Inspection·April 21, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to come to rooms #243, #237, #246, she stated the shower chair had black a substance on the shower chair. The housekeeper H revealed she cleaned resident rooms daily, including showers. The housekeeper H stated the CNA's clean the resident shower chairs. Interview on 4/18/2023 at 1:17 PM, CNA I, she was in the hallway and asked by surveyor to come to room [ROOM NUMBER], #237, #246, she stated the shower chair had black substance on the back side of the nylon mesh and the bottom of the shower chair. The CNA I revealed she cleaned the resident shower chairs after each resident use but did not clean the back side or bottom of the shower chair. CNA I stated she cleaned on top of shower chair where the resident sits for showers. CNA I stated the housekeeper cleans the resident shower chairs and curtains. CNA I stated she would report to housekeeping about shower rooms. Observations on 4/20/2023 at 4:33 PM RN J stated resident room [ROOM NUMBER] shower chair had black substance, room [ROOM NUMBER] shower curtain had mildew and room [ROOM NUMBER] shower curtain had mildew. Interview on 4/20/23 at 4:33 PM with RNJ stated the resident shower chair and curtains for rooms #243, #237 and #246 had mildew and black substance on them. RN J stated the shower rooms were not reported to the nurse but will let housekeeping supervisor and maintenance supervisor aware. Observation and interview on at 4/20/23 at 4:44 PM the housekeeping supervisor and maintenance supervisor observed rooms #243, #237 and #246. The housekeeping supervisor stated the CNAs clean after and in between residents, this should be reported into maintenance software, we can pressure wash the shower chairs, staff could also call the front desk, she does work order, or they tell maintenance. The maintenance supervisor stated the shower chair was not safe, so it will be removed from room. Interview on 4/21/2023 at 3:58 PM with the Administrator discussed concerns with resident room shower chair and shower curtains. The Administrator did not say anything and wrote down the surveyor concerns with resident shower rooms. Surveyor asked for policy, no policy provided before exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455523 If continuation sheet Page 2 of 10 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 455523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morningside Manor 602 Babcock Rd San Antonio, TX 78201 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a Minimum Data Set (MDS) was electronically completed and transmitted to the CMS System within 14 days after completion for 1 of 70 (Resident #53) residents reviewed for MDS transmittal in that: Residents Affected - Few Resident #53's 5-day MDS assessment dated [DATE] and discharge MDS assessment dated [DATE] was not submitted as of 4/21/2023. This deficient practice could place residents at risk of not having their assessments transmitted timely. Findings included: Record review Resident #53's admission record dated 4/20/2023 revealed he was admitted on [DATE] and readmitted on [DATE] with a discharge date d 1/8/2023. Resident #53's diagnoses included shortness of breath, fluid overload, acute respiratory failure, acute pulmonary edema, pleural effusion, dysphasia, cognitive communication deficit, chronic kidney disease, altered mental status, diabetes II, dependence of renal dialysis, anemia, major depressive disorder, end stage renal disease, and anemia. Record review of Resident #53's EMR (electronic medical record) indicated the 5- day MDS dated [DATE] and discharge MDS dated [DATE] was documented as completed under the MDS tab. Further review revealed both the MDS assessment were not submitted on the electronic transmittal log signed by MDS nurse. Interview on 4/21/2023 at 3:34 PM the MDS nurse, revealed Resident #53 was discharged to hospital dated 1/8/2023 at 6 PM. The MDS nurse stated Resident #53's MDS's were not submitted. The MDS nurse stated they forgot to push button to submit the MDS to CMS. The MDS nurse stated he had 14 days to submit a discharge MDS. The MDS nurse stated he was responsible for resident MDS's and the stated they follow the CMS RAI MDS [NAME]. The 5-day MDS assessments should have been submitted on 12/28/2023 and the discharge MDS should have been submitted on 1/22/2023. Interview on 4/21/2023 at 3:58 PM the Administrator stated she was not aware that an MDS was not submitted to CMS. The Administrator stated she was not here at the time. The Administrator did not say anything else and just wrote the concerns down on a piece of paper. Record review of the facility's policy Resident Assessment Instrument dated November 2010 revealed A Comprehensive assessment of a resident's needs shall be made within fourteen (14) days of the resident's admission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455523 If continuation sheet Page 3 of 10 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 455523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morningside Manor 602 Babcock Rd San Antonio, TX 78201 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 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure a medication error rate below 5% for 2 of 8 Residents (Residents #25 and #36) reviewed for medication administration errors, in that: Residents Affected - Some The Facility staff administered 28 medications of which 7 were administered to Residents #25 and # 36, 1 to 1.5 hours after they were scheduled, which resulted in a 27% medication error rate. This failure