Health inspection·August 9, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to store, prepare, distribute, and serve food under sanitary conditions in accordance with professional standards for food safety in the facility kitchen. 1) CNA A failed to put on a hair net before entering the facility kitchen. This failure could place residents receiving food from the facility kitchen at risk for cross contamination. The findings included: During an observation on 08/08/2024 at 9:45 a.m., no hair nets were observed in the wall mounted container labeled hair nets on the outside of the facility kitchen entrance. During an observation during kitchen rounds on, 08/08/2024 at 9:50 a.m., CNA A was observed entering the kitchen and walking approximately 4 feet to the ice machine without a hair net covering her hair. Dietary Aide A was observed approaching CNA A and asked her to leave the kitchen. During an interview with the Dietary Manager on, 08/08/2024 at 9:52 a.m., the Dietary Manager stated it was mandatory for all employees to wear a hair net in the kitchen. The Dietary Manager said the expectation was for non-dietary employees to ring the bell outside of the door and a dietary employee would answer the bell. The Dietary Manager stated staff had received training on wearing hair nets in the kitchen a few months ago. During an interview with Dietary Aide A on, 08/08/2024 at 9:56 a.m., Dietary Aide A stated she asked CNA A to step out of the kitchen when she noticed CNA A did not have on a hair net. Dietary Aide A said the staff had received training on wearing hair nets in the kitchen and said it was important to wear a hair net because hair can fall into the resident's food, drinks or appliances. During an interview with CNA A on, 08/08/2024 at 11:25 a.m., CNA A confirmed she entered the kitchen without a hair net covering her hair and stated she had received training prior to 08/08/2024 about the importance of wearing hair nets in the kitchen. CNA A stated hair nets should be worn in the kitchen for sanitary reasons and to keep hair out of patient's food. During an interview with the DON on, 08/09/2024 at 11:00 a.m., the DON said facility staff had (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: 455597 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 455597 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Memorial Medical Nursing Center 307 W Cypress St 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)