Inspection·December 12, 2025

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete a resident had pulled the curtain rod down in their room. She stated he had verified that the resident had been relocated to another room and that maintenance was notified. She stated she had believed the room change was temporary and not considered a permanent move. During an interview on 10/08/2025 at 05:16 p.m., the DON stated Resident #1 pulled on his privacy curtain resulting in it coming down. She stated the rail for the privacy curtain was now bent and Resident #1's prior room, room [ROOM NUMBER], was currently unoccupied. She stated she believed someone reached out to Resident #1's guardian regarding his room change but would have to check the notes. During an interview on 10/08/2025 at 05:51 p.m., the ADMIN stated as far as she knew Resident #1 was moved rooms temporarily. She stated she did not know if the guardian was contacted but that the facility procedure was for the staff to contact the family/guardian and usually document the notification in a progress note. She stated the importance of notifying the family/guardian was to obtain consent for the move, indicating they were okay with it. During an interview on 10/08/2025 at 06:22 p.m., the DON stated she could not locate in Resident #1's notes of his guardian having been contacted regarding the room change. She stated that she reached out to LPN A, who stated he did not notify the guardian since he thought the room change was temporary. The DON stated that even if LPN A reached out to Resident #1's guardian it would have been after-hours and the guardian's contact number does not allow messages to be left. She stated she told LPN A that even if a resident's move was temporary, the resident representative would still need to be notified. During an interview on 10/13/2025 (after investigation exit) at 10:50 a.m., Resident #1's guardian stated he did not recall receiving notification of Resident #1's room change. Record review of policy titled, Change in a Resident's Condition or Status, dated 2018, revealed Our facility shall promptly notify the resident, his or her Attending Physician, and representative (sponsor) of changes in the resident's medical/mental condition and/or status.4. Unless otherwise instructed by the resident, a nurse will notify the resident's representative when: . c. There is a need to change the resident's room assignment;. Event ID: Facility ID: 675002 If continuation sheet Page 2 of 10 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 12/12/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to consult with the resident's physician and notify the representative when there was a significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications) for one of eleven residents (Resident #2) reviewed for quality of care. The facility failed to notify Resident #2's resident representatives of Resident #2's increase of exit seeking behavior with refusal for redirection resulting in police intervention observed on 10/03/2025. This failure could place residents at risk of unmet physical and psychosocial needs, physical harm and a decrease in quality of life and could result in the family or representative not being aware of conditions that may require them to make medical decisions. The findings included: Record review of Resident #2's admission Record, dated 10/07/2025, revealed a [AGE] year-old male initially admitted on [DATE] and readmitted on [DATE]. Resident #2 had two emergency contacts, emergency contact #1 and emergency contact #2. Record review of Resident #2's Diagnosis Report, dated 10/07/2025, revealed diagnoses including schizoaffective disorder (a chronic mental illness involving symptoms of schizophrenia and characterized by symptoms such as delusions and hallucinations), type 2 diabetes mellitus (a condition that develops with the way the body regulates and uses sugar as fuel), and dementia (a general term for impaired ability to remember, think, or make decisions). Record review of Resident #2's quarterly MDS, dated [DATE], reflected Resident #2 had a BIMS of 07, indicating he had severe cognitive impairment. He was noted to have had physical and verbal behaviors, rejected evaluation or care, and wandered 1-3 days per week. He used a walker and required supervision or touching assistance for walking 50 feet with two turns or at least 150 feet. Record review of Resident #2's care plan, dated 09/18/2025, revealed Resident #2 had the following focuses and interventions:- Behavioral Complex Care Plan: behaviors which affect others: Physical behavioral symptoms, date initiated 08/06/2024 and revised 09/12/2025, with interventions: - If resident can not be redirected or calmed, and if safe to do so, staff to attempt to perform cares at a later time after resident is more calm., date initiated 08/06/2024, - Redirect with snacks and verbal redirection., date initiated 01/27/2025, - Staff to involve family as necessary to assist with behavioral management, date initiated 08/06/2024, and - Walk with Resident outside as tolerated., date initiated 01/27/2025. - At risk for elopement for elopement as evidenced by History of attempts to leave facility unattended, Impaired safety awareness, date initiated 08/22/2025 and revised 06/04/2025, with interventions: - Provide Resident with safe place to wander if necessary., date initiated 08/22/20224 and - Use wander guard, date initiated 12/06/2024. - At risk for injury d/t wanders, date initiated 08/22/2024 and revised 04/15/2025, with