Health inspection·December 3, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 11/28/2025-11/29/2025 indicated: 11/28/2025-Shift: 6 a.m.- 2:00 p.m.- LVN A did not assess Resident #1 bowels nor document if resident had a bowel movement. 6 a.m.- 2:00 p.m.- CNA D did not document if Resident #1 had a bowel movement. 10:00 p.m.- 6:00 a.m.- LVN B did not assess Resident #1 bowels nor document if resident had a bowel movement. 10:00 p.m. -6:00 a.m.- CNA E did document if Resident #1 had a bowel movement. 11/29/2025-Shift: 2:00 p.m.- 10:00 p.m.- RN C did not assess Resident #1 bowels nor document if resident had a bowel movement. 2:00 p.m.- 10:00 p.m.- CNA F did not document if Resident #1 had a bowel movement. During an attempted interview with Resident #1 on 12/02/2025 at 10:50 a.m., she was being transported out of the facility to the hospital by medical transport unrelated to constipation. Resident #1 did not return to the facility during investigation. During an interview with the facility nurse practitioner on 12/02/2025 at 1:30 p.m., he said nursing should have done a bowel assessment on Resident #1 when she had not had a bowel movement for two days due to her recent fecal impaction that was surgically removed four days ago. He said he had not given the facility an order for a two-day assessment. During an interview with the facilities physician on 12/02/2025 at 2:00 p.m., he said Resident #1 was sent to the hospital due to a syncope episode and bradycardia. The hospital discovered she was impacted with stool in her colon that the hospital removed. He said the nurses were responsible for assessing, monitoring, documenting and reporting changes in Resident #1's bowel patterns. During an interview with unit manager G on 12/02/2025 at 2:15 p.m., she said nurses were responsible for assessing, monitoring, documenting and reporting changes in Resident #1's bowel patterns. She said the CNAs was also responsible for documenting Resident #1's bowel patterns each day in the electronic medical records. The unit manager G said she expects the nurses to assess Resident #1's bowel each shift to ensure no impaction was forming due to and CNAs to follow Resident #1's care plan for her bowels. She said documentation indicated LVN A, LVN B, RN C did not assess Resident #1 bowels on 11/28/2025-11/29/2025 nor document it in the electronic medical records. She said CNA D, CNA E, CNA F failed to document if Resident #1 had a bowel movement on 11/28/2025-11/29/2025. During an interview with the DON on 12/02/2025 at 2:45 p.m., she said a bowel assessment should have been completed and documented by the LVN A, LVN B, RN C to ensure Resident #1 was not constipated. She said the CNA's are expected to document if a resident had a bowel movement or not per shift and report it to their nurse. She said it is her responsibility to ensure assessments were initiated and facility policy complied and follow up with staff to ensure assignments are carried out. She said the CNA D, CNA E, and CNA F did not document or report to their nurses whether Resident #1 had a bowel movement on their shift. She said if the CNA did not document resident's bowel movements, then the nurse should have assessed Resident #1 to ensure she was not constipated due to her taking medications that had side effects of constipation. She said when Resident #1 was re-admitted from the hospital the facility physician ordered docusate sodium (stool softener, twice a day), glycolax powder (laxative), and milk of magnesium (laxative- as needed.)(The DON said all staff had been in-serviced on expectations with bowel continence and incontinence on 06/18/2025. She said all staff had been in- serviced on assessments on 07/30/2025. She said nurses physically assessing residents bowels and documenting the findings minimize the risk of fecal impaction to residents. During an interview with the Administrator on 12/02/2025 at 3:05 p.m., he said the nurses were responsible for assessing, monitoring, documenting and reporting changes in Resident #1's bowel patterns. He said the LVN A, LVN B, RN C were responsible to assess and document if she had a bowel movement. He said the CNA D, CNA E, and CNA F were responsible for documenting Resident #1's bowel patterns and reporting findings each day in the electronic medical records and failed to do so. During an interview with LVN A on 12/03/2025 at 12:32 p.m., she said she did not assess Resident #1's bowels on 11/28/2025 on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676444 If continuation sheet Page 2 of 4 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 676444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bonne Vie 8595 Medical Center Boulevard Port Arthur, TX 77640 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the 6:00 a.m.- 2:00 p.m. shift because she had not showed any symptoms of constipation. She said she was aware that Resident #1 took medication that had side effects of constipation. LVN A said she did not know CNA D did not document Resident #1's bowels for the shift in the electronic medical record. She said she did not follow up with CNA D to ensure bowel pattern was documented on Resident #1 for the 6:00 a.m.