Health inspection·October 14, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few pain to her left foot. LVN C said she immediately assessed Resident #1 and she noted discoloration to her left foot and notified the nurse practitioner. LVN C said that the nurse practitioner ordered X-Rays. During a phone interview on 10/8/25 at 4:39 p.m. CNA A said she and CNA B around 8:30 AM were transferring Resident # 1 on 8/29/2025 from the bed to the wheelchair. CNA A said that during the transfer, CNA B moved the resident to the left which caused her to bump her foot against the mast of the mechanical lift. CNA A said, Resident # 1 did not complain of pain, we continued with the transfer and did not report to LVN C because I thought it was not significant. During an interview on 10/9/25 at 10:00 a.m. CNA B said while she and CNA A transferred Resident # 1 on 8/29/25 from bed to wheelchair via mechanical lift, she was in charge of guiding Resident # 1 to her wheelchair. CNA B said Resident #1 grunted at the moment her foot hit the mast of the mechanical lift. CNA B said after the transfer she and CNA A looked at her left foot and did not notice anything wrong. CNA B said she had failed to report the incident to LVN C. During an interview on 10/9/2025 at 11:00 a.m. DON said CNAs did not report the incident because it was only a tap against the mechanical lift and that Resident#1 did not complain of pain. DON said that investigation and assessments were initiated immediately after being notified by the Director of Rehabilitation. DON said that the facility does not have a policy on mechanical lifts. An Immediate Jeopardy was identified on 10/10/2025. The Immediate Jeopardy template was provided to the administrator's facility on 10/10/2025 at 02:59 p.m. Verification of IJ: Started on 10/11/2025 at 09:00 a.m. and included:Record review of an In-Service with subject of Change of Condition, dated 09/15/2025, indicated that working staff signed the in-service record. Record review of an In-Service with subject of Hoyer Transfer, dated 08/29/2025, indicated that working staff signed the in-service record. Record review of an In-Service with subject of Hoyer Transfer and training, dated 10/09/2025, indicated that working staff signed the in-service record.Record review of an In-Service with subject of Abuse, Neglect, and Exploitation, dated 08/29/2025, indicated that working staff signed the in-service record. Record review of Resident #1 pain assessment done on 10/10/2025. Record review of Resident #1 head to toe assessment done on 10/10/2025. Record review of QAPI with subject of notification of changes condition,, dated 10/11/2025, indicated that Director of Nurses, Director of Rehabilitation, Dietary Representative, Activities representative, and MDS participated in the QAPI meeting. Record Review of updated change in condition policy dated 10/10/25. Record review of 24 hour review and random mechanical lift transfer monitoring done on 10/10/2025. Record review of safety/abuse survey on random residents dated 10/10/25. During interviews on 10/11/2025 from 9:00 a.m., to 6:00 p.m. CNAs A, B, E, G, I, P, S were from the 6 am to 2 pm shift, CNAs F, H, J, K, L, M, Q, R, T from the 2 pm to 10 pm shift, CNAs N, O, and from the 10 pm to 6 am shifts revealed. were all knowledgeable of the expectation that if when providing care to a resident a change was noticed CNAs were to stop the care and inform the charge nurse verbally and with the stop and watch form. CNAs indicated where the stop and watch form was located at the nurses' station. LVNs C, U, and V from the 7 a.m. to 7 p.m. shift and RN W from the 7 a.m. to p.m. shift and DOR from the 8 am to 5 pm shift, revealed were knowledgeable of the procedure of that the CNAs should follow when a change was noted in a resident. LVNs interviews revealed LVNs should immediately assess resident after CNAs notified them of a change. A mechanical lift observation was done on 10/11/25 at 11:00 a.m., for Resident#1 assisted by CNAs A and B revealed CNAs follow procedure to transfer resident from wheelchair to bed using mechanical lift. CNAs used a bed sheet to assist with bed reposition as instructed by training. A mechanical lift observation was done on 10/11/25 at 12:00 p.m., for Resident #2 assisted by CNAs A and B revealed CNAs follow procedure to transfer resident from wheelchair to bed using mechanical lift. CNAs used a bed sheet to assist with bed reposition as instructed (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 10/14/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete by training. A mechanical lift observation was done on 10/11/25 at 01:58 p.m., for Resident #3 assisted by CNAs A and B revealed CNAs follow procedure to transfer resident from wheelchair to bed using mechanical lift. CNAs used a bed sheet to assist with bed reposition as instructed by training. A mechanical lift observation was done on 10/11/25 at 02:40 p.m., for Resident #4 assisted by CNAs A and B revealed CNAs follow procedure to transfer resident from wheelchair to bed using mechanical lift. CNAs used a bed sheet to assist with bed reposition as instructed by training. A mechanical lift observation was done on 10/11/25 at 03:20 p.m., for Resident #5 assisted by CNAs A and B revealed CNAs follow procedure to transfer resident from wheelchair to bed using mechanical lift. CNAs used a bed sheet to assist with bed reposition as instructed by training. The Administrator was informed that the Immediate Jeopardy was removed on 10/11/2025 at 6:10 p.m., however, the facility remained out of compliance at a severity of no actual harm with potential for more than minimal harm that is not an immediate jeopardy and a scope of isolated due to the facility need to evaluate the effectiveness of the corrected system. Event ID: Facility ID: 676398 If continuation sheet Page 3 of 3