Inspection·November 25, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete revealed he had originally spoken with the rounding physician regarding Resident #6's need for a larger Bariatric bed and trapeze on 08/29/2025 and the physician had agreed with the recommendations and approved the orders along with the implementation of the equipment as soon as possible. He stated he had tried to follow up numerous times with the Administrator, DON and Corporate RVP to see if the order for the equipment had been placed but was unable to get either a purchase order or confirmation of purchase from any of these staff members. An interview with the DON on 11/20/2025 at 10:39AM revealed she had a copy of an order for the larger Bariatric bed and trapeze from the rounding physician bearing today's date. She stated she was unable to say why the bed and trapeze had not been purchased in August when the therapist and rounding physician had originally given the order due to Resident #6's medical necessity, other than the equipment was not available for purchase. The DON was unable to produce a purchase order for the equipment and stated today was the first time she had been notified of Resident #6's need for the equipment. An interview with the DON on 11/20/2025 at 2:22PM revealed a purchase order for the equipment was placed on 11/14/2025 but review of the purchase order did not confirm the equipment had actually been ordered or paid for by the facility. The purchase order showed the equipment in the cart of the Administrator, but there was no indication of a credit card being utilized for the purchase. Review of facility policy entitled Resident Rights dated October 2024 revealed the following:You have a right to request reasonable accommodation, which is a change in policy or practice, communication, or the physical space needed for a person to have equal opportunity to use their home. Examples include requests to add a ramp to a building, adaptive equipment needed to maintain activities of daily living, allowing you to use a service animal, and making information about your care easy to understand. Event ID: Facility ID: 455804 If continuation sheet Page 2 of 14 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 11/25/2025 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 0563 Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews the facility failed to ensure residents had the right to receive visitors of his or her choosing at the time of his or her choosing, subject to the resident's right to deny visitation when applicable, and in a manner that does not impose on the rights of another resident.The facility failed to ensure door access to residents after 8:00PM daily for 1 of 10 residents (Resident #3) reviewed for visitation rights.This failure could lead to reduced communication and contact between residents, families and others, resident isolation and a decreased quality of life. Findings included: Record review of Resident #3's admission record dated 11/19/2025 revealed Resident #3 was an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #3 had diagnoses of Alzheimer's Disease with late onset, Dysphagia, Oropharyngeal Phase (swallowing difficulties due to neurological or muscular impairments), Other Abnormalities of Gait and Mobility, Vascular Dementia (cognitive impairment due to loss of blood flow to the brain), moderate with other behavioral disturbance, Major Depressive Disorder, single episode, moderate; Other Specified Anxiety Disorders; Muscle Weakness, generalized; Cognitive Communication Deficit and Other Lack of Coordination.Resident #3's annual MDS dated [DATE] reflected Resident #3 had a BIMS score of 00 indicating severe cognitive impairment.An interview with Resident #3's POA on 11/19/2025 at 9:05AM revealed the POA had to come to the facility prior to 8:00PM to see Resident #3 due to the front door being locked and no one answering the doorbell after 8:00PM. She stated Resident #3 had an electronic surveillance device in her room and the POA had asked staff entering the room to come to the front door because she had been standing there and no one had answered the doorbell. The POA stated she had spoken with the DON, the Administrator and the Corporate RVP regarding the door not being answered after 8:00PM, but nothing had been done to rectify the situation.An interview with the DON and Administrator on 11/21/2025 at 10:15AM revealed the DON thought the door alarm for the front door was attached to the fire system, so the facility could not have a push button that could be used by families to enter through the front door at their leisure. She stated discussion had taken place regarding an on-call phone number being posted outside the front door for families to call to request entrance to the facility but had not been put into place by the leadership team. The Admn. stated the leadership team had discussed a schedule for the team to cover phone/door duty but the schedule had not been put into practice. She was unable to answer what families were to do when leadership team members were not in the building, particularly after regular business hours, but thought a solution might be to give one of the charge nurses a cordless phone so they could answer the phone or door if needed. Review of facility policy entitled Resident Rights dated February 2021 revealed the following: Policy Statement: Employees shall treat all residents with kindness, respect, and dignity.Policy Interpretation and Implementation1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the residents' right