Inspection·July 24, 2025

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few member in charge of obtaining consents for psychotropic medications. The DON stated when a consent is needed for psychotropic medications, the facility will speak to the responsible party and provide them information on the medication including side effects and any other information. The DON stated if consent is granted, they get a verbal consent or written signature on the consent form. The DON stated it was important to get psychotropic medication consents signed quickly, so residents can be aware of what they are taking and how it can affect them. During an interview with the Administrator on 7/24/25 at 9:54 AM, the Administrator stated the nursing staff is primarily responsible for obtaining psychotropic medication consents, and the social worker will sometimes help with those consents. When asked what her expectation is of the timeline for getting psychotropic medication consents, the Administrator stated as soon as possible, within the first few days of admissions. The Administrator stated for any changes to medications, her expectation is for staff to get the consents quickly, within a few days of the change. When discussing the importance of getting psychotropic medication consents signed as soon as possible, the Administrator stated without a signed consent, the facility is unable to give a medication and a breakdown in care could occur for the resident. The Administrator further stated the consent aides the resident in understanding what a medication is for, why they are taking it, and how it can affect them. Review of the facility’s policy titled Statement of Resident Rights, undated, noted “You have a right to: (23) receive information about prescribed psychoactive medication from the person who prescribes the medication or that person's designee, to have any psychoactive medications prescribed and administered in a responsible manner, as mandated by the Texas Health and Safety Code, §242.505, and to refuse to consent to the prescription of psychoactive medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 2 of 11 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 07/24/2025 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)

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure 1 of 8 residents (Resident #2) received services in the facility reviewed for reasonable accommodation of resident needs related to call lights. The facility failed to ensure the call light was within reach for Resident #2. This deficient practice could affect any resident and place them at risk of not being able to ask for help as needed.The findings were: Record review of Resident #2's face sheet revealed she was admitted to the facility on [DATE] with diagnoses which included: catatonic disorder (person experiences significant disruptions in movement and behavior), Neoplasm of uncertain behavior of parathyroid gland (growth in the parathyroid gland), Sick sinus syndrome (heart's natural pacemaker doesn't work properly). Record review of Resident #2's MDS assessment, dated 05/07/2025, revealed the resident's BIMS score was 99, which indicated severe cognitive impairment. The MDS assessment further revealed Resident #2 required substantial/maximal assistance (helper does more than half the effort) for ADL assistance. Record review of Resident #2's care plan revealed Resident #2 is at risk for falls d/t impaired cognition, impaired mobility, no safety awareness and Keep call light within reachObservation on 07/22/2025 at 1:25 pm. revealed Resident #2 lying in bed with her call light lying on the floor under the head of the bed, out of view and reach of the resident. During an interview on 07/22/2025 at 1:28 pm LVN A she observed the call light was not visible to the resident and the resident was unable to reach it. She stated the potential for harm could be a lack of care due to the resident unable to call for help. During an interview on 07/22/2025 at 1:46 pm the DON stated that the call light should be within resident reach to be able to call for assistance. Record review of facility's Call LightUse of policy, dated December 2017, showed, When providing care to residents, be sure to position the call light conveniently for the resident to use. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 3 of 11 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 07/24/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as was possible for 4 of 7 residents (Resident #23, Resident #9, Resident #37 and Resident #17) reviewed for accidents and hazards: 1. The facility failed to ensure Resident #23 did not have a disposable razor at the bedside.2. The facility failed to ensure Resident #9 did not have a pair of large nail clippers in her room.3. The facility failed to ensure Resident #37 did not have a pair of large nail clippers and a disposable razor in her room.4. The facility failed to ensure Resident #17 did not have a pair of scissors at the bedside.These failures could place residents at risk of harm or injury and contribute to avoidable accidents and a decline in health.The findings included:1. Record review of Resident #23's face sheet dated 7/22/25 revealed a [AGE] year old male admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included schizoaffective disorder (a mental health condition characterized by mood symptoms such as depression or mania), history of suicidal ideations, and dementia (general term for a decline in mental ability that is severe enough to interfere with daily life). Record review of Resident #23's most recent quarterly MDS dated [DATE] revealed the resident was cognitively intact for daily decision-making skills and required setup or clean-up assistance with personal hygiene.Record review of Resident #23's comprehensive care plan with edited date 5/27/25 revealed the resident had an ADL self-care performance deficit related to dementia with approached that included to provide independent/supervision by 1 staff with bathing.During an observation and interview on 7/21/25 at 11:15 a.m. revealed Resident #23 lying in bed and a disposable razor was at the bedside inside of a disposable emesis basin (a shallow, kidney-shaped container use in medical settings to collect vomit, oral secretions, or other bodily fluids). Resident #23 stated he shaved himself but could not recall the last time he had shaved himself. Observations on 7/22/25 at 7:38 a.m. and again at 1:33 p.m. revealed a disposable razor blade inside of a disposable emesis basin at Resident #23's bedside.2. Record review of Resident #9's face sheet dated 7/21/25 revealed a [AGE] year old female admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included type 2 diabetes (a chronic medical condition where the body either does not produce enough insulin or doesn't use insulin effectively), long term use of anticoagulants, contracture of right shoulder, elbow, wrist, and hand, and hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (paralysis or weakness on one side of the body that occurs after a stroke). Record review of Resident #9's most recent quarterly MDS assessment dated [DATE] revealed the resident was severely cognitively impaired for daily decision-making skills and was dependent on staff for personal hygiene.Record review of Resident #9's comprehensive care plan with edited date 6/29/25 revealed the resident had an ADL self-care performance deficit related to cerebral infarction and approaches that included the resident required total assist with ADL's.Observation on 7/21/25 at 11:39 a.m. revealed Resident #9 in bed and a large pair of nail clippers were observed on top of a chest of drawers. Resident #9 could not verbalize if she had used the nail clippers but indicated she needed help to get in and out of bed. Observation on 7/22/25 at 9:29 a.m. revealed Resident #9 in bed and a large pair of nail clippers were observed on the top of a chest of drawers. 3. Record review of Resident #37's face sheet dated 7/22/25 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included lack of coordination, cognitive communication deficit, abnormalities of gait and mobility, type 2 diabetes (a chronic medical condition where the body either does not produce enough insulin or doesn't use insulin effectively), and muscle weakness.Record review of Resident #37's most recent comprehensive MDS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 4 of 11 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 07/24/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some assessment dated [DATE] revealed the resident was cognitively intact for daily decision-making skills and required substantial/maximal assistance with personal hygiene, and set-up or clean-up assistance with personal grooming.Record review of Resident #37's comprehensive care plan with edited date 6/29/25 revealed the resident had limited physical mobility and required ADL assistance from staff with approaches that included extensive to total assistance by 1 to 2 staff with bathing.Observation and interview on 7/22/25 at 1:23 p.m., Resident #37 stated she used the disposable razor blade seen in a cup on the bedside table to shave her whiskers on her chin. Resident #37 was asked if she trimmed her own nails, and the resident took a pair of large nail clippers stored in the same cup as the disposable razor blade and stated she also trimmed her own nails. Resident #37 stated staff were aware she had the disposable razor blade and the nail clippers in her possession. Resident #37 stated LVN B had given her the large nail clippers when she asked for them.During an interview on 7/22/25 at 1:55 p.m., LVN A stated Resident #23 was alert and oriented and was capable of shaving himself and cutting his own fingernails. LVN A stated Resident #37 was not supposed to cut her own nails or had access to a disposable razor because she could cut herself. LVN A stated Resident #9 could not have nail clippers because the