09/30/23. RNS stated the nurses were responsible for ensuring the wander guard was in place and working, stating nursing would check it per shift and document it on the MAR (Medication Administration Record). RNS stated everyone in general and maintenance were responsible for ensuring the door alarms were working, stating she was not sure how often they were checked but stated they were working that day. RNS stated as per family Resident #100 had a history of this behavior which was why Resident was placed in facility. RNS stated residents eloping could negatively impact the residents due to injury, and death if they are not gotten to on time and on a busy street they could get hit and lost or dehydrated. During an interview with the ADM on 10/14/23 at 11:57AM he stated he did not work on 09/30/23 when Resident #100 eloped from facility. The ADM stated RNS was responsible for supervising Resident #100. The ADM did not have the exact time Resident #100 exited the facility. The ADM stated he had not been told about Resident #100 verbalizing she wanted to leave the facility. The ADM stated Resident #100 had not eloped from the facility before 09/30/23. The ADM stated Resident #100 had a wander guard placed after assessment was completed and stated it had been care planned. The ADM stated nursing was responsible for completing that assessment. The ADM stated Resident #100 was cognitively impaired and had poor safety awareness. The ADM stated Resident #100 was able to ambulate on her own. The ADM stated staff were aware residents who are wandering/elopement risk through an elopement book that was kept at nurses station and included all the demographics of the residents so they could be identified, the ADM stated he believed there was also another system more on the clinical side. The ADM stated staff received elopement in services and drills, and stated they complete them yearly through an online training program and throughout the year as part of their emergency preparedness plan. The ADM stated staff did look outside the door but stated he did not know how far they did, he stated staff had not seen anyone in the parking lot. The ADM stated they should have gone outside to search. The ADM stated Resident #100 was found across the street and had a skin tear to lip and bruising to forehead. The ADM stated if you were to step outside the door and look to where Resident #100 was found your line of sight would have been obscured by the vehicles in the parking lot. The ADM stated Resident #100 was found in under 15 minutes. The ADM stated from what he gathered from staff Resident #100 was going to the store. He stated there was no other injuries identified at the hospital. The ADM stated the facility elopement policy and procedures stated to search the outside, complete an internal head count, check for resident inside facility. The ADM was asked if the facility's policy was followed in this situation, and he stated staff should have gone further out. The ADM was not sure why staff did not follow their policy and stated staff had been trained to do that. The ADM stated it was possible that NAIT L had not been trained. The ADM stated he monitored that staff provided the appropriate level of supervision for residents to prevent elopement by completing drills to ensure staff follow the process and maintain the resident's safety. During an interview with the DON on 10/14/23 at 2:22PM she stated she did not work on 09/30/23 when Resident #100 eloped from facility. The DON stated RNS, NAIT L, LVN N and NAIT O were responsible for supervising Resident #100. The DON stated Resident #100 was out of the facility for about 15 minutes. The DON stated to her knowledge Resident #100 had not verbalized she wanted to leave the facility. The DON stated Resident #100 had not eloped from the facility before 09/30/23. The DON stated Resident #100 would wander into the nurse's station but would not try and get out, the DON stated it had been care planned. The DON stated the nurse that placed the bracelet, herself or sometimes the MDS Coordinator was responsible for completing development assessments. The DON stated Resident #100 was cognitively impaired but was aware, alert but forgetful, stating she had dementia. The DON stated Resident #100 did not have impaired safety awareness. The DON stated Resident #100 was able to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 34 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few ambulate on her own. The DON stated staff were aware of residents who were wandering/elopement risks through a wander guard note book at nurses' station and included resident demographics and a picture of resident. The DON stated NAIT L notified nurse of door alarm and stated NAIT L did open the door and look outside and sated she also looked through the glass windows and then went to notify the nurses. The DON stated NAIT L should have done a done a search of the outside area. The DON stated if NAIT L had stepped outside and looked at the surrounding areas she would have seen Resident #100. The DON stated Resident #100 sustained abrasion to nose, upper lip, left knee, left hand knuckle, hematoma to right aspect of forehead and had some bleeding noted. The DON stated based on what nurses told her there was some cars that saw Resident #100 and assisted when nurses went to get Resident #100. The DON stated Resident #100 stated she was going to the store. The DON stated there were no other injuries identified at the hospital. The DON stated they placed Resident #100 on a 1:1 and did a room change to place her in front of the nurse's station and in front of HR (human resources) office. The DON stated they had a care plan meeting with the family and stated based on Resident #100's risk a secure unit would be beneficial. The DON stated Resident #100's family was going to be taking her home for private care. The DON stated the facility elopement policy and procedures stated staff should go outside, check surrounding areas, if no one was found then an internal head count should be completed to identify who was missing. The DON stated NAIT L had not been trained prior to Resident #100's elopement on 09/30/23. The DON stated their previous elopement drill was on 09/26/23 and stated NAIT L had not worked that day. However, the DON stated staff had been verbally educated that when they hear alarms they are to immediately go and see why the alarm was sounding and which alarm it was, the DON stated NAIT L had received this verbal training from her before Resident #100's elopement. The DON stated she monitored that staff provided the appropriate level of supervision for residents to prevent elopement with wander guards and stated drills and in services over elopement were completed periodically on different shift. The DON stated residents eloping from the facility could negatively impact them because they could fall. Record review of facility policy titled Elopement Response & Exit Seeking Management with an implementation date of 2019 and a reviewed date of January 2023 stated under section, A. Elopement Response: unable to locate resident. 1. If a resident is unable to be located or the alarms have sounded, immediately initiate a search of the entire community both inside and outside premises. The Administrator and DON were notified of an IJ on 10/13/23 at 3:53PM and were given a copy of the IJ Template and a Plan of Removal (POR) was requested. The Plan of Removal was accepted on 10/14/23 at 4:00pm and included the following: Immediate Plan of Removal for:

