Inspection·October 25, 2025

F 0686 Level of Harm - Actual harm Residents Affected - Few cm x 2 cm x 0.8 cm.7. Left lateral foot stage 3 pressure ulcer with 20% slough that measured 3.2 cm x 2.5 cm x 0.8 cm.8. Right hallux that measured 4 cm x 2 cm x 0.8 cm. 9. Right lateral malleolus stage 3 pressure ulcer that measured 1 cm x 1 cm x 0.8 cm. Record review of Resident #1's Physician Order Summary Report, dated 10/24/2025, revealed there were treatment orders with a start date of 10/03/2025 for the wounds on his left rear thigh, left lower rear leg, sacrum and left lateral foot. The treatment orders for the wounds on the groin and right hallux had a start date of 10/14/2025; and the wounds on the right heel, left hallux, and right lateral malleolus had a start date of 10/15/2025. An antibiotic, Levaquin oral 750 mg tablet, was ordered on 10/20/25 and was to be administered once daily for osteomyelitis. Record review of Resident #1's October 2025 TARs revealed it was not documented that he received wound care to the wounds on his right heel, groin, left hallux deep tissue injury, left hallux abrasion and right lateral malleolus until 10/15/2025. Record review of Resident #1's Wound Assessments dated 10/09/2025, completed by Treatment Nurse LVN C, revealed there was an assessment for the wounds on his left lower rear leg, sacrum, left hallux, and left lateral foot; but there was no assessment for the wounds on his left rear thigh, right heel, groin, right hallux and right lateral malleolus. Record review of Resident #1's Wound Assessments dated 10/13/2025, completed by Treatment Nurse LVN C, revealed there was a wound assessment for all 9 wounds which had the following measurements:1. Left rear thigh stage 3 pressure ulcer with 20% slough that measured 9 cm x 5 cm x 2 cm.2. Left lower rear leg stage 3 pressure ulcer with 20% slough that measured 1.5 cm x 3.5 cm x 1.5 cm.3. Right heel stage 3 pressure ulcer with 20% slough that measured 3.5 cm x 5.5 cm x 0.8 cm.4. Sacrum stage 4 pressure ulcer with serosanguinous drainage that measured 26 cm x 29 cm x 8 cm.5. Groin stage 3 pressure ulcer that measured 1 cm x 1.5 cm x 0.8 cm.6. Left hallux deep tissue injury that measured 1 cm x 2 cm x 0.8 cm.7. Left lateral foot stage 3 pressure ulcer with 20% slough that measured 3.0 cm x 2.5 cm x 0.8 cm.8. Right hallux abrasion that measured 4 cm x 2 cm x 0.8 cm. 9. Right lateral malleolus stage 3 pressure ulcer that measured 1 cm x 1 cm x 0.8 cm. Record review of Resident #1's Wound Nurse Practitioner's progress note dated 10/13/2025, revealed his 9 wounds were assessed by Wound NP OO with the following measurements:1. Left rear thigh stage 3 pressure ulcer with 20% slough that measured 9 cm x 5 cm x 2 cm.2. Left lower rear leg stage 3 pressure ulcer with 20% slough that measured 1.5 cm x 3.5 cm x 1.5 cm.3. Right heel stage 3 pressure ulcer with 20% slough that measured 3.5 cm x 5.5 cm x 0.8 cm.4. Sacrum stage 4 pressure ulcer with serosanguinous drainage that measured 26 cm x 29 cm x 7 cm.5. Groin stage 3 pressure ulcer that measured 1 cm x 1.5 cm x 0.8 cm.6. Left hallux deep tissue injury that measured 1 cm x 2 cm x 0.8 cm.7. Left lateral foot stage 3 pressure ulcer with 20% slough that measured 3.0 cm x 2.5 cm x 0.8 cm.8. Right hallux abrasion that measured 4 cm x 2 cm x 0.8 cm. 9. Right lateral malleolus stage 3 pressure ulcer that measured 1 cm x 1 cm x 0.8 cm. Record review of Resident #1's Wound Nurse Practitioner's progress note dated 10/20/2025, revealed his 9 wounds were assessed by Wound NP OO with the following measurements:1. Left rear thigh stage 3 pressure ulcer with 20% slough that measured 9 cm x 4 cm x 1.5 cm.2. Left lower rear leg stage 3 pressure ulcer with 20% slough that measured 1.4 cm x 4 cm x 1 cm.3. Right heel stage 3 pressure ulcer with 20% slough that measured 3.5 cm x 5.5 cm x 0.8 cm.4. Sacrum stage 4 pressure ulcer with serosanguinous drainage that measured 26 cm x 30 cm x 7 cm.5. Groin stage 3 pressure ulcer that measured 1 cm x 1 cm x 0.8 cm.6. Left hallux deep tissue injury that measured 1 cm x 2 cm x 0.8 cm.7. Left lateral foot stage 3 pressure ulcer with 20% slough that measured 4.0 cm x 2 cm x 0.8 cm.8. Right hallux abrasion that measured 2 cm x 1 cm x 0.8 cm. 9. Right lateral malleolus stage 3 pressure ulcer that measured 1 cm x 1 cm x 0.8 cm.Record review of Resident #1's Nurse's Note, dated 10/02/2025, by LVN OO revealed approached resident for assessment and he asked to be left (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0686 Level of Harm - Actual harm Residents Affected - Few alone and did not want to be touched. Nurse advised resident that it was important to do assessment. ‘I said, I do not want to be touch (sic).'Record review of Resident #1's Nurse's Note, dated 10/06/2025, by Treatment Nurse LVN C revealed [Resident #1] refused to be seen by Wound NP OO for initial evaluation. He stated he did not want to get back in bed and was happy being outside enjoying the sun.Record review of Resident #1's Nurse's Note, dated 10/10/2025, by RN NN revealed [Resident #1] refused meds and wound care this shift, attempted x6 and [Resident #1] continued to refuse.this nurse asked another nurse to accompany for one last effort to ask [Resident #1] if he would take [his] medication and allow wound care to be complete[d] he continues to refuse at this time. Record review of Resident #1's Nurse's Note, dated 10/12/2025, by RN B revealed [Resident #1] was outside the facility the whole shift 1400-2142 (2:00 p.m. 9:42 p.m.). He was asked politely multiple times by different staff to come inside the facility to have his wounds dressed but he refused.He was reminded on multiple occasions that he has to come inside to eat, take his medications and have his wounds dressed which were already weeping, oozing fluid mixed with blood.but he again refuses and was calling staff names.Record review of Resident #1's Nurse's Note, dated 10/14/2025 by Treatment Nurse LVN C, revealed upon arriving to my shift [Resident #1] up in his chair outside in patio area, I asked if I could do his wound care he stated ‘No, I am staying outside'. I then asked when, he shrugged his shoulders.Record review of Resident #1's Nurses Notes from 10/02/2025 to 10/15/2025 revealed there was no documentation if wound care was provided to Resident #1's wounds on his left rear thigh, right heel, groin, right hallux and right lateral malleolus.Record review of Resident #1's SBAR note, dated 10/16/25 at 9:23 p.m., authored by LVN D, reflected .Wound