Inspection·February 13, 2026

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few a superficial scrape on her left wrist. The resident sent out for evaluation of suicidal thoughts. The resident was placed on one-to-one care until ambulance service arrived for transport. The MD and family were notified on 2/5/2026 at 10:45 and 11:00 AM; signed by LVN B on 2/5/2026. Record review of self-reported incident filed by the ADM of the facility dated 2/6/2026 at 10:28 AM revealed the Brief summary of the report: on 2/5/2026 at approximately 10:30 am the ADM learned of Resident #1's intent to self-harm, as reported to the DON. LVN B stated she received report from CNA C the resident had voiced wanting to kill herself while in the dining room and decided not to have dinner and went to her room. LVN B immediately initiated monitoring one to one by assigning CNA A in the resident's room. LVN B, the AM-Charge Nurse, reported the incident to the NP and DON. The NP ordered the residents to be sent out to hospital for treatment and evaluation. The police/behavioral team came in to assess the incident and determined that residents did not meet criteria due to her denial of self-harm. LVN B reported to have secured a razor blade from the resident's room, as she had voiced wanting to shave her legs. LVN E, PM-Charge Nurse, reported Resident #1 informing the police that she was upset because she thought they were in a relationship, when she saw a male resident talking to other women. Resident #1 was seen ambulating and communicating with the male resident that may have caused her emotional imbalance. LVN E administered her night medications, routinely monitoring, and the resident slept well overnight. On 2/6/2026, LVN B and the ADON learned of the resident having a self-inflicting superficial abrasion to her left wrist while sitting in the dining room with other staff members and residents. Resident #1 was tearful because she did not want to get anyone in trouble, claiming the injury was only a scratch. When asked about the razor, she reported having hidden a razor in a drawer in her room and then moved it to the bag on her walker. LVN B notified the MD, and orders to discharge resident to hospital were received. Resident #1 was discharged to hospital for evaluation and treatment where she was admitted . Observation on 2/8/2026 at 8:30 AM with Resident #1, at the hospital behavioral unit, she revealed her left wrist, underside, had a superficial 1 inch scratch. Resident #1 stated she did scrap herself due to a broken heart and she knew that was wrong. Resident #1 stated she did not blame the facility. During an interview on 2/8/2026 at 8:30 AM Resident #1 stated she asked CNA A for a razor to shave her legs and received 2 shavers with no supervision. Resident #1 stated she was upset because a male resident had broken her heart. Resident #1 stated she did scrap herself due to a broken heart and she knew that was wrong. Resident #1 stated she did not blame the facility. During an interview on 2/8/2026 at 10:15 am LVN B started on 2/4/2026 at 5:30 PM, during dinner, CNA C reported to LVN B that Resident #1 did not want to be here (kill herself) anymore. LVN B had CNA A follow Resident #1 to her room and picked up a razor and brought it to LVN B. LVN B stated she called the DON, NP and ordered Resident #1 to the hospital due to suicidal ideation, then called 911. CNA A was with Resident #1 until the police came. LVN B stated the police had talked to Resident #1, and the police stated she did not meet qualifications to be sent out to emergency room-hospital. LVN B stated Resident #1 had told police she was upset because a male resident broke up with her and did not want to hurt herself. LVN B stated she had texted the DON about the police response and Resident #1 did not meet requirements. LVN B stated that when the ambulance was called the police arrived. This was protocol the police/behavior response team stated for SI. LVN B stated the next day, 2/5/2026 at 10 AM, Resident #1 was downstairs, with the ADON staying Resident #1 until the ambulance arrived at the facility. Resident #1 had a razor in her hand, and had a superficial scratch on her left wrist. LVN B stated she Buspirone HCI oral tablet 10 mg give 1 tablet by mouth three times a day for anxiety and Sertraline HCI oral tablet 50 mg give 1 tablet by mouth one time a day for depression took the razor form Resident #1, notified the NP, ordered Resident #1 to go (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455390 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few to hospital for evaluation of suicidal ideation. LVN B stated she started the SBAR on 2/4/2026, then the police/behavioral team arrived and stated Resident #1 did not [NAME] the requirements. Then when Resident #1 cut herself on 2/5/2026, she completed the SBAR. During interview on 2/8/2026 at 3:50 PM with CNA C stated she wrote a statement for ADM. CNA C stated she was stayed with Resident #1 on 2/4/2026, when she had stated she did not want to kill herself, CNA C stated she went reported this to LVN B that was in the dining room. CNA C stated CNA A was stayed with Resident #1 while she reported this incident to LVN B. During an interview on 2/8/2026 at 3:55 PM CNA A stated she gave Resident #1 two shavers on 2/4/2026. Resident #1 stated she wanted the shavers to shave her legs and did not supervise her with the razors. CNA A stated on Wednesday (2/4/2026), around dinner, Resident #1 stated she wanted to kill herself and the aide reported that to LVN B. CNA A stated while in Resident #1's room she removed a razor from her room and was with her until the police arrived. CNA A stated she had forgotten that she gave