Inspection·November 13, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services to ensure accurate administration and documentation of medications for 2 of 12 residents (Residents #1 and #2) reviewed for pharmacy services and medication administration in that: The facility failed to administer medications as prescribed for Residents #1 and #2. This failure placed residents at risk of inadequate therapeutic outcomes, increased negative side effects, and a decline in health. The findings included: Record review of the admission face sheet, dated 11/9/2023, reflected Resident #1 was a female initially admitted on [DATE], readmitted [DATE], with a diagnosis included: hypertensive heart disease without heart failure (high blood pressure without affecting the pumping action of the heart muscles), atherosclerotic heart disease of native coronary artery without angina pectoris (the arteries become narrowed and hardened due to buildup of plaque (fats) in the artery wall without chest pain), peripheral vascular disease (slow and progressive circulation disorder), and essential hypertension (high blood pressure). Record review of the care plan with a start date of 11/7/2023, reflected Resident #1 had a Focus of The resident has hypertension (high blood pressure) with associated intervention of: Give anti-hypertensive medications as ordered. had a Focus of The resident has coronary artery disease r/t hypercholesterolemia with associated intervention of: Give all cardiac meds as ordered by the physician Give meds for hypertension Record Review of Resident #1's Order Summary Report dated 11/9/2023 revealed: Isosorbide Dinitrate Oral Tablet 30 MG, Give 1 tablet by mouth one time a day related to HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE Hold if SBP less than 110, DBP less than 60 or HR less than 60 and NIFEdipine Oral Capsule 10 MG, Give 3 tablets by mouth one time a day for HTN Administer 3 tablets to equal total dosage of 30mg Hold if SBP less than 110, DBP less than 60 or HR less than 60 Record review of the MAR for Resident #1 from 10/1/2023 to 10/31/2023, reflected the following medications were administered outside of parameters: Isosorbide Dinitrate Oral Tablet 30 MG, Give 1 tablet by mouth one time a day related to (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 3 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 11/13/2023 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)