Inspection·November 14, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident's bed and in the bathroom. Resident #2 stated he had informed the CNA staff about the broken tiles, the hole in the wall, and the missing/torn rubber baseboards about 3 weeks ago. Resident #2 stated he had seen the Maintenance Director, but not in his room. Resident #2 stated the condition of his bedroom made him feel bad because, I'm paying to live here, and they haven't done anything over here on this side of the unit. Resident #2 stated the entry door from the smoking area was dangerous and the door was heavy, and it did not stay open long enough to allow residents in wheelchairs to come inside and the ramp on the threshold was too high and there was a gap between the ramp and the threshold. 3. Record review of Resident #3's face sheet dated 11/14/25 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included abnormal posture, severe protein-calorie malnutrition, muscle weakness, and need for assistance with personal care.Record review of Resident #3's most recent comprehensive MDS assessment dated [DATE] revealed the resident was moderately cognitively impaired for daily-decision making skills, utilized a wheelchair, and required substantial/maximal assistance with mobility and transfers. During an observation on 11/12/25 at 2:15 p.m., Resident #3 was observed in her wheelchair attempting to enter the building from the door which led to the smoking area and unable to get inside. Resident #3 called for help and was assisted by an unidentified staff back into the building. Observation of the entry/exit door to the patio which led to the smoking area was observed closing rapidly and the mechanism for slowing the door that was supposed to be mounted at the top of the frame was missing. The entry/exit door threshold was observed with a ramp that had a metal plate over it and there was a one-inch crack/gap on the floor between the entrance and exit. During an interview on 11/12/25 at 2:15 p.m., Resident #3 stated she sometimes got stuck on the ledge (ramp) that was on the door. Resident #3 stated there used to be a rubber mat and it would help to slow down her wheelchair when she entered from the patio door. Resident #3 stated she had nearly fallen trying to get back into the building when she used the entryway door that led to the patio. Resident #3 stated the door to the patio entryway had been replaced and the door used to have a mechanism that would help to close the door slowly instead of shutting rapidly.During an observation on 11/14/25 at 8:40 a.m., Resident #3 was observed self-propelling in her wheelchair and attempting to get back into the building from the exit/entryway door that led to the patio. Resident #3 called for help and CNA A assisted the resident back into the building. During an observation and interview on 11/14/25 beginning at 8:42 a.m., CNA A stated Resident #3 could not push herself up and down the ramp. CNA A stated, the door to the exit entryway that led to the patio had been replaced about a month ago because the residents broke the door and the mechanism that helped to slow the door when it was opened or closed was broken and was not safe because for those residents who can't get in quickly can get hurt, especially those residents in wheelchairs. CNA A stated the ramp observed with the metal plate was slippery when there was rain which made it hard for residents in wheelchairs to roll up the ramp. CNA A observed the bathroom door in Resident #1's room and stated it had been that way, only opening 1/4 of the way since she had been employed by the facility 7 years ago. CNA A stated the former Maintenance Director had tried to repair it several times. CNA A stated, since both Resident #1 and his roommate were wheelchair bound, they did not use the bathroom in the room, and visitors weren't supposed to use a resident's bathroom. CNA A stated unless a mobile resident was transferred to Resident #1's room then it could be a problem. CNA A stated she would not like the bathroom door getting stuck because it would delay having to get to the bathroom when I needed to and I could have an accident. CNA A stated she had not made the recent Maintenance Director aware of the bathroom door not opening completely. CNA A observed Resident #2's room and stated the missing/torn rubber baseboards in the room had come off several times and they've tried to fix (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455597 If continuation sheet Page 2 of 9 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 11/14/2025 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some it. CNA A stated, the hole around the pipe above the resident's bed had always been like that. CNA A stated the broken tiles in Resident #2's shower was unacceptable. CNA A stated, if I lived in a room like that I would not want to because it's not safe, and it's not healthy.During an observation and interview on 11/14/25 at 9:19 a.m., the Maintenance Director stated he had worked at the facility for over a year. The Maintenance Director stated staff utilized a computer application to report anything that needed to be repaired, and he prioritized the repairs based on importance, such as overflowing toilets, broken light fixtures, broken beds, and broken call lights. The Maintenance Director stated he also made routine rounds and if