F689 Each resident receives adequate supervision and assistance devices to prevent accidents. Immediate Response: Elopement search had commenced, Resident #1 was noted nearby facility and nurse immediately assessed resident and resident #1 was sent to the ER for further evaluation and treatment. Identified team member was re-educated on the elopement concern: 1. Missing Person Response & Elopement / Exit Seeking Risk and Proper Response to Missing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 35 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 Resident/Resident Elopement Protocol-Implementing inside and outside on grounds search when there is a risk of a missing resident or elopement of a resident. Level of Harm - Immediate jeopardy to resident health or safety Risk Response: Residents Affected - Few There are 8 out of 100 residents who require a wander guard monitoring device and who may be potentially affected. Director of Nursing/Designee will conduct an audit of all recent new admissions and readmission, reviewing the exiting seeking assessment in order to identify any concerns with exiting seeking or elopement risks and the IDT will review the plan of care to ensure it appropriately reflects potential elopement/exit seeking risks and/or will update the plan of care as indicated. Date completed: 10-14-23. Administrator/Social Worker/Director of Nursing/Designee will conduct staff and resident interviews to identify any concerns of exiting seeking / elopement behaviors. If identified the IDT will review the plan of care and/or will update the plan of care as indicated in order to ensure it appropriately reflects potential exiting seeking / elopement risk noted. Date completed: 10-14-23. System Response: Director of Nursing / Designee to conduct retraining for all team members prior to assuming next shift regarding: o Inservice conducted on Missing Person Response & Elopement / Exit Seeking Risk and Proper Response to Missing Resident/Resident Elopement Protocol o Identifying and Responding to Triggers to Prevent Elopement and Behaviors o Preventing, Identifying and Reporting Abuse and Neglect. Date Completed:10-15-23. Director of Nursing / Designee to conduct retraining to all licensed nurses prior to assuming next shift regarding: o Identifying exit seeking / elopement risk for all new admission/re-admissions and utilizing a wander guard device if the person is identified as an elopement risk. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 36 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 o Level of Harm - Immediate jeopardy to resident health or safety What to do or response to a missing/unaccounted for resident/patient as per community's process. Immediately initiating a search of inside and outside of facility to search for resident as per facility's expected practice, Elopement Response Protocol reviewed. Residents Affected - Few Date Completed:10-15-23. Ad Hoc QAPI held with Administrator, Director of Nursing and Medical Director to review the concerns and plan of removal implemented. Date Completed:10-15-23. Monitoring Response: ADMIN/DNS/SW/ Designee will conduct random daily rounds 3-7 days a week, on various shifts to validate the safety and well-being of our residents. Director of Nursing/Designee will conduct random weekly audits of 1-3 new admission and/or readmissions' initial care plans and comprehensive care plans in order to validate the accuracy of the care plan by ensuring identified elopement risk are noted in the plan of care and appropriate interventions are in place. Director of Nursing/Designee will audit and review progress notes, changes in conditions, risk management reports and the nursing 24 hr. report daily 5-7 days per week during the morning clinical meeting in order to validate appropriate follow up and necessary interventions are in place accordingly. Administrator/Director of Nursing/Designee will conduct Elopement / Missing Person Response Drills at least weekly on random shifts to ensure all shifts have had elopement drills in order to identify competency of TMs work all three shifts or to identify additional education needs. Drills will be conducted weekly for the next 3 months. This plan will remain in place for the next 3 months and findings will be reported to the QAPI committee during monthly meeting for the next 3 months. The QAPI committee will then determine compliance or identify a need for additional training. The surveyor verification of the Plan of Removal on 10/15/23 and 10/16/23 was as follows: During an interview with the DON on 10/15/23 at 12:16pm she stated through audits and staff interviews the facility identified a total of 6 residents appropriate for wander guards. The DON stated they will be completing elopement drills weekly for the next 3 months and would be monitoring residents on a daily basis during morning meetings, through clinical reviews that would include reviewing the 24 hour report that would state any behaviors or changes. The DON stated residents care plans would be updated immediately in the morning meeting if needed. During an interview with the ADM on 10/15/23 at 1:06pm he stated residents would be monitored by completing rounds, reviewing them during morning meetings, going over 24hour reports, census, admissions and discharges, nursing notes. The ADM stated elopement/missing person drills would be done (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 37 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 weekly for the next 3 months. Level of Harm - Immediate jeopardy to resident health or safety Record review on 10/16/23 of resident charts and facility plan of removal revealed facility had previously identified 8 residents who used a wander guard however, Resident #100 had been discharged and Resident #90 had been downgraded and had wander guard removed due to not exhibiting exit seeking behaviors. Resident #90's updated care plan reflected she was a wander risk but not exit seeking. Resident #90's updated exit seeking risk tool reflected she had been seen walking slowly in the hall way but has not been exhibiting exit seeking behaviors. Residents Affected - Few All other 6 residents had updated exit seeking risk tools, and all 6 resident's care plans appropriately reflect exit seeking/wandering risk. Record review of in services dated 10/13/23 revealed 90 team members were in serviced over, monitoring/observing/reporting behavioral concerns. Elopement, specifically Missing Person Response & Elopement / Exit Seeking Risk and Proper Response to Missing Resident/Resident Elopement Protocol, Identifying and Responding to Triggers to Prevent Elopement and Behaviors. The importance of immediately completing the admission assessment/evaluation and exit seeking tool. Identifying exit seeking/elopement risk for all new admission/re-admission and utilizing a wander guard device if the person is identified as an elopement risk and what to o or response to a missing/unaccounted for resident/patient as per community process. Record review of in services revealed NAIT L was in serviced on 10/14/23 over Missing Person Response & Elopement / Exit Seeking Risk and Proper Response to Missing Resident/Resident Elopement Protocol. NAIT L was interviewed on 10/16/23 at 9:52 am and was aware of search protocols, missing person/elopement response and procedures, how to identify and respond to triggers and exit seeking behaviors and how to prevent elopement. Who to report to and where to document identified behaviors. NAIT L was able to define abuse and neglect, she gave examples of abuse and neglect, and aware of signs to identify abuse