Health inspection·October 17, 2025

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few stroke and increases bleeding risk) oral tablet 75 mg, give one tablet by mouth one time a day for blood thinner with a start date of [DATE]. -Monitor and report to MD immediately any signs and symptoms of unusual bleeding, pale skin, weakness, black/tarry stools, head injury related to fall/trauma with a start date of [DATE]. Record review of Resident #7's progress notes revealed: -[DATE] 12:36 p.m.-Resident on day 1 of 3 fall follow up. Vitals WNL, no visible injuries noted at this time. Resident in wheelchair, call bell in reach. Documented by LVN C. There were no notes on the actual fall or interventions post fall. -[DATE] at 12:42 pm SBAR Summary to Providers: documented below. No orders documented. No interventions documented. The note indicated Resident #7 was an anticoagulant. Documented by LVN C. -[DATE] at 9:21 p.m. Resident #7 was quietly resting in bed during afternoon, she was not trying to get out of bed without assistance, denies pain/discomfort, pain in low position, call light in reach. Will continue to monitor. Documented by LVN D-[DATE] at 7:20 a.m. Change of Condition: Unresponsiveness. Documented by LVN B and ADON I. Record review of a facility fall incident report for Resident #7 dated [DATE]-25 at 12:00 p.m., documented by LVN C revealed the resident was observed on the floor in the restroom in between commode and sink. Resident #7's description of events included: I thought I heard someone say go ahead and stand up, so I was going to get on commode. I bumped my head on toilet and my arms. I don't have no bumps (sic), but my arms were hurting already. Immediate Action Taken: Resident assessed at this time, no visible injuries noted this shift, no bumps to back of head. Call placed to (physician's office) spoke with (RN at physician's office) at this time who stated to follow protocol. (LVN C) advised resident on aspirin 81 mg and had started a new medication buspirone (anti-anxiety medication). RN at physician's office stated if resident had any changes to call back. No injuries observed at time of incident. Predisposition situation factors: recent room change. Record review of Resident #7's SBAR Communication Form dated [DATE] and completed by LVN C indicated Resident #7 was on an anticoagulant medication (not specified) and had a fall. The Resident/Patient Evaluation (assessment) LVN C marked no changes in mental evaluation. LVN C marked not clinically applicable to the change of condition reported to behavior, respiratory, cardiovascular, skin evaluation, pain evaluation and neurological evaluation. Notification to the physician office RN was documented at [DATE] at 12:00 p.m. with check marks in other with note na (not applicable) x 2. No physician orders or feedback was documented. Further review revealed the time of the fall was not documented and there were no interventions documented on this form. Record review of Resident #7's Neurological Assessment Flow Sheet dated 10/02-10/03 (2025) revealed the last neurological assessment was completed on [DATE] at 2:45 a.m. without any documented abnormalities. The next neurological assessment due 4 hours later at 6:45 a.m. was missing from the documentation (in error) and a handwritten note: deceased was written and labeled 6-2 (6 am-2 pm to indicate an assessment due during that time frame). The assessment due at 6:45 am was not marked on the form. Record review of a local police department Incident Detail Report dated [DATE] revealed the first call to 911 was made on [DATE] at 7:28 a.m. for Resident #7 described as a [AGE] year-old female, full code status, CPR in progress. at 7:42 p.m., Resident #7 was pronounced and marked as DOA (dead on arrival). Resident #7 was found by CNA A and RN B estimated at approximately 7:10 a.m. with last wellness check at 4:00 a.m. as reported to EMS personnel. Record review of a police report dated [DATE] revealed local police responded to a DOA at 7:42 am. Police contacted the Medical Examiner's office for an apparent sudden death. The Medical Examiner's office released the body to jurisdiction and staff notified the funeral home. During an interview on [DATE] at 10:12 a.m., CNA A stated on [DATE] at almost lunch time as part of her daily routine, she was going to change Resident #7. She stated she told the resident she was going to get supplies and left her seated in the wheelchair beside the bed. CNA A (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455754 If continuation sheet Page 2 of 10 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 455754 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northeast Rehabilitation and Healthcare Center 603 Corinne St San Antonio, TX 78218 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few stated when she returned approximately 5 minutes later, she found Resident #7 on the ground in the bathroom between the toilet and the sink, trying to get up. CNA A stated she asked Resident #7 what happened, and the resident stated she thought she could get up and go (to the toilet). CNA A stated Resident #7 was sometimes continent and sometimes incontinent, and as part of the routine, she would take Resident #7 to the toilet. She stated the resident stood and helped, and could tell her what she needed, but did not walk and used a wheelchair. CNA A stated she called the nurse, LVN C, right away. She stated Resident #7 was still on the floor when the nurse arrived. CNA A stated she thought Resident #7 said she