Health inspection·January 16, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few agitated behavior. Head to toe assessment done on [R#1] with no visible skin issues noted at this time and [R#1] denies pain at this time. Administrator, DON and ADON notified. An observation and interview on 01/15/25 at 5:45 p.m., R#1 was observed in the dining room. R#1 said hace tiempo (some time ago) a CNA (did not remember her name) had used obscene language while she tried to transfer him from his bed to his wheelchair. R#1 said the only details he remembered was that CNA A trying to transfer him to his wheelchair, him punching her and CNA A responded with obscene language. R#1 said he was told by a staff member CNA A no longer worked at the facility. R#1 said after the incident, he felt safe in the facility and had no fears of retaliation or was afraid of any staff or resident. R#1 said the incident did not affect him in any way, the only thing he did not appreciate was the way CNA A had spoken to him. R#1 said he felt content with the investigation, especially LVN B who had walked in when CNA A was talking to him. Record review of the Administrator's written statement with R#1 on 05/20/24 reflected, Administrator interviewed [R#1] after incident occurred on 05/20/24. [R#1] stated CNA that helped him this morning told him bad words and he tried to hit her. He sated while trying to hit her he hit his hands in the wheelchair, and she was redirecting his arms away from her. Resident stated he attempted to pushed away and hit her. Record review of LVN B's written statement he provided on 05/20/24 reflected, On Monday 05-20-24, I [LVN B] was the charge nurse on 300 hall. At approximately 0700 I was standing outside RM [ROOM NUMBER] when I heard loud obscene yelling in Spanish coming from RM [ROOM NUMBER]. I immediately went into room [ROOM NUMBER] and saw [R#1] sitting on the side of bed and CNA A standing in from of [R#1] trying to assist him to transfer to wheelchair, but [R#1] was trying to punch CNA A. CNA A was deflecting the punches with her hands and yelling to resident in Spanish que chingado tienes (what the hell is wrong with you) A mi no me vas a pegar (you are not going to hit me) ya parale con [NAME] chingada (damn it, stop it) [R#1] stated he did not want to go to dining room, but did not say why he was hitting CNA. Skilled nurse told [R#1] to stop hitting CNA and that's when resident allowed to be assisted to wheelchair. Once [R#1] was safely seated in wheelchair skilled nursed immediately told CNA A to walk out of room and clock out and go home due to her agitated behavior. Head to toe assessment done on [R#1] with no visible skin issues noted at this time and [R#1] denies pain at this time. Administrator, DON and ADON notified. A phone interview on 01/15/25 at 11:11 a.m., LVN B said that on 05/20/34, he was the charge nurse for hall 300 and as he was exiting another resident's room, he overheard a women's voice yelling obscene language coming from R#1's room. LVN B said he overheard her saying no me estes pagando con [NAME] chingada. (damn it, don't be hitting me) LVN B said he became concerned and immediately went into R#1's room to see what was going on. He said he observed R#1 sitting on the side of his bed and CNA A standing in front of him trying to transfer him to his wheelchair. He said he observe R#1 attempting to hit CNA A. He said CNA A tried to shield herself with her hands and yelled to R#1 in Spanish, que chingados tienes (what the hell is wrong with you) a mi no me vas a pegar (you are not going to hit me) ya parale con [NAME] chingada (damn it, stop it). He said he told R#1 to stop hitting CNA A and instructed CNA A to leave R#1's room and to clock out due to her inappropriate behavior. He said he stayed with R#1's and assessed him. He said R#1 voiced that he was ok and had no visible signs of injuries. LVN B said R#1 showed no signs of distress, his vitals were within range and did not complain of pain. LVN B said after he assessed R#1 he contacted the facility's Administrator who was the abuse coordinator to tell him what he had witnessed. He said the Administrator told him to immediately send CNA A home in which he responded he had already done so. He said the incident happened before breakfast. He said CNA A told him before she exited R#1's room that [R#1] was trying to hit (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 2 of 5 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 01/16/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm her, and she had lost her temper. He said CNA A obeyed his orders without hesitation and left the facility. LVN B said he had never observed that behavior from CNA A before or any other staff member. LVN B said as soon as the Administrator started his investigation, he continued with her daily tasks. LVN B said CNA 's and nursing staff were in-serviced on the topic of ANE that same day. LVN B said he was frequently in-serviced on the topic of ANE. Residents Affected - Few Record review of CNA A's written statement she provided on 05/20/24 reflected, Today 05/20/24 about 6:45 am I was working on the 300 hall .I went to [R#1's] to change him and get him up for breakfast .I started to change his diaper and to get him dressed for breakfast. As I sat him on the edge of the bed to change his shirt he was falling (leaning) back on the bed so I pulled him forward so I can change him he started calling me names and said he was going to hit me. I told him not to be hitting me and when I went to put my arms around him, he leaned back made a fist and hit me right in the middle of my chest. I kept saying in Spanish, no me estes pagando (don't be hitting me) but also at the same time trying to make the transfer to the chair. He hit me again and my reaction was no me estes pagando que chingaos tienes (don't be hitting me, what the hell is wrong with you). When LVN B entered the room and heard me say that he asked me what was going on I told him I'm trying to transfer him, but he started hitting me. LVN B goes just leave him there and come back later. I said I can't the bed is high, and he can fall. He goes I need to report what you said, what I saw. Put [R#1] in the chair and go the hallway. LVN B says everyone heard you. I said who it's just me, you, and roommate in the room. I know I shouldn't said that maybe something but not that. But that was my reaction at the moment. LVN B said you need to leave go home and DON will call you. And I left about 7 am. I never hit him never intended