and neglect, NAIT L was aware of what to do when abuse and neglect was suspected and who to report to. A total of 47 staff members were interviewed on 10/15/23 and 10/16/23 across 3 separate shifts, from 6am-2pm, 2pm-10pm and 10pm-6am. Interviewed staff included both direct care and non-direct care staff. Al staff member stated they had recently been trained over elopement, behaviors, exit seeking, facility procedures and abuse and neglect. Nurses were aware of identifying exit seeking behaviors and elopement risks and with all new residents and utilizing a wander guard if resident was an elopement risk. Nurses were also aware of how to respond when a resident is missing and search procedures to follow and initiate. All staff members interview were aware of search protocols were aware of missing person and elopement response and procedures, how to identify and respond to triggers and exit seeking behaviors and how to prevent elopement. Who to report to and where to document identified behaviors. Staff were able to define abuse and neglect, staff gave examples of abuse and neglect, identify abuse and neglect, staff were aware of what to do when abuse and neglect was suspected and who to report to. During an interview with the Medical Director on 10/16/23 at 4:13pm he stated he was a part of a meeting over the weekend (10/14/23-10/15/23) with the facility that covered elopement, door alarms, strategies to monitor the doors, monitoring patients, behaviors and training of the staff to be aware and facility procedures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 38 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0689 An IJ was identified on 10/13/23. The IJ template was provided to the facility on [DATE] at 3:53pm. While the IJ was [NAME][TRUNCATED] Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 39 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 that residents requiring respiratory care were provided such care, consistent with professional standards of practice for 1 of 3 residents reviewed for respiratory care (Resident #160). Residents Affected - Few The facility did not ensure Resident #160 was receiving supplemental oxygen as ordered. Resident #160 was without supplemental oxygen for more than an hour. This deficient practice could affect residents who receive oxygen and result in respiratory compromise. The findings were: Record review of Resident #160's face sheet accessed on 10/13/2023 revealed an [AGE] year-old female admitted on [DATE] with diagnoses of fracture of superior rim of right pubis (resulting in pain to pubis bone), atherosclerotic heart disease (a buildup of fats and cholesterol on the artery walls), essential hypertension (high blood pressure) and diaphragmatic hernia (opening in the diaphragm that allows internal organs to move into the chest). Possible symptoms of a diaphragmatic hernia include difficulty breathing, fast breathing and fast heart rate. Record review of Resident #160's physician's orders revised on 10/10/2023 reflected continuous oxygen at 2 liters per nasal cannula. Record review of Resident #160's care plan indicated administer oxygen per MD orders. Observation on 10/11/2023 at 9:23 AM revealed oxygen nasal cannula worn inappropriately above Resident #160s nose. Resident was sitting in front of an oxygen concentrator in a wheelchair and in no apparent distress. LVN A was informed, and nasal cannula was correctly re-positioned. Observation and interview on 10/13/2023 beginning 1:27 PM revealed Resident #160 without nasal cannula on, oxygen concentrator turned off, and cannula and tubing draped on concentrator. Resident was sitting in front of oxygen concentrator in a wheelchair, eating a banana and in no apparent distress. Upon questioning LVN A what the orders were for Resident #160, she said resident had an order for 2 liters continuous O2 via nasal cannula. LVN A immediately turned on the O2 concentrator and placed the nasal cannula on resident. Initial resident oxygen saturation reading was 79% which is considered low. After about 5 minutes it rose to 97%, which is considered normal. For most people, a normal pulse oximeter reading for your oxygen saturation level is between 95% and 100%. Record review of Resident #160's oxygen saturation accessed on 10/13/2023 indicated readings with an oxygen nasal cannula of 97% to 100% oxygen saturation from 9/7/2023 - 10/13/2023. A reading taken on 10/13/2023 at 1:19 PM with room air indicated 79% oxygen saturation. During an interview with CNA in training M on 10/13/2023 at 1:40 PM she said she took Resident #160 to have a shower and had disconnected the oxygen concentrator. CNA in training M said she forgot to tell the nurse to hook the concentrator back up when she returned Resident #160 to her room. CNA in training M said Resident #160 was returned to her room around 12:15 PM to 12:20 PM and she left Resident #160 in her room to eat lunch. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 40 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with CNA G on 10/13/2023 at 1:49 PM she said she assisted CNA in training M with Resident #160's transfer to the shower. CNA G said Resident #160 was already on an oxygen bottle when she arrived in the room. CNA G said a nurse is supposed to attach the oxygen bottle to the resident. During an interview with LVN A on 10/13/2023 at 1:55 PM she said the CNAs are supposed to notify her if the residents need to be disconnected from oxygen or connected to oxygen. LVN A said CNA in training M did not tell her she disconnected Resident #160 from the oxygen concentrator. LVN A said the CNAs are not allowed to do that. LVN A said the CNAs did not tell her to connect Resident #160 to the oxygen concentrator when she was brought back to her room. During an interview with the DON on 10/13/2023 at 2:05 PM she said Resident #160 should have been connected to oxygen. The DON said the staff should have notified the nurse that the resident needed to be re-connected to the oxygen concentrator. The DON said the resident could have de-saturated without oxygen and gone into respiratory distress. The DON said the CNA trainees are trained at the facility. The DON said the Director of Education RN instructs them and checks off their skills as they complete them. During an interview with the Director of Education on 10/13/2023 at 2:18 PM he said CNA in training M should have gotten a nurse to disconnect and re-connect Resident #160. The Director of Education said he taught the CNAs their skills, and handling oxygen is outside of the CNAs scope of practice. The Director of Education said he did not teach CNA in training M. He said CNA in training M was previously a CNA and she only had to work 70 hours at the facility to re-apply for certification. Record review of training for CNA in training M reflected a date of hire of 7/11/2023 with orientation done that day that included clinical-nursing orientation. A computer transcript of CNA in training M's Relias online courses indicate 38.73 hours of courses were passed by CNA in training M from 1/24/2023 through 7/5/2023 that included no training in oxygen therapy. A CNA competency checklist was completed by CNA in training M on 8/3/2023 that included no training in oxygen therapy. Record review retrieved on 10/17/2023 at https://allnurses.com/profile/274278-houtx/ indicates there is no Scope of Practice for Certified Nursing Assistance in Texas because the term only applies to licensed staff. In Texas, CNAs are credentialed through the Department of Disability and Aging Services. CNAs are allowed to perform tasks which are included in the CNA training curriculum. Oxygen therapy is not included in CNA training. Record review of Facility policy and procedures dated 3/12/2019 indicated: 1 Certified Nursing Assistants shall provide services and care for residents under the direct supervision of the licensed nurse. 