Inspection·July 17, 2025

F 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 06/28/2025 at 10:39 a.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [painful urination] [sic] Active SX: retention / distension of bladder. GU appliance used is an indwelling catheter. Other observations and interventions include Indwelling [sic] foley cath is drainingwell [sic] via gravity, no sediment noted, pt is tolerating well, no c/o pain or discomfort. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN E, effective 06/29/2025 at 06:00 p.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN D, effective 06/30/2025 at 11:31 p.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] Other active symptoms or treatments are described below. GU appliance used is an indwelling catheter. Other observations and interventions include Resident [sic] has wounds and rash to perianal [area surrounding the anus] area- foley is to provide relief and promote skin integrity. Resident response to treatment is indweling [sic] foley catheter. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN D, effective 07/01/2025 at 07:00 p.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. GU appliance used is an indwelling catheter. Other observations and interventions include Resident [sic] has wounds and rash to perianal area- foley is to provide relief and promote skin integrity. Resident response to treatment is indweling [sic] foley catheter. Record review of Resident #1's Daily Skilled Note Progress Note, by ADON G, effective 07/01/2025 at 10:53 p.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renalsymptoms [sic] observed. GU appliance used is an indwelling catheter. Other observations and interventions include Resident [sic] has wounds and rash to perianal area- foley is to provide relief and promote skin integrity. Resident response to treatment is indweling [sic] foley catheter. Record review of Resident #1's Nursing Progress Note, by LPN H, effective 07/02/2025 at 05:09 a.m., reflected Output noted for this shift was 250ml. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN D, effective 07/02/2025 at 06:35 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. Resident response to treatment is indweling [sic] foley catheter. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN D, effective 07/03/2025 at 10:28 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. GU appliance used is an indwelling catheter. Resident has wounds and rash to perianal areafoley is to provide relief and promote skin integrity. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN I, effective 07/04/2025 at 02:54 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN E, effective 07/05/2025 at 02:27 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] Active SX: retention / distention of bladder. GU appliance used is an indwelling catheter. Other observations and interventions include Indwelling foley cath is draining well via gravity, no sediment noted, pt is tolerating well, no c/o pain or discomfort. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN E, effective 07/06/2025 at 05:41 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 2 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Genitourinary/Renal symptoms observed. Record review of Resident #1's Daily Skilled Note Progress Note, by ADON G, effective 07/07/2025 at 06:27 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. GU appliance used is an indwelling catheter. Other observations and interventions include Indwelling foley cath is draining well via gravity, no sediment noted, pt is tolerating well, no c/o pain or discomfort. Record review of Resident #1's Progress Notes did not reveal a Daily Skilled Note or mention of indwelling catheter care or monitoring on 07/08/2025, 07/09/2025, or 07/10/2025. Record review of Resident #1's local hospital History and Physical/admission Notes, dated 07/11/2025, reflected Resident #1 presented at the hospital on [DATE] with a chief complaint of altered mental status. She was found to have a urinary tract infection upon arrival. Her history of present illness included she was recently hospitalized , discharged [DATE], for an acute cerebrovascular accident (a stroke) with altered mental status. During an interview on 07/13/2025 at 02:15 p.m., RN K, a local hospital nurse, revealed she had provided care for Resident #1 during her current and most recent prior hospitalization. RN K stated Resident #1 was being treated for a urinary tract infection during her current hospitalization. RN K stated Resident #1 had the foley inserted during her last hospitalization, after Resident #1 had a stroke. During an interview with Resident #1, at a local hospital, on 07/13/2025 at 02:37 p.m., revealed Resident #1 admitted , on 07/10/2025, to a local hospital. Resident #1 stated she did not feel she had consistent catheter care at the nursing facility; however, Resident #1 was noted as a poor historian and was mixing her complaints about her recent nursing facility admission and a prior assisted living admission. Resident #1 ended conversation by stating she only had complaints regarding the assisted living. During an interview on 07/14/2025 at 12:11 p.m., MD L, a local hospital physician, stated she had provided care for Resident #1 during her current and most recent prior hospitalization. MD L stated she did not believe the reason for Resident #1's return to the local hospital was due to the care provided by the nursing facility. During an interview on 07/14/2025 at 01:00 p.m., NP F stated she had assessed and visited with Resident #1 four times while she was at the nursing facility. NP F stated the last time she saw Resident #1 was the day prior to Resident #1's discharge, discharged [DATE]. NP F stated she recalled Resident #1 was admitted to the nursing facility with a foley from a local hospital due to urinary retention. During an interview on 07/14/2025 at 04:12 p.m., LPN D stated she was the admitting and discharging nurse for Resident #1. LPN D stated she recalled Resident #1 admitted with an indwelling catheter. LPN D stated she was unable to complete a full assessment on Resident #1 prior to her discharge, on 07/10/2025, but did note that Resident #1's urine was amber with no sedimentation, there was no odor, and Resident #1's vitals were normal. During an interview on 07/15/2025 at 12:17 p.m., LPN M stated she recalled providing care for Resident #1 and knew Resident #1 had an indwelling catheter. LPN M stated she did not recall Resident #1 having had any symptoms of an infection. She stated the nurses would monitor for changes in mental status and for resident's with foley catheters, monitor the foley bag for changes in urine color and concentration, and for sediment. LPN M stated she did not recall Resident #1 having had any issues with her foley catheter. She recalled Resident #1's urine was yellow, and Resident #1 was up in her wheelchair for lunch during her shift. LPN M stated Resident #1 did not verbalize any concerns or complaints during her shift and she acted normal, within her baseline. LPN M stated she believed she provided Resident #1 with direct care over 5-7 days and over those days, Resident #1's urine was yellow, not amber or any other concerns. LPN M stated she did not recall if Resident #1 had orders or care planned interventions for her foley catheter, however; she would have still known about the catheter by observing it during