Inspection·October 6, 2025

F 0583 Level of Harm - Minimal harm or potential for actual harm review of a facility document titled, Resident Rights, the document revealed, A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 2 of 29 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 10/06/2025 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)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to protect the residents' right to be free from neglect for 1 of 8 residents (Resident #1) reviewed for neglect in that: 1. Resident #1 was not provided wound care daily to the left ankle or skin assessments by facility nursing staff from 08/28/2025 09/24/2025. Resident #1 was admitted to the hospital on [DATE] for osteomyelitis and had to have a left BKA. 2. Resident #1 went for approximately one month without adequate treatment for wounds which led to infection and right BKA. 3. The facility failed to ensure Resident #1 was provided with wound care to a surgical wound on the resident's right leg. 4. The ADON failed to ensure wound care treatment orders were added to Resident #1's EMR. An Immediate Jeopardy (IJ) was identified on 10/04/2025. The IJ template was provided to the facility on [DATE] at 12:35 p.m. While the IJ was removed on 10/06/2025 the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with the potential for more than minimal harm that is not IJ, due to the need to evaluate the effectiveness of the corrective systems. These failures could place residents at risk for neglect, worsening of existing wounds or the development of new pressure ulcers. The findings were: Record review of Resident #1's, undated, face sheet revealed Resident #1 was a [AGE] year old male who admitted to the facility on [DATE] with diagnoses that included malignant neoplasm of unspecified part of unspecified bronchus of lung (cancer of the lung or respiratory airway), quadriplegia (paralysis of a person's limbs), kidney disease (damage to kidney function), viral hepatitis c (a liver disease), cirrhosis of liver (scarring and damage to the liver) and encephalopathy (condition that caused brain dysfunction). Record review of Resident #1's quarterly MDS assessment, dated 08/19/2025, revealed Resident #1 had a BIMS score of 15, indicating no cognitive impairment. Section GG - Functional Abilities revealed Resident #1 had impairment on one side of his upper and lower extremity, used a wheelchair for mobility, required moderate assistance with bed mobility and was dependent on staff for transfers and personal hygiene. Section M - Skin Conditions revealed Resident #1 was at risk for developing pressure ulcers, had one or more unhealed pressure ulcers, had 1 Stage III pressure ulcer and 2 unstageable pressure ulcers. Record review of Resident #1's undated comprehensive care plan revealed a care plan, the resident has a pressure ulcer or potential for pressure ulcer development: 1. Unstageable left lateral, (outer) ankle, dated 08/05/2025 and revised 08/11/2025. The goal of the care plan was for Resident #1's pressure ulcer to show signs of healing and remain free from infection with a target date of 11/07/2025. Interventions revealed staff would administer treatments as ordered, monitor the effectiveness and replace loose or missing dressings PRN. The interventions also included for staff to assess/record/monitor wound healing at least weekly and measure length, width, and depth, document the status of the wound perimeter and wound bed and healing process. Staff were to report declines to the MD. 2. Unstageable right heel, dated 08/05/2025 and revised 08/11/2025. The goal of the care plan was for Resident #1's pressure ulcer to show signs of healing and remain free from infection with a target date of 11/07/2025. Interventions revealed staff would administer treatments as ordered, monitor the effectiveness and replace loose or missing dressings PRN. The interventions also included for staff to assess/record/monitor wound healing at least weekly and measure length, width, and depth, document the status of the wound perimeter and wound bed and healing process. Staff were to report declines to the MD. Record review of Resident #1's September WAR/TAR orders revealed orders, keep dressing clean, dry intact. Do not remove, do not get wet. Cover to shower, every shift for surgical wound and monitor right leg stump for signs and symptoms of infection every shift for surgical wound, with a start date of 08/19/2025. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 3 of 29 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 10/06/2025 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)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some WAR/TAR administration record for these orders was not initialed as completed on 09/07/2025 at 11 p.m. and 09/13/2025 on 3 p.m.- 11 p.m. Further review revealed there were no wound treatment orders for the left ankle. Record review of Resident #1's EMR revealed Resident #1 had a readmission initial skin assessment, dated 08/19/2025, that had yes checked for surgical incision. The assessment did not identify any other wounds and was not signed. Resident #1 had no additional weekly skin assessments or weekly pressure ulcer assessments through the end of August and during the month of September until 09/25/2025, after Resident #1 was admitted to the hospital on [DATE]. Further review revealed Resident #1 had no weekly skin assessments or weekly pressure ulcer assessments during the month of September until 09/25/2025, after Resident #1 was admitted to the hospital on [DATE]. Record review of wound care physician assessment, dated 08/26/2025, revealed Resident #1 had a Stage IV pressure wound (a wound that has full thickness skin and tissue loss with exposed muscle, tendon, ligament, cartilage or bone in the ulcer) of the left, lateral ankle and measured 3.5cm x 2.5 cm x 0.1 cm with a surface area of 8.75cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 9 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 9 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 9 days. The goal of the treatment was healing evidenced by a 75% decrease in nonviable tissue within the wound bed in comparison to the previous wound care visit. Further review revealed Resident #1 had an (unstageable (due to necrosis) of the right heel (signing off-area has been amputated). The etiology revealed pressure and stage was unstageable necrosis. Record review of wound care physician assessment, dated 09/02/2025, revealed Resident #1 had a Stage IV pressure wound of the left, lateral ankle and measured 3 cm x 2.5 cm x 0.5 cm with a surface area of 7.50 cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 30 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 30 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 30 days. The goal of the treatment was healing evidenced by a 14.3% decrease in surface are within the wound bed in comparison to the previous wound care visit. Record review of wound care physician assessment, dated 09/09/2025, revealed Resident #1 had a Stage IV pressure wound of the left, lateral ankle and measured 3.5 cm x 2.5 cm x 0.5 cm with a surface area of 8.75 cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 23 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 23 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 23 days. The assessment revealed, Thorough review of history performed, including speaking with nursing staff for further information and Coordination of care and plan for this wound discussed with nursing staff for further information. Record review of Resident #1's Nurse Practitioner (NP) progress notes, dated 09/09/2025, revealed, surgical dressing orders reinforced; stump dressing remains clean/dry/intact without drainage. Record review of an outpatient clinic wound progress note, dated 09/15/2025, revealed, Veteran seen in clinic today with [physician name]. Veteran is at [facility name]. Wound dressings are soiled, and odor present to left foot dressing. The wound assessment revealed a stage IV pressure ulcer to the left lateral malleolus (bony prominence on the outer side of the ankle) measuring 4.0 cm x 4.5 cm x 0.5 cm. The assessment revealed a DTI pressure ulcer (deep tissue injury characterized by damage to tissue underneath intact skin) inferior (inside) to left lateral malleolus measuring 6.7 cm x 7.0 cm x 0.0 cm. The wound assessment identified the right BKA and revealed the wound bed sutures were in place and no drainage noted. Record review of wound (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 4 of 29 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 10/06/2025 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)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some care physician assessment, dated 09/16/2025, revealed Resident #1 had a Stage IV pressure wound of the left, lateral ankle and measured 3.5 cm x 2.9 cm x 0.5 cm with a surface area of 10.15 cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 16 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 16 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 16 days. The goal of the treatment was healing evidenced by a 66.7% decrease in nonviable tissue within the wound bed in comparison to the previous wound care visit. The assessment revealed, the patient's plan of care was discussed with patient assigned nurse. Record review of wound care physician assessment, dated 09/23/2025, revealed Resident #1 had a Stage IV pressure wound of the left, lateral ankle and measured 5.0 cm x 4.0 cm x 0.5 cm with a surface area of 20.00 cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 9 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 9 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 9 days. The assessment included an arterial wound (skin injury caused by poor blood circulation) of the left, distal (outer), lateral foot that was arterial and measured 1.5 cm x 1.7cm x 0 and described as a scab. Record review of Resident #1's podiatry progress note, dated 09/24/2025, revealed, patient presents to clinic in a stretcher for left lateral ankle decubitus ulcer (caused by prolonged pressure to an area). The note revealed the left lateral ankle pressure ulcer measured 2.5 cm x 3.0 cm on 09/04/2025 and measured 3.5 cm x 3.5 cm on 09/24/2025. The wound was described as necrotic (death of tissue) in the peri wound (tissue surrounding a wound), had purulent drainage (a skin of infection. Thick milky fluid that comes out of a wound) noted and revealed the fibula bone (long slender bone in the lower leg) was exposed. The assessment revealed a left lateral ankle pressure ulcer stage 4 and history of right BKA. The plan revealed purulent drainage, malodor (offensive odor), necrotic wound base (dead or dying cells and tissues within a wound that are no longer able to carry out their normal function), and exposed fibula notified to left lateral ankle wound. Due to this and high risk right BKA patient was advised to go to [hospital] ED for further workup. Patient was transported via [ambulance]. Record review of Resident#1's emergency department hospital notes, dated 09/24/2025 revealed, Chief Complaint: patient presents from a nursing home with low blood pressure and possible wound infections. History of Present Illness (HPI): The patient was transported from a nursing home to a podiatry appointment where they were noted to have low blood pressure and significant ulcers. The ulcers include a deep ulcer on the left lateral malleolus open wound, as well as a recent BKA on the right, both appearing infected. The patient is found to be lethargic and poorly responsive, indicating altered mentation (occurs when illnesses, disorders and injuries affect brain function). Onset of symptoms is acute, with ulcers likely developing over time due to underlying conditions. Exam revealed, sutures in place from R BKA, central area with small area of chronic weeping wound (a type of wound that produces clear fluid, blood, or pus that seeps from the injured area), no cellulitis (bacterial infection of the skin and soft tissues causing swelling, redness and pain), no pain, or crepitus extending proximally (air inside body tissues that can cause popping or cracking sounds). Left ankle with 4 cm lateral wound with exposed lat al, appears to track to joint (tunneling of wounds underneath the skin). CT imaging of the LLE revealed, lateral malleolus soft tissue ulceration which extends to the bone. Osteomyelitis (infection in the bone) of the distal fibula. Septic tibiotalar joint (infection in the joint of the ankle) with associated osteomyelitis of the tibia and talus (small bone in the ankle). CT of RLE revealed, no evidence of active osteomyelitis at this time. No evidence of soft tissue gas. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 5 of 29 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 10/06/2025 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)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some disposition plan was to admit Resident #1 to the hospital for further management and stabilization with the diagnosis of osteomyelitis of the left ankle and stated a surgical intervention was scheduled for the following day. Record review of Resident #1's hospital ED critical care note, dated 09/24/2025, revealed, the patient meets the criteria for critical illness, with acute impairment of circulation, septic shock (life threatening immune system reaction to an infection) in the setting of osteomyelitis. Vital organ systems, and is at high risk of imminent, life threatening deterioration without urgent intervention and revealed, Upon my evaluation, this patient had a high probability of imminent or life-threatening deterioration due to sepsis and osteomyelitis, which required my direct attention, intervention and personal management. Record review of Resident #1's facility progress note, dated 09/25/2025 at 12:48 a.m. by RN G, revealed, received report that patient is out to a doctor's appointment. At this time, the patient still out. Reported to administrator. There were no other relevant progress notes related to Resident #1's wounds observed in the progress notes. Record review of Resident #1's facility weekly skin assessment, effective date 09/25/2025 at 12:00 p.m. and signed by LVN K 09/26/2025, revealed a question, Does the resident have a pressure, venous, arterial, or diabetic ulcer? If yes, complete the Ulcer Assessment. The answer was coded yes and also revealed for other skin findings, L ankle covered with dressing, L foot art. Wound. Wound provider consult in place and Tx orders in place. Record review of Resident #1's facility progress note, dated 09/25/2025 at 3:26 p.m. by ADON/LVN revealed, Patient went out for a scheduled appointment and was admitted to [hospital] following appointment. Record review of Resident #1's hospital discharge notes, dated 10/01/2025, revealed Resident #1's principal discharge diagnoses were, osteomyelitis of left ankle status post (a patients condition after a specific procedure, treatment or event) left below knee amputation, completed 09/24/2025 and history of right below knee amputation status post right below knee amputation incision and drainage by orthopedic surgery. Equipment supplies listed for discharge included, two portable [company] incision management system. Record review of Resident #1's facility progress note, dated 10/01/2025 at 9:45 p.m. by LVN N, revealed, Resident has wound vacs (vacuum-assisted closure is a type of therapy that uses a device to decrease air pressure on a wound) to BLE, has bilateral below knee amputations. Record review of Resident #1's weekly skin assessment, dated 10/02/2025 at 1:55 p.m. by LVN N, revealed Resident had wound vacs to BLE related to bilateral below knee amputations and LVN N was unable to assess due to bandages and wound vacs. Record review of Resident #1's October 2025 administration orders revealed the following orders, Monitor surgical incision to LBKA, surgical wound vac in place and will be discontinued by surgeon. Wound vac not to be changed by nurses, contact [hospital] if wound vac malfunctions. Every shift for wound care dated 10/02/2025, Monitor surgical incision to RBKA, surgical wound vac in place and will be discontinued by surgeon. Wound vac not to be changed by nurses, contact [hospital] if wound vac malfunctions. Every shift for wound care dated 10/02/2025, Wound MD to evaluate resident dated 10/02/2025 and an ortho (orthopedic) follow up appointment scheduled for 10/7/2025 at 9:30 a.m. During an interview with the hospital case manager, 09/30/2025 at 3:08 p.m., the hospital case manager stated Resident #1 was sent to the hospital directly from a doctor's appointment on 09/24/2025 due to Resident #1 having an infection in his left leg wound and stated Resident #1 had to have a below the knee amputation. The hospital case manager stated an outpatient wound nurse would go to the facility to see Resident #1 approximately once a week. She stated the outpatient wound care nurse would have to perform wound care for Resident #1 because it was not getting done by the facility and observed Resident #1 with no treatment dressings to his left ankle. The hospital case manager stated the outpatient wound care nurse discussed her concerns with nurses providing care and with the ADON/LVN, but nothing was done about (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 6 of 29 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 10/06/2025 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)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some it. The hospital case manager expressed concern over Resident #1's lack of wound care that resulted in an amputation. During an interview with LVN T, 10/02/2025 at 9:50 a.m., LVN T stated Resident #1 had orders for wound care for his right amputated knee and stated she did not provide wound care to Resident #1's left foot in the month of September because he did not have any orders. LVN T stated she followed the physician orders for the right stump. LVN T was aware of the wound to the left foot because LVN T stated the wound had had black tissue (dead or dying tissue) but did not report it to anyone including the physician, because everyone already knew. During an interview with LVN D, 10/02/2025 at 10:07 a.m., LVN D stated the wound care nurse was responsible for doing weekly skin assessments when a resident had a wound. During an interview with LVN B, 10/02/2025 at 10:51 a.m., LVN B stated he was assigned to Resident #1 and had been assigned to work with Resident #1 on previous shifts. LVN B stated he was aware that Resident #1 had a right BKA and wounds to his left foot and did not recall Resident #1 having treatment orders for his left foot. LVN B stated the nurses were responsible for performing wound care and completing skin assessments if the wound care nurse was not available. During an interview with Resident #1, 10/02/2025 at 11:41 a.m., Resident #1 stated he just returned from the hospital and said, they amputated my left foot so now I have no feet. Resident #1 stated his right foot was amputated about a month ago and stated the left foot was amputated because it was infected. Resident #1 stated the doctors at the hospital just told him his foot was infected, and he stated he was glad that the infection did not go up further into his body. Resident #1 denied having pain and did not appear in psychosocial distress. Resident #1 was observed lying in bed with a wound vac connected to his R and L BKA. Dressings appeared clean and dry. Resident #1 stated staff were checking his right stump when he returned from the hospital after the right BKA but stated he did not recall any staff members providing wound dressings to his left foot in the last month. During an interview with CNA F, 10/02/2025 at 1:13 p.m. CNA F stated she was aware that Resident #1 had wounds on his left foot and stated she was in his room a day or two before he went to the hospital on [DATE]. CNA F stated Resident #1's left foot had an odor, and she would have to open the window to let the stench out of the room. CNA F stated Resident #1 told her he could not feel his leg and Resident #1 told CNA F that he thought it was getting infected and stated, he could also smell it and asked me to open the window. CNA F stated she told LVN H that Resident #1's foot had an odor when CNA F would give him bed baths. CNA F stated she thought other CNAs reported the wound odor to the nurses as well but could not confirm. During an interview with ADON/LVN, 10/02/2025 at 2:19 p.m., ADON/LVN stated she was hired as the wound care treatment nurse in July 2025 and transferred into the ADON/LVN position right before the facility had their recertification survey 08/27/2025. ADON/LVN stated when she transitioned to ADON/LVN the charge nurses were responsible for wound treatments and the charges nurses would follow the physician orders for wound care. The ADON/LVN stated Resident #1 was being followed by a wound care physician and the wound care physician would write wound orders in the wound care physician's progress notes and the progress notes were uploaded into the resident EMR. The ADON/LVN stated that she was responsible for reviewing the wound care physician notes and entering new wound care orders into a resident's EMR. The ADON/LVN stated, it's me, I am responsible for all the systems, and we should have a DON, but we don't, so I missed it. The wound care physician comes on Tuesday, and I will look in the system the next day to see if she saw any patients. IF there are new orders I go in and update them, but she does not change the orders often, so I didn't verify them every single week. ADON/LVN stated Resident #1 did not have wound care orders in his administration record and charge nurses would not have known to do wound care if there were no wound care orders. The ADON/LVN stated she performed wound care for Resident #1's left ankle wound several days (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 7 of 29 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 10/06/2025 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)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some during the month of September but did not know what days and did not document the wound care. The ADON/LVN stated she followed the orders in the wound care physician progress notes to complete the treatments for Resident #1 and stated she should have reviewed Resident #1's treatment orders and added the wound orders into Resident #1's orders at that time. The ADON/LVN stated the nurses were responsible for completing weekly skin assessments. The ADON/LVN stated she was responsible for completing the pressure ulcer assessments and no pressure ulcer assessments were completed for Resident #1 during September. The ADON/LVN stated she had received training on completing the pressure ulcer assessments and said the assessments were important to monitor the progress of wounds. The ADON/LVN stated it was important for residents to have treatment orders for their wounds, so the wound did not worsen or get infected. The ADON/LVN stated Resident #1 did not have any weekly skin assessments or pressure ulcer assessments during the month of September and stated she was responsible for monitoring the UDAs to ensure they were completed weekly. During an interview with the RCN, 10/02/2025 at 4:05 p.m., the RCN stated she became aware of a concern regarding Resident #1's wound care the prior night, 10/01/2025, when the RCN was reviewing Resident #1's clinicals and found that Resident #1 did not have wound care orders for his left ankle prior to his hospitalization and amputation of the left BKA. The RCN stated the concern was identified as neglect and reported the incident to HHSC. During an interview with LVN L, 10/02/2025 at 6:16 p.m., LVN L stated she worked the night shift and was assigned to Resident #1's hall. LVN L stated she was aware that Resident #1 had an amputation of his right leg, a few weeks ago and LVN L stated she did not recall any wound care orders for him and there was really not anything documented in the computer for what to do about the stump. LVN L stated she observed the stump on several occasions and stated that every time she observed the stump it did not have a dressing on it. LVN L stated she was unaware of Resident #1 having any wounds on his left foot and did not recall any treatment orders for his left foot. LVN L stated LVN N told her last week that Resident #1's stump was red and warm and stated LVN N reported the stump concern to nursing management. During an interview with LVN N, 10/02/2025 at 7:20 p.m., LVN N stated she was notified by a CNA that Resident #1's stump did not have a dressing on it and LVN N reviewed Resident #1's orders and recalled an order for the stump to have a wound dressing and to be kept clean and dry and stated Resident #1 had no other treatment orders. LVN N stated she did not recall the wound being red or warm and did not recall reporting an issue with Resident #1's stump. During an interview with CNA Q, 10/03/2025 at 8:35 a.m., CNA Q stated she had worked at the facility for two months and CNA Q stated she would help get Resident #1 ready for doctor appointments and stated she did not observe any wound care bandages on Resident #1's left foot. During an interview with LVN H, 10/03/2025 at 8:49 a.m., LVN H stated she was not sure if Resident #1 had any wounds, did not perform any wound care for Resident #1 and stated she never observed any wound care orders for Resident #1. During an interview with the Nurse Practitioner, 10/03/2025 at 10:42 a.m., the Nurse Practitioner stated when a resident returns from the hospital with wounds and no wound care orders, the nursing staff should have reassessed and measured the wounds, and a nurse should have called to get wound care orders. The Nurse Practitioner stated Resident #1 should have had wound care treatments completed daily and stated the lack of wound care treatments daily could have led to a catastrophic event. With such a complicated medical history, yes, it is very possible for lack of wound care to have led to that and worse. The Nurse Practitioner stated the facility wound care had room for improvement. During an interview with the Wound Care Physician, 10/03/2025 at 12:11 p.m., the Wound Care Physician stated that any changes in treatment orders were documented in her progress notes and uploaded into a resident's EMR and stated she did not have access to view resident orders. The Wound Care Physician stated it was up (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 8 of 29 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 10/06/2025 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)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some to the facility as to who was responsible for adding the Wound Care Physician orders into a resident's administrative orders and stated in most facilities it was completed by the Wound Care Nurse or the ADON. The Wound Care Physician stated she had concerns about the wound care performed for Resident #1 because he would have wound dressings that were not dated and there was no way for the Wound Care Physician to know when the treatment