Health inspection·April 4, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few thermometer, Resident #1's room temperature registered at 81.6 degrees. He said the resident rooms should be between 71 to 81 degrees. In an interview on 04/04/25 at 1:40 pm., CNA A said for past couple of days, she had felt the temperature in Resident #1's room was warmer than other rooms (in the same hall). She said Resident #1 had not complained of the temperature in her room, and thought it was because she had two fans directly in front of her on all the time. CNA A said she mentioned the temperature in Resident #1's room to CNA B earlier that day and CNA B told her she had already reported it to their Charge Nurse, RN C. CNA A said since CNA B had already reported it, she did not report it to anyone else. In an interview on 04/04/25 at 1:50 p.m., CNA B said she had noticed Resident #1's room had been hot the past 2 days. She said she had reported it to RN C earlier that day. She said Resident #1 had two fans directly in front of her bed that helped circulate the air. CNA B said Resident #1 was on continuous oxygen therapy. In an interview on 04/04/25 at 1:58 p.m RN C said CNA B had mentioned to him earlier that day that Resident #1's room seemed warmer compared to the other rooms in Hall 400. He said CNA B mentioned it in a casual conversation they had about something else and he did not taken it as a concern. He said he could not remember if he had reported it to the Maintenance Director or to his ADON. He was not able to say what negative outcome if any to Resident #1 if her room was too hot. In an interview on 2:10 p.m., the Maintenance Director said he checked the temperature in all 6 halls every morning and logged them in the facility's temperature log. He said he had not encountered any concerns regarding the temperatures in the halls in the past month. He said he would not check the temperature in the resident's room unless a concern was reported. He said he had not received any concerns regarding the temperature in Resident #1's room. He said the air condition that would cool Resident #1's room had not been serviced in 12 months. In an interview on 04/04/25 at 2:00 p.m., the ADON said she had not received any concerns regarding Resident #1's room temperature. She said each resident had what they called guardian angels that were assigned to them. She said the guardian angels would visit their residents daily. An interview on 04/04/25 at 3:25 p.m., CMA F said had noticed Resident #1's room was humid the past couple of days. She said Resident #1 was continuous oxygen therapy and the temperature in the room could make it uncomfortable for her. She said she had not reported it to anyone because she did not think it could negatively affect Resident #1. An interview on 04/04/25 at 3:45 p.m., the Medical Records/Guardian Angel said her responsibilities as a guardian angel were to visit her assigned residents daily. She said during those visits, she would ensure their room was safe and comfortable. She said she had noticed Resident #1's room was stuffy which she said was not normal the past 2 days. She said she had verbally reported it to the Maintenance Director on 04/03/25 and 04/04/25 but the Maintenance Director did not acknowledge her. She said she had not reported it to anyone else. Record review of Resident #1's medical electronic record reflected she had not had a change in condition or had been transferred to the local hospital in the past 2 weeks. Record review of the facility's air temperature-daily morning inspection log reflected the temperature in hall 400 was between 72 and 73 degrees from 03/01/25 to 04/04/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676391 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 676391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Calallen 4162 Wildcat Dr Corpus Christi, TX 78410 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete In an interview on 04/04/25 at 4:00 p.m., the Administrator said he had not received any concerns regarding Resident #1's room temperature. He said the Maintenance Director would check the temperature in all six halls daily and would keep a log. He said he did not review the logs unless there was a concern. He said the Maintenance Director would not go into any resident rooms when checking the temperature in the halls. The Administrator said he had personally checked Resident #1's room temperature at 1:45 p.m. with the Maintenance Director infrared thermostat and verified the temperature was 81.6 degrees. He said he had immediately instructed the Maintenance Director to install a window unit in Resident #1's room. He said Resident #1 had not voiced any concerns about her room temperature to him. The Administrator said there were no negative outcome to Resident #1 for having her room temperature at 81.6 degrees since she had two fans. The Administrator said the facility did not have a policy related to room temperatures. Event ID: Facility ID: 676391 If continuation sheet Page 3 of 3