Health inspection·November 17, 2023

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete would be easy to schedule a meeting with her as well as the resident. The SW stated Resident #73 will be added to their care plan list for this month. Record review of an undated policy for the Comprehensive Resident Care Plans revealed: Each resident's plan of care shall be developed within seven days after completion of the comprehensive assessment. Comprehensive care plans are prepared by an interdisciplinary team that integrates resident participation and preferences. The interdisciplinary team includes .6. The resident, the resident's family, or the resident's representative to the extent practical. An explanation will be in a resident's medical record if the participation of the resident or their resident representative is determined not practicable for the development of the resident's care plan .The resident can request a care plan meeting; participate in setting goals and outcome of care regarding type, amount, frequency and duration of care; receive the services in the plan of care; see the care plan; request revisions; and sign after significant changes. Event ID: Facility ID: 676346 If continuation sheet Page 2 of 23 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 11/17/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure residents' right to formulate an advance directive for 4 of 12 residents (Residents #2, #34, #55, and #97) reviewed for advanced directives, in that: 1. The facility failed to ensure Resident #2's Out-of-Hospital Do Not Resuscitate (OOH-DNR) was executed correctly as it was not signed by witnesses or a physician and there were no dates on the form. 2. The facility failed to ensure Resident #34's OOH-DNR was executed correctly as the physician's printed signature and license number were missing from the form. 3. The facility failed to ensure Resident #55's OOH-DNR was executed correctly as it was not signed by the responsible party and there was no date the form was signed. 4. The facility failed to ensure Resident #97's OOH-DNR was in the medical record. These failures could place residents at-risk of not having their end of life wishes honored. The findings included: 1. Record review of Resident #2's admission Record dated 11/17/23 documented an [AGE] year-old female admitted to facility 11/27/20. Her diagnoses included unspecified dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), dysphagia (difficulty swallowing), chronic kidney disease (long standing disease of the kidneys leading to renal failure), anemia (blood doesn't have enough healthy red blood cells), peripheral vascular disease (a slow and progressive circulation disorder - narrowing, blockage, or spasms in a blood vessel) and atherosclerotic heart disease of native coronary artery without angina pectoris (when fats, cholesterols and other substances collect on the inner walls of the heart's arteries which hinders the supply of blood and oxygen to the heart). The admission Record also indicated resident was her own responsible party. Record review of Resident #2's Quarterly MDS dated [DATE] revealed a BIMS score of 2 indicating severe cognitive impairment. Record review of Resident #2's OOH-DNR form was signed by a person listed as Emergency Contact #1 on the admission Record but checked as Guardian on the DNR. The form was dated 02/26/23. There were no witnesses on the form and an illegible signature on the line for the physician that read Declaration by physician based on directive to physicians by a person now incompetent or nonwritten communication to the physician by a competent person. The same illegible signature was found on the lines for the Physician's Statement, the line for Directive by two physicians as well as the line at the bottom of the form indicating the document has been properly executed. There was no printed signature for the physician, a license number or a date. The person who signed the form at the top of the page as guardian did not sign the bottom of the form. During an interview on 11/16/23 at 10:58 AM with the SW, the DNR form for Resident #2 was discussed. SW stated the form was not valid since it was not completed correctly. The SW stated, I will get (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 3 of 23 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 11/17/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with the resident and let her know that she will need to be a full code until the DNR is redone. I will call her family member since he signed the original form. I don't know why it was filled out like this. During the interview on 11/16/23 at 10:58 AM, the SW stated, our Medical Records person told our corporate office that we needed to have a paper copy of each DNR so I've started completing a DNR binder. The SW did not have a copy of Resident #2's DNR in the binder. The SW stated the purpose of having a readily available copy of the DNR was to be able to send a copy of the DNR along with the Face Sheet and MAR if EMS came to take a resident to the hospital. Furthermore, the SW stated it was the policy of this company to recognize a DNR as valid if the family or resident had signed the form along with witnesses even though they were waiting for the physician's signature. 2. Record review of Resident #34 admission Record dated 11/14/23 documented an [AGE] year-old female admitted to the facility 03/25/21. The diagnoses included cerebral infarction due to thrombosis of unspecified cerebral artery (stroke caused by blood clot), hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (severe or complete loss of strength on one side of the body following a stroke) and major depressive disorder (a persistently low or depressed mood). The Advance Directive status on this form was listed as DNR. Record Review of the DNR form for Resident #34 did not include a printed physician's signture or license number on the form. During an interview with the SW on 11/16/23 at 10:58 AM, the SW was asked to review the DNR form for Resident #34 that showed the form did not contain the physician's printed signature or license number. Although the SW thought the form would still be considered valid, she stated she would have the form corrected. 