interventions: - Assess for emotional or psychological distress, such as anxiety, fear, or felling lost., date initiated 08/22/2024, - Assess for physical distress or needs, such as hunger, thirst, pain, discomfort, or elimination., date initiated 08/22/2025, - Frequent monitoring for exit seeking behaviors and/or actions, every shift, date initiated 09/30/2024, - Refer to psych [psychosocial] services., date initiated 10/01/2024, Use wander guard, date initiated 08/22/2024 and revised 12/06/2024, and - When wandering, redirect resident to another activity, date initiated 08/22/2024. Record review of Resident #2's progress notes, dated 10/06/2025 revealed:- Incident note dated 10/03/2025 at 10:53 p.m. by RN B, Resident left the facility through the door at D hall. Almost all the staff went out trying to get him back in without any success. Resident was hitting staff and was almost running of [sic] into the road. Police was [sic] called. He continued walking on the sidewalkguided [sic] by staff very close (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 If continuation sheet Page 3 of 10 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 12/12/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to the end of the road that terminates into the highway before the cops arrived. On arrival, they gently ask [sic] [Resident #2] what was going on and the [sic] lashed out at then [sic], tried fighting them so they had to restrained [sic] and cuff him. He was forces [sic] into the vehicle snd [sic] drove him to the front of the facility and let him back in. - Administrator note dated 10/04/2025 at 05:14 p.m. by the ADMIN, noted to be LATE ENTRY, Admin followed up with staff to ensure that the resident was supervised by staff throughout his duration outside the facility. Staff confirmed this. Elopement risk and wandering assessments updated. Resident currently being followed by psych services, provider notified for follow up. Will continue to monitor. - Nurses note dated 10/06/2025 at 10:33 a.m. by LPN C, Call placed to [Resident #2's emergency contact #2] in regard to resident if could get labs and maybe a UA& [sic] C&S d/t reported behaviors. Record review of Resident #2's Elopement Assessment, dated 09/05/2025, revealed Resident #2 was At Risk for elopement. He was documented as not having past wandering behaviors as part of his past, not displayed wandering without a sense of purpose, wandering was not a new behavior, and not alert but non-complaint with facility protocols regarding leaving the unit. He was noted to have verbalized the desire to go home and cognitively impaired with poor decision making skills. Record review of Resident #2's Elopement Assessment, dated 10/06/2025, revealed Resident #2 was At Risk for elopement. He was documented as having had wandering behaviors as part of his past, does display wandering without a sense of purpose, wandering was not a new behavior, and not alert but non-compliant with facility protocols regarding leaving the unit. He was noted to have verbalized the desire to go home and cognitively impaired with poor decision making skills. Record review of Resident #2's Wandering Assessment, dated 08/29/2025, revealed Resident #2 was at Moderate risk for Wandering. He was documented as forgetful/short attention span and independent for mobility with an aide (cane/walker). The assessment findings were noted that a wander/elopement alarm was indicated. Record review of Resident #2's Wandering Assessment, dated 10/06/2025, revealed Resident #2 was at Moderate risk for Wandering. He was documented as forgetful/short attention span with behaviors/moods of combative/severe agitation, does not understand surroundings, and was independent for mobility with an aide (cane/walker). The assessment findings were noted that a wander/elopement alarm was indicated. The assessment was unsigned on 10/07/2025. Record review of Resident #2's EMR on 10/06/2025 did not reveal documentation of a notification to Resident #2's emergency contact #1 or emergency contact #2 regarding police intervention required for Resident #2's wandering behavior on 10/03/2025 until 10/06/2025. Record review of video posted on social media by unknown source of Resident #2 walking down the sidewalk outside the facility on 10/03/2025 revealed two facility staff members visible in the video. The staff members appeared to be attempting to redirect Resident #2 back to the nursing facility. During an observation and attempted interview on 10/07/2025 at 04:2504:35 p.m., at 04:25 p.m. Resident #2 was observed walking down the hall without his walker. A nursing staff member was observed getting up from the nurses' station, approached Resident #2 to ask him where his walker was, and guided Resident #2 back to his room with her arm on his back for support. At 04:35 p.m., Resident #2 was observed in the central dining room sitting at a table with his walker next to him, eating a snack. Attempted interview revealed Resident #2 was not interviewable. Resident #2 appeared clean and without injury. During an interview on 10/08/2025 at 10:12 a.m., Resident #2's Emergency Contact #1 stated she was notified of Resident #2 leaving the facility on 10/03/2025 by Emergency Contact #2. She stated that she had not received a phone call from the nursing facility. She stated that Resident #2 had a history of trying to exit the facility due to his tendency to attempt to follow when observing another person exiting. During an interview on 10/08/2025 at 10:21 a.m., Resident #2's