to:f. communication with and access to people and services both inside and outside the facility;aa. visit and be visited by others from outside the facility;bb. be informed of safety or clinical restrictions or limitations of visitation;cc. access to a telephone, mail and email;dd. communicate in person and by mail, email and telephone with privacy.Review of facility policy entitled Visitation dated September 2022 revealed the following:Policy Statement:Our facility permits residents to receive visitors subject to the residents' wishes and the protection of the rights of other residents in the facility.Policy Interpretation and Implementation:1. Residents are permitted to have visitors of their choosing at the time of their choosing.2. The facility provides 24-hour access to individuals visiting with the consent of the resident. 3. Family Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 3 of 14 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 11/25/2025 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 0563 Level of Harm - Minimal harm or potential for actual harm members are designated by the resident or resident representative. Immediate family is not limited to individuals related by blood, adoption, marriage or common law.4. Visitors may include, but are not limited to:a. spouses (including same-sex and transgender spouses).b. domestic partners (including same-sex and transgender domestic partners). c. other family members; andd. friends. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 4 of 14 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 11/25/2025 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 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to ensure residents had the right to reasonable access to the use of a telephone and a place in the facility where calls can be made without being overheard.The facility failed to protect and facilitate residents' right to communicate with individuals and entities within and external to the facility, including reasonable access to a telephone, for 2 of 10 residents (Resident #4 and Resident #10) reviewed for Resident Rights.Resident #4 had a personal cell phone but was unable to use it due to decline in visual impairment.Resident #10 did not have a personal cell phone and the only means of outside communication was through a facility-provided telephone.These failures could lead to reduced communication and contact between residents, families and others, resident isolation, and decreased quality of life. Findings Included: Record review of Resident #4's admission record dated 11/19/2025 revealed Resident #4 was a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #4 had a diagnoses of Other Acute Osteomyelitis (infection of a bone), Right Femur; Presence of Right Artificial Hip Joint; Subacute Osteomyelitis (bone infection of more than 2 weeks), Right Femur; Generalized Anxiety Disorder; other Speech and Language Deficits following Cerebral Infarction (stroke); Difficulty in Walking, not elsewhere classified; Depression, unspecified; Major Depressive Disorder, recurrent, moderate; Anxiety Disorder, unspecified; other Chronic Pain; Hemiplegia and Hemiparesis (weakness on half the body) following Cerebral Infarction affecting left non-dominant side; Hemiplegia, unspecified affecting left non-dominant side; other Abnormalities of Gait and Mobility; other Lack of Coordination, and Muscle Weakness, generalized. Resident #4 had a BIMS score of 13, indicating she was cognitively intact. An interview with Resident #4's Emergency Contact on 11/20/2025 at 11:42AM revealed Resident #4 had a personal cell phone but was unable to understand how the phone was used at times, due to rapid decline in visual function. He stated he called the facility almost daily to inquire how Resident #4's day had been and to see how she was feeling. The Emergency Contact stated the telephone rang multiple times every time he called but was rarely answered. The Emergency Contact stated he inquired about Resident #4's use of a landline phone when he spoke with the Activities Director and was told there was a cordless phone that was used by residents on the hallway where Resident #4 lived.Record review of Resident #10 admission record dated 11/20/2025 reflected Resident #10 was an [AGE] year-old female who was admitted to the facility on [DATE].Resident #10 had a diagnosis of Difficulty in Walking not Elsewhere Classified, Muscle Weakness (Generalized), Dysphagia, Oral Phase (swallowing disorder), Other Chronic Pain, Other Specified Anxiety Disorders, Other sequelae of Cerebral Infarction (loss of consciousness during a stroke), Vascular Dementia (cognitive impairment due to loss of blood to the brain), Moderate, without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance, and Anxiety, Other Atrioventricular Block (problem of heartbeat signal from top to bottom of heart), Chronic Diastolic (Congestive) Heart Failure and Other Speech and Language Deficits following Cerebral Infarction. Record review of Resident #10's Resident #10 had a BIMS score of 15 indicating she was cognitively intact.An interview with Resident #10 on 11/20/2025 at 1:18PM revealed she did not have a cell phone for her personal use and the cordless phone that could be used by residents who lived on the hallway was not in operating order. She stated she had asked the nursing staff many times about the cordless phone and had been told the phone needed charging or was not in working order.Observation of the cordless phone on the 300/400 hallway reflected it was not plugged