Inspection·October 20, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop a comprehensive person-centered care plan for each resident that includes measurable objectives and time frames to meet a resident's medical, nursing, and mental needs that are identified in the comprehensive assessment, and services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 2 of 2 residents (Resident #3 and #7) reviewed for care plans. The facility failed to ensure proactive, measurable interventions were in place to address focus areas listed involving falls and other injuries for Residents #3 and #7. Different interventions were not identified after each fall to prevent future falls. This failure could place residents at risk for not receiving proper care and services due to inaccurate or incomplete care plan interventions. The findings included: Record review of Resident #3's face sheet, dated 10/17/23, reflected a [AGE] year-old female initially admitted to facility 03/23/23 with the latest admission of 05/23/23. Resident #3's diagnoses included encephalopathy, unspecified (a term for any brain disease that alters brain function or structure), atherosclerotic heart disease of native coronary artery without angina pectoris (thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery), unspecified dementia (impaired ability to remember, think or make decisions that interferes with everyday activities), generalized anxiety disorder (excessive, and persistent worry and fear about everyday situations), muscle wasting and atrophy, and difficulty in walking, not elsewhere classified. Record review of Resident #3's Quarterly MDS, dated [DATE], reflected a BIMS score of 2 indicating severe cognitive impairment and reception of hospice services. Section J1800 (Any Falls since Admission/Entry or Reentry or Prior Assessment) was coded 1 - Yes and J1900 (Number of Falls Since Admission/Entry or Reentry or Prior Assessment) was coded 1 - A. No injury. Under Section O - O0400 - Therapies - Item B Occupational Therapy - 116 minutes of therapy was received with a Start Date of 09/11/2023 and Item C Physical Therapy - 80 minutes of therapy was received with a start date of 09/01/2023. Record review of Resident #3's Care Plan reflected: - Focus: The resident is High risk for falls related to history of multiple falls prior to admission Date Initiated: 03/25/23 (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 6 Event ID: 455789 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 455789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Park Nursing and Rehabilitation Center 7302 Oak Manor Dr San Antonio, TX 78229 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)