Inspection·November 20, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few LVN C stated that the consequences of not administering each medication separately could cause stomach upset to Resident # 1, it could affect how the medication works, and it could clog the tube. She stated the facility had a bootcamp on peg tube medication administration two months ago, where they had mannequins / dummy (to demonstrate) peg medication administration. LVN C said the facility trainers did verbal explanation which was followed by demonstration. She stated the nurses did a return demonstration and were all checked off. During an interview with RN A on 11/19/2025 at 2:08 p.m., she said, I put the medications in separate cups. I crush them separately. I mix them separately and administer them one at a time via gravity. She stated she would administer the medications separately because the chemical compositions are different. RN A stated, she does not want to create any chemical reaction before the medications get into a resident's system. She said, if there was a reaction, Resident # 1 might have anaphylactic reaction (a severe life-threatening allergic reaction that can occur within minutes of exposure to a trigger like medications, food or insect stings), and abdominal issues. During an interview with LVN D on 11/19/2025 at 2:23 p.m., he acknowledged the fact that he was trained to administer peg tube medications. He said the facility's corporate nurse retrained all the nurses on all nursing skills six weeks ago. LVN D said during peg tube medication administration, he checks to make sure it's the right resident, the right medication and the right route. He said he would wash his hands and assemble all the required medications. LVN D said he would crush every medication individually in separate cups. He said, if there are five pills, he would have five separate cups. LVN D said prior to administering the medications, the nurse should stop the tube feeding. He said the medications are administered separately because some medications can react with others and ensure the residents tolerate each medication. Also, the residents might have an adverse reaction. LVN D said if the medications are not administered separately, it means a medication error has occurred. He said he had never seen any facility Dr who wrote an order for peg tube medications to be administered as a cocktail (combination of multiple medications). During an interview with RN B on 11/20/2025 at 11:00 a.m., She said, if she had a resident with enteral medications (medications administered directly into the gastrointestinal tract), she will crush the medications separately and administer them separately. RN B said, that is what she was told in nursing school. She said enteral medications are not administered together because the medications can react with one another. She said if the medications are administered together, the nurse will not know how much water to use because you must flush after each medication administration. The nurse is expected to flush each medication because you do not want the medication to clog the peg tube. RN B said if you administer enteral medications together, it might cause medication reaction, and you might be pushing too much medication at once. During a telephone interview with the DON on 11/20/2025 at 1:04 p.m., she said, if a resident had more than one enteral medication, the nurse should separate the medications except there is a Dr's order to administer otherwise. The DON said, if a nurse administered enteral medications as a cocktail, it might clog the peg tube. She said it depends on where the peg tube is clogged, it could prevent the residents from getting prescribed medications and can cause unwanted hospitalization if the facility cannot unclog the peg tube. The DON said, if a nurse was seen administering enteral medications as a cock tail, that nurse would be reeducated, followed by a check -off. During a telephone interview with LVN A on 11/20/2025 at 1:48 p.m., she said she was taught to administer enteral medications separately. She said she was nervous when she was watched by a state Surveyor on 11/18/2025 when she administered enteral medications to Resident # 1. She said it was also because she was nervous that she did not use warm water as stated in the order. LVN A said, if enteral medications are not administered correctly, the medications would not have their desired effects and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676450 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 676450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Terra Bella Health and Wellness Suites 12262 Cityscape Ave Houston, TX 77047 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident # 1 could have reaction such as hives ( outbreak of red, itchy, raised, and swollen areas on the skin that can be caused by allergic reactions and other factors) and anaphylactic shock (a severe allergic reaction that affects the whole body and can be life-threatening if not treated immediately). During an interview with the Administrator on 11/20/2025 at 12:29 p.m., she said she was not a nurse, her understanding of enteral medication administration was, you crush the medication and put them in the peg tube, flush with water. She said she had never attended any of the nursing competencies when they demonstrated medication administration. During a telephone interview on 11/19/2025 at 11:45 a.m., with Pharmacist A, he said the pharmacy was only responsible for dispensing the medications. The facility and the Drs decide on how the medication should be administered. During a telephone interview on 11/19/2025 at 5:20 p.m., Dr A said she would call back. There was no return call. On 11/20/2025 at 09:41 a.m., there was an unsuccessful phone call to Dr. A. Record review of enteral feeding-administering medications dated 05/05/2023 revealed: The licensed nurse will administer medications prescribed by the physician to be given by enteral tube, using the appropriate method according to recognized standards of practice. The licensed nurse will verify correct tube placement on those devices that are not inserted directly into the gut, per current clinical standards of practice. Record review of facility's staff education/orientation policies and procedures revised on 07/01/2013, 09/10/2019 and 11/18/2012 revealed: After medications have been administered, deliver the 30 ml post medication or per physician order and warm water flush by gravity. In the event where flushing with 30 ml before and after each single medication may overload the patient/resident with fluid, flush before and after a group of multiple medications is acceptable, unless there are known compatibility problems between medications being mixed. Administer medications separately. Do not mix, as this may cause a drug reaction. Record review of Resident #'s general peg order retrieved on 11/20/2025 at 09:50 a.m., did not reveal that the medication could have been administered as a cocktail. Event ID: Facility ID: 676450 If continuation sheet Page 3 of 3