into a power source, and the wiring had been pushed into a hole in the wall behind the phone.An interview with the DON on 11/20/2025 at 1:24PM while inspecting the phone revealed the phone worked fine and there were no issues with residents Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 5 of 14 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 11/25/2025 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 0576 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete using the phone. She was shown the phone with the wiring not plugged into a power source and the cords pushed into a hole behind the phone and stated the maintenance man would have to look at it. The maintenance man approached during the conversation and stated the phone had not worked for an undetermined period of time and he would inquire about getting a new phone for the hallway. He stated the residents could have walked to the 100/200 hall and used their cordless phone but was unable to say how the bed bound residents were to access a phone if they did not possess a personal cell phone.An interview with the DON and Administrator on 11/21/2025 at 10:15AM revealed the DON thought the door alarm for the front door was attached to the fire system, so the facility could not have a push button that could be used by families to enter through the front door at their leisure. She stated discussion had taken place regarding an on-call phone number being posted outside the front door for families to call to request entrance to the facility but had not been put into place by the leadership team. The Admn. stated the leadership team had discussed a schedule for the team to cover phone/door duty but the schedule had not been put into practice. She was unable to answer what families were to do when leadership team members were not in the building, particularly after regular business hours, but thought a solution might be to give one of the charge nurses a cordless phone so they could answer the phone or door if needed. Review of facility policy entitled Resident Rights dated February 2021 revealed the following: Policy Statement:Employees shall treat all residents with kindness, respect, and dignity.Policy Interpretation and Implementation1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the residents' right to:f. communication with and access to people and services both inside and outside the facility;aa. visit and be visited by others from outside the facility;bb. be informed of safety or clinical restrictions or limitations of visitation;cc. access to a telephone, mail and email;dd. communicate in person and by mail, email and telephone with privacy. Event ID: Facility ID: 455804 If continuation sheet Page 6 of 14 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 11/25/2025 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 - Few 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 observations, interviews and record reviews the facility failed to ensure that the resident environment remains as free of accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents for 1 of 10 residents (Resident #1) reviewed for smoking safety.The facility failed to ensure that a resident did not keep cigarettes and a lighter in their personal possession.This failure could lead to risk of injury, potential fire incidents and a decreased quality of life.Findings included:Record review of Resident #1's admission record dated 11/18/2025 reflected a [AGE] year-old female who was admitted to the facility on [DATE] with the following diagnosis: chronic obstructive pulmonary disease with (acute) exacerbation; other persistent atrial fibrillation; cough, unspecified; other hereditary and idiopathic neuropathies; other muscle spasm, and insomnia, unspecified. Record review of Resident #1's quarterly MDS dated [DATE] revealed Resident #1 had a BIMS score of 15, indicating she was cognitively intact. Resident #1 was fully ambulatory and required supervision to no assistance with ADLs. Resident #1's revised care plan dated 10/02/2025 reflected a Focus of Resident #1 was a smoker, Goals of no complications from smoking through next review and stop keeping cigarettes in her own possession in her room and Interventions of assess smoking safety quarterly and as needed; provide supervised smoking as needed; store cigarettes safely and store lighter safely.Resident #1's revised care plan dated 10/02/2025 also reflected a Focus of Resident was a safe smoker as determined through assessment, Goals of Resident will be allowed to smoke with supervision per facility policy, will follow the requirements of the facility smoking policy, will not be injured as a result of smoking and will not hide cigarettes and lighters in her room, through the next review date and Interventions of Assess resident's ability to smoke safely, observe resident for adherence to smoking policy, provide resident with copy of facility smoking policy and explain policy to resident/family and refer non-compliance with smoking policy to the administrator and social services.Record review of Resident #1's smoking assessment dated [DATE] reflected she was not required to wear a smoking vest and was deemed a safe smoker.An observation of Resident #1 on 11/18/2025 at 1:59PM revealed Resident #1 in her room, preparing to go outside for a smoking break with her cigarettes and lighter in her room atop her bedside table. In an interview on 11/18/2025 at 2:02PM Resident #1 stated she was allowed to keep her cigarettes and lighter in her room because she was a safe smoker and did not require