to right heel is noted with live maggots falling from wound site. Resident is noted with history of refusing wound care and non-compliance of staying outdoors in wheelchair for long periods of time. Wound site is cleaned and wound care provided. [MD call center] on call notified of finding and recommendation to send to ED for eval (evaluation) and treatment.Record review of Resident #1's SBAR noted, dated 10/17/25 at 12:17 p.m., authored by the DON, reflected .maggots noted to patient wounds on feet [right heel] .wound care provided. persuaded patient to go to hospital with education of the outcome if not getting treatment for maggots in his wounds [right heel] . [arrived at hospital at 2:44 p.m.]Record review of Resident #1's Nurse Note, dated 10/17/22 at 12:22 p.m., authored by the DON, reflected .Resident (#1) stated ‘ I know my body and I don't really need to go to the hospital, I'm used to having maggots and they come whenever [I] skip wound care, I should have told y'all that happens.'Record review of Resident #1's Hospital records reflected Resident #1 was sent to the hospital for refusing care and now has maggots on 10/17/25.Record review of Resident #1's Social Services note, dated 10/20/25, revealed she had Followed up with resident regarding refusal of care. Resident stated he is not currently refusing care and is allowing them to do wound care. Discussed refusal of lower extremities and resident stated he is allowing wound care to bottom but dressings were done the day before on the lower extremities. Educated and discussed with resident following doctors' orders and verbalized understanding of the risks of noncompliance.Record review of Resident #1's Nurse's Note, dated 10/20/25 at 12:45 p.m. by RN K, revealed Resident stated he wanted to go to ER related to sacral itching. This nurse educated resident that his wound had been treated by the wound NP and wound nurse and new healthy tissue was noted and that is why he was having more sensation. Resident acknowledged but continued to request ER visit. This nurse called for transport but resident refused to go by stretcher. This nurse educated resident on EMS policy of stretcher transport for ER visits. Resident refused transport and stated he would leave AMA. This nurse informed administration. Resident was educated on leaving AMA and risk associated with be unable to receive care from facility. Resident acknowledged and stated he still (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0686 Level of Harm - Actual harm Residents Affected - Few would be going AMA.Record review of Resident #1's Nurse's Note, dated 10/20/2025 at 1:24 p.m. by Treatment Nurse LVN C, revealed .[Resident #1] stated he would just leave AMA, I educate[d] [Resident #1] on the importance of wound care and medication management. He states he knows and understands any risk he is taking, he signed the AMA form, thanked me for helping him but he wants to be able to come and go as he wants. He signed form, I called DON and informed [his] Primary Care Provider.Record review of Resident #1's AMA sheet, dated 10/20/25 at 12:45 p.m., reflected the resident signed the sheet with 3 witnesses present (DON, LVN C and RN K). Reason for AMA: resident wanted to be independent.During an interview on 10/22/25 at 10:04 a.m., the DON stated the resident ‘s dressing was clean and dry except on 10/16/25 at 6:00 a.m., when the dressing was soiled and the resident refused wound care. The DON stated maggots were discovered on 10/16/25 around 8:30 a.m. and cleaned by the DON and LVN C (wound nurse) were present. The DON added, she saw 3-4 maggots on the right heel. The DON stated the resident still had maggots on 10/17/25 around 9:00 a.m. located on the right heel and the toe of the right foot (no wound); and several maggots on the right foot. The DON stated, other staff who saw the maggots were the Administrator on the wound (right heel) and LVN C on the bed. During an interview on 10/22/2025 at 10:20 a.m., Treatment Nurse LVN C stated while doing wound care to Resident #2, she observed some flies in the resident's room. Treatment Nurse LVN C stated, He is really messy with food, and he [NAME] on food and spills it everywhere, so he does get flies sometimes. We try to clean it up quickly, but there's never been any infestation or anything. During a telephone interview on 10/22/25 at 11:05 a.m., NP PP stated Resident #1 had the habit of going out on pass and refusing wound care. NP PP stated there were no issues with the wound care given to residents by facility nursing staff. NP PP stated Resident #1 skipping wound care for 2 days or more could result in maggots being present. NP PP stated she never saw maggots in the resident's wounds, but the resident could be infected with maggots given his habit of refusing care and spending hours outside the facility in the heat.During a telephone interview on 10/22/25 at 12:07 p.m., the MD stated the skipping of wound care could lead to maggots developing within 8-12 hours especially if the wound was soaked, there was heat, and the dressing was uncovered. The MD added some cleansing wound care solutions could kill maggots. The MD stated there were standing orders when the resident missed wound care. The MD stated she first became aware of the maggots when reported on 10/16/25 by LVN D. During a telephone interview on 10/22/25 at 6:24 p.m., LVN D stated, he saw maggots on Resident #1's right heel on 10/16/25 around 9:30 p.m. and called the MD for guidance. LVN D stated the MD gave an order to send the resident to the ER for an assessment; but the resident refused to go to the ER.During a telephone interview on 10/23/25 at 1:30 p.m., LVN D (night nurse) stated: he only focused on wound care for the right heel where the maggots were present. LVN D stated he only visually looked at the other wounds and saw no maggots. LVN D stated he saw the maggots on 10/16/25 around 9:30 p.m. LVN D stated he had not seen maggots in the resident's wounds in the past. In a telephone interview on 10/24/2025 from 10:33 a.m. to 10:54 a.m., LVN D stated he completed a skin assessment on Resident #1 on the first day he cared for Resident #1, which was the resident's second day in the facility because the resident had refused to let the nurses do an assessment the previous day. LVN D said Resident #1 was very noncompliant with letting the nurses complete skin assessments and wound care despite encouragement from the nurses.In a telephone interview on 10/24/2025 at 11:05 a.m., RN B stated he would provide