Health inspection·March 9, 2023

F 0641 Level of Harm - Minimal harm or potential for actual harm did the assessment must have not completed the assessment properly, and that there could be harm in that he would not be properly treated because of the inaccuracy of the assessment. The ADON stated that the staff members who admit residents are trained on properly conducting assessments. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 2 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to develop a baseline care plan that included information to properly meet residents needs for 1 (Resident #183) of 5 residents in that: Resident #183's baseline care plan did not contain information or care planning about the residents' pressure ulcer. These failures could place residents at risk for not receiving necessary care for their wellbeing. The findings include: Record review of Resident #183's MDS dated [DATE] reflected that Resident #183 was admitted on [DATE] with a BIMS score of 12, indicating the resident is moderately cognitively impaired. Record review revealed that Resident #183's MDS did not indicate that the resident had a pressure ulcer. Record review of Resident #183's face sheet indicates the resident is a [AGE] year-old male. Record review of Resident #183's admitting diagnosis state the resident has diagnosis of Human Immunodeficiency Virus, a virus that attacks the body's immune system. Record review of Resident #183's orders reflected there was a pressure ulcer to their sacrum, a triangular bone in the lower back situated between the hips Interview on 3/8/2023 at 11:55 AM, Resident #183 stated that facility staff clean his pressure ulcer about twice daily. He stated he did not know anything about his care plan. Record review on 3/8/2023 at 12:39 PM of resident #183's baseline care plan dated 2/20/2023 reflected that for Resident #183, no resident care plans since admission have included information on wound care for his pressure ulcer. Record review of Resident #183's orders show the pressure ulcer order was discontinued on 3/8/2023 at approximately 7:00 PM. In an interview on 3/9/2023 at 10:10 AM, Resident #183 stated his pressure ulcer did not hurt him anymore, and that staff told him last night that it was healed. Resident #183 stated he was in pain and did not want to continue the interview. Interview on 3/9/2023 at 4:45 PM with the ADON stated that Resident #183's pressure ulcer should have been in his care plan. The ADON stated she noticed yesterday that there was no mention of it in his care plan. The ADON stated that it was part of her responsibilities to ensure care plans were appropriately completed. The ADON stated that she understood that it was a mistake to not have Resident #183's pressure ulcer information on his care plan and that it can cause harm in that care staff potentially not knowing it needed to be cleaned, or even from it being overtreated by not recording how often it was cleaned. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 3 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 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 observations, interviews and record reviews the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs and includes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 1 (#12) resident with a trapeze bar (a short horizontal bar hung by ropes or metal straps from a ceiling)over her bed in that Resident #12 had an overhead trapeze bar over her bed, and it was not care planed. This could affect all residents and could result in residents not being able to move around in bed. The Findings were: Record review of Resident #12's admission Record dated 3/8/2023 revealed she was admitted on [DATE]. re-admitted on [DATE], she was her own responsible party, her diagnoses included lack of coordination, muscle wasting/atrophy, obesity, major depressive disorder, anxiety and chronic pain syndrome. Observation on 3/06/2023 at 3:45 PM with Resident #12 in her room revealed a trapeze bar over her bed. Interview on 3/06/2023 at 3:46 PM with Resident #12 stated she used the trapeze bar to move herself in bed. Observation on 3/09/2023 at 11:21 AM in Resident # 12's room revealed she was lying in bed watching TV and the trapeze bar was over her bed. Interview on 3/09/2023 at 11:22 AM in Resident # 12's room she stated she used the trapeze bar to turn and reposition herself in bed. Record review of Resident #12's physicians telephone order dated 5/7/2022 reflected an overhead trapeze device to be used for self-positioning. Record review of Resident #12's Quarterly MDS dated [DATE] revealed her BIMS score was 12/15 (moderately cognitively impaired), ADL-bed mobility- she required extensive assistance. transfers required total dependence, dressing required extensive assistance, eating required extensive assistance, bathing required total dependence, she had an impairment on both lower extremities, and used a wheelchair for mobility. Record review of Resident #12's care plan dated 2/15/2023 revealed no care plan for her trapeze bar over her bed. Interview on 3/09/2023 at 11:32 AM with the MDS coordinator stated Resident #12's care plan did not include the trapeze bar. The MDS nurse stated she was not aware that the trapeze bar had to be on Resident #12's care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 4 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the facility Proper Use of Side Rails policy dated December 2016 revealed The purpose of these guidelines are to ensure the safe use of side rails as resident mobility aids and to prohibit the use of side rails as restraints unless necessary to treat a resident's medical symptom. General Guidelines 4. The use of side rails as a mechanical device will be addressed in the resident care plan. 6. Less restrictive interventions that will be incorporated in care planning include: b. providing a trapeze to increase bed mobility. Record review of Care Planning -Interdisciplinary Team policy dated September 2013 revealed Our facility's care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident. 1. A comprehensive care plan for each resident is developed within seven ( 7) days of completion of the resident assessment (MDS). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 5 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents who were unable to carry out activities of daily living were provided with the necessary services to maintain good personal hygiene for 3 (Resident #7, #19, and #5) of 9 residents reviewed for ADL care, in that Residents Affected - Few The facility failed to ensure Residents #7, #19, and #5 were provided bathing as scheduled: 1. Resident #7 missed 6 of 13 scheduled baths between 2/08/2023 and 3/08/2023; 2. Resident #19 missed 13 of 13 scheduled baths between 2/08/2023 and 3/08/2023; and 3. Resident #5 missed 12 of 13 scheduled baths between 2/08/2023 and 3/08/2023. This deficient practice could place residents who require assistance from staff for personal hygiene at risk of not receiving care and services to meet their needs and not reaching their highest practicable physical and psychosocial well-being. The findings included: 1.Record review of admission Record revealed Resident #7 was an [AGE] year-old female admitted [DATE]. Diagnosis information included: neuromuscular dysfunction of bladder [results from disease or injury of the central nervous system or peripheral nerves involved in the control of urination], contracture [permanent tightening of the muscles, tendons, skin and surrounding tissues that cause joints to shorten and stiffen], hemiplegia [paralysis of one side of the body], and hemiparesis [weakness to one side of the body]. Record review of quarterly MDS assessment dated [DATE] revealed Resident #7 was admitted for medically complex conditions related to cerebral infarction [brain lesion in which a cluster of brain cells die due to disruption in blood supply]. Active diagnoses included: diabetes mellitus; lack of coordination; muscle wasting and atrophy. BIMS summary score of 7 [indicative of severely impaired cognitive status]. ADL assistance was coded as extensive assistance with two or more persons physical assistance for bed mobility; total dependence for bathing; dependent for toileting hygiene. Documentation indicated presence