anyone to keep them for her. Resident #1 stated she did not have to go outside with the other smokers in the facility and was allowed to smoke whenever she desired. She stated she knew what the facility policy was regarding smoking and keeping cigarettes and lighters in her room but did not have to follow the policy due to being a safe smoker. An interview with the Corporate RVP on 11/19/2025 at 12:07PM revealed it was against facility policy for residents to keep cigarettes and/or lighters in their rooms, regardless of safe smoker status. He stated Resident #1 should have given her cigarettes and lighter to whomever was supervising the smoke break, so they were locked in the smoking lock box with all other resident's cigarettes and lighters. He was unable to say why the cigarettes and lighter had not been confiscated from Resident #1 by the smoking attendant, other than it was against facility policy to search resident's persons or rooms, even if they were care planned for hiding their cigarettes. An interview with the DON on 11/19/2025 at 12:19PM revealed Resident #1 was a safe smoker and was allowed to smoke unsupervised.An interview with the Corporate RVP and DON on 11/19/2025 at 12:22PM revealed the DON stated to the Corporate RVP that all smokers were to be supervised while smoking and their cigarettes and lighters were to be given to the smoking attendant when they finished smoking. The Corporate RVP told the DON he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 7 of 14 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 11/25/2025 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 - Few would have to discuss this discrepancy with what she had told me, with the corporate team to ensure policy was being followed.Review of Resident #1's smoking assessment dated [DATE] reflected she was not required to wear a smoking vest and was deemed a safe smoker. Review of facility smoking in-service dated 04/08/2025 revealed 16 staff members who were designated as smoking attendants attended the in-service. Each staff member received a copy of the Smoking Policy, Staff Smoking Monitoring Reminders, a list of residents who smoked and their smoking vest/apron status and the smoking times along with which department would be in charge of supervision during those times. Review of the Staff Smoking Monitoring Reminders revealed the following: Designated smoking times are 8:30AM (Activities), 11:00AM (Housekeeping Staff), 2:00PM (Dietary Staff), 5:00PM (Nursing Staff) and 8:00PM (Nursing Staff). Please report at your designated time. Staff will ensure that residents who require smoking aprons/vests have them on and are properly placed. Each resident has their own apron/vest. When finished, please sanitize the vests and place them back in their bag. Ensure no oxygen tanks are present during smoking time. Only 1 cigarette may be given at a time; not multiple. Smoking sessions last 20 minutes; last cigarette may be lit within the 15-minute mark. All ash trays will be emptied in the red can after each smoking session. Please no trash in the red can. No sharing or gifting of cigarettes between residents. If resident is new to the building, please ensure a smoking assessment has been done prior to the resident smoking. Check with a nurse. Smoking will be done behind the yellow/black tape. Doors closer to the kitchen will be used to exit/enter for smoke breaks. Please make sure both doors are properly aligned and the alarm back on at the end of the smoke break. Fire blanket is available in the red box on the wall.Review of facility smoking in-service dated 06/06/2025 revealed 9 staff members were in attendance and documentation of the number of cigarettes given to each smoking resident during a smoking session and when a new pack was provided were discussed. The documentation sheet was to be kept in the lock box along with the residents' cigarettes and lighters. Observation of the documentation sheet on 11/19/2025 at 2:00PM revealed it had not been filled out for the past 30 days. An interview with the dietary staff member on duty on 11/19/2025 at 2:04PM revealed she was unaware of the sheet and had not attended the meeting back in June because she had not worked at the facility at that time. The dietary staff member stated she always passed the cigarettes out to each resident and lit their cigarettes separately to ensure the cigarettes and lighters were returned to the lock box. She stated she had never seen Resident #1 try to hide or keep her cigarettes and lighter.Review of facility Smoking Meeting minutes dated 09/30/2025 revealed Resident #1 was in attendance at the meeting and received a copy of the smoking policy. The items discussed included smoking in designated areas only and safety precautions. Review of facility Smoking Policy dated October 2022 revealed the following:Policy Statement: This facility shall establish and maintain safe resident smoking practices.Policy Interpretation and Implementation:1. Prior to and upon admission, residents shall be informed of the facility smoking policy, including designated smoking areas, and the extent to which the facility can accommodate their smoking or non-smoking preferences.2. Smoking is not permitted in the facility under any circumstances.3. Smoking is only permitted in designated areas, which are located outside of the building. 4. Oxygen use is prohibited in smoking areas. 