Health inspection·August 19, 2025

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some residents and staff. 2. Record review of Resident #3's undated face sheet revealed Resident #3 was a [AGE] year old female who admitted to the facility on [DATE] and had diagnoses that included acute respiratory failure (occurs when the lungs cannot adequately exchange oxygen and carbon dioxide leading to low levels of oxygen).Record review of Resident #3's quarterly MDS assessment, dated 07/23/2025, revealed Resident #3 was receiving tracheostomy care and had an invasive mechanical ventilator. Record review of Resident #3's August 2025 medication administration orders revealed Resident #3 had an order, TRACH Shiley 6CN75H every shift, start date 07/01/2025 and Maintain enhanced barrier precautions during high-contact resident care activities (i.e. dressing, bathing/showering, transferring, providing hygiene, linen changes, pericare/changing briefs/toileting, chronic wound care, an all indwelling device care: trachs, central lines, feeding tubes, urinary catheters) every shift for EBP. Start date 01/15/2025.Record review of Resident #3's undated care plan revealed, I require enhanced barrier precautions. The interventions listed in the care plan revealed, Maintain enhanced barrier precautions during high contact resident care activities (i.e. dressing, bathing/showering, transferring, providing hygiene, linen changes, pericare/changing briefs/toileting, chronic wound care, an all indwelling device care: trachs, central lines, feeding tubes, urinary catheters) and staff will doff/don PPE as needed per my EBP status.During an observation, 08/18/2025 at 10:45 a.m., Resident #3 had a sign posted outside of her room door that stated Resident #3 was on enhanced barrier precautions and stated staff must wear a gown and gloves for high contact care activities and listed device care or use of tracheostomies. RT D entered Resident #3 room wearing a face mask that was pulled down below her mouth and a pair of gloves. RT D performed a nebulizer treatment by attaching a nebulizer canula to Resident #3's tracheostomy tubing. During an interview with RT D, 08/18/2025 at 10:49 a.m., RT D stated she was not sure if Resident #3 was on enhanced barrier precautions and stated PPE required for EBP was gown, gloves, and a mask. RT D observed the EBP sign on the resident door and stated she had received training on EBP and should have worn a gown. RT D stated a face mask should be worn over the mouth and nose when in use. RT D stated it was important to use the appropriate PPE for a resident on EBP because the precautions were to protect residents and staff from infection. 3. During an observation of Resident #9, 08/18/2025 at 10:22 a.m. Resident #9 was observed with a tracheostomy and Resident #9 did not have an EBP sign on the outside of his room.During an observation of Resident #8, 08/18/2025 at 10:26 a.m., Resident #8 was observed with a tracheostomy and Resident #8 did not have an EBP sign on the outside of his room.During an observation of Resident #7, 08/18/2025 at 10:26 a.m., Resident #7 was observed with a tracheostomy and Resident #7 did not have an EBP sign on the outside of his room.During an observation of Resident #6, 08/18/2025 at 10:32 a.m., Resident #6 was observed with a tracheostomy and Resident #6 did not have an EBP sign on the outside of her room.During an observation of Resident # 5, 08/18/2025 at 10:32 a.m., Resident #5 was observed with a tracheostomy and Resident #5 did not have an EBP sign on the outside of her room.During an interview with RT A, 08/18/2025 at 10:23 a.m., RT A stated Resident #9 did not have an EBP sign outside of Resident #9's door. RT A stated residents on EBP were identified by the EBP sign on the outside of their room door and staff would not know to use enhanced barrier precautions when providing care to Resident #9. During an interview with LVN B, 08/18/2025 at 10:28 a.m., LVN B stated residents on EBP should have had a sign outside of their room door that stated the resident was on enhanced barrier precautions. LVN B stated Residents #7 and #8 should have had an EBP sign on the outside of their door because both residents were on EBP for tracheotomies. LVN B stated the nurses were responsible for ensuring the EBP signs were placed on the outside of resident doors and stated she had received training on EBP. LVN B stated EBP was important to prevent cross contamination and to protect (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 08/19/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete the residents. During an interview with CNA E, 08/18/2025 at 10:59 a.m., CNA E stated a resident on EBP had a sign outside of their door that reflected the resident was on EBP and which PPE supplies were required when providing care to the resident. Record review of a facility policy titled, Enhanced Barrier Precautions (copyright 2001 [company] August 2022), provided by the Administrator on 08/19/2025, revealed the policy statement, Enhanced barrier precautions (EBPs) are utilized to prevent the spread of multi-drug resistant organisms (MDROs) to residents. The Policy Interpretation and Implementation revealed, 2. EBP's employ targeted gown and glove use during high contact resident care activities when contact precautions do not otherwise apply. A. Gloves and gowns are applied prior to performing the high contact resident care activity (as opposed to before entering the room) C. Face protection may be used if there is also a risk of splash or spray. 3. Examples of high contact resident care activities requiring the use of gown and gloves for EBPs include: .g. device care or use (central line, urinary catheter, feeding tube, tracheostomy/ventilator, etc.). 10. Signs are posted in the door or wall outside the resident room indicating the type of precautions and PPE required. Event ID: Facility ID: 455450 If continuation sheet Page 3 of 3