Inspection·July 11, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that all allegations involving abuse, neglect, and misappropriation were reported immediately, but no later than 2 hours after the allegation was made to the State Survey Agency for 1 of 8 residents (Resident #1) reviewed for abuse and neglect. The facility did not report to the State Survey Agency (HHSC) an alleged romantic relationship between Resident #1 and LVN A, as reported by Resident #1 to the DON, and LVN A to the ADON. This failure could place residents at risk for abuse/neglect and could lead to a diminished quality of life and psychosocial harm. The findings included: Record review of Resident #1's admission record, undated, reflected a [AGE] year-old resident with an initial admission of 02/03/2025 and diagnoses including acute respiratory failure with hypoxia (a condition where the lungs cannot adequately oxygenate the blood) and quadriplegia (paralysis of all four limbs). Record review of Resident #1's BIMS Assessment reflected that Resident #1 had a BIMS score of 9, reflecting moderate cognitive impairment. Record review of Resident #1's Care Plan, undated, did not indicate that Resident #1 had a history of sexually inappropriate behavior toward residents or staff. Record review of Resident #1's Progress note, dated 05/13/2025, reflected that Resident #1 requested to be sent to the emergency room for evaluation that day due to started to cough while asleep and had difficulty catching his breath. Record review of the Intake Investigation Worksheet #1009602 dated 0514/2025 revealed facility reported residents' allegations of abuse and neglect and not wanting to return to the facility. Neither self-report nor addendums revealed concern for possible sexual abuse or exploitation. Record review of the Provider Investigation Report (PIR), dated 05/19/2025, reflected that Resident #1 complained about the facility at the hospital, but when the DON went to speak with him at the hospital, Resident #1 declined the complaints, saying he was angry and just wanted to go to where LVN A worked. The PIR did not reflect possible sexual abuse or exploitation.Interview on 07/10/2025 at 3:55 PM, the facility's previous DON (DON C), who was the DON at the facility at the time of the incident, stated that she initially she went to the hospital to check on Resident #1 because of the complaints he had at the hospital of the facility, including pest control issues and being left soiled for a long time. Resident #1 recanted the complaints to DON C, stating he was just upset due to them firing LVN A, and wanted to live where she was because they were in a relationship. DON C stated that she had heard from Resident #1's Stepsister, LVN B, that she had a suspicion Resident #1 and LVN A were having a relationship. DON C stated she had reported LVN A to the Texas Board of Nursing on 05/22/2025 out of an abundance of caution due to the allegations of LVN A having a physical relationship with Resident #1. DON C stated LVN A had not been fired, but had changed her employment to PRN status. Interview on 07/10/2025 at 4:22 PM, LVN B stated she had informed the DON, at the time, DON C, that she felt Resident #1 was having a relationship with LVN A. LVN B stated that everything seemed normal at first for a working relationship between a nurse and a patient, but toward the end of LVN A working at the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 455390 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 455390 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Buena Vida Nursing and Rehab-San Antonio 5027 Pecan Grove San Antonio, TX 78222 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)