he saw something that needed to be fixed, or a resident asked him to fix something he would try to do it at that time. The Maintenance Director observed the entryway/exit door to the patio and stated the mechanism used to keep the door from shutting rapidly was not needed and stated the door needed to be adjusted so it did not close rapidly. The Maintenance Director stated the door closing fast would not hurt a resident. The Maintenance Director stated the gap between the ramp and the threshold was a cosmetic thing. The Maintenance Director stated he had the part in his office to fix the door/entryway and got it on Monday; just haven't had time to fix it. During an observation and interview on 11/14/25 at 9:32 a.m., the Maintenance Director observed Resident #1's bedroom and stated the bathroom door only opening 1/4 of the way could hinder the resident from getting to the bathroom. The Maintenance Director stated the broken hinge on the resident's bedroom door prevented the door from being shut completely, which would not allow for privacy. The Maintenance Director stated he would not want to live in Resident #1's room because since the bedroom door didn't close completely, he would not have privacy.During an observation and interview on 11/14/25 at 9:40 a.m., the Maintenance Director observed the broken/torn rubber baseboards, holes in the wall, and broken/missing tiles in the shower in Resident #2's room and stated he knew about the missing shower tiles and had tried to repair them once. The Maintenance Director stated he had the replacement tiles and had known they needed to be replaced for about a week. The Maintenance Director stated he was not aware of Resident #2's broken/torn rubber baseboards because nobody told me. The Maintenance Director stated the hole above the resident's bed with the pipe should be covered for aesthetics and to prevent bugs from coming in. The Maintenance Director stated the items needing repair in Resident #2's room was unacceptable and cosmetically looked ugly. During an observation and interview on 11/14/25 beginning at 9:53 a.m., the Administrator observed Resident #2's room and stated she was not aware of the broken tiles in the shower, or the missing/torn rubber base boards. The Administrator stated the hole above the residents' bed was supposed to have a metal plate covering the hole to keep bugs from getting in. The Administrator stated the Residents in the room used the shower, including Resident #2 and the broken tiles would not injure the resident because staff used a shower chair. The Administrator stated she would not be happy living in this environment, because it had to be maintained and it was a dignity and rights issue. The Administrator observed the entry/exit door to the patio which led to the smoking area and stated she was aware the door had to be replaced approximately a month ago because residents damaged it from hitting the door with their wheelchairs. The Administrator pointed to a sign on the door which read, Caution Open Door Slowly which was placed there so the door did not slam on the residents. The Administrator stated she was not aware of any issues with the gap between the ramp and the threshold but stated it would be replaced with a rubber trim on the floor. The Administrator stated the purpose of the door was to prevent flies and insects from coming into the building. The Administrator observed Resident #1's room and stated, the bathroom door only opening 1/4 of the way and the bedroom door not closing completely because the hinge was not attached properly prevented the resident from having privacy. The Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455597 If continuation sheet Page 3 of 9 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 11/14/2025 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete stated, if I lived in a room like this it would bother me because it's not dignified. Record review of the facility document titled Resident Rights with revision date 6/15/2025 revealed in part, .The resident has the right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility.The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences.Safe environment.The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Event ID: Facility ID: 455597 If continuation sheet Page 4 of 9 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 11/14/2025 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access for 4 of 7 Residents (Resident #4, #6, #1 and #7) reviewed for labeling and medication storage:1. The facility failed to ensure Resident #4 did not have an ampule of Ipratropium-Albuterol Solution (prescribed for use with a nebulizer for breathing treatments for shortness of breath) at the bedside.2. The facility failed to ensure Resident #6 did not have a jar of medicated mentholated ointment (a combination product that is used to relieve itching, minor muscle, or joint pain. This product may also be used as a chest rub to soothe symptoms associated with the common cold), a bottle of eye drops, and a medication cup with antacids at the bedside. 3. The facility failed to ensure Resident #1 did not have a bottle of medication that contained magnesium hydroxide used to relieve constipation, heartburn, or indigestion, and a bottle of vitamins at the bedside. 