3. Record review of Resident #55's face sheet, dated 11/16/2023, revealed the resident had an original admission date of 09/12/2020 and a most recent re-admission date of 02/18/2021 with diagnoses that included: heart failure, acute respiratory failure with hypoxia (condition where region of the body is deprived of adequate oxygen supply), sleep apnea (sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal), and type 2 diabetes mellitus. Further review of Resident #55's face sheet revealed under the section ADVANCE DIRECTIVE: **Code Status: ***DNR***. Record review of Resident #55's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 99, which indicated the resident to have severe cognitive impairment. Record review of Resident #55's Care Plan, last review completed 11/14/2023, revealed a focus: Resident is a DNR. Resident wishes will be followed. Date initiated 03/15/2023 and revision on 09/14/2023. Record review of Resident #55's electronic medical record Order Summary Report, Active Orders as of 11/16/2023, revealed an order dated 03/14/2023 for **Code Status: ***DNR***. Record review of Resident #55's OOH-DNR, dated 03/14/2012, revealed a family member, two witnesses and the physician had signed the OOH-DNR. Further review revealed Resident #55's OOH-DNR was not signed by the resident's responsible party and was not dated by the RP. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 4 of 23 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 11/17/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview with the SW on 11/16/2023 at 1:50 p.m., the SW revealed Resident #55 did not have an MPOA in place however one of her family members had been identified upon admission as her RP. The SW stated a family member had signed the OOH-DNR but it was not the designated RP. The SW further added that the OOH-DNR should have been signed and dated by the designated RP as the qualified family member approved to give consent. The SW stated she had not worked at the facility during that time period and hospice assisted with the completion of the OOH-DNR document, however the hospice agency did not have an MPOA on file. The SW stated the OOH-DNR would be considered invalid, and she would obtain a new OOH-DNR. 4. Record review of Resident #97's admission Record documented a [AGE] year old male admitted to the facility 10/05/23 with diagnoses that included unspecified dementia (a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems), heart failure, anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), dysphagia (trouble swallowing), and acquired absence of left upper limb below elbow. Resident #97 was also on hospice services. Record review of Resident #97's electronic medical record did not reveal the presence of a DNR form although his electronic chart indicated he was a DNR. Record review of Resident #97's undated Care Plan revealed a Problem area with a Date Initiated of 10/07/23 that stated, I have completed documentation for DNR status. Record review of the Hospice binder with information for Resident #97 revealed an IDT Care Plan form that indicated a certification period of 10/05/23 to 12/03/23. Under the Heading Advance Directive was written Do Not Resuscitate. During an interview on 11/16/23 at 11:03 AM, the SW indicated Resident #97 was on hospice. The SW stated the facility was not given a copy of the DNR when he transferred here. The SW stated she would try to contact the hospice company again to get the DNR form. During an interview and record review on 11/16/23 at 03:43 PM, the SW stated they had been unable to reach anyone at the hospice agency who could provide the DNR so the resident had to be treated as a full code until they could get the required document. Following this conversation with the SW, a further record review of the electronic medical record and admission Record revealed Resident #97 code status was changed to reflect Full Code. The SW stated she had called the family to inform them of this situation. During an interview on 11/17/23 at 10:37 AM with the DON, the DNR process was discussed. The DON stated the DNR process was different from the hospital since the patient or family just had to ask to be a DNR at the hospital. The DON stated that in the long-term care facility, the family or resident had to sign the OOH-DNR form along with 2 witnesses and the physician had to sign. The DON stated the form was not valid until the physician had signed and dated the form, added the physician's license number and all parties had signed and dated in both places of the form. The DON was asked if there were risks related to invalid OOH-DNRs and the DON responded that a resident could be coded when they had chosen not to be, and their rights not honored. The DON added the SW had contacted the families to make the changes needed. The DON stated they had a code in-service to verify DNRs. Record review of the facility's policy titled, Do Not Resuscitate Order, undated, revealed, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 5 of 23 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 11/17/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 1. Do not resuscitate orders must be signed by the resident's attending physician on the physician's order sheet maintained in the resident's medical record. 2. A Do Not Resuscitate (DNR) order form must be completed and signed by the attending physician and resident (or resident's legal surrogate, as permitted by state law) and placed in the front of the resident's medical record. 4. Should the resident be transferred to the hospital, a photocopy of the DNR order form must be provided to the personnel transporting the resident to the hospital. 5. Do not resuscitate (DNR) orders will remain in effect until the resident (or legal surrogate) provides the facility with a signed and dated request to end the DNR order. 6. The interdisciplinary care planning team will review advance directives with the resident during quarterly care planning sessions to determine if the resident wishes to make changes in such directives. