Inspection·January 18, 2023

F 0558 table. Level of Harm - Minimal harm or potential for actual harm In an observation on 01/16/2023 at 12:25 PM, CNA B entered Resident #72's room to assist him with breakfast. This constituted a delay of 60 minutes from the time the meal was available on the hallway, to the time Resident #72 could partake of his meal. Residents Affected - Few In an interview on 01/16/2023 at 12:45 PM Resident #72 stated the food was okay and the food was warm-ish. Resident #72 stated he was really hungry and would eat lunch even if it were cold. In an interview on 01/16/2023 at 12:48 PM CNA B stated meal trays are inspected when the cart arrives on the wing by the nurse; Once released the two CNAs will distribute trays and provide set up assistance to the residents who need it; One CNA will report to the dining area to assist the residents who participate in communal dining while the other CNA assists the residents in their room with eating. CNA B stated the two CNAs will alternate which CNA reports to the dining room versus assisting residents in the room with eating. CNA B stated there are two residents on B wing hallway who eat in room and require assistance with eating. When asked for a rationale as to which resident gets fed 1st, CNA B stated she alternates who goes first at each meal. CNA B stated the all the food items were warm enough. 2. Record review of admission Record revealed Resident #6 was admitted on [DATE]with the following diagnoses: feeding difficulties, unspecified; anorexia; and other symptoms and signs involving cognitive functions following unspecified cerebrovascular disease. Record review of the quarterly MDS dated [DATE] revealed Resident #6 was coded as dependent, meaning the helper does all of the effort; resident does none of the effort required to complete the activity for the activity of eating, which was defined as the ability to use suitable utensils to bring food/liquid to the mouth and swallow once the meal is placed before the resident. Record review of the Care Plan initiated 08/10/2022, and revised 10/19/2022, revealed Resident #6 had a focus area of: ADL [Activities of Daily Living] self-care deficit; with associated interventions: require staff participation to eat and need assistance on eating. Resident #6 had a focus area of impaired nutrition; with associated interventions: assist with meals (feed/set-up) as needed. Record review of Dietary Progress Note written 01/09/2023 at 4:32 PM, by RD, revealed Resident #6 had an unfavorable weight loss of 11% since 07/05/2022 most likely due to reduced PO intake; PO intake is poor at 26-50%. In an observation on 01/17/2023 at 7:35 AM, the breakfast tray cart was available on Resident #6's hallway. In an observation on 01/17/2023 at 8:42 AM, CNA B entered Resident #6's room to assist the resident with her breakfast. This constituted a delay of 67 minutes from the time the meal was available on the hallway, to the time Resident #6 could partake of her meal. In an interview on 01/18/2023 at 11:35 AM the Medical Director (MD), stated if the meal was intended to be hot it should be hot and if the meal was intended to be cold it should be cold. After 67 minutes the meal most likely would not be hot. MD stated Resident #6 has been recommended for end-of-life palliative care and receiving a hot meal would be comforting for Resident #6. The MD stated an hour lag time is not acceptable for a meal tray. The MD stated he was especially concerned as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 2 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few palliative care is his specialty and not having a hot meal for what could be one of a residents' last meals at the end of his or her life was distressing to him. In a group interview on 01/18/2023 at 12:40 PM with the DON and the ADON stated residents who need assistance with eating should be assisted with their meal as soon as possible. The DON stated being assisted with eating a meal 67 minutes after it was served was not within her expectations, I would not want a meal after 67 minutes (of being served). The ADON stated each hall has 2 CNAs and during meals residents are assisted to the dining room and 1 CNA stays in the dining room to assist residents with the meal service and the other CNA stays in the hall and is responsible to deliver the meal to residents who choose to stay in their rooms and then assist residents who need help eating their meal. The DON stated she was unaware of any residents having to wait a protracted amount of time for assistance with eating; The ADON stated 67 minutes is too long for a resident to wait to be fed. ADON stated that staffing distribution would be reviewed to determine if adjustments were necessary. Record review of Grievance/Complaint Report dated 11/08/2022, written by SS, revealed, Residents in resident council meeting .described concerns related to 'trays sit on hall and food gets cold. An In-Service was provided on 11/25/2022, that included the highlighted statement, Provide trays in a timely manner. Review of Policy entitled, Assistance with Meals, revised July 2017 revealed that for Residents Requiring Full Assistance: 2. Residents who cannot feed themselves will be fed with attention to safety, comfort and dignity. All residents: 1. Hot foods shall be held at a temperature of 136 degrees or above until served. Cold foods shall be held at 40 degrees or below until served. Nursing and Dietary Services will establish procedures such that delivery of food to serving areas accommodates this requirement. 