Inspection·November 12, 2024

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 review, the facility failed to ensure resident medical records were kept in accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete and accurately documented for 1 of 3 residents (Resident #1) reviewed for clinical records. The facility failed to ensure Resident #1's EMR reflected accurate wound care documentation on 10/24/2024,10/26/2024,10/27/2024 and 10/31/2024. These deficient practices could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records. Findings included: Record review of Resident #1's face sheet, computer dated 11/8/2024, revealed he was a [AGE] year old male with an initial admit date of 2/21/24 and readmitted on [DATE] with diagnoses which included cerebral vascular accident(cva-medical term for a stroke. When blood flow to a part of the brain is stopped.), left side affected, Diabetes Mellitus 2( the body has a problem regulating sugar and the way it uses it.),hyperlipidemia(abnormally high levels of fat in the blood, it can cause blocked arteries and can lead to serious health conditions),anxiety(excessive,persistent and uncontrollable worry and fear about everyday situations),dementia(deterioration in mental status),arterial sclerotic heart disease(plaque buildup in the artery walls. can cause conditions such as heart attack and peripheral artery disease(disorder of blood vessels can affect the legs,feet,brain and other organs.). Record review of Resident #1's Quarterly MDS dated [DATE] revealed a BIMS score of 13, which indicated cognitively intact. Record review of Resident #1's Care plan dated 9/6/2024 with revision 10/10/2024 revealed the resident had a diabetic ulcer of the right lateral foot related to diabetes pressure ulcer or potential for pressure ulcer development. 10/15/24-Stage 4 decubitus left heel. Record review of Resident #1's physician Order Summary Report dated 10/1/2024-10/31/2024 revealed the following wound treatment orders: Right foot diabetic ulcer proximal Phalanx of great toe: cleanse with normal saline, pat dry with 4 x 4 gauze,apply skin prep to peri wound apply santyl to wound bed, cover with calcium alginate and dry dressing every day shift.(start date 9/5/2024 dc date 11/3/2024). Wound care left heel deep tissue injury with open area:cleanse with normal saline and or wound cleanser,pat dry with 4 x 4 gauze, apply santyl nickel thick to wound bed,cover with calcium (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 11/12/2024 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)