was completed. The Wound Care Physician stated Resident #1 should have had daily wound care treatments and stated Resident #1's wound had declined prior to Resident #1 going to the hospital on [DATE]. The Wound Care Physician stated leaving a wound dressing in place too long for Resident #1 could lead to infection for someone like him who had multiple other comorbidities and is vascular compromised and that can lead to wound deterioration and risk of infection. The Wound Care Physician stated a lack of daily wound care could have contributed to Resident #1 being admitted to the hospital with sepsis, osteomyelitis, and an amputation. The Wound Care Physician stated she would do a wound dressing for Resident #1 when she assessed him but stated she would only see him weekly. During an interview with the Administrator, 10/03/2025 at 2:42 p.m., the Administrator stated resident skin assessment should be completed by the nursing staff on admission, readmission and weekly. The Administrator stated it was important to complete weekly skin assessments because, it tells us if there is skin breakdown, wounds, pressure, etc. and we can monitor to see if skin is changing and what the baseline of the patient is and what the integrity of the skin is and to make sure the skin is taken care of because if you don't, it can lead to infection, sepsis, etc. During an interview with the Administrator, 10/03/2025 at 4:31 p.m., the Administrator stated that the lack of wound care for Resident #1 was neglect because it was a failure of the facility to not inquire about Resident #1's wound care and treatments and stated, all around, the staff were not doing their due diligence to take care of the wound. During an observation, 10/04/2025 at 11:45 a.m., Resident #1 was observed and had clean and dry bandages to the left and Right BKA, and wound vac was attached to both BKAs. Record review of an undated facility policy titled, Documentation, revealed, Special forms in the clinical record are utilized in nursing documentation, such as assessment, care plan, nursing progress notes, flow sheets, medication sheets, incident reports, and summary sheets (daily, weekly, monthly, discharge). The procedure revealed, document completed assessments in a timely manner and per policy. Record review of a facility policy, revised 05/05/2025, titles, Pressure Injury: Prevention, Assessment and Treatment, revealed, Assessment: 1. All residents should have a skin assessment on a weekly basis completed in [EMR]. Record review of facility wound treatment management policy, revised 05/05/2025, revealed in the absence of treatment orders, the licensed nurse will notify physician to obtain treatment orders. This may be the treatment nurse or the assigned licensed nurse in the absence of the treatment nurse and treatments will be documented on the Treatment Administration Record. The effectiveness of treatments will be monitored through ongoing assessment of the wound. Record review of the facility's undated abuse and neglect policy revealed, neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. This was determined to be an Immediate Jeopardy (IJ) on 10/04/2025 at 12:26 p.m. The Administrator and Interim DON were notified. The Administrator and the DON were provided with the IJ Template on 10/04/2025 at 12:35 p.m. The following Plan of Removal submitted by the facility was accepted on 10/04/2025 at 4:43 p.m.: Plan of Removal F600 Problem: The facility failed to protect the residents' right to be free from neglect. Resident #1 was not provided wound care daily or skin assessments by facility nursing staff from 08/28/2025 09/24/2025. He was admitted to the hospital on [DATE] for osteomyelitis and had to have a left BKA. Interventions:100% skin rounds completed by 5pm 10/2/2025 by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 9 of 29 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 10/06/2025 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)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Administrative Nurses and Corporate Compliance Nurses. All findings will be communicated to MD and orders transcribed in [EMR].The following in-services were initiated by Regional Compliance Nurse on 10/02/2025: Any nurse not present or in-serviced on 10/02/2025 will not be allowed to assume their duties until in-serviced. All new hires will receive education upon hire.Licensed NursesPressure ulcer prevention and treatment including providing treatment as ordered and Initialing/Dating dressing.Documentation and Accurate Assessment of Pressure UlcersInitiating wound orders per MD and upon admission/readmission.If a C.N.A reports to a charge nurse about a change in skin integrity/wound status, the charge nurse must assess and notify MD of changes immediately.Notification of Physician with change of condition immediately.Admin Personnel Wound care monitoring will be reviewed in stand up and stand down (morning and afternoon meetings) WARS and TARs will be reviewed for holes/omissions daily in stand up and stand down All staffo Abuse, Neglect, Exploitation Policy in-service was initiated on 10/2/25 by Administrator and completed on 10/3/2025.o Inservice all staff that complaints or concerns from outside care teams are to be director [sic] to the administrator for initiation of investigation on 10/4/2025 by Regional Staff/Administrator Administratoro Inservice for Ensuring that Nursing Manager(s) review any new wound orders and validate that the orders were transcribed and entered into [EMR] on 10/4/2025 by Area Director of Operations by auditing the order listing report each day in stand up. DON/DESIGNEE INSERVICED TO ROUND WITH WOUND MD/NP STARTING 10/7/25 UNTIL INDEFINATLEY [sic] AND ENTER ORDERS IN [EMR]AS SOON AS THE ORDER IS VERBALLY GIVEN BY MD. ALL [Wound Care physician] PROGRESS NOTES WILL BE PRINTED WITHIN 24 HRS OF RECIEPT AND ORDERS WILL BE REVIEWED BY DON/DESIGNEE IN STAND UP TO ENSURE OR Event ID: Facility ID: 455390 If continuation sheet Page 10 of 29 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 10/06/2025 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)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents with surgical wounds received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing, for 1 of 8 residents (Resident 1) reviewed for surgical wounds in that: Resident #1 did not have weekly skin assessments during the month of September 2025, did not receive care to the right surgical wound as ordered by the physician and was admitted to the hospital on [DATE] with an infection to Resident #1's right below the knee amputation. An Immediate Jeopardy (IJ) was identified on 10/04/2025. The IJ template was provided to the facility on [DATE] at 12:35 p.m. While the IJ was removed on 10/06/2025 the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with the potential for more than minimal harm that is not IJ, due to the need to evaluate the effectiveness of the corrective systems. These failures could place residents at risk for worsening of existing surgical wounds or development of new pressure ulcers. The findings were: Record review of Resident #1's, undated, face sheet revealed Resident #1 was a [AGE] year old male who admitted to the facility on [DATE] with diagnoses that included malignant neoplasm of unspecified part of unspecified bronchus of lung (cancer of the lung or respiratory airway), quadriplegia (paralysis of a person's limbs), kidney disease (damage to kidney function), viral hepatitis c (a liver disease), cirrhosis of liver (scarring and damage to the liver) and encephalopathy (condition that caused brain dysfunction). Record review of Resident #1's quarterly MDS assessment, dated 08/19/2025, revealed Resident #1 had a BIMS score of 15, indicating no cognitive impairment. Section GG - Functional Abilities revealed Resident #1 had impairment on one side of his upper and lower extremity, used a wheelchair for mobility, required moderate assistance with bed mobility and was dependent on staff for transfers and personal hygiene. Section M - Skin Conditions revealed Resident #1 was at risk for developing pressure ulcers, had one or more unhealed pressure ulcers, had 1 Stage III pressure ulcer and 2 unstageable pressure ulcers. Record review of Resident #1's undated comprehensive care plan revealed a care plan, the resident has a pressure ulcer or potential for pressure ulcer development: 2. Unstageable right heel, dated 08/05/2025 and revised 08/11/2025. The goal of the care plan was for Resident #1's pressure ulcer to show signs of healing and remain free from infection with a target date of 11/07/2025. Interventions revealed staff would administer treatments as ordered, monitor the effectiveness and replace loose or missing dressings PRN. The interventions also included for staff to assess/record/monitor wound healing at least weekly and measure length, width, and depth, document the status of the wound perimeter and wound bed and healing process. Staff were to report declines to the MD. Record review of Resident #1's September 2025 WAR/TAR revealed orders, start date 08/19/2025, keep dressing clean, dry intact. Do not remove, do not get wet. Cover to shower, every shift for surgical wound and monitor right leg stump for signs and symptoms of infection every shift for surgical wound. The WAR/TAR administration record for these orders was not initialed as completed on 09/07/2025 at 11 p.m. and 09/13/2025 on 3 p.m.- 11 p.m. Record review of Resident #1's EMR revealed Resident #1 had no weekly skin assessments or weekly pressure ulcer assessments during the month of September until 09/25/2025, after Resident #1 was admitted to the hospital on [DATE]. Record review of wound care physician assessment, dated 08/26/2025, revealed Resident #1 had an (unstageable (due to necrosis) of the right heel (signing off-area has been amputated). The etiology revealed pressure and stage was unstageable necrosis. Record review of Resident #1's Nurse Practitioner (NP) progress notes, dated 09/09/2025, revealed, surgical dressing orders reinforced; stump dressing remains clean/dry/intact without drainage. Record review Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 11 of 29 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 10/06/2025 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)

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some of an outpatient clinic wound assessment progress note, dated 09/15/2025, revealed, Resident #1 had a right BKA and the wound bed sutures were in place and no drainage noted. Record review of Resident#1's emergency department hospital notes, dated 09/24/2025 revealed, Chief Complaint: patient presents from a nursing home with low blood pressure and possible wound infections. History of Present Illness (HPI): The patient was transported from a nursing home to a podiatry appointment where they were noted to have low blood pressure and significant ulcers. The ulcers include a deep ulcer on the left lateral malleolus open wound, as well as a recent BKA on the right, both appearing infected. The patient is found to be lethargic and poorly responsive, indicating altered mentation (occurs when illnesses, disorders and injuries affect brain function). Onset of symptoms is acute, with ulcers likely developing over time due to underlying conditions. Exam revealed, sutures in place from R BKA, central area with small area of chronic weeping wound (a type of wound that produces clear fluid, blood, or pus that seeps from the injured area), no cellulitis (bacterial infection of the skin and soft tissues causing swelling, redness and pain), no pain, or crepitus extending proximally (air inside body tissues that can cause popping or cracking sounds). CT of RLE revealed, no evidence of active osteomyelitis at this time. No evidence of soft tissue gas. Record review of Resident #1's hospital ED critical care note, dated 09/24/2025, revealed, the patient meets the criteria for critical illness, with acute impairment of circulation, septic shock (life threatening immune system reaction to an infection) in the setting of osteomyelitis. Vital organ systems, and is at high risk of imminent, life threatening deterioration without urgent intervention and revealed, Upon my evaluation, this patient had a high probability of imminent or life-threatening deterioration due to sepsis and osteomyelitis, which required my direct attention, intervention and personal management. Record review of Resident #1's facility weekly skin assessment, effective date 09/25/2025 at 12:00 p.m. and signed by LVN K 09/26/2025, revealed a question, Does the resident have a pressure, venous, arterial, or diabetic ulcer? If yes, complete the Ulcer Assessment. The answer was coded yes and revealed, Wound provider consult in place and Tx orders in place. Record review of Resident #1's facility progress note, dated 09/25/2025 at 3:26 p.m. by ADON/LVN revealed, Patient went out for a scheduled appointment and was admitted to [hospital] following appointment. Record review of Resident #1's hospital discharge notes, dated 10/01/2025, revealed Resident #1's principal discharge diagnoses revealed, history of right below knee amputation status post right below knee amputation incision and drainage by orthopedic surgery. Equipment supplies listed for discharge included, two portable [company] incision management system. Record review of Resident #1's facility progress note, dated 10/01/2025 at 9:45 p.m. by LVN N, revealed, Resident has wound vacs (vacuum-assisted closure is a type of therapy that uses a device to decrease air pressure on a wound) to BLE, has bilateral below knee amputations. Record review of Resident #1's weekly skin assessment, dated 10/02/2025 at 1:55 p.m. by LVN N, revealed Resident had wound vacs to BLE related to bilateral below knee amputations and LVN N was unable to assess due to bandages and wound vacs. Record review of Resident #1's October 2025 administration orders revealed the following orders, Monitor surgical incision to RBKA, surgical wound vac in place and will be discontinued by surgeon. Wound vac not to be changed by nurses, contact [hospital] if wound vac malfunctions. Every shift for wound care dated 10/02/2025, Wound MD to evaluate resident dated 10/02/2025 and an ortho (orthopedic) follow up appointment scheduled for 10/7/2025 at 9:30 a.m. During an interview with LVN D, 10/02/2025 at 10:07 a.m., LVN D stated the wound care nurse was responsible for doing weekly skin assessments when a resident had a wound. During an interview with Resident #1, 10/02/2025 at 11:41 a.m., Resident #1 stated his right foot was amputated about a month ago. Resident #1 denied having pain and did not appear in psychosocial distress. Resident #1 was observed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 12 of 29 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 10/06/2025 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)