resident had right sided weakness and did not have dexterity. LVN A stated residents who were allowed to use items such as nail clippers, or disposable razor blades were supposed to be addressed on a care plan. LVN A stated the ambassadors were supposed to be looking for those items when they made their rounds. LVN A stated when she saw something a resident was not supposed to have it was reported to the DON or ADON.During an interview on 7/22/25 at 2:13 p.m., the Activity Director stated she was assigned as an ambassador which included making rounds of assigned rooms and checked areas such as making sure the call light was working, cleanliness of resident rooms, and to look for disposable razors, and nail clippers or medications left at the bedside. The Activity Director stated items such as nail clippers and disposable razors were supposed to be disposed of in a sharps container and she was supposed to notify the nurse. The Activity Director stated she was not aware of any residents who were allowed to have disposable razors or nail clippers in their possession because it could be a safety hazard. During an interview on 7/22/25 at 3:25 p.m., CNA D stated she was unsure if there were any residents in the facility who could cut their own nails or shave themselves. CNA D stated she could do nail care on a resident except for those residents who were on blood thinners or who were diabetic. CNA D stated, once nail care was provided to a resident, the nail clippers were supposed to be disposed of in a sharps container. An attempt at a telephone interview on 7/22/25 at 3:40 p.m. with LVN B was unsuccessful. LVN B's voicemail indicated she was not accepting calls.During an interview on 7/22/25 at 4:43 p.m., the DON stated if a resident were allowed to use items such as nail clippers or disposable razors, the resident needed to be assessed, and it had to be care planned. The DON stated the care plan was important because it provided instruction on how to care for the resident. The DON stated there were residents who would do things on their own without asking staff for help but, I prefer staff watch them to make sure they are doing it safely.4. Record review of Resident #17's face sheet dated 7/23/25 revealed a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included abnormalities of gait and mobility, lack of coordination, and muscle weakness.Record review of Resident #17's most recent quarterly MDS assessment dated [DATE] revealed the resident was cognitively intact for daily decision-making skills, required substantial to maximal assistance with transfers and required substantial/maximal assistance with grooming. Record review of Resident #17's comprehensive care plan with edited date 6/29/25 revealed the resident had limited physical mobility and approaches that included 1 to 2-person assist with mobility, and transfers.Observation on 7/23/25 at 8:33 a.m., during (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 5 of 11 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 07/24/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete the medication pass revealed Resident #17 sitting up in bed and a pair of scissors were observed on the resident's bedside table. During an interview on 7/23/25 at 8:47 a.m., LVN C stated, he was responsible for cutting resident's fingernails and as far as he knew, residents were not allowed to have items, including nail clippers, or disposable razor blades at the bedside. LVN C stated items such as nail clippers and disposable razor blades were provided to the residents, but staff used those items on the residents and could not have the items in their rooms because they could cut themselves or have an accident.During an interview on 7/23/25 at 9:11 a.m., Resident #17 stated she could cut her own fingernails if she wanted to, and the scissors belonged to her and were used to cut things such as to open packages. Resident #17 stated the scissors were provided to her by a family member.Record review of the facility document untitled and undated, provided by the Activity Director on 7/22/25 at 2:13 p.m. revealed a check list used by the assigned ambassador to monitor during the rounds. The untitled document included to monitor for No ‘dangerous items' chemicals, etc., and instructions with if yes, please fill out form. Record review of the facility document titled Statement of Resident Rights, undated, revealed in part, .You have a right to.all care necessary for you to have the highest possible level of health.safe, decent and clean conditions. Event ID: Facility ID: 455804 If continuation sheet Page 6 of 11 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 07/24/2025 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)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that a resident who is fed by enteral means receives the appropriate treatment and services to prevent complications of enteral feeding for 1 of 3 resident (Resident #9) reviewed for enteral feeding:The facility failed