Emergency Contact #2 stated the facility did not call or notify (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 If continuation sheet Page 4 of 10 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 12/12/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few her about Resident #2's attempted elopement on 10/03/2025. She stated she was notified by a family member who saw the incident reported on a social media page. She stated due to the incident occurring on a Friday night, she waited until Monday, 10/06/2025 to speak with the facility social worker and administrator about the incident. She stated she was concerned about the incident because he, Resident #2, could have been hit by a car and killed. She stated Resident #2 had previously gotten out of the facility, a few months prior, and she did not feel the facility staff took the incident seriously enough. She stated she tried to ask Resident #2 about the incident but due to his memory loss, he did not recall the incident. She stated he would only state that he wanted to get out of here but did not know where he was. Resident #2's Emergency Contact stated during her meeting with the social worker and administrator on 10/06/2025, she requested the facility email her instead of calling her when the facility needed to contact her in the future. During an interview on 10/08/2025 at 12:50 p.m., RN B stated Resident #2 had a WanderGuard on his arm and when Resident #2 first attempted to leave the facility on 10/03/2025, Resident #2 set off the door alarm. RN B stated another nurse tried to redirect Resident #2 prior to exiting the facility but was unsuccessful. RN B stated he and three other staff members stayed with Resident #2 while outside the facility to ensure Resident #2's safety. He stated the staff members continually tried to redirect Resident #2 back to the facility, by offering known preferred snacks and a cigarette, but he refused to calm down. RN B stated he called the police once he determined Resident #2 was heading toward an unsafe area, where the sidewalk ended and a highway crossing was located. RN B stated Resident #2 was verbally aggressive with the police when they arrived and tried to hit them. He stated the police had to restrain Resident #2 and drove him back to the facility. RN B stated he believed another staff member called Resident #2's representatives while he was out of the building with Resident #2, but he was unsure who. He stated he did not call the representatives. RN B stated Resident #2 did not sustain any injuries while outside the facility. During an interview on 10/08/2025 at 05:16 p.m., the DON stated Resident #2 was never outside unattended on 10/03/2025 and due to Resident #2's WanderGuard, the facility staff was aware of his attempted exit immediately due to the door alarm sounding. She stated Resident #2's Emergency Contact #2 had notified her that she, Emergency Contact #2, had not been notified of the incident. The DON stated she could not find any documentation to indicate Resident #2's Emergency Contact had been notified. The DON stated Resident #2's attempted elopement was not a change of condition due to Resident #2's documented history and the facility policy was to notify the resident representative for a change of condition, so the Emergency Contact did not need to be notified. The DON stated Resident #2 would usually come back in easily after attempting to elope, but he responds better to females when being redirected and the nurse that Resident #2 responded to the best was out on leave. The DON stated there were more male staff on shift the night of Resident #2's attempted elopement, 10/03/2025. During an interview on 10/08/2025 at 05:51 p.m., the ADMIN stated Resident #2's family (Emergency Contact #2) came to the facility on Monday, 10/06/2025 and was upset after finding out about Resident #2's attempted elopement on 10/03/2025. The ADMIN stated she, the DON, and the social worker spoke with Resident #2's Emergency Contact and explained Resident #2 was never unaccompanied while outside and due to Resident #2 having been accompanied by staff, the incident was not an elopement. Record review of policy titled, Change in a Resident's Condition or Status, dated 2018, revealed Our facility shall promptly notify the resident, his or her Attending Physician, and representative (sponsor) of changes in the resident's medical/mental condition and/or status.4. Unless otherwise instructed by the resident, a nurse will notify the resident's representative when: a. The resident is involved in any accident or incident that results in an injury including injuries of an unknown (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 If continuation sheet Page 5 of 10 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 12/12/2025 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 0580 source; b. There is a significant change in the resident's physical, mental, or psychosocial status;. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 If continuation sheet Page 6 of 10 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 12/12/2025 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure that the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment for two of eleven residents (Resident #1 and Resident #3) reviewed for care plans. 1. The facility failed to update or add interventions to Resident #1's care plan regarding behaviors that impact his safety, stripping the bed and the suspected behavior of repeatedly pulling on the privacy curtain resulting in pulling the curtain track down from the ceiling. 