Health inspection·August 14, 2025

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 interview and record review, the facility failed to maintain medical records that were complete and accurately documented in accordance with accepted professional standards and practices for 1 of 5 (Resident #1) residents reviewed for medical records. The facility failed to obtain Resident #1's hospital records and a hospital discharge summary on 7/5/2025 and when the resident returned to the facility and the computerized medical record on 8/13/2025 and 8/14/2025 revealed no evidence of a hospital record or hospital discharge summary from Resident #1's hospital discharge. This failure placed residents at risk for delayed or inaccurate information of hospital history which could result in lack of continuity of care and missed history of treatment. The findings included: Record review of Resident #1's face sheet dated 8/12/2025 revealed an [AGE] year-old female, admitted on [DATE] with diagnoses which included: Type 2 diabetes mellitus, dementia with agitation and chronic kidney disease. Record review of Resident #1's annual MDS assessment, dated 7/05/2025 revealed a BIMS of 6 which indicated a severe cognitive impairment. Record review of Resident #1's progress notes dated 7/05/2025 at 2:01 p.m. revealed: Resident #1 was transported via EMS to hospital. Resident alert .EMS given report on resident fall and status. Documented by LVN A. Record review of Resident #1's progress notes dated 7/05/2025 at 7:05 p.m. revealed: Resident #1 returned to facility. No new orders from hospital. Documented by LVN A. Record review of Resident #1's computerized medical record on 8/13/2025 and 8/14/2025 revealed no evidence of a hospital record or hospital discharge summary from 7/05/2025. During an interview on 8/13/2025 at 1:24 p.m., LVN B stated she was unable to locate the hospital records for Resident #1 for the 7/05/2025 hospital visit. She stated she was unsure if maybe Resident #1 maybe did not come back with one. LVN B stated normally the resident would come back with hospital records. The nurse would review and contact the physician to let them know the resident had returned to the facility and review a plan of care. LVN B stated the hospital records would then be placed in the basket on the nurses' station desk. She stated the Medical Records staff was responsible for picking up the hospital records from the basket and uploading to the medical record. LVN B stated it was important to have the hospital records available as part of the medical record, so they were available for review. During an interview on 8/14/2025 at 12:16 p.m., Medical Records C (MR C) stated she had not seen any hospital records for Resident #1. She stated if she didn't see a record, she would normally ask the nurses if they got the hospital stuff and they will contact the hospital to get the records. MR C stated she did not notify anyway or even notice the missing hospital records for Resident #1. She stated the facility utilized a white board at the nurses' station to track hospital stays and she had access to review the white board. MR C stated usually a resident who had a hospital visit came back with paperwork and she would have to ask for it several times. MR. C stated she keeps a bin at the nurses' station for documentation and checks and uploads into the computer daily. She stated her turnaround time for uploading was (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: 455742 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 455742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Lev at San Antonio 7703 Briaridge Drive San Antonio, TX 78230 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)