5. Metal containers, with self-closing cover devices, are available in smoking areas.6. Ashtrays are emptied only into designated receptacles.7. The resident will be evaluated on admission to determine if he or she is a smoker or non-smoker. If a smoker or smokeless tobacco user the evaluation will include:a. Current level of tobacco consumption.b. Method of tobacco consumption (traditional cigarettes; electronic cigarettes; pipe, etc.).c. Desire to quit smoking if a current smoker, andd. Ability to smoke safely with or without supervision (per a completed smoking assessment). 8. A resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 8 of 14 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 11/25/2025 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete ability to smoke or chew tobacco safely will be re-evaluated quarterly, upon a significant change (physical or cognitive) and as determined by staff.9. Any smoking-related and smokeless tobacco use privileges, restrictions, and concerns shall be noted in the care plan and all personnel caring for the resident shall be alerted to these issues.10. Residents are not permitted to give smoking articles to other residents.11. Residents may not keep or have any smoking articles, including cigarettes, tobacco, lighters, etc., except when they are under direct supervision.12. This facility maintains the right to confiscate smoking articles found in violation of our smoking policies. Event ID: Facility ID: 455804 If continuation sheet Page 9 of 14 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 11/25/2025 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 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews the facility failed to provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident for 1 of 10 resident (Resident #6) reviewed for Diet Meets the Needs of Each Resident.The facility failed to ensure Resident #6 received the prescribed therapeutic diet.This failure could place residents at risk of their nutritional needs not being met. Findings included:Record review of Resident #6's admission record dated 11/19/2025 reflected a [AGE] year-old male who was admitted to the facility on [DATE].Resident #6 had a diagnoses of Acute Respiratory Failure with Hypoxia (low levels of oxygen in muscle tissues); Muscle Weakness (Generalized); Difficulty in Walking, Not Elsewhere Classified; Unspecified Lack of Coordination, Mild Intermittent Asthma, Uncomplicated; Pain in Right Shoulder; Age-related Osteoporosis without Current Pathological Fracture (progressive bone density loss in aging adults); Body Mass Index (BMI) 70 or greater; Morbid (Severe) Obesity due to excess calories; Post-traumatic Stress Disorder, Chronic; Bipolar Disorder, Current Episode Mixed, Moderate, and Major Depressive Disorder, Recurrent, Moderate.Resident #6's annual MDS dated [DATE] reflected Resident #6 had a BIMS score of 15 indicating he was cognitively intact.Record review of Resident #6's dietary orders dated 10/16/2024 reflected he was to receive a Regular diet; Regular texture, thin liquids; Double portions of protein at all meals and double portions of vegetables at lunch and dinner.An interview with the Ombudsman on 11/18/2025 at 4:36PM revealed Resident #6 had communicated with the Ombudsman concerning not receiving his prescribed meal portions. She stated Resident #6 had sent her several photos of his meal tray tickets and the accompanying meal. The Ombudsman stated in most of the photos, the tray tickets indicated Resident #6 was to receive double portions of protein at all meals and double portions of vegetables at lunch and dinner, but the accompanying photo of the meal tray did not depict portions prescribed by the physician.An interview with Resident #6 on 11/19/2025 at 1:50PM revealed Resident #6 was a Bariatric patient who weight approximately 559 pounds. Resident #6 was a good historian and produced several photos from an undetermined amount of time, that showed he had not received his prescribed diet. Resident #6 produced photos of the tray ticket from his lunch tray today and the accompanying entree. Photo #1 showed the tray ticket that was on the tray of food he received at lunch today. The tray ticket indicated he was allergic to fish and a tuna salad sandwich was on the menu. The substitution was a ham and cheese sandwich with French fries.The accompanying photo (photo #2) depicted the plate Resident #6 received, which consisted of 2 ham and cheese sandwiches and a serving of French fries. The prescribed double portion of protein was satisfied by the ham and cheese sandwiches, but the serving of French fries did not satisfy the double portion of vegetables which were prescribed.Photo #3 depicted the breakfast tray ticket from yesterday, 11/18/2025. The tray ticket showed Resident #6 should have received a 4-ounce glass of juice, 8 ounces of cereal of choice, 1 slice of bacon 8 ounces of scrambled eggs, 1 slice of bread of choice, 1 pat of margarine, 1 tablespoon of jelly, 8 ounces of milk and 8 ounces of another beverage of choice. The ticket showed Double Protein circled and the Resident's request for fried eggs.The accompanying photo (photo #4) depicted 1 serving of scrambled eggs, one slice of toast and one sausage patty. There was also a container of margarine on the tray. There was no cereal, juice, bacon, jelly, milk or another beverage.The text message that accompanied the photo of the breakfast place that was sent to this investigator by Resident #6 describe the following: Because of budget that are always running out of food, and you don't get your full meal. If you don't have family that can send you food, you're in bad (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 10 of 14 