2. The facility failed to update or add interventions to Resident #3's care plan regarding reported suicidal ideation that occurred on 10/05/2025. These failures could place residents at risk of not receiving the necessary services or having the appropriate interventions to meet their current needs. The findings included: 1. Record review of Resident #1's admission Record, dated 10/07/2025, revealed an [AGE] year-old male admitted on [DATE]. Record review of Resident #1's Diagnosis Report, dated 10/07/2025, revealed diagnoses including vascular dementia (a change in thinking and memory that occurs when the brain experiences a disruption in blood flow), chronic obstructive pulmonary disease (a type of progressive lung disease), and interstitial pulmonary disease (inflammation and progressive scarring of lung tissue). Record review of Resident #1's quarterly MDS, dated [DATE], reflected Resident #1 was rarely/never understood, had short and long-term memory problems, and was severely impaired for daily decision making. Record review of picture allegedly taken 10/05/2025 by LPN A revealed Resident #1 in a resident room, lying in a bed with the room's privacy curtain and track system disconnected from the drop ceiling and part of the drop ceiling broken and on the floor. Resident #1 and the bed appear to be outside the area of debris. Resident#1's bed noted to not have sheets attached to the bed with a naked mattress under Resident #1, but Resident #1 appeared to be wrapped in a sheet. Record review of Resident #1's care plan, dated 07/31/2025, revealed Resident #1 had cognitive impairment due to diagnosed dementia, had a mood problem related to the disease process of dementia with behaviors, was at risk for behaviors related to demonstrates physically abusive behaviors, and was at risk for injury due to wandering behavior. The care plan did not note Resident #1's behaviors of stripping the bed or pulling on his privacy curtain resulting in it being pulled from the ceiling. During an observation and attempted interview on 10/06/2025 at 03:42 p.m., Resident #1 was observed in the dining area of the facility secure unit interacting with a facility staff member. Resident #1 appeared calm but confused. Attempted interview with Resident #1 revealed he was not interviewable. During an interview on 10/08/2025 at 02:00 p.m., LPN D stated she worked with Resident #1 on Monday morning, 10/06/2025. She stated Resident #1 had been moved rooms when she came in for her shift because Resident #1 probably pulled down the curtains. She stated Resident #1 had done that before. She stated Resident #1 also had a history of pulling the sheets off his bed. During an interview on 10/08/2025 at 02:49 p.m., LPN A stated there was an incident on either Saturday or Sunday morning, could not recall date, in which Resident #1 had pulled on the curtain resulting in the curtain railing having disconnected from the ceiling. He stated Resident #1 did not sustain injuries and the falling debris did not fall on him. He stated Resident #1 had a behavior of pulling his sheets off his bed as soon as staff put them on; however, the staff continue to try to keep them on. LPN A stated he was unsure if Resident #1's behavior of stripping the bed was care-planned, but he knew Resident #1 had that behavior. He stated the curtain having been pulled from the ceiling was the second time Resident #1 had demonstrated that behavior. During an interview on 10/08/2025 at 05:16 p.m., the DON stated Resident #1 takes all of his sheets off his bed and wraps himself in them. She stated she would consider that action a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 If continuation sheet Page 7 of 10 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 12/12/2025 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few behavior but did not know if the behavior was noted in his care plan. She stated she thought the facility should care plan for it. She stated Resident #1's action of pulling the curtains down in his room was assumed since she was unsure if staff ever witnessed him doing it; however, she stated that was the only possibility that made sense. She stated she would consider that action a behavior if staff witnessed it and that documented behaviors should be care-planned so appropriate interventions could be created. She stated that for dementia residents the staff might have to remove the privacy curtains for safety reasons, but there must be a documented reason. She stated Resident #1's behavior of stripping the bed having not been care planned would not impact him because staff would just keep making the bed. She stated Resident #1 had not sustained any injuries from the curtain track having been pulled down in his room. During an interview on 10/08/2025 at 05:51 p.m., the ADMIN stated the known behavior of a resident for stripping the bed would typically be care-planned. She stated incidents such the curtain track having been pulled from the drop ceiling on Sunday, 10/03/2025, would have been discussed during the management's morning meeting on Monday. She stated the management team would discuss the incident and update the care plan at that time. She stated behaviors having not been documented or care planned would impact staff communication, staff might not be on the same page. 2. Record review of Resident #3's admission Record, dated 10/07/2025, revealed a [AGE] year-old female initially admitted on [DATE] and readmitted on [DATE]. Resident #3 had one responsible party listed as her only contact. Record review of Resident #3's Diagnosis Report, dated 10/07/2025, revealed diagnoses including schizoaffective disorder (a chronic mental illness involving symptoms of schizophrenia and characterized by symptoms such as delusions and hallucinations), major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest), and chronic bronchitis (long-lasting inflammation of the bronchial tubes in the lungs). Record review of Resident #3's quarterly MDS, dated [DATE], reflected Resident #3 had a BIMS of 15, indicating she was cognitively intact. Her mood was documented as having had little interest or pleasure in doing things and feeling down, depressed, or hopeless nearly every day; however, she had no thoughts that she would be better off dead or thoughts of hurting herself. She was noted as always feeling lonely or isolated from others around her. She rejected evaluation or care 4-6 days a week, but not daily. She did not have wandering behaviors. She used a cane/crutch for mobility with setup or clean-up assistance when walking. She required setup or clean-up assistance for toileting hygiene and toilet transfer and was occasionally incontinent of bowel and bladder. Record review of Resident #3's progress notes, dated 10/08/2025 for progress notes created 10/05/2025 to 10/08/2025, reflected: - SBAR Summary for Providers note dated 10/05/2025 at 05:00 p.m. by LPN E, Situation: The Change in Condition/s reported on this CIC Evaluation are/were: Other change in condition.- Behavioral Status Evaluation: Suicide potential.Primary Care Provider Feedback: Primary Care Provider responded with the following feedback: A. Recommendations: Send to ER for further evaluation. - Administrator Note dated 10/05/2025 at 06:41 p.m. by the ADMIN, Admin received a call regarding resident informing staff that she was signing out to get some air. Resident [sic] norm is to sit out front during the day. Staff stated shortly after resident was let outsomeone was banging on the door to notify staff that resident was crossing the street. Staff went to assist, and resident voiced wanting to get hit by a car. Admin notified on call to ensure she maintained on 1:1 and sent out to the hospital for evaluation. - Incident Note dated 10/06/2025 at 04:01 a.m. by RN B, Med tech reported that resident [Resident #3] refused her pills, stated that she wants to leave the facility but later said that she just wants to have some air outside [sic] so she was let out. A visitor later called us that [Resident #3] is on the street. We got her back to the facility [sic] but she had repetitively said that she wants [sic] to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 If continuation sheet Page 8 of 10 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 12/12/2025 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few die. She was later sent out due to suicidal ideation. She was cleared to return to the facility [sic] and she came back around 2130 [09:30 p.m.]. Record review of Resident #3's SBAR Communication Form, dated 10/05/2025, reflected: Other change in condition: Suicidal ideation.Yes, Suicide potential.This started on: 10/05/2025. Behavioral evaluation was noted as suicide potential. Physician recommendation was Send to ER for further evaluation. Record review of Resident #3's care plan, dated 08/15/2025, revealed Resident #3- sometimes had behaviors of removing food from fellow resident's trays, - had a psychosocial well-being problem related to anxiety with the intervention to include consult with social services and psych services, date initiated 01/16/2025, - had a behavioral problem related to picking at her skin/existing injuries, - had a history of refusing care related to cognitive impairment and poor insight/judgement, - received antidepressant medication with interventions to include monitor for depressive symptomology including suicidal ideations every shift, date initiated 09/24/2024, and- was at risk for violence directed at self/others related to schizoaffective disorder, date initiated 10/11/2024 and revised 12/27/2024. Her care plan did not include a noted history of suicidal ideation. During an observation and interview on 10/06/2025 at 04:19 p.m., Resident #3 was observed walking down the hallway. She appeared groomed, appropriately dressed, and was walking unassisted. She stated she became angry on Sunday, 10/05/2025, because she could not go anywhere and her family would not come to see her. She revealed she knew she could sign herself out on pass but had to notify staff prior to doing so and did not want to follow this rule on Sunday, 10/05/2025. She stated she was upset, and she tried to walk out of the facility without notifying staff or a nurse and then staff began to follow her. She stated staff were concerned she might fall, which was the reason they followed her outside. She stated staff would not let her go outside on her own and stayed near her as she was walking toward the street. She stated she went into the street and wanted a car to hit her. She stated a nurse came and walked her back into the facility and then she was put on suicide watch. She stated she had been very depressed lately and did not want to do therapy. She stated she didn't want to take her medications and didn't want to go to therapy because she was angry. She stated she didn't want to hurt herself; she was just angry and wanted staff to leave her alone. During an interview on 10/08/2025 at 11:05 a.m., CNA F stated Resident #3 was