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some lying in bed with a wound vac connected to his R and L BKA. Dressings appeared clean and dry. Resident #1 stated staff were checking his right stump when he returned from the hospital after the right BKA During an interview with ADON/LVN, 10/02/2025 at 2:19 p.m., ADON/LVN stated she was hired as the wound care treatment nurse in July 2025 and transferred into the ADON/LVN position right before the facility had their recertification survey 08/27/2025. The ADON/LVN stated the charge nurses were responsible for completing weekly skin assessments and the ADON/LVN was responsible for completing the pressure ulcer assessments. The ADON/LVN stated she had received training on completing the pressure ulcer assessments and said the assessments were important to monitor the progress of wounds. The ADON/LVN stated Resident #1 did not have any weekly skin assessments or pressure ulcer assessments during the month of September and stated she was responsible for monitoring the UDAs to ensure they were completed weekly. During an interview with LVN L, 10/02/2025 at 6:16 p.m., LVN L stated she worked the night shift and was assigned to Resident #1's hall. LVN L stated she was aware that Resident #1 had an amputation of his right leg, a few weeks ago and LVN L stated she did not recall any wound care orders for him and there was really not anything documented in the computer for what to do about the stump. LVN L stated she observed the stump on several occasions and stated that every time she observed the stump it did not have a dressing on it. LVN L stated she was unaware of Resident #1 having any wounds on his left foot and did not recall any treatment orders for his left foot. LVN L stated LVN N told her last week that Resident #1's stump was red and warm and stated LVN N reported the stump concern to nursing management. During an interview with LVN N, 10/02/2025 at 7:20 p.m., LVN N stated she was notified by a CNA that Resident #1's stump did not have a dressing on it and LVN N reviewed Resident #1's orders and recalled an order for the stump to have a wound dressing and to be kept clean and dry and stated Resident #1 had no other treatment orders. LVN N stated she did not recall the wound being red or warm and did not recall reporting an issue with Resident #1's stump. During an interview with the Administrator, 10/03/2025 at 2:42 p.m., the Administrator stated resident skin assessment should be completed by the nursing staff on admission, readmission and weekly. The Administrator stated it was important to complete weekly skin assessments because, it tells us if there is skin breakdown, wounds, pressure, etc. and we can monitor to see if skin is changing and what the baseline of the patient is and what the integrity of the skin is and to make sure the skin is taken care of because if you don't, it can lead to infection, sepsis, etc. During an observation, 10/04/2025 at 11:45 a.m., Resident #1 was observed and had clean and dry bandages to the left and Right BKA, and wound vac was attached to both BKAs. Record review of an undated facility policy titled, Documentation, revealed, Special forms in the clinical record are utilized in nursing documentation, such as assessment, care plan, nursing progress notes, flow sheets, medication sheets, incident reports, and summary sheets (daily, weekly, monthly, discharge). The procedure revealed, document completed assessments in a timely manner and per policy. Record review of a facility policy, revised 05/05/2025, titles, Pressure Injury: Prevention, Assessment and Treatment, revealed, Assessment: 1. All residents should have a skin assessment on a weekly basis completed in [EMR]. This was determined to be an Immediate Jeopardy (IJ) on 10/04/2025 at 12:26 p.m. The Administrator and Interim DON were notified. The Administrator and the DON were provided with the IJ Template on 10/04/2025 at 12:35 p.m. The following Plan of Removal submitted by the facility was accepted on 10/04/2025 at 4:43 p.m.: Plan of Removal Problem: The facility failed to protect the residents' right to be free from neglect. Resident #1 was not provided wound care daily or skin assessments by facility nursing staff from 08/28/2025 - 09/24/2025. He was admitted to the hospital on [DATE] for osteomyelitis and had to have a left BKA. Interventions:100% skin rounds completed by 5pm 10/2/2025 by Administrative Nurses and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 13 of 29 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 10/06/2025 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)

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Corporate Compliance Nurses. All findings will be communicated to MD and orders transcribed in [EMR].The following in-services were initiated by Regional Compliance Nurse on 10/02/2025: Any nurse not present or in-serviced on 10/02/2025 will not be allowed to assume their duties until in-serviced. All new hires will receive education upon hire.Licensed NursesPressure ulcer prevention and treatment including providing treatment as ordered and Initialing/Dating dressing.Documentation and Accurate Assessment of Pressure UlcersInitiating wound orders per MD and upon admission/readmission.If a C.N.A reports to a charge nurse about a change in skin integrity/wound status, the charge nurse must assess and notify MD of changes immediately.Notification of Physician with change of condition immediately.Admin Personnel Wound care monitoring will be reviewed in stand up and stand down (morning and afternoon meetings) WARS and TARs will be reviewed for holes/omissions daily in stand up and stand down All staffo Abuse, Neglect, Exploitation Policy in-service was initiated on 10/2/25 by Administrator and completed on 10/3/2025.o Inservice all staff that complaints or concerns from outside care teams are to be director [sic] to the administrator for initiation of investigation on 10/4/2025 by Regional Staff/Administrator Administratoro Inservice for Ensuring that Nursing Manager(s) review any new wound orders and validate that the orders were transcribed and entered into [EMR] on 10/4/2025 by Area Director of Operations by auditing the order listing report each day in stand up. DON/DESIGNEE INSERVICED TO ROUND WITH WOUND MD/NP STARTING 10/7/25 UNTIL INDEFINATLEY [sic] AND ENTER ORDERS IN [EMR]AS SOON AS THE ORDER IS VERBALLY GIVEN BY MD. ALL [Wound Care physician] PROGRESS NOTES WILL BE PRINTED WITHIN 24 HRS OF RECIEPT AND ORDERS WILL BE REVIEWED BY DON/DESIGNEE IN STAND UP TO ENSURE ORDERS MATCH. THIS MONITORING WILL BE INIATED [sic] ON 10/7/25 AND INDEFINATELY [sic]. CNAs INSERVICED ON REPORTING ALL NEW SKIN ISSUES TO NURSE ASAP AND DOCUMENTING THE FINDING/ALERT IN THE KIOSK ON 10/4/25 BY REGIONAL COMPLIANCE NURSE. CNAs INSERVICED ON S/SX OF SKIN BREAKDOWN, COMMON PRESSURE AREAS, AND PREVENTION ON 10/4/25 BY REGIONAL COMPLIANCE NURSE NURSES WERE INSERVICED ON COMPLETING SKIN ASSESSMENTS ON ADMISSION/readmission AND WEEKLY THEREAFTER, PER THE SCHEDULE PROVIDED. MANAGERS INSERVICED TO REVIEW CLINICAL ALERTS IN DAILY STAND UP TO MONTIOR FOR NEW WOUNDS, CHANGES IN WOUND, AND DECLINING WOUNDS. The medical director [physician] was notified of the immediate jeopardy situation on 10/4/2025 at 1:25 pm. MonitoringThe DON / designee will view each wound weekly AND ENDURE [sic] CORRECT ORDER IS IN PLACEThe DON / designee will audit all skin assessments and Weekly ulcer assessments weekly to ensure all assessment match the resident's current condition weekly.DON/Designee will audit all skin assessments and ulcer assessments weekly to ensure all residents received an assessment.DON/Designee will review all admissions/readmissions within 24 hours of admission to ensure orders are transcribed correctly and appointments are scheduled.DON/Designee will review WAR for completion of ordered wound treatments DAILY IN STAND UPDON/Designee will assess all dressings to ensure date reflects current date 5 x week X 4 WEEKSRegional Compliance Nurse will monitor DON/Designee for monitoring compliance weekly x 4 weeks.The QA committee will review findings and makes changes as needed monthly.The Administrator/Designee will review during stand up meetings if there was any evidence of any potential Neglect and initiate investigation / Self Report to HHSCADO/Regional Compliance Nurse will monitor by participating in facility's weekly SOC meeting x 6 weeks and at least 1 x per month x 3 months or until compliance is met. Monitoring of the POR included the following: During an observation, 10/04/2025 at 11:45 a.m., Resident #1 was observed and had clean and dry bandages to the left and Right BKA, and wound vac was attached to both BKAs. During an observation, 10/05/2025 at 9:23 a.m. and 10:08 a.m., HHSC Investigator W completed a head to toe skin assessment for Resident #3 and #5. The findings had been identified by facility nursing staff, listed on skin assessments completed on 10/02/2025 and orders were present for the observed skin findings. Record review of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 14 of 29 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 10/06/2025 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)

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some EMR UDA log revealed 63 resident names. The log revealed that each resident had a UDA, weekly skin assessment created on 10/02/2025 and the status of the assessments were completed. Record review of 9 sample residents revealed skin assessments completed on 10/02/2025 and treatment orders were present. Record review of a facility staff roster revealed 44 direct care employees that included 26 CNAs (4 PRN), 15 LVNs (6 PRN), 2 RNs (1PRN). Record review of a facility in-service tracking spreadsheet revealed 16 CNAs received in person training and 6 CNAs had not worked on the schedule and had received a text message with the training for reporting and identifying skin concerns, abuse and neglect and reporting grievances or concerns from outside care teams. 4 CNAs had not worked on the floor and were unable to be contacted by phone or text. Record review of an in-service, dated 10/4/2025 and 10/06/2025, titled CNAReport all new skin issues to nurse asap and documenting the findings/alert in the kiosk. CNAs in serviced on s/sx of skin breakdown, common pressure areas and prevention. The in-service had 16 signatures. Record review of staffing schedule for 10/04/2025 revealed all CNAs scheduled for 6 a.m.-6 p.m. and 6 p.m.-6 a.m. signed the CNA in-service and on 10/05/2025 6 a.m.-6 p.m. all CNA's had been in-serviced on abuse and neglect and identifying and reporting skin concerns. Record review of an in-service, dated 10/4/2025, directed to Admin Personnel, read DON/Designee must round with MD/NP and enter orders in [EMR] as soon as the order is verbally given by MD. All [wound care physician] progress notes will be printed within 24 hrs and orders will be reviewed to ensure orders match. The in-service had 4 signatures including the Administrator, Interim DON, RN, and ADON/LVN. Record review of an in-service, dated 10/2/2025, directed to Admin/Personnel, revealed the DON/designee will review each wound weekly x 4 weeks. The DON/designee will audit all skin assessments and weekly ulcer assessments weekly to ensure all assessments match the resident's current condition weekly x 4 weeks. DON/Designee will review WAR for completion of ordered wound treatments 5 x weekly. DON/Designee will assess all dressings to ensure date reflects the current date of 5 x week. DON/Designee will validate all wounds have treatment orders in place weekly x 4 weeks. The QA committee will review the findings and make changes as needed monthly. Wound care monitoring will be reviewing in stand up and stand down. Wound care monitoring will be reviewed for holes/omissions daily in stand up and stand down. Admin personnel must ensure systems will have adequate coverage when position is vacated. The in-service was signed by the ADON/LVN, Administrator and Interim DON. Record review of a facility in-service tracking spreadsheet revealed 12 licensed nurses received in person training and 6 licensed nurses had not worked the floor and received a text message with the training for identifying, assessing, notification, skin assessments and treatments. Record review of the daily staffing schedules for 10/02/2025 - 10/05/2025 and 10/06/2025 6a-6p revealed that all licensed nurses had signed the in-service for licensed nurses. Record review of an in-service dated 10/2/2025, for licensed nurses, read Pressure ulcer prevention and treatment including providing treatment as ordered and initialing/dating dressings-see attached policy. Documentation and accurate assessment of pressure ulcers- see policy. Initiating wound orders per MDs and upon admission/readmission. If a CNA reports to a charge nurse about a change in skin integrity/wound status, the charge nurse must assess and notify MDs of changes immediately. Notification of physician with change of condition immediately. The in-service was signed by 12 LVNs. Record review of an employee roster revealed 73 total employees. Record review of an in-service dated 10/02/2025 revealed the topic was abuse and neglect and revealed 40 employee signatures. Record review of an in-service, dated 10/04/2025, revealed an in-service, complaints or concerns form outside care teams are to be directed to the administrator for initiation of investigation. The in-service revealed 62 signatures. During an interview with CNA R, 10/04/2025 at 9:43 a.m. CNA R stated she had received training on identifying wounds and reporting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 15 of 29 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 10/06/2025 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)

