Inspection·January 11, 2024

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure an encoded, accurate and complete discharge MDS was electronically completed and transmitted to the CMS System within 14 days after completion for 4 of 4 residents (Resident #1, #2, #3, and #4) reviewed for discharge MDS assessments. Residents Affected - Some 1. The facility failed to ensure Resident #1's discharge MDS was completed and transmitted. 2. The facility failed to ensure Resident #2's discharge MDS was completed and transmitted. 3. The facility failed to ensure Resident #3's discharge MDS was completed and transmitted. 4. The facility failed to ensure Resident #4's discharge MDS was completed and transmitted. These deficient practices placed residents at risk of not having assessments completed and submitted in a timely manner as required. The findings included: 1. Record review of Resident #1's face sheet accessed on [DATE] revealed the resident was a [AGE] year old female admitted on [DATE] and readmitted [DATE] with diagnoses that included cerebral infarction with hemiplegia and hemiparesis affecting right dominant side (stroke resulting in weakness and paralysis), Type II diabetes (a problem in the way the body regulates and uses blood sugar), and local infection of the skin and subcutaneous (under the skin) tissue. Record review of Resident #1's EMR revealed a discharge summary signed by MD C indicating the resident's discharge date was [DATE]. Resident #1's disposition was Acute care hospital. Record review of Resident #1's EMR revealed a progress note signed by the DON dated [DATE] indicating Resident #1 was still in the hospital and would not be returning to the facility. Record review of Resident #1's electronic MDS assessments revealed no documented evidence of a discharge MDS was completed or transmitted to CMS. 2. Record review of Resident #2's face sheet accessed on [DATE] revealed the resident was a [AGE] year old female admitted on [DATE] with diagnoses that included cerebral infarction (stroke), encephalopathy (a disease affecting the brain structure or function, causing altered mental state and confusion), and end-stage renal disease (a condition in which the kidneys do not function normally and (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 675138 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 01/11/2024 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)