allowed to go outside and sit on her own on the porch. Stated Resident #3's family doesn't take her out on pass or visit her, so Resident #3 would just sit on the porch daily for around 45 minutes. Stated Resident #3 needed to sign in and out daily and staff would go outside and give her snacks and water and notify her of lunch time and any activities. She stated Resident #3 did not have a history of leaving the facility. CNA F stated Resident #3 notified an unnamed lady that was stopped in the street that she doesn't get changed, even though Resident #3 was independent for changing her briefs. CNA F stated she was unsure what set Resident #3 off on Sunday, 10/05/2025, but a nurse brought Resident #3 a milkshake to calm her down. During an interview on 10/08/2025 at 11:58 a.m., CNA G stated she was not on shift during the incident on 10/05/2025 with Resident #3 but knew that the incident was the first incident of this type with Resident #3. She stated Resident #3 was never aggressive and very sweet. She stated she knew Resident #3 was upset and heartbroken because her boyfriend didn't want to speak with her. During an interview on 10/08/2025 at 02:40 p.m., the SW stated Resident #3 was receiving psychological services and had met with a provider today, 10/08/2025. The SW stated Resident #3 had instances of stating she wanted to leave, but then she would recant. The SW stated Resident #3 would get upset because she hadn't seen her family or upset about other circumstances. The SW stated Resident #3 did not want to go to the hospital on [DATE], but she (the SW) spoke with staff about sending Resident #3 out for an evaluation for psych services. The SW stated she was unsure what set Resident #3 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675002 If continuation sheet Page 9 of 10 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 12/12/2025 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete off on 10/05/2025 but she had followed up with Resident #3 on 10/06/2025 after Resident #3 returned from having been evaluated at the hospital and discharged . The SW stated when she completed her follow up with Resident #3 following the incident on 10/05/2025, Resident #3 was apologetic, stated she didn't want to leave, and was not unhappy. The SW did not mention updating Resident #3 care plan. During an interview on 10/08/2025 at 05:16 p.m., the DON stated Resident #3 had a change of condition on 10/05/2025 due to suicidal ideation. Stated Resident #3 could sign herself out and would generally sit on the front porch to listen to music, but per reports, Resident #3 was refusing her psych medication that day. The DON stated Resident #3 was sent out to the hospital for suicidal ideation but was now doing a lot better since she was back on her medication. The DON stated Resident #3 did not typically have behaviors other than stating I'm going to move. The DON stated she would have to check if Resident #3's suicidal ideation was care-planned yet, but Resident #3 was sent out, evaluated at the hospital and then sent back. The DON stated she could not recall if Resident #3 had any additional interventions. During an interview on 10/08/2025 at 05:51 p.m., the ADMIN stated Resident #3 had a change of condition completed on 10/05/2025 because Resident #3 did not have a prior history of suicidal ideations. She stated Resident #3 was sent out to the hospital due to her, Resident #3, having made verbal statements (regarding suicide). The ADMIN stated when Resident #3 was interviewed following the incident on 10/05/2025, Resident #3 didn't confirm she made those statements, but just seemed to infer that she had a bad day. The ADMIN stated she was unsure if Resident #3 was care-planned for suicidal ideation, but the social worker would have had to complete an assessment, and the interdisciplinary team would have discussed. The ADMIN stated the facility's policy on suicidal ideations was for it to be care-planned. The ADMIN stated the social worker was the staff member typically responsible for adding suicidal ideation to the care plan. The ADMIN revealed Resident #3's care would not have been impacted by suicidal ideation not having been care-planned because Resident #3 was receiving psych services and they were notified of the incident. Record review of policy titled, Behavioral Assessment, Intervention and Monitoring, dated 2018, revealed: Management1. The interdisciplinary team will evaluate behavioral symptoms in residents to determine the degree of severity, distress and potential safety risk to the resident, and develop a plan of care accordingly. Safety strategies will be implemented immediately if necessary to protect the resident and others from harm. a. Atypical behavior will be differentiated from behavior that is dangerous or problematic for the resident(s) or staff, or behavior that signals underlying distress.2. The care plan will incorporate findings from the comprehensive assessment and be consistent with current standards of practice.7. Interventions will be individualized and part of an overall care environment that supports physical, functional and psychosocial needs, and strives to understand, prevent or relieve the resident's distress or loss of abilities. 8. Interventions and approaches will be based on a detailed assessment of physical, psychological and behavioral symptoms and their underlying causes, as well as the potential situational and environmental reasons for the behavior. Event ID: Facility ID: 675002 If continuation sheet Page 10 of 10