her rounds. LPN M stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 3 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she would have still checked Resident #1's foley catheter even without an order or care planned intervention. During an interview on 07/15/2025 at 02:43 p.m., the DON stated she could not find foley catheter orders for Resident #1. During an interview on 07/15/2025 at 03:41 p.m., LPN N stated she picked up a 02:00 p.m. to 10:00 p.m. shift on 07/09/2025 and worked on a hall that she did not typically work on. She stated provided care to Resident #1 during that shift. She stated she did not recall providing foley catheter care to Resident #1 during that shift, but she typically provided care per the resident's orders. She stated she would not have known Resident #1 had a foley if she did not have orders to provide foley catheter care, if she did not personally see it during her shift, was told about it by another staff member, or was given the resident's outputs to log. During an interview on 07/15/2025 at 04:04 p.m., CNA O stated she provided care for Resident #1 around 2 times. CNA O stated she also assisted other CNAs with Resident #1's care on other days. CNA O stated she would give Resident #1 showers, check and empty her catheter bag, wipe around the catheter insertion site, and provide perineal care (clean around the resident's genital and anal areas). During an interview on 07/15/2025 at 04:21 p.m., ADON G stated she might have provided care for Resident #1 due to covering the floor Resident #1 was on that day or shift. ADON G stated she did not recall providing foley catheter care for Resident #1. She stated she may not have known Resident #1 had a foley unless it was told to her or unless she had a reason to have checked for it. During an interview on 07/17/2025 at 10:40 a.m., LPN I stated he vaguely recalled Resident #1, but did remember checking her catheter during his shift and completing a routine assessment. LPN I stated he checked Resident #1's catheter bag and did not see any signs of issues, no sediment at that time. He stated he did not remember if Resident #1 had orders for foley catheter care, but he still provided care. During an interview on 07/17/2025 at 11:48 a.m., LPN D stated for admissions, the admitting nurse will get a report sheet when the resident arrives and the nurse will call the physician to obtain verification and depending on the physician, enter the orders for them. LPN D stated the admitting nurse will ask the transferring nurse if the admitting resident has wounds and/or ostomies, and if so, would ask the transferring nurse for the diagnoses and treatment orders for them. Upon the resident's admission, the admitting nurse would review the treatment orders with the physician and determine if the physician would want to continue those treatments or start new treatments per facility protocol. LPN D stated she did not recall Resident #1's admitting orders. She stated she believed the ADONs would follow up after a resident was admitted by completing a chart audit and they would often enter batch orders. LPN D stated the indwelling catheter orders were part of the batch orders. During an interview on 07/17/2025 at 12:10 p.m., LPN H stated she remembered providing Resident #1's foley catheter care. She stated Resident #1 came in with a foley catheter and she had provided care to Resident #1 for a couple of overnight shifts. LPN H stated Resident #1's foley was okay, but Resident #1 did complain of pain, in her back and leg. She stated she did not remember if Resident #1 had orders for foley catheter care. During an interview on 07/17/2025 at 02:07 p.m., CNA P stated she provided care for Resident #1 at least once or twice. CNA P stated she remembered Resident #1 had a foley catheter and providing care for the foley. She stated Resident #1 never complained when she provided Resident #1's foley catheter or perineal care. CNA P stated when providing perineal and foley catheter care, she would wipe from top down, look for redness, look for any redness or cloudiness in the urine, and watch for any complaints of pain when changing the resident or transferring her. During an interview on 07/17/2025 at 03:10 p.m., CNA R stated she provided care for Resident #1 for the two weeks Resident #1 was admitted . CNA R stated she remembered proving foley catheter care for Resident #1. She stated she did not observe Resident #1's urine having an unusual color or cloudiness, and Resident #1 would deny (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 4 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pain when she was cleaning her in that area. During an interview on 07/17/2025 at 05:17 p.m., LPN E revealed he recalled providing care for Resident #1 over two weekends. LPN E stated he was scheduled to work double weekends, 06:00 a.m. to 10:00 p.m. He stated he remembered providing foley catheter care for her and did not note any concerns while providing foley catheter care. He stated he did not remember Resident #1 having an order for her foley catheter to be flushed, so he would use disinfectant wipes to clean the area and clean the tubing. 2. Record review of Resident #2's admission Record, dated 07/16/2025, reflected Resident #2 was admitted on [DATE]. Resident #2 was noted to be [AGE] years old. Record review of Resident #2's Diagnosis Report, undated and accessed 07/16/2025, reflected Resident #2 was diagnosed with displaced intertrochanteric fracture of right femur (a break in the hip bone), thrombocytopenia (a low number of platelets, which are blood cells that cause clotting, in the blood), and dementia (a general term for impaired ability to remember, think, or make decisions). Record review of Resident #2's admission MDS assessment, dated 06/23/2025, reflected Resident #2's BIMS score of 02 indicated she was moderately cognitively impaired. She was noted to have an indwelling catheter and always incontinent of bowel. Record review of Resident #2's LN- Initial admission Record, effective date 06/21/2025, reflected Resident #2 had an indwelling urinary catheter in place upon admission for retention. Record review of Resident #2's Order Recap Report, dated 07/17/2025 for order dates 06/20/2025 to 07/31/2025, reflected the following orders:- CATHETER CARE EVERY SHIFT. MONITOR URETHRAL SITE FOR S/S OF SKIN BREAKDOWN, PAIN/DISCOMFORTS [sic], UNUSUAL ODOR, URINE CHARACTERISTIC OR SECREATIONS, CATHETER PULLING CAUSING TENSION every shift, noted as Active, order and start date 06/23/2025. - CATHETER TYPE: 16 FR # 10 ML_TO CLOSED URINARY DRAINAGE SYSTEM- DIAGNOSIS FOR USE: urinary retention, noted as Active, order and start date 06/21/2025.- CHANGE DRAINAGE BAG MONTHLY ON 15 DAY OF EACH MONTH &PRN [sic] one time a day for urinary retention, noted as Discontinued on 06/24/2025, order date 06/21/2025, start date 06/22/2025, and end date 06/24/2025.- CHANGE DRAINAGE BAG MONTHLY ON 15 DAY OF EACH MONTH &PRN [sic] one time a day every 1 month(s) starting on the 15th for 1 day(s), noted as Active, order date 06/23/2025 and start date 07/15/2025.- CHANGE FOLEY CATHETER MONTHLY ON 15 DAY OF EACH MONTH. REINSERT PRN FOR ACCIDENTAL REMOVAL, DISLODGEMENT, OBSTRUCTION OF URINE FLOW one time a day starting on the 15th and ending on the 15th every month, noted as Active, order date 06/21/2025 and start date 07/15/2025.