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some wounds to the charge nurse. During an interview with LVN P, 10/04/2025 at 11:56 a.m., LVN P stated she received training on wound care, following physician orders and abuse and neglect on 10/02/2025 and stated the training was provided by the RCN. During an interview with CNA U, 10/04/2025 at 12:13 p.m. CNA U stated she had received training on identifying wounds and abuse and neglect on 10/02/2025 and stated she would report any skin concerns to the charge nurse and report allegations of abuse to the Administrator. During an interview with the Administrator, 10/4/2025 at 3:30pm, the Administrator stated Admin/Personnel were identified as the Administrator, Interim DON, and ADON. The Administrator revealed the Medical Director was notified of the immediate jeopardy regarding neglect and wound care on 10/4/2025. The Administrator revealed monitoring forms were created to monitor the wound care processes and stated the DON/Designee will review wounds weekly to ensure the correct orders are in place, will audit skin assessments and weekly pressure ulcer assessments, review admission and readmissions within 24 hours of admission, review resident WAR/TAR weekly to ensure treatments are being completed and will observe resident wound dressing for accurate dates and validate that resident wounds have treatment orders in place. These findings will be documented on the monitoring forms and the findings will be brought to QA. The Administrator stated she received the training and education on expectations from the RCN on 10/4/25. During an interview with the Administrator, 10/05/2025 at 3:30 p.m., the Administrator stated staff in-servicing on abuse and neglect was initiated on 10/02/2025 and all staff that have worked since 10/02/25 have been educated on abuse and neglect. The Administrator stated staff were educated on types of abuse and neglect, who to report to, how soon to report and the importance of reporting complaints or concerns from visitors, vendors, etc. directly to the administrator. During interviews conducted on 10/05/2025 and 10/06/2025, included a total of 10 CNAs [CNA E, R, F, Q, LL, KK, X, LL, MM, NN] ( 5 - 6a-6p and 1 6p-6a) (2 6a-6p and 1 6p-6a who confirmed receipt of a text message with training on abuse and neglect [CNA LL, MM, NN]), 4 LVNs [LVN P, O, B, H] (2 6a-6p, 1 6p-6a, 1 PRN both shifts), 1 PRN 6p-6a RN [ RN J] who confirmed receipt for a text in-service on abuse and neglect, 1 RN [RN G] ( 6p-6a), 1 MDS/LVN, 1 BOM, 4 Dietary [Dietary Y, DD, EE, FF], 5 Housekeeping [Housekeeping Z, AA, BB, CC, JJ], 1 Maintenance Director, 2 Therapists [Therapy GG, HH], 1 Social Worker, 1 Activity Director, 1 Medical Records/Central Supply and 1 HR. Staff interviews revealed staff had received education on abuse and neglect and were able to provide examples of neglect Staff demonstrated understanding of reporting allegations of abuse and neglect directly to the administrator immediately and reporting any concerns or complaints to the Administrator immediately. During an interview with the Administrator, 10/04/2025 at 4:03 p.m., revealed the Administrator was educated by the ADO on 10/04/2025 on ensuring the DON/ADON reviewed new wound orders and validated the orders that were transcribed into PCC accurately by auditing an order listing report and the Administrator was to investigate and report to corporate and HHSC any incidents that may be considered abuse or neglect. During an interview with the RCN, 10/05/2025 at 9:45 a.m., the RCN revealed 100% resident skin rounds were completed on 10/02/2025 that included head to toe assessments of each resident. Skin assessments were completed with detailed findings and new orders were transcribed into [EMR]. The RCN revealed multiple in-services were initiated for CNAs, licensed nurses and administration/personnel and all staff currently working had been in-serviced by discipline. The RCN stated any staff that had not been in-serviced would be in-serviced prior to the start of their shift and the in-servicing was completed by the RCN and Administrator. The RCN stated CNAs were in-serviced on 10/04/2025 and ongoing on identifying skin breakdown, reporting skin issues to the nurse immediately and where to document new findings on the kiosk. The RCN stated licensed nurses were in-serviced on 10/02/2025 regarding pressure ulcer prevention and initialing and dating dressing, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 16 of 29 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 10/06/2025 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)

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some documentation and completing accurate assessments, initiating wound orders upon admission/readmission, immediately assessing and notifying the physician, documenting and obtaining treatment orders when notified or observing a new skin issue and notifying the physician immediately of changes in condition. The RCN stated all facility staff were in-serviced on abuse and neglect and reporting complaints directly to the Administrator. The Administrator/DON and ADON were educated on 10/04/2025 that the DON/Designee will round with the wound care physician weekly and will ensure orders are immediately entered into the EMR when the order is verbally given by the wound care physician and the progress notes will be printed 24 hours after the wound care physician visit to ensure the orders match in the EMR. The RCN revealed the Administrator, DON and ADON were educated on expectations monitoring of the plan of removal. The RCN stated monitoring forms were created to track the monitoring, and the DON/Designee was responsible for completing and documenting on the monitoring tool. Monitoring included viewing each wound weekly and making sure the correct orders were in place and round with the wound care physician weekly. Audit all skin and ulcer assessments weekly to make sure they match the resident's current condition and audit to make sure all residents have weekly skin assessments and ulcer assessments. Review admission/readmissions to ensure the orders are transcribed correctly and appointments were scheduled as needed. Review the administration record for the completion of ordered wound treatments from the previous day and ensure all dressing have the current date and are initialed. The monitoring forms will be reviewed, signed, and dated by the RCN weekly to validate it was being completed. The RCN and ADO will attend standard of care meetings weekly. Findings from the monitoring will be brought to QAPI monthly and reviewed for compliance and changes to the plan initiated as needed. During an interview with the ADO, 10/05/2025 at 10:50 a.m., revealed the ADO educated the Administrator on 10/04/2025 regarding checking orders daily in the morning meeting and ensuring the nursing managers were reviewing wound orders and validating the orders were transcribed into the EMR. During an interview with DON, 10/05/2025 at 11:48 a.m., revealed the DON received education and training from the RCN on 10/2/2025 and 10/4/2025 regarding expectations for rounding with the wound care physician weekly and validating daily in clinical review that resident treatment orders reflect the wound care physician progress notes, wound assessments are completed weekly and on admission and readmission, each resident has appropriate wound care orders, wound dressings are accurately dated and monitoring wound administration to ensure wound treatments are completed daily. The DON stated she would track the monitoring on a monitoring log and document her findings, and the findings would be brought to the monthly QAPI to review for compliance. During an interview with Medical Director, 10/5/2025 at 2:09pm, revealed the Medical Director and [physician] were notified of the immediate jeopardy for neglect and wound care by the Administrator on 10/04/2025 and the Medical Director reviewed the plan of removal, the protocols and steps being taken to ensure compliance. Record review of a monitoring document revealed, The DON/designee will view each wound weekly to ensure the correct order is in place. The document had 5 blocks with blanks for a date, resident name, and staff name. Record review of a monitoring document revealed, The DON/designee will audit all skin assessments and weekly ulcer assessments weekly to ensure all assessments match the resident's current condition weekly. The document had 5 blocks with blanks for the date, weekly skin assessments correct YES/No, staff name. Record review of a monitoring document revealed, DON/Designee will review all admissions/readmissions within 24 hours of admission. The document had 5 blocks with blanks for date, resident name, admission complete YES/NO if no describe on back of form and staff name. Record review of a monitoring document revealed, DON/Designee will review WAR for completion of ordered wound treatments 5 x weekly. The document had 5 blocks for date, resident name, WAR/TAR completed YES/No If no, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 17 of 29 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 10/06/2025 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)

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete describe on back of form and staff name. Record review of a monitoring document revealed, DON/Designee will assess all dressing to ensure date reflects current date. The document had 5 blocks for date, resident name, Dressing dated correctly YES/NO if no, describe on back of form and staff name. Record review of a monitoring document revealed, DON/Designee will validate all wounds have treatment orders in place weekly x 4 weeks. The document had 5 blocks for date, resident name, treatment orders in place YES/NO If no, describe on back of form and staff name. Record review of an ADHOC QAPI meeting, dated 10/2/2025 revealed signatures including the Administrator, Interim DON, and ADON. The Administrator was informed that the Immediate Jeopardy was removed on 10/06/2025 at 2:24 p.m. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy and a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 455390 If continuation sheet Page 18 of 29 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 10/06/2025 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)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing, for 1 of 8 residents (Resident 1) reviewed for pressure ulcers in that: Resident #1 had a Stage IV pressure ulcer on his left ankle and did not have wound treatment orders in the month of September 2025. Resident #1 was admitted to the hospital on [DATE] with osteomyelitis and had a left below the knee amputation on 09/25/2025. An Immediate Jeopardy (IJ) was identified on 10/03/2025. The IJ template was provided to the facility on [DATE] at 4:53 p.m. While the IJ was removed on 10/06/2025 the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with the potential for more than minimal harm that is not IJ, due to the need to evaluate the effectiveness of the corrective systems. These failures could place residents at risk for worsening of existing wounds or development of new pressure ulcers. The findings were: Record review of Resident #1's, undated, face sheet revealed Resident #1 was a [AGE] year old male who admitted to the facility on [DATE] with diagnoses that included malignant neoplasm of unspecified part of unspecified bronchus of lung (cancer of the lung or respiratory airway), quadriplegia (paralysis of a person's limbs), kidney disease (damage to kidney function), viral hepatitis c (a liver disease), cirrhosis of liver (scarring and damage to the liver) and encephalopathy (condition that caused brain dysfunction). Record review of Resident #1's quarterly MDS assessment, dated 08/19/2025, revealed Resident #1 had a BIMS score of 15, indicating no cognitive impairment. Section GG - Functional Abilities revealed Resident #1 had impairment on one side of his upper and lower extremity, used a wheelchair for mobility, required moderate assistance with bed mobility and was dependent on staff for transfers and personal hygiene. Section