hit the back of her head and it was hurting although she did not see any injuries. CNA A stated she last saw Resident #7 seated in a chair totally fine at the end of the shift. She stated her shift ended at 2:00 p.m. She stated her relief (unknown name) did not show up, so she had no relief. She stated she told the nurse (unknown) she was leaving and left. She stated she did not give report to the oncoming shift or do rounds. CNA A stated on [DATE], her shift started at 6 a.m., but she got to the facility late and did not get a report. She stated she arrived at approximately 6:15-6:20 a.m. She stated she started her rounds and went to Resident #7's room and did not see the resident. CNA A stated because she knew she had the fall the previous day, she thought the resident had probably gone to the hospital, so she continued working. CNA A stated after she got all the other residents up for breakfast, she was just checking rooms as part of her routine. She stated she came to a room that was dark. She later found out Resident #7 had been moved to a new room. She stated the lights were all off, so she turned the light on. She stated she noticed Resident #7 was pale. She stated she did not see any injuries on Resident #7. She stated she tried to wake up Resident #7 and there was no response. She stated she immediately told RN B, who came right away. CNA A stated she watched RN B complete her assessment, she called for help and then they did CPR right away. CNA A stated RN B did chest compressions. She asked for help and for the crash cart and defibrillator. CNA A stated Resident #7 was on the ground. She stated she was running to get help and getting supplies, and someone called 911. She stated she waited outside for the ambulance. CNA A stated after EMS left, they left Resident #7's body in the building after she was pronounced (dead). She stated they waited for the police. CNA A stated she did not know what happened after that because she had other residents to take care of and was no longer with Resident #7. CNA A stated she had received fall prevention training on the computer system after she was hired (unknown time frame). During an interview on [DATE] at 10:47 a.m., RN B stated on [DATE] she worked the 6 a.m.-2 p.m. shift. She stated she was late to work and made arrangements to come in late, approximately 6:35 a.m. She stated when she arrived, the night shift nurse LVN F was still there and had given her a report. She stated LVN F had told her Resident #7 had a fall. She stated she was aware there were neuro checks but could not remember when the next neuro check was due. She stated she just remembered it wasn't due yet. She stated it was reported there had been no changes in her neuro status and she had been sleeping (during the night). RN B stated her assignment was two hallways, D and E. She stated she started working on hallway E, while Resident #7 was located on hallway E. RN B stated while working on hallway E, she was called and told Resident #7 was unresponsive. She stated she asked for the resident's code status and crash cart. She stated she was told she had full code. She stated when she arrived Resident #7 was unresponsive. She appeared to be sleeping with her arms resting on her abdomen. She was not breathing, there was no chest movement, and she was not reacting to stimuli. She stated she completed an assessment, checked for a pulse, looked for chest rise and fall and opened her eye lids. She stated there was no response to her pupils and no signs of life. RN B stated she had a CNA (unknown) to assist getting Resident #7 to the floor where three staff members took turns doing compressions and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455754 If continuation sheet Page 3 of 10 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 455754 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northeast Rehabilitation and Healthcare Center 603 Corinne St San Antonio, TX 78218 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few using the Ambu bag. She stated the AED was placed on the resident, but EMS arrived and took over before it was fully utilized. RN B stated Resident #7 had recently had a room change because she was not getting along with her roommate. She stated there was no physical altercation and no change of condition. She stated she did not have any other details to the room change. RN B stated she had received fall training on an unknown date and had received abuse/neglect training. She stated she was to report immediately to the Administrator. During an interview on [DATE] at 11:08 a.m., LVN C stated a CNA (unknown) told her Resident #7 fell so she went to assess the resident in the bathroom. She stated she did not see any bruises or injury. She stated Resident #7 told her she was in the wheelchair and thought someone told her to get up. She thought she heard someone say stand up but was unable to say whom. LVN C stated Resident #7 was never put on the toilet. LVN C stated CNA A told her she did not put the resident on the toilet and last saw her in the wheelchair. LVN C stated the resident could self-propel in the wheelchair and ambulate with assistance. She described the resident's cognitive status as alert and oriented and able to make her needs known. LVN C stated the resident had not had any recent decline and no increases in pain. She stated the resident requested tramadol approximately one time a day for shoulder pair reported at level 4-5 (moderate pain). LVN C stated she completed the assessment while Resident #7 was on the floor. She stated she felt her head (for bumps) and looked at her arms and legs. She stated once she assessed she was okay; she had the aides get her up. She stated she did not see any knots on the head or any bruising. LVN C stated she notified the physician's office of the fall. She stated she reported to the RN at the physician's office Resident #7 no knots on the head or bruising and that she hit her head, right in the back. She also reported the resident was on aspirin and had a recent change of medications, buspirone. She stated Plavix (blood thinner) was not sticking in her brain, but she had documented it in the SBAR documentation and believed she had notified the RN since she documented it. LVN C stated she marked the SBAR in error as not clinically insignificant. She stated she did assess for injuries and for pain. She stated the resident was not having any significant pain. LVN C stated the RN at the physician office told her to follow the facility protocol which included neuro checks. She stated she was not aware of any other interventions other than monitoring and did not have a copy of the protocol. She stated the facility protocol for unwitnessed falls was to assess vitals and neuros every 15 minutes then every 30 minutes, etc. on a neuro sheet. She stated she did complete the neuros and the vitals, and there was no change of condition. LVN C stated she could not remember if she passed along the fall information in change of shift. She stated she knew it was a male nurse but did not remember who or how report was given. She stated she had received fall protocol in-servicing on [DATE], prior to this incident. She stated it covered change of condition and documentation. She stated she was trained to notify the Administrator for any abuse or neglect. During an interview on [DATE] at 12:37 p.m., LVN D stated she worked evening shift from 2 pm-10 pm on [DATE]. She stated Resident #7 was alert and oriented. LVN D stated at approximately 8:30 p.m. Resident #7 had gotten into an argument with her roommate. She stated Resident #7 was being aggressive verbally with her roommate and would not calm down, so she moved her to a different room across the hall. LVN D stated Resident #7 had a history of arguing with roommates, so it was not a new thing. She stated it was verbal aggression and nothing physical had occurred. She stated both roommates were lying in bed, but Resident #7 just wouldn't stop; she wanted to fight with her roommate. LVN D stated they tried getting her to stop, she tried to close the curtain, but she declined to go to sleep and kept pulling the curtain over. LVN D stated she asked the roommate not to engage, but she was scared, so she decided to make the room change. LVN D stated after the room change Resident #7 was calm. Another staff member gave her a cinnamon roll, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455754 If continuation sheet Page 4 of 10 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 455754 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northeast Rehabilitation and Healthcare Center 603 Corinne St San Antonio, TX 78218 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few she was fine, and not angry at all. This was approximately 10:00 p.m. She stated she did not complete an assessment or vitals when Resident #7 was verbally aggressive because when she moved her out of the room, she was calm. She did not notify the physician and did not document the behavior, or the room change because it was not a change of condition, it was just two roommates who were arguing. She stated she was aware of the neuro checks. She stated she didn't know when the fall had occurred but believed the last of the neuro checks were completed on her shift. LVN D stated she knew neuro checks lasted 3 days, so if the last of the neuro checks were on her shift, the resident's fall had to not have been that day. LVN D stated neuro checks were every 15 minutes x 4, every 30 minutes x 4, every one-hour x 4, every four hours x 4 and then every shift x 4. LVN D stated Resident #7 had not had a change of condition during her shift, her vitals and neuro checks had been normal all shift, and she had been calm the rest of the shift and after the room change. She stated at end of shift she gave report to RN UU. During an interview on [DATE] at 1:10 pm with RN UU, there was no answer to phone call. At 3:48 RN UU returned the call and stated, when she came in, she had not gotten report from the evening shift. She stated she could not remember the evening nurse's name, but she had written out a report for her. RN UU stated she was assigned to work on Resident #7's hallway, but she decided to switch the assignments and give the hallway to RN F. RN UU stated the evening shift nurse left before RN F arrived to take the assignment and she did not look at the report because it was not her hallway and just gave it to RN F when he got there. RN UU stated she was not aware of Resident #7's fall or any behaviors. She stated she did see Resident #7 in her room at approximately 9:45 p.m. She stated the resident had asked for a cinnamon roll, so she gave her one and sat with her while she ate it. RN UU stated she spoke to Resident #7 who had a lot of complaints about her roommate. RN UU stated she did not think Resident #7 wanted to share a room and she was trying to get a room to herself, like she had done with a previous roommate. RN UU stated Resident #7's cognition was normal, she was talking normal and having normal