wound care to Resident #1's sacrum wound when incontinent care was provided and would try to do wound care on his other wounds, but Resident #1 would frequently refuse care to his other wounds despite encouragement and education. RN B said Resident #1 did allow the nurse to provide wound care to his right heel, but RN B could not remember when that was. In a telephone interview on 10/24/2025 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0686 Level of Harm - Actual harm Residents Affected - Few from 12:16 PM to 12:48 p.m., Treatment Nurse LVN C stated she would complete a skin assessment and wound assessment when a resident was admitted to the facility and then a weekly assessment would be completed. Treatment Nurse LVN C said Resident #1's skin was pretty bad.he had nine wounds, he was seen weekly by the Wound NP A, but Resident #1 had refused to let the Wound NP A assess him on 10/06/2025 when she was in the facility because he was outside because if he was up [in his wheelchair] that was it, there was no going back [to bed to do wound care]. Treatment Nurse LVN C stated she thought there were orders for all of Resident #1's wounds when he was admitted but could not remember without looking at his chart. The Treatment Nurse said she was responsible for entering resident's wound orders into their clinical record and the harm of not having a wound treatment order was . the wound could become infected; it could get bigger.In an interview on 10/24/2025 from 1:34 p.m. to 1:45 p.m., CNA F stated she remembered the nurses would provide wound care to Resident #1 when he was in bed and when he allowed them to do so but he would be combative or refuse at times. In an interview on 10/24/2025 at 1:48 p.m., RN G stated she cared for Resident #1 only on 2 days and she did not provide wound care to him because the facility has a Treatment Nurse. RN G said she remembered seeing Treatment Nurse LVN C provide wound care to Resident #1 one day in the hallway to his heels because that was the only place the resident would allow the treatment nurse to do it, and because he did not want to be put back into bed and the wound dressings needed to be changed.In a follow-up telephone interview on 10/25/2025 from 11:34 a.m. to 11:41 a.m., Treatment Nurse LVN C stated she could not remember why orders were not written for Resident #1's wounds on his left rear thigh, right heel, groin, right hallux and right lateral malleolus. She said the reason why a weekly wound assessment was not done on 10/09/2025 for his wounds on his left rear thigh, right heel, groin, right hallux and right lateral malleolus was because she might have been interrupted during her wound assessments and forgot to go back to finish the assessment on those wounds. LVN C stated with Resident #1, Once you start, you can't stop and if you stop, he won't let you go back to him.In an interview on 10/25/2025 at 11:55 a.m., the Regional Clinical Resource (corporate nurse), stated Resident #1 was assessed by Wound NP OO before he left the facility AMA.In an interview on 10/25/25 at 3:34 p.m., the Regional Clinical Resource stated she reviewed Resident #1's clinical record and could not find any admission treatment orders for his wounds on his left rear thigh, right heel, groin, right hallux and right lateral malleolus; and the orders for those wounds were started on either 10/14/2025 or 10/15/2025. The Regional Clinical Resource said when she spoke to the DON, the DON stated the treatment nurse provided wound care to Resident #1's wounds when he would let her. In an interview on 10/24/2025 at 2:57 p.m., the DON stated when she would do her daily rounds in the facility, she had observed that Resident #1 had wound dressings on both of his feet which were dated with that day's date, so she knew the wound care nurse was providing the wound care. The DON stated wound care was to be documented on the resident's TAR, but it was not documented on Resident #1 because it looked like there was an error due to orders that were not in the chart for the wounds. The DON reviewed Resident #1's wound assessments completed on 10/09/2025 and stated there were only 4 wound assessments done for the sacrum, left lower rear leg, left lateral foot and left hallux wounds. The DON stated the Treatment Nurse was responsible for ensuring the weekly wound assessments were completed and the harm of not completing a weekly wound assessment was that it would be difficult to determine if the wound was healing or deteriorating. The DON said the procedure for ensuring admission treatment orders were transcribed for wounds was the treatment nurse's responsibility; and the harm of not having a treatment order could result in wound care not being provided to the resident.In an interview on 10/24/2025 at 3:38 p.m., the Administrator stated the treatment nurse, or the admitting nurse was responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0686 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete entering the treatment orders for wounds into the resident's clinical record upon admission; and not having a treatment order for wounds could result in the resident's plan of care not being followed. The Administrator said the treatment nurse was responsible for completing the weekly wound assessments and not having it completed could result in not following the plan of care and cause a decrease in the skin's integrity.Record review of the facility's policy Wound Care, dated 2021, revealed The purpose of this procedure is to provide guidelines for the care of wounds to promote healing.Preparation 1. Verify that there is a physician's order for this procedure. 2. Review the resident's care plan to assess for any special needs of the resident.Documentation. The following information may be recorded in the resident's medical record, if applicable: 1. The type of wound care given. 2. The date and time the wound care was given. Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an effective pest control program so that it was free of pests and rodents for 1 of 7 residents (Resident #1) reviewed for pest control program.? The facility failed to ensure Resident #1 was not found with maggots in his right stage 3 heel wound on 10/16/25. Resident #1 refused an ER referral when the maggots were found and was sent to the emergency room a day after the maggots were discovered. An IJ was identified on 10/23/25. The IJ template was provided to the facility on [DATE] at 3:25 p.m. While the IJ was removed on 10/25/25, the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy because the facility's need to monitor the implementation and effectiveness of its Plan of Removal. This failure could place residents at risk of experiencing a diminished quality of life, infections and/or death. The findings include: Record review of Resident #1's face sheet, dated 10/21/25, reflected a 32 -year-old male who was admitted to the facility on [DATE] and discharged AMA on 10/20/2025. Resident #1 had diagnoses which included: osteophyte, right foot (bone spur) ,osteophyte (a bony outgrowth) right ankle and left foot and ankle, pressure ulcer to left buttock stage 3, pressure ulcer left hip stage 3, paraplegia (loss of impairment in both lower limes), amputation at level between elbow and wrist, open wound of lower back and pelvis, pressure ulcer to left buttock stage 3, pressure ulcer of right buttock stage 4, and pressure ulcer right heel stage 3. The RP was listed as the resident. Record review of Resident#1's admission MDS, dated [DATE], reflected a BIMS score of 12, indicative of moderate impairment in cognition. The ADLs for: B/B was catheter for blader; bowel was incontinent. Transfer was total assistance; and bed mobility was supervision. Assistive device was listed as motorized W/C. ROM was documented as impairment to lower body. Record review of Resident #1's skin assessment on admissions, dated 10/3/25, reflected a right heel pressure ulcer with measurements of 3.5 x5.5x08 full thickness stage 3 20% slough (puss) serosanguinous (mix of blood and serum) and drainage. Record review of Resident #1's NP A' skin assessment on 10/13/25 of the right heel reflected the following measurements: 3.5 Length by 5.5 Width by 0.8 Depth.Record review of Resident #1's CP, dated 10/16/25, reflected .Reports of having live maggots in his right heel wounds. Interventions listed in the CP included: education to the residents, MD notified, sent to ER on [DATE] for any treatment, and daily wound treatment and weekly skin assessments. The CP documented to notify the physician as needed when resident refused wound care.Record review of Resident #1's physician orders, dated 10/15/25, read: . Wound care to right heel stage 3 pressure injury, cleanse with normal saline, pat dry, apply medihoney, (calcium) alginate, cover with dry dressing daily. Record review of Resident #1's Nurse Note, dated 10/16/25 at 6:00 a.m., authored by RN A, reflected: Multiple wounds with purulent drainage. Record review of Resident #1's SBAR note, dated 10/16/25 at 9:23 p.m., authored by LVN D, reflected .Wound to right heel is noted with live maggots falling from wound site. Resident is noted with history of refusing wound care and non-compliance of staying outdoors in wheelchair for long periods of time. Wound site is cleaned and wound care provided. [MD call center] on call notified of finding and recommendation to send to ED for eval (evaluation) and treatment.Record review of Resident #1's SBAR noted, dated 10/17/25 at 12:17 p.m., authored by the DON, reflected .maggots noted to patient wounds on feet [right heel] .wound care provided. persuaded patient to go to hospital with education of the outcome if not getting treatment for maggots in his wounds [right heel] . [arrived at hospital at 2:44 p.m.] Record review of Resident #1's Nurse Note, dated 10/17/22 at 12:22 p.m., authored by the DON, reflected .Resident (#1) stated ‘ I know my body and I don't really need to go to the hospital, Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0925 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few I'm used to having maggots and they come whenever [I] skip wound care, I should have told y'all that happens.' Record review of Resident #1's Hospital records reflected Resident #1 was sent to the hospital for refusing care and now has maggots on 10/17/25. Record review of Resident #1's AMA sheet, dated 10/20/25, reflected the signed resident sheet with 3 witnesses present (DON, LVN C and RN K). Reason for AMA: resident wanted to be independent.Observation on 10/22/25 at 10:20 a.m., revealed some flies in Resident #2's room while observing wound care given to Resident #2 by LVN C. [flies in the room had the potential of landing on the resident's wound or laying eggs throughout the room and later infecting the resident's wounds] Observation of Resident #1's room on 10/22/25 at approximately 12:15 p.m. reflected that the screen was not fully adjusted to the frame, potentially allowing for flies/gnats to enter. There were no flies or gnats observed. During an interview on 10/21/25 at 12:30 p.m., the DON stated: Resident #1 was discovered with maggots tohis right wound heel on 10/16/25 by LVN D. The DON stated the timeline was as follows: ---10/2/25-resident was admitted with 9 pressure ulcers to include stage 3 to the right heel. No maggots were present in the wounds. MD Orders for daily wound care.---10/3/25- to 10/13/25 daily wound care done.---10/14/25 skin assessment: no change to wounds and no maggots in any wound.---10/15/25-resident refused wound care all day. ---10/16/25 during the day shift (6:00 a.m. to 2:00 p.m.) resident refused wound care.---10/16/25 at 9:23 p.m. maggots were observed by LVN D in the right heel dressing. The resident refused to go to the ER. LVN D attempted to remove the maggots.---10/17/25 at 6:00 a.m. resident refused wound care.---10/17/25 around 8:30 a.m., Resident accepted wound care from the DON and maggots were again found in the right heel. MD was again notified and order given to send resident to the ER for an assessment.---10/17/25-DON convinced resident to be assessed at the ER and DON accompanied the resident.---10/17/25-ER note: [Right] lower extremity with a lateral [well] healing ulcer, no maggots. discharged to facility in a stable condition.