to ensure Resident #9's feeding formula and water containers were labeled with the appropriate identifiers and did not discard the feeding containers after the feeding was completed.This deficient practice could place residents who received enteral nutrition at risk of infection, and bloating discomfort.The findings included:Record review of Resident #9's face sheet dated 7/21/25 revealed a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included nausea, aphasia (medical condition that affects a persons' ability to communicate) following cerebral infarct (a type of stroke that prevents blood flow to a part of the brain), dysphagia(condition that involves difficulty with language), gastro-esophageal reflux (chronic condition where stomach acid or bile flows back into the esophagus causing irritation), and gastrostomy status (a medical procedure in which a surgical opening is made into the stomach through the abdominal wall which allows for the placement of a feeding tube).Record review of Resident #9's most recent quarterly MDS assessment dated [DATE] revealed the resident was severely cognitively impaired for daily decision-making skills and utilized a feeding tube.Record review of Resident #9's comprehensive care plan with edited date 6/29/25 revealed the resident had a feeding tube and approaches that included to provide feedings and water flushes as ordered. Record review of Resident #9's Physician Order Report for July 2025 revealed the following:- Enteral: Free water flushes at 60 ml/hr x 12 hours, special instructions: RUN water at 60 ml per hour from 6:00 p.m. to 6:00 a.m. every night with order date 7/21/25 and no end date.Nocturnal feedings of Novasource Renal at 45 ml with 60 ml free water flushes x 12 hours feeding tube via dual flow pump (down 6:00 a.m., on 6:00 p.m.) with order date 6/3/25 and end date 7/7/25.Observation on 7/22/25 at 9:29 a.m. revealed Resident #9 in bed and the Novasource formula and water containers were hanging from the feeding pole with the feeding tube connected to the feeding pump and the connecting end of the tube was under the resident's blanket. Resident #9's Novasource formula and water containers were unlabeled, and the feeding pump was turned off.Observation on 7/22/25 at 1:36 p.m. revealed Resident #9's Novasource formula and water containers were hanging from the feeding pole and the feeding pump turned off. During an observation and interview on 7/22/25 at 1:47 p.m., LVN A stated, Resident #9 received nocturnal feedings but was not sure of the time frame. LVN A observed the Novasource formula and water containers hanging from the feeding pole and stated, both the formula and water containers were unlabeled. LVN A stated both the formula and water containers were supposed to be labeled because it was used to identify right person, right rate, right time and right dosage. LVN A stated, without those identifiers, it would not be known how long the formula had been left there. LVN A stated she believed the formula and water had been used/infused even though there was still formula and water seen in the containers. LVN A stated, even though the formula was not finished, they could still use it again, but that would depend on how much of the formula had been infused.During an interview on 7/22/25 at 4:43 p.m. the DON stated Resident #9's feeding formula and water containers should have been labeled with the resident's name, the time, and date the formula was infused. The DON stated, the formula was only good for 24 hours and once it was used, it should be thrown away. The DON stated the resident could be affected if the formula did not have a label that indicated when the formula was given and how much and if the formula was old, it could upset the resident's stomach and make them (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 7 of 11 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 07/24/2025 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)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete sick.Record review of the facility document titled Enteral Formula Via: Feeding Tube, Bolus, Gravity, Pump (Closed/Open) Administration, with effective date 12/2017 revealed in part, .It is the policy of this home that the resident, who utilizes enteral nutrition, will be free, to the extent possible, from complications related to enteral nutrition.Pump - administration of formula utilizing a bottle/bag with the tubing placed through the pump device and the rate set on the pump to administer the formula. This method provides a more accurate administration as well as the pump provides the volume administered in a specified time period.The syringe and bag (if used) should be changed every 24 hours. The ready-to-hang bottles should be changed according to the manufacturer recommendations or when total amount has infused if less than the manufacturer recommendation.The syringe, bag, and/or bottle should be labeled with the resident name, room number, date changed, and the nurses' signature/initials. The bag or bottle should also specify the physician order the formula, rate, route, and means of administration. Event ID: Facility ID: 455804 If continuation sheet Page 8 of 11 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 07/24/2025 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development of communicable diseases and infections for 6 of 8 residents (Resident #15, #18, #31, #19, #17 and #9) reviewed for infection control.1. The facility failed to ensure LVN A sanitized the blood pressure cuff when obtaining Resident #15, Resident #18, and Resident #31's blood pressure. 