of indwelling catheter and always incontinent of urine, frequently incontinent of bowel. No current unhealed pressure ulcers/injuries documented. Record review of Care Plan revealed Resident #7 had a focus area of potential for skin breakdown/conditions related to bowel incontinence and impaired physical mobility initiated on 1/15/2018 and revised on 5/19/2021 with associated interventions: disposable briefs, change every 2 hours and as needed. Additional focus area of pain related to history of pressure ulcer to left buttock initiated 8/13/2021with associated interventions: administer analgesia as per orders; give before treatments or care. Additional focus area of stage II pressure ulcer to left buttock potential for pressure ulcer (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 6 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm development related to immobility initiated on 2/15/2023, with associated interventions: administer treatments as ordered; follow facility policies/protocols for the prevention/treatment of skin breakdown. Record review of undated Shower List revealed Resident #7 was scheduled for showers on Mondays, Wednesdays, Fridays on the 6:00 AM to 2:00 PM shift. Residents Affected - Few Record review of Point of Care tasks for bathing, 30-day look back, accessed 3/08/2023, revealed Resident #7 received bathing on the following Mondays, Wednesdays and Fridays dates: 2/15/2023, 2/17/2023, 2/20/2023, 2/27/2023, 3/03/2023, 3/06/2023, and 3/08/2023. No documented refusals, and no documented resident not available indicated during that 30 day look back time frame. [No documentation for showers on 2/08/2023, 2/10/2023, 2/13/2023, 2/22/2023, 2/24/2023, or 3/01/2023.] 2. Record review of admission Record revealed Resident #19 was a [AGE] year-old female admitted [DATE]. Diagnosis information included: multiple sclerosis [debilitating disease of the brain and spinal cord], muscle wasting and atrophy [progressive and degeneration or shrinkage of muscles or nerve tissues], lack of coordination, muscle spasm, and pain. Record review of quarterly MDS assessment dated [DATE] revealed Resident #19 was admitted for other neurological conditions. Active diagnoses included: diabetes mellitus; lack of coordination; muscle wasting and atrophy and depression. BIMS summary score of 15 [indicative of intact cognitive status]. ADL assistance was coded as total dependence with two or more persons physical assistance for bathing. Documentation indicated always incontinent of urine and bowel. Formal, clinical assessment tool indicated Resident #19 was at risk of developing pressure injuries, with new current wounds; treatment modalities included pressure reducing device for bed and application of ointments/medications (other than feet). Resident #19 was documented at a height of 65 inches and weight at 383 pounds. Record review of Care Plan revealed Resident #19 had a focus area of ADL Self Care Performance Deficit related to Multiple Sclerosis and lack of coordination with associated interventions for bathing: .totally dependent on staff to provide a bath as necessary. Record review of undated, Shower List revealed Resident #19 was to receive showers on 2-10pm shift Tuesdays, Thursdays, and Saturdays. Record review of Point of Care tasks for bathing, 30-day look back, accessed 3/08/2023, revealed Resident #19 had Not applicable documented on the following Mondays, Wednesdays and Fridays dates: 2/08/2023, 2/10/2023, 2/13/2023, 2/15/2023, 2/17/2023, 2/20/2023, 2/22/2023, 2/24/2023, 2/27/2023, 3/01/2023, 3/03/2023, 3/06/2023, and 3/08/2023. No documented refusals, no documented resident not available indicated and no indications a bath was provided during that 30 day look back time frame. Record review of Physician Orders revealed Resident #19 had orders for Nystatin Powder with instructions to Apply to all skin folds topically two times a day for skin/wound support to clean skin folds, pat dry, apply powder with a start date of 12/11/2022. Record review of Medication Administration Record for the month of February 2023 revealed Resident #19 received Nystatin Powder twice daily at 9:00 AM and 8:00 PM with instructions to Apply to all skin folds topically two times a day for skin/sound support to clean skin folds, pat dry, apply powder. Medication Administration Record for the month of March 2023 revealed Resident #19 received Nystatin Powder twice daily through current date and time of 3/09/2023 at 11:58 AM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 7 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an observation on 3/06/2023 at 3:28 PM Resident #19 was observed with dull/greasy hair while being helped to transfer from her wheelchair to the toilet by staff. Resident #19 declined interview at that time but consented to be interviewed at a later time. In an observation on 3/09/2023 at 11:20 AM in the shower room, Shower Chair A was labeled as 300-pound capacity and the seating area measured 17 inches wide; Shower Chair B was labeled as 500-pound capacity and was 23.5 inches wide. In an interview on 3/07/2023 at 12:57 PM, Resident #19 stated she has not had any showers since she was admitted to the facility in mid-November 2022. Resident #19 stated she has been provided with a bed bath about one time a week. Resident #19 stated her last bath was 10 days prior. Resident #19 stated she feels dirty and wishes she could get baths, or preferably showers 3 times per week. Resident #19 stated her hair looks and feels greasy and that she has body odor. Resident #19 stated she has requested baths from CNAs frequently over time but does not want to be a burden so she will ask only once per day or less. In an interview on 3/09/2023 at 10:28 AM, CNA G, stated Resident #19 gets bed baths because the high weight capacity shower chair was too narrow for her and was uncomfortable. CNA G stated she did not know what the actual weight limits or size of the chair was. CNA G stated no residents have complained to her about repeatedly missing showers or baths. CNA G stated on occasion either staff or residents have told her they missed a bath the day prior and she makes it a point to get that resident a bath on an unscheduled shower day as necessary. CNA G stated the expectation is that the CNA documents showers and baths in both the Point of Care electronic health record and a paper form to denote any skin issues. CNA G stated the facility has had to use a lot of agency staff for CNA roles, and some of the agency staff either don't know or don't care to document appropriately. In an interview on 3/09/2023 at 11:15 AM, CNA C stated Resident #19 had been trialed with the high weight capacity shower chair, but Resident #19 found it uncomfortable because it was slightly too small. CNA C stated bed baths are provided because of that. No residents have complained that they consistently miss showers; occasionally a resident will tell her that they missed the previous days scheduled shower, and she will then get the resident a shower on the nonscheduled shower day. CNA C stated that does not occur often. CNA C stated she was not aware of any consistent problems with showers or documentation of showers. CNA C stated all refusals, and all showers or bed baths are to be documented on a shower sheet and electronically in the Point of Care application of PCC. In an interview on 3/09/2023 at 11:49 AM, Resident #19 stated she had not gotten a shower or bed bath in about 14 days. Resident #19 stated this made her feel bad as if she was a burden. Resident #19 stated not being clean limits her wanting to be social in the facility and she does not want her family to see her like this. Resident #19 stated she had a fungal infection in her skin folds, but the staff were putting a powder on it. Resident #19 stated she felt itchy sometimes. Resident #19 stated she had not ever been in a shower chair at this facility. Resident #19 stated she felt like it was her fault she was in this condition where her family could not take care of her, and really did not want to have them feel even more of a burden if the facility cannot take good care of her. Resident #19 explained she had an autoimmune disease that progressively worsened her condition, and the decline deeply affected her emotional outlook. In an interview on 3/09/2023 at 2:16 PM, Resident #19 stated she did not know what days of the week her showers were scheduled. Resident #19 stated she had not received a shower or bed bath that week, and it had now been close to 2 weeks since her last bed bath. Resident #19 stated she did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 8 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few think the smaller shower chair would be safe for her weight, and the larger capacity chair would not be wide enough. Resident #19 did not know what her shower schedule was supposed to be as no one from the facility had explained it to her but she would not turn down any offered opportunity to be cleaned. Resident #19 stated she had not been trialed in either the smaller shower chair or the higher capacity shower chair. 