Resident #1 two shavers. During interview on 2/9/2026 at 1:40 PM with CNA E stated the police were at the facility when she arrived for her shift at 6:00 PM. CNA E stated the police had stated Resident #1 was not a risk for SI. CNA E stated she monitored Resident #1 and she had slept and rested all night. Resident #1 was back to normal. CNA E stated the staff were supposed to stay with residents if they ask for a shaver, and staff dispose of it in sharps container, after use. CNA E stated residents are not supposed to have sharp objects. During interview on 2/9/2026 at 2:03 PM the ADON stated on 2/5/2026 soon after the morning meeting, at 10:35 AM, CNA D had brought him a razor from Resident #1 and stated she was going to kill herself. The ADON stated he stayed with Resident #1, until the ambulance came to transport her to hospital for suicidal ideation. The ADON stated the ADM and DON were also waiting and talking with Resident #1. ADON stated the staff were supposed to stay with residents if they ask for a shaver, and staff dispose of it in sharps container, after use. ADON stated residents are not supposed to have sharp objects. ADON stated no resident had attempted SI before at facility. ADON stated he was not aware of Resident #1's SI before 2/5/2026. Record review of policy revealed resident suicide threats must be taken seriously and immediately reported to the nurse supervisor/charge nurse. Immediately notify the physician, staff member must remain at 1:1 with the resident until the threat of immediate danger has changed. Record reviews of policy for razors revealed no razors to be given to residents, residents that can and choose to shave independently must be monitored, and staff will properly dispose of used razors. PNC IJ verification: During an interview on 2/9/2026 at 3:28 PM with the ADM stated she was with Resident #1 on 2/5/2026 in morning and talked with Resident #1. The ADM stated Resident #1 had 2 razor blades she was provided by CNA A. The ADM stated CNA A was suspended on 2/5/2026 pending an investigation. The ADM stated staff were in-serviced on abuse/neglect, razors, and suicidal ideation, dated 2/5/2026 to 2/8/2026. The facility took the following actions to ensure residents are adequately supervised to prevent suicide attempts: This was all verified by surveyors by observations, interviews and record review. Record review of Resident #1's comprehensive care plan was revised on 2/6/2026 to address the resident's statements and actions that she wanted to end her life. Resident #1 was placed on 1:1 on 2/5/2026 until EMS arrived. The MD and Resident #1's RP/family were notified. The SW met with Resident #1, she was referred to psychological services, a urine test was ordered, and she was sent to the emergency room for evaluation and treatment. The 1:1, psychological referral and urine test was verified for Resident #1's orders. The urine test was negative. The facility suspended CNA A on 2/5/2026 pending an investigation and submitted a self-report for the incident to HHSC. Record review was verified of CNA A suspension on time records and was disciplined. Record review the facility assessed the other residents in the facility for suicidal ideations and ensured all sharp objects (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455390 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455390 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete were removed from resident rooms and bathrooms. Record review and interview with Interview with maintenance supervisor on 2/11/2026 at 12:48 PM the facility did conduct a sweep of the facility to ensure no razors or sharp objects to ensure resident safety. Interviews on 2/12/2026 between 11 AM and 6:00 PM with staff confirmed those who had not received the above education were not allowed to work until the in-services were provided. Record review of in-service for Abuse/Neglect and Exploitation was dated 2/5/2026 to 2/8/2026 revealed all staff were in-serviced. Record review of in-service for Razors was dated 2/5/2026 to 2/8/2026 revealed all direct care staff were in-serviced. Record review of in-service for Suicidal Ideation was dated 2/5/2026 to 2/8/2026 revealed all staff were in-serviced. Interviews with all staff on 2/12/2026 between 11 AM and 6:00 PM and 2/13/2026 at 8:00 AM to 4:00 PM revealed they had received training for Abuse/Neglect and Exploitation and Suicidal Ideation staff were able to state what they were trained on. Interviews with direct care staff on 2/12/2026 between 11:00 AM and 6:00 PM and 2/13/2026 at 8:00 AM to 4:00 PM revealed they had received training for razors, not to leave razors with the resident, supervise and throw away in sharps containers. Nursing staff were able to state what trained on. Record review the staff trained in-services on Abuse/Neglect and Exploitation to keep residents safe, notify ADM the ANE coordinator and monitor the residents. Suicidal Ideation to notify DON, ADM, MD, follow orders, keep resident safe, place on 1:1, make sure they don't hurt themselves. Razors were to be supervised by staff and dispose of them in the sharp's containers. During interviews on 2/8/2026 from 12:56 PM to 2/11/2026 at 3:38 PM with CNA G, CNA F, LVN H, CNA I, ADON, Wound nurse, LVN J, CNA D, LVN K, CNA C, Hsk L, CNA M, Hsk N, Activities O, MDS P, PT Q, SW U, ST R, OT S, Dietary T, Dietary Supervisor U, Laundry V, Hsk Supervisor W, Hsk X, CNA Y, Maintenance Supervisor CC, CNA Z, HR AA and OTA BB. During an interview on 2/12/2026 at 4:37 PM with the ADM and DON stated they had discussed incident with Resident #1 with QAPI and during Adhoc (staff meeting) meetings. Event ID: Facility ID: 455390 If continuation sheet Page 4 of 4