Health inspection·January 17, 2025

F 0759 bitter taste in mouth, Dysphagia, substernal chest pain, increased gag response.; Level of Harm - Minimal harm or potential for actual harm and a goal to remain free from discomfort, complications or s/sx related to dx of GERD through review date. Target date of goal noted as 03/04/2025. Residents Affected - Few 2. a focus area of .history of constipation with an intervention to Monitor/document/report to my MD PRN s/sx of complications related to constipation: and a goal to have a normal bowel movement at least every 3 day through the review date. Target date of goal noted as 03/04/2025. Record review of Resident #1's Order Summary Report, dated as Active Orders As Of: 01/17/2025, reflected Resident #1 had the following active physician orders: - Carafate Tablet 1 GM (Sucralfate) Give 1 tablet by mouth two times a day for GERD BEFORE MEALS, noted as active order status, order date: 01/17/2025 and start date: 01/18/2025. No end date noted. - Carafate Tablet 1 GM (Sucralfate) Give 1 tablet by mouth two times a day for GERD BEFORE MEALS, noted as active order status, order date: 11/08/2024 and start date: 11/08/2024. No end date noted. - Enulose Solution 10 GM/15ML (Lactulose Encephalopathy) Give 30 ml by mouth three times a day for constipation, noted as active order status, order date: 11/08/2024 and start date: 11/08/2024. No end date noted. Record review of Resident #1's 1/1/2025 - 1/31/2025 Medication Administration Record, printed on 01/17/2024, reflected the schedule for Resident #1's carafate tablet 1 gm was scheduled for administration at 0700 (07:00 a.m.) and 1600 (04:00 p.m.) and her 30 milliliters of enulose solution 10 gm/15 mL was scheduled for 0800 (08:00 a.m.), 1200 (12:00 p.m.), and 1600 (04:00 p.m.). Resident #1's order for carafate tablet, started on 11/08/2024 was scheduled to be discontinued on 01/17/2025 at 05:51 p.m. and the order scheduled to start on 01/18/2024 was to start at 07:00 a.m. on 01/18/2025. During an observation on 01/17/2025 at 05:29 p.m., RN A was observed to administer the following medications to Resident #1: 1 tablet carafate tablet 1 gm and 30 milliliters of enulose solution 10 gm/15 mL. The carafate and enulose orders were observed to be highlighted in red on RN A's electronic medical record screen and noted to be scheduled for administration at 1600 (04:00 p.m.). The dinner meal tray was observed to be delivered to Resident #1 after the medication administration. During an interview on 01/17/2025 at 08:12 p.m., RN A confirmed the administration of the carafate tablet and enulose solution to Resident #1 at 05:29 p.m. were late. RN A stated the medication administration for Resident #1 was late due to this shift was his first time working on this side of the hall and he was not very familiar with the residents and their medications. RN A stated he was new to the facility and was still working on picking up his pace with the medication administration procedures. He stated he was trained during orientation on the facility procedures for medication administration and how to use and read the electronic medical record program. During an interview on 01/17/2025 at 08:15 p.m., the DON revealed she and the facility provide staff training on medication administration several times per year, often focusing on different topics that fall under the umbrella of medication administration. The DON confirmed RN A was a new staff member and his late medication administration was most likely due to his lack of familiarity with the residents and their medications he was administering. The DON stated she did not believe the carafate having been administered around an hour and 30 minutes late would have impacted Resident #1, if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455450 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meridian Care Monte Vista 616 W Russell Pl San Antonio, TX 78212 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #1 received it prior to her meal. The DON stated the late administration of the carafate may have only minimized its effectiveness in coating Resident #1's stomach prior to her meal. The DON stated the 30-minute late administration of the enulose would not have impacted Resident #1. Record review of facility policy, Administering Medications, date illegible, reflected under Policy Statement, Medications are administered in a safe and timely manner, and as prescribed., and under Policy Interpretation and Implementation, 5. Medication administration times are determined by resident need and benefit, not staff convenience. Factors that are considered include: a. enhancing optimal therapeutic effect of the medication; b. preventing potential medication or food interactions; and c. honoring resident choices and preferences, consistent with his or her care plan. and 7. Medications are administered within one (1) hour of their prescribed time, unless otherwise specified (for example, before and after meal orders). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455450 If continuation sheet Page 3 of 3