3. Record review of the quarterly MDS dated [DATE] revealed Resident #5 was an [AGE] year-old female admitted on [DATE] with other neurological conditions with lack of coordination as the primary medical condition category for admission. Other active diagnoses included: muscle wasting and atrophy, and lack of coordination. Other health conditions included shortness of breath when sitting at rest. BIMS summary score of 15 [indicative of intact cognition]. ADL assistance was coded as physical help in part of bathing activity with one-person physical assist. Formal, clinical assessment of skin conditions revealed Resident #5 had Skin and Injury treatments that included nutrition or hydration intervention to manage skin problems; and applications of ointments/medications other than to feet. Record review of Care Plan revealed Resident #5 had a focus area of ADL self-care performance deficit related to a lack of coordination with associated interventions that included: require one staff participation with bathing; I require extensive assistance with bathing and showering. Record review of Order Summary revealed Resident #5 had physician orders for down time for feeding 4:00 AM to 6:00 AM for ADL's one time per day with a start date of 11/10/2022. Record review of undated Shower List revealed Resident #5 was scheduled for showers on Mondays, Wednesdays, Fridays on the 2:00 to 10:00 PM shift. Record review of Point of Care tasks for bathing, 30-day look back, accessed 3/08/2023, revealed Resident #5 had Not Applicable documented on the following Mondays, Wednesdays, and Fridays dates: 2/08/2023, 2/10/2023, 2/15/2023, 2/17/2023, 2/20/2023, 2/22/2023, 2/24/2023, 2/27/2023, 3/01/2023, 3/03/2023, 03/06/2023. Resident #5 had Proceeded with bathing documented on 2/22/2023. In an observation on 3/06/2023 at 3:26 PM, Resident #5 was supine in bed with head of bed elevated between 45-60 degrees with her eyes closed, television and lights were off. Resident #5 was observed with a tracheostomy with humidified oxygen; large bandage over left shin. Resident #5 had short hair that was not neatly combed and appeared shiny. In an observation an interview on 3/07/2023 at 11:11 AM Resident #5 was observed with a 2 by 4-inch dressing to left lower shin with a dark brown-ish red substance shadowed under the undated dressing. Resident #5 stated the injury occurred about 5 days ago, and the dressing had been changed 3 days ago. Resident #5 stated she had not had a bath in about 10 days. Resident #5 stated she uses the bath wipes on herself but would prefer showers. Resident #5 stated not having a shower made her feel bad. Resident #5 stated staff only ever used the wipes on her. Resident #5 stated she had not been given a reason as to why she has not had a shower or bath. In an observation and interview on 3/09/2023 at 2:45 PM, Resident #5 stated her bandage to the left shin had not been changed in about 5 days. Resident #5 stated the injury occurred when she was trying to transfer with her daughter from the wheelchair back to her bed. Resident #5 stated she was on blood thinners and would bleed easily. Resident #5 stated it had been about 2 weeks since her last bath (Resident #5 stated the word bath with an air quote gesture). Resident #5 stated she preferred more frequent showers, as she felt more clean when freshly showered. Resident #5 stated she would not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 9 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 turn down a bed bath 3 times per week, if offered. Resident #5 stated that would be better than nothing. Level of Harm - Minimal harm or potential for actual harm In an interview on 3/09/2023 at 11:15 AM, CNA C stated Resident #5 frequently complained of being cold and would consent to a bed bath only. Residents Affected - Few In an interview on 3/09/2023 at 3:50 PM, the DON stated residents should be getting bathing 2-3 times per week, refusals or out of facilities are expected to be documented in POC along with baths performed. Bathing or ADL policies not received prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 10 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 2 of 3 Residents (Resident #5 and #7) reviewed for quality of care, in that: Residents Affected - Few 1. The facility failed to ensure Resident #5 had Physician Orders initiated to treat the wound to her left shin; and 2. The facility failed to ensure Resident #7's Physician Orders were implemented to treat the wound to her sacrum (large triangular bone formed at the base of the spine by the fusing of the sacral vertebrae between the ages of 18 and 30, between the two wings of the pelvis at the upper, back part of pelvic cavity). This failure could place residents at risk for not receiving appropriate care and treatment resulting in infection, delayed healing, pain and diminished quality of life. The findings were: 1. Record review of the quarterly MDS dated [DATE] revealed Resident #5 was an [AGE] year-old female admitted on [DATE] with other neurological conditions with lack of coordination as the primary medical condition category for admission. Other active diagnoses included: muscle wasting and atrophy, and lack of coordination. Other health conditions included shortness of breath when sitting at rest. BIMS summary score of 15 [indicative of intact cognition]. ADL assistance was coded as physical help in part of bathing activity with one-person physical assist. Formal, clinical assessment of skin conditions revealed Resident #5 was not at risk of developing pressure injuries, had no unhealed pressure injuries, no venous or arterial ulcers, but Skin and Injury treatments were implemented that included nutrition or hydration intervention to manage skin problems; and applications of ointments/medications other than to feet. Medications received included anticoagulant. Record review of Care Plan revealed Resident #5 had a focus area of ADL self-care performance deficit related to a lack of coordination with associated interventions that included: require one staff participation with bathing; I require extensive assistance with bathing and showering. Additional focus area of Anticoagulant therapy Eliquis related to deep vein thrombus, pulmonary embolism, with associated interventions that included: avoid activities that could result in injury, take precautions to avoid falls, signs and symptoms of bleeding. Record review of Order Summary revealed Resident #5 had physician orders for down time for feeding 4:00 AM to 6:00 AM for ADL's one time per day with a start date of 11/10/2022. Additional orders for Weekly Skin Assessment every Friday with a start date of 11/11/2022. Additional orders for Apixaban [Eliquis, a medication to prevent blood clots or anticoagulation] tablet 5 mg give via G-Tube two times a day for afib [a-fibrillation, dysfunctional contractions of the heart muscles]; Aspirin tablet chewable 81 mg give 1 tablet via G-Tube one time a day for blood clot prevention. [Both (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 11 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 medications increase risk of bruising and bleeding. No orders for wound care.] Level of Harm - Minimal harm or potential for actual harm Record review of Point of Care tasks for bathing, 30-day look back, accessed 3/08/2023, revealed Resident #5 received 1 bath between 2/08/2023 and 3/08/2023 on 2/22/2023 with no documentation of wound indicated. Residents Affected - Few Record review of Progress