could place residents at risk for not receiving therapeutic effects of their medications and possible adverse reactions. The findings included: Resident #25 A record review of Resident #25's face sheet, dated 04/20/2023, revealed an admission date of 11/20/2020, with diagnoses which included acute kidney failure, major depressive disorder, type II diabetes [a disease which the body cannot use sugar due to poor insulin levels result in too much damaging sugar in the blood], glaucoma [a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve], and hypertension [high blood pressure]. A record review of Resident #25's quarterly MDS, dated [DATE], revealed Resident #25 was a [AGE] year-old-female who had impaired sight, used glasses, could usually make herself understood, and utilized a hearing aide. Record review of Resident #25's BIMS score revealed a 15 out of 15, which indicated no mental cognitive impairment. A record review of Resident #25's care plan, dated 04/20/2023, revealed, Resident #25 requires and antidepressant medication duloxetine, related to depression . give antidepressant medications ordered by physician. monitor document side effects and effectiveness . resident #25 has impaired visual function related to glaucoma . monitor document report to doctor the following signs and symptoms of acute eye problems: change inability to perform activities of daily life, declines in mobility, sudden visual loss . I have diabetes mellitus . diabetes medication as ordered by doctor, monitor document for side effects and effectiveness . A record review of Resident #25's physician's orders revealed Resident #25 was to receive the following medications twice a day at 08:00 AM and again at 08:00 PM: allopurinol 1 tablet 100 MG [works by reducing the production of uric acid in the body. High levels of uric acid may cause gout attacks or kidney stones]; duloxetine 30mg 1 tablet [used to manage major depressive disorder]; glipizide 2.5mg 1 tablet [lowers blood sugar by causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the body) and helping the body use insulin efficiently]; hydralazine 25mg 1 tablet [a medication used to treat high blood pressure and heart failure]; metoprolol 50mg 1 tablet [used alone or in combination with other medications to treat high blood pressure]; dorzolamide-timolol 2-0.5% 2 drops in each eye [the combination of dorzolamide and timolol is used to treat eye conditions, including glaucoma and eye high pressure]. During an observation, interview, and record review, on 04/20/2023 at 09:19 AM revealed LVN D was the charge nurse for unit 3. A record review of the unit-3 medication administration records revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455523 If continuation sheet Page 4 of 10 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 455523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morningside Manor 602 Babcock Rd San Antonio, TX 78201 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 - Some 8 residents were highlighted in red. LVN D stated the residents highlighted in red were indicated to receive late medication administration. LVN D stated the professional standard for medication administration was for the medications to be administered within 1 hour prior and up to 1 hour past the prescribed medication administration time. LVN D stated residents who would be receiving late medications were, Residents #5, #7, #24, #25, #32, #36, #54, and #61. LVN D stated he had not given any supervisor a report of the upcoming late administration of medications. LVN D stated he had not given any physician a report of the up coming late medication administrations. LVN D stated he intended to continue with the medication administration for the residents on unit-3 and began to prepare medications for Resident #25 which were scheduled for administration at 08:00 AM. LVN D prepared allopurinol 1 tablet 100 MG; duloxetine 30mg 1; glipizide 2.5mg 1 tablet; hydralazine 25mg 1 tablet; metoprolol 50mg 1 tablet; dorzolamide-timolol 2-0.5% 2 drops in each eye. Observation revealed LVN D administered the medications to Resident #25 at 09:23 AM. Resident #36 A record review of Resident #36's admission record, dated 04/20/2023, revealed an admission date of 11/17/2022, with diagnoses which included, hypertension [high blood pressure] and constipation. A record review of Resident #36's quarterly MDS, dated [DATE], revealed Resident #36 was an [AGE] year-old-female who had adequate hearing and vision, and could usually make herself understood. Resident #36 had a BIMS score of 5 out of 15 indicated severe mental cognitive impairment. A record review of Resident #36's care plan, dated 04/20/2023, revealed, [resident number 36] has a potential for dehydration or fluid deficit related to diuretic use . administer medications as ordered. monitor document for side effects and effectiveness . monitor document report as needed any signs and symptoms of dehydration . notify physician if persistent symptoms of diarrhea, nausea vomiting unresolved past 48 hours. A record review of Resident #36's physician's orders revealed Resident #36 was to receive the following medications twice a day at 08:00 AM and again at 08:00 PM: docusate, 1 capsule, 100mg [used for relief of constipation] and losartan, 1 tablet, 50mg [used to control high blood pressure]. During an observation and interview, on 04/20/2023 at 09:50 AM revealed Medication Aide E assisted LVN D administer medications to residents who resided on unit 3. MA E stated he was originally assigned to administer medications on unit-4 and