Health inspection·September 1, 2023

F 0926 Have policies on smoking. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to establish policies, in accordance with applicable Federal, State, and local laws and regulations, regarding smoking, smoking areas, and smoking safety that also take into account nonsmoking residents for 1 of 1 facility reviewed for smoking, in that: Residents Affected - Some The facility failed to ensure unknown staff or unknown residents were not smoking in a non-smoking designated area. This failure could place residents at risk for smoking-related injuries and fires in the facility. The findings were: During an observation, in a middle courtyard area located by B hall, on 09/01/2023 at 11:05 a.m., revealed several smoked and used cigarette butts on the ground. Further observation revealed some of the cigarette butts were just outside the right side and out front of the doorway. Many more cigarette butts were all around a sitting area in the grass and/or dirt areas. During an observation, in a middle courtyard area by B hall, and interview on 09/01/2023 at 12:57 p.m., the MA observed and confirmed the several smoked and used cigarette butts in all (mentioned) areas of this courtyard. The MA stated he had just cleaned this area several days prior of smoked and used cigarette butts. He stated was not able to state who were smoking in this area. The MA also observed and confirmed the two non-smoking signs posted; one on the doorway to walk out to this courtyard and another on the brick wall to walk back inside from this courtyard. During an interview on 09/01/2023 at 2:12 p.m., the MD stated he had, previously, seen used cigarette butts in that courtyard. He was unable to recall the last time he had walked over to that area to observe the courtyard himself. The MD stated there was not supposed to be any smoked and used cigarette butts in that courtyard. The MD stated the potential harm to residents was a fire hazard if one of those used cigarette butts were not fully extinguished. During an interview on 09/01/2023 at 8:40 p.m., the DON stated there were supposed to be no smoked and used cigarette butts on the ground in that courtyard. She further stated that location was not a smoking area and the facility was not a smoking facility. The DON believed there was not a potential harm to residents because residents with cognitive issues do not go out to that courtyard and would not pick up those smoked butts. During an interview on 09/01/2023 at 8:43 p.m., the ADMN stated there were supposed to be no used cigarette butts out in that courtyard, even on the ground. He stated that location was not a (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: 455467 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 455467 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Asbury Care Center of Alamo 8223 Broadway San Antonio, TX 78209 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)