Note dated 3/07/2023 at 12:20 AM authored by RN H revealed Resident #5 had the following documentation for skin: Skin warm and dry, skin color within normal limits, mucous membranes moist, turgor [elasticity or firmness of skin as an assessment of dehydration] normal. [No entry for incident report, injury, or assessment of wound to left shin.] In an observation on 3/06/2023 at 3:26 PM, Resident #5 was supine in bed with a large, undated bandage over her left shin. In an observation an interview on 3/07/2023 at 11:11 AM Resident #5 was observed with a 2 by 4-inch dressing to left lower shin with a dark brown-ish red substance shadowed under the undated dressing. Resident #5 stated the injury occurred about 5 days ago, and the dressing had been changed 3 days ago. Resident #5 stated she had not had a bath in about 10 days. Resident #5 stated, Staff placed dressing about 5 days prior, but she couldn't not recall name or description. Resident #5 stated it was different staff who changed the dressing about 3 days prior, but she was not sure of name and could not provide description. In an interview on 3/09/2023 at 2:45 PM, Resident #5 stated her bandage to the left shin had not been changed in about 5 days. Resident #5 stated the injury occurred when she was trying to transfer with her family member from the wheelchair back to her bed. Resident #5 stated she was on blood thinners and would bleed easily. Resident #5 stated it had been about 2 weeks since her last bath. (Resident #5 stated the word bath with an air quote gesture). Resident #5 stated she preferred more frequent showers, as she felt more clean when freshly showered. Resident #5 stated she would not turn down a bed bath 3 times per week, if offered. Resident #5 stated that would be better than nothing. In an interview on 3/09/2023 at 4:15 PM, the ADON stated she had just come from assessing the wound on Resident #5's left shin, had just spoken with the physician and received orders for wound care to include triple antibiotic and dressing changes as needed. The ADON stated she would contact the physician for clarification as to how often dressing should be changed and wound assessed. The ADON stated the expectation was for the nurse who first observed the wound and applied the bandage should have obtained and entered physician orders for wound care along with the incident report. The ADON stated the dressing should be reported during bathing by the CNA to the nurse. The nurse should have assessed the dressing and the wound. The ADON stated she had removed the dressing to assess the wound and treated the wound as per the physician orders. The ADON stated the wound was not fully healed but looked good with no signs of infection, inflammation or suppuration [formation of pus, to fester; another descriptor of infection]. The ADON stated while no harm occurred to Resident #5, a resident could have been harmed by not having a wound documented for follow up and could result in infection, delayed wound healing or pain. 2. Record review of admission Record revealed Resident #7 was an [AGE] year-old female admitted [DATE]. Diagnosis information included: neuromuscular dysfunction of bladder [results from disease or injury of the central nervous system or peripheral nerves involved in the control of urination], contracture [permanent tightening of the muscles, tendons, skin and surrounding tissues that cause joints to shorten and stiffen], hemiplegia [paralysis of one side of the body], and hemiparesis [weakness (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 12 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 to one side of the body]. Level of Harm - Minimal harm or potential for actual harm Record review of quarterly MDS assessment dated [DATE] revealed Resident #7 was admitted for medically complex conditions related to cerebral infarction [brain lesion in which a cluster of brain cells die due to disruption in blood supply]. Active diagnoses included: diabetes mellitus; lack of coordination; muscle wasting and atrophy. BIMS summary score of 7 [indicative of severely impaired cognitive status]. ADL assistance was coded as extensive assistance with two or more persons physical assistance for bed mobility; total dependence for bathing; dependent or toileting hygiene. Documentation indicated presence of indwelling catheter and always incontinent of urine, frequently incontinent of bowel. No current unhealed pressure ulcers/injuries documented. Residents Affected - Few Record review of Care Plan revealed Resident #7 had a focus area of potential for skin breakdown/conditions related to bowel incontinence and impaired physical mobility initiated on 1/15/2018 and revised on 5/19/2021 with associated interventions: disposable briefs, change every 2 hours and as needed. Additional focus area of pain related to history of pressure ulcer to left buttock initiated 8/13/2021with associated interventions: administer analgesia as per orders; give before treatments or care. Additional focus area of stage II pressure ulcer to left buttock potential for pressure ulcer development related to immobility initiated on 2/15/2023, with associated interventions: administer treatments as ordered; follow facility policies/protocols for the prevention/treatment of skin breakdown. Record review of Order Details revealed orders to cleanse sacrum with normal saline, pat dry. Apply Triad BID and foam dressing two times a day with a start date of 1/3/2023. Record review of Weekly Pressure Ulcer Record revealed Resident #7 acquired the wound in-house on 12/25/2022; assessment dated [DATE] described the wound as to the left buttock measuring 1.5 centimeters in length, 0.6 centimeters in width, and 0.2 centimeters in depth at a stage II (defined as partial thickness loss of dermis, or skin, presenting as a shallow open ulcer with a red/pink wound bed, without slough, a necrotic debris that will impede healing). Risk factors listed only diabetes; and did not include incontinence, paralysis, immobility, or contractures. In an observation on 3/08/2023 between 12:00 -12:15pm for wound care, Resident #7 was observed to be left side lying, with a positioning pillow between her knees. CNA D assisted LVN E with positioning. CNA D loosened Resident #7's adult brief allowing LVN E to have access to the area of the wound at the sacrum. The wound was observed to have a dried white substance over the wound bed, and the wound was open to air. LVN E cleansed the wound with Dermal Wound Cleanser with an expiration date of 5/2025 and gauze. LVN E applied Triad wound cream with an expiration date of 11/2023 to approximately 2 inches beyond margins of wound. LVN E applied foam dressing with adhesive edges into the margins of the wound cream. The dressing was observed to be very loosely adhered. LVN E included the date written in permanent marker on the dressing. Advised LVN E and CNA D that the next peri-care, incontinent care or adult brief change needed to be observed by this surveyor on Resident #7. In an interview on 3/08/2023 at 12:20 PM, LVN E stated the previous dressing had been removed prior to wound care in anticipation of wound care being observed by a state surveyor. LVN E stated Resident #7 had been provided incontinence care and repositioned just before the start of wound care. LVN E stated previously the wound dressing had been applied in the evening on 3/07/2023 according to the date on the dressing. LVN E reiterated that she had removed the dressing shortly prior to wound care being provided, when the CNA went in Resident #7's room to provide incontinent care and repositioning according to the turning schedule posted above the head of the bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 13 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an observation and interview on 3/08/2023 at 4:20pm with CNA I present, LVN E stated they were ready to provide peri-care and repositioning to Resident #7. The bottom border of the wound dressing was observed to be loose with gaps between the edge of the dressing and the skin. LVN E was standing on the right side of the bed assisting Resident #7 to lie on her side, while CNA I provided care. CNA I did not advise LVN E that the dressing was loose until prompted by this surveyor. LVN E stated Resident #7 had been