---10/20/25- wound care given by NP PP in the morning. Resident signed out AMA around 2:00PM [MD had given new orders for IV daptomycin (wound infection) and Levaquin (wound infection) prior to the resident going out AMA.] During an interview on 10/21/25 at 4:26 PM, the DON stated Resident #1 received daily wound care and was seen by the NP [A] Wound Nurse Weekly but had a history of refusing wound care. The DON stated NP PP was aware Resident #1 at times refused wound care. During an interview on 10/22/25 at 9:55 AM, the DON stated Resident #1's right heel wound was covered when the resident was up and about based on observations by nursing staff to include the DON. During an interview on 10/22/25 at 10:04 a.m., the DON stated the resident ‘s dressing was clean and dry except on 10/16/25 at 6:00 a.m., when the dressing was soiled and the resident refused wound care. The DON stated maggots were discovered on 10/16/25 around 8:30 a.m. and cleaned by the DON and LVN C (wound nurse) were present. The DON added, she saw 3-4 maggots on the right heel. The DON stated the resident still had maggots on 10/17/25 around 9:00 a.m. located on the right heel and the toe of the right foot (no wound); and several maggots on the right foot. The DON stated, other staff who saw the maggots were the Administrator on the wound (right heel) and LVN C on the bed. During an interview on 10/22/2025 at 10:20 a.m., LVN C stated while doing wound care to Resident #2, she observed some flies in the resident's room. LVN C stated, He is really messy with food, and he [NAME] on food and spills it everywhere, so he does get flies sometimes. We try to clean it up quickly, but there's never been any infestation or anything. During a telephone interview on 10/22/25 at 11:05 a.m., NP PP stated rubbing could kill the maggot eggs on a wound. NP PP stated heat, and the smell of dry blood could lead to flies laying eggs on a resident and develop into maggots within 8-20 hours. NP PP stated Resident #1 had the habit of going out on pass and refusing wound care. NP PP stated there were no issues with the wound care given to residents by facility nursing staff. NP PP stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0925 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Resident #1 skipping wound care for 2 days or more could result in maggots being present. NP PP stated she never saw maggots in the resident's wounds, but the resident could be infected with maggots given his habit of refusing care and spending hours outside the facility in the heat. During an interview on 10/22/25 at 11:15 a.m., the Administrator stated the last pest control spraying was done on 10/10/25 and the next spraying was scheduled for every two weeks (10/24/25). The Administrator stated the Pest Company sprayed all the common interior areas and exterior for occasional insects; no issues noted on the spraying on 10/10/25. During a telephone interview on 10/22/25 at 12:07 p.m., the MD stated the skipping of wound care could lead to maggots developing within 8-12 hours especially if the wound was soaked, there was heat, and the dressing was uncovered. The MD added some cleansing wound care solutions could kill maggots. The MD stated there were standing orders when the resident missed wound care. The MD stated she first became aware of the maggots when reported on 10/16/25 by LVN D. During a telephone interview on 10/22/25 at 3:25 p.m., the Pest Control Vendor stated flies were controlled by checking for room sanitation, checking dumpsters, and spraying. The Vendor added, flies could be controlled by fly lights [not present in the facility] and wiping down surfaces with special liquids. The Vendor stated he had not seen an infestation of flies in the facility, but flies could be present in the facility from doors opening. During an interview on 10/22/25 at 3:35 p.m., the Administrator stated the facility had not identified a fly problem. The Administrator stated no fly lights had been installed in the facility to include the kitchen, and no request had been made to the pest control vendor for special spraying and wiping down surfaces for fly prevention. During an interview on 10/22/25 at 5:08 p.m., LVNC stated: when Resident #1 allowed wound care per physician orders was completed. LVN C stated she saw no issues with the wound care provided by other nursing staff. LVN stated she never saw maggots in Resident#1's wounds. On 10/17/25 while assisting the DON, LVN C stated she saw maggots on the resident's bed on 10/17/25 and removed the maggots from the bed. During an interview on 10/22/25 at 6:02 p.m., the Administrator stated she saw a few maggots on the resident's heel on 10/17/25 at 9:30 a.m. The Administrator stated the DON cleaned the maggots and disposed of them. During a joint interview on 10/22/25 at 6:15 p.m., the Administrator and DON stated the sheets were removed on 10/17/25 and Resident #1's room was cleaned and sanitized/bleached. The DON did not know whether the sheets were changed, and room cleaned on the 10/16/25 night shift when LVN D saw maggots. During a telephone interview on 10/22/25 at 6:24 p.m., LVN D stated, he saw maggots on Resident #1's right heel on 10/16/25 around 9:30 p.m. and called the MD for guidance. LVN D stated the MD gave an order to send the resident to the ER for an assessment; but the resident refused to go to the ER. LVN D stated he could not remember whether the sheets were changed, and the room cleaned and sanitized/bleached. During an interview on 10/23/25 at 9:12 a.m., the Housekeeping Manager stated: housekeeping was not on done the night of 10/16/25 when LVN D saw maggots on Resident#1 heel wound. The Housekeeping manager stated Resident #1's room was not cleaned or bleached or the linen changed because no housekeeping staff were on duty the night of 10/16/25. The Housekeeping Manager stated she assumed nursing staff at night was responsible for housekeeping. The Housekeeping Manager started around 2:00-3:00 p.m. on 10/17/25 housekeeping services were provided to Resident #1's which included: cleaned, sanitized and bleached; and linen was changed. The Housekeeping Manager stated the linen was discarded; no maggots were seen. The Housekeeping Manager stated housekeeping services were provided again when the DON saw maggots in the afternoon on 10/16/25. The Housekeeping Manager stated the effective method for maggot control was deep surface cleaning, bleaching, and discarding affective linen and materials. During a telephone interview on 10/23/25 at 1:30 p.m., LVN D (night nurse) stated: he only focused on wound care for the right heel where the maggots were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0925 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few present. LVN D stated he only visually looked at the other wounds and saw no maggots. LVN D stated he saw the maggots on 10/16/25 around 9:30 p.m. LVN D stated he had not seen maggots in the resident's wounds in the past. LNV D stated Resident #1's gown was changed and there was a brief change. LVN D stated there was no linen changed, and he was not aware of the room being cleaned and sanitized. During a telephone interview on 10/24/25 at 10:30 a.m., LVN D stated: the resident had a right heel pressure ulcer at