conversation, and her cognitive status was normal. RN UU stated the resident was not complaining of pain or a headache. RN UU stated she had no further interactions with the resident and was too busy with her own assignment to pay attention to notice what was going on hallway D during the shift. During an interview on [DATE] at 2:00 p.m., the Treatment Nurse stated on [DATE] at approximately 7:20-7:30 a.m., he heard a code blue called. The Treatment Nurse stated he ran over and saw Resident #7 already on the floor with staff doing chest compressions. He stated he put the AED on which showed no shockable rhythm. He stated staff were rotating chest compressions and bagging until EMS arrived. The Treatment Nurse stated once EMS arrived, they continued to work on Resident #7 before pronouncing her death. He stated Resident #7 had not had a recent noticeable decline. He stated he was not aware of the fall event prior to the CPR event and only learned about it later. The Treatment Nurse stated expectations of staff after an unwitnessed fall included: assessment of the resident, neuro checks, ask the resident if they hit their head or had an injury, and call the MD before sending a resident out (to the hospital) to see if it was okay. He stated to his understanding, the doctor in this case did not want her sent out; just to do neuro checks. The Treatment Nurse stated Resident #7 had a past history of verbal aggression, but he was not aware of any recent behavior changes. During an interview on [DATE] at approximately 1:40 p.m., CNA E stated she worked night shift on [DATE]-[DATE]. She stated during her shift; Resident #7 was her normal self. CNA E stated they had moved Resident #7 to a new room earlier in the day. She said in the evening Resident #7 was eating a cinnamon roll. She stated she did not notice anything different and did not see any injuries. CNA E stated the resident then slept through the night. CNA E stated she last checked on Resident #7 at 4 something in the morning and saw she had respirations. CNA E stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455754 If continuation sheet Page 5 of 10 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 455754 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northeast Rehabilitation and Healthcare Center 603 Corinne St San Antonio, TX 78218 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few she turned on the light but did not provide any care to the resident. She stated her last rounds during night shift typically occur between 4:15-4:30 a.m. and they were supposed to check on the residents every 2 hours. CNA E stated she did not give a report to the oncoming CNA because she was not there when she left. CNA E stated she was trained to just leave. She stated she told the day shift nurse (unknown) she was leaving. She stated she just said Bye. I am leaving. CNA E stated they were not trained to give report or to do walking rounds. She stated since this incident, they had new training and they were supposed to do walking rounds and report, but that just started. She said they were not doing this when Resident #7 died. During an interview on [DATE] at 2:09 p.m., ADON I stated she was not aware of Resident #7's fall on the date of the incident and did not learn about it until the next day. She stated she learned about it when she checked her fall reports. ADON I stated when she arrived at the facility on [DATE], they were already coding her, in the middle of CPR. She stated 911 had already been notified. ADON I stated the paramedics wanted to know who the last person was who saw her alive. ADON I stated she started making calls to find out. ADON I stated she spoke to RN F and he stated 2:30 a.m. was the last time he saw her and CNA E said 4:15-4:30 a.m. ADON I stated she had no concerns about CPR or how the facility responded. ADON I stated the facility policy for an unwitnessed fall was that no one touched the resident until they were assessed for injuries. If there were no injuries, then staff would help the resident up. ADON I stated the nurse should then notify the physician, check to make sure there were no anticoagulants. She stated if the resident was on anticoagulants, then go to the hospital, even if they say they did not hit their head, as a precautionary measure. ADON I stated there was a written policy and the DON had it. She briefly left the interview and returned saying the DON stated they didn't have the policy. ADON I stated staff were trained to send to the hospital for anticoagulants. She stated she was not aware Resident #7 was on them. ADON I stated Resident #7 had a history of making friends and then fighting with them verbally, and she would call her roommates names. ADON I stated she had been moved out of two other shared room situations. ADON I stated any behavior that was enough to cause a room change should be reported and documented. She stated she did not believe this indicated a behavior change for the resident. She stated it was part of the resident's personality. ADON I stated as part of her duties she reviewed neuro checks every morning. She stated Resident #7 only received two of her every four-hour neuro checks. She stated there was a written discrepancy on the neuro check form where someone mis labeled the times and had omitted the 6:45 am neuro check. ADON I stated Resident #7 should have received a neuro check at 6:45 a.m. on [DATE]. During an interview on [DATE] at 2:29 p.m., a staff member for the resident's physician stated on [DATE] at 12:05 p.m. LVN C notified