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 11/25/2025 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 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete shape. The facility gets paid to house, feed us and take care of our needs, but out of greed, the facility is trying to cut corners.Photo #5 showed the dinner tray ticket from 11/04/2025 which indicated Resident #6 should have received 3 ounces of glazed meatloaf, 4 ounces of roasted red potatoes, 4 ounces of green beans, a roll, margarine, a 4-ounce gelatin parfait and an 8-ounce beverage of choice. Again, Double Protein and Vegetables is circled on the ticket.The accompanying photo of the dinner plate Resident #6 received (photo #6) depicted 2 slices of meatloaf, 2 scoops of mashed potatoes with gravy and a serving of what appeared to be cooked red cabbage. Resident #6 also received vanilla pudding and iced tea. There were no red potatoes, green beans, roll or parfait on Resident #6's tray.An interview with the Dietary [NAME] on 11/20/2025 at 9:45AM revealed he did not think that French fries or mashed potatoes qualified as a vegetable. He stated both are starches. He also stated residents could receive fried eggs, if requested.An interview with the Administrator and DON on 11/20/2025 at 9:52AM revealed the Administrator and DON did not think French fries or mashed potatoes were considered vegetables. The Administrator stated residents could have eggs prepared however they pleased, but there were no fresh eggs in the kitchen, due to the new management company did not allow fresh eggs to be served. The Administrator stated she would have to contact the corporate office to get a list of vegetables that could be served.Record review of the facility's Dining Master list of foods did not indicate what foods were considered to be vegetables, rather it showed serving sizes for various vegetables.Observation of the kitchen and the refrigerators on 11/21/2025 at 9:30AM reflected the following:7 heads of Romaine lettuce1 partial 10-pound box of fresh onions, and1 partial 10-pound box of fresh tomatoesObservation of the freezer reflected the following:(2) 2-pound bags of frozen green beans1 partial 20-pound box of frozen cut carrots, and1 partial 20-pound box of frozen Capri blend vegetables.There were no fresh fruit or eggs.An interview with the Dietary Manager on 11/21/2025 at 9:42AM revealed the new management company had cut her food budget and she did not have enough money to purchase fresh items for the residents. She stated 6 heads of lettuce from their distributer cost $30 and she used to get an entire case of lettuce for that price. She stated she had spoken with the management team regarding the issue, but they were not concerned about the residents receiving fresh food. She stated, If my residents want something I should be able to give it to them. It breaks my heart to not be able to give them what they want. She stated she used to be able to offer a hamburger/cheeseburger plate and/or a chef salad as an alternative choice but had been told both were too expensive and would not be provided. She also stated there often was not enough food to provide what would be considered to be a double portion of food, as she was only allowed to cook for the number of residents in the building. She stated this number did not consider second helpings or double portions. If the recipe stated it was 50 servings, that was all she was allowed to prepare.Review of facility policy Therapeutic Diets dated 04/2021 reflected the following:Policy Statement:Therapeutic diets are an integral part of resident well-being and nutrition and shall be served accordingly.Policy Interpretation and Implementation: The Physician shall give an order for all therapeutic diets served to residents. Physician orders shall be followed without exception.a. Substitutions can be made for resident allergies and preference according to the physician's order and review from the registered dietician. The facility will provide all necessary food to fulfill the physician's order, including protein shakes and fortified foodsThe registered dietician could not be reached for comment. Event ID: Facility ID: 455804 If continuation sheet Page 11 of 14 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 11/25/2025 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 observations, interviews and record reviews the facility failed to establish and maintain an infection control program designed to provide a safe sanitary, and comfortable environment for 6 of 10 residents (Resident #3, Resident #4, Resident #5, Resident #6, Resident #7, Resident #8 and Resident #10) reviewed for infection control.The facility failed to ensure residents who lived on the 300/400 hallway of the facility received showers in a room that was free of potentially infectious debrisThe facility failed to ensure Resident #4, and Resident #6 were screened for tuberculosis prior to or upon admission to the facility and annually.These failures could cause the spread of infections from one resident to another, leading to sickness and a decreased quality of life. Findings included:Record review of Resident #3's admission record dated 11/18/2025 revealed she was an [AGE] year-old female who was admitted to the facility on [DATE].Resident #3 had a diagnosis of Alzheimer's Disease with Late Onset, Pressure-induced Deep Tissue Damage of Left Heel, Dysphagia, Oropharyngeal Phase (disruption or delay of swallowing), Vascular Dementia (decreased blood-flow to areas of the brain), Moderate, with Other Behavioral Disturbance, Major