M Skin Conditions revealed Resident #1 was at risk for developing pressure ulcers, had one or more unhealed pressure ulcers, had 1 Stage III pressure ulcer and 2 unstageable pressure ulcers. Record review of Resident #1's undated comprehensive care plan revealed a care plan, the resident has a pressure ulcer or potential for pressure ulcer development: 1. Unstageable left lateral, (outer) ankle, dated 08/05/2025 and revised 08/11/2025. The goal of the care plan was for Resident #1's pressure ulcer to show signs of healing and remain free from infection with a target date of 11/07/2025. Interventions revealed staff would administer treatments as ordered, monitor the effectiveness and replace loose or missing dressings PRN. The interventions also included for staff to assess/record/monitor wound healing at least weekly and measure length, width, and depth, document the status of the wound perimeter and wound bed and healing process. Staff were to report declines to the MD. Record review of Resident #1's September 2025 WAR/TAR revealed no wound care treatment orders for the left ankle. Record review of Resident #1's EMR revealed Resident #1 had no weekly skin assessments or weekly pressure ulcer assessments during the month of September until 09/25/2025, after Resident #1 was admitted to the hospital on [DATE]. Record review of wound care physician assessment, dated 08/26/2025, revealed Resident #1 had a Stage IV pressure wound (a wound that has full thickness skin and tissue loss with exposed muscle, tendon, ligament, cartilage or bone in the ulcer) of the left, lateral ankle and measured 3.5cm x 2.5 cm x 0.1 cm with a surface area of 8.75cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 9 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 9 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 9 days. The goal of the treatment was healing evidenced by a 75% decrease in nonviable tissue within the wound bed in Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 19 of 29 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 10/06/2025 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)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some comparison to the previous wound care visit. Record review of wound care physician assessment, dated 09/02/2025, revealed Resident #1 had a Stage IV pressure wound of the left, lateral ankle and measured 3 cm x 2.5 cm x 0.5 cm with a surface area of 7.50 cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 30 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 30 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 30 days. The goal of the treatment was healing evidenced by a 14.3% decrease in surface are a within the wound bed in comparison to the previous wound care visit.Record review of wound care physician assessment, dated 09/09/2025, revealed Resident #1 had a Stage IV pressure wound of the left, lateral ankle and measured 3.5 cm x 2.5 cm x 0.5 cm with a surface area of 8.75 cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 23 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 23 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 23 days. Record review of an outpatient clinic wound progress note, dated 09/15/2025, revealed, Veteran seen in clinic today with [physician name]. Veteran is at [facility name]. Wound dressings are soiled, and odor present to left foot dressing. The wound assessment revealed a stage IV pressure ulcer to the left lateral malleolus (bony prominence on the outer side of the ankle) measuring 4.0 cm x 4.5 cm x 0.5 cm. The assessment revealed a DTI pressure ulcer (deep tissue injury characterized by damage to tissue underneath intact skin) inferior (inside) to left lateral malleolus measuring 6.7 cm x 7.0 cm x 0.0 cm. Record review of wound care physician assessment, dated 09/16/2025, revealed Resident #1 had a Stage IV pressure wound of the left, lateral ankle and measured 3.5 cm x 2.9 cm x 0.5 cm with a surface area of 10.15 cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 16 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 16 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 16 days. The goal of the treatment was healing evidenced by a 66.7% decrease in nonviable tissue within the wound bed in comparison to the previous wound care visit. Record review of wound care physician assessment, dated 09/23/2025, revealed Resident #1 had a Stage IV pressure wound of the left, lateral ankle and measured 5.0 cm x 4.0 cm x 0.5 cm with a surface area of 20.00 cm. The dressing treatment plan revealed, Leptospermum honey apply once daily and as needed: if saturated, soiled or dislodged. For 9 days; Alginate calcium apply once daily and as needed: if saturated, soiled or dislodged, for 9 days. Secondary Dressing - gauze island w/bdr apply once daily and as needed: if saturated, soiled or dislodged. For 9 days. The assessment included an arterial wound (skin injury caused by poor blood circulation) of the left, distal (outer) lateral foot that was arterial and measured 1.5 cm x 1.7cm x 0 and described as a scab. Record review of Resident #1's podiatry progress note, dated 09/24/2025, revealed, patient presents to clinic in a stretcher for left lateral ankle decubitus ulcer (caused by prolonged pressure to an area). The note revealed the left lateral ankle pressure ulcer measured 2.5 cm x 3.0 cm on 09/04/2025 and measured 3.5 cm x 3.5 cm on 09/24/2025. The wound was described as necrotic (death of tissue) in the peri wound (tissue surrounding a wound), had purulent drainage (a skin of infection. Thick milky fluid that comes out of a wound) noted and revealed the fibula bone (long slender bone in the lower leg) was exposed. The assessment revealed a left lateral ankle pressure ulcer stage 4 and history of right BKA. The plan revealed purulent drainage, malodor (offensive odor), necrotic wound base (dead or dying cells and tissues within a wound that are no longer able to carry out their normal function), and exposed fibula notified to left (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 20 of 29 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 10/06/2025 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)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some lateral ankle wound. Due to this and high risk right BKA patient was advised to go to [hospital] ED for further workup. Patient was transported via [ambulance]. Record review of Resident#1's emergency department hospital notes, dated 09/24/2025 revealed, Chief Complaint: patient presents from a nursing home with low blood pressure and possible wound infections. History of Present Illness (HPI): The patient was transported from a nursing home to a podiatry appointment where they were noted to have low blood pressure and significant ulcers. The ulcers include a deep ulcer on the left lateral malleolus open wound, as well as a recent BKA on the right, both appearing infected. The patient is found to be lethargic and poorly responsive, indicating altered mentation (occurs when illnesses, disorders and injuries affect brain function). Onset of symptoms is acute, with ulcers likely developing over time due to underlying conditions. Exam revealed, left ankle with 4 cm lateral wound with exposed lat al, appears to track to joint (tunneling of wounds underneath the skin). CT imaging of the LLE revealed, lateral malleolus soft tissue ulceration which extends to the bone. Osteomyelitis (infection in the bone) of the distal fibula. Septic tibiotalar joint (infection in the joint of the ankle) with associated osteomyelitis of the tibia and talus (small bone in the ankle). The disposition plan was to admit Resident #1 to the hospital for further management and stabilization with the diagnosis of osteomyelitis of the left ankle and stated a surgical intervention was scheduled for the following day. Record review of Resident #1's hospital ED critical care note, dated 09/24/2025, revealed, the patient meets the criteria for critical illness, with acute impairment of circulation, septic shock (life threatening immune system reaction to an infection) in the setting of osteomyelitis. Vital organ systems, and is at high risk of imminent, life threatening deterioration without urgent intervention and revealed, Upon my evaluation, this patient had a high probability of imminent or life-threatening deterioration due to sepsis and osteomyelitis, which required my direct attention, intervention and personal management. Record review of Resident #1's facility progress note, dated 09/25/2025 at 12:48 a.m. by RN G, revealed, received report that patient is out to a doctor's appointment. At this time, the patient still out. Reported to administrator. There were no other relevant progress notes related to Resident #1's wounds observed in the progress notes. Record review of Resident #1's facility weekly skin assessment, effective date 09/25/2025 at 12:00 p.m. and signed by LVN K 09/26/2025, revealed a question, Does the resident have a pressure, venous, arterial, or diabetic ulcer? If yes, complete the Ulcer Assessment. The answer was coded yes and also revealed for other skin findings, L ankle covered with dressing, L foot art. Wound. Wound provider consult in place and Tx orders in place. Record review of Resident #1's facility progress note, dated 09/25/2025 at 3:26 p.m. by ADON/LVN revealed, Patient went out for a scheduled appointment and was admitted to [hospital] following appointment. Record review of Resident #1's hospital discharge notes, dated 10/01/2025, revealed Resident #1's principal discharge diagnoses were, osteomyelitis of left ankle status post (a patient's condition after a specific procedure, treatment or event) left below knee amputation, completed 09/24/2025. Equipment supplies listed for discharge included, two portable [company] incision management system. Record review of Resident #1's facility progress note, dated 10/01/2025 at 9:45 p.m. by LVN N, revealed, Resident has wound vacs (vacuum-assisted closure is a type of therapy that uses a device to decrease air pressure on a wound) to BLE, has bilateral below knee amputations. Record review of Resident #1's weekly skin assessment, dated 10/02/2025 at 1:55 p.m. by LVN N, revealed Resident had wound vacs to BLE related to bilateral below knee amputations and LVN N was unable to assess due to bandages and wound vacs. Record review of Resident #1's October 2025 administration orders revealed the following orders, Monitor surgical incision to LBKA, surgical wound vac in place and will be discontinued by surgeon. Wound vac not to be changed by nurses, contact [hospital] if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 21 of 29 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 10/06/2025 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)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some wound vac malfunctions. Every shift for wound care dated 10/02/2025. Wound MD to evaluate resident dated 10/02/2025 and an ortho (orthopedic) follow up appointment scheduled for 10/7/2025 at 9:30 a.m. During an interview with the hospital case manager, 09/30/2025 at 3:08 p.m., the hospital case manager stated Resident #1 was sent to the hospital directly from a doctor's appointment on 09/24/2025 due to Resident #1 having an infection in his left leg wound and stated Resident #1 had to have a below the knee amputation. The hospital case manager stated an outpatient wound nurse would go to the facility to see Resident #1 approximately once a week. She stated the outpatient wound care nurse would have to perform wound care for Resident #1 because it was not getting done by the facility and observed Resident #1 with no treatment dressings to his left ankle. During an interview with the Interim DON, 10/1/2025 at 12:51 p.m. The Interim DON stated she started at the facility 3 days prior, and the previous DON had not worked in the facility for approximately 3 weeks. The Interim DON stated ADON/LVN was the prior wound care nurse and moved into the ADON/LVN position several weeks ago. During an interview with LVN C, 10/01/2025 at 2:03 p.m., LVN C said she was assigned to Resident #1's hall and stated she had not received training on completing wound care and stated the wound care nurse was responsible for wound care treatments and she thought the facility had a wound care physician but did not know who reported findings to the physician. LVN C stated if the wound care nurse was not in the facility, the charge nurses were responsible for completing wound care and LVN C said she would review a resident's administration orders in the EMR to determine what wound treatments are ordered. LVN C stated wound orders are located in a resident's EMR under the TAR or WAR section of the orders and the orders would detail the interventions to follow to provide wound care. LVN C stated if she were aware of a resident wound that did not have an order for treatment, she would have notified the wound care nurse or the ADON. LVN C stated she was not aware of any residents having wounds without orders and stated it was important for resident wounds to be treated, to prevent further breakdown of the skin and they could become septic. We want to stop infection. During an interview with LVN D, 10/02/2025 at 10:07 a.m., LVN D stated she knew when a resident had wounds because she would review a resident's physician orders and see if the resident had wound care treatment orders. LVN D stated the wound treatment nurse was responsible for wound treatments and if that person was not available, the charge nurses were responsible for wound care. LVN D stated she thought the ADON, or