the office of Resident #7's fall. She stated the responding RN (identified as RN for physician's office), documented she told LVN C to transport Resident #7 to the ER. She stated the physician's office did not receive any other notifications about Resident #7 until the death notice. She stated she was unable to answer any questions about what LVN C told the RN for the physician's office, or whether or not she notified about anti-coagulate usage. She stated that information was in the resident's medical record and was available to their staff. This surveyor left a request to speak with the resident's physician. During an interview on [DATE] at 2:46 p.m., ADON VV stated Resident #7 had a fall the day before she passed. She stated LVN C had reported it to the physician, to herself, and to the DON. She stated she was notified that the doctor gave no new orders. ADON VV stated the next day, she was told the resident had passed, that they had coded her, and the resident was pronounced by EMTs. ADON VV stated LVN C had no complaints, no disciplinary action, and was a wonderful nurse. She stated the facility's policy for falls included: Evaluate-assessment by the nurse. ADON VV stated based on the assessment of a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455754 If continuation sheet Page 6 of 10 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 455754 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northeast Rehabilitation and Healthcare Center 603 Corinne St San Antonio, TX 78218 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few resident, they go from there. If there were any complaints of pain, they would look into it more. She stated they go from there to make sure there are no injuries, no alterations in skin. If there are, the wound nurse gets involved. ADON VV stated neuro checks were put in place for 72 hours. She stated any changes were to be documented and any abnormal findings are reported to the physician to get new orders if needed. ADON VV stated for unwitnessed falls, neuro checks and if the resident was receiving any blood thinners, the resident was to be sent out to the hospital for further evaluation. She stated Plavix was a blood thinner. She stated it was best practice to get a physician order to send out, but in an emergency service, no. ADON VV stated nursing staff were aware of this as they had received in-service training. She stated she was not sure it was part of a written policy, but it was something that was taught. She stated she was not sure why Resident #7 was not sent out to the hospital since she was on anticoagulants. ADON VV stated she did not think much of it, and she suspected everything was fine because she saw Resident #7 moving around in her wheelchair. She stated LVN C had told her she did not get any orders. ADON VV reviewed Resident #7's neuro sheet and stated the next neuro check should have been completed on [DATE] at 6:45 a.m. She stated the night nurse, RN UU assigned to Resident #7, was still there and should have done it. ADON VV stated there were three licensed staff on shift that night. She stated the off-going shift should not leave without giving a hand off report. During an interview on [DATE] at 3:02 p.m., RN F stated he arrived at work late on [DATE] for the 10 pm-6 am shift. He stated he could not remember but thought the evening shift nurse (name unknown) was still there. He stated he was informed Resident #7 had a fall during the day. He stated he completed neuro checks on Resident #7 during the shift. RN F stated she was responsive early in the shift while awake and her vitals were within her baseline and there were no changes during the shift. He stated it was after or around 7:00 a.m. before Resident #7 was found unresponsive. He stated he left before that happened. He stated he had already given report to the oncoming nurse RN B when the 6:45 a.m. shift was due and had not done it. He stated he made RN B aware of the fall and the neuro checks. He stated he could not remember if RN B came to work on time as he was busy with another resident. He stated the last time he saw Resident #7 during the shift was as aware around 4:30-ish a.m. where he looked for risk and fall of the resident's chest. He stated he last checked on the residents during his med pass, although he had not given any meds to Resident #7. RN F stated he coordinated with the CNA (unknown) to check on the residents. He stated they do not turn on lights or wake the residents up. RN F stated he used his cell phone light to look. RN F stated Resident #7 did not show any behaviors or change of condition during the night. He stated he thought they changed her room the previous day because of aggression but did not recall exactly. He stated they last time he saw Resident #7 awake, she was her normal self without any signs of injury. Attempted interview with Resident #7's physician on [DATE] at 3:15 p.m., left voicemail requesting a return call. No phone call was received. During an interview on [DATE] at 3:20 p.m., the DON stated Resident #7 had a fall on [DATE]. The DON stated she was in the facility on the date of the fall but not on [DATE], her date of death , as she worked remotely. The DON stated ADON I was the facility fall preventionist and staff would let her know of any falls, and if there was anything out of the ordinary, ADON I would let her know. The DON stated ADON I did not tell her about it on [DATE]. After the death, she went and saw that Resident #7 had fallen the day before. She stated she reached