Health inspection·January 24, 2025

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure an adequate communication system to allow residents to call for staff assistance for 1 of 6 rooms (Room # 1's room) on the PCC hallway reviewed for an operating call light system. Residents Affected - Few The facility failed to ensure Resident #1's room had an operating call light system. This deficient practice could place residents at-risk of not being able to call for staff assistance to meet care needs. The findings include: Record review of (Resident #1's) face sheet, dated 1/22/25, revealed an admission date of 3/5/24 for the [AGE] year male with diagnoses which included: type 2 diabetes( a condition in which the body does not control blood sugar), essential hypertension( a condition in which high blood pressure develops), and unspecified gout (a painful form of arthritis). Record review of (Resident #1's) Quarterly MDS assessment, dated 11/29/24, revealed the resident had a BIMS score of 13, which indicated intact cognition. Resident #1 needed moderate assistance with ADL care. Record review of (Resident #1's) care plan, initiated on 2/1/24 revealed the resident was at risk for injury due to a history of falls and that call light accessibility was monitored. Observation on 1/21/25 at 2:40 p.m., revealed that the call light for Resident #1 was not working with a visible light above the resident room when the call light was engaged and an audible call signal was not heard at the nurses station During an interview on 1/21/25 at 2:45 p.m., Resident #1 stated that he does use his call light sometimes to request nursing assistance. Resident #1 stated he was not aware the call light was not working. During an interview on 1/21/25 at 3:10 p.m., with the Maintenance Director he stated that Resident #1's call light was not working with a visible light above the resident room or an audible call signal heard at the nurses station when the call light was engaged. He stated that he was not made aware of the call light malfunction and would repair it immediately. During an interview on 1/21/25 at 3:20pm with LVN-B she stated that she was not aware of the call (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 3 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 01/24/2025 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)