2 The CNA may only provide services within the scope of practice allowed by the state in which they work. FACILITY FTAGDIR FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 41 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that one (1) of four (4) CNAs (CNA M) was able to demonstrate competency in the provision of skills and techniques necessary to care for one (1) of three (3) residents (Resident # 160) reviewed for competent staff in that: CNA in training M failed to connect Resident #160 to an oxygen concentrator after disconnecting it from an oxygen bottle. Resident #160 was left without prescribed oxygen for more than an hour. This deficient practice could lead to respiratory distress or hypoxia. Hypoxia is a state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis. Findings include: Oxygen therapy is the administration of oxygen at concentrations greater than that in ambient air (20.9%) with the intent of treating or preventing the symptoms and manifestations of hypoxia. Record review of Resident #160's face sheet accessed on 10/13/2023 revealed an [AGE] year-old female admitted on [DATE] with diagnoses of fracture of superior rim of right pubis (resulting in pain to pubis bone), atherosclerotic heart disease (a buildup of fats and cholesterol on the artery walls), essential hypertension (high blood pressure) and diaphragmatic hernia (opening in the diaphragm that allows internal organs to move into the chest). Possible symptoms of a diaphragmatic hernia include difficulty breathing, fast breathing and fast heart rate. Observation and interview on 10/13/2023 at 1:27 PM revealed Resident #160 without nasal cannula on, oxygen concentrator turned off, and cannula and tubing draped on concentrator. Resident #160 was sitting in front of oxygen concentrator in a wheelchair, eating a banana and in no apparent distress. Upon questioning LVN A what the orders were for Resident #160, she said resident had an order for 2 liters continuous O2 via nasal cannula. LVN A immediately turned on the O2 concentrator and placed the nasal cannula on resident. Initial resident oxygen saturation reading was 79% which is considered low. After about 5 minutes it rose to 97%, which is considered normal. For most people, a normal pulse oximeter reading for your oxygen saturation level is between 95% and 100%. Record review of Resident #160's oxygen saturation accessed on 10/13/2023 indicated readings with an oxygen nasal cannula of 97% to 100% oxygen saturation from 9/7/2023 - 10/13/2023. A reading taken on 10/13/2023 at 1:19 PM with room air indicated 79% oxygen saturation. Record review of Resident #160's care plan indicated administer oxygen per MD orders. Record review of Resident #160's Doctors orders indicate Oxygen at 2.0 Liters continuous via nasal cannula. During an interview with CNA in training M on 10/13/2023 at 1:40 PM she said she took Resident #160 to have a shower and disconnected the oxygen concentrator. CNA in training M said she forgot to tell the nurse to hook the concentrator back up when she returned Resident #160 to her room, resulting in Resident #160 being deprived of oxygen. CNA in training M said Resident #160 was returned to her room around 12:15 PM to 12:20 PM and she left Resident #160 in her room to eat lunch. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 42 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0726 Level of Harm - Minimal harm or potential for actual harm During an interview with LVN A on 10/13/2023 at 1:55 PM she said the CNAs are supposed to notify her if the residents need to be disconnected from oxygen or connected to oxygen. LVN A said CNA in training M did not tell her she disconnected Resident #160 from the oxygen concentrator. LVN A said the CNAs are not allowed to do that. LVN A said the CNAs did not tell her to connect Resident #160 to the oxygen concentrator when she was brought back to her room resulting in Resident #160 being deprived of oxygen. Residents Affected - Few During an interview with the DON on 10/13/2023 at 2:05 PM she said Resident #160 should have been connected to the oxygen. The DON said the staff should have notified the nurse that the resident needed to be re-connected to the oxygen concentrator. The DON said the resident could have de-saturated without oxygen and gone into respiratory distress. The DON said the CNA trainees are trained at the facility. The DON said the Director of Education Registered Nurse instructs them and checks off their skills as they complete them. During an interview with the Director of Education on 10/13/2023 at 2:18 PM he said CNA in training M should have gotten a nurse to disconnect and re-connect Resident #160. The Director of Education said he taught the CNAs their skills and taught the CNAs that handling oxygen is outside of the CNAs scope of practice. The Director of Education said he did not teach CNA in training M. He said CNA in training M was previously a CNA and she only had to work 70 hours at the facility to re-apply for certification. During an interview with CNA N on 10/13/2023 at 1:40 PM she said nurses were supposed to connect and disconnect residents from their oxygen. During an interview with CNA Q on 10/13/2023 at 5:40 PM she said she knew she was not allowed to disconnect residents from oxygen because she is not trained how to do that. During an interview with CNA R on 10/13/2023 at 5:50 PM she said she was not allowed to disconnect residents from oxygen. She said only nurses could do that. Record review of training for CNA in training M reflected a date of hire of 7/11/2023 with orientation done that day that included clinical-nursing orientation. A computer transcript of CNA in training M's Relias online courses indicate 38.73 hours of courses were passed by CNA in training M from 1/24/2023 through 7/5/2023 that included no training in oxygen therapy. A CNA competency checklist was completed by CNA in training M on 8/3/2023 that included no training in oxygen therapy. Record review retrieved on 10/17/2023 from https://allnurses.com/profile/274278-houtx/ indicates there is no Scope of Practice for Certified Nursing Assistance in Texas because the term only applies to licensed staff. In Texas, CNAs are credentialed through the Department of Disability and Aging Services. CNAs are allowed to perform tasks which are included in the CNA training curriculum. Oxygen therapy is not included in CNA training. Record review of Facility policy and procedures dated 3/12/2019 indicated: 1 Certified Nursing Assistants shall provide services and care for residents under the direct supervision of the licensed nurse. 2 The CNA may only provide services within the scope of practice allowed by the state in which they work. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 43 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for sanitation in that: 1. The facility failed to ensure utensils were clean 2. The facility failed to keep accurate temperature and chemical logs 3. The facility failed to ensure dry storage foods were sealed 4. The facility failed to maintain items in the dry storage area properly 5. The facility failed to remove expired items in the nutrition room These failures could place residents at risk of foodborne illnesses. Findings include: Initial tour observation and interview with the DM on 10/10/23 beginning at 9:25 a.m. revealed 2 large, open bags of dried pasta inside re-sealable bags that were open to the air. The lid of a large container of breadcrumbs was ajar and open to the air. There were 18 of 48 plastic cups with a heavy brownish residue inside them on the clean rack. There were 21 of 21 small plastic drinking glasses with a thick white residue inside them on the clean rack. The 3-compartment sink chemical strip was 400ppm and the logs documented 50ppm. The DM took the chemical strip. The DM was not sure which chemical was being used for the log. Observation of the nutrition room near the nurse's station on 10/13/23 at 9:31 a.m. revealed 8, 1-liter containers of enteral feeding expired with use by date of 10/01/23. The freezer log was documented in Celsius, but the log stated the temperatures should be documented in Fahrenheit. An interview with the DM on 10/10/23 at 9:30 a.m. revealed it was important to keep accurate logs so kitchen staff would know if the chemicals needed to be adjusted because too many chemicals would not rinse properly and could make residents sick. The DM stated the re-sealable bags containing the pasta should have been closed and she did not know who put them there, but the staff should have known better. The DM stated the breadcrumbs should have been sealed to keep moisture out because it could mold and make the residents sick if they accidentally got it in their food. The DM stated she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 44 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0812 responsible for traing the kitchen staff on labeling and storage, and sanitation. Level of Harm - Minimal harm or potential for actual harm An interview with the DA stated the dirty bowls and glasses were in the clean rack. The DM stated it was all kitchen staff's responsibility to ensure dishes were clean before use. The DA stated he did not know what the residue was and would not want to eat from the bowls or drink from the dirty glasses. The DA stated whatever the residue was, could come off in the food or drink and make the residents sick. The DA stated he did not know if dishes with residue in them got soaked prior to washing or not. Residents Affected - Many An interview with the DM on 10/12/23 at 4:10 p.m. revealed she received her DM certification on 07/13/20 and worked at the facility for about a year. The DM stated she should be looking at the sanitation and temperature logs at least weekly. The DM stated she knew to look at the logs, but she had not looked at the logs because she had so many other things to do, and missed it; it was an oversight. The DM stated it was important to check the sanitation logs for cleanliness and for the health of the residents. The DM stated the dishes could be contaminated if the logs were not right. The DM stated she was responsible for ensuring the dishes were clean. The DM stated she checked the clean racks and if there were dirty dishes, she would throw them away. The DM stated she cleaned the dirty dishes found on the clean rack on 10/10/23 after they were found. The DM stated dirty dishes should not be on the clean rack. The DM stated the dirty dishes on the clean rack were likely being used to serve since they were in the clean rack. The DM stated the residents report dirty dishes to the administrator. The DM stated she trained new staff. An interview with the DON on 10/13/23 at 9:49 a.m. revealed the kitchen staff and HR were responsible for stocking and maintaining the nutrition room. The DON stated, it had always been their responsibility. An interview with HR on 10/13/23 at 9:52 a.m. revealed she had nothing to do with the nutrition room, but thought the kitchen and nurses were responsible for stocking and making sure expiration dates were good. An interview with the RD on 10/13/23 at 11:15 a.m. revealed about a week ago, he noticed the water temperature on the dishwasher was below 120F and told the MS and the MS increased the hot water at that time. The RD stated he would have expected the dishwasher logs to reflect a variance in temperatures both before he noticed the dishwasher temperature, and after the hot water was increased. The RD stated he saw the same numbers in all of the columns of the water temperature logs and the sanitation logs when this surveyor saw them, and knew they were not correct. An interview with the MS on 10/13/23 at 11:25 a.m. revealed about a week ago, the RD told him the water in the dishwasher was low, so after looking at the thermostat on the dishwasher himself, he increased the hot water in the dishwasher. The MS stated the temperature of the water at the time he looked at it was about 115F-118F. The MS stated he did not look at the temperature logs. An interview with the DM on 10/13/23 at 10:10 a.m. revealed the kitchen staff was responsible for stocking and maintaining the nutrition room and did not know how or why there was expired enteral feeding on the shelf. The DM stated she would get a thermometer that only showed Fahrenheit for the freezer The DM stated she would in-service the staff. An interview with the ADM on 10/13/23 at 5:00 p.m. revealed the residents did not and never had reported dirty dishes to him. The ADM stated he was unaware of the kitchen logs and thought the DM was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 45 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0812 in charge of the kitchen. The ADM stated he did not go into the kitchen very often. Level of Harm - Minimal harm or potential for actual harm A record review of the Kitchen Pot Sink Temperature/Sanitizer Test strip and Dish Machine Logs dated 01/01/23-10/12/23 revealed: Residents Affected - Many 01/01/23-01/31/23, the morning temperature ranged from 120F-140F, noon from 115F-150F, and night was 120F all days. The sanitation was documented at 200 ppm morning, noon, and night. The Dish Machine log documented temperatures as 120F for all days and shifts, and 50 ppm for all days and shifts. 02/01/23-02/31/23, the morning temperature was 120F for all days, the noon temperature was 110F for all days except 02/30/23 and 02/31/23, where it was documented at 120F, and the night was 120F all days except 02/19/23 where it was missing the documentation. The sanitation was documented from 50 ppm-200 ppm for morning and noon, and 200 ppm for the night, except for 02/19/23 where it was missing the documentation. The Dish Machine log documented temperatures as 120F for all days and shifts and 50 ppm for all days and shifts with the exception of the 02/19/23 night shift had no documentation. 03/01/23-03/31/23 The morning temperature ranged from 114F-125F morning, noon, and night. The sanitation was documented at 200 ppm on all days and all shifts. The Dish Machine log documented temperatures of 120F on all days, all shifts except 03/01, and 03/02 documented 130F for the morning and noon temperatures. The sanitation was documented as from 30 ppm-200 ppm for the morning, 50 ppm-200 ppm for noon, and 50 ppm-400 ppm for nights. 04/01/23-04/31/23, the morning temperature ranged from 120F-140F, noon from 120-125F, and night 120F-135F. The sanitation was documented from 200 ppm-300 ppm for the morning, and noon, and from 200 ppm-400 ppm for the night shift. The Dish Machine Log documented the morning temperatures at 120F, except 04/03 was 125F, and 04/14 was 140F. the noon temperatures ranged from 120F-140F, and 120F-140F on nights. 