4. The facility failed to ensure Resident #7 did not have a jar of medicated mentholated ointment and the same product in a roll-on stick (a combination product that is used to relieve itching, minor muscle, or joint pain. This product may also be used as a chest rub to soothe symptoms associated with the common cold) at the bedside.These deficient practices could affect residents who received medications in the facility and place them at risk for not receiving the correct medications, medication misuse or drug diversion.The findings included:1. Record review of Resident #4's face sheet dated 11/12/25 revealed a [AGE] year old female admitted to the facility on [DATE] with diagnoses that included sepsis (medical condition that happens when the body has an extreme, dysregulated response to an infection), hypertension (high blood pressure), and chronic obstructive pulmonary disease (a chronic progressive lung disease that makes it hard to breathe due to airflow obstruction that is not fully reversible).Record review of Resident #4's most recent comprehensive MDS assessment dated [DATE] revealed the resident was moderately cognitively impaired for daily decision-making skills.Record review of Resident #4's Order Summary Report dated 12/12/25 revealed the following:- Ipratropium-Albuterol Inhalation Solution 0.5-2.5 (3) MG/3ML, 3ml inhale orally three times a day for SOB with order date 10/19/25 and no end date.During an observation and interview on 11/12/25 at 10:01 a.m., Resident #4 was observed sitting up in bed and a nebulizer machine was on the resident's nightstand on the left of the bed. The nebulizer mask and tube were resting on the nightstand. Resident #4 stated she had received a breathing treatment earlier in the morning but needed another breathing treatment because she had a history of asthma and knew she needed another breathing treatment. Resident #4 took an ampule of Ipratropium-Albuterol Inhalation Solution that was on the nightstand and placed the nebulizer mask on her face to give herself the breathing treatment. Resident #4 stated RN B had given her the Ipratropium-Albuterol Inhalation Solution that same morning, a few hours ago, and stated she usually kept the ampule in her pocket. During an interview on 11/12/25 at 3:23 p.m., RN B stated Resident #4 received nebulizer breathing treatments and had given the resident the Ipratropium-Albuterol Inhalation Solution on 11/12/25 and should not have because the resident was not able to self-medicate. RN B stated she got busy with a request for narcotics and pain medication for another resident. RN B stated nursing administered breathing treatments, period and Resident #4 could not self-medicate because she would over-medicate herself, and because she would need to follow up with the resident to check for response to the treatment. RN B stated breathing treatments could also elevate the heart rate, which was also a reason for nursing intervention. RN B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455597 If continuation sheet Page 5 of 9 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 11/14/2025 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated, residents here are not allowed to self-medicate. 2. Record review of Resident 6's face sheet dated 11/14/25 revealed a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included Parkinson's disease (a progressive neurological disorder that affects movement), chronic obstructive pulmonary disease (a chronic progressive lung disease that makes it hard to breathe due to airflow obstruction that is not fully reversible), diabetes (a chronic medical condition where the body has trouble controlling the level of sugar in the blood), heart failure, dementia (a group of conditions that cause a decline in memory, thinking, and daily functioning), acute bronchitis (a short-term inflammation of the airways that carry air in and out of the lungs), acute respiratory failure with hypoxia (a medical condition in which the lungs cannot get enough oxygen into the blood to meet the body's needs), and Alzheimer's disease (a progressive brain disorder that leads to a continuous decline in memory, thinking, behavior, and the ability to carry out daily activities).Record review of Resident #6's most recent comprehensive MDS assessment dated [DATE] revealed the resident was moderately cognitively impaired for daily decision-making skills.Record review of Resident #6's comprehensive care plan with revision date 11/13/25 revealed the resident may safely self-administer medication upon request with interventions that included for the nurse to evaluate the resident was able to self-medicate, and to remind the resident's family member that over-the-counter medications would be kept locked in the medication cart. During an observation and interview on 11/12/25 at 11:54 a.m., Resident #6 was observed sitting up in bed and stated the jar of medicated mentholated ointment was used in her nostrils, the bottle of eye drops was used for her eyes, and the medication cup with antacids at the bedside were used to relieve indigestion. Resident #6 stated the medications observed on the bedside were her personal items. Resident #6 stated she last used the mentholated ointment, and the eye drops the night before and the antacid was last taken earlier that morning. 