Health inspection·December 9, 2025

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to utilize nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required for 1of 1 facilities.The facility failed to ensure Staff Member A had an MA certificate from [DATE] to [DATE] for a total of 88 shifts and passed medications to residents.This failure could place residents at risk of medication errors, inaccurate assessment, and illness.The findings were: Record review of the staff roster provided by the facility on [DATE] revealed Staff Member A's title was LVN. Record review of Staff Member A's employee file revealed a hire date of [DATE] as a MA. Review of the Texas Board of Nursing license verification on [DATE] at 5:26 p.m. revealed Staff Member A had a graduation permit that was issued on [DATE] and expired on [DATE]. Record review of 4 resident's EMAR's for the facility revealed Staff Member A was signing as an MA. Record review of Staff Member A's shifts worked at the facility as a MA provided by the DON revealed Staff Member A worked the 6a-2p shift on [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], 10//27/25 through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], [DATE] through [DATE], and [DATE] 6a-5pm. This was a total of 88 shifts. Record review of a facility training for CMA's and nurses on documentation for [DATE] revealed Staff Member A signed the facility training on [DATE] at 1:45pm as a CMA.Record reviews of 4 resident records revealed no hospitalizations, harm, or negative outcomes due to Staff Member A's administration of medications to residents.Record review of TULIP application screenshot provided by the DON shows Staff Member A submitted her application for CNA examination on [DATE]. Under the NA certificate and MA permit status both say prospective.In an interview on [DATE] at 1:07 p.m., Staff Member A stated she was a GVN and had been working at the facility since March of 2025. Staff Member A stated she had been a GVN for 7 months. Staff Member A stated she was always supervised by the same nurse RN C and worked the same shift and schedule as RN C.Interview and observation with Staff A on [DATE] @ 4:30 p.m., Staff Member A pulled up her GVN number on her phone and the DON went to the Texas BON license verification portal and confirmed GVN name and number on Texas BON was expired [DATE]. Interview with DON on [DATE] @ 4:30 p.m. revealed the staff roster where Staff Member A was listed as an LVN was incorrect and she was unsure why she was listed as an LVN. The DON stated the facility was monitoring the BON status for Staff Member A. The DON then stated Staff Member A was not an MA and had not taken the MA test as she could not submit anything to the BON Page 1 of 2 455817 455817 12/09/2025 San Antonio North Nursing and Rehabilitation 501 Ogden San Antonio, TX 78212

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some or TULIP and does not have her medication aide certificate. The DON confirmed Staff Member A was listed in the facility's computer system as an MA. The DON stated Staff Member A worked as an MA or CNA but not as a nurse since she was hired at this facility. The DON stated she was not aware of the expirations or that she had no MA certificate or that her CNA certificate had expired. The DON stated Staff Member A had always worked with a nurse's supervision and there had been no medication errors or incidents with Staff Member A administering medications. The DON stated Staff Member A only worked on the first-floor halls, which currently consisted of 40 residents. In an interview on [DATE] at 6:20 p.m., the HRD stated she had verified Staff Member A's GVN was expired upon hire, and she had no LVN license and she had no MA certificate. The HRD stated she informed the DON and the DON told her it was okay because she was going to work with Staff Member A in preparation for her licensure exam. In an interview on [DATE] at 6:45 p.m., the DON stated the possible consequences of staff not having certifications or permits could be complications in general but there had not been any. Interview with Administrator on [DATE], Administrator stated he was not aware that Staff A did not possess a current MA certificate. Review of the facility policy on license verification undated but at the bottom uses references dated 2025 with a copyright for 2025 revealed All personnel that require a license or certification shall be verified through the appropriate issuing agency. 1. The Human Resources Director, or designee, is responsible for maintaining and ensuring the validity and current status of individual certification/licensure. 2. An individual will not be employed and or/will be terminated from employment (whichever case may apply) if: a. The individual has lost licensure/certification for any reason. 455817 Page 2 of 2