wound care nurse communicated directly with the wound care physician regarding resident wound progress and orders. LVN D stated resident wound care orders and treatments were listed in the EMR under the TAR/WAR for the residents and stated the ADON or DON were responsible for adding wound care orders to the TAR/WAR. LVN D stated it was important for residents to have wound care treatment orders if they had a wound, because if not, they could get an infection and get septic, and the wound will never heal if it does not get treated. LVN D stated the wound care nurse was responsible for doing weekly skin assessments when a resident had a wound. During an interview with LVN B, 10/02/2025 at 10:51 a.m., LVN B stated he would look at a resident's treatment orders in the EMR to see if a resident had a wound and what treatment orders were to be administered for the resident. LVN B stated nurses were responsible for completing weekly skin assessments and performing wound care if the wound care nurse was not available. LVN B stated he was assigned to Resident #1 and had been assigned to work with Resident #1 on previous shifts. LVN B stated Resident #1 had wounds on his left leg. LVN B stated he would complete wound treatments for Resident #1 based on the wound treatment orders in the EMR and stated he was unaware of what treatment orders were in place for Resident #1. During an interview with Resident #1, 10/02/2025 at 11:41 a.m., Resident #1 stated he just returned from the hospital and said, they amputated my left foot so now I have no feet. Resident #1 stated his right foot was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 22 of 29 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 10/06/2025 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)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some amputated about a month ago and stated the left foot was amputated because it was infected. Resident #1 stated the doctors at the hospital just told him his foot was infected, and he stated he was glad that the infection did not go up further into his body. Resident #1 denied having pain and did not appear in psychosocial distress. Resident #1 was observed lying in bed with a wound vac connected to his R and L BKA. Dressings appeared clean and dry. Resident #1stated he did not recall any staff members providing wound dressings to his left foot in the last month. During an interview with CNA F, 10/02/2025 at 1:13 p.m. CNA F stated she was aware that Resident #1 had wounds on his left foot and stated she was in his room a day or two before he went to the hospital on [DATE]. CNA F stated Resident #1's left foot had an odor, and she would have to open the window to let the stench out of the room. CNA F stated Resident #1 told her he could not feel his leg and Resident #1 told CNA F that he thought it was getting infected and stated, he could also smell it and asked me to open the window. CNA F stated she told LVN H that Resident #1's foot had an odor when CNA F would give him bed baths. CNA F stated she would see a bandage on his left ankle at times but unable to recall dates or times. CNA F stated she thought other CNAs reported the wound odor to the nurses as well but could not confirm. During an interview with ADON/LVN, 10/02/2025 at 2:19 p.m., ADON/LVN stated she was hired as the wound care treatment nurse in July 2025 and transferred into the ADON/LVN position right before the facility had their recertification survey 08/27/2025. ADON/LVN stated when she transitioned to ADON/LVN the charge nurses were responsible for wound treatments and the charges nurses would follow the physician orders for wound care. The ADON/LVN stated Resident #1 was being followed by a wound care physician and the wound care physician would write wound orders in the wound care physician's progress notes and the progress notes were uploaded into the resident EMR. The ADON/LVN stated that she was responsible for reviewing the wound care physician notes and entering new wound care orders into a resident's EMR. The ADON/LVN stated, it's me, I am responsible for all the systems, and we should have a DON, but we don't, so I missed it. The wound care physician comes on Tuesday, and I will look in the system the next day to see if she saw any patients. IF there are new orders I go in and update them, but she does not change the orders often, so I didn't verify them every single week. ADON/LVN stated Resident #1 did not have wound care orders in his administration record and charge nurses would not have known to do wound care if there were no wound care orders. The ADON/LVN stated the charge nurses were responsible for completing weekly skin assessments and the ADON/LVN was responsible for completing the pressure ulcer assessments. The ADON/LVN stated she had received training on completing the pressure ulcer assessments and said the assessments were important to monitor the progress of wounds. The ADON/LVN stated it was important for residents to have treatment orders for their wounds, so the wound did not worsen or get infected. During an interview with LVN H, 10/02/2025 at 3:51 p.m., LVN H stated no one had reported Resident #1 having an odor to his left foot wound. During an interview with the RCN, 10/02/2025 4:05 p.m., the RCN stated she became aware of a concern regarding Resident #1's wound care the prior night, 10/01/2025, when the RCN was reviewing Resident #1's clinicals and found that Resident #1 did not have wound care orders for his left ankle prior to his hospitalization and amputation of the left BKA. The RCN stated the concern was identified as neglect and reported the incident to HHSC. During an interview with LVN L, 10/02/2025 at 6:16 p.m., LVN L stated she worked the night shift and was assigned to Resident #1's hall. LVN L stated she was unaware of Resident #1 having any wounds on his left foot, did not perform any wound care for Resident #1's left foot, and did not recall any treatment orders for his left foot. During an interview with LVN N, 10/02/2025 at 7:20 p.m., LVN N stated she was not aware of Resident #1 having any wounds on his left foot. LVN N stated she did not provide wound care for Resident #1's left foot and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 23 of 29 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 10/06/2025 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)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some never observed anyone doing wound care for Resident #1's left foot. During an interview with CNA Q, 10/03/2025 at 8:35 a.m., CNA Q stated she had worked at the facility for two months and CNA Q stated she would help get Resident #1 ready for doctor appointments and stated she did not observe any wound care bandages on Resident #1's left foot. During an interview with LVN H, 10/02/2025 at 8:49 a.m., LVN H stated she did not perform any wound care for Resident #1 and stated she never observed any wound care orders for Resident #1. During an interview with the Nurse Practitioner, 10/03/2025 at 10:42 a.m., the Nurse Practitioner stated when a resident returns from the hospital with wounds and no wound care orders, the nursing staff should have reassessed and measured the wounds, and a nurse should have called to get wound care orders. The Nurse Practitioner stated Resident #1 should have had wound care treatments completed daily and stated the lack of wound care treatments daily could have led to a catastrophic event. With such a complicated medical history, yes, it is very possible for lack of wound care to have led to that and worse. The Nurse Practitioner stated the facility wound care had room for improvement. During an interview with the Wound Care Physician, 10/03/2025 at 12:11 p.m., the Wound Care Physician stated that any changes in treatment orders were documented in her progress notes and uploaded into a resident's EMR and stated she did not have access to view resident orders. The Wound Care Physician stated it was up to the facility as to who was responsible for adding the Wound Care Physician orders into a resident's administrative orders and stated in most facilities it was completed by the Wound Care Nurse or the ADON. The Wound Care Physician stated she had concerns about the wound care performed for Resident #1 because he would have wound dressings that were not dated and there was no way for the Wound Care Physician to know when the treatment was completed. The Wound Care Physician stated Resident #1 should have had daily wound care treatments and stated Resident #1's wound had declined prior to Resident #1 going to the hospital on [DATE]. The Wound Care Physician stated leaving a wound dressing in place too long for Resident #1 could lead to infection for someone like him who had multiple other comorbidities and is vascular compromised and that can lead to wound deterioration and risk of infection. The Wound Care Physician stated a lack of daily wound care could have contributed to Resident #1 being admitted to the hospital with sepsis, osteomyelitis, and an amputation. The Wound Care Physician stated she would do a wound dressing for Resident #1 when she assessed him but stated she would only see him weekly. During an interview with the Administrator, 10/03/2025 at 2:42 p.m., the Administrator stated the ADON/LVN was still responsible for doing wound care treatments 3 days out of the week and overseeing the wound care responsibilities after she transitioned to the ADON/LVN position. The Administrator stated it should have been communicated to the Wound Care Physician that Resident #1 did not have wound care orders to provide wound care and stated a resident who had a wound and no wound care orders could lead to an amputation of an extremity and cause infections and sepsis. Record review of facility wound treatment management policy, revised 05/05/2025, revealed in the absence of treatment orders, the licensed nurse will notify physician to obtain treatment orders. This may be the treatment nurse or the assigned licensed nurse in the absence of the treatment nurse and treatments will be documented on the Treatment Administration Record. The effectiveness of treatments will be monitored through ongoing assessment of the wound. Record review of a facility policy, revised 05/05/2025, titles, Pressure Injury: Prevention, Assessment and Treatment, revealed, Assessment: 1. All residents should have a skin assessment on a weekly basis completed in [EMR]. 2. If the resident has any type of ulcer (pressure injury, arterial, venous, diabetic) an ulcer assessment should be completed at least weekly. This was determined to be an Immediate Jeopardy (IJ) on 10/03/2025 at 4:20 p.m. The Administrator and Interim DON were notified. The Administrator and the DON were provided with the IJ Template on 10/03/2025 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 24 of 29 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 10/06/2025 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)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 4:53 p.m. The following Plan of Removal submitted by the facility was accepted on 10/04/2025 at 12:26 p.m.: Problem: The facility failed to ensure that a resident with pressure ulcers (Resident #1) received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from development. Interventions:100% skin rounds completed by 5pm 10/2/2025 by Administrative Nurses and Corporate Compliance Nurses. All findings will be communicated to MD and orders transcribed in [EMR].The following in-services were initiated by Regional Compliance Nurse on 10/02/2025: Any nurse not present or in-serviced on 10/02/2025 will not be allowed to assume their duties until in-serviced. All new hires will receive education upon hire.Licensed NursesPressure ulcer prevention and treatment including providing treatment as ordered and Initialing/Dating dressing.Documentation and Accurate Assessment of Pressure UlcersInitiating wound orders per MD and upon admission/readmission.If a C.N.A reports to a charge nurse about a change in skin integrity/wound status, the charge nurse must assess and notify MD of changes immediately.Notification of Physician with change of condition immediately.Admin Personnel Wound care monitoring will be reviewed in stand up and stand down (meetings) WARS and TARs will be reviewed for holes/omissions daily in stand up and stand down DON/DESIGNEE INSERVICED TO ROUND WITH WOUND MD/NP STARTING 10/7/25 UNTIL INDEFINATLEY [sic] AND ENTER ORDERS IN [EMR] AS SOON AS THE ORDER IS VERBALLY GIVEN BY MD. ALL [Wound care physician] PROGRESS NOTES WILL BE PRINTED WITHIN 24 HRS OF RECIEPT AND ORDERS WILL BE REVIEWED BY DON/DESIGNEE IN STAND UP TO ENSURE ORDERS MATCH. THIS MONITORING WILL BE INIATED [sic] ON 10/7/25 AND INDEFINATELY [sic]. CNAs INSERVICED ON REPORTING ALL NEW SKIN ISSUED [sic] TO NURSE ASAP AND DOCUMENTING THE FINDING/ALERT IN THE KIOSK ON 10/4/25 BY REGIONAL COMPLIANCE NURSE. CNAs INSERVICED ON S/SX OF SKIN BREAKDOWN, COMMON PRESSURE AREAS, AND PREVENTION ON 10/4/25 BY REGIONAL COMPLIANCE NURSE NURSES WERE INSERVICED ON COMPLETING SKIN ASSESSMENTS ON ADMISSION/readmission AND WEEKLY THEREAFTER, PER THE SCHEDULE PROVIDED. MANAGERS INSERVICED TO REVIEW CLINICAL ALERTS DAILY STAND UP TO MONTIOR FOR NEW WOUNDS, CHANGES IN WOUND, AND DECLINING WOUNDS. The medical director [name] was notified of the immediate jeopardy situation on 10/3/2025 at 5:26 pm. MonitoringThe DON / designee will view each wound weekly AND ENDURE [sic] CORRECT ORDER IS IN PLACEThe DON / designee will audit all skin assessments and Weekly ulcer assessments weekly to ensure all assessment match the resident's current condition weekly.DON/Designee will audit all skin assessments and ulcer assessments weekly to ensure all residents received an assessment.DON/Designee will review all admissions/readmissions within 24 hours of admission to ensure orders are transcribed correctly and appointments are scheduled.DON/Designee will review WAR for completion of ordered wound treatments DAILY IN STAND UPDON/Designee will assess all dressings to ensure date reflects current date 5 x week X 4 WEEKSRegional Compliance Nurse will monitor DON/Designee for monitoring compliance weekly x 4 weeks.The QA committee will review findings and make changes as needed monthly. Monitoring of the POR included the following: During an observation, 10/04/2025 at 11:45 a.m., Resident #1 was observed and had clean and dry bandages to the left and Right BKA, and wound vac was attached to both BKAs. During an observation, 10/05/2025 at 9:23 a.m. and 10:08 a.m., HHSC Investigator W completed a head-to-toe skin assessment for Resident #3 and #5. The findings had been identified by facility nursing staff, listed on skin assessments completed on 10/02/2025 and orders were present for the observed skin findings. Record review of EMR UDA log revealed 63 resident names. The log revealed that each resident had a UDA, weekly skin assessment created on 10/02/2025 and the status of the assessments were completed. Record review of 9 sample residents revealed skin assessments completed on 10/02/2025 and treatment orders were present. Record review of a facility staff roster revealed 44 direct care employees that included 26 CNAs (4 PRN), 15 LVNs (6 PRN), 2 RNs (1PRN). Record review of a facility in-service (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 25 of 29 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 10/06/2025 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)

