Health inspection·February 23, 2024

F 0656 and interventions and/or goals. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #1's POC response dated 02/01/2024-02/06/2024 revealed no swallowing problems noted. Residents Affected - Some Record review of Resident #1's progress note dated 02/06/2024 written by LVN C revealed [Resident #1] was brought to nurses' station due to being restless, resident was eating a granola and he started choking. Another nurse started Heimlich Maneuver on resident, [Resident #1] lost conscious approximately 30 seconds. [Resident #1] was laid on floor, nurse started one compression and [Resident #1] regained consciousness. Vitals blood pressure 160/108, pulse 104, respirations 16, oxygen 90% room air. EMS (Emergency Medical Services) was called [Resident #1] was transported to [local hospital], RP, DON, MD, PA notified. Record review of Resident #1's incident report dated 01/06/2024 written by LVN C revealed time of incident was 5:50 am and location was nurse's station. Type of incident was choking , MD was notified at 6:36 am, RP was notified at 6:14 am, and [Resident #1] was transported to hospital/ emergency room. Vitals signs taken were temperature 96 degrees Fahrenheit, pulse 73, respirations 22, blood pressure 160, 108. Incident described was [Resident #1] due to not staying and being restless was brought to nurses' station, had a snack, he was eating and started choking. Heimlich Maneuver performed and EMS called'. Record review of local hospital physician note dated 02/06/2024 revealed this is a [AGE] year-old male here s/p (status post) an episode of choking ( when a person can't speak, cough, or breathe because something is blocking (obstructing) the airway) on a granola bar. Patient is in no acute distress and in in stable condition. Decision was made to de-escalate care and discharge to previous living arrangement was made due to acute uncomplicated illness/injury. Rationale reassessment at the time of disposition that patient is in no acute distress. Patient has remained hemodynamically stable (blood pressure and heart rate are stable) throughout the entire emergency department visit and is without objective evidence for acute process requiring urgent intervention of hospitalization. No necessity for further emergent imaging or laboratory analysis. The patient is stable for discharge. Record review of Resident #1's physician order dated 01/10/2024 revealed a dietary order for minced moist foods. Review of texture modifications provided by facility revealed minced moist consisted of ground mechanical soft, 4mm size particles and no bread. Record review of Resident #1's speech therapy dated 1/11/24 revealed diagnoses of dysphagia and suggested thin liquids with mechanical soft/chopped diet. Review of texture modifications provided by facility revealed mechanical soft consisted of minced moist, chopped was 1.5 cm size particles and no bread. During an interview on 02/07/2024 at 8:23 am, the DON stated he had received a text yesterday morning (02/06/2024) from LVN C where she said Resident #1 had eaten a granola bar at the nurses' station and had a choking episode. The DON stated LVN C had also mentioned they had performed Heimlich Maneuver and he had lost consciousness for about 30 seconds, when brought down for compressions he [Resident #1[ had regained consciousness and EMS had been called and was transported to hospital for further evaluation. The DON stated he asked her to complete the incident report. The DON stated he was still in the process of the investigation and was unclear on how he [Resident #1] had gotten the granola bar. The DON stated Resident #1 was on a minced moist diet. The DON stated Resident #1 food consistency was downgraded to puree upon return from hospital. The DON stated he was pending interview (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 2 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with LVN C and had already started in-services with staff on minced moist snacks, therapeutic diets, checking diets before snacks provided, and do not enter kitchen after hours to get a head start on possible outcomes. During observation on 02/07/2024 at 9:17 am, Resident #1 was in bed sleeping and no snacks were noted at bedside. During an observation on 02/07/2024 at 11:09 am, the nutrition room had a consistency census report printed on the cabinet doors. Resident #1 was accounted for with level 7, easy to chew (regular diet). During an observation on 02/07/2024 at 11:13 am, resident diet/consistency binder was located outside of kitchen door. Resident #1 was accounted for with level 7, easy to chew (regular diet). During observation on 02/07/2024 at 11:54 am, Resident #1 was in bed sleeping and food tray was at bedside. Dietary ticket next to food revealed Resident #1 puree texture/consistency and nectar liquid. During observation and interview on 02/07/2024 at 11:59 am, CNA D stated she was the CNA assigned to Resident #1 and had worked with him prior to the choking incident as well. CNA D stated prior to the chocking incident, Resident #1 was on a minced moist diet and was able to eat independently. CNA D stated Resident #1 had not had any trouble swallowing in the past and had not had a chocking episode prior to the chocking incident yesterday (02/06/2024). CNA D stated they (CNAs) had access to Resident #1's diet orders thru POC and showed Investigator Resident #1 profile care plan nutritional status reflected puree consistency and thick liquids. During an interview on 02/07/2024 at 1:59 pm, Speech Language Pathologist stated Resident #1 was admitted on minced moist diet. Speech Language Pathologist stated she had evaluated Resident #1 the day after admission [DATE]) and had determined to continue the minced moist diet due to not having issues chewing and/or swallowing. Speech Language Pathologist stated she was made aware of Resident #1 chocking yesterday (02/06/2024) on a granola bar. Speech Language Pathologist stated when Resident #1 returned from hospital the nurses had downgraded his consistency to puree and she had agreed with change due to coughing when attempting to eat minced moist consistency. Speech Language Pathologist stated she put in order diet on 02/06/2024 for Resident #1 for puree consistency. During an interview on 02/07/2024 at 6:37 pm, LVN C stated she had worked night shift (10 pm-6 am) on 02/05/2024 going into the morning of 02/06/2024. LVN C stated Resident #1 had a minced moist food consistency ordered and had not had choking episodes prior to the incident on 02/06/2024 early morning. LVN C stated Resident #1 had woken up around 5:30 am due to an incident that occurred that required EMS activity and that noise had disturbed Resident #1's sleep . LVN C stated Resident #1 appeared restless and was placed in wheelchair and brought out to the hallway for staff to observe him. LVN C stated the CNA F assigned to that hallway was going to start last rounds and had advised her she would be down the hall providing brief changes. LVN C stated she was at the nurse's station and had eyes on Resident #1 and had seen him standing up. LVN C stated she ran to Resident #1 to assist him back to his wheelchair, when she approached him (Resident #1) was going thru a lunch bag and asked him to put everything back. LVN C stated she then took Resident #1 with her to a different hallway on his wheelchair to have him closer for observation. LVN C stated as she was down the hallway to administer a medication to a different resident, she heard Resident #1 coughing. LVN C stated she turned and saw Resident #1 was choking and ran to start Heimlich Maneuver. LVN C stated she noticed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 3 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some crumbs on the floor and saw a granola bar wrap on the floor. LVN C stated LVN E was across the hallway and saw the incident and had approached to take over the Heimlich maneuver. LVN C stated when called EMS due to Resident #1 head dropped and lost consciousness for about 20 seconds. LVN C stated when his (Resident #1) head dropped and lost consciousness LVN E assisted him to the floor to start chest compressions. LVN C stated when Resident #1 was placed on the floor and LVN E started first chest compression, Resident #1 had regained conscious. LVN C stated when Resident #1 had regained conscious, he was alert and was able to answer questions. LVN C stated EMS arrived when Resident #1 had regained conscious and was still taken for further evaluation. LVN C stated the granola bar wrapper was from the snacks the facility provided and the texture was within his food consistency due to being soft. LVN C stated she reported to DON, RP and MD. LVN C stated she completed incident report and was later notified Resident #1 had returned to hospital with no injuries and/or concerns. During interview on 02/08/2024 at 11:17 am, call placed to CNA F. Left voicemail to return call and call was not returned by time of exit. During an interview on 02/08/2024 at 1:12 pm, ADON stated comprehensive care plan was completed by the IDT team and each department was responsible for updating if needed when reviewed quarterly, annually, and as needed per policy. The ADON stated Resident #1 did not account for minced moist food consistency and did not have interventions. The ADON stated risk for not including food consistency was interventions were not followed and lack of independently achievement in goals for each resident. The ADON stated she was responsible for overseeing care plan to ensure they were accurate and had missed the nutrition part. During an interview on 02/08/2024 at 1:54 pm, the Administrator stated after admission the care plans were reviewed and revised by the IDT team during quarterly, annually, and as needed upon a significant change. The Administrator stated all IDT team were responsible for ensuring their portion of the