Health inspection·April 6, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Record review of 30-day Discharge Notice dated 02/19/24 revealed the notice was sent to Resident #1's RP indicating the facility was discharging Resident #1 due to facility could not meet his needs, the health of other individuals in the facility were endangered, and the safety of other individuals in the facility were endangered. The Notice indicated the reason Resident #1 was being discharged was that he was a threat to residents and staff. Residents Affected - Few Record review of Notice of Hearing dated 03/07/24 revealed an appeal to the Discharge Notice was requested by Resident #1's RP and the hearing was dated for 04/04/24 at 3:00 p.m. via telephone. In an interview on 04/05/24 at 3:03 p.m., the Local Ombudsman said she had assisted Resident #1's RP to file an appeal against the Discharge Notice. The Local Ombudsman said the appeal indicated Resident #1 should not be transferred or discharge until the Hearing Officer decided. The Ombudsman said Resident #1 had been transferred to the hospital on [DATE]. The hospital discharged Resident #1 and the facility refused to let Resident #1 return. In an interview on 04/05/24 at 3:15 PM The DON said Resident #1 was sent to the hospital because he hit an elderly female resident in the mouth. The DON said Resident #1 refuses to take his medications. Resident #1 had been prescribed Seroquel and Haldol but would not take his meds. Resident #1 had a UTI and was prescribed an antibiotic and he would not take it. If the nurses tried to give him the medications, Resident #1 would become aggressive and would throw a shoe at the nurse and the Med Aide. The DON said Resident #1 also hit the NP. The Resident threw a shoe at the NP and hit him in the chest. Resident #1 would go sit in the dining room at a table by himself because he would get upset if anyone at the table was talking. Resident #1 would sit with another male resident in the dining room. The other male resident was very social and liked to talk to other residents. The other male resident was talking to Resident #1 and Resident #1 became upset and began yelling at the other male resident and hit him. Resident #1 had a couple of encounters with that resident. The DON said Resident #1 also had an encounter with a female resident and Resident #1 hit the female resident in the face. Resident #1 was sent to the ER for evaluation and to be cleared for the Behavioral Center. The DON said the ER cleared Resident #1, but the Behavioral Center refused to take Resident #1 because his aggression. The DON said when the Behavioral Center refused to take Resident #1 the Administrator refused to let Resident #1 return to facility. In an interview on 4:05 PM, Med Aide A said Resident #1 would not take his meds. Resident #1 had been here a long time, when he used to walk he would take his medications but as his illness progressed he began refusing his medications. Med Aide A said she would offer the medications and depending on Resident #1's mood he would say no, I am not taking those medications, or he would throw them at her and refuse. Med Aide said she witnessed the incident between Resident #1 and the female resident. Med Aide A said she was in the dining room and her back was toward the hall. The Med Aide said she heard people arguing. There were four female residents in the hall way and Resident 1's wheelchair was locked with the female resident. Med Aide A said she saw the female resident was holding Resident #1's hands. Resident #1 let go of one of her hands and then punched the female resident. Resident #1 hit her with his right hand with a closed fist on her left cheek. Med Aide A said she yelled for the nurse. The Med Aide A said she felt realy bad because she was too late and could not stop Resident #1. Med Aide A said you always had to be careful when he passes by because if he can't get through he will get upset and would lash out. In an interview with the nurse from the hospital on [DATE] at 5:10 PM, the RN said Resident #1's mood changes; sometimes he was calm and sometimes he was not. The RN said Resident #1 had been taking his medications lately. The RN said they were waiting for the Social Worker to find placement for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676398 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 676398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Hollow Post Acute 310 America Dr Brownsville, TX 78526 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 0626 Resident #1. Level of Harm - Minimal harm or potential for actual harm In an interview at the hospital on [DATE] at 5:15 PM, Resident #1 said he was doing well but there was nothing wrong with him and he wanted to be discharged . Surveyor asked if Resident #1 wanted to go back to the facility and Resident #1 said wanted to go to his ranch. Residents Affected - Few In an interview on 04/06/24 at 9:46 AM via phone with Administrator said Resident #1 was sent to the hospital to be cleared for sectioning to the Behavioral Center. The hospital said there was nothing wrong with Resident #1 and were going to send him back to the facility, but the Administrator refused to take him back because he is a threat to the residents and staff. Resident #1 has had four incidents where he hit staff and residents. The Administrator said Resident #1 refuses care, medications and does not allow staff to enter his room to clean. The Administrator said the appeal was scheduled for 04/04/24 but he requested the appeal to be rescheduled so he could gather all the documents needed for the hearing. The Administrator said Resident #1's RP was notified of the transfer to the ER, and she agreed with the decision to transfer Resident #1 to the ER. In an interview on 04/06/24 at 2:27 PM the Assistant Administrator said Resident #1 had 15 incidents of aggression and there were several self-reports of Resident #1 aggression toward other residents. The Assistant Administrator said the facility has tried to get family to assist with Resident #1's behavior. The Assistant Administrator said they have tried numerous interventions, but Resident #1 refuses all care. Record review of facility's Transfer or Discharge policy dated August 2018 revealed: 1. Residents will not be transferred unless: a. The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility. b. The transfer or discharge is appropriate because resident's health has improved sufficiently . 2. If a resident exercises his or her right to appeal a transfer or discharge notice, he or she will not be transferred or discharged while the appeal is pending unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676398 If continuation sheet Page 3 of 3