2. The facility failed to ensure LVN A wore gloves when applying a lidocaine patch to Resident #18's lower back. 3. The facility failed to ensure LVN C sanitized the blood pressure cuff when obtaining Resident #19, and Resident #17's blood pressure. 4. The facility failed to ensure LVN C wore a gown while administering a bolus of water to Resident #9's feeding tube who was on EBP (enhanced barrier precautions) on 7/23/25.These deficient practices could affect residents who require assistance and treatments and could place residents at risk for cross contamination and infection or illness.The findings included:1. Observation on 7/22/25 at 7:44 a.m. during the medication pass revealed LVN A obtained Resident #15's blood pressure and did not sanitize the blood pressure cuff after use. LVN A then obtained Resident #18's blood pressure and Resident #31's blood pressure with the same blood pressure cuff without sanitizing the cuff between resident use. During an interview on 7/22/25 at 8:27 a.m., LVN A stated the blood pressure cuff used on the residents was her own personal equipment. LVN A stated she had forgotten to sanitize the blood pressure cuff between the residents and said she should have sanitized the blood pressure cuff because it was considered cross contamination. LVN A stated she had never been instructed by the facility to sanitize the blood pressure cuff between residents. LVN A stated cross contamination meant, whatever somebody got they could give it to somebody else. 2. Record review of Resident #18's face sheet dated 7/24/25 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included chronic pain syndrome, muscle spasm, and difficulty in walking.Record review of Resident #18's Physician Order Report dated 6/24/25-7/24/25 revealed the following:- lidocaine adhesive patch, medicated 4%, 1 patch topical twice a day for pain with order date 6/17/25 and no end date.Observation on 7/22/25 at 8:13 a.m. during the medication pass revealed LVN A applied Resident #18's lidocaine patch to the lower back without using gloves. During an interview on 7/22/25 at 8:27 a.m., LVN A stated she did not wear gloves when applying the lidocaine patch to Resident #18's lower back because the gloves stick to the patch. LVN A stated she did not believe she needed to wear gloves when applying the patch because she had washed her hands prior to handling the patch. 3. Observation on 7/23/25 at 8:06 a.m. during the medication pass revealed LVN C obtained Resident #19's blood pressure and did not sanitize the blood pressure cuff after use. LVN C then obtained Resident #17's blood pressure with the same blood pressure cuff used on Resident #19. During an interview on 7/23/25 at 8:47 a.m., LVN C stated the blood pressure cuff used on the residents was his own personal equipment. LVN C stated he had forgotten to sanitize the blood pressure cuff between resident use and not sanitizing the blood pressure cuff was considered cross contamination. 4. Record review of Resident #9's face sheet dated 7/21/25 revealed a [AGE] year old female admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included nausea, aphasia (neurological condition that affects the ability to communicate) following cerebral infarction (a type of stroke causing brain tissue to die due to lack of oxygen and nutrients), dysphagia (partial loss or difficulty with language abilities), gastro-esophageal reflux disease (a chronic digestive disorder where stomach acid or bile flows back into the esophagus), and gastrostomy status (surgical procedure in which a hole [stoma] is created through the abdominal wall directly into the stomach which allows placement for a Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 9 of 11 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 07/24/2025 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some feeding tube). Record review of Resident #9's Physician Order Report dated 6/22/25-7/22/25 revealed the following:- Enteral: free water flushes at 60 ml per hour every 12 hours. Special Instructions: RUN water at 60 ml per hour from 6:00 p.m. to 6:00 a.m. every night with order date 7/21/25 and no end date.- Enteral: Flush G-tube (feeding tube) with 10-15 cc water before and after medication administration every shift with order date 10/27/24 and no end date.