- CHANGE LEG STRAP EVERY WEEK and AS NEEDED as needed AND one time a day every 7 day(s), noted as Active, order and start date 06/23/2025.DX TO SUPPORT USE OF INDWELLING CATHETER: RETENTION, noted as Active, order date 06/23/2025.- Enhanced Barrier Precautions: PPE required for high resident contact care activities. Indication: Indwelling Catheter every shift for foley, noted as Active, order and start date 06/21/2025.MONITOR / RECORD /REPROT TO MD FOR ANY S/S OF UTI: PAIN/DISCOMFORTS [sic], [NAME] BLOOD TINGED URINE, CLOUDINESS, SCANTY OR NO URINARY OUTPUT, DARK URINE COLOR, HIGH TEMP., CHILLS, ALTERED MENTAL STATUS, CHANGES IN BEHAVIOR, CHANGES IN EATING PATTERN, FOUL SMELLING URINE every shift, noted as Active, order and start date 06/23/2025.- Monitor Catheter Output every shift, noted as Active, order and start date 06/23/2025.- POSITION PRIVACY BAG &TUBING [sic] BELOW THE LEVEL OF THE BLADDER every shift, noted as Active, order and start date 06/23/2025.- SECURE CATHETER WITH A LEG STRAP/LEG BAND OR ANCHOR TO MINIMIZE CATHETER RELATED INJURY AND ACCIDENTAL REMOVAL OR OBSTRUCTION OF URINE OUTFLOW, CHECK PLACEMENT as needed AND every shift, noted as Active, order and start date 06/23/2025. Record review of Resident #2's MAR, dated 06/01/2025- 06/30/2025, reflected the following indwelling catheter orders did not start until 06/23/2025 or 06/24/2025:- CHANGE LEG STRAP EVERY WEEK and AS NEEDED as needed AND one time a day every 7 day(s), noted as active, order date 06/23/2025 at 03:10 p.m., noted as Administered once, on 07/24/2025 at AM 07.- CATHETER CARE EVERY SHIFT. MONITOR URETHRAL SITE FOR S/S OF (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 5 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0635 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few SKIN BREAKDOWN, PAIN/DISCOMFORTS [sic], UNUSUAL ODOR, URINE CHARACTERISTIC OR SECREATIONS, CATHETER PULLING CAUSING TENSION every shift, order date 06/23/2025 at 03:10 p.m., first noted as Administered on 07/23/2025 at NOC2, then noted as Administered three times a day for the remainder of the month.- MONITOR / RECORD /REPROT TO MD FOR ANY S/S OF UTI: PAIN/DISCOMFORTS [sic], [NAME] BLOOD TINGED URINE, CLOUDINESS, SCANTY OR NO URINARY OUTPUT, DARK URINE COLOR, HIGH TEMP., CHILLS, ALTERED MENTAL STATUS, CHANGES IN BEHAVIOR, CHANGES IN EATING PATTERN, FOUL SMELLING URINE every shift, order date 06/23/2025 at 03:10 p.m., first noted as Administered on 07/23/2025 at NOC2, then noted as Administered three times a day for the remainder of the month.- Monitor Catheter Output every shift, order date 06/23/2025 at 03:16 p.m., first noted as Administered on 07/23/2025 at NOC2, then noted as Administered three times a day for the remainder of the month.- POSITION PRIVACY BAG &TUBING [sic] BELOW THE LEVEL OF THE BLADDER every shift, order date 06/23/2025 at 03:10 p.m., first noted as Administered on 07/23/2025 at NOC2, then noted as Administered three times a day for the remainder of the month.SECURE CATHETER WITH A LEG STRAP/LEG BAND OR ANCHOR TO MINIMIZE CATHETER RELATED INJURY AND ACCIDENTAL REMOVAL OR OSTRUCTION OF URINE OUTFLOW. CHECK PLACEMENT every shift, order date 06/23/2025 at 03:10 p.m., first noted as Administered on 07/23/2025 at NOC2, then noted as Administered three times a day for the remainder of the month.- CHANGE LEG STRAP EVERY WEEK and AS NEEDED as needed, order date 06/23/2025 at 03:10 p.m., noted as scheduled PRN and not noted as Administered. - SECURE CATHETER WITH A LEG STRAP/LEG BAND OR ANCHOR TO MINIMIZE CATHETER RELATED INJURY AND ACCIDENTAL REMOVAL OR OSTRUCTION OF URINE OUTFLOW. CHECK PLACEMENT as needed, order date 06/23/2025 at 03:10 p.m., noted as scheduled PRN and not noted as Administered. Observation and attempted interview with Resident #2 on 07/17/2025 at 09:40 a.m. Resident #2 observed to lying in bed, watching her television. Resident #2 observed to be alert, but her speech was garbled and her response to questions was inconsistent to interview prompt. During an interview on 07/15/2025 at 01:02 p.m., the DON stated the admitting nurse was to put the foley catheter orders in and then the NP or MD would sign off on them. The DON stated if there were not orders, the monitoring orders would not be in place and measuring output wouldn't be triggered for monitoring. She stated the nurses are hands-on, and they continue to monitor even without an order. She stated her expectation was that if a nurse were to observe a foley catheter and identify that there was not an order, the nurse was supposed to put in the order or notify her. During an interview on 07/15/2025 at 02:43 p.m., the DON stated the nurses would have documented the care provided and monitoring of the foley catheter care in their daily skilled note, even if they were not documenting it in the MAR. During an interview on 07/15/2025 at 04:21 p.m., ADON G stated if foley catheter care was not provided per order or care plan intervention, lack of care could result in a larger infection including the development of sepsis. During an interview on 07/17/2025 at 12:17 p.m., NP F stated she deferred to facility protocols for indwelling catheter care unless she identified a need for the orders and care to be changed. NP F stated she expected the facility staff to initiate the orders, generally upon admission. She stated the impact of the facility not putting in the orders could result in the indwelling catheter care was not being done, which could harm the resident. NP F stated she could not necessarily state the degree of harm to a resident if the care was delayed 2-3 days or more; however, she stated that the delay in care would not be best practice. During an interview on 07/17/2025 at 03:34 p.m., the DON stated it was the responsibility of the admitting nurse to put in orders for a resident's foley catheter care. She stated the ADONs or weekend supervisor will then audit the admission the next day; however, for Resident #1 it was missed. The DON stated the orders are patient specific, but even without orders the charge nurses would still see the foley catheter and provide care, including monitoring for signs and symptoms of a urinary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 6 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0635 Level of Harm - Minimal harm or potential for actual harm tract infection. Record review of facility policy, Indwelling Urinary Catheter Care, dated revised/reviewed April 2025, revealed under Policy, It is the policy of this facility that each resident with an indwelling catheter will receive catheter care daily and as needed (PRN) to promote hygiene, comfort, and decrease the risk of infection. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 7 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident's functional capacity for 2 of 4 (Residents #1 and #2) reviewed for assessments. 1. The MDS Coordinator failed to complete Resident #1's admission comprehensive assessment within 14 days after admission. MDS Coordinator A verified as complete on 07/12/2025. Resident #1 was admitted on [DATE]. 