admissions (10/2/25). LVN D stated there were no maggots on the 9 PU sites upon admission. LVN D stated, the skin condition was awful at admissions. The resident was total assistance for transfer. LVN D stated there were no flies or gnats in the room where the assessment was conducted on 10/16/25 at 9:23 p.m. of the right heel with maggots. LVN D stated the right heel dressing was intact the days he saw the resident. LVN D stated the dressings to the right heel were sometimes moist, and the resident sometimes refused care. LVN D stated Resident #1 was always outside in a gown and would have blankets on the motorized W/C. LVN D stated the resident enjoyed spending time outside. LVN D stated he called the MD around shift change after seeing the maggots. Record review of pest control logs reflected pest control visit on 10/10/25 with no noted issues. Record review of facility's grievance log for the past 90 days (August-October 2025) reflected no grievances involving pests. Record review of the facility's Cleaning and Disinfection of Environment Surfaces policy, dated revised June 2009, read, .Environmental surfaces will be cleaned and disinfected according to current CDC recommendations for disinfection of healthcare facilities and the OSHA Pathogens Standard. Record review of the facility's Pest Control policy, dated revised May 2008, read, .Our facility shall maintain an effective pest control program.to ensure that the building is kept free of insects and rodents. This was determined to be an Immediate Jeopardy (IJ) on 10/23/25 at 3:25 p.m. The Administrator was notified. The Administrator was provided with the IJ template on 10/23/25 at 3:25 p.m. The following Plan of Removal submitted by the facility was accepted on 10/24/25 at 12:43 a.m. [Facility] respectfully submits this plan of removal to abate the allegations of immediate jeopardy identified on 10/23/2025. Plan submitted on 10/23/2025 at 6:30pm The facility allegedly failed to maintain an effective pest control program so that it is free of pests and rodents. ? On 10/16/25, Resident #1 was found with maggots in his right stage 4 heel wound. On 10/16/2025, when maggots were discovered in Resident #1's heel wound, the Director of Nursing (DON) and LVN C. immediately cleansed the wound per wound protocol. Resident #1's room [was] thoroughly cleaned and sanitized in accordance with the facility's cleaning and disinfection policy.Observation of Resident #1's room at approximately 12:15 p.m. on 10/22/25 revealed the screen was not fully adjusted to the frame, potentially allowing for flies/gnats to enter. However, no flies or gnats were observed. Observation of Resident #1's room at approximately 12:15 p.m. on 10/22/25 revealed the screen was not Fully adjusted to the frame, potentially allowing for flies/gnats to enter. However, no flies or gnats were observed. Surveyor and Administrator confirmed that the window was sealed appropriately, and that the screen's previous misalignment would not [allow] any insects or pests to enter the facility. A facility-wide environmental inspection was completed on 10/22/2025 by the Maintenance Director to ensure all windows, screens, and entry points were intact and secure. No issues noted. Observation on 10/22/25 at 10:20 a.m.flies were observed in Resident #2's room while observing wound care given to Resident #2 by LVN C. [Not Resident #1] During an interview on 10/22/2025 at 10:20 AM, LVN C stated while doing wound care to Resident #2, she observed some flies in the resident's room. LVN C stated, He is really messy with food, and he [NAME] on food and spills it everywhere, so he does get flies sometimes. We try to clean it up quickly, but there's never been any infestation or anything. Record review of pest control logs reflected pest control visit on 10/10/25 with no noted issues. During interview on 10/22/25 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0925 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 3:25 p.m., [Pest] Control Vendor stated flies were controlled by checking for room sanitation, checking dumpsters, and spraying. He said flies could be controlled by fly lights [not present in the facility] and wiping down surfaces with special liquids [not sure if done at the facility]. Record review of facility's Pest Control policy, dated revised May 2008, reflected, .Our facility shall maintain an effective pest control program.to ensure that the building is kept free of insects and rodents The Administrator confirmed the facility currently utilizes three fly zap lights as part of its pest control prevention program. These devices are strategically located at the facility entrance, kitchen area, and along A Hall and B Hall to minimize insect activity. In addition, the facility employs three high-velocity door fans, positioned at the E Hall exit, B Hall exit, and kitchen exit, to deter flying insects from entering the building. On 10/22/2025, the Administrator contacted Pest Control and placed an order for three additional fly zap lights to further enhance pest prevention coverage throughout the facility. The Zap lights were delivered and installed on 10/23/2025 by Pest Prevention Technician [.] in the following locations. B Hall Dining Room, C Hall Dining Room and E Hall dining room. The effectiveness of the newly installed Zap Lights will be monitored utilizing the environmental daily check list. The Housekeeping Supervisor and Maintenance Director and or designee will be responsible for Zap Light Effectiveness. On 10/23/2025 the Pest Prevention Technician assisted the facility utilized the wipe down method in rooms of residents with treatment orders. This method entails wiping down surfaces and walls. Observation of Resident #1's room at approximately 12:15 p.m. on 10/22/25 revealed the screen was not fully adjusted to the frame, potentially allowing flies/gnats to enter. However, no flies or gnats were observed. Surveyor and Administrator confirmed that the window was sealed appropriately, and that the screen's previous misalignment would not allow any insects or pests to enter the facility. A facility-wide environmental inspection was completed on 10/22/2025 by the Maintenance Director to ensure all windows, screens, and entry points were intact and secure. No issues noted Observation on 10/22/25 at 10:20 a.m., revealed some flies in Resident #2's room while observing wound care given to Resident #2 by LVN C. [Note-this is part of the facility's POR]During an interview on 10/22/2025 at 10:20 AM, LVN C stated while doing wound care to Resident #2, she observed some flies in the resident's room. LVN C stated, He is really messy with food, and he [NAME] on food and spills it everywhere, so he does get flies sometimes. We try to clean it up quickly, but there's never been any infestation or anything. Record review of pest control logs show pest control visit on 10/10/25 with no noted issues. [Note-this is part of the facility's POR]During interview on 10/22/25 at 3:25 p.m., the Pest Control Vendor stated flies were controlled by checking for room sanitation, checking dumpsters, and spraying. He said that flies could be controlled by fly lights [not present in the facility] and wiping down surfaces with special liquids [not sure if done at the facility].