care plan was accurate based on the care of resident. The Administrator stated there was no risk for food consistency not included due to CNAs, nurses, and kitchen staff access to physician orders, resident diet/ consistency binder located outside the kitchen, diet tickets provided when meals were served, and consistency census report located in nutrition room. During an interview on 02/23/2024 at 9:27 am, CNA F stated she had worked the night shift (10pm-6 am) on 02/05/2024 going into the morning of 02/06/2024. CNA F stated Resident #1 had woken up at around 5:30- 5:45 am and had been restless. CNA F stated Resident #1 had history of falls and she placed him in his wheelchair outside in the hallway for more observation. CNA F stated when she had walked out of another unidentified room, she had noticed Resident #1 had a granola bar and did not take it away. CNA F stated she did not think Resident #1 would have been able to open the granola bar wrap. When asked why she thought that Resident #1 would have not been able to open the wrapper, CNA F only answered she just did not think Resident #1 would had been able to open the granola bar wrap. CNA F stated she did not know Resident #1 food consistency diet and stated she assumed he was regular because she had seen him well before. CNA F denied lunch bag left out in the hallway on top of a bedside tray table was hers. CNA F stated appeared defensive after that questions was asked and her answer were very short. CNA F stated there were snacks left behind out in the hallway on top of a bedside tray table by the previous shift. CNA F stated she had seen the snacks out in the hallway since the beginning of her shift. CNA F stated she did not remove the snacks from the hallway on top of a bedside tray table and should had placed them in a more secured place. Resident #2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 4 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 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 Record review of Resident #2's face sheet dated 2/8/24 revealed a [AGE] year-old male who was admitted on [DATE] with diagnoses of dysphagia (difficulty swallowing). Record review of Resident #2's admission MDS assessment dated [DATE] revealed a BIMS score of 10, he was cognitively intact. Residents Affected - Some Record review of Resident #2's physicians order for January 2024 reflected diet order for level 7 easy to chew (regular consistency diet) that was started on 12/28/23. Record review of Resident #2's care plan dated 12/28/23 revealed a focus area for nutritional status to provide diet as ordered by physician. The care plan does not address regular consistency diet and interventions and/or goals. During an interview on 02/07/2024 at 10:31 am, Resident #2 was alert and oriented to person, place, time, and event. Resident #2 stated he did not have any trouble chewing and denied any incidents related to chocking. Resident #2 stated he did not require special consistency to eat, ate regular food. During an interview on 02/07/2024 at 10:41 am, MDS Nurse A stated she was covering the floor to assist with medication pass and was assigned to Resident #2. MDS Nurse A stated Resident #2 was on a regular diet and did not have any trouble when eating. MDS Nurse A stated she had access to his physician orders and would be able to verify diet before snacks and meals were provided. MDS Nurse A stated CNAs had access to Resident #2 electronic record and had a POC tab to do document where the diet consistency would be available for them to verify consistency needed for residents. MDS Nurse A stated the Dietary team had access to care plans and were able to update and/or revise any diet related issues on care plans. MDS Nurse A stated Resident #2 had a care plan for nutrition status but did not specify the consistency he needed MDS Nurse A stated there was no risk of not addressing food consistency due to CNAs access to diet cards when meals were provided for reference, a resident/diet binder located outside the kitchen door, and in nutrition room there was a census with residents' consistency listed for reference. During an observation and interview on 02/07/2024 at 10:56 am, CNA B stated she was the CNA assigned to Resident #2. CNA B stated Resident #2 was on a regular food consistency diet. CNA B stated she had access to Resident #2 electronic record thru POC that reflected his food consistency. CNA B stated showed Investigator Resident #2 POC and stated his food consistency under diet/consistency section was blank. CNA B stated #2 had access to his diet card provided when meal was served for reference and stated there was also a binder located outside the kitchen with resident census that showed their food consistency for reference. CNA B stated if she was not sure of a food consistency for new admissions and was not documented on POC, she had been trained to ask the charge nurse for food consistence clarification. During an