2. The MDS Coordinator failed to complete Resident #2's admission comprehensive assessment within 14 days after admission. MDS Coordinator A verified as complete on 07/13/2025. Resident #2 was admitted on [DATE]. This failure could affect newly admitted residents and result in residents not receiving the care and services as needed.The findings included: 1. Record review of Resident #1's admission Record, dated 07/16/2025, reflected Resident #1 was admitted on [DATE] and discharged on 07/10/2025. Resident #1 was noted to be [AGE] years old. Record review of Resident #1's Diagnosis Report, undated and accessed 07/14/2025, reflected Resident #1 was diagnosed with other sequelae of cerebral infarction (long-term complications or effects that can occur after a stroke), acute kidney failure (a sudden condition when the kidneys stop working or being able to filter waste products from the blood), and chronic kidney failure, stage 3 (a condition where the kidneys lose their ability to filter blood and remove wastes). Record review of Resident #1's admission MDS assessment, dated 06/30/2025, reflected Resident #1 was admitted on [DATE] and had a BIMS score of 12 indicating she was mildly cognitively impaired. The admission MDS assessment was completed and signed by MDS Coordinator A on 07/12/2025; 15 days after Resident #1's admission. Interview with Resident #1, at a local hospital, on 07/13/2025 at 02:37 p.m., revealed Resident #1 admitted , on 07/10/2025, to a local hospital. Resident #1 stated she did not feel she had consistent care at the nursing facility; however, Resident #1 was noted as a poor historian and was mixing her complaints between the recent nursing facility administration and a prior assisted living administration. Resident #1 ended conversation by stating she only had complaints regarding the assisted living. 2. Record review of Resident #2's admission Record, dated 07/16/2025, reflected Resident #2 was admitted on [DATE]. Resident #2 was noted to be [AGE] years old. Record review of Resident #2's Diagnosis Report, undated and accessed 07/16/2025, reflected Resident #2 was diagnosed with displaced intertrochanteric fracture of right femur (a break in the hip bone), thrombocytopenia (a low number of platelets, which are blood cells that cause clotting, in the blood), and dementia (a general term for impaired ability to remember, think, or make decisions). Record review of Resident #2's EMR (electronic medical record) on 07/16/2025, reflected Resident #2 had four MDS Assessments, an Entry MDS, dated [DATE], and noted as Accepted, an admission - None PPS MDS, dated [DATE], and noted as Accepted, a Medicare- 5 Day MDS, dated [DATE], and noted as Completed, and a Discharge Return NotAnticipated [sic] MDS, dated [DATE], and noted as In Progress. Record review of Resident #2's admission MDS assessment, dated 06/23/2025, reflected Resident #2 was admitted on [DATE] and had a BIMS score of 02 indicating she was moderately cognitively impaired. The admission MDS assessment was completed and signed by MDS Coordinator A on 07/13/2025; 23 days after Resident #2's admission. Observation and attempted interview with Resident #2 on 07/17/2025 at 09:40 a.m. Resident #2 observed to lying in bed, watching her television. Resident #2 observed to be alert, but her speech was garbled and her response to questions was inconsistent to interview prompt. During an interview on 07/16/2025 at 09:26 a.m., MDS Coordinator A stated she worked on a PRN (as needed) basis. She revealed she would review the in-progress list and just complete the MDS Assessments that needed to be done. She stated a late MDS Assessment would impact a resident depending on the specific (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 8 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete sections of the MDS Assessment that were not completed. She did not clarify how an assessment signed late could impact a resident. During an interview on 07/16/2025 at 09:41 a.m., MDS Coordinator B stated the assessments were scheduled based on the RAI (Resident Assessment Instrument). MDS Coordinator B stated the facility had herself and another MDS Coordinator, MDS Coordinator C, completing the assessments, but MDS Coordinator C was new and still in training. She stated MDS Coordinator A was working PRN and MDS Coordinator A would review and complete the MDS Assessments that were in-progress. MDS Coordinator B stated Resident #1's admission MDS was probably signed late because the MDS Coordinators were behind and still attempting to get caught up. MDS Coordinator B was not asked about Resident #'2's admission MDS. MDS Coordinator B stated a late MDS Assessment could impact a resident because it could delay triggers for care planning. Record review of facility policy, Resident Assessment and Associated Processes, dated revised/reviewed December 2023, revealed under Procedure, 3. Comprehensive assessments will be conducted within 14 days of admission., 7. Each individual who completes a portion of the assessment will electronically sign and certify the accuracy of that portion of the assessment, as well as the date the data was obtained., and 8. A Registered Nurse will electronically sign and certify that the assessment is completed. Event ID: Facility ID: 675509 If continuation sheet Page 9 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 interview and record review, the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person- centered care of the residents that meets professional standards of quality of care within 48 hours of a resident's admission for 1 of 5 (Resident #1) reviewed for baseline care plans. The facility failed to include Resident #1's catheter care and monitoring in her initial baseline care plan dated 06/28/2025, when Resident #1 was admitted on [DATE]. This deficient practice could place residents at risk of not having their individual care needs met in a timely manner or diminished quality of life, infection, and hospitalization.The findings included: Record review of Resident #1's admission Record, dated 07/16/2025, reflected Resident #1 was admitted on [DATE] and discharged on 07/10/2025. Resident #1 was noted to be [AGE] years old. Record review of Resident #1's Diagnosis Report, undated and accessed 07/14/2025, reflected Resident #1 was diagnosed with other sequelae of cerebral infarction (long-term complications or effects that can occur after a stroke), acute kidney failure (a sudden condition when the kidneys stop working or being able to filter waste products from the blood), and chronic kidney failure, stage 3 (a condition where the kidneys lose their ability to filter blood and remove wastes). Record review of Resident #1's hospital transfer documents, dated 06/25/2025, reflected Resident #1 had completed a 5-day course of antibiotics for a urinary tract infection but no growth was found on the culture. She was noted to have genitourinary skin (skin around the genital and urinary organs) breakdown with a foley (an indwelling catheter to drain urine from the bladder) approved for comfort. Record review of Resident #1's LN- Initial admission Record, signed and dated 06/27/2025 at 06:45 p.m. by LPN D, reflected Resident #1 had a urinary indwelling catheter in place. Record review of Resident #1's admission MDS assessment, dated 06/30/2025, reflected it had been completed and signed by MDS Coordinator A on 07/12/2025. Resident #1's BIMS score of 12 indicated she was mildly cognitively impaired, and her bowel and bladder appliances noted she had an indwelling catheter (a tube inserted into the body). Record review of Resident #1's Initial Care Plan., signed and dated 06/28/2025 by the DON, did not reflect a focus or intervention regarding incontinent care or indwelling catheter care. Record review of Resident #1's IDT- Care Plan Review., signed and dated 07/03/2025, did not reflect person-centered comprehensive care planning on Bowel and Bladder Evaluation or Care Plan elements to include indwelling catheter care under additional comments, special treatments, procedures and devices, or additional nursing plan of care. Record review of Resident #1's Care Plan, accessed 07/14/2025, did not reflect a focus or intervention regarding incontinent care or indwelling catheter care. Record review of Resident #1's Nursing Progress Note, by LPN D, effective 06/27/2025 at 05:55 p.m., reflected .She has an indwelling foley catheter. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN E, effective 06/28/2025 at 10:39 a.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [painful urination] [sic] Active SX: retention / distension of bladder. GU appliance used is an indwelling catheter. Other observations and interventions include Indwelling [sic] foley cath is drainingwell [sic] via gravity, no sediment noted, pt is tolerating well, no c/o pain or discomfort. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN E, effective 06/29/2025 at 06:00 p.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. Record review of Resident #1's History and Physical Note Progress Note, by NP F, effective 06/30/2025 at 04:42 p.m., reflected While in hospital noted with UTI [urinary tract infection, an infection in any part of the urinary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 10 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 system] treated with Rocephin [antibiotic]. Has been experiencing diarrhea, n/v with no clear reason.foley cath was placed in hospital for skin integrity. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN D, effective 06/30/2025 at 11:31 p.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] Other active symptoms or treatments are described below. GU appliance used is an indwelling catheter. Other observations and interventions include Resident [sic] has wounds and rash to perianal [area surrounding the anus] area- foley is to provide relief and promote skin integrity. Resident response to treatment is indweling [sic] foley catheter. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN D, effective 07/01/2025 at 07:00 p.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. GU appliance used is an indwelling catheter. Other observations and interventions include Resident [sic] has wounds and rash to perianal area- foley is to provide relief and promote skin integrity. Resident response to treatment is indweling [sic] foley catheter. Record review of Resident #1's Daily Skilled Note Progress Note, by ADON G, effective 07/01/2025 at 10:53 p.m., reflected Urine is [sic] pt has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renalsymptoms [sic] observed. GU appliance used is an indwelling catheter. Other observations and interventions include Resident [sic] has wounds and rash to perianal area- foley is to provide relief and promote skin integrity. Resident response to treatment is indweling [sic] foley catheter. Record review of Resident #1's Nursing Progress Note, by LPN H, effective 07/02/2025 at 05:09 a.m., reflected Output noted for this shift was 250ml. Record review of Resident #1's Np / PA Progress Note Progress Note, by NP F, effective 07/02/2025 at 10:00 a.m., reflected While in hospital noted with UTI treated with Rocephin. Has been experiencing diarrhea, n/v with no clear reason.foley cath was placed in hospital for skin integrity. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN D, effective 07/02/2025 at 06:35 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. Resident response to treatment is indweling [sic] foley catheter. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN D, effective 07/03/2025 at 10:28 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. GU appliance used is an indwelling catheter. Resident has wounds and rash to perianal area- foley is to provide relief and promote skin integrity. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN I, effective 07/04/2025 at 02:54 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN E, effective 07/05/2025 at 02:27 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] Active SX: retention / distention of bladder. GU appliance used is an indwelling catheter. Other observations and interventions include Indwelling foley cath is draining well via gravity, no sediment noted, pt is tolerating well, no c/o pain or discomfort. Record review of Resident #1's Daily Skilled Note Progress Note, by LPN E, effective 07/06/2025 at 05:41 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. Record review of Resident #1's NP / PA Progress Note Progress Note, by NP F, effective 07/07/2025 at 05:50 a.m., reflected While in hospital noted with UTI treated with Rocephin. Has been experiencing diarrhea, n/v with no clear reason.foley cath was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 11 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 placed in hospital for skin integrity. Record review of Resident #1's Daily Skilled Note Progress Note, by ADON G, effective 07/07/2025 at 06:27 p.m., reflected Urine is [sic] resident has indwelling foley cath, urine is yellow and clear, no foul odor noted, no c/o dysuria [sic] No active Genitourinary/Renal symptoms observed. GU appliance used is an indwelling catheter. Other observations and interventions include Indwelling foley cath is draining well via gravity, no sediment noted, pt is tolerating well, no c/o pain or discomfort. Record review of Resident #1's NP / PA Progress Note Progress Note, by NP F, effective 07/09/2025 at 05:16 a.m., reflected While in hospital noted with UTI treated with Rocephin. Has been experiencing diarrhea, n/v with no clear reason.foley cath was placed in hospital for skin integrity.Start bladder retraining dc foley in 2 days. Record review of Resident #1's Nursing Progress Note, by LPN D, effective 07/10/2025 at 05:07 p.m., reflected Family was informed that order was received to send resident out to ER to which the [family member] at bedside stated her [family member] who is also at bedside called 911 for emergency service to transfer resident due to increased thrashing and nausea/vomiting. [ADON J] was informed and paperwork was printed out for EMS. Resident is in bed, HOB [head of bed] in high fowlers [elevated as high as 60 to 90 degrees in relation to lower half of bed] and able to answer quesitons [sic]. Resident was moving around but not thrashing and was not vomiting when this writer was in the room. Record review of Resident #1's local hospital History and Physical/admission Notes, dated 07/11/2025, reflected Resident #1 presented at the hospital on [DATE] with a chief complaint of altered mental status. She was found to have a urinary tract infection upon arrival. Her history of present illness included she was recently hospitalized , discharged [DATE], for an acute cerebrovascular accident (a stroke) with altered mental status. During an interview on 07/13/2025 at 02:15 p.m., RN K, a local hospital nurse, revealed she had provided care for Resident #1 during her current and most recent prior hospitalization. RN K revealed Resident #1 was being treated for a urinary tract infection during her current hospitalization. RN K revealed Resident #1 had the foley inserted during her last hospitalization. Interview with Resident #1 on 07/13/2025 at 02:37 p.m., revealed Resident #1 admitted , on 07/10/2025, to a local hospital. Resident #1 stated she did not feel she had consistent catheter care at the nursing facility; however, Resident #1 was noted as a poor historian and was mixing her complaints about her recent nursing facility admission and a prior assisted living admission. Resident #1 ended conversation by stating she only had complaints regarding the assisted living. During an interview on 07/14/2025 at 12:11 p.m., MD L, a local hospital physician, stated she had provided care for Resident #1 during her current and most recent prior hospitalization. MD L stated she did not believe the reason for Resident #1's return to the local hospital was due to the care provided by the nursing facility. MD L stated residents can get sick regardless of what you do, and Resident #1 was not septic and did not have a fever upon her rehospitalization. MD L stated she did believe Resident #1 was more confused upon her return, with a little more symptoms that might suggest a urinary infection. She stated Resident #1 did not discharge to the nursing home on antibiotics and the current urinary tract infection was not the same that the hospital had treated previously. She stated Resident #1's urinary cultures did not show a clear urinary infection during her last hospitalization, only contamination of the culture. She stated Resident #1's culture from her current hospitalization was growing, indicating a specific bacterial infection. MD L stated Resident #1 [or family member] had asked her when the infection started, and she was unable to provide an answer. MD L stated Resident #1's [family member] clarified that her complaints regarding Resident #1's care were more about Resident #1's care provided at her prior Assisted Living. During an interview on 07/14/2025 at 01:00 p.m., NP F stated she had assessed and visited with Resident #1 four times while she was at the nursing facility. NP F (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 12 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 revealed the last time she saw Resident #1 was the day prior to Resident #1's discharge, discharged [DATE]. NP F revealed she recalled Resident #1 was admitted to the nursing facility with a foley from a local hospital due to urinary retention. NP F revealed she recalled looking at Resident #1's catheter bag on 07/09/2025 and the urine was yellow and clear, without cloudiness. NP F revealed from her perspective, Resident #1 did not have any signs of a urinary tract infection. Resident #1's mentation (mental activity) was the same as when she admitted , she had not voiced or expressed any sign of discomfort, she did not have a fever, and her urine was clear. NP F revealed Resident #1 did not have an order for a urinary analysis until the day of her discharge, 07/10/2025, when the nurse, LPN D, called her and said the family was saying Resident #1 did not appear to be herself. NP F revealed she asked LPN D if Resident #1 appeared different than the prior day, 07/09/2025, and the nurse said no. NP F revealed Resident #1 was sent out to the hospital prior to the urine sample having been collected for analysis. During an interview on 07/14/2025 at 04:12 p.m., LPN D stated she was the admitting and discharging nurse for Resident #1. LPN D stated she recalled Resident #1 admitted with an indwelling catheter. LPN D revealed on Resident #1's day of discharge, the only change she noted was Resident #1 was sitting up in her wheelchair in the dining room when she, LPN D arrived for her shift, around 02:00 p.m. LPN D revealed prior to 07/09/2025, she had only observed Resident #1 staying in her bed during her shifts. LPN D revealed she said hello to Resident #1 upon her arrival on 07/10/2025, and Resident #1 appeared to recognize her and did not indicate she was uncomfortable. LPN D stated later during her shift, Resident #1's family arrived and asked for Resident #1 to be assisted back to bed. Resident #1's family later notified her that Resident #1 was anxious and thrashing her head in the bed; and they felt Resident #1 was just not right. LPN D stated she told Resident #1's family she would notify the NP, but also went to check on Resident #1 and noted Resident #1 was moving her head back and forth but not slamming or thrashing it. LPN D stated Resident #1's family approached her again, asked for Resident #1 to be sent out, and then stated the staff were not moving fast enough and notified her the family had called 911. LPN D stated she was unable to complete a full assessment on Resident #1 prior to her discharge but did note that Resident #1's urine was amber with no sedimentation, there was no odor, and Resident #1's vitals were normal. During an interview on 07/15/2025 at 12:17 p.m., LPN M stated she recalled providing care for Resident #1 and knew Resident #1 had an indwelling catheter. LPN M stated she did not recall Resident #1 having had any symptoms of an infection. She stated the nurses would monitor for changes in mental status and for resident's with foley catheters, monitor the foley bag for changes in urine color and concentration, and for sediment. LPN M revealed she did not recall Resident #1 having had any issues with her foley catheter. She recalled Resident #1's urine was yellow, and Resident #1 was up in her wheelchair for lunch during her shift. LPN M stated Resident #1 did not verbalize any concerns or complaints during her shift and she acted normal, within her baseline. LPN M stated she believed she provided Resident #1 with direct care over 5-7 days and over those days, Resident #1's urine was yellow, not amber or any other concerns. LPN M stated she did not recall if Resident #1 had orders or care planned interventions for her foley catheter, however; she would have still known about the catheter by observing it during her rounds. LPN M stated she would have still checked Resident #1's foley catheter even without an order or care planned intervention. During an interview on 07/15/2025 at 12:48 p.m., ADON J stated she had not provided direct care with Resident #1 and had only encountered Resident #1 on the day of her discharge, 07/10/2025. ADON J revealed LPN D notified her Resident #1's family wanted to send Resident #1 out to the hospital due to a change in Resident #1's behaviors, including involuntary movements. ADON J stated her observation of Resident #1 revealed Resident #1 having her hands (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 13 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 interlocked and light or subtle rocking back and forth. She stated she told LPN D to notify the NP and to start the process for sending Resident #1 out, per family request. ADON J stated she asked LPN D to complete her assessment, but the family wouldn't wait and called 911 before LPN D could complete the transferring assessment. ADON J stated she asked LPN D about the involuntary movements and LPN D stated they were present upon Resident #1's admission. During an interview on 07/15/2025 at 01:02 p.m., the DON stated the initial care plan had to be opened by an RN, so either herself or the RN MDS Coordinator. She stated the initial care plan or baseline care plan was not fully detailed until the MDS Coordinator and infection control nurse completes their systems, usually within 48 hours. She stated foley catheters would not be specifically on the baseline care plan but there should be orders if a resident was