Health inspection·May 16, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm at 8:25 PM [ after surveyor inquired of the Administrator on 5/14/25 was law enforcement contacted about the alleged sexual abuse of Resident #1]. Record review of facility's internal investigation file dated 5/13/25 reflected: No law enforcement case number. Residents Affected - Few During joint interview with the Administrator and DON on 5/14/25 at 11:15 AM, the Administrator stated the facility made a self-report on 5/13/25 to HHS. The Administrator stated, Resident #1's RP alleged that an agency CNA [A] inappropriately trounced, in the peri-area, of Resident #1, when providing incontinent care on 5/11/25. The Administrator stated, the interventions put in place included: Resident #1 sent to ER for an assessment; and returned 5/14/25 with no negative findings. The Administrator stated the agency CNA [A] was suspended; and in-service started on ANE; and internal investigation initiated. The DON stated that Resident #1 experienced no psychosocial harm and there was no signs and symptoms of sexual abuse. The DON stated, Resident #1 had not withdrawn from activities, accepted treatment, and services, and smiled this morning [5/14/25]. Both the Administrator and the DON stated that law enforcement was not contacted when the initial allegation of sexual abuse was made on 5/13/25 and not immediately contacted when Resident #1's hospital discharge record dated 5/14/25 documented an assessment for an alleged incident of sexual abuse. During an interview on 5/14/25 at 2:00 PM, the Hospital Nurse stated, Resident #1 did not have the capacity to consent to sexual contact. The Hospital Nurse stated, during the assessment (5/13/25), Resident #1 had redness in the genital (vaginal) area and the resident became tense during the assessment; and the assessment was not fully completed. The Hospital Nurse stated the resident was given a prophylactic medication to treat any STD. The Hospital Nurse stated the expectation was when there was an allegation of sexual abuse law enforcement had to be contacted. During an interview on 5/14/25 at 4:05 PM, admission Supervisor stated: he did not know whether law enforcement was called at the time of the incident or when the grievance was filed on 5/13/25. During an interview on 5/14/25 at 4:41 PM, the SW stated: she did not know whether the Administrator, when alerted on 5/13/25 around 1:30 PM about an alleged abuse of Resident #1 by a CNA [A], called law enforcement. During telephone interview, in Spanish, on 5/14/25 at 3:00 PM the RP stated, the alleged incident of abuse occurred on 5/11/25 around 10:00 PM. The RP stated he alerted the facility on 5/13/25 in the early afternoon and expected that Resident #1 was sent to the ER for an evaluation and law enforcement notified of a possible physical or sexual abuse. The RP stated that Resident #1 alleged the incident of sexual abuse. During telephone interview on 5/15/25 at 9:41 AM, LVN E stated the procedure the facility should follow when there was an allegation of abuse, either physical or sexual, was: immediate assessment of the resident, notification to the MD and RP, call to law enforcement, and call to EMS. During an interview on 5/15/25 at 11:06 AM, LVN H, stated she attended ANE training and the message for staff was to report immediately and contact to the Abuse Coordinator. LVN H stated the contacting of law enforcement for any allegations of abuse was the purview of the Administrator who was the Abuse Coordinator. During a telephone call on 5/15/25 at 11:42 AM, the MD stated he was notified of an alleged sexual (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455824 If continuation sheet Page 2 of 4 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 455824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wurzbach Nursing and Rehabilitation 8300 Wurzbach Rd San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few abuse incident involving Resident #1 and that the family wanted the resident sent to the ER for an assessment on 5/13/25. The MD stated he had seen the resident the prior week and she was clinical normal; no distress or S/S of abuse. The MD stated that his expectation was that the sooner the better he should be notified when an allegation was made about abuse so that he could issue any new orders. The MD stated the resident was assessed in the ER and no finding of sexual abuse. The MD did not provide a response as to when law enforcement was to be notified; except it was in the arena of the Administrator. During an interview on 5/15/25 at 3:10 PM, the Administrator stated: he was notified of the alleged abuse involving Resident #1 by CNA A on 5/13/25 around 1:30 PM. The Administrator stated, the actions taken by the facility included: head to toe assessment of Resident #1, self -report to HHS within 2 hours of knowing about the allegation of abuse, suspension of CNA A, and initiation of facility investigation, the MD and Medical Director were notified., the SW initiated safe surveys, and skin assessments were completed on non-verbal residents. The Administrator stated, ANE in-service was initiated on 5/13/25. On 5/14/25 at 9:24 AM, the resident returned to facility with the assignment of female CNAs. The Administrator stated he followed the HHS PL 2024-14 (Attachment 2: How to report ANE) and the PL did not require the notification of law enforcement. When asked about compliance with the law involving elder abuse and state laws, the Administrator stated: he had not reported the incident to law enforcement as of today (5/15/25 at 3:34 PM) because he had not established in his investigation that any sexual abuse occurred involving Resident #1 by a CNA. The Administrator stated that he became aware of the alleged sexual abuse from the hospital report received the morning of 5/14/25 around 9:46 AM. The Administrator stated that he was not aware of any law enforcement case opened on an allegation of sexual abuse involving Resident #1. During an interview on 5/15/25 at 5:10 PM, the Administrator stated he called law enforcement on the case involving Resident #1 late in the afternoon to ensure the resident and all residents were safe. The Administrator stated he made the call, after the discussion was held with the surveyor involving elder abuse, hospital documentation of alleged sexual abuse, and requirements for reporting to HHS and state/local agencies, to contact law enforcement. Record review of facility's incident report dated 5/13/25 [prior to surveyor's entrance on 5/14/25] repeated the same information for the above interview with Administrator and DON on 5/14/25 at 11:15 AM. The facility was still in the process of investigating the incident and no finding had been established. Record review of the facility's Abuse, Neglect, Exploitation Prevention Program, dated revised April 2021 read: .Investigate and report any allegations within timeframes required by federal requirements . Assessment Record review of Stage regulations (N3568) on reporting ANE read: A local or state law enforcement agency must be notified of reports described in subsection (a) of this section, that allege that: (1) a resident's health or safety is in imminent danger. . (3) a resident has been hospitalized or treated in an emergency room because of conduct alleged (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455824 If continuation sheet Page 3 of 4 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 455824 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wurzbach Nursing and Rehabilitation 8300 Wurzbach Rd San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 in the report of abuse or neglect or other complaint. Level of Harm - Minimal harm or potential for actual harm (4) a resident has been a victim of any act or attempted act described in the Texas Penal Code, §§21.02,21.11, 22.011, or 22.021; or Residents Affected - Few (5) a resident has suffered bodily injury, as that term is defined in the Texas Penal Code, §1.07, because of conduct alleged in the report of abuse or neglect or other complaint. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455824 If continuation sheet Page 4 of 4