observation on 02/07/2024 at 11:09 am, the nutrition room had a consistency census report printed on the cabinet doors. Resident #2 was accounted for with level 7, easy to chew (regular diet). During an observation on 02/07/2024 at 11:13 am, resident diet/consistency binder was located outside of kitchen door. Resident #2 was accounted for with level 7, easy to chew (regular diet). During an interview on 02/08/2024 at 1:12 pm, ADON stated baseline care plan had a 7-day grace (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 5 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some period to be completed per policy. The ADON stated the admitting nurse would have been responsible of addressing nutritional status to reflect food consistency the resident was admitted with. The ADON stated the admitting nurse could reference physicians' orders when they admitted a resident to include in base line care plan. The ADON stated it was expected for the admitting nurse to clarify the food consistency was documented on the base line care plan. The ADON stated risk for not including food consistency was interventions were not followed and lack of independently achievement in goals for each resident. The ADON stated she was responsible for overseeing care plan to ensure they were accurate and had missed the nutrition part. During an interview on 02/08/2024 at 1:54 pm, the Administrator stated the baseline care plan was created by the admitting nurse. The Administrator stated she was not aware if baseline care plan list would include diets to address food consistency. The Administrator stated after admission the care plans were reviewed and revised by the IDT team during quarterly, annually, and as needed upon a significant change. The Administrator stated all IDT team were responsible for ensuring their portion of the care plan was accurate based on the care of resident. The Administrator stated there was no risk for food consistency not included due to CNAs, nurses, and kitchen staff access to physician orders, resident diet/ consistency binder located outside the kitchen, diet tickets provided when meals were served, and consistency census report located in nutrition room. Record review of Snack list for Texture Modified Diets (not dated) provided by facility revealed examples for minced moist snacks were minced fruit, cottage cheese, minced tune, minced egg, pudding, applesauce, yogurt, ice cream, and cereal moistened with excess milk drained. Record review of Care Plan Process, Person Centered- Care policy dated 5/5/2023 read in part The facility will develop and implement a baseline and comprehensive care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality of care. The IDT will review for effectives and revise the person-centered care plan after each assessment. This includes both the comprehensive and quarterly assessments. For the comprehensive assessment the review will be completed with 7 days of and no more than 21 days after admission, FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 6 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review facility failed to ensure residents were provided supervision and assistive devices to prevent accidents for 1 of (Resident #1) of 10 residents reviewed for accidents. Residents Affected - Few The facility failed to ensure Resident #1 had adequate supervision to prevent a choking episode on 02/06/24 when CNA F left her lunch bag unsupervised out in the hallway. Resident #1 grabbed a granola bar from CNA F and choked, resulting in loss of consciousness. This failure resulted in an identification of an Immediate Jeopardy (IJ) on 02/23/24. The IJ template was provided to the Administrator and DON. The IJ was removed on 02/23/24, but the facility remained out of compliance at a scope of isolated and a severity of potential of more than minimal harm that is not an Immediate Jeopardy, due the facility's need to monitor their plan of removal. This failure placed Residents at risk of choking. Findings included: Record review of Resident #1's face sheet dated 02/07/2024 revealed a [AGE] year-old male who was admitted on [DATE] with diagnoses of dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), mood disturbance, anxiety (feeling of fear, dread, and uneasiness), and dysphagia (difficulty swallowing). Record review of Resident #1's admission MDS assessment dated [DATE] revealed a BIMS score of 6, he was severely cognitively impaired who did not require any assistance with eating and was on a mechanically altered diet. Resident #1 was able to eat independently with no assistance and did not have a swallowing problem. Record review of Resident #1's physician order dated 01/10/2024 revealed a dietary order for level 5minced/moist consistency. Record review of texture modifications guide (not dated) provided by facility revealed minced moist consisted of ground mechanical soft consistency, 4mm size particles and no bread. Record review of Resident #1's