was reassigned to assist MA F and LVN D on unit-3 to help resolve the late medication administration. Observation revealed MA E prepare medications for Resident #36. MA E prepared docusate 1 capsule 100mg and losartan I tablet 50mg. MA E stated the medications were scheduled for 08:00 AM administration. Observation revealed MA E administered the medications at 10:01 AM. During an interview on 04/2023 at 09:30 AM the DON and the ADON stated they had not received any report from nursing staff to alert for the upcoming late medication for the residents residing on unit 3. The ADON stated the expectation was for any nurse or medication aide who had upcoming late medication administration should give leadership an alert as to allow interventions to help eliminate the late medication administration. The DON stated measures to mitigate the late medication administration were being implemented, MA E was assigned to assist with medication administration on unit-3 and the medical director was to receive a report of the late medication administrations. The DON and the ADON stated the expectation were for residents to receive medications at the prescribed time the medication was ordered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455523 If continuation sheet Page 5 of 10 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 455523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morningside Manor 602 Babcock Rd San Antonio, TX 78201 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete A record review of the facility's policy Administering Medications, dated April 2009, revealed, policy interpretation and implementation: the director of nursing services will supervise and direct all nursing personnel who administer medications and or have related functions. medications must be administered in accordance with the orders, including any required time frame . the individual administering the medication must check the label to verify the right medication, right dosage, right time and right method of administration before giving the medication . medications may not be prepared in advance and must be administered within one hour of their prescribed time . Event ID: Facility ID: 455523 If continuation sheet Page 6 of 10 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 455523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morningside Manor 602 Babcock Rd San Antonio, TX 78201 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interview and record review revealed the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for 1 of 1 kitchens in that: Residents Affected - Some 1. Ice machine had a pink film across the lip of the ice shoot. 2. Low temperature dishwasher temperature for wash cycle was 114 degrees Fahrenheit and 115 degrees Fahrenheit. should have been 120 degrees Fahrenheit. 3. The Dish machine log was not completed. 4. Dietary aid _G_ was at dish machine and had several jewelry on, such as rings and bracelets. This failure could place residents at risk of cross contamination Ns food borne illness. The Findings included were: 1. Observation on 4/18/23 at 9:45 AM to 10:00 AM during the initial tour of kitchen with the CDM and the FSM revealed the following: a. the ice machine had a pink film across the lip of the ice machine. b. The dishwasher was a low temperature machine running the wash cycle was at 114 degrees Fahrenheit. c. the dish machine log was missing temperatures from 4/15/2023-4/16/2023 for the dinner temperature check, and 4/17/2023 missing temperature for breakfast, lunch and dinner check. d. Dietary aide G was washing dishes while using the dish machine and had several rings, bracelets on both hands and had long fingernails. Dietary aide G was not wearing gloves. Interview on 4/18/23 at 9:46 AM during the initial tour of kitchen with the CDM stated cranberry juice must have spilled in the ice machine. The FSM stated the ice machine was completely cleaned inside once a month or as needed. The FSM stated the dish machine was a low temperature. The CDM and FSM had no comment at the time . about the ice machine. 2. Observation on 4/21/2023 at 1:04 PM dietary aide G was wearing several rings, bracelets and long (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455523 If continuation sheet Page 7 of 10 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 455523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morningside Manor 602 Babcock Rd San Antonio, TX 78201 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 0812 fingernails while washing dishes in the dish machine area. Dietary aide G was not wearing gloves. Level of Harm - Minimal harm or potential for actual harm Observation on 4/21/2023 at 1:04 PM the low temperature dish machine wash cycle was at 115 degrees Fahrenheit. Residents Affected - Some Observation on 4/21/2023 at 1:08 PM the plate guard on the dish machine revealed The equipment is intended for the washing and sanitizing of dishes and glassware as well as pots., pans and utensils. Hot Water sanitizing revealed wash temperature was 160-degree Fahrenheit minimum and Chemical sanitizing was documented Wash temperature at 130 degrees Fahrenheit minimum. Interview on 4/21/2023 at 1:05 PM dietary aide G had no comment. on her jewelry. Interview on 4/21/2023 at 1: 18 PM, the FSM stated the staff should not be wearing rings, bracelets and long fingernails in the kitchen. The FSM stated she talked to the dish machine vendor and stated they will be getting hot water booster for dish machine. Interview on 4/21/2023 at 1:37 PM, the CDM confirmed the dish machine