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 6 of 23 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 11/17/2023 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that include measurable objectives and time frames to meet residents' mental, nursing, and psychosocial needs and to ensure that the comprehensive care plan described the services that were to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including the right to refuse treatment for 1 of 6 residents (Resident #15) reviewed for care plans, in that: The facility failed to implement Resident #15's comprehensive person-centered care plan to address oxygen use and therapy services. This failure could affect residents who have care areas not addressed by the care plan by not having their needs met and putting them at risk of not receiving appropriate care. The findings included: Record review of Resident #15's face sheet, dated 11/16/2023, revealed the resident was initially admitted to the facility on [DATE], and re-admitted on [DATE], with diagnoses that included: fractured right femur, muscle wasting and atrophy, dysphagia (difficulty swallowing), and moderate protein-calorie malnutrition. Record review of Resident #15's Significant change MDS, dated [DATE], revealed the resident had a BIMS score of 02, which indicated severe cognitive impairment. Further review revealed the resident had a used oxygen while a resident at the facility and within the last 14 days. Continued review of Resident #15's MDS revealed resident had received PT, OT, and ST services in the last 7 days, with a start date for therapy services of 10/20/2023. Record review of Resident #15's Comprehensive Care Plan last review completed 11/05/2023, revealed no focus area related to oxygen use. Further review revealed no focus area related to PT, OT, or ST services. Record review of Resident #15's electronic medical record Order Summary Report of Active Orders as of 11/16/2023, revealed an order on 10/19/2023 for: 02 @ 4L/Min via NC PRN to maintain 02 sats > 92% PRN. Record review of Resident #15's electronic medical record Medication Administration Record dated 11/1/2023-11/30/2023, revealed oxygen therapy had been administered daily from 11/01/2023 through 11/15/2023. In an interview with LVN A, (one of the MDS coordinators) on 11/15/2023 at 2:54 p.m., LVN A revealed she and another LVN share the responsibility of updating care plans. LVN A stated the oxygen therapy, PT, OT, and ST services should have been on the comprehensive care plan and must have been overlooked. LVN A identified potential risks related to care plans due to care plans show the staff what the resident's needs are. In an interview with the DON on 11/15/2023 at 3:08 p.m., the DON revealed care plans must be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 7 of 23 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 11/17/2023 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 0656 accurate for staff to have the information needed to provide specific care for residents. Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy titled, Comprehensive Resident Care Plans, undated, revealed, .All items or services ordered to be provided or withheld shall be included in each resident's plan of care .Each resident's plan of care shall be developed within seven days after completion of the comprehensive assessment. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 8 of 23 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 11/17/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments for 2 of 7 residents (R#20 and 80), reviewed for care plan revisions, in that: R#20 requested an activity preference while in isolation that did not result in the revision of CP involving activities and CP was not revised. R#80 requested an activity preference while in COVID-19 isolation that did not result in the revision of CP involving activities and CP was not revised. These failures could place residents at risk for lack of coordination of services and activity preferences. The finding included: Record review of Resident #20's face sheet, dated 11/15/2023, and EMR revealed, the resident was admitted on [DATE] with diagnoses that included: MRSA (infection resistant to antibiotics), depression, and HTN. Resident was a male; age [AGE]. RP was listed as: the resident. Record review of Resident #20's Care Plan, dated 10/27/2023, revealed, the goals and interventions for activities included: share the activity calendar and to remind the resident to attend group activities. CP was not revised to list the resident's activity preferences while the resident was in isolation for MRSA. Record review of Resident #20's MDS, dated [DATE], revealed: o BIMS Score was 13 (cognitively intact) o ADLs: B/B was continent of bowel; and catheter for bladder. Transfer was supervision. Bed Mobility was supervision. ROM: no impairment. Record review of an Activity Director's progress note for Resident #20 dated 11/08/2023 revealed: she attended the IDT meeting. Activity intervention was to visit resident. Record review of Resident #80's face sheet, dated 11/15/2023, and EMR revealed, the resident was re-admitted on [DATE] with diagnoses that included: Acute and chronic respiratory failure, COVID-19, and depression. Resident was a female; age [AGE]. RP was listed as: the resident. Record review of Resident# 80's Care Plan, dated 11/01/2023 , revealed, the goal of activity and interventions included: invite to group activities, AD will visit me 2-3 times per week and provide (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 9 of 23 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 11/17/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm 1:1 [activity] .AD will visit me 2-3 times a week to provide activity supplies if needed and to engage in conversation ., and the share the activity calendar. CP was not revised to reflect activities while the resident was in isolation for COVID-19 (isolation started on 11/06/23). Record review of Resident #80's MDS, dated [DATE], revealed: Residents Affected - Few o BIMS Score was 15 (cognitively intact) o ADLs: B/B was frequently incontinent for both. Transfer was required assistance one staff. Bed Mobility was required assistance one staff. ROM: no impairments. During an observation and interview on11/15/2023 at 10:44 AM revealed the resident (R#20) was in bed; alert and oriented. The resident stated that he felt bored and wanted some activities. The resident stated he enjoyed listening to music and family visits. The activity the resident requested was to leave his room and be outside in the sunlight. The resident stated he had no visits from the activity director. During an interview