medicated for pain with Tylenol #3 [a narcotic, opioid pain reliever] and lactulose [a medication to relieve constipation] just prior to observation. Resident #7 stated she was constipated, still needed to defecate, and was not finished at the time of observation. LVN E stated she expected the lactulose to have an effect soon and LVN E would change the loose dressing after the resident defecates. In a group interview on 3/08/2023 at 5:09 PM, the ADON stated having a loose dressing would be the same as not having a dressing in place. The ADON stated that could result in infection or delayed healing. The DON stated she would provide a policy on wound care shortly. Record review of policy entitled Pressure Ulcers/Skin Breakdown - Clinical Protocols, reviewed December 2021, revealed instructions under the heading Treatment /Management in step #1. The physician will authorize pertinent orders related to wound treatments, including wound cleansing and treatment approaches, dressings (occlusive, absorptive, etcetera), and application of topical agents if indicated for type of skin alteration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 14 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review the facility failed to ensure a resident who needs respiratory care is provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 3 (#16) residents reviewed for tracheostomy care in that: Residents Affected - Few Resident #16 did not have did not have emergency equipment for tracheostomy care at his bedside, no tracheostomy cannula and did not have a treatment record. This failure did not meet professional standards of practice. This could afffect the resident and result in the resident not being able to breathe in an event of an emergency. The necessary emergency equipment was not present and available, as stated in the care plan. The Findings were: Record Review of Resident # 16's admission Record dated 3/8/2023 revealed he was admitted on [DATE], re-admitted on [DATE] with diagnoses of tracheostomy status, acute cough, chest pain, and anxiety, Record review of Resident # 16's Order Summary Report for March 2023 revealed Trach (tracheostomy) care: using sterile technique provide Tracheostomy Care cleanse inner cannula or replace with disposable inner cannula every 1 hour as needed. Record review of Resident # 16's Significant change MDS dated [DATE] revealed his BIMs score was 11/15 (cognition moderately impaired), he required a wheelchair, he had 1 impairment on upper extremity and two impairments on both side in the lower extremity, his diagnoses was respiratory failure, tracheotomy status, he had health condition shortness of breath when sitting or lying flat, he had oxygen therapy, suctioning and tracheostomy care. Record review of Resident # 16's care plan dated 3/2/2023 revealed I have Tracheostomy related to impaired breathing mechanics, TUBE OUT PROCEDURES: Keep extra trach tube and obturator (then fed into the surgical opening in the trachea) at bedside. Record review of Resident # 16's treatment record reflected it did not have information on when the tracheostomy tube at bedside was checked. Observation on 3/09/23 at 08:51 AM with the ADON in Resident #16's room revealed he had a bag near his bed. Further observation of the bag revealed it did not contain the tracheostomy cannula (tubing) for emergency, Interview on 3/09/23 at 08:51 AM with ADON in Resident #16's room stated she could not find his tracheostomy cannula in the bag or in his drawers, near his bed. The ADON stated staff should check all resident's emergency equipment for tracheostomy care daily, should be kept at bedside . The ADON stated the emergency equipment why at bedside, for emergency if res needs and is in distress . should be kept at bedside . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 15 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm Interview on 3/09/2023 at 8:51 AM with Resident # 16 stated the tracheostomy cannula usually was kept in the bag, he stated staff take care of his needs. Record Review of facility policy for Tracheostomy Care dated August 2013 reflected A replacement tracheostomy tube must be available at the bedside at all times. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 16 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observations, interviews and record reviews the facility failed to ensure Nurse Staffing Information was posted daily, including the current date and the total number and the actual hours worked by nursing staff responsible for resident care per shift, and maintained for a minimum of 18 months for 1 of 1 building in that: Residents Affected - Many The nurse staffing posting had the wrong date for 2 days and nurse staffing data for at least 18 months was not maintained. This failure could result in residents not being aware of the date and how many nursing staff are working on that date. The Findings were: Observation on 3/08/2023 at 1:30 PM in the front lobby, the nurse staffing posting dated was 3/6/2023, the date was 3/8/2023. Observation on 3/09/2023 at 8 AM in the front lobby, the nurse staffing posting had a date of 3/6/2023. The date today was 3/09/23. Interview on 3/09/2023 at 8:18 AM with the Administrator confirmed the nurse staffing posting was dated 3/6/2023, instead of 3/9/2023. The Administrator stated there was no policy for the nurse staffing posting. Interview on 3/09/2023 at 9:47 AM with the DON provided nurse staffing posting they had as far as retention, she stated the HR/front desk clerk was responsible for posting the nurse staffing for day and done in the morning time. Interview on 3/09/2023 at 10:42 AM revealed the front desk clerk was not sure who was responsible for putting up nurse staffing posted daily. Interview on 3/09/2023 at 10:44 AM with the BOM stated the HR (human resources) staff was on leave. Record review of the nurse staffing postings reflected the facility did not have 18 months of nurse staffing postings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 17 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 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 observation, interview, and record review the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 2 of 3 Residents (Resident #5 and #7) reviewed for quality of care, in that: 1. The facility failed to ensure Resident #5 had Physician Orders initiated to treat the wound to her left shin; and 2. The facility failed to ensure Resident #7's Physician Orders were implemented to treat the wound to her sacrum (large triangular bone formed at the base of the spine by the fusing of the sacral vertebrae between the ages of 18 and 30, between the two wings of the pelvis at the upper, back part of pelvic cavity). This failure could place residents at risk for not receiving appropriate care and treatment resulting in infection, delayed healing, pain and diminished quality of life. The findings were: 1. Record review of the quarterly MDS dated [DATE] revealed Resident #5 was an [AGE] year-old female admitted on [DATE] with other neurological conditions with lack of coordination as the primary medical condition category for admission. Other active diagnoses included: muscle wasting and atrophy, and lack of coordination. Other health conditions included shortness of breath when sitting at rest. BIMS summary score of 15 [indicative of intact cognition]. ADL assistance was coded as physical help in part of bathing activity with one-person physical assist. Formal, clinical assessment of skin conditions revealed Resident #5 was not at risk of developing pressure injuries, had no unhealed pressure injuries, no venous or arterial ulcers, but Skin and Injury treatments were implemented that included nutrition or hydration intervention to manage skin problems; and applications of ointments/medications other than to feet. Medications received included anticoagulant. Record review of Care Plan revealed Resident #5 had a focus area of ADL self-care performance deficit related to a lack of coordination with associated interventions that included: require one staff participation with bathing; I require extensive assistance with bathing and showering. Additional focus area of Anticoagulant therapy Eliquis related to deep vein thrombus, pulmonary embolism, with associated