speech therapy dated 1/11/24 revealed diagnoses of dysphagia and suggested thin liquids with mechanical soft/chopped diet. Record review of texture modifications guide (not dated) provided by facility revealed mechanical soft consisted of soft was referenced as minced moist consistency, chopped was 1.5 cm size particles and no bread. Record review of Resident #1's care plan dated 01/14/2024 revealed Resident #1's care plan did not address the minced moist consistency it states it did not address regular consistency and had behavioral issues of wandering and entering other rooms. Record review of Resident #1's POC response dated 02/01/2024-02/06/2024 revealed no swallowing problems noted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 7 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of Resident #1's progress note dated 02/06/2024 written by LVN C revealed [Resident #1] was brought to nurses' station due to being restless, resident was eating a granola and he started choking. Other nurse on board started Heimlich Maneuver on resident, [Resident #1] lost conscious approximately 30 seconds. [Resident #1] was laid on floor, nurse started one compression and [Resident #1] recuperated consciousness. Vitals blood pressure 160/108, pulse 104, respirations 16, oxygen 90% room air. EMS (Emergency Medical Services )was called [Resident #1] was transported to [local hospital], RP, DON, MD, PA notified. Record review of Resident #1's incident report dated 02/06/2024 written by LVN C revealed time of incident was 5:50 am and location was nurse's station. Type of incident was choking, MD was notified at 6:36 am, RP was notified at 6:14 am, and [Resident #1] was transported to hospital/ emergency room. Vitals signs taken were temperature 96 degrees Fahrenheit, pulse 73, respirations 22, blood pressure 160, 108. Incident described was [Resident #1] due to not staying and being restless was brought to nurses' station, had a snack, he was eating and started choking. Heimlich Maneuver performed and EMS called'. Record review of Resident #1's local hospital physician note dated 02/06/2024 revealed this is a [AGE] year-old male here s/p (status post) an episode of choking on a granola bar. Patient is in no acute distress and in in stable condition. Decision was made to de-escalate care and discharge to previous living arrangement was made due to acute uncomplicated illness/injury. Rationale reassessment at the time of disposition that patient is in no acute distress. Patient has remained hemodynamically stable (blood pressure and heart rate are stable) throughout the entire emergency department visit and is without objective evidence for acute process requiring urgent intervention of hospitalization. No necessity for further emergent imaging or laboratory analysis. The patient is stable for discharge. Record review of Resident #1's physicians order dated 02/06/2024 revealed a dietary order for level 4puree consistency. Review of texture modifications provided by facility revealed pureed consisted of smooth, pudding like consistency. Record review of in-services dated 02/06/2024 for: minced moist snacks, checking diet before snacks, therapeutic diets, and do not enter kitchen after hours. Record review of Snack list for Texture Modified Diets (not dated) provided by facility revealed examples for minced moist snacks were minced fruit, cottage cheese, minced tune, minced egg, pudding, applesauce, yogurt, ice cream, and cereal moistened with excess milk drained. During an interview on 02/07/2024 at 8:23 am, the DON stated he had received a text yesterday morning (02/06/2024) from LVN C where she said Resident #1 had eaten a granola bar at the nurses' station and had a choking episode. The DON stated LVN C had also mentioned they had performed Heimlich Maneuver and he had lost consciousness for about 30 seconds, when brought down for compressions he [Resident #1] had regained consciousness and EMS had been called and was transported to hospital for further evaluation. The DON stated he asked her to complete the incident report. The DON stated he was still in the process of the investigation and was unclear on how he [Resident #1] had gotten the granola bar. The DON stated Resident #1 was on a minced moist diet. The DON stated Resident #1 food consistency was downgraded to puree upon return from hospital. The DON stated he was pending interview with LVN C and had already started in-services with staff on minced moist snacks, therapeutic diets, checking diets before snacks provided, and do not enter kitchen after hours to get a head start on possible outcomes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 8 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few During observation on 02/07/2024 at 9:17 am, Resident #1 was in bed sleeping and no snacks were noted at bedside. During an interview on 02/07/2024 at 1:59 pm, Speech Language Pathologist stated Resident #1 was admitted on minced moist