[Note-this is part of the facility's POR] Record review of the facility's Pest Control policy, dated revised May 2008, reflected, .Our facility shall maintain an effective pest control program.to ensure that the building is kept free of insects and rodents. [Note-this is part of the facility's POR] The Administrator confirmed that the facility currently utilizes three fly zap lights as part of its pest control prevention program. These devices are strategically located at the facility entrance, kitchen area, and along A Hall and B Hall to minimize insect activity. In addition, the facility employs three high-velocity door fans, positioned at the E Hall exit, B Hall exit, and kitchen exit, to deter flying insects from entering the building.Residents with the potential to be affected by the alleged deficient practice: A comprehensive skin and wound audit was completed for all residents with pressure injuries on 10/23/25 by the nurse managers to ensure no other residents were affected. No other maggots or pests were found. This assessment was documented in a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0925 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few progress note. No other issues were discovered. All Staff were in serviced on the facilities Pest Control Program. The training was completed on 10/23/25 and was conducted by the Administrator and Director of Nurses. Resident identified to have been affected by the alleged deficient practice: On 10/16/2025, after providing additional education and multiple attempts to encourage compliance with medical care, Resident #1 agreed to be transported to the emergency room for further evaluation and treatment. The Director of Nursing (DON) personally accompanied the resident to the hospital. Prior to transfer, the DON, Administrator, Social Worker, Treatment Nurse, Charge Nurse, and Certified Nursing Assistant (CNA) were all involved in efforts to educate and persuade the resident regarding the importance of receiving medical attention. Resident stated, I get maggots when I refuse care, and I had them before coming here. Resident was [educated] on multiple occasions by providers. Progress notes [input] on 10/9, 10/13, 10/14 and 10/20. Care Plan on 10/15 also references history of refusal of care. Systemic Measures:[all staff]Training provided to all staff on the Pest Control Policy and protocols for pest prevention, environmental inspection, and staff reporting. This was completed on 10/23/25. 100% completed. This was completed by the Administrator and Director of Nurses. [Housekeeping]Training provided to all staff on the cleanliness of resident rooms to ensure rooms remain as free as possible of items that may attract pests. The staff [were] educated on cleaning procedures in the event pest are identified. Housekeeping Cart is available in E hall housekeeping closet for after-hour [use]. This was completed on 10/23/25. 100% completed. This was completed by the Administrator and Director of Nurses. The facility increased pest control vendor visits from biweekly to weekly and added three additional fly light installations in key areas. Weekly vendor visits initiated on 10/22/25 for 4 weeks. The three additional Zap Lights were installed on 10/23/25 by by Pest Prevention Technician. Maintenance initiated a weekly environmental inspection log for all window seals, screens, and potential pest entry points. This will be completed by the Maintenance Director and [/] or designee. The facility began utilizing this log on 10/23/25. Environmental Services implemented a daily cleaning checklist focusing on food debris and sanitation in resident rooms and dining areas. This will be conducted by the Housekeeping Supervisor and or [/] designee. The facility began utilizing this log on 10/23/25. Nurses received re-education on wound care refusal documentation, physician notification, and resident education procedures. 100% completed. The training was completed on 10/23/2025 and was conducted by the Director of Nurses. Quality Assurance Performance Improvement: On 10/23/2025 the Quality Assessment and Assurance Committee members to include, the Medical Director, Administrator, and Director of Nursing, District Director of Clinical Services and Division VP of Operations met to review and approve this plan. The facility will review the pest control log daily for any pest control issues. The Admin/ DON/designee will review and observe. In addition, the Admin/DON/designee will complete 5 observations per week. If any pest control issues or deficient practices are discovered the Admin/ DON/designee will provide additional training [for] staff. Training to include. Pretest, Inservice, Post Test and Return Demonstration. The results of the Admin/ Director of Nursing/designee reviews will be presented to the Quality Assessment and Assurance Committee for review of trends and/or negative findings and further recommendations during the scheduled meetings for 3 months. The committee will make recommendations for further education as warranted and develop further performance improvement plans as necessary. Date of Correction:10/23/2025 Monitoring of the POR included the following: Observation and interview on 10/24/25 at 4:30 p.m. Housekeeping Staff GG was observed involved in the deep cleaning of the facility wall edges. Housekeeping Staff GG stated she was instructed on the wipe down method by the Pest Control vendor. Also, Housekeeping Staff GG stated she did deep cleaning and wall frame rubbing down of rooms where residents had orders for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0925 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few pressure ulcer wound care; the room assignments were given by the Housekeeping Manager. Observation on 