Health inspection·May 9, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed establish and 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 diseases and infections for 1 of 2 (3rd floor)community shower rooms in that: The 3rd floor shower room had 2 shower stalls that had drains with gobs of hair. There was brown substance under 1 shower chair, and floors were dirty with darkened areas and brown substance droppings on 1 of the shower stalls. 30 possible residents could use the 3rd floor shower room. This could affect all resident that shower in the 3rd floor shared shower and could result in infections. The Findings were: Observation on 5/6/2025 at 4:21 PM The 3rd floor shower room had 2 shower stalls that had drains with gobs of hair. There was brown substance under 1 shower chair, and floors were dirty with darkened areas and brown substance droppings on 1 of the shower stalls. Interview on 5/6/2025 at 4:22 PM with CNA A stated he provided a resident a shower earlier today, he cleaned the shower chair with shampoo and had not disinfectant the shower chair, because the facility did not have anymore products to disinfect the shower chair. CNA A stated the night shifts were to stock the shower rooms. CNA A stated after each resident use, the shower chairs were cleaned between residents. CNA A stated the hsk staff clean the shower stalls and the CNAs clean any feces and shower chairs. Interview on 5/6/2025 at 4:31 PM with RN B observed the 3rd floor shower room, floors were dirty, shower grates had lots of hair, and feces on the shower room floor. RN B notified maintenance the shower room on 3rd floor needed a deep cleaning. Interview on 5/6/2025 at 4:36 PM, the ADON stated CNAs were supposed wipe the resident shower chairs after each use with disinfectant wipes. The Hsk clean the shower stalls, floors, and drainage. The ADON stated the Hsk staff leaves at 4:00 PM. The ADON stated the DON was in charge of the nursing task and the Maintenance/Hsk supervisor was in charge of the hsk task in the shower rooms. Interview on 5/6/2025 at 4:42 PM, the Maintenance Assistant C stated staff were supposed to use disinfected wipes to disinfect the resident shower chairs, between use. Hsk did not clean up feces, the Page 1 of 2 455689 455689 05/09/2025 San Pedro Manor 515 W Ashby Pl San Antonio, TX 78212

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some CNAs do. Maintenance Assistant C stated the Hsk staff cleaned the shower rooms and mop the floor. He stated the hsk staff had left for the day. Interview on 5/6/2025 at 5:00 PM with the ADM and DON, the ADM and DON stated they would make sure the Maintenance/Hsk supervisor was aware and to educate the staff on cleaning/disinfecting resident shower rooms. Interview on 5/8/25 at 12:59 PM a with Maintenance/Hsk Supervisor stated the resident Showers floors had buildup. He cleaned the floors before lunch, and the floor tech does the floors before he leaves between 4:00-5:00 PM. The Hsk sanitizes everything in the shower room, take-out trash, touch up shower chairs, sanitize using 9name of company) chemical. The floor tech checks the floors before-4pm, one last time before he leaves for the day. The Maintenance/Hsk Supervisor stated he was not sure about the buildup on the floors, he cleans the dirt build up and he used a cleaning product that was easy to clean up. The Maintenance/Hsk Supervisor stated the CNAs were responsible for cleaning up the resident feces and urine. The Maintenance/Hsk Supervisor stated the [NAME] staff disinfect and move the cover/grates/drains and clean out the hairs. The Maintenance/Hsk Supervisor stated the female residents had quite a bit of hair that was caked up hair/shampoo on shower drains. The Maintenance/Hsk Supervisor stated the CNAs clean the shower chairs between use with the disinfectant wipes at nurse's station. Policy for CNA responsibilities for cleaning/disinfecting the shower rooms between staff was not provided before exit by the ADM/DON. Record review of policy for Housekeeping Services (no date) was documented Policy: It is the policy of this facility to maintain a clean environment for the residents. 7. Floors, are cleaned according to an established schedule. 8. Cleaning agents approved by the Infections Control Committee are in areas known to be contaminated with pathogenic bacteria. Record review of policy Cleaning Checklist for Housekeeping, (no date) was documented floor care: sweep the floor, and mop the floor, Shower area task: remove hair form drains, and disinfect shower stalls. 455689 Page 2 of 2