2. Foods that are left on trays with out a source of heat (for hot foods) or refrigeration (for cold foods) longer than 2 hours will be discarded. 3. All employees who provide resident assistance with meals will be trained and shall demonstrate competency in the prevention of foodborne illness. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 3 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews the facility failed to encode and transmit to CMS a subset of items upon a resident's death for 1 of 1 Resident(s) (Resident #19) reviewed for encoding and transmitting a subset of items upon a resident's death, in that; Residents Affected - Few Resident #19 passed away in the facility without the facility transmitting to CMS the event assessment. This deficient practice placed residents at risk for harm by denying the CMS accurate data and placing the facility at risk for fraud and/or financial hardship. The findings include: A record review of Resident #19's admission record revealed an admission date of [DATE] and a discharge date of [DATE] with diagnoses which included atherosclerotic heart disease (a type of thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of arteries). A record review of Resident #19's medical record revealed the most recent MDS dated [DATE], coordinated by LVN C . The MDS was a significant change of status MDS assessment. The MDS revealed Resident #19 was a [AGE] year-old female without mental cognition impairment receiving hospice services. A record review of Resident #19's Nurse Progress notes revealed an [DATE] note Authored by LVN D, Resident pronounced expired by Hospice Nurse E at 07:59 PM. Family present in room during passing. Resident medication had been discontinued prior shift due to retention of medication and inability to swallow, continued on morphine, lorazepam, and atropine drops until time of passing. Director of Nursing notified of passing . Medical Examiner . in building. At 2230 [10:30 PM] exited building with the Resident accompanied by family at 2306 [11:06 PM]. Family exited building with all Resident's belongings. A record review on [DATE] of Resident #19's medical record revealed no MDS assessment and/or transmittal to CMS to reflect Resident #19's death in the facility on [DATE]. During an interview on [DATE] at 01:22 PM LVN C stated he was the facility's MDS nurse responsible for assessing residents and coordinating and transmitting to CMS the MDS assessments for residents. LVN C stated there was no MDS assessment or transmittal to CMS with a subset of items to reflect Resident #19's death. LVN C stated there should be an assessment or transmittal, for Resident #19, to CMS with a subset of items to reflect Resident #19's death. LVN C stated the assessment or transmittal to reflect Resident #19's death was not completed because he was not alerted by the medical records computer program to perform one. When asked what consequences this lack of assessment could produce LVN C stated there could be inaccurate information held by CMS. During an interview on [DATE] at 04:58 PM with the DON and the Administrator, the DON stated the MDS nurse should report to CMS a resident's death in the facility via the MDS system. The DON stated she would review the record for accuracy. A policy for the MDS discharge was requested from the facility on [DATE] from LVN C and again from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 4 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0640 The Administrator on [DATE] at 5:32 PM and as of the exit at 7:00 PM the policy was not provided. Level of Harm - Minimal harm or potential for actual harm A record review of Centers for Medicare and Medicaid Services website, accessed [DATE], https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIMa Residents Affected - Few long term care facility resident assessment instrument 3.0 user's manual, version one point 17.1, dated [DATE], titled chapter 2 assessment for the RAI revealed instructions for the MDS coordinator specific for when a Resident died in the facility, death in a facility tracking record section, AO31OF equals 12, must be completed when the resident dies in the facility .must be completed within seven days after the Resident's death which is recorded in item A2000 .discharge date A2000 plus seven calendar days must be submitted within 14 days after the residence death. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 5 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that include measurable objectives and time frames to meet residents' mental and psychosocial needs for 2 of 15 Residents (Resident #12 and Resident #35) reviewed for comprehensive care plans, in that: 1. Resident #12's pressure relieving device for his wheelchair was not addressed in the resident's care plan. 2. Resident #35's gastrostomy tube (a tube inserted through the belly that brings nutrition directly to the stomach) and enteral feedings (intake of food through the gastrostomy tube) were not addressed in the resident's care plan. This failure could place residents who had gastrostomy tubes and enteral feedings at risk of not receiving care needed; This deficient practice could place residents at risk for developing pressure injuries at risk for a decline in health, infection or diminished quality of life. The findings were: 1. Record review of admission Record revealed Resident #12 was a [AGE] year-old male, admitted [DATE] with the following diagnoses: pressure ulcer, dermatitis, rash and other nonspecific skin eruption. Record review of annual MDS, dated [DATE], Section G - Functional Status, Resident #12 normally utilized a wheelchair as a mobility device. In Section M - Skin Conditions, Resident #12 was at risk for developing pressure injuries; had 2 Stage II pressure injuries, and 2 Stage III pressure injuries; and utilized a pressure reducing device for chair and a pressure reducing device for bed. Record review of Care Plan initiated 04/21/2019, revised on 1/16/2023 and printed by this surveyor on 1/18/2023 at 1:32 PM, revealed Resident #12 had a Focus Area of potential/actual impairment to skin integrity due to immobility; with the associated interventions: air mattress due to impaired skin integrity to protect the skin while in bed; however, the Care Plan did not address a pressure reducing device for his wheelchair. This section also revealed the resident was admitted [DATE] with Stage II pressure injury to left buttock, resolved 6/5/2019; Stage II pressure injury 8/12/2019 to right ischium, resolved 01/03/2020; Stage II pressure injury 12/6/2019 to right proximal ischium, resolved 1/3/2020; reoccurring Stage III pressure injury 4/13/2022 to right ischium, marked resolved but undated; Stage II pressure injury 4/20/2022 to right and left buttocks, marked resolved, but undated; Stage II pressure injury 12/22/2022 to right ischium and right medial ischium, not marked as resolved. Focus Area also included, Air mattress in place due to impaired skin integrity, and Q [every] 2 hours repositioning order in plcae(sp) [place]. Record review of Skin/Wound Note dated 12/28/2022 at 10:16 AM written by LVN I revealed Resident #12 was seen by the wound care practitioner for stage II pressure injury to right and right medial ischium for which orders included: cleanse with wound cleanser, pat dry, and apply triad BID [twice a day] and PRN [as needed]; and Educated resident on limiting time on wheelchair to relieve pressure. Orders did not include pressure relieving device for wheelchair. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 6 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 01/15/2023 at 1:47 pm, Resident #12 stated that approximately 5 months ago, over the summer, or maybe in July, the ROHO cushion that he had prior to admission, sprung an air leak. Resident #12 stated he was advised there was no money for a replacement by the facility, and he was given a gel mat for the wheelchair seat. Resident #12 stated he recently developed a pressure ulcer on his backside. Resident #12 stated that late last month, [December] someone in the rehab department found him a ROHO replacement cushion. Resident #12 stated the pressure ulcer is just about healed now after being on the new ROHO cushion only 3 weeks or so. In an interview on 01/18/2023 at 1:08 PM, LVN I stated resident had a damaged ROHO cushion. LVN I stated that the cushion had recently been replaced. LVN I stated Resident #12's wound is intact and if it remains so the Wound Care Physician will most likely diagnose it as resolved sometime next week. In an interview on 01/18/2023 at 7:32 PM, the DON stated that Resident #12 did have instructions for a ROHO cushion but under the Focus area, and not under the Interventions area of the Care Plan. Further review of the EHR Care Plan correlates with this information. This surveyor advised the DON that information was not on the Care Plan printed earlier in the day [1:32 PM]. The DON stated the Care Plan showed a revision date of 01/18/2023 but did not indicate a time or who updated the Care Plan. Record review of policy entitled Prevention of Pressure Ulcers/Injuries, revised December 2021, revealed the following interventions: Risk Assessment .4. Inspect the skin daily; Mobility/Repositioning .4. Reposition more frequently as needed, based on the condition of the skin and the resident's comfort; and 5. Provide support devices and assistance as needed; Support Surfaces and Pressure Redistribution: Select appropriate support surfaces based on resident's .[condition]. 