out to ADON I and the Treatment Nurse who said her neuros were stable. The Medical Examiner came to the facility and released the body to the funeral home. She stated the Medical Examiner's office did not do any autopsy and did not find any foul play. She stated Resident #7's vitals had been stable and her neuros had been stable. They coded her and did everything they could for the resident. The DON stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455754 If continuation sheet Page 7 of 10 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 455754 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northeast Rehabilitation and Healthcare Center 603 Corinne St San Antonio, TX 78218 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete facility did not correlate her death to the fall. The DON stated her expectation for an unwitnessed fall was always neuro checks and notification of the family and the physician. She stated if they hit their head, neuros. She stated if there was any deviation in neuros, they should notify the physician. The DON stated she was aware Resident #7 hit her head, and they did neuro checks. She stated for a resident on anti-coagulants they tell the physician and let them decide. The DON said the facility did not have a policy to send the resident out to the hospital. She stated she did not know why some staff thought that was their policy. She said that had not been taught. She stated she had not spoken with Resident #7's physician about her fall or her death but knew he was aware because it was a required notification. The DON stated if LVN C had gotten an order to send out (to the hospital) then she should have sent the resident out, but she was not aware of it. The DON stated she was aware Resident #7 was bickering over TV volume with another resident. She stated a staff member (unknown) had asked if she could move the resident and she said yes. The DON stated that was not something the physician would need to be notified of. She stated they had moved Resident #7 a few times because she would [NAME] with roommates and that was not a change of condition. The DON stated staff had been trained on de-escalation and redirection of residents, fall prevention training, and abuse and neglect (dates unknown). The DON stated this surveyor would need to speak with the Medical Director instead of the resident's physician. During an interview on [DATE] at 4:08 p.m., the Medical Director stated Resident #7's physician was not available and her providers were not allowed to be interviewed unless she was present. She stated she looked through the call center log and they had been notified when the fall happened. She stated they (facility) had been given orders to monitor for neuros. The Medical Director stated the representative for the physician's office notified her (on [DATE]) she incorrectly stated (when interviewed) that there was an order to send the resident out to the hospital. The Medical Director stated she listened to the call (original call on the date of fall) and the RN just gave orders to monitor and do neuro checks and no orders to send to the hospital. The Medical Director stated there was no one-set of professional standards of practice for when a resident had an unwitnessed fall, hit their head, and was on anticoagulants. She stated it would depend on the si[TRUNCATED] Event ID: Facility ID: 455754 If continuation sheet Page 8 of 10 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 455754 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northeast Rehabilitation and Healthcare Center 603 Corinne St San Antonio, TX 78218 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 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 interviews and record reviews, the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained on each resident that were complete and accurately documented for 1 of 13 residents (Resident #7) reviewed for clinical records. The facility failed to document Resident #7's verbal aggression and room change, time or location of fall, monitoring and neuro check orders from physician, or pain and skin/injury assessment on 10/02/2025. This failure could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records. The findings included:Record review of Resident #7's face sheet dated 10/13/2025 revealed a [AGE] year-old female admitted on [DATE] with diagnoses which included: hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (stroke affecting the right side), gout (a type of arthritis affecting one or more joints with sudden attacks of severe pain and swelling), and hypertension (high blood pressure). Record review of Resident #7's SBAR Communication Form dated 10/02/2025 and completed by LVN C indicated Resident #7 had a fall. LVN C marked not clinically applicable to the change of condition reported to behavior, evaluation, pain evaluation and neurological evaluation. Notification to the physician office RN was documented at 10/02/2025 at 12:00 p.m. with check marks in other with note na (not applicable) x 2. No physician orders or feedback were documented. The time of the fall or location of the fall was not documented and there were no interventions documented on this form. Record review of Resident #7's UDA revealed an incomplete pain assessment had been started by LVN C on 10/02/2025 but the actual assessment was not documented, and the assessment was blank. There were no UDA [SH3] for skin observation or assessments documented in the EMR. Record review of Resident #7's progress notes