05/01/23-05/30/23, the morning, noon, and night temperatures were 110F. The sanitation was documented as 100 ppm-120 ppm for the morning, 100 ppm for noon and night; all days, except 05/31/23, which was missing all documentation. The Dish Machine Log documented the morning, noon, and night temperatures at 120F on all days, all shifts, and the Sanitation at 50 ppm, on all days, all shifts. The exception was 05/31/23 night shift had no documentation. 06/01/23-06/30/23 documented the temperature as 120F for the morning, 110F for noon and night, except 06/20,21, and 22/2023 the noon temperature was 120F. The sanitation was documented as 50 ppm for morning, noon, and night, except for 06/20/23 the noon and night sanitation were documented as 100 ppm. The Dish Machine Log documented the morning, noon, and night temperatures at 120F on all days, all shifts, and the Sanitation at 50 ppm, on all days, all shifts. The exceptions were on the 06/21 and 06/22/23 day shifts, the sanitation was documented at 100 ppm, and the 06/20-22/23 night shifts, documented sanitation as 100 ppm. 07/01/23-07/31/23, the morning temperatures were documented as 120F, the noon temperature was documented at 110F except 07/03, 05-07, 30, and 31 were documented at 120F. The sanitation was documented as 50 ppm on all days and shifts. The Dish Machine Log documented the morning, noon, and night temperatures at 120F on all days, all shifts, and the Sanitation at 50 ppm, on all days, all shifts. The exceptions were on the 07/11 morning and noon shifts, the sanitation was documented at 100 ppm, and on the 07/10-07/13/23 night shifts, documented sanitation was 100 ppm. 07/31/23 had no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 46 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0812 documentation on the noon and night shifts for temperatures or sanitation. Level of Harm - Minimal harm or potential for actual harm 08/01/23-08/31/23 the morning temperatures ranged from 100F-145F, noon from 120F-135F, and night 120F-140F. The sanitation was documented as 200 ppm on all days and all shifts. The Dish Machine Log documented the morning, noon, and night temperatures at 120F on all days, all shifts, and the Sanitation at 50 ppm, on all days, all shifts. Residents Affected - Many 09/01/23-09/30/23 documented temperatures for the morning and night shifts, all day as 120F. The noon temperature on all days and all shifts were documented as 110F. The sanitation was documented as 50 ppm on all days and shifts. The Dish Machine Log documented the morning, noon, and night temperatures at 120F on all days, all shifts, and the Sanitation at 50 ppm, on all days, all shifts. 10/01/23-10/10/23 documented temperatures for morning, noon, and night as 120F, sanitation was documented as 50 ppm, all days, all shifts. The Dish Machine Log documented the morning, noon, and night temperatures at 120F on all days, all shifts, and the Sanitation at 50 ppm, on all days, all shifts. A record review of Kitchen In-services: 09/13/23 Scheduled hours to take food out, maintain work always clean. 09/28/23 Menu extensions, recipes, thermometer calibration, food holding, food storage. 10/10/23 3-compartment sink, range of ppm for the sanitizer. 10/11/23 Cleaning of cups, dishes, and bowls: All items must go through the dishwasher at the proper temperature and be placed on the clean rack. No dirty items were to be placed on clean racks. 3-compartment sink education regarding sanitizer ranges and temperature. These were the only in-services provided for the year 2023. A record review of the Kitchen facility policy titled Manual Cleaning and Sanitizing of Utensils and portable equipment dated 10/01/18 revealed Procedure: 5. Prior to washing, pre-flush or pre-scrape all equipment and multi-use utensils. When necessary, presoak to remove gross food particles and soil. A record review of the Kitchen facility policy titled Mechanical Cleaning and Sanitizing of Utensils and Portable Equipment dated 10/01/18 revealed The facility will follow the cleaning and sanitizing requirements of the state and US Food Codes for mechanical cleaning in order to ensure that all utensils and equipment are thoroughly cleaned and sanitized to minimize the risk of food hazards. 7. a. The temperature of the wash water must be at least 120F. 7. f. A test kit or other device that accurately measures the parts per million concentrations of the solution must be available and used. A sample Dish Machine Temperature and Sanitizing Log follows this Policy. A record review of the kitchen policy titled Kitchen Sanitation to Prevent the Spread of Viral Illness revised 08/17/20 revealed 3. g. Ware washing: In order to ensure that all dishware is appropriately cleaned and sanitized, the dish machine and 3-compartment sink must be operated at the appropriate temperature and chemical level. This should be monitored by staff and the dietary manager as per facility policy. If the machine is not operating at the appropriate levels, dishware may be contaminated and could spread illness throughout the facility. If temperature and chemical levels cannot be obtained, the facility should serve residents on disposables until the machine can be corrected. Record review of the Dish Machine Washing and Sanitizing sample documented: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 47 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0812 *Wash-120 degrees Fahrenheit Level of Harm - Minimal harm or potential for actual harm *Final Rinse 50 ppm (parts per million) chlorine on dish surface in final rinse . Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete References: TAC 228.111 (p) Warewashing equipment (three-compartment-sink) determining chemical sanitizer concentration: concentration of the sanitizing solution shall be accurately determined by using a test kit or other device. Figure: 25 TAC 228.111(n)(1) Sanitizer Concentration range: 25-49 ppm, when the minimum temperature is 120 degrees Fahrenheit. Event ID: Facility ID: 676313 If continuation sheet Page 48 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that are complete and accurately documented for 1 of 8 Residents (Resident #60) reviewed for medical records accuracy, in that: Resident #60's April Medication Administration Record (MAR) did not reflect documentation for identified pain and acetaminophen that was administrated by LVN C on 04/20/23. This deficient practice could affect residents whose records are maintained by the facility and could place them at risk for errors in care, and treatment. The findings were: Record review of Resident #60's face sheet, dated 08/17/23, revealed the resident was a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included: Alzheimer's disease, unspecified (a progressive disease that destroys memory and other important mental functions), personal history of (healed) traumatic fracture (break), pneumonitis (general inflammation in lungs that can affect breathing and cause other bodily symptoms) due to inhalation of food and vomit , acute respiratory failure with hypoxia (an absence of enough oxygen in the tissues to sustain bodily functions), hyperthyroidism, unspecified ( thyroid gland does not make enough thyroid hormones to meet the body's needs) . Record review of Resident #60's significant change MDS assessment, dated 09/28/23, revealed Resident #60 did not have a BIMS conducted due to resident rarely/never understood. Record review of Resident #60's nursing note dated 04/20/23 at 10:58pm by LVN C stated Resident #60 was identified with a swollen right hand, LVN C assessed Resident #60's arm and noted she would scream to touch. Record review of Resident #60's physician orders revealed an order for, acetaminophen ER (extended release) tablet extended release 650MG (milligrams) with directions of give 1 tablet by mouth every 6 hours as needed for pain do not exceed 3000mg (milligrams) within 24 hr (hour) period from any source with a start date of 08/20/21 and an end date of 09/22/23. Record review of Resident #60's care plan revealed a focus of I have an alteration of musculoskeletal stated due to history of fracture of right wrist; OA (osteo arthritis) multiple sites; right ulna (1 of 2 forearm bones) fracture(break) with an intervention of give analgesics as ordered by the physician. Monitor and document for side effects and effectiveness with an initiated date of 04/24/23. Record review of Resident #60's April Medication Administration Record (MAR) revealed no documentation of pain identified on 04/20/23 or acetaminophen administered on 04/20/23 or any day in the month of April 2023. During a telephone interview with LVN C on 10/14/23 at 8:19am she stated she worked with Resident #60 on 04/20/23 and stated she had identified Resident #60 with pain and swelling and had provided her with Tylenol. LVN C stated she was responsible for completing documentation on Resident #60's MAR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 49 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on 04/20/23. LVN C stated she had probably forgotten to complete documentation on that day, 04/20/23. LVN C stated identified pain and administered Tylenol should have been documented on Resident #60's MAR. LVN C stated she had previously been trained over documentation by the DON. LVN C stated the facility policy for clinical documentation stated they had to document everything. LVN C stated she did not know the facility's procedure for monitoring the records to ensure accurate documentation. LVN C stated she did not think incorrect documentation such as this could negatively affect a resident because intervention was provided, and the resident was taken care of. During an interview with the DON on 10/14/23 at 2:11pm she stated LVN C worked on 04/20/23 with Resident #60 and was responsible for documentation. The DON stated based off Resident #60's MAR she did not see any Tylenol/acetaminophen was provided or any pain was identified. The DON stated the identified pain and administration of Tylenol should have been documented on Resident #60's MAR. The DON stated she would not know why documentation was not completed. The DON stated LVN C had been previously trained over documentation and stated the Director of Education was responsible for providing that training. The DON stated if a medication was given it needed to be documented and stated it should have been checked off. The DON stated the facility's procedure for monitoring the records to ensure accurate documentation was for her to check the MAR to ensure there was no missed medication. The DON stated incorrect documentation such as this could negatively affect the resident because they would not have known a medication was provided. Record review of the facility policy titled MEDICATION ADMINISTRATION with an implementation date of March 2019 and a reviewed date of January 2023 stated under section DOCUMENTATION reads, Initial the electronic administration record after the medication is administered to the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 50 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0880 Provide and implement an infection prevention and control program. 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 establish and maintain an Infection Prevention and Control Program designed to help prevent the standard and transmission-based precautions to be followed to prevent the spread of infections or diseases for 1 of 3 residents (R #13) observed for infection control, in that; Residents Affected - Few 1. LVN D placed an open, uncovered wound on a soiled pad while providing wound care on R #13. This failure could place residents at risk for healthcare associated cross-contamination and infections. Findings include: Record review of R #13's Face Sheet revealed a [AGE] year-old female, with an original admission date of 04/25/2019 and a readmission date of 09/08/2023. Diagnoses included type two diabetes (condition resulting from insufficient production of insulin) with polyneuropathy (general degeneration of peripheral nerve that spreads toward the center of the body), congestive heart failure (impairment of the heart's blood pumping function), myocardial infarction (heart attack), muscle wasting and atrophy (loss or decrease of muscle mass), end stage renal failure ( kidney failure), and acute osteomyelitis (infection of bone) of the right foot and ankle. Record review of R #13's Quarterly Minimum Data Set, dated [DATE] revealed R #13 had a BIMS (Brief Interview Mental Status) of 14 (Cognition Intact) and requires extensive assistance with, bed mobility, transfers, dressing, toilet use and personal hygiene. Record review of R #13's Care Plan dated 09/27/2023 revealed R #13 had fragile skin and was at risk for skin injury, new or worsening skin condition related to diabetes and renal failure and was at risk for complications associated with diabetes, with possibility of frequent infections, diabetic wounds, vision impairment, hyper\hypo-glycemia. R #13 had arterial ulcers to right 1st digit, left 1st digit, 4th and 5th digit and left heel. Record Review of R #13's physician orders dated 10/12/2023 stated: Betadine External Solution (Povidone-Iodine) Apply to Left Dorsum 1st digit topically every day shift for Arterial Wound Cleanse w/NS (normal saline), , pat dry, apply betadine-soaked gauze, cover w/dry gauze, wrap in kerlix and secure w/tape and apply to left Dorsum (the back) 1st digit topically as needed for Arterial Wound Cleanse w/NS (normal saline), pat dry, apply betadine, cover w/ gauze, wrap in kerlix and secure w/tape. Betadine External Solution (Povidone-Iodine) Apply to Left dorsum 4th digit topically every day shift for Arterial wound Cleanse w/NS (normal saline), , pat dry, apply betadine-soaked gauze, cover w/dry gauze, wrap in kerlix and secure w/tape. AND Apply to Left dorsum (the back) 4th digit topically as needed for arterial wound Cleanse w/NS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 51 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0880 (normal saline), , pat dry, apply betadine, cover w/ gauze, wrap in kerlix and secure w/tape. Level of Harm - Minimal harm or potential for actual harm Betadine External Solution (Povidone-Iodine) Residents Affected - Few Apply to Left dorsum 5th digit topically every day shift for arterial wound Cleanse w/NS (normal saline), , pat dry, apply betadine-soaked gauze, cover w/dry gauze, wrap in kerlix and secure w/tape. and apply to left dorsum (the back) 5th digit topically as needed for arterial wound Cleanse w/NS (normal saline), pat dry, apply betadine, cover w/ gauze, wrap in kerlix and secure w/tape. Betadine External Solution (Povidone-Iodine) Apply to Right Dorsum (the back)1st digit topically every day shift for Arterial wound Cleanse w/NS (normal saline), , pat dry, apply betadine soaked gauze, cover w/dry gauze, wrap in kerlix and secure w/tape and apply to Right Dorsum (the back) 1st digit topically as needed for Arterial wound Cleanse w/NS (normal saline), , pat dry, apply betadine, cover w/ gauze and secure w/tape. Dated 9/30/2023 Santyl External Ointment 250 UNIT/GM (Collagenase) Apply to Left heel topically every day shift for arterial wound Cleanse w/NS (normal saline), , pat dry, apply santly, cover w/gauze, wrap in kerlix and secure w/tape. Observation