Depressive Disorder, Other Specified Anxiety Disorders, Muscle Weakness, Generalized, and Kidney Disease, Stage 3A (kidneys are working at about 49-52% of usual function).Resident #3's Annual MDS dated [DATE] revealed she had a BIMS score of 00 indicating severe cognitive impairment.Record review of Resident #4's admission record dated 11/19/2025 revealed a [AGE] year-old female who was admitted to the facility on [DATE].Resident #4 had a diagnosis of Other Acute Osteomyelitis (bone infection), Right Femur, Generalized Anxiety Disorder, Other Speech and Language Deficits following Cerebral Infarction (stroke), Major Depressive Disorder, Hemiplegia and Hemiparesis (paralysis or muscle weakness) following Cerebral Infarction, Methicillin Susceptible Staphylococcus Aureus Infection (infection that is sensitive to Methicillin antibiotics) as the Cause of Diseases Classified Elsewhere, Muscle Weakness, and Other Abnormalities of Gait and Mobility.Resident #4's Quarterly MDS dated [DATE] revealed she had a BIMS score of 13 indicating she was cognitively intact.Resident #5's admission Record dated 11/19/2025 revealed she was a [AGE] year-old female who was admitted to the facility on [DATE].Resident #5 had a diagnosis of Unspecified Dementia, Severe, with Other Behavioral Disturbance, Vascular Dementia, Moderate, without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance, and Anxiety, Dysphagia (difficulty swallowing), Oral Phase, Generalized Idiopathic Epilepsy and Epileptic Syndromes, Not Intractable, without Status Epilepticus (epilepsy that does not respond to treatment), and Chronic Embolism and Thrombosis of Unspecified Vein (blood clots that start in the veins of the lower extremities).Resident #5's Quarterly MDS dated [DATE] revealed she had a BIMS score of 06 indicating she was severely cognitively impaired.Resident #6's admission Record dated 11/19/2025 revealed a [AGE] year-old male who was admitted to the facility on [DATE].Resident #6 had a diagnosis of Acute Respiratory Failure with Hypoxia (respiratory failure with low levels of oxygen in body tissues), Muscle Weakness, Generalized, Difficulty in Walking, not Elsewhere Classified, Mild, Intermittent Asthma, Rash and Other Non-Specific Skin Eruption, Post-Traumatic Stress Disorder, Morbid Obesity (Severe), Body Mass Index of > 70, and Other Heart Failure.Resident #6's Annual MDS dated [DATE] revealed he had a BIMS score of 15 indicating he was cognitively intact.Resident #7's admission Record dated 11/20/2025 revealed she was a [AGE] year-old female who was admitted to the facility on [DATE].Resident #7 had a diagnosis of Parkinson's Disease without Dyskinesia (Parkinson's Disease without involuntary muscle movements), without mention of Fluctuations, Hypertensive Heart Disease (Heart issue caused by high blood pressure) without Heart Failure, Mild, Intermittent Asthma, Uncomplicated, and Diverticulitis of Intestine, Part Unspecified, without Perforation, Abscess, or Bleeding Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 12 of 14 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 11/25/2025 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 (inflammation or infection of the pockets in the lining of the intestine).Resident #7's admission MDS dated [DATE] revealed she had a BIMS score of 14 indicating she was cognitively intact.Resident #8's admission Record dated 11/24/2025 revealed a [AGE] year-old female who was admitted to the facility on [DATE].Resident #8 had a diagnosis of Cellulitis (Infection and swelling of the skin) of Left Lower Limb, Other Recurrent Depressive Disorders, Pressure Ulcer of the Sacral Region, Stage 4 (full-thickness tissue loss with exposure of underlying muscle, tendon, or bone at the base of the spine).Resident #8's admission MDS dated [DATE] revealed she had a BIMS score of 15 indicating she was cognitively intact.Resident #10's admission Record dated 11/24/2025 revealed an [AGE] year-old female who was admitted to the facility on [DATE].Resident #10 had a diagnosis of (the body's inability of process sugar) without Complications, Difficulty in Walking, not Elsewhere Classified, Muscle Weakness, Generalized, Dysphagia (swallowing difficulty), Oral Phase, Other Speech and Language Deficits Following Cerebral Infarction (stroke), and Vascular Dementia (memory difficulties related to lack of blood flow to the brain), Moderate, without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance and Anxiety.Resident #10's Quarterly MDS revealed she had a BIMS score of 15 indicating she was cognitively intact.An interview with Resident #6 on 11/19/2025 at 1:50PM revealed Resident #6 had just returned from independently taking a shower in the shower room on the 300/400 hallway. He stated a soiled brief, and soiled linens were on the floor when he entered the room, and a dirty bath towel had been left on a shower chair. He stated he was usually the last person on the hallway to take a shower because most of the residents on the hallways took their showers at night or early in the morning or received bed baths.An interview with Resident #5 on 11/19/2025 at 2:35PM revealed Resident #5 utilized the shower room on the 300/400 hallways but had not seen dirty linens or other debris on the floor or shower chair.An observation of the shower room on the 300/400 hallway on 11/19/2025 at 5:10PM revealed the soiled brief and soiled linens described by Resident #6, along with a dirty bath towel sitting on the shower chair. Pictures of these items were taken and shown to the Administrator, DON and Corporate RVP.An