revealed there was no documentation of the fall expect the SBAR Communication. There were no orders documented, no physician feedback, no interventions and the time and location of the fall was not documented. Record review of Resident #7's Order Summary Report for October 2025 revealed there were no orders for neuro checks or monitoring post fall on 10/02/2025. Record review of Resident #7's EMR including progress notes, assessments, and orders there was no documentation of LVN D's recollection of events of verbal aggression directed toward a roommate and subsequent room change on 10/02/2025. During an interview on 10/13/2025 at 11:08 a.m., LVN C stated a CNA (unknown) told her Resident #7 fell so she went to assess the resident in the bathroom. She stated she did not see any bruises or injuries. She stated she did not see any knots on the head or any bruising. LVN C stated she notified the physician's office of the fall. She stated she reported to the RN at the physician's office Resident #7 had no knots on the head or bruising and that she hit her head, right in the back. She stated she completed the pain assessment and the resident was not having significant pain. She completed the skin and injury assessment and did not see any injuries. She stated she did assess for injuries and for pain. She stated the resident was not having any significant pain. LVN C stated the RN at the physician office told her to follow the facility protocol which included neuro checks. She stated she was not aware of any other interventions other than monitoring and did not have a copy of the protocol. LVN C stated she marked the SBAR in error as not clinically insignificant for the assessments in error and marked the orders as na and other because it referenced the facility policy. She stated she did not enter orders because it was a facility protocol. During an interview on 10/13/2025 at 12:37 p.m., LVN D stated she worked the evening shift from 2 pm-10 pm on 10/02/2025. LVN D stated at approximately 8:30 p.m. Resident #7 had gotten into an argument with her roommate. She stated Resident #7 was being aggressive verbally with her roommate and would not calm down, so (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455754 If continuation sheet Page 9 of 10 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 455754 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northeast Rehabilitation and Healthcare Center 603 Corinne St San Antonio, TX 78218 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 she moved her to a different room across the hall. She stated it was verbal aggression and nothing physical had occurred. She stated both roommates were lying in bed, but Resident #7 just wouldn't stop. She wanted to fight with her roommate. LVN D stated they tried getting her to stop, she tried to close the curtain, but she declined to go to sleep and kept pulling the curtain over. LVN D stated she asked the roommate not to engage, but it continued so she decided to make the room change. LVN D stated after the room change Resident #7 was calm. She stated she did not document the verbal aggression and did not document the room change because as soon as the resident was moved to a new room, she was calm. She stated she also did not think about documenting it because it was just two roommates arguing. She stated she should have documented it in the medical record. During an interview on 10/14/2025 at 3:34 p.m., the DON stated she reviewed the SBAR documentation by LVN C. She stated every fall triggered a separate UDA [SH4] that should have been completed. She stated the SBAR was a new form for the staff, and she thought maybe it was misunderstood by staff and that was why it was incorrectly documented as not clinically significant. The DON stated a skin/injury assessment should be documented after a fall and a pain assessment should be documented. The DON stated the word monitor was not a specific MD order. She stated if the doctor said something specific, they would add it as an order. She stated the SBAR checklist was the order or the place to document back what the physician response was to the notification. She stated LVN C marking other and na for orders should have been more specific. During an interview on 10/15/2025 at 4:11 p.m., the DON stated they document exceptions and they were required to follow up with expectations with what intervention was put in place. She stated they put a note for the intervention in the medical record. The DON stated Resident #7 was unhappy with the TV being too loud with her roommate and needing to be moved was not a reason to document. The DON stated Resident #7 did not have a family to notify about the move, so no notification was required to be documented. The DON stated what should be documented included any change of condition, and behaviors that required interventions, any complaints from the resident such as pain, any refusals, any changes from baseline. She stated it was important to document in the medical record so monitoring and interventions were in place. Record review of the facility's policy titled Administration-Content of Medical Records last revised August 2007 revealed: All physicians, nursing staff and other health care professionals involved in the resident's care will be responsible for making prompt, appropriate entries in the record. 6. List of contents of the medical record: Licensed Nurses Notes, other assessments ( .bowel and bladder, skin, etc.) Event ID: Facility ID: 455754 If continuation sheet Page 10 of 10