of wound care on R #13 on 10/12/23 beginning at 02:11 PM with LVN D and CNA J assisting. LVN D sanitized bedside table/equipment and set up with necessary wound care supplies. Hand washing hygiene performed by both LVN D and CNA J with no concerns identified. Observation of wound care to right dorsum 1st digit as per physician orders with no concerns identified. LVN D began to perform wound care on R #13's left foot by removing previous bandages and began to perform wound care on 1st, 4th, and 5th digit as per physician orders. After LVN D placed betadine soaked gauze and covered with dry gauze on R #14's 5th digit, LVN D removed gloves, sanitized hands and was about to put on new gloves to begin wound care to R #14's left heel when the gauze on R #13's 4th and 5th digit fell off and onto the floor (CNA J was holding R #13's leg up to aid in wound care). At that time, LVN D instructed CNA J to put R #13's foot down where R #13's foot on underneath pad. R #13's heel had an open, uncovered wound and was placed on a visibly soiled pad (for approximately 3 to 5 minutes) while LVN D went to the wound care cart (stationed right outside R #13's door) to get more betadine and gauze. LVN D returned to perform wound care as ordered with no other concerns identified at that time. Interview on 10/13/23 at 02:14 PM, LVN D stated he had been the wound care nurse for a year and a half at the facility. LVN D stated placing R #13's open wound of the heel on a soiled pad could lead to more infections and more serious health issues for R #13. LVN D stated he became nervous after the gauze fell off R #13 and lost track of his normal wound care practice. LVN D stated the last infection control in-service was conducted within the past week. Interview on 10/16/2023 at 12:00pm the DON, stated it is not normal practice to place an open wound on a soiled pad and R #13's wound should have been covered prior. The DON stated that by placing an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 52 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0880 Level of Harm - Minimal harm or potential for actual harm open wound on a soiled pad could infect the wound further. The DON stated an in-service on changes of condition and infection control was conducted on 9/212023, and the DON stated the wound care nurse has been at the facility for over two years and the last time wound care nurse was observed was on 10/6/2023 by the DON and no concerns were identified at that time. The DON stated R #13's leg was put down as to rest the leg as CNA J was assisting LVN D. Residents Affected - Few Record review of Infection Control in-service conducted on 10/14/2023. Record review of Infection Prevention and Control Program Policy dated 3/13/2019 and revised on 10/2022 stated: 7. Prevention of Infection a.) Important facets of infection prevention include: 1. Identifying possible infections or potential complications of existing infections. 2. Instituting measures to avoid complications of existing infections. 3. Educating staff and ensuring that they adhere to proper techniques and procedures. 6. Educating staff and ensuring that they adhere to proper infection prevention and control practices when performing resident care activities as it pertains to his/her role responsibilities and situation. 10. Enhanced Barrier Precautions (EBP) are an infection control intervention designed to reduce transmission of MDROs ([NAME]-drug resistant organisms) that may indicate the use of PPE, such as gown and glove use during high contact resident care activities. EBP (Enhanced Barrier Precautions) can be applied when contact precautions do not otherwise apply to residents with any of the following: Wounds Examples of high-contact resident care activities where gown and glove use for enhanced barrier precautions are recommended include: Wound care: any skin opening requiring a dressing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 53 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0940 Develop, implement, and/or maintain an effective training program for all new and existing staff members. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record review, the facility failed to develop, implement, and maintain annually an effective training program for individuals providing services, consistent with their expected roles for 7 of 7 employees (CNA L, Restorative Aide (RA) G, DON, RD, SW, PT, and the BOM) reviewed for training. Residents Affected - Some The facility failed to ensure that required training was provided for CNA L, Restorative Aide (RA) G, the DON, the RD, the SW, PT , and the BOM for the review period of October 2022 to October 2023. The facility failed to ensure that required training was provided for 1 CNA, 1 restorative aide, and the BOM for the review period of October 2022 to October 2023. This failure could place residents at risk of being cared for by staff who have been insufficiently trained. The findings were: A record review of personnel records provided by HR for CNA L revealed falls training was last completed on 09/04/22, and restraint training on 10/12/23. A record review of personnel records provided by HR for RA G revealed falls training was last completed on 09/29/22. A record review of personnel records provided by HR for the BOM revealed restraints training was last completed on 10/11/22. A record review of the employee files provided by HR revealed there was no HIV, Falls, Restraints, or Dementia training available for: the DON, Hire date 06/07/21, The RD, hire date 10/04/21, the SW hire date was02/16/20, and the physical therapist, hire date 06/01/23. An interview with the BOM on 10/13/23 at 2:00 p.m. revealed she thought the employees must have been having trouble with their computers and could not complete their testing. The BOM stated it was important to have annual training as a refresher in case someone may have forgotten something or if anything new had been added. The BOM stated she was responsible for ensuring staff maintained all required training. The BOM stated required training was done electronically and she thought the delinquencies must have been due to the computers acting up. The BOM stated she did not not always look at the statuses of employee training and depended on staff to be self aware enough to complete the training on their own. An interview with the DON and ADM on 10/13/23 at 3:00 p.m. revealed it was possible for residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 54 of 55 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 676313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laredo Nursing and Rehabilitation Center 1701 Tournament Trail Dr Laredo, TX 78041 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 0940 Level of Harm - Minimal harm or potential for actual harm to become injured if the staff were not up to date on their competencies because that was why they had competencies and training. They both stated it was their responsibility, as well as the BOM and HR to ensure training was completed timely. The DON and ADM stated required training was done electronically and they did not not always look at the statuses of employee training and depended on staff to be self aware enough to complete the training on their own. Residents Affected - Some Although requested from the DON, the BOM, and ADM on several occasions throughout the survey, there was no facility policy provided for annual training and no in-services provided related to annual training. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676313 If continuation sheet Page 55 of 55