-2;00 p.m. shift on 11/28/2025. She said she should have documented Resident #1's bowel pattern on her shift since CNA did not. During an interview with CNA D on 12/03/2025 at 12:38 p.m., she said she did not document Resident #1 bowel pattern in the electronic medical record on 11/28/2025 on the 6:00 a.m.2:00 p.m. shift because the computers were not working. She said she did not think to inform LVN A because her nurse had experienced computer problems. During an interview with LVN B on 12/03/2025 at 12:45 p.m., she said she did not assess Resident #1 bowels on 11/28/2025 on the 10:00 p.m.- 6:00 a.m. shift. She said she was aware that Resident #1 took two medications that had side effects of constipation. LVN B said she was aware that Resident #1 had a fecal impaction that required surgery when she cared for her four days after hospital discharge. She said she relied on the computer to alert her when Resident #1 had gone 3 days without a bowel movement. She said a staff member has to enter bowel movement data for the computer system to alert them that a resident had gone 3 days without a bowel movement. She said if residents do not inform her that they are constipated or show signs of constipation then she does not assess/ touch the residents stomachs every day. She said it's the CNA's and the charge nurse's responsibility to ensure residents bowel patterns are recorded. An interview with CNA E was attempted two times by telephone (12/03/2025- 12:05 p.m., 12/03/2025- 12:38 p.m.- voicemail left.) Surveyor was unable to speak with CNA E regarding the reason she did not document Resident #1 bowel pattern in her medical records for 11/28/2025 on the 10:00 p.m.- 6:00 a.m. shift. An interview with CNA F was attempted 12/5/2025 at 1:20 p.m., the DON said CNA F does not have a working telephone. Surveyor was unable to speak with CNA E regarding the reason she did not document Resident #1 bowel pattern in her medical records for 11/29/2025 on the 2:00 p.m.- 10:00 p.m. shift. During an interview with RN C on 12/03/2025 at 1:20 p.m., she said she did not physically assess Resident #1's bowels on 11/29/2025 on the 2:00 p.m.10:00 p.m. shift because Resident #1 had not gone past three days without a bowel movement. She said she was aware that Resident #1 took two medications that had side effects of constipation. She said she was not aware that Resident #1 had orders to be monitored every shift for sedative/ hypnotic side effects such as constipation. She said she did not ask Resident #1 about her bowels because the computer did not flag or alert her that Resident #1 went without a bowel movement for three days or more. She said the CNA's cannot assess residents bowels, the nurses must do so. RN C said she knew Resident #1 had a fecal impaction removed surgically four days ago and was not aware of what was on her updated care plan interventions said related to constipation. During an interview with the Regional Director of clinical services on 12/03/205 at 1:45 p.m., she said the facility was unable to provide documentation showing a bowel assessment was completed on 11/28/2025-11/29/2025.She said the nurses were responsible for assessing Resident # 1's bowels and documenting their findings in the electronic medical records. She said she expected the nursing staff to follow facility policy to ensure residents' needs were met. She said nurses assessing resident's bowels and documenting the finds minimized the risk of fecal impaction. During an interview with Resident #1's family member on 12/03/2025 at 2:00 p.m. he said Resident #1 was impacted with stool in her colon and required surgery to remove the hard stool. Resident #1's family member stated, her stool was the size of a 20-ounce tumbler. Resident #1's family member said he expected Resident #1 to be checked for constipation every shift and as needed because she cannot verbalize her needs because of her advanced dementia. Record review of facility policy (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676444 If continuation sheet Page 3 of 4 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 676444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bonne Vie 8595 Medical Center Boulevard Port Arthur, TX 77640 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete CONTINUING CARE NETWORK PATIENT CARE MANAGEMENT SYSTEM 6 -Continence dated 09/2025 indicated: 1. The continence status of all patients will be evaluated upon admission, readmission, quarterly, and as needed through the completion of a Bowel and Bladder Assessment by a licensed nurse. Based on the total outcome score, the patient will be evaluated for candidacy of an appropriate continence maintenance program. See the attached Continence Management Protocols. 2. If the Patient scores 0 through 6 on the Bowel and Bladder Assessment, the Patient must be placed on the Incontinence Care Protocol.4. A Bowel and Bladder Management Record must be initiated for each Patient based on the elimination pattern documented on the Continence Diary. The Patient Care Plan and Daily Care Guide/ Kardex must be updated to reflect interventions related to continence/incontinence. 5. A Patient on a Continence Management Program must have a Weekly Continence Progress Note completed by the charge nurse at least every 7 days. Event ID: Facility ID: 676444 If continuation sheet Page 4 of 4