Inspection·October 31, 2023

F 0564 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Inform each resident of his or her visitation rights and ensure that all visitors enjoy equal visitation privileges. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure that all visitors enjoy full and equal visitation privileges consistent with resident preferences for 1 of 5 residents (Resident #1) reviewed for Visitation Rights, in that: The facility put stipulations on the form of Resident #1's visits with family members that went against the resident's choices. This deficient practice could place residents at risk for decreased quality of life, depression, and isolation. The findings were: Record review of Resident #1's face sheet, dated 10/30/2023, revealed the resident was admitted [DATE]. Resident #1's diagnoses included: major depressive disorder, schizophrenia, anxiety, and insomnia. Record review of Resident #1's Quarterly MDS Assessment, dated 9/11/2023, revealed Resident #1 had a BIMS of 15 which indicated Resident #1 was cognitively intact. Record review of Resident #1's care plan, with an effective date 8/30/2023, stated, (Resident #1) is independent in activities in room and out of room. (Resident #1) at times requires some encouragement to attend activities. Leads group activities, assists in facilitating BINGO, cooking class or other activities of choice. Assists others in playing or coming to activities. Very helpful personality to both residents and staff. Spends time with family often, frequent visits from family or visits to home. Has two (family members) who visit and (family member) provides with some of her needs. (Resident #1) signs herself out the facility as desired and shops for herself, others. (Resident #1) is President of the Resident Council meeting. Goals included, (Resident #1) will maintain involvement in cognitive stimulation, social activities as desired through review date. Interview on 10/27/2023 at 10:31 AM, SW stated Resident #1 was one of the younger residents and was very helpful with activities. SW said Resident #1 was unhappy with her the last several days because SW required Resident #1 and her (family member) to meet in common areas due to allegations Resident #1's (family member) was coming into the facility and laying next to the resident and taking a shower in the facility, and also eating facility food. SW said she spoke to Resident #1's (family member) in law and said there may be some psychological issues with the Resident #1's (family member). SW indicated she told Resident #1 that she would prefer that if/when her (family member) visits that (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: 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 10/31/2023 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)