diet. Speech Language Pathologist stated she had evaluated Resident #1 the day after admission [DATE]) and had determined to continue the minced moist diet due to not having issues chewing and/or swallowing. Speech Language Pathologist stated she was made aware of Resident #1 choking yesterday (02/06/2024) on a granola bar. Speech Language Pathologist although the granola was soft, it was not moist and was not considered safe for Resident #1 to consume. During an interview on 02/07/2024 at 6:37 pm, LVN C stated she had worked night shift (10 pm-6 am) on 02/05/2024 going into the morning of 02/06/2024. LVN C stated Resident #1 had a minced moist food consistency ordered and had not had choking episodes prior to the incident on 02/06/2024 early morning. LVN C stated Resident #1 had woken up around 5:30 am due to an incident that occurred that required EMS activity and that noise had disturbed Resident #1's sleep . LVN C stated Resident #1 appeared restless and was placed in wheelchair and brought out to the hallway for staff the have eyes on him. LVN C stated the CNA F assigned to that hallway was going to start last rounds and had advised her she would be down the hall providing brief changes. LVN C stated she was at the nurse's station and had eyes on Resident #1 and had seen him standing up. LVN C stated she ran to Resident #1 to assist him back to his wheelchair, when she approached him (Resident #1) was going thru a lunch bag and asked him to put everything back. LVN C stated she then took Resident #1 with her to a different hallway on his wheelchair to have him closer for observation. LVN C stated as she was down the hallway to administer a medication to a different resident, she heard Resident #1 coughing. LVN C stated she turned and saw Resident #1 was choking and ran to start Heimlich Maneuver. LVN C stated she noticed crumbs on the floor and saw a granola bar wrap on the floor. LVN C stated LVN E was across the hallway and saw the incident and had approached to take over the Heimlich maneuver. LVN C stated when called EMS due to Resident #1 head dropped and lost consciousness for about 20 seconds. LVN C stated when his (Resident #1) head dropped and lost consciousness LVN E assisted him to the floor to start chest compressions. LVN C stated when Resident #1 was placed on the floor and LVN E started first chest compression, Resident #1 had regained conscious. LVN C stated when Resident #1 had regained conscious, he was alert and was able to answer questions. LVN C stated EMS arrived when Resident #1 had regained conscious and was still taken for further evaluation. LVN C stated the granola bar wrapper was from the snacks the facility usually provided to the residents and the texture was within his food consistency due to being soft. LVN C stated she reported to DON, RP and MD. LVN C stated she completed incident report and was later notified Resident #1 had returned to hospital with no injuries and/or concerns. LVN C stated she had asked CNA F to not leave her lunch bag out next time to address the unsupervised foods being a risk for residents. During an interview on 02/23/2024 at 8:35 am, the ADON stated after Resident #1 choking incident the facility provided in-services addressing following diets. The ADON stated it was not common practice for staff to leave their personal belongings anywhere unattended. The ADON stated she had verbally reminded staff to not leave any personal belongings unattended. The ADON stated the facility had not provided a written in-service to address personal belongings/ snacks left unattended. During an interview on 02/23/2024 at 9:27 am, CNA F stated she had worked the night shift (10pm-6 am) on 02/05/2024 going into the morning of 02/06/2024. CNA F stated Resident #1 had woken up at around 5:30- 5:45 am and had been restless. CNA F stated Resident #1 had history of falls and she placed him in his wheelchair outside in the hallway for more observation. CNA F stated when she had walked out of another unidentified room, she had noticed Resident #1 had a granola bar and did not take it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 9 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few away. CNA F stated she did not think Resident #1 would have been able to open the granola bar wrap. When asked why she thought that Resident #1 would have not been able to open the wrapper, CNA F only answered she just did not think Resident #1 would had been able to open the granola bar wrap. CNA F stated she did not know Resident #1 food consistency diet and stated she assumed he was regular because she had seen him well before. CNA F denied lunch bag left out in the hallway on top of a bedside tray table was hers. CNA F stated appeared defensive after that questions was asked and her answer were very short. CNA F stated there were snacks left behind out in the hallway on top of a bedside tray table by the previous shift. CNA F stated she had seen the snacks out in the