interview with the Administrator, DON and Corporate RVP on 11/19//2025 at 5:22PM reflected the Corporate RVP stated he was appalled at the photos of the soiled brief and linens. The Administrator stated the photos could not be accurate, as the shower room was cleaned by housekeeping after each use.An interview with the Corporate RVP on 11/19/2025 revealed the photos of the shower room had been taken minutes before they were shown to him, the Administrator and the DON during the discussion in the Administrator's office. The Corporate RVP stated the corporate leadership team were trying to put many new protocols into place and everything they were doing was going to take time. He stated he knew this was not an answer that justified the photos and residents should not have to suffer while new practices were being put into place. He stated he was working with the Administrator and DON to try to get the new processed moving more quickly and efficiently. The Corporate RVP stated he was unsure whether there was a specific company policy regarding infection control in the showers, but would get the policy for me, if it were available.An interview with Resident #10 on 11/20/2025 at 12:34PM revealed Resident #10 used the shower on the 300/400 hallway and had seen dirty towels on the floor on different occasions. She stated she thought the housekeeping staff probably picked them up and took them to the laundry. She stated she had not thought about the towels being potentially infectious.An interview with an unnamed housekeeper on 11/20/2025 at 1:50PM reflected she cleaned the shower after every use, and the dirty linens were placed in a laundry bag and taken to the laundry. She stated the negative outcome of soiled or infectious linens and briefs being left on the floor and shower chair in the shower room was they could potentially pass infection from one resident to another, if they were handled without gloves.Record review of Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455804 If continuation sheet Page 13 of 14 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 11/25/2025 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 #4's Physician Orders reflected no physician's order for admission/annual TB screening. Resident #4 was admitted to the facility on [DATE] and the orders reflected there was no TB screening done prior to or at admission, nor was there evidence of a screening being performed within the last year.Record review of Resident #6's Physician Orders reflected a physician's order for annual TB screening. Resident #6 was admitted to the facility on [DATE] and progress notes from the date of admission reflected Resident #6 tested negative for TB at admission, but he had not been screened for TB annually.Facility policy for Infection Control related to showers dated 03/2024 revealed the following:Use Standard Precautions for the care of all residents when contact with blood or body fluids are likely. Standard Precautions should be used during every interaction with a resident regardless of suspected or confirmed infection status.Standard Precautions include:Hand hygieneUse of Personal Protective Equipment, (PPE)Respiratory hygiene/cough etiquetteWaste disposalCleaning and DisinfectingStandard Precautions for:BloodBody fluids, secretions, and excretions (except sweat)Mucous membrane and non-intact skin (of resident or nurse aide)Contaminated items: Linen and equipment soiled with blood or body fluids should be handled carefully and discarded in biohazard bags that are puncture-resistant, leak-proof, and labeled with a biohazard symbol or red in color. Such items may also include used PPE and disposable rags and cloths. Contaminated environmental surfaces should be cleaned and disinfected following facility policy. Disposal of biohazardous waste should be done following facility policy for proper handling, labeling and disposal of items contaminated with blood or body fluids.Contact Precautions: Use Contact Precautions as ordered (in addition to Standard Precautions) to control infections spread by direct or indirect contact with certain pathogens and parasites such as MRSA, head lice, scabies, and C-Diff.Wash hands and put on glove before entering the isolation room. Wear a gown if your skin or clothing will have substantial contact with the resident or the environment.Remove and discard gloves and gown and wash hands (usually with antimicrobial soap) before leaving the shower room.Facility policy for Screening Residents for Tuberculosis dated August 2019 reflected the following: Policy Statement:This facility shall screen all residents for tuberculosis infection and disease (TB). Individuals identified with active TB disease shall be isolated from other residents and ancillary staff and transported to an appropriate care facility as soon as possible.Policy Interpretation and Implementation:1. The admitting nurse will screen referrals for admission and readmission for information regarding exposure to or symptoms of TB.2. Signs and symptoms of TB include:a. Coughing for > 3 weeks;b. Loss of appetite;c. Fatigue;d. Weight loss;e. Night sweats;f. Bloody sputum or hemoptysis;g. Hoarseness;h. Fever; and/[NAME]. Chest pain.3. Individuals with signs and symptoms of active TB disease shall be isolated from other residents and ancillary staff and transported to an appropriate care facility as soon as possible.4. Screening of new admissions or readmissions for TB infection and disease is in compliance with state regulations. Event ID: Facility ID: 455804 If continuation sheet Page 14 of 14