3. Record review of Resident #1's face sheet dated 11/14/25 revealed a [AGE] year-old male admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included chronic viral hepatitis C (long term infection of the liver caused by a virus leading to ongoing inflammation and damage to liver cells), dementia (a general term used for a chronic, progressive decline in cognitive function that is severe enough to interfere with a person's daily life and independence), anemia (a medical condition in which the body has too few healthy red blood cells or not enough protein in red blood cells that carries oxygen), chronic pain syndrome, need for assistance with personal care, and anxiety disorder (a mental health condition characterized by persistent and excessive worry that interferes with daily life). Record review of Resident #1's most current quarterly MDS assessment dated [DATE] revealed the resident was moderately cognitively impaired for daily decision-making skills.Record review of Resident #1's comprehensive care plan with revision date 10/28/24 revealed the resident had impaired cognitive function related to dementia with interventions which included monitor/document/report to the physician any changes in cognitive function, specifically changes in decision making ability, memory, recall and general awareness.During an observation and interview on 11/12/25 at 12:14 p.m. Resident #1 was observed sitting up in his wheelchair and was noted with a bottle of magnesium hydroxide and a bottle of vitamins at the bedside. Resident #1 stated the medications observed were provided to him by his family and had used magnesium hydroxide a month ago and the vitamins the night before. 4. Record review of Resident #7's face sheet dated 11/14/25 revealed a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included cellulitis (swelling) of right lower limb, muscle weakness, need for assistance with personal care, heart failure, and mild cognitive impairment. Record review of Resident #7's most recent quarterly MDS assessment dated [DATE] revealed the resident was cognitively intact (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455597 If continuation sheet Page 6 of 9 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 11/14/2025 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete for daily decision-making skills.Record review of Resident #7's comprehensive care plan with revision date 12/3/24 revealed the resident had heart failure and required respiratory therapy with interventions including oxygen as ordered and respiratory therapy as ordered.During an interview on 11/13/25 at 7:46 a.m. the Administrator stated the residents in the facility had been assessed to determine if they could self-medicate and stated there were no residents in the facility who could self-medicate. The Administrator stated, in reference to Resident #4 having self-administered the breathing treatment with the Ipratropium-Albuterol Inhalation Solution, it was her expectation for nursing to assess the resident before and after the treatment to check for effectiveness. The Administrator stated treatments with Ipratropium-Albuterol Inhalation Solution could increase heart rate and can cause an abnormality which would need to be reported to the physician.During an observation and interview on 11/13/25 at 8:09 a.m. with the Administrator, Resident #7 was observed sitting up in bed and a small jar of medicated mentholated ointment and the same product in a roll-on stick was seen at the bedside. Resident #7 stated she used the ointment in the jar to rub on her feet and the roll-on stick for when she experienced cold symptoms. Resident #7 stated she had not used the roll-on stick in a while because she was not experiencing any cold symptoms. The Administrator instructed an unidentified staff to remove the bedside medications.Record review of the facility document titled Storage of Medications dated 2018 revealed in part, .The facility shall store all drugs and biologicals in a safe, secure, and orderly manner.2. The nursing staff shall be responsible for maintaining medication storage.8. Drugs shall be stored in an orderly manner in cabinets, drawers, carts, or automatic dispensing systems.10. Only persons authorized to prepare and administer medications shall have access to the medication room, including any keys. Event ID: Facility ID: 455597 If continuation sheet Page 7 of 9 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 11/14/2025 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)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 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 interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that were complete and accurately documented for 1 of 5 residents (Resident #5) reviewed for accuracy of records:The facility failed to ensure nursing staff documented Resident #5's admission nursing assessment.This failure could affect residents whose records were maintained by the facility and could place the residents at risk for errors in care and treatment.The findings included:Record review of Resident #5's face sheet dated 11/13/25 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included cerebral infarction (type of stroke that occurs when blood flow to a part of the brain is blocked), acute respiratory failure with hypoxia (medical condition in which the lungs suddenly cannot provide enough oxygen to the blood), diabetes (chronic medical condition in which the body has trouble