2. Review of Resident #35's face sheet dated 1/16/2023 revealed she was admitted to the facility on [DATE] and had diagnoses that included type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar, either by the body not producing enough insulin or it resists insulin) without complications, hypertensive heart disease (heart problems that occur because high blood pressure that is present over a long time) with heart failure, unspecified dementia (a group of conditions characterized by impairment of at least two brain functions, such as memory loss and judgement), schizophrenia unspecified (a serious mental disorder in which people interpret reality abnormally, impairing daily functioning, but do not meet full diagnostic criteria for the disease), squamous cell carcinoma of skin (a common form of skin cancer that develops in the squamous cells that make up the middle and outer layer of the skin) and gastrotomy status (a tube inserted through the wall of the abdomen directly into the stomach). Review of Resident #35's physician orders, last reviewed 1/9/2023, revealed orders to flush gastrostomy tube every 6 hours and to cleanse peg tube site every shift, dated 7/15/2022. Further review of the resident's record revealed enteral feed FiberSource HN (tube feeding formula) 250 ml carton 5 times a day, with a start date of 12/2/2022. Further review of the physician orders revealed the resident had an order for fortified diet regular texture with a start date of 1/23/2023. Review of Resident #35's Significant Change in Status MDS dated [DATE], revealed the resident had a BIMS score of 3, severely impaired cognitive status and required extensive to total assistance of 2 person for bed mobility, transfers, toileting and personal hygiene. Review of Resident #35's care plans revealed a nutritional status care plan with an initiation date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 7 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of 10/19/2022 with a goal of consuming 75% of ordered diet each day and a care plan that addressed the resident was on a modified diabetic diet with intervention the dietary department would offer varied menu with choices. Further review of Resident #35's care plan did not reveal a care plan that addressed the resident's gastrostomy tube and enteral feedings. In an interview with the MDS Coordinator on 1/16/2023 at 12:47 p.m. he revealed he should have addressed Resident #35's gastrostomy tube in the nutritional care plan whether she had been receiving enteral feedings or not. The MDS Coordinator also reported he should have updated the resident's care plan when she began enteral feedings. The MDS Coordinator stated he was not sure how he missed Resident #35's gastrostomy tube. He stated the computer program would usually alert him when a resident has something such as a gastrostomy tube, especially when it was part of the resident's diagnosis. He stated he possibly missed the gastrostomy tube because the computer program did not alert him. In an interview with the DON on 1/18/2023 at 3:21 p.m. she reported the care was being provided to Resident #35 regarding her gastrostomy tube and enteral feedings and the only potential outcome was the care plan was not updated. Review of the facility policy, Comprehensive Assessments and the Care Delivery Process, reviewed December 2020, revealed the comprehensive assessments, care planning and the care delivery process involve collecting and analyzing information, choosing and initiating interventions, and then monitoring results and adjusting interventions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 8 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that a resident with pressure injuries received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new injuries from developing for one of three residents (Resident #12) reviewed for pressure sores, in that, Residents Affected - Few The facility failed to ensure Resident #12 received all appropriate wound care treatments, specifically, a pressure relieving device for his wheelchair. This deficient practice could place residents at risk for pressure injuries at risk for a decline in health, infection or diminished quality of life. The findings included: Record review of admission Record revealed Resident #12 was a [AGE] year-old male, admitted [DATE] with the following diagnoses: pressure ulcer, dermatitis, rash and other nonspecific skin eruption. Record review of annual MDS, dated [DATE], Section G - Functional Status, Resident #12 normally utilized a wheelchair as a mobility device. In Section M - Skin Conditions, Resident #12 was at risk for developing pressure injuries; had 2 Stage II pressure injuries, and 2 Stage III pressure injuries; and utilized a pressure reducing device for chair and a pressure reducing device for bed. Record review of Care Plan initiated 04/21/2019, revised on 1/16/2023 and printed by this surveyor on 1/18/2023 at 1:32 PM, revealed Resident #12 had a Focus Area of potential/actual impairment to skin integrity due to immobility; with the associated interventions: air mattress due to impaired skin integrity to protect the skin while in bed; however, the Care Plan did not address a pressure reducing device for his wheelchair. This section also revealed the resident was admitted [DATE] with Stage II pressure injury to left buttock, resolved 6/5/2019; Stage II pressure injury 8/12/2019 to right ischium, resolved 01/03/2020; Stage II pressure injury 12/6/2019 to right proximal ischium, resolved 1/3/2020; reoccurring Stage