log was not completely filled out and created a new log for staff to better read and record dish machine times. The CDM stated dietary staff should not be wearing jewelry or have long fingernails in the kitchen. The CDM stated the dish machine wash cycle needs to be hotter, so the vendor said they need a booster. Record review of the facility's policy Ware Washing dated 4/14/2003 revealed Primary Responsibility Director, Food Service Supervisor, Purpose: To reduce bacterial and the possibility of transmission of undesirable food borne organisms. Th e local, state, and federal regulations pertaining to public health safety. Policy: Dishes and other reusable components of meal service shall be washed using he proper temperature, correct chemicals and then air-dried. Procedure: 1. The #4 position is responsible for monitoring the dish machine for the proper temperature, wash and rinse 120-140 degrees. 3. The supervisor on duty will be responsible to see that he chlorine is tested and logged on the proper form daily. 4. The supervisor on duty is responsible to report any malfunctions of the machine, plumbing or chemicals to appropriate service associates. Fingernail Care: unless wearing intact gloves in good repair, no fingernail polish or artificial nails are allowed when working with exposed food. Clothing/jewelry: Avoid wearing jewelry such as dangling earrings and rings. Record review of the facility's policy Dishwasher dated 2/18/299 revealed 1. The dishwasher is responsible for maintaining the dish machine at the proper temperature, wash 120 degrees Fahrenheit. 3. The check (temperature form for dish washer) must be done and entered on the sheet three times a day, before breakfast, dinner and supper. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455523 If continuation sheet Page 8 of 10 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 455523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morningside Manor 602 Babcock Rd San Antonio, TX 78201 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on interviews and record reviews the facility failed to maintain medical records on each resident that are complete, accurately documented, readily accessible, and systematically organized, for 1 of 8 Residents (Resident #19) reviewed for complete and accurate medical records, in that: Resident #19 medical record was missing 7 of 16 weekly Skin Assessments since 1/01/2023. This deficient practice could affect residents whose records were maintained by the facility and place them at risk for errors or delays in care and treatment. The findings included: Record review of Resident #19's admission Record revealed she was an [AGE] year-old female and was admitted to the facility on [DATE]. Record review of Resident #19's quarterly MDS dated [DATE] revealed primary reason for admission was non traumatic brain dysfunction related to dementia. Cognitive Patterns section revealed Resident #19 was unable to complete BIMS assessment. Functional Status section for bathing revealed Resident #19 was at total dependence level and required one-person physical assistance. Skin Conditions section revealed Resident #19 had a formal, clinical assessment that indicated she was at risk of developing pressure injuries. Resident #19 required a pressure reducing device for chair and applications of ointments/medications (other than to feet). Record review of Resident #19's Care Plan revealed a focus area of potential for alteration in skin integrity with the following associated interventions: monitor and document skin condition weekly, notify physician and family if any abnormalities noted, initiated 7/25/2022. Record review of Resident #19's Order Summary revealed orders for Skin Assessment weekly, Tuesdays on the day shift initiated 7/13/2022. Record review of Resident #19's Assessments tab of the electronic health record revealed the Skin and Wound - Total Body Skin Assessments were missing on the following dates: *3/28/2023, *3/7/2023, *2/21/2023, *2/07/2023, *1/31/2023, *1/24/2023, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455523 If continuation sheet Page 9 of 10 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 455523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morningside Manor 602 Babcock Rd San Antonio, TX 78201 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 0842 *1/10/2023. Level of Harm - Minimal harm or potential for actual harm In an interview on 4/21/2023 at 8:00 PM, the DON reviewed the Assessments Tab of the electronic health record for Resident #19 stated there were multiple missing weekly Skin Assessments The DON stated there were intermittent skin assessments not documented on the same dates listed above. The DON stated this failure could negatively affect the residents by not having accurate medical records. The DON stated the direct care nurses on duty the day the assessments were due were expected to complete the assessment. Residents Affected - Few Record review of Skin and Wound Management Policy and Procedure, revised 9/06/2010, entitled II-15-021 Pressure Ulcers, revealed under step 4.) Weekly skin assessments will be performed routinely on all residents. Additional skin assessments will be performed if ordered or indicated. 5.) Assessment tools are utilized to create a plan of care .care plan modifications will be made as necessary. Physician orders will be followed. 6.) .weekly skin assessments .will be documented and maintained in the residents' clinical record. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455523 If continuation sheet Page 10 of 10