interventions that included: avoid activities that could result in injury, take precautions to avoid falls, signs and symptoms of bleeding. Record review of Order Summary revealed Resident #5 had physician orders for down time for feeding 4:00 AM to 6:00 AM for ADL's one time per day with a start date of 11/10/2022. Additional orders for Weekly Skin Assessment every Friday with a start date of 11/11/2022. Additional orders for Apixaban [Eliquis, a medication to prevent blood clots or anticoagulation] tablet 5 mg give via G-Tube two times a day for afib [a-fibrillation, dysfunctional contractions of the heart muscles]; Aspirin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 18 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few tablet chewable 81 mg give 1 tablet via G-Tube one time a day for blood clot prevention. [Both medications increase risk of bruising and bleeding. No orders for wound care.] Record review of Point of Care tasks for bathing, 30-day look back, accessed 3/08/2023, revealed Resident #5 received 1 bath between 2/08/2023 and 3/08/2023 on 2/22/2023 with no documentation of wound indicated. Record review of Progress Note dated 3/07/2023 at 12:20 AM authored by RN H revealed Resident #5 had the following documentation for skin: Skin warm and dry, skin color within normal limits, mucous membranes moist, turgor [elasticity or firmness of skin as an assessment of dehydration] normal. [No entry for incident report, injury, or assessment of wound to left shin.] In an observation on 3/06/2023 at 3:26 PM, Resident #5 was supine in bed with a large, undated bandage over her left shin. In an observation an interview on 3/07/2023 at 11:11 AM Resident #5 was observed with a 2 by 4-inch dressing to left lower shin with a dark brown-ish red substance shadowed under the undated dressing. Resident #5 stated the injury occurred about 5 days ago, and the dressing had been changed 3 days ago. Resident #5 stated she had not had a bath in about 10 days. Resident #5 stated, Staff placed dressing about 5 days prior, but she couldn't not recall name or description. Resident #5 stated it was different staff who changed the dressing about 3 days prior, but she was not sure of name and could not provide description. In an interview on 3/09/2023 at 2:45 PM, Resident #5 stated her bandage to the left shin had not been changed in about 5 days. Resident #5 stated the injury occurred when she was trying to transfer with her family member from the wheelchair back to her bed. Resident #5 stated she was on blood thinners and would bleed easily. Resident #5 stated it had been about 2 weeks since her last bath. (Resident #5 stated the word bath with an air quote gesture). Resident #5 stated she preferred more frequent showers, as she felt more clean when freshly showered. Resident #5 stated she would not turn down a bed bath 3 times per week, if offered. Resident #5 stated that would be better than nothing. In an interview on 3/09/2023 at 4:15 PM, the ADON stated she had just come from assessing the wound on Resident #5's left shin, had just spoken with the physician and received orders for wound care to include triple antibiotic and dressing changes as needed. The ADON stated she would contact the physician for clarification as to how often dressing should be changed and wound assessed. The ADON stated the expectation was for the nurse who first observed the wound and applied the bandage should have obtained and entered physician orders for wound care along with the incident report. The ADON stated the dressing should be reported during bathing by the CNA to the nurse. The nurse should have assessed the dressing and the wound. The ADON stated she had removed the dressing to assess the wound and treated the wound as per the physician orders. The ADON stated the wound was not fully healed but looked good with no signs of infection, inflammation or suppuration [formation of pus, to fester; another descriptor of infection]. The ADON stated while no harm occurred to Resident #5, a resident could have been harmed by not having a wound documented for follow up and could result in infection, delayed wound healing or pain. 2. Record review of admission Record revealed Resident #7 was an [AGE] year-old female admitted [DATE]. Diagnosis information included: neuromuscular dysfunction of bladder [results from disease or injury of the central nervous system or peripheral nerves involved in the control of urination], contracture [permanent tightening of the muscles, tendons, skin and surrounding tissues that cause (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 19 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few joints to shorten and stiffen], hemiplegia [paralysis of one side of the body], and hemiparesis [weakness to one side of the body]. Record review of quarterly MDS assessment dated [DATE] revealed Resident #7 was admitted for medically complex conditions related to cerebral infarction [brain lesion in which a cluster of brain cells die due to disruption in blood supply]. Active diagnoses included: diabetes mellitus; lack of coordination; muscle wasting and atrophy. BIMS summary score of 7 [indicative of severely impaired cognitive status]. ADL assistance was coded as extensive assistance with two or more persons physical assistance for bed mobility; total dependence for bathing; dependent or toileting hygiene. Documentation indicated presence of indwelling catheter and always incontinent of urine, frequently incontinent of bowel. No current unhealed pressure ulcers/injuries documented. Record review of Care Plan revealed Resident #7 had a focus area of potential for skin breakdown/conditions related to bowel incontinence and impaired physical mobility initiated on 1/15/2018 and revised on 5/19/2021 with associated interventions: disposable briefs, change every 2 hours and as needed. Additional focus area of pain related to history of pressure ulcer to left buttock initiated 8/13/2021with associated interventions: administer analgesia as per orders; give before treatments or care. Additional focus area of stage II pressure ulcer to left buttock potential for pressure ulcer development related to immobility initiated on 2/15/2023, with associated interventions: administer treatments as ordered; follow facility policies/protocols for the prevention/treatment of skin breakdown. Record review of Order Details revealed orders to cleanse sacrum with normal saline, pat dry. Apply Triad BID and foam dressing two times a day with a start date of 1/3/2023. Record review of Weekly Pressure Ulcer Record revealed Resident #7 acquired the wound in-house on 12/25/2022; assessment dated [DATE] described the wound as to the left buttock measuring 1.5 centimeters in length, 0.6 centimeters in width, and 0.2 centimeters in depth at a stage II (defined as partial thickness loss of dermis, or skin, presenting as a shallow open ulcer with a red/pink wound bed, without slough, a necrotic debris that will impede healing). Risk factors listed only diabetes; and did not include incontinence, paralysis, immobility, or contractures. In an observation on 3/08/2023 between 12:00 -12:15pm for wound care, Resident #7 was observed to be left side lying, with a positioning pillow between her knees. CNA D assisted LVN E with positioning. CNA D loosened Resident #7's adult brief allowing LVN E to have access to the area of the wound at the sacrum. The wound was observed to have a dried white substance over the wound bed, and the wound was open to air. LVN E cleansed the wound with Dermal Wound Cleanser with an expiration date of 5/2025 and gauze. LVN E applied Triad wound cream with an expiration date of 11/2023 to approximately 2 inches beyond margins of wound. LVN E applied foam dressing with adhesive edges into the margins of the wound cream. The dressing was observed to be very loosely adhered. LVN E included the date written in permanent marker on the dressing. Advised LVN E and CNA D that the next peri-care, incontinent care or adult brief change needed to be observed by this surveyor on Resident #7. In an interview on 3/08/2023 at 12:20 PM, LVN E stated the previous dressing had been removed prior to wound care in anticipation of wound care being observed by a state surveyor. LVN E stated Resident #7 had been provided