hallway since the beginning of her shift. CNA F stated she did not remove the snacks from the hallway on top of a bedside tray table and should had placed them in a more secured place. During an interview on 02/23/2024 at 9:48 am, the DON stated after Resident #1 choking incident he had started in-service on diet textures, double checking diets before providing snacks and had started system to add labels to snacks. The DON stated he had not provided an in-service to address personal belongings/ snacks left out unsupervised. The DON stated expectations were to not to leave any personal belongings at nurses' station to include snacks. The DON stated the staff had a breakroom available to place their belongings. The DON stated there was a verbal notice to staff regarding personal belongings/ snacks being placed in a secured place, but no written in-service was completed. The DON stated CNA F should have checked the consistency for Resident #1 before leaving him with the granola bar. The DON stated CNA F should have removed the snacks from the hallway and placed in secured room. Record review of Nutrition Policies and Procedures: Therapeutic Diets (not dated) read in part Therapeutic and mechanically altered diets are ordered by the physician and planned dietician. A mechanically altered diet is a diet specifically prepared to alter the consistency of food to facilitate oral intake. Examples include 4- pureed, 5-minced moist, 6- bitesize, and 7 easy to chew. Use of therapeutic and mechanically altered diet is continually monitored to ensure they continue to be medically indicated. Evening snacks are planned to correspond with the therapeutic and mechanically altered diet unless contraindicated. Prepare and serve all therapeutic and mechanically altered diets as planned. Check trays for accuracy before they are served to the resident. The policy did not address snacks left unsupervised. The Administrator and DON were informed on 02/23/2024 at 1:08 PM that Immediate jeopardy (IJ) had been identified and copy of the IJ Template identifying the areas of noncompliance, elements of risk, and need for immediate action were provided to the Administrator and a Plan of Removal was requested within the hour. The plan or removal was accepted on 02/23/2024 at 3:36 pm. The Plan of Removal revealed the facility took the following actions: 1. Resident #1 was immediately attended to at time of incident with appropriate measures taken place. Resident #1 was assessed immediately and sent to higher level of care for evaluation and treatment if indicated. Resident #1 returned on 2/22/24 and was receiving care per physician orders and plan of care. 2. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 10 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Residents who reside at the facility who are cognitively impaired with dysphagia have the potential to be affected by this alleged deficient practice. An audit of residents who are cognitively impaired with dysphagia was completed by the Director of Nursing/designee to validate appropriate diets are being followed per order, appropriate interventions are in place to prevent choking incidents, interventions are on resident profile to communicate with facility personnel regarding assistance required. Any issues identified will be addressed upon discovery. Audit to be completed 2/23/2204. A facility wide observation was conducted to validate employee personal belongings were not stored in resident care areas. None discovered. Audit completed 2/23/2204. Beginning 2/8/24 snacks are placed in nutrition room allowing facility staff only to have access to snacks for distribution. 3. Director of Nursing and/or designee will re-educate Licensed Nurses and Certified Nursing Assistants on the following: 1. Employee personal belongings are to be placed in designated employee breakroom at all times. 2. Facility provided snacks are placed in nutrition room This re- education will be completed by 2/23/2024. Any Licensed Nurse or Certified Nursing Assistant not receiving this re-education by this date will receive prior to next scheduled shift. This information will be presented in new hire orientation. 4. Director of Nursing and/or designee to conduct random observation to validate no personal belongings are noted in resident care areas to ensure safety of the residents. Assistant Director of Nursing and/or designee will validate night shift no personal belongings in resident care areas to ensure safety of the resident. The above audits to be completed five days a week for four weeks, then weekly for an additional eight weeks then randomly thereafter, any issues identified to be addressed upon discovery. A QAPI meeting was held 02/23/2024. Facility Administrator will be responsible for the overall implementation and validation of this plan. Facility Medical Director will be informed of this plan and given progress updates. The Medical Director was notified of the Immediate Jeopardy on 2/23/2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 11 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Observations, Interviews and Record Review to confirm implementation of the Plan of Removal were conducted as follows: Observations on 2/23/24: 3:52 pm, 400 hall no personal belongings/ snacks noted in the hallway/ med carts. Residents Affected - Few 3:57 pm, no personal belongings/ snacks noted in nurses' station. 