regulating blood sugar), hematemesis (vomiting blood), lack of coordination, need for assistance with personal care, abnormalities of gait and mobility, hyperlipidemia (high cholesterol), epilepsy (chronic neurological disorder in which a person has recurrent, unprovoked seizures), and chronic obstructive pulmonary disease (long term lung disease in which the airways and air sacs become damaged, inflamed, and narrowed, making it difficult to breath).Record review of Resident #5's most recent comprehensive MDS assessment dated [DATE] revealed the resident was moderately cognitively impaired for daily decision-making skills.Record review of Resident #5's History and Physical document revealed an admission physical assessment was completed by the physician on 10/29/25.During an interview on 11/12/25 at 2:41 p.m., Resident #5 stated she could not recall having seen or checked by a doctor since she was admitted on [DATE]. The resident stated she believed she did not receive her diabetes pills, insulin, or seizure medications the first couple of days after being admitted . During an interview on 11/14/25 at 10:56 a.m., the Administrator, who is also an RN, stated it was best practice for Resident #5's nursing admission assessment to be completed at the time of admission and no later than 72 hours. The Administrator stated at the time of Resident #5's admission on [DATE], the admitting nurse had to leave the floor due to a family emergency and the Administrator and the ADON took over. The Administrator stated she verified the physician orders and input the resident's medications into the electronic record. The Administrator stated the nursing admission assessment for Resident #5 was not in the electronic record and could not be found. The Administrator stated there was a problem with not having a complete nursing assessment because the assessment was used to develop the resident's care plan. Event ID: Facility ID: 455597 If continuation sheet Page 8 of 9 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 11/14/2025 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)

F 0880 Provide and implement an infection prevention and control program. 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 maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 1 of 5 residents (Resident #4) reviewed for infection control:The facility failed to ensure Resident #4's oxygen mask and tubing were stored properly when not in use.This deficient practice could place residents at-risk for infection due to improper care practices.The findings included:Record review of Resident #4's face sheet dated 11/12/25 revealed a [AGE] year old female admitted to the facility on [DATE] with diagnoses that included sepsis (medical condition that happens when the body has an extreme, dysregulated response to an infection), hypertension (high blood pressure), and chronic obstructive pulmonary disease (a chronic progressive lung disease that makes it hard to breathe due to airflow obstruction that is not fully reversible).Record review of Resident #4's most recent comprehensive MDS assessment dated [DATE] revealed the resident was moderately cognitively impaired for daily decision-making skills.Record review of Resident #4's Order Summary Report dated 12/12/25 revealed the following:- Ipratropium-Albuterol Inhalation Solution 0.5-2.5 (3) MG/3ML, 3ml inhale orally three times a day for SOB with order date 10/19/25 and no end date.On 11/12/25 at 10:01 a.m., Resident #4 was observed sitting up in bed and a nebulizer machine was on the resident's nightstand on the left of the bed. The nebulizer mask and tube were resting on the nightstand, not properly stored in a bag. Resident #4 stated she had a breathing treatment earlier in the morning but needed another breathing treatment because she had a history of asthma and knew she needed another breathing treatment. Resident #4 took an ampule of Ipratropium-Albuterol Inhalation Solution that was on the nightstand and placed the nebulizer mask on her face to give herself a breathing treatment. During an interview on 11/12/25 at 3:23 p.m., RN B stated Resident #4 received nebulizer breathing treatments and had given the resident the Ipratropium-Albuterol Inhalation Solution and should not have because the resident was not to self-medicate but got busy with a request for narcotics and pain medication for another resident. RN B stated, when the nebulizer mask and tubing were not in use they were supposed to be stored in a bag because spores were everywhere, and it was a break in infection control which could result in the resident getting sick. RN B stated, the nebulizer mask and tubing were changed out every Sunday or as needed.During an observation and interview with the Administrator on 11/13/25 at 8:19 a.m. revealed Resident #4's nebulizer machine on the nightstand to the left of the bed had the nebulizer mask and tubing on the counter and not stored in a bag. The Administrator stated it was her expectation for the nebulizer mask and tubing, when not in use, should be stored in a plastic bag to prevent cross contamination which could result in the resident developing an infection. The Administrator stated, since the nebulizer mask and the tubing were not stored properly, they would have to be discarded. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455597 If continuation sheet Page 9 of 9