on 11/15/2023 at 11:51 AM, the Activity Director stated: there were about 12 residents that were bedfast or did not leave their room. She added that there were three residents in isolation. I have not developed an individualized calendar for residents who are bedfast or in isolation .Administration has never told me about an individualized calendar .I have not seen resident [R#20] lately and asked about activity .no summary notes on either resident [ R#20 and R#80] this past month .I am still looking for a policy on activities for bedfast residents or residents in isolation . The AD stated that the CP for R#20 and R#80 were not revised during the time the residents were in isolation. During an interview on 11/15/2023 at 2:32 PM, the Administrator stated: the Activity Director reports to the Administrator. The Administrator stated per policy every resident was assessed for activities and preferences. Also, per policy, the Administrator stated the Activity Director, or a designee will visit a bedfast resident. The Administrator's expectation was that the visit be documented; and CP updated as appropriate. The Administrator will check on the existence of documentation The Administrator stated the residence's activity assessment and any updates were captured in the comprehensive care plan. During an interview on 11/15/2023 at 3:06 PM, the DON stated that all staff knew if a resident verbalized an activity desire; it needed to be documented. Residents on hospice, isolation, cognitively impaired, bedfast and COVID positive were required an activity assessment and updated if there was a major change of condition. The DON stated the CP was updated for activities when a change of condition occurred and the resident expressed an activity preference that was new and not captured in the initial CP. The DON stated the facility had 7 residents in isolation and to include one resident in isolation for COVID 19 positive. The DON was not certain whether the care plans for residents (R#20 and R#80) had been updated to reflect any new activity preferences the resident made during isolation. The DON revealed that R# 80 was COVID-19 positive on 11/06/2023. During an observation and interview on 11/15/2023 at 5:35 PM, R#80, (isolated for COVID-19), (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 10 of 23 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 11/17/2023 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed: she was alert and oriented to person and place; receiving continuous oxygen. The resident was in bed watching TV. The resident stated she had a visit from the Activity Director late in the afternoon (11/15/23) to discuss activity preferences while in isolation. Resident stated this was the first time since she was in isolation for COVID-19 that staff inquired about her activity preferences. The resident stated that an activity she wanted daily was to have a non-clinical interaction with a staff member so as to feel human. The resident stated she did not want her family to visit because of fear they would be exposed to COVID-19. During an interview on 11/16/2023 at 9:44 AM, LVN A (MDS) stated: the CP was revised when there was a change in the resident or a new assessment requiring a CP revision. LVN A stated that she was not aware of any revisions to the CP involving activities when the resident (R#80) converted to COVID-19 positive on 11/06/23. Regarding resident (R#20), he was put in isolation upon admissions (10/27/23) because of the diagnoses of MSRA. LVN A stated that (R#20's) CP had not been revised for activities since admissions. Record review of the facility's Comprehensive Care Plans, undated, read: Each resident's plan of care shall be reviewed by an interdisciplinary team after each MDS assessment is conducted and revised as necessary to reflect the resident's care needs . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 11 of 23 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 11/17/2023 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 0679 Provide activities to meet all resident's needs. 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 provide resident preferences for individual activities and independent activities designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, for 2 of 7 residents (R#20 and R#80), reviewed for activity preferences, in that: Residents Affected - Few R#20's activity preference was not provided while he was in an isolation room. R#80's activity preference was not provided while she was isolated for COVID-19. These failures could affect residents' psychosocial well-being and could lead to a diminished quality of life. The finding included: Record review of Resident #20's face sheet, dated 11/15/2023, and EMR revealed, the resident was admitted on [DATE] with diagnoses that included: MRSA (infection resistant to antibiotics), depression, and HTN. Resident was a male; age [AGE]. RP was listed as: the resident. Record review of Resident# 20's Care Plan, dated 10/27/2023, revealed, the goals and interventions for activities included: share the activity calendar and to remind the resident to attend group activities. CP did not list the resident's activity preferences while the resident was in isolation for MRSA. Record review of Resident #20's MDS, dated [DATE], revealed: o BIMS Score was 13 (cognitively intact). o ADLs: B/B was continent of bowel; and catheter for bladder. Transfer was supervision. Bed Mobility was supervision. ROM: no impairment. Record review of Activity Director's progress note for Resident #20 dated 11/08/2023 revealed: she attended the IDT meeting. Activity intervention was to visit resident. Record review of Resident #80's face sheet, dated 11/15/23, and EMR revealed, the resident was re-admitted on [DATE] with diagnoses that included: acute and chronic respiratory failure, COVID-19, and depression. Resident was a female; age [AGE]. RP was listed as: the resident. Record review of Resident# 80's Care Plan, dated 11/01/2023 , revealed, the goal of activity and interventions included: invite to group activities, AD will visit me 2-3 times per week and provide 1:1 [activity] .AD will visit me 2-3 times a week to provide activity supplies if needed and to engage in conversation ., and the share the activity calendar. CP was not revised to reflect activities while the resident was in isolation for COVID-19 (isolation started on 11/06/23). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 12 of 23 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 11/17/2023 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 0679 Record review of Resident#1's MDS, dated [DATE], revealed: Level of Harm - Minimal harm or potential for actual harm o BIMS Score was 15 (cognitively intact) Residents Affected - Few o ADLs: B/B was frequently incontinent for both. Transfer was required assistance one staff. Bed Mobility was required assistance one staff. ROM: no impairments. During an observation and interview on11/15/2023 at 10:44 AM revealed the resident (R#20) was in bed; alert and oriented. The resident stated that he felt bored and wanted some activities. The resident stated he enjoyed listening to music and family visits. The activity the resident requested was to leave his room and be outside in the sunlight. The resident stated he had no visits from the activity director. During an interview on 11/15/2023 at 11:51 AM, the Activity Director stated: there were about 12 residents that were bedfast or did not leave their room. She added that there were three residents in isolation. I have not developed an individualized calendar for residents who are bedfast or in isolation .Administration has never told me about an individualized calendar .I have not seen resident [R#20] lately and asked about activity .no summary notes on either resident [ R#20 and R#80] this past month .I am still looking for a policy on activities for bedfast residents or residents in isolation . During an interview on 11/15/2023 at 2:32 PM, the Administrator stated: the Activity Director reports to the Administrator. The Administrator stated per policy every resident was assessed for activities and preferences. Also, per policy, the Administrator stated the Activity Director, or a designee will visit a bedfast resident. The Administrator's expectation was that the visit be documented. The Administrator will check on the existence of documentation. The Administrator stated that her expectation was that the following residents were offered a form of activity and refusal documented: hospice, bedfast, and residents severely impaired, and physically impaired. The Administrator stated the resident's activity assessment were captured in the comprehensive care plan. During an interview on 11/15/2023 at 3:06 PM, the DON stated that all staff knew if a resident verbalized an activity desire; it needed to be documented. Residents on hospice, isolation, cognitively impaired, bedfast and COVID positive were required an activity assessment and updated if there was a major change of condition. The DON stated the CP was updated for activities when a change of condition occurred, and the resident expressed an activity preference that was new and not captured in the initial CP. The DON stated the facility had 7 residents in isolation and to include one resident in isolation for COVID 19 positive. The DON was not certain whether the care plans for residents (R#20 and R#80) had been updated to reflect any new activity preferences the resident made during isolation. The DON revealed that R# 80 was COVID-19 positive on 11/06/23. During an observation and interview on 11/15/2023 at 3:18 PM, the Activity Director stated: she documents visit using POC computer entry. The Activity Director stated that she would check whether an activity visit was made to Resident (R#80) isolated for COVID-19 and (R#20) in isolation for contact precaution. No additional evidence was provided prior to exit whether an activity visit had been made to R#20 and R#80. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 13 of 23 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 11/17/2023 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation and interview on 11/15/2023 at 5:35 PM, R#80, isolated for COVID-19, revealed: she was alert and oriented to person and place; receiving continuous oxygen. The resident was in bed watching TV. The resident stated she had a visit from the Activity Director late in the afternoon (11/15/23) to discuss activity preferences while in isolation. Resident stated this was the first time since she was in isolation for COVID-19 that staff inquired about her activity preferences. The resident stated that an activity she wanted daily was to have a non-clinical interaction with a staff member so as to feel human. The resident stated she did not want her family to visit because of fear they would be exposed to COVID-19. During an interview on 11/16/2023 at 9:44 AM, LVN A (MDS) stated: the CP was revised when there was a change in the resident or a new assessment requiring a CP revision. LVN A stated that she was not aware of any revisions to the CP involving activities when the resident (R#80) converted to COVID-19 positive on 11/06/23. Regarding resident (R#20), he was put in isolation upon admissions (10/27/23) because of the diagnoses of MSRA. LVN A stated that (R#20's) CP had not been revised for activities since admissions. Record review of facility's Resident and Wellness and Activities Program policy, undated, read: The facility provides an ongoing program providing a variety of activity functions through the Resident Wellness and Activities Program. The program is designed to include attractions to meet the interests and physical, mental and psychosocial well-being of each resident in accordance with the resident's comprehensive assessment .All residents, particularly bedfast and those residents unable to participate in group functions will be visited by the Wellness and Life Enrichment Director and/or a volunteer . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 14 of 23 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 11/17/2023 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 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure the activities program was directed by a qualified professional who was a qualified therapeutic recreation specialist or an activities professional who was licensed or registered by the state for 1 of 1 Activity Director reviewed, in that: Residents Affected - Some The facility failed to ensure the AD was qualified to serve as the director of the activities program. This failure could place residents at risk for reduced quality of life due to lack of activities that were individualized to match the skills, abilities, and interests/preferences of each resident. The findings included: Record review of the staff roster, provided by the facility, undated, revealed the staff member was listed as Activities Director. Further review revealed the AD was hired on [DATE]. Record review of a certificate provided by the facility for the AD revealed she had been certified as an Activity Director through [name of certification company] with an expiration date of [DATE]. During an interview with the AD on [DATE] at 2:00 p.m., the AD stated her certification had expired on [DATE] during the COVID pandemic. The AD stated she had been unable to attend classes to renew her certification and could not afford the online classes during the COVID crises. The AD stated she was originally certified in 2016 and had renewed every 2 years until 2020. The AD stated she was finally able to get the funds together to pay the $1400 fee to begin the class for recertification since the facility did not assist with this cost. The AD provided a letter from the [name of certification company] instructor showing she had enrolled in the class effective [DATE]. The AD further stated she had been unable to afford to attend any continuing education courses since 2020. During an interview with the HR Director on [DATE] at 2:04 p.m., the HR Manager stated the AD's certification had expired and she had just enrolled for the class upon the surveyor requesting information regarding her certification and training. Review of the [name of certification company], website, https://ctractexas.org/, on [DATE] revealed the Recertification Process as The recertification process will occur every two (2) years. Two (2) continuing education units (CEUs) or 20 contact hours from at least four areas of the Body of Knowledge are required. During an interview with the Administrator on [DATE] at 2:50 p.m., the Administrator stated she was not aware the AD's certification had expired however added that she had been at the facility less than 3 weeks and was still learning all the staff. Record review of the AD's job description provided by the facility revealed a section, Qualifications: the activity program must be directed by a qualified professional and completes continuing education each year, per the requirements of licensure/certification. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 15 of 23 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 11/17/2023 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for each resident receiving hospice services, to ensure quality of care for the resident, ensuring communication with the hospice medical director, the resident's attending physician, and others participating in the provision of care for 3 of 3 residents (Resident #15, #55 and #97) reviewed for hospice services, in that: 1. The facility failed to obtain Resident #15's most recent hospice Plan of Care and documentation by specific interdisciplinary hospice staff providing services to the resident. 2. The facility failed to obtain Resident #55's most recent hospice Plan of Care and documentation by specific interdisciplinary hospice staff providing services to the resident. 3. The facility failed to obtain Resident #97's most recent hospice Plan of Care, Hospice Election Form and Physician Certification of Terminal Illness. These failures could place the resident who received hospice services at-risk of receiving inadequate end-of-life care due to a lack of documentation, coordination of care and communication of resident needs. The findings included: 1. Record review of Resident #15's face sheet, dated 11/16/2023, revealed the resident was initially admitted to the facility on [DATE], and re-admitted on [DATE], with diagnoses that included: fractured right femur, muscle wasting and atrophy, dysphagia (difficulty swallowing), and moderate protein-calorie malnutrition. Record review of Resident #15's Significant change MDS, dated [DATE], revealed the resident had a BIMS score of 02, which indicated severe cognitive impairment. Further review revealed the resident had a life expectancy of less than 6 months and had received hospice care while a resident at the facility. Record review of Resident #15's Care Plan last review completed 07/12/2023, revealed a problem area, The resident has a terminal prognosis r/t CVA. admitted under services of [Hospice A]. Further review revealed an intervention consult with physician and social services to have hospice care for resident in the facility. There was no hospice interdisciplinary team information, visit frequencies, or coordination of care to be provided found in the care plan. Record review of Resident #15's electronic medical record Order Summary Report of Active Orders as of 11/16/2023, revealed an order on 10/19/2023 for: Admit into [Hospice A] under care of MD [name]. Record review of Resident #15's electronic medical record, miscellaneous documents, revealed no Hospice documentation. 2. Record review of Resident #55's face sheet, dated 11/16/2023, revealed the resident had an original admission date of 09/12/2020 and a most recent re-admission date of 02/18/2021 with diagnoses (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 16 of 23 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 11/17/2023 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that included: heart failure, acute respiratory failure with hypoxia (condition where region of the body is deprived of adequate oxygen supply), sleep apnea (sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal), and type 2 diabetes mellitus. Record review of Resident #55's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 99, which indicated the resident to have severe cognitive impairment. Further review revealed the resident had a life expectancy of less than 6 months and had received hospice care while a resident at the facility. Record review of Resident #55's Care Plan, last review completed 09/19/2023, revealed a focus: The resident has a terminal prognosis r/t bradycardia, not candidate for pacemaker. admitted under [Hospice A] services. Intervention listed was work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical and social needs are met. There was no further hospice interdisciplinary team