Inspection·January 23, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the resident had a right to a safe, clean, comfortable, and homelike environment for 1 (Resident #1 room) of 4 resident reviewed for resident rights, in that: A pile of yellow liquid was seen on the restroom floor of Resident #1's room. This failure could result in physical and psychosocial harm due to diminished quality of life and increased risk for falls. The findings were: Record review of Resident #1's face sheet, dated 04/06/23, noted the resident was admitted to the facility on [DATE] with diagnoses including: Depression, Anxiety, Tremor, Lack of Coordination, Type 2 Diabetes Mellitus, Hyperlipidemia, Chronic Obstructive Pulmonary Disease (a lung disease that blocks airflow and makes it difficult to breath), Cognitive Communication Deficit (difficult with communication caused by an impairment in cognitive processes), Unsteadiness on Feet, Paranoid Schizophrenia, Seizures, and Abnormalities of Gait and Mobility. Record review of Resident #1's Quarterly MDS assessment, dated 12/23/24, noted a BIMS score of 08 which indicated moderate cognitive impairment. Record review of Resident #1's care plan, dated 01/13/25, noted Resident #1 exhibits functional bowel/bladder incontinence, with a goal, Resident #1 will be free from complications related to bowel incontinence through the review date. Approaches included Check resident frequently and assist with toileting, incontinent, and pericare needs as needed and to Provide loose fitting, easy to remove clothing and to Provide pericare after each incontinent episode. The care plan further noted Resident #1 is at risk for falling R/T unsteady gait. Approaches included Assure the floor is free of glare, liquids, foreign objects. and staff tor perform frequent housekeeping rounds. Observation on 01/22/25 at 11:10 AM revealed the presence of a pile of yellow liquid on the floor of the bathroom. A foul odor was noted in the room, and the floor of the room was sticky underfoot. During an interview with LVN A on 01/22/25 at 11:10 AM, when asked what was on the floor of Resident 1's bathroom, LVN A stated it looked like urine. When asked what could happen if urine was on the floor, LVN A stated a resident could slip and fall and get a fracture. (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: 455804 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 455804 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Northgate Health and Rehabilitation Center 5757 N Knoll San Antonio, TX 78240 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)