F 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete tracking spreadsheet revealed 16 CNAs received in person training and 6 CNAs had not worked on the schedule and had received a text message with training for reporting and identifying skin concerns. 4 CNAs had not worked on the floor and were unable to be contacted by phone or text. Record review of an in-service, dated 10/4/2025 and 10/06/2025, titled CNA- Report all new skin issued to nurse asap and documenting the findings/alert in the kiosk. CNAs in serviced on s/sx of skin breakdown, common pressure areas and prevention. The in-service had 16 signatures. Record review of staffing schedule for 10/04/2025 revealed all CNAs scheduled for 6 a.m.-6 p.m. and 6 p.m.-6 a.m. signed the CNA in-service and on 10/05/2025 6 a.m.-6 p.m. all CNA's had been in-serviced on abuse and neglect and identifying and reporting skin concerns. Record review of an employee roster revealed 73 total employees. Record review of an in-service, dated 10/04/2025, revealed an in-service, complaints or concerns form outside care teams are to be directed to the administrator for initiation of investigation. The in-service revealed 62 signatures. Record review of an in-service, dated 10/4/2025, directed to Admin Personnel, read DON/Designee must round with MD/NP and enter orders in [EMR] as soon as the order is verbally given by MD. All [Wound care physician] progress notes will be printed within 24 hrs and orders will be reviewed to ensure orders match. The in-service had 4 signatures including the Administrator, Interim DON, RN, and ADON/LVN. Record review of an in-service, dated 10/2/2025, directed to Admin/Personnel, revealed the DON/designee will review each wound weekly x 4 weeks. The DON/designee will audit all skin assessments and weekly ulcer assessments weekly to ensure all assessments match the resident's current condition weekly x 4 weeks. DON/Designee will review WAR for completion of ordered wound treatments 5 x weekly. Event ID: Facility ID: 455390 If continuation sheet Page 26 of 29 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 10/06/2025 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)

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview and record review, the facility failed to post the daily nursing staffing formation that included the facility name, the current date, the total number and actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: registered nurses, licensed practical nurses, certified nurse aides and resident census in a prominent place readily accessible to residents, staff, and visitors for 61 residents in that: The facility failed to post the daily staff posting information on 10/01/2025 and 10/02/2025. This failure could place residents and visitors at risk of not being able to review the facility's daily staffing hours. The findings included: During an observation, 10/01/2025 at 8:28 a.m., a daily staffing poster was observed on top of the receptionist desk in a plastic display holder that was titled, Daily report of nursing staff directly responsible for resident care and was dated 09/10/2025. During an observation, 10/02/2025 at 12:02 p.m., the daily staffing poster display was observed to be empty with no staffing poster observed. During an observation, 10/02/2025 at 4:00 p.m., the daily staffing poster display was observed to be empty with no staffing poster observed. Record review of a facility staff schedule, dated 10/01/2025, revealed the facility had 5 licensed nurses, 2 MAs and 11 CNAs scheduled throughout the day. Record review of a facility staff schedule, dated 10/02/2025, revealed the facility had 5 licensed nurses, 2 MAs and 10 CNAs scheduled throughout the day. During an interview with the Administrator, 10/03/2025 at 1:36 p.m., the Administrator stated the ADON was responsible for updating the daily staffing posters daily and the ADON had received a directive to complete the daily staffing form and post it daily at the reception desk. The Administrator said it was important to post the daily staffing posters because it gives families and visitors the ability to know how many staff are present for the patients and gives us a visual number of staff available and it is part of our regulatory requirements. The Administrator stated the facility did not have a policy on posting staffing information daily but followed the regulatory guidelines. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 27 of 29 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 10/06/2025 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 8 residents (Resident # 5, 6 and 8) reviewed for infection control in that: Resident #5 had a foley catheter and did not have a sign for Enhanced Barrier Precautions (EBP).Resident #6 had a foley catheter and was observed with her foley catheter tubing touching the floor under Resident #6's wheelchair.Resident #8 had a gastric tube and did not have a sign for Enhanced Barrier Precautions (EBP). This deficient practice could affect residents on enhanced barrier precautions and place them at risk for infection. The findings were: 11.Record review of Resident #5's undated face sheet revealed Resident #5 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses that included diabetes mellitus type 2 (high blood sugar levels), cerebral infarction (stroke) and hydronephrosis with renal and ureteral calculous obstruction (swelling of one or both kidneys causing a blockage or obstruction).Record review of Resident #5's MDS assessment, dated 08/12/2025, reflected Resident #5 had a BIMS score of 04, indicating severe cognitive impairment. Section GG- Functional Abilities revealed Resident #5 was dependent on staff for bed mobility, transfers, toileting hygiene, and bathing. Section H - Bladder and Bowel revealed Resident #5 had an indwelling catheter and was incontinent of bowel and bladderRecord review of Resident #5's comprehensive care plan revealed a care plan, dated 08/11/2025 and revised 09/11/2025, that read, [Resident] is on enhanced barrier precautions. An intervention revealed, posting at the residents room entrance indicating the resident is on enhanced barrier precautions.During an observation, 10/01/2025 at 1:17 p.m., Resident #5's room did not have any postings indicating Resident #5 was on enhanced barrier precautions. During an interview with LVN D, 10/02/2025 at 10:07 a.m., LVN D stated she was assigned to Resident #5 and stated Resident #5 was on EBP. LVN D stated residents on EBP should have had a sign outside of the door indicating the residents were on EBP and what PPE supplies were required to provide direct care. LVN D stated she had received training on EBP and stated it was important to identify residents on EBP to prevent the spread of infection.2. Record review of Resident #6's undated face sheet revealed Resident #6 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses that included hemiplegia (paralysis on one side of the body), dysphagia (difficulty swallowing), cerebral infarction (stroke) and chronic kidney disease (loss of kidney function to filter waste from the blood). Record review of Resident #6's quarterly MDS assessment, dated 09/02/2025 revealed Resident #6 had short term and long-term memory deficits and Resident #6's cognitive decision making was severely impaired. Section GG - Functional Abilities revealed Resident #6 required supervision assistance with transferring from the bed to wheelchair and required maximum assistance with toileting hygiene. Section H - Bladder and Bowel revealed Resident #6 had an indwelling catheter and was incontinent of bowel and bladder.Record review of Resident #6's comprehensive care plan revealed a care plan dated 03/07/2025, catheter. The interventions revealed, check tubing for kinks and maintain the drainage bag off the floor.During an observation of Resident #6, 10/01/2025 at 1:45 p.m., Resident #6 was observed sitting at the nurse's station with a foley catheter bag underneath her wheelchair and the foley tubing was touching the floor underneath the wheelchair.During an interview with LVN C, 10/01/2025 at 2:03 p.m., LVN C stated a resident's foley catheter tubing should not touch the floor and the tubing should have been secured to prevent the spread of infection. LVN C stated all nursing staff were responsible for ensuring tubing was not loose or touching the floor and LVN C stated she had received training on infection control.3. Record review of Resident #8's Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 28 of 29 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 10/06/2025 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete undated face sheet revealed Resident #8 was a [AGE] year-old male who admitted to the facility in 07/11/2025 with diagnoses that included spastic quadriplegic cerebral palsy (a disorder that causes muscle stiffness in all four limbs), dysphagia (difficulty swallowing) and epilepsy (a disorder causing seizures).Record review of Resident #8's quarterly MDS assessment, dated 09/05/2025, revealed Resident #8 had a BIMS score of 00, indicating a severe cognitive impairment. Section GG - Functional Abilities revealed Resident #8 was dependent on staff for eating, transfers, and bed mobility. Section K Swallowing/Nutritional Status revealed Resident #8 had a feeding tube. Record review of Resident #8's undated comprehensive care plan revealed a care plan, dated 07/11/2025 and revised 07/30/2025, [Resident] is on enhanced barrier precautions in relation to the gastric tube placement and the intervention, posting at the residents room entrance indicating the resident is on enhanced barrier precautions.During an observation, 10/01/2025 at 1:52 p.m., Resident #8's room had PPE supplies outside of the room door and no EBP sign posted to indicate that Resident #8 was on EBP.During an interview with LVN C, 10/01/2025 at 1:58 p.m., LVN C stated Resident #8 had a peg tube and stated Resident #8 had a PPE cart outside of his room because he had a peg tube. LVN C stated she was not sure if there was a EBP sign indicating Resident #8 was on EBP. LVN C stated she had training on EBP precautions not too long ago but it was not recent and stated she did not know who was responsible for posting the EBP signs. LVN C stated it was important to post the signs, I guess so we know what to put on.During an interview with the Administrator, 10/03/2025 at 1:36 p.m., the Administrator stated EBP was to be used for a list of reasons and for anything that can be contagious when contacting the patient. The Administrator stated residents on EBP would have a PPE container outside of the resident room and would have a sign on the resident door indicating they were on EBP. The Administrator stated staff had received training on EBP and it was important for residents on EBP to be identified with a sign because We have residents with suppressed immune systems and if they were in contact with someone who has something that is contagious, they could get infected and put them at greater risk. The Administrator stated catheter tubing should not touch the floor Because there is debris on the floor and particles can get in the peri area and it is an infection control concern. Floors are unsanitary and stated staff had received training on keeping foley tubing off of the floor. Record review of a facility policy titled, Enhanced Barrier Precautions revealed, Enhanced Barrier Precautions (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employ targeted gown and glove use during high contact resident care activities. The policy revealed, Communication to Staff: The facility will utilize postings outside the room and [EMR] to communicate to staff is a resident requires EBP. Event ID: Facility ID: 455390 If continuation sheet Page 29 of 29