incontinence care and repositioned just before the start of wound care. LVN E stated previously the wound dressing had been applied in the evening on 3/07/2023 according to the date on the dressing. LVN E reiterated that she had removed the dressing shortly prior to wound care being provided, when the CNA went in Resident #7's room to provide incontinent care and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 20 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 repositioning according to the turning schedule posted above the head of the bed. Level of Harm - Minimal harm or potential for actual harm In an observation and interview on 3/08/2023 at 4:20pm with CNA I present, LVN E stated they were ready to provide peri-care and repositioning to Resident #7. The bottom border of the wound dressing was observed to be loose with gaps between the edge of the dressing and the skin. LVN E was standing on the right side of the bed assisting Resident #7 to lie on her side, while CNA I provided care. CNA I did not advise LVN E that the dressing was loose until prompted by this surveyor. LVN E stated Resident #7 had been medicated for pain with Tylenol #3 [a narcotic, opioid pain reliever] and lactulose [a medication to relieve constipation] just prior to observation. Resident #7 stated she was constipated, still needed to defecate, and was not finished at the time of observation. LVN E stated she expected the lactulose to have an effect soon and LVN E would change the loose dressing after the resident defecates. Residents Affected - Few In a group interview on 3/08/2023 at 5:09 PM, the ADON stated having a loose dressing would be the same as not having a dressing in place. The ADON stated that could result in infection or delayed healing. The DON stated she would provide a policy on wound care shortly. Record review of policy entitled Pressure Ulcers/Skin Breakdown - Clinical Protocols, reviewed December 2021, revealed instructions under the heading Treatment /Management in step #1. The physician will authorize pertinent orders related to wound treatments, including wound cleansing and treatment approaches, dressings (occlusive, absorptive, etcetera), and application of topical agents if indicated for type of skin alteration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 21 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of infections and communicable illnesses for 2 of 8 residents (Residents #7 and #184) reviewed for infection control, in that: Residents Affected - Few 1. The facility failed to ensure infection control principles were maintained during wound care for Resident #7. 2. The facility failed to ensure infection control principles were maintained during isolation precautions for Resident #184. These deficient practices could place all residents at risk for infection and or communicable illness due to improper care. The findings were: 1.Record review of admission Record revealed Resident #7 was an [AGE] year-old female admitted [DATE]. Diagnosis information included: neuromuscular dysfunction of bladder [results from disease or injury of the central nervous system or peripheral nerves involved in the control of urination], contracture [permanent tightening of the muscles, tendons, skin and surrounding tissues that cause joints to shorten and stiffen], hemiplegia [paralysis of one side of the body], and hemiparesis [weakness to one side of the body]. Record review of quarterly MDS assessment dated [DATE] revealed Resident #7 was admitted for medically complex conditions related to cerebral infarction [brain lesion in which a cluster of brain cells die due to disruption in blood supply]. Active diagnoses included: diabetes mellitus; lack of coordination; muscle wasting and atrophy. BIMS summary score of 7 [indicative of severely impaired cognitive status]. ADL assistance was coded as extensive assistance with two or more persons physical assistance for bed mobility; total dependence for bathing; dependent for toileting hygiene. Documentation indicated presence of indwelling catheter and always incontinent of urine, frequently incontinent of bowel. No current unhealed pressure ulcers/injuries documented. Record review of Care Plan revealed Resident #7 had a focus area of potential for skin breakdown/conditions related to bowel incontinence and impaired physical mobility initiated on 1/15/2018 and revised on 5/19/2021 with associated interventions: disposable briefs, change every 2 hours and as needed. Additional focus area of pain related to history of pressure ulcer to left buttock initiated 8/13/2021with associated interventions: administer analgesia as per orders; give before treatments or care. Additional focus area of stage II pressure ulcer to left buttock potential for pressure ulcer development related to immobility initiated on 2/15/2023, with associated interventions: administer treatments as ordered; follow facility policies/protocols for the prevention/treatment of skin breakdown. Record review of Order Details for Resident #7 revealed orders to cleanse sacrum with normal saline, pat dry. Apply Triad BID and foam dressing two times a day with a start date of 1/3/2023. Record review of Weekly Pressure Ulcer Record revealed Resident #7 acquired the wound in-house on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 22 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm 12/25/2022; assessment dated [DATE] described the wound as to the left buttock measuring 1.5 centimeters in length, 0.6 centimeters in width, and 0.2 centimeters in depth at a stage II (defined as partial thickness loss of dermis, or skin, presenting as a shallow open ulcer with a red/pink wound bed, without slough, a necrotic debris that will impede healing). Risk factors listed only diabetes; and did not include incontinence, paralysis, immobility, or contractures. Residents Affected - Few In an observation on 3/08/2023 between 12:00 -12:15pm for wound care, revealed Resident #7 observed to be left side lying, with a positioning pillow between her knees. CNA D assisted LVN E with positioning. CNA D loosened Resident #7's adult brief allowing LVN E to have access to the area of the wound at the sacrum. The wound was observed to have a dried white substance over the wound bed, and the wound was open to air. LVN E cleansed the wound with Dermal Wound Cleanser with an expiration date of 5/2025 and gauze. LVN E removed gloves, but failed to sanitize or wash hands before donning new gloves. [Surveyor stopped LVN E from continuing for patient safety.] LVN E washed hands at in-room sink for 20-25 seconds and returned to the bedside where she applied hand sanitizer provided by CNA D and then donned clean gloves. LVN E resumed wound care treatment. Surveyor advised LVN E and CNA D that the next peri-care, incontinent care or adult brief change needed to be observed on Resident #7. In an interview on 3/08/2023 at 12:20 PM, LVN E stated the previous dressing had been removed prior to wound care in anticipation of wound care being observed by a state surveyor. LVN E stated Resident #7 had been provided incontinence care and repositioned just before the start of wound care. LVN E stated she knew she was to sanitize or wash hands before donning gloves but was nervous being observed by state surveyors. LVN E stated this information is reinforced upon orientation, at annual competency, and periodically during in-service trainings. LVN E stated previously the wound dressing had been applied in the evening on 3/07/2023 according to the date on the dressing. LVN E reiterated that she had removed the dressing shortly prior to wound care being provided, when the CNA went in Resident #7's room to provide incontinent care and repositioning according to the turning schedule posted above the head of the bed. In an observation and interview on 3/08/2023 at 4:20pm with CNA I, LVN E stated they were ready to provide peri-care and repositioning to Resident #7. The bottom border of wound dressing was observed to be loose with gaps between the edge of the dressing and the skin. LVN E was standing on the right side of the bed assisting Resident #7 to lie on her side, while CNA I provided care. CNA I did not advise LVN E that the dressing was loose until prompted by this surveyor. LVN E stated Resident #7 had been medicated for pain with Tylenol #3 [a narcotic, opioid pain reliever] and lactulose [a medication to relieve constipation] just prior to observation. Resident #7 stated she was constipated, still needed to defecate, and was not finished at the time of observation. LVN E stated she expected the lactulose to have an effect soon and LVN E would change the loose dressing after the resident defecates. In a group interview on 3/08/2023 at 5:09 PM, the DON stated there were many adverse effects that could happen when the nurse does not wash or sanitize hands between glove use, such as cross contamination, delayed wound healing or worsening of an infection. The ADON stated having a loose dressing would be the same as not having a dressing in place and could result in infection or delayed healing. The DON stated she would provide a policy infection control and wound care shortly. 