to hit him I just reacted verbally. A telephone interview on 01/15/24 at 12:24 p.m., CNA A said she no longer worked at the facility and did not remember the 05/20/24 incident with R#1. She said she had nothing else to say. Record review of R#1's progress notes dated 05/21/24 at 7:02 p.m., authored by SW reflected, SW met with [R#1] at bedside to follow up regarding abuse allegation from CNA during adl care the previous day. Investigation was completed, CNA involved suspended resident will continue to receive adl care assistance from other cna staff in the 300 hall. [R#1] laying down in bed [R#1] in a calm and pleasant mood, well-groomed and oriented x2. [R#1] reports he used the following coping mechanisms: talking to his family member and is trying not to think about the event because it gets him upset. [R#1]expressed no further concerns. SW notified resident outside counseling services will be coming out speak with him tomorrow resident verbalized understanding. Record review of R#1's progress notes dated 05/22/24 at 7:33 p.m., SW met with [R#1] at bedside to follow up regarding abuse allegation. [R#1] laying down in bed [R#1] in a calm and pleasant mood, well-groomed and oriented x2. [R#1] reports he is doing better and is no longer upset. [R#1] expressed no further concerns. [R#1]met with counseling services and enjoyed his session with SW. Outside counseling services will continue to meet with [R#1]. Record review of R#1's counseling notes from an outside source dated 05/23/24 reflected, [R#1] states CNA told him some mean things and used bad words. Resident reports this was the first time this happened .[R#1]was advised that CNA is no longer working at facility and reports he feels comfortable at facility. [R#1] report staff have tried to be helpful with him. [R#1] denied any feelings of not being safe or fear of retaliation. An interview on 01/15/25 at 4:25 p.m., Administrator said on 05/20/24, he received a telephone call from LVN B right before breakfast and advised him that he had overheard CNA A cussing at R#1. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 3 of 5 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 01/16/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few said LVN B quickly intervened and deescalated the situation. He said LVN B instructed CNA A to leave R#1's room and to clock out. He said LVN B assessed R#1 and was fine. The Administrator said as soon as he arrived at the facility, he immediately interviewed R#1. He said R#1 told him CNA A had told him bad words and he admitted to trying to hit her. The Administrator said R#1 did not show any signs or symptoms of distress during his interview. He said he then called CNA A on her cell phone to get statement. The Administrator said CNA A told him she had yelled at R#1 and had told him a mi no me vas a pegar (you are not going to hit me) and used the Spanish word chingado (what the hell). The Administrator said CNA A told him the Spanish word chingado (what the hell) was not a bad word for her and would say it regularly. He said during their conversation, CNA A used the word Spanish word chingado (what the hell) while talking to him. The Administrator said his number one priority was the safety and wellbeing of his residents. He said CNA A was terminated due to her lack of professionalism. He said CNA A admitted to reacting verbally and apologized for using the word chingado (what the hell). The Administrator said CNA A was not referred because he felt she was remorseful. He said all staff were immediately in-serviced on the topic of abuse and neglect on 05/20/24. The Administrator said the facility had taken the following steps to remedy the situation, CNA A was immediately removed from the facility to protect all residents, R#1 was assessed and was found to be physically unharmed, CNA A was suspended while the investigation was on-going, staff were in-serviced on the topic of ANE on 05/20/24, after the investigation, CNA was terminated, reported the allegation of abuse to state, and R#1 was referred and continued receiving counseling services. Record review of facility's complaint/grievance follow-up report completed by the Administrator on 05/20/24 reflected the nature of the complaint was R#1 voiced CNA A was abusive toward him. The final resolution indicated the investigation had been completed, and the allegation were unfounded. Record review of CNA A's employee record reflected she was hired on 03/01/24. Her background check was clear and her last in-service on abuse and neglect was on 05/09/24. Record review of the facility's Employee Counseling Report completed by the Administrator, dated 05/23/24 reflected: Incident description: abuse allegations towards resident. Self-report submitted. Performance Improvement Plan: Suspension on 05/20/24, Termination on 05/23/24. Record review of the facility's Abuse, Neglect and Exploitation policy dated 08/12/22 reflected: Policy: It is the policy of this facility to provide protections for the health, welfare, and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation, and misappropriation of resident property. Definitions: Staff: includes employees, the medical director, consultants, contractors, volunteers, caregivers who provide care and services to resident on behalf of the facility, students in the facility's nurse aide training program, and student from affiliated academic institutions, including therapy, social and activity programs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 4 of 5 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 01/16/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Verbal Abuse: means the use of oral, written, or gestured communication or sounds that willfully includes disparaging and derogatory terms to resident or their families, or within their hearing distance regardless of their age, ability to comprehend, or disability. Alleged Violation: is a situation or occurrence that is observed or reported by staff, resident, relative, visitor or others but has not yet been investigated and, if verified, could be indication of noncompliance with Federal requirement related to mistreatment, exploitation, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property. IV. Identification of Abuse, Neglect and Exploitation B. Possible indicators of abuse include, but are not limited to: 1. Resident, staff, or family report of abuse 5. Verbal abuse of a resident overheard FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676346 If continuation sheet Page 5 of 5