information, visit frequencies, or coordination of care to be provided found in the care plan. Record review of Resident #55's electronic medical record Order Summary Report of Active Orders as of 11/16/2023, revealed an order on 03/16/2023 for: Admit into [Hospice A] under care of MD [name]. DX CHF. Record review of Resident #55's electronic medical record, miscellaneous documents, revealed only an election of hospice benefits and certification of terminal illness. In an observation and interview with LVN D on 11/16/2023 at 1:39 p.m., LVN D located a hospice binder at the nurse's station and a hospice folder in Resident #15's room. Both the binder and folder contained only general information regarding the hospice agency but not specific to Resident #15. LVN D was unable to locate a binder for Resident #55. LVN D stated she could call the hospice agency to ask why the documentation was not in the facility. In an interview with the SW on 11/16/2023 at 1:50 p.m., the SW revealed she discusses with families their options and makes the referrals to hospice and then the charge nurse coordinates with the hospice representative and family to complete admission documentation. The SW stated Resident #15's hospice election form and certificate of terminal illness were found in the business office. The SW added that sometimes the hospice agencies leave those documents with the business office for billing purposes. In a follow-up interview with the SW on 11/16/2023 at 2:33 p.m., the SW provided the POC (Plan of Care) and stated the hospice agency had faxed the POC over today after the SW called and requested. The facility had not received any other IDT documentation. Record review of the facility's hospice services agreement with [Hospice Company A], with effective date October 24, 2023, revealed, in Agreements: 2. Services to be provided by hospice; 2.2 (a) Initial Plan of Care. In accordance with applicable federal and state laws and regulations, Hospice shall coordinate with Facility to timely develop a Plan of Care for each new Hospice Patient. Hospice shall furnish Facility with a copy of the Plan of Care within twenty-four (24) hours of its completion. 4. Communication; Hospice and Facility will communicate with each other either verbally weekly or at each hospice patient visit to ensure that the needs of each hospice patient are addressed and met 24 hours per day. Documentation of such communication shall be included in the patient's medical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 17 of 23 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 11/17/2023 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 0849 record. Level of Harm - Minimal harm or potential for actual harm 3. Record review of Resident #97's admission Record documented a [AGE] year old male admitted to the facility 10/05/23 with diagnoses that included unspecified dementia (a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems), heart failure, anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), dysphagia (trouble swallowing), and acquired absence of left upper limb below elbow. Resident #97 was also noted to be on hospice services upon his admission to facility. Residents Affected - Some Record review of Resident #97's Baseline Care Plan with the effective date of 10/06/23 upon admission indicated a code status of DNR and the name of the hospice company was under the section titled, DIsciplines that contributed to the Post admission Plan of Care. Record review of Resident #97's MDS dated [DATE] in Section O - Special Treatments, Procedures, and Programs had Hospice Care checked under b. While a resident. During an interview with the DON on 11/15/23 at 3:25 PM, the presence of hospice binders was discussed. When surveyor had asked for the binder for Resident #97 at the nurse's station, no binders could be found. The DON stated she would have someone look for the binder since often the hospice agencies kept a folder in the resident's room. Record review of the information faxed to facility on 11/16/23 by [Hospice Company B] only revealed the Hospice Medicare Election Statement, the Hospice admission Consent forms, and the Hospice Level of Care information. Record review of the hospice binder for Resident #97 produced on 11/16/23 at 03:47 PM revealed the hospice binder had information faxed earlier but was still missing the Individual Hospice Election Form 3071 and the Physician's Certification of Terminal Illness form 3074. Hospice Plan of Care forms listed Advance Directives as DNR, but no DNR form was in the binder and could not be located. During an interview on 11/17/23 at 10:47 AM with the DON, the DON stated, We are responsible for ensuring all the forms from hospice are here - especially for DNRs. Medical Records is responsible for ensuring Hospice forms are completed and in the building. The DON stated she did not know why the Forms 3071 and 3074 were not in the binder or available for Resident #97. Record review of the facility's policy titled, Hospice Program, revised July 2017, revealed, 12. Our facility has designated the DON and the SW to coordinate care provided to the resident by our facility staff and the hospice staff .He or she is responsible for the following: d. Obtaining the following information from the hospice: (1) The most recent hospice plan of care specific to each resident; (2) Hospice election form; (3) Physician certification and recertification of the terminal illness specific to each resident; (4) Names and contact information for hospice personnel involved in hospice care of each resident; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 18 of 23 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 11/17/2023 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 0849 (5) Instructions on how to access the hospice's 24-hour-on-call system; Level of Harm - Minimal harm or potential for actual harm (6) Hospice medication information specific to each resident; and (7) Hospice physician and attending physician (if any) orders specific to each resident. Residents Affected - Some .13. Coordinated care plans for residents receiving hospice services will include the most recent hospice plan of care as well as the care and services provided by the facility (including the responsible provider and discipline assigned to specific tasks) in order to maintain the resident's highest practicable physical, mental and psychosocial well-being. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 19 of 23 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 11/17/2023 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 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, interviews and record reviews, the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one resident (#1) of two residents observed for infection control in that: Residents Affected - Few 1. CNA B failed to doff her soiled gloves after performing peri care for Resident #1 and before grabbing a clean sheet and brief for the resident. 2. CNA B failed to sanitize her hands prior to donning new gloves while performing peri care for Resident #1. This deficient practice could affect residents who receive incontinent care and could result in cross contamination of germs and could result in a urinary tract infection (a painful infection of the urinary system, which includes the kidneys, bladder, urethra, and ureters). The findings were: Review of Resident #1's electronic face sheet dated 11/16/2023 revealed he was admitted to the facility on [DATE] with diagnoses of Guillain-Barre Syndrome, (a rare disorder where the body's immune system damages nerve), dysphagia (swallowing difficulties) and muscle wasting and atrophy. Review of Resident #1's quarterly MDS assessment with an ARD of 09/18/2023 revealed Resident #1 scored a 14/15 on his BIMS which indicated he was cognitively intact. Review of Resident #1's comprehensive person-centered care plan revised date 02/16/2023 revealed The resident is totally dependent on (2) staff to provide .bed bath .incontinence care .dressing. Observation on 11/16/2023 at 09:30 a.m. of CNA B performed peri care for Resident #1 revealed CNA B did not doff her soiled gloves after performing peri care and prior to grabbing a clean sheet and brief for the resident. When CNA B did doff her soiled gloves, she did not sanitize her hands prior to donning new gloves. During an interview with CNA B on 11/16/23 at 9:48 a.m., CNA B stated she should have changed her gloves prior to grabbing the new sheet and brief and should have sanitized her hands prior to donning new gloves. CNA B stated that there was a potential for cross contamination from using soiled gloves. Interview on 11/16/23 at 10:35 a.m. with the ADON revealed that the CNA's needed to sanitize their hands before putting on clean gloves and between glove changes because it could cause contamination and could result in an infection for the resident. Review of CNA B's Skill Assessment, dated 10/13/2023, revealed CNA B were checked off for completing hand hygiene and peri-care/incontinence care. Review of the facility policy titled Handwashing/Hand Hygiene revision date 08/2019 revealed The use of gloves does not replace hand washing/hand hygiene .Perform hand hygiene before applying (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 20 of 23 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 11/17/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm non-sterile gloves . use an alcohol-based hand rub containing at least 62% alcohol; or alternatively soap, (antimicrobial or non-antimicrobial) and water for the following situations: before and after direct contact with residents .after removing gloves. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 21 of 23 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 11/17/2023 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 0944 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on interviews and record reviews, the facility failed to ensure Quality Assurance and Performance Improvement (QAPI) training that outlines and informs staff of the elements and goals of the facility's QAPI program for 15 of 26 employees (CNA C, CNA E, CNA F, CNA G, CNA H, CNA I, CNA J, CNA K, LVN L, LVN M, LVN N, RN O, PT P, the FNSD and the AD) reviewed for training, in that: The facility failed to ensure that quality assurance and performance improvement training was provided to CNA C, CNA E, CNA F, CNA G, CNA H, CNA I, CNA J, CNA K, LVN L, LVN M, LVN N, RN O, PT P, the FNSD and the AD. This failure could place residents at risk of staff not being aware of the facility's QAPI processes that focus on the outcomes of care and quality of life due to a lack of training. The findings included: Review of the Facility Staff Roster, undated, revealed: CNA C - date of hire - 08/07/2013 CNA E - date of hire - 04/26/2022 CNA F - date of hire - 03/25/2022 CNA G - date of hire - 02/17/2022 CNA H - date of hire - 10/29/2021 CNA I - date of hire - 08/25/2021 CNA J - date of hire - 05/01/2019 CNA K - date of hire - 03/13/2015 LVN L - date of hire - 11/24/2021 LVN M - date of hire - 10/01/2021 LVN N - date of hire - 12/17/2015 RN O - date of hire - 01/16/2014 PT P - date of hire - 10/30/2015 FNSD - date of hire - 10/01/2021 AD - date of hire - 08/10/2017 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 22 of 23 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 11/17/2023 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 0944 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a record review and interview with the HR Personnel on 11/17/2023 at 1:55 p.m., the HR Director revealed online training transcripts for each reviewed employee. The HR Director confirmed QAPI was not one of the trainings that trigger for staff to take each month and therefore CNA C, CNA E, CNA F, CNA G, CNA H, CNA I, CNA J, CNA K, LVN L, LVN M, LVN N, RN O, PT P, the FNSD and the AD had not received training of the QAPI program. The HR Director further explained that corporate had established a set of required trainings and staff were prompted each month to take a particular training modular to stay current. During an interview with the Administrator on 11/17/2023 at 2:40 p.m., the Administrator stated she was not aware of the requirement for QAPI training for all staff however she would discuss it with corporate staff to ensure the training was added for all staff. Record review of the facility's policy titled, Facility Assessment, revised October 2018, and the attached facility assessment, revealed, 7. Personnel. Training includes all required topics outlined in 483.95 (a)-(i). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 23 of 23