2. Record review of admission Record revealed Resident #184 was a [AGE] year-old female admitted on [DATE] with COVID-19, pneumonia, and chronic obstructive pulmonary disease. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 23 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Order Summary Report revealed Resident #184 had physician orders Resident has tested Positive for COVID-19 and requires Strict Isolation with Droplet Precautions every shift for COVID-19 Positive [status] with an order start date of 3/06/2023. Additionally, physician orders for monitoring for signs and symptoms of respiratory issues, lethargy, altered mental status changes .every shift for COVID-19 with a start date of 3/06/2023. Every 4 hours respirations, temperature, cough, oxygen saturations with a start date of 3/06/2023. Record review of Care Plan with initiation date of 3/03/2023 revealed no focus areas or interventions related to COVID-19 positive status for Resident #184. Record review of Progress Note dated 3/03/2023 authored by LVN F revealed documentation that Resident #184 [admitted to] skilled for lack of coordination due to covid, remains on strict isolation. Record review of Progress Note dated 3/8/2023 authored by the DON revealed Resident #184 has completed 10 days of isolation due to covid positive on 2/25/2023. In an observation on 3/06/2023 at 11:20 AM revealed the facility had one main entrance with staff present; signage indicating symptoms that prohibit entry. No visible temperature screening apparatus. Some staff observed with no mask including the receptionist, the administrator; some staff observed utilizing a surgical mask; Residents in common areas without mask. In an observation on 3/06/2023 at 11:45 AM the door to room [ROOM NUMBER] was open; The resident [Resident #184] was sitting upright in bed dressed appropriately for the weather wearing a surgical mask. Signage on the open door indicated droplet precautions and a small PPE cart was observed at the threshold. In an interview on 3/06/2023 at 11:22 AM the ADM stated there was one resident who was at the end of her isolation for being COVID positive. In an interview on 3/06/2023 at 11:38 AM LVN A stated Resident #184 was on isolation precautions due to being a newly admitted resident. She stated it was acceptable to have the door open; LVN A stated that when staff enter the room full PPE must be donned and included: gloves, gown, N95 mask, and face shield or goggles. She stated upon exiting the room all of the PPE was removed in the room and placed in the receptacle there including the mask and then hand washing or use hand sanitizer upon exit. In an interview on 03/06/2023 at 11:45 AM the DON stated only one resident was on isolation due to COVID positive status. She stated Resident #184 had been on COVID isolation precautions since admission on [DATE]. Record review of policy entitled Novel Coronavirus Prevention and Response implemented 12/2020 and revised 9/2022 revealed on page four of seven, under section 7. Procedure when COVID-19 is suspected or confirmed: b. Place resident in a private room (containing a private bathroom) with the door closed (if safe to do so). Record review of policy entitled Infection Control Guidelines for All Nursing Procedures, reviewed 12/2021, revealed instructions under the General Guidelines heading in Step 3. employees must wash their hands for 10 to 15 seconds using antimicrobial or non-antimicrobial soap and water under the following conditions: .d. after removing gloves; e. after handling items potentially contaminated with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 24 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm blood, body fluids, or secretions. 4. In most situations, the preferred method of hand hygiene is with an alcohol-based hand rub .e. Before handling clean or soiled dressings, gauze pads, etc.; f. before moving from a contaminated body site to a clean body site during resident care; .h. after handling used dressings, contaminated equipment, etcetera; .j. after removing gloves. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 25 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Many Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide a minimum of 80 square feet per resident in 33 of 39 resident rooms (Rooms 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 202, 203, 204, 205, 206, 208, 209, 210, 211, 302, 304, 307, 308, 309, 310, 311, 312, 313, 314, 317, and 319). This deficient practice could result in inadequate space to provide care and resident dissatisfaction with the environment. The findings were: During interview on 3/6/2023 at 11:57 AM the Administrator stated the room waivers everything was the same and there were no changes to the room waivers. Interview with the Administrator requested room waivers for 33 rooms. Observations on 3/6/2023 starting at 3:05 PM to 4:08 PM: residents in room room [ROOM NUMBER]-two residents - 71.86 square feet per resident. room [ROOM NUMBER]-two residents- 79.74 square feet per resident. room [ROOM NUMBER]-two residents - 71.91 square feet per resident. room [ROOM NUMBER]-two residents - 75.049 square feet per resident. room [ROOM NUMBER]-two residents - 66.79 square feet per resident. room [ROOM NUMBER]- one resident - 74.81 square feet per resident. room [ROOM NUMBER]-two residents - 72.59 square feet per resident. room [ROOM NUMBER]-two residents - 74.80 square feet per resident. room [ROOM NUMBER]- two residents - 71.42 square feet per resident. room [ROOM NUMBER]-One residents - 74.63 square feet per resident. room [ROOM NUMBER]-two residents - 70.89 square feet per resident. room [ROOM NUMBER]-One resident - 77.24 square feet per resident. room [ROOM NUMBER]-two residents - 73.21 square feet per resident. room [ROOM NUMBER]-One residents - 75.28 square feet per resident. room [ROOM NUMBER]-two resident - 72.57 square feet per resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 26 of 27 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 675205 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Atrium Rehabilitation Center 7602 Louis Pasteur St San Antonio, TX 78229 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0912 room [ROOM NUMBER]-one resident - 74.59 square feet per resident. Level of Harm - Potential for minimal harm room [ROOM NUMBER]-two resident - 76.31 square feet per resident. room [ROOM NUMBER]-two residents - 73.36 square feet per resident. Residents Affected - Many room [ROOM NUMBER]-one resident - 73.53 square feet per resident. room [ROOM NUMBER]-one residents - 73.77 square feet per resident. room [ROOM NUMBER]-No resident - 71.92 square feet per resident. room [ROOM NUMBER]-No resident - 71.48 square feet per resident. room [ROOM NUMBER]-No residents - 68.30 square feet per resident. room [ROOM NUMBER]- No resident- 69.14 square feet per resident. room [ROOM NUMBER]-no residents - 68.02 square feet per resident. room [ROOM NUMBER] and 311-no residents- 67.46 square feet per resident. room [ROOM NUMBER]- no resident - 69.59 square feet per resident. room [ROOM NUMBER]-no resident - 67.79 square feet per resident. room [ROOM NUMBER]- no resident - 69.19 square feet per resident. room [ROOM NUMBER]-no resident - 68.82 square feet per resident. room [ROOM NUMBER]- no resident - 68.87 square feet per resident. (*) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675205 If continuation sheet Page 27 of 27