- Enteral: Verify G-tube placement by aspirating stomach contents before feedings/flushes/meds. If residual is more than 60 cc, replace contents, stop feeding and notify MD, every shift with order date 10/27/24 and no end date.- Staff may utilize EBP (enhanced barrier precautions) for high contact resident care, with order date 5/20/25 and no end date.Record review of Resident #9's comprehensive care plan with edited date 6/29/25 revealed the resident required enhanced barrier precautions during contact care related to enteral feeding tube with approaches that included staff to provide/utilize appropriate PPE along with standard precautions while providing resident care including care to enteral tubes.On 7/23/25 at 2:36 p.m. during observation of the water bolus to Resident #9's feeding tube revealed LVN C checked for placement of the resident's feeding tube, checked for residual and administered 15 cc of water without using a gown. During an interview on 7/23/25 at 2:43 p.m., LVN C stated Resident #9 was on enhanced barrier precautions (infection control practices used in healthcare settings to prevent the spread of multi drug-resistant organisms) because she utilized a feeding tube. LVN C stated he should have worn a gown so there was no cross contamination. LVN C stated all residents who had feeding tubes, colostomies, and indwelling urinary catheters were placed on enhanced barrier precautions and during care staff were supposed to wear gloves and gowns. During an interview on 7/24/25 at 10:36 a.m., the ADON, who stated she had obtained certification for infection control prevention, and stated enhanced barrier precautions were utilized when providing direct care to residents who had feeding tubes, wounds, skin issues, or indwelling urinary catheters. The ADON stated, those residents on enhanced barrier precaution required the staff to use gloves and gown when providing direct care to prevent passing an infection. The ADON stated, residents who required the use of a topical medication, such as a patch were supposed to wear gloves because it was considered direct contact with the resident. The ADON stated, applying a lidocaine patch to the resident without using gloves was considered cross contamination.During an interview on 7/24/25 at 10:48 a.m., the DON stated, residents who utilized an indwelling catheter, feeding tubes, and wounds would be considered to be on enhanced barrier precautions. The DON stated it was her expectation that staff should be wearing gloves and gown when providing direct care to the resident on enhanced barrier precautions in case of encountering bodily fluids and to prevent spread of infection. The DON stated, if cross contamination were to occur, the resident could become infected.During an interview on 7/24/25 at 11:18 a.m., the RN Regional Nurse stated, the package for the lidocaine patch applied to Resident #18's lower back did not indicate that gloves needed to be used, but stated the facility policy indicated staff should be wearing gloves because it was considered an infection control issue and, you have to wear gloves and treat everybody as if they ae contagious to prevent cross contamination.Record review of the facility document titled Infection Control - Prevention and Control Program with effective date 12/2017 revealed in part, .The intent of this program is to assure that the home develops, implements, and maintains an Infection Prevention and Control Program to prevent, recognize, and control, to the extent possible, the onset and spread of infection within the facility.The program will.Prevent and control outbreaks and cross-contamination using transmission-based precautions in addition to standard precautions.Record review of the facility document titled Infection Control Precautions- Categories and Notices with effective date 12/2017 revealed in part, .It is the policy of this home to assure that appropriate (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 10 of 11 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 07/24/2025 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete precautions will be established to ensure that the necessary isolation techniques are implemented.Standard Precautions will be used in the care of all residents regardless of their diagnosis, or suspected or confirmed infection status.In addition to Standard Precautions, Contact Precautions must be implemented for residents known or suspected to be infected or colonized with microorganisms that can be transmitted by direct contact with the resident or indirect contact with environmental surfaces or patient-care items in the resident's environment.Resident-Care Equipment.non-critical patient-care equipment items such as a.sphygmomanometer (blood pressure cuff).adequately clean and disinfect them before use for another resident.For residents for who EBP are indicated, EBP is employed when performing the following high-contact resident care activities.Device care or use.feeding tube. Event ID: Facility ID: 455804 If continuation sheet Page 11 of 11