3:58 pm, 300 hall no personal belongings/snacks noted in hallway/med carts. 4:05 pm, kitchen no personal belongings/ snacks noted left out. 4:06 pm, no personal belongings / snacks noted in lobby area. 4:06 pm, 100 hall no personal belongings/ snacks noted in hallway/med cart. 4:07 pm, 200 hall no personal belongings/ snacks noted in hallway/ med cart. 4:11 pm, common area next to kitchen no personal belongings/snacks noted. Interviews on 2/23/24: 3:45 pm, called MD stated he was notified of IJ. 3:53 pm, LVN G- 2-10 pm shift, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 3:55 pm, MA H - 6am-2 pm shift, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 3:58 pm, LVN I, wound care nurse, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 4:00 pm, LVN J 2pm-10pm shift. confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 4:02 pm, CNA K rotates 2pm-10 pm shift, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 4:08 pm, MA L and CNA M, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 12 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 4:21 pm, MDS Nurse A, stated she works night shift on the weekend and oversee the restorative aides, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 4:24 pm, LVN D/ telephone- 10-6 shift, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 4:40 pm, CNA F/telephone, did not answer left VM to return call. 4:43 pm, LVN N/telephone double weekends 6a-10p, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 4:46 pm, LVN E/telephone 10-6 shift, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. 4:48 pm, ADON and DON, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. The DON and ADON stated they would have the binders with residents' census and diet orders for reference. The DON and ADON stated they would monitor 5 times a week at random to include all shifts. The DON and ADON stated any findings, if any, would be documented in calendar. The DON and ADON stated they both conducted audits and no concerns identified. The DON and ADON stated they both assisted with observations rounds earlier today with no concerns identified. The DON and ADON stated they both assisted with completing all staff in-services. The DON and ADON stated they were part of the QAPI held meeting today. 4:56 pm, Administrator, confirmed in-services on no personal items, no snacks, no drinks to be left in hallway, nurses' station, or med cart. Was told to utilize lockers in break room. If residents seen with food, verify texture to ensure they are following correct diet order. The administrator stated ADON and DON or designee would be conducting random observations 5 times a week to include all shifts and will document on calendar. The Administrator stated she was part of QAPI meeting held today. Record review: Reviewed QAPI (Quality Assurance and Performance Improvement) dated 2/23/24 at 1:20 pm revealed personal belongings secured. Facility floor plan with handwritten notes to address observation rounds dated 2/23/24 validated by nursing administration. Reviewed clinical diagnoses census used to cross reference diets dated 2/23/24 validated by regional clinical manager. Reviewed in-service dated 2/23/24: all snacks are to be placed in secured nutrition room, facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 13 of 14 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 676393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Las Ventanas DE Socorro 10064 Alameda Avenue Socorro, TX 79927 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 staff to pass out snacks. Level of Harm - Immediate jeopardy to resident health or safety Reviewed in-service dated 2/23/24: verify snacks to ensure correct diet/texture is followed. Residents Affected - Few Reviewed in-service dated 2/23/24: no personal belongings should be at the nursing station, hallways, or med carts. Reviewed in-service dated 2/23/24:do not leave residents alone while eating. Reviewed in-service dated 2/23/24: belongings should only be in the assigned area with placement in breakroom. Reviewed in-service dated 2/23/24: any items to include water bottles, mugs, backpacks, handbags, and storage bags to be stored in breakroom. The IJ was removed on 02/17/24 at 3:35 pm, the facility remained out of compliance at a scope of isolated and a severity of potential of more than minimal harm that is not an Immediate Jeopardy, due the facility's need to monitor their plan of removal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676393 If continuation sheet Page 14 of 14