III pressure injury 4/13/2022 to right ischium, marked resolved but undated; Stage II pressure injury 4/20/2022 to right and left buttocks, marked resolved, but undated; Stage II pressure injury 12/22/2022 to right ischium and right medial ischium, not marked as resolved. Focus Area also included, Air mattress in place due to impaired skin integrity, and Q [every] 2 hours repositioning order in plcae(sp) [place]. Record review of Skin/Wound Note dated 12/28/2022 at 10:16 AM written by LVN I revealed Resident #12 was seen by the wound care practitioner for stage II pressure injury to right and right medial ischium for which orders included: cleanse with wound cleanser, pat dry, and apply triad BID [twice a day] and PRN [as needed]; and Educated resident on limiting time on wheelchair to relieve pressure. Orders did not include pressure relieving device for wheelchair. In an interview on 01/15/2023 at 1:47 pm, Resident #12 stated that approximately 5 months ago, over the summer, or maybe in July, the ROHO cushion that he had prior to admission, sprung an air leak. Resident #12 stated he was advised there was no money for a replacement by the facility, and he was given a gel mat for the wheelchair seat. Resident #12 stated he recently developed a pressure ulcer on his backside. Resident #12 stated that late last month, [December] someone in the rehab department found him a ROHO replacement cushion. Resident #12 stated the pressure ulcer is just about healed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 9 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 now after being on the new ROHO cushion only 3 weeks or so. Level of Harm - Minimal harm or potential for actual harm In an interview on 01/18/2023 at 1:08 PM, LVN I stated resident had a damaged ROHO cushion. LVN I stated that the cushion had recently been replaced. LVN I stated Resident #12's wound is intact and if it remains so the Wound Care Physician will most likely diagnose it as resolved sometime next week. Residents Affected - Few In an interview on 01/18/2023 at 7:32 PM, the DON stated that Resident #12 did have instructions for a ROHO cushion but under the Focus area, and not under the Interventions area of the Care Plan. Further review of the EHR Care Plan correlates with this information. This surveyor advised the DON that information was not on the Care Plan printed earlier in the day [1:32 PM]. The DON stated the Care Plan showed a revision date of 01/18/2023 but did not indicate a time or who updated the Care Plan. Record review of policy entitled Prevention of Pressure Ulcers/Injuries, revised December 2021, revealed the following interventions: Risk Assessment .4. Inspect the skin daily; Mobility/Repositioning .4. Reposition more frequently as needed, based on the condition of the skin and the resident's comfort; and 5. Provide support devices and assistance as needed; Support Surfaces and Pressure Redistribution: Select appropriate support surfaces based on resident's .[condition]. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 10 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record reviews the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each Resident for 1 of 4 residents (Resident #17) reviewed medications, in that; Resident #17 received a medication with the wrong administration instructions contrary to the manufacturing pharmacy's guidelines, after the pharmacist reviewed the order for accuracy. This failure could have placed residents at risk for harm by not receiving the therapeutic effects of the medications prescribed and/or received adverse effects from the medication. The findings included: A record review of Resident #17's admission record revealed an admission date of 04/07/2022 with diagnoses which included osteoporosis [a bone disease that develops when bone mineral density and bone mass decreases]. A record review of Resident #17's quarterly MDS dated [DATE] revealed Resident #17 was a [AGE] year-old female with mild cognitive impairment. The assessment revealed Resident #17 was admitted with a primary diagnosis of Other Orthopedic Conditions [conditions involving the musculoskeletal system]. A record review of Resident #17's medication order, dated 06/29/2022, revealed Resident #17 was to receive the medication alendronate 70mg once every 7 days for osteoporosis. The order stated, give with 8 oz. of water on an empty stomach, to lay down for 30 minutes after med given. Further review revealed the order was reviewed by the ADON. A record review of Resident #17's medication card for the drug alendronate revealed the medication card had printed on the card from the manufacturer which read, take tablets with 6-8oz. of water before first food, beverage, or medication of day. Do not lay down for at least 30 minutes and until after first food. Further review revealed the pharmacy placed a printed label on the medication card which read, give 1 tablet by mouth in the morning every 7 days **give with 8oz of water on empty stomach to lay down for 30 minutes after med given. A record review of Resident #17's monthly November 2022 Pharmacist Drug Regiment Review titled, Consultant Pharmacist Medication Regimen Review: Listing of Residents Reviewed with No Recommendations, For Recommendation Created Between November 7th, and November 8th, 2022, revealed Resident #17 on the list. A record review of Resident #17's monthly December 2022 Pharmacist Drug Regiment Review titled, Consultant Pharmacist Medication Regimen Review: Listing of Residents Reviewed with No Recommendations, For Recommendation Created Between December 8th, and December 9th, 2022, revealed Resident #17 on the list. During an interview on 01/16/2022 at 08:00 Am Resident #17 stated she has been receiving the drug alendronate early in the morning, they wake me up around 6 AM and give me the med once a week. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 11 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0755 Level of Harm - Minimal harm or potential for actual harm Resident #17 stated she has learned to stay awake and upright, for about an hour afterwards due to, If I lay down, I throw up. When asked if anyone has taught her the medications manufacturer's guideline to not lay down for at least 30 minutes after receiving the medication, Resident #17 stated no one from the facility taught her but she learned from trial and error. I stay up so I don't get sick, I'll read or watch television and then I will go back to bed for a nap. Residents Affected - Few During an interview on 01/17/2023 at 02:11 PM the ADON stated the drug order procedure begins with the nurse who receives the medication order from the physician. The nurse transcribes the order into the resident's electronic medical record. The order is then reviewed by the ADON and the DON for accuracy and safety. The order is electronically sent to the facility's pharmacy where a pharmacist reviews the order for safety and then dispenses the medication which is delivered to the facility for administration to the intended Resident. The ADON stated the medication alendronate was an esophageal irritant (irritates the throat) and should be given with the instructions to not lay down for at least 30 minutes after administration. The ADON reviewed Resident #17 alendronate order and recognized the error in administration instructions and stated the instructions should have read do not lay down for 30 minutes. The ADON stated the pharmacist comes to the facility monthly and reviews all medications for all residents. The ADON stated the pharmacist was responsible for reviewing all medications for errors. The ADON stated the pharmacists did not alert the facility to the administration instruction error. The ADON stated the error could have caused administration confusion and possible adverse outcomes for residents. A record review of the facility's Medication Regiment Reviews policy, dated April 2017, revealed, the primary purpose of this review is to help the facility maintain each residence highest practicable level of functioning by helping them utilize medications appropriately and prevent or minimize adverse consequences related to medication therapy to the extent possible. A record review of the National Library of Medicine's website: https://medlineplus.gov/druginfo/meds/a601011.html . Accessed 01/24/2023. Revealed, Alendronate is used to treat and prevent osteoporosis (a condition in which the bones become thin and weak and break easily) in women who have undergone menopause . Alendronate comes as a tablet, .to take by mouth. The .70-mg tablets are usually taken on an empty stomach once a week in the morning . Alendronate may not work properly and may damage the esophagus (tube between the mouth and stomach) or cause sores in the mouth if it is not taken according to the following instructions. Tell your doctor if you do not understand, you do not think you will remember, or you are unable to follow these instructions: You must take alendronate just after you get out of bed in the morning, before you eat or drink anything. Never take alendronate at bedtime or before you wake up and get out of bed for the day. After you take alendronate, do not eat, drink, or take any other medications (including vitamins or antacids) for at least 30 minutes. Do not lie down for at least 30 minutes after you take alendronate. Sit upright or stand upright until at least 30 minutes have passed and you have eaten your first food of the day. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 12 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to store all drugs and biologicals in locked compartments and permit only authorized personnel to have access, for 2 of 3 medication storage rooms (A-hall and B-hall medication store rooms), reviewed for security access, in that; Medication storerooms for A-hall and B-hall, were discovered unattended and unsecured. This failure could place residents at risk for harm by misappropriation of property and/or not receiving the therapeutic effects of their medications. The finding include: A record review of Resident #11's MDS Quarterly assessment, dated 12/16/2022, revealed Resident #11 was an [AGE] year-old female who was admitted to the facility on [DATE]. The assessment revealed Resident #11 had moderately impaired cognition skills for