Inspection·December 23, 2025

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 1 of 3 residents (Resident #3) reviewed for infection control in that: LVN A did not wash his hands between removing soiled gloves and putting on clean gloves when providing direct care to Resident #3 who had a skin tear and was on enhanced barrier precautions (EBP). The DON did not wash her hands after touching a window blind, bed controls, and bed linens prior to providing direct care to Resident #3 who had a skin tear and was on EBP. This deficient practice could affect residents who are receiving wound care or were on enhanced barrier precautions placing them at risk for infection.The findings were: Record review of Resident #3's admission record printed on 12/23/2025 revealed she was a [AGE] year-old female who admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included Parkinsonism (slow movements, stiffness, tremor and problems with walking and balance) and a stage IV pressure ulcer (full-thickness skin and tissue loss exposing bone, tendon, or muscle) of the sacral region (triangular bone at the base of the spine). The admission record indicated that Resident #3 was seen by the MD Wound Care who provided orders for daily treatment. Record review of Resident #3's comprehensive care plan printed on 12/23/2025 revealed a care plan that revealed, Resident #3 had a skin tear on the right arm and left thigh requiring treatment for the injury, date initiated 12/4/2025 and required enhanced barrier precautions, date initiated 11/10/2025. Resident #3 had a stage IV pressure ulcer (PU) to her sacrum (present on admission) requiring treatment, date initiated 11/10/2025. Record review of Resident #3's orders printed on 12/23/2025 revealed that she was to receive wound care treatment once a day for non-pressure wounds of the right arm, left thigh, and a stage IV PU, sacrum. During a wound care treatment observation on 12/23/2025 at 2:25 PM, Resident # 3 was observed lying in bed with her eyes closed. She did not give a response when LVN A or the DON communicated with her prior to or during the procedure. She had received morphine sulfate prior to the treatment for pain as ordered. LVN A and the DON prepared to perform wound care on Resident #3's right arm skin tear. Resident #3 had a sign on her door that reflected Enhanced Barrier Precautions. Prior to starting the procedure, LVN A and the DON washed their hands and donned (put on) gowns and gloves.In preparation for the procedure, the DON lowered and closed the blinds, adjusted the bed using the attached remote, and moved the sheets exposing Resident #3's right arm. She then held Resident #3's arm up for treatment, touching both sides of the arm an inch from the wound cover without washing her hands or changing gloves.LVN A was observed cleaning the wound with wound cleanser. He needed more gloves, so he removed his soiled gloves, walked to the treatment cart, obtained more gloves, and donned a clean set of gloves without washing his hands. He completed dressing the wound. During an interview with LVN A on 12/23/2025 at 4:15 PM, he stated that the Wound Care MD saw the resident weekly and LVN A made rounds with the MD. He agreed Residents Affected - Few (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 455444 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 455444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesa Vista Inn Health Center 5756 N Knoll Dr San Antonio, TX 78240 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)