10/24/25 from 4:25 p.m. to 4:35 p.m., of all window screens reflected no holes and properly fitted to the window frames. Also, windows of 6 residents receiving wound care were sealed. During an observation on 10/24/25 from 5:00 p.m. to 5:10 p.m., of the facility reflected, there were three fly zap lights as part of its pest control prevention program present. These devices were strategically located at the facility entrance, kitchen area, and along A Hall and B Hall to minimize insect activity. The facility employed three high-velocity door fans, positioned at the E Hall exit, B Hall exit, and kitchen exit, to deter flying insects from entering the building During an observation on 10/25/25 at 11:00 a.m. revealed 6 fly zaps were all working. During an interview on 10/24/25 at 1:25 p.m., RN G stated she attended in-service on Pest Control policy and the highlights were to report any insects or rodents found anywhere in the facility through the system TELS. RN G stated Prevention included keeping the residents clean and food out of the room. During an interview on 10/24/25 at 1:32 p.m., LVN H stated the highlights of the in-service included: increased pest control spray and install fly lights. LVN H stated Environmental inspection involved checking on hoarding of food by residents. LVN H stated Reporting involved making an entry in TELS and notifying the Administrator. During an interview on 10/24/25 at 1:41 p.m., RN K stated the training highlighted to prevent insects and rodents by checking for cleanliness of rooms and food in the room. RN K stated Prevention also included changing of linen. RN K stated Reporting involved notifying the to the Administrator and documenting in TELS. During an interview on 10/24/25 at 1:56 p.m., CNA N stated the training included: prevention of pests by fly lights and fans blowing out. CNA N stated the environment was to be kept clean During an interview on 10/24/25 at 2:04 p.m. CNA O stated: prevention of pests included the use of zap lights. Prevent CNA O stated food was to be discarded in trash cans and rooms kept clean. CNA O stated to report any COC to Nursing staff. During an interview on 10/24/25 at 2:07 p.m., CNA P stated: prevention of pests involved by keeping areas Cleaned and keep residents bathed. CNA P stated to Report to nurse and Administration any room changes. During an interview on 10/24/25 at 2:10 p.m., LVN Q stated prevention involved keeping the area clean, the residents clean and take out trash. LVN Q state Reporting involved documenting in TELS. During an interview on 10/24/25 at 2:25 p.m., Staff R (Social Worker) stated the highlights were: prevention by cleanliness and Resident rooms should not have leftover food. Staff R stated, Report by documenting in the maintenance binder and notify management.,During an interview on 10/24/25 at 2:27 p.m., Staff S (Rehab) stated: highlights of the training involved shutting windows and keeping rooms cleaned. Staff S stated residents were to be kept clean and received incontinent Care; and report any COC on wounds to nursing staff. During an interview on 10/24/25 at 2:30 p.m., Staff T (Maintenance) stated prevention training included: maintain the facility and seal any openings in screens or windows. Staff T stated Notify nursing staff if insects or rodents were seen in the facility and document in the maintenance log. During an interview on 10/24/24 at 2:35 p.m. the Maintenance Director stated he received no W/O to seal windows or screens during the time of the incident on 10/16-10/17/25. The Maintenance Director added prior to the incident the facility did not have fly lights. During an interview on 10/24/25 at 2:38 p.m. Staff U (Kitchen) stated: highlights of the training included to keep kitchen and facility clean and practice hygiene; and Report W/O to management. During an interview on 10/24/25 at 2:39 p.m. Staff V (kitchen) stated: prevention of pests through cleaning and checking; and Reporting of pests through W/O. During an interview on 10/24/25 at 2:40 p.m. Staff W (kitchen) stated training involved keep the kitchen clean and the facility and throw out trash and inspect dumpsters. Staff W stated Report to the administrative staff about any issues with insects. During an interview on 10/24/25 at 2:41 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 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 675002 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Antonio West Nursing and Rehabilitation 636 Cupples Rd San Antonio, TX 78237 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 0925 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Staff X (kitchen) stated: in-service stressed to keep the facility and kitchen clean as a prevention measure against pests. Staff X stated to check on the appearance of residents.and Report immediately if insects were on ceiling lights During an interview on 10/24/25 at 1:42 p.m., LVN I stated the highlights of training included: prevention through spraying and keeping rooms clean. LVN I stated Reporting involved to report to the DON and put in the maintenance log. During an interview on 10/24/25 at 1:43 p.m., CNA J stated the highlights were: check rooms for food and drinks. CNA J stated the environment involved to make sure it was kept clean. CNA J stated Reporting to the charge nurse and any COC and to document. During an interview on 10/24/25 at 1:52 p.m., CNA L stated the highlights of training included: prevention by keeping the facility clean. CNA L stated Check that residents were bathed as a prevention measure. CNA L stated to Report to housekeeping and the Administrator any room change. During an interview on 10/24/25 at 1:54 p.m., CNA M stated the training emphasized prevention of pests by having the resident cleaned and showered; and ensuring trash was removed. CNA M stated Report on TELS and report to DON and COC. During an interview on 10/24/25 at 2:50 p.m., Staff Y (Rehab) stated highlights of training included: cleanliness in rooms and no clutter and no food. Staff Y stated check on resident odors and cleanliness as prevention. Staff Y added to Check on wound dressings; and inform the nursing staff if the residents appear dirty and unkempt. During an interview on 10/24/25 at 2:51 p.m., Staff Z (Rehab) stated: prevention of pests included rooms needed cleaning and windows sealed; and Residents should be clean and kept clean. Staff Z stated Report issues to the nursing staff. During an interview on 10/ Event ID: Facility ID: 675002 If continuation sheet Page 14 of 14