daily decision making and utilized a wheelchair. A record review of Resident #54's MDS admission assessment, dated 12/16/2022, revealed Resident #54 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of schizophrenia [a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning] and dementia [an impaired ability to remember, think, or make decisions that interferes with doing everyday activities]. During an observation on 01/15/2023 at 12:30 PM revealed Resident #54 walking at leisure by the A-hall nurse station and Resident #11 was seated in her wheelchair by the A-hall nurse's station. During an observation on 01/15/2023 at 12:32 PM revealed the medication storage room for the facility's A-hall was located within the A-hall nurses' station. Further review revealed the door to the medication room was unlocked and allowed anyone access to the medications stored within. Further review of the medication storage room revealed medications stored in cabinets and in a medication refrigerator. During an interview on 01/15/2023 at 12:37 PM LVN F stated the medication room was left unattended and unsecured and was likely left unsecured by the ADON G who was the last person in the medication room. LVN F stated the medication storage room should always be locked for safety of property and Resident safety. During an observation on 01/16/2023 at 04:59 PM revealed the medication storage room for the facility's B-hall was located within the B-hall nurses' station. Further review revealed the door to the medication room was unlocked and allowed anyone access to the medications stored within. Further review of the medication storage room revealed medications stored in cabinets and in a medication refrigerator. During an interview on 01/16/2023 MA H stated she observed this surveyor exit the unlocked (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 13 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medication storage room. MA H stated the room should always be locked and was surprised it was not locked. MA H stated the unlocked room could have allowed for resident's medications to have been misappropriated and/or could have caused harm to residents. During an interview on 1/18/2023 at 12:40 PM with the Administrator and the DON, the DON stated the facility has 3 medication rooms and was made aware of the unattended and unsecured medication rooms on 1/15/2023 and 1/16/2023. The DON stated the medication rooms should always locked when not in use. A record review of the facility's Storage of Medications policy, dated April 2018, revealed, policy statement: the facility shall store all drugs and biologicals in a safe, secure, and orderly manner. Policy interpretation and implementation: . compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biologicals shall be locked when not in use, . only persons authorized to prepare and administer medications shall have access to the medication room . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 14 of 15 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 675138 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inspiration Hills Rehabilitation Center 1939 Bandera Rd San Antonio, TX 78228 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 0912 Level of Harm - Potential for minimal harm Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on observation, interview and record review the facility failed to provide a minimum of 80 square feet per resident in 6 of 54 multiple resident rooms as required (Room A9, A18, B9, B18, C5 and C10) in that: Residents Affected - Some Rooms A9, A18, B9, B18, C5 and C10 were 2 bed resident rooms with less than 80 square feet per resident. This could affect residents who resided in multiple resident bedrooms and decrease their ability to carry out their activities of daily living. The findings were: Review of the previous year's survey dated 10/22/2021 revealed: Room A-9 measured 12.336 x 11.223 = 138.45 for 69.22 square feet per resident. Room A-18 measured 11.210 x 12.317 = 138.07 for 69.03 square feet per resident. Room B-9 measured 11.236 x 112.340 = 138.65 for 69.33 square feet per resident. Room B-18 measured 11.240 x 12.332 = 138.61 for 69.31 square feet per resident. Room C-5 measured 12 X 4 X 11 X 3 = 141.5 for 70.5 square feet per resident. Room C-10 measured 11.216 x 12.303 = 137.99 for 68.99 square feet per resident. Review of the Bed Classification form, completed by the facility, signed and dated 1/16/2023, revealed rooms A-9, A-18, B-9, B-18, C-5 and C-10 were each identified as double occupancy rooms. Observation on 1/18/2023 at approximately 2:30 pm revealed multiple resident rooms A-9, A-18, B-9, B-18, C-5 and C-10 each currently had 1 bed in the room. Interview with the Administrator on 1/15/23 at 10:33 am upon entrance to the facility confirmed the facility was requesting a room waiver for resident rooms that were less than minimum square footage. Interview with the Maintenance Director on 1/18/23 at 10:30 a.m. confirmed there had been no changes to the rooms or floor plan since the prior year's survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675138 If continuation sheet Page 15 of 15