Health inspection·August 26, 2022

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 08/24/22 at 10:01 a.m. Resident #9 was in bed on his back, had his nasal cannula on, two pillows under his head, top pillow had a towel wrapped around it. The oxygen concentrator was at 4 liters per minute. Interview on 08/24/22 at 10:10 a.m. CNA A said Resident #9 was alert and oriented, able to feed himself and required assistance for all other activities of daily living. CNA A said Resident #9 was transferred to his chair if his ulcer had been resolved. If his ulcer was still open, then they would not be transferred. CNA A said Resident #9 had been at facility a long time. Resident #9 had been on O2 since he got there. Observation on 08/26/22 at 11:13 a.m. Resident #9 was assisted by COTA B down the hall and toward his room. Resident #9 has his portable oxygen canister attached to the back of the wheelchair and has a mask over his nasal cannula. The COTA took resident into the room and then closed the door. In an interview on 08/26/22 at 11:30 a.m. Resident #9 said he had been on oxygen for about a year. Resident #9 said he could be without the O2 for about 30 minutes to an hour. Resident #9 said he gets short of breath and would ask to have it put back on. In an interview on 08/26/22 at 11:31 a.m. CNA C said Resident #9 had been on O2 for a while but does not recall if he had the O2 since he was admitted . CNA C said Resident #9 had it on but when he goes to therapy, he will go without the O2. Resident #9 would be able to say when he wants it on or off. In an interview on 08/26/22 at 11:39 a.m. LVN D said she could not find the Physician's orders for O2 for Resident #9 on PCC. LVN D said she was looking to see when it was ordered. LVN D said the orders were likely discontinued due to Resident #9 being discharged to the hospital in February of 2022. LVN D said Resident #9 was on oxygen PRN. In an interview and observation on 08/26/22 at 1:33 p.m. LVN E said it did not matter if the oxygen was continuous or PRN, they need physician's orders for the resident to receive O2 therapy and the physician would describe what setting the patient requires and how often the nurse should change the tubing and the nasal cannula. LVN E said if a Resident's O2 sats were below 89, the LVN can raise the setting higher and then call the physician and the physician can decide to keep it at the higher level or bring it down. LVN E said if the resident does not have orders for oxygen therapy and his oxygen levels go down the nurse can provide oxygen at 2 liters and then call the doctor. If the doctor decides to leave the resident on oxygen, the doctor can give orders for the setting and when to change the tubing and nasal cannula. LVN E said the negative impact for the resident would be that he could stop breathing or his O2 saturation could go below normal if he was not getting the correct amount of O2. LVN went into Resident's room and checked the O2 concentrator and said the O2 was set at 3L. Interview on 08/26/22 at1:55 p.m., COTA B said she took Resident #9 to the therapy department with O2 because once he started the exercises his O2 sats would go down. In an interview on 08/26/22 at 3:06 p.m. the DON said Resident #9 might have been weaned off the oxygen and that was why there were no orders. The DON said the physician needs to give orders for the oxygen therapy even if it was PRN. Resident #9 had not gone out to the hospital, so she does not know why there were no orders. If a Resident's oxygen levels were below 92, the nurse could administer oxygen, and then would call the physician and the physician would then give the orders for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 2 of 3 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 676346 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hidalgo Nursing and Rehabilitation Center 4503 S Sugar Rd Edinburg, TX 78539 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 oxygen. The DON said the oxygen would be administered between two to three liters. The DON checked in the computer and said the last order for oxygen was in December of 2021 and Resident #9 went to the hospital in February of 2022. The DON said the normal process when a resident goes to the hospital and was discharged from the hospital the nurse will call report to the facility nurse. The facility nurse will then ask if the resident has a foley or was on oxygen or on any other special treatments. The DON said she did not know why Resident's oxygen therapy was not caught. In an interview on 08/26/22 at 4:15 p.m., the Administrator said usually the hospital would call with a referral and if the resident was approved for admission the hospital will call and give report. The facility nurse will receive the report and then call the physician to confirm the orders. So, the facility will accept the resident according to the hospital's report. Record review of the policy for Oxygen Administration revised in October 2010 provided by the facility revealed: Purpose: The purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation: 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. 2. Review the resident's care plan to assess for any special needs of the resident. 3. Assemble the equipment and supplies as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 3 of 3