admitted with a foley catheter. She stated the nurses are hands-on, and they continue to monitor even without an order. During an interview on 07/15/2025 at 02:43 p.m., the DON stated the nurses would have documented the care provided and monitoring of the foley catheter care in their daily skilled note, even if they were not documenting it in the MAR. During an interview on 07/15/2025 at 03:41 p.m., LPN N stated she picked up a 02:00 p.m. to 10:00 p.m. shift on 07/09/2025 and worked on a hall that she did not typically work on. She stated provided care to Resident #1 during that shift. She stated she did not recall providing foley catheter care to Resident #1 during that shift, but she typically provided care per the resident's orders. She stated she would not have known Resident #1 had a foley if she did not personally see it during her shift, was told about it by another staff member, or was given the resident's outputs to log. During an interview on 07/15/2025 at 04:04 p.m., CNA O stated she provided care for Resident #1 around 2 times. CNA O stated she also assisted other CNAs with Resident #1's care on other days. CNA O stated she would give Resident #1 showers, check and empty her catheter bag, wipe around the catheter insertion site, and provide perineal care (clean around the resident's genital and anal areas). CNA O stated she remembered Resident's urine to always be a little dark, slightly brownish yellow. She stated she believed it was due to Resident #1 liking to eat snacks and drink soda. She stated she told her nurse about Resident #1's urine color, unable to identify who, and gave the nurse Resident #1's output for the day, unable to provide a date. CNA O stated she did not notice any concerns with Resident #1's foley because the area around the foley was clean and not irritated. During an interview on 07/15/2025 at 04:21 p.m., ADON G stated she might have provided care for Resident #1 due to covering the floor Resident #1 was on that day or shift. ADON G revealed she did not recall providing foley catheter care for Resident #1. She stated she may not have known Resident #1 had a foley unless it was told to her or unless she had a reason to have checked for it. ADON G stated if foley catheter care was not provided per order or care plan intervention, lack of care could result in a larger infection including the development of sepsis. During an interview on 07/17/2025 at 10:40 a.m., LPN I stated he vaguely recalled Resident #1, but did remember checking her catheter during his shift and completing a routine assessment. LPN I stated he checked Resident #1's catheter bag and did not see any signs of issues, no sediment at that time. During an interview on 07/17/2025 at 11:48 a.m., LPN D stated care plans were opened by the facility RNs since that was an RN designated role. She did not believe there was a designated person to complete the resident's care plan, so the resident's care needs were relayed to the RN. LPN D stated she would call the RN. LPN D stated she remembered having called the DON following Resident #1's admission. LPN D stated she told the DON about Resident #1's overcall condition upon admission, including that Resident #1 had a foley and Resident #1's family concerns regarding wounds. During an interview on 07/17/2025 at 12:10 p.m., LPN H stated she remembered providing Resident #1's foley catheter care. She stated Resident #1 came in with a foley catheter and she had provided (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 14 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 care to Resident #1 for a couple of overnight shifts. LPN H stated Resident #1's foley was okay, but Resident #1 did complain of pain, in her back and leg. During an interview on 07/17/2025 at 12:17 p.m., NP F stated she deferred to facility protocols for indwelling catheter care unless she identified a need for the orders and care to be changed. NP F stated she expected the facility staff to initiate the orders, generally upon admission. She stated the impact of the facility not putting in the orders could result in the indwelling catheter care was not being done, which could harm the resident. NP F revealed she could not necessarily state the degree of harm to a resident if the care was delayed 2-3 days or more; however, she stated that the delay in care would not be best practice. During an interview on 07/17/2025 at 02:07 p.m., CNA P stated she provided care for Resident #1 at least once or twice. CNA P stated she remembered Resident #1 had a foley catheter and providing care for the foley. She stated Resident #1 never complained when she provided Resident #1's foley catheter or perineal care. CNA P stated when providing perineal and foley catheter care, she would wipe from top down, look for redness, look for any redness or cloudiness in the urine, and watch for any complaints of pain when changing the resident or transferring her. During an interview on 07/17/2025 at 03:10 p.m., CNA R stated she provided care for Resident #1 for the two weeks Resident #1 was admitted . CNA R revealed she had to encourage Resident #1 to eat and drink water because she didn't want to eat or drink a lot. CNA R stated she thought Resident #1 was the same throughout her admission and did not have a change in condition. CNA R revealed she had told the nurse, did not provide a name, that Resident #1 wasn't eating but Resident #1's family would bring her food, and she would eat that. CNA R revealed Resident #1 would love to drink the Coke the family brought for her. CNA R stated she remembered proving foley catheter care for Resident #1. She stated she did not observe Resident #1's urine having an unusual color or cloudiness, and Resident #1 would deny pain when she was cleaning her in that area. CNA R stated Resident #1 was the same throughout her admission and her foley catheter was good. During an interview on 07/17/2025 at 03:34 p.m., the DON stated the baseline care plan would be opened within 24-hours of a resident's admission by an RN and then completed by a MDS Coordinator. She stated the initial care plan would have two names, the person who opened it and the person who last edited it. She stated the signature on the bottom of the initial care plan would be the person who opened it, on Resident #1 it was her, and per the Care Plan tab in the EMR, the person named would be the person that last revised the initial care plan, for Resident #1 it was MDS Coordinator A. The DON stated the initial care plan would populate to the resident's comprehensive care plan, and it was patient specific per the report from the admitting charge nurse. The DON stated the foley catheter would not be included in the baseline care plan. It would be added later to the comprehensive care plan, because it was not one of the selections within the baseline care plan. The DON stated the nurses provide a report following an admission and that would be when additions would be added to the comprehensive care plan. The DON stated she did not receive a report for Resident #1. The DON stated the orders are patient specific, but even without orders the charge nurses would still see the foley catheter and provide care, including monitoring for signs and symptoms of a urinary tract infection. During an interview on 07/17/2025 at 05:17 p.m., LPN E stated he recalled providing care for Resident #1 over two weekends. LPN E stated he was scheduled to work double weekends, 06:00 a.m. to 10:00 p.m. He stated he remembered providing foley catheter care for her and did not note any concerns while providing foley catheter care. He stated he did not remember Resident #1 having an order for her foley catheter to be flushed, so he would use disinfectant wipes to clean the area and clean the tubing. He stated Resident #1 had a baseline of being confused, which he noted the first day he worked with her, the day after her admission to the nursing facility, 06/30/2025. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 15 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 FORM CMS-2567 (02/99) Previous Versions Obsolete stated he did not observe a change in her condition during the times he provided care for her. Record review of facility policy, Comprehensive Person-Centered Care Planning, dated revised/reviewed December 2023, revealed under Policy, .The IDT team will also develop and implement a baseline care plan for each resident, within 48 hours of admission, that includes minimum healthcare information necessary to properly care for each resident and instructions needed to provide effective and person-centered care that meet professional standards of quality care. Under Procedure, 3.The facility team will provide a written summary of the baseline care plan to the resident and their representative that includes initial goals of the resident, a summary of medication and dietary instructions, and any services and treatments to be administered. Event ID: Facility ID: 675509 If continuation sheet Page 16 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure a resident who had an indwelling catheter received appropriate treatment and services to prevent urinary tract infections for 1 of 2 (Resident #3) reviewed for indwelling catheter care. 1. The facility failed to ensure CNA S cleaned Resident #3's indwelling catheter properly during incontinent care. 2. The facility failed to ensure Resident #3's indwelling catheter was secured appropriately and per physician's order. These failure could place residents with indwelling catheters at risk for pain, infection, injury, and hospitalization. The findings included: 1. Record review of Resident #3's admission Record, dated 07/16/2025, reflected Resident #3 was admitted on [DATE]. Resident #3 was noted to be [AGE] years old. Record review of Resident #3's Diagnosis Report, undated and accessed 07/16/2025, reflected Resident #3 was diagnosed with displacement of indwelling urethral catheter (also known as a foley catheter, a tube inserted in the urethra to drain urine), urinary tract infection, and type 2 diabetes mellitus (a condition that develops with the way the body regulates and uses sugar as fuel). Record review of Resident #3's admission MDS assessment, dated 04/29/2025, reflected Resident #3's had a BIMS score of 14, indicating he was cognitively intact. He was noted to have an indwelling catheter and always incontinent of bowel. Record review of Resident #3's Order Summary Report, dated active orders as of 07/16/2025, reflected the orders: - CHANGE LEG STRAP EVERY WEEK and AS NEEDED as needed [sic], order status noted as Active, order date and start date of 04/28/2025. CHANGE LEG STRAP EVERY WEEK and AS NEEDED one time a day every 7 day(s), order status noted as Active, order date of 04/28/2025 and start date of 04/29/2025.- SECURE CATHETER WITH A LEG STRAP/LEG BAND OR ANCHOR TO MINIMIZE CATHETER RELATED INJURY AND ACCIDENTAL REMOVAL OR OBSTRUCTION OF URINE OUTFLOW, CHECK PLACEMENT as needed, noted as Active, order date and start date of 04/25/2025.- SECURE CATHETER WITH A LEG STRAP/LEG BAND OR ANCHOR TO MINIMIZE CATHETER RELATED INJURY AND ACCIDENTAL REMOVAL OR OBSTRUCTION OF URINE OUTFLOW, CHECK PLACEMENT every shift, noted as Active, order date and start date of 04/25/2025. During an interview on 07/15/2025 at 01:02 p.m., the DON revealed CNAs were expected to empty the resident foley catheters and record the output. She revealed the facility completed skills checkoffs with the CNAs and they were to notify a nurse if they observed a urine color change, such as blood in the urine. During an observation on 07/16/2025 at 10:52 a.m., CNA S was providing incontinent and foley catheter care to Resident #3. No leg strap was noted to be present, securing Resident #3's catheter tubing in place. CNA S was observed to clean Resident #3's perineum (area between the genitals and anus), thigh folds, shaft and head of the penis, and around the catheter insertion site, but did not clean the catheter. During an interview on 07/16/2025 at 11:58 a.m., CNA S stated she needed to notify the nurse Resident #3 did not have a leg strap on his catheter. She stated residents with catheters should have a leg strap on at all times. She stated Resident #3 had just returned from a shower and sometimes they come loose in the shower, however; he did not have one on this morning, 07/16/2025, before his shower. CNA S stated she did not clean the catheter when providing perineal care. She stated she knew she was supposed to clean the catheter by holding it and wiping from the tip away from the body. She stated she was distracted because there was a lot going on, her gown kept falling off, and she was nervous. During an interview on 07/17/2025 at 09:45 a.m., Resident #3 stated he did not have any concerns about his foley catheter care. He stated the staff check and clean his foley catheter well. During an interview on 07/17/2025 at 09:46 a.m., CNA S stated she messed up. She revealed it was part of her training to always clean the tubing and if the resident complained of pain, clean it and then let the nurse know. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 17 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete She stated there were a lot of distractions with the roommate continuously asking what was going on, her phone alarm going off for her scheduled break, and another CNA had asked for assistance. She stated her nerves just got the best of her. During an interview on 07/17/2025 at 03:34 p.m., the DON stated CNAs were expected to perform foley catheter care, including monitoring. She revealed the CNAs were to empty the foley catheters, but the nurses were to monitor for signs and/or symptoms of urinary tract infections. Record review of facility policy, Indwelling Urinary Catheter Care, dated revised/reviewed April 2025, revealed under Procedure, 9.clean the catheter in a downward motion (front to back) beginning at the urinary meatus (insertion point) and at least 4 inches down (from resident toward the collection bag).12. May secure the tubing with a securement device, as needed (PRN) to prevent migration, friction, or tension of the catheter. Event ID: Facility ID: 675509 If continuation sheet Page 18 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure resident medical records were kept in accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete and accurately documented for 1 of 11 residents (Resident #4) reviewed for clinical records. The facility failed to ensure Resident #4's weekly skin assessments were documented in his medical record for 2 of 15 weeks (the weeks of: 05/15/2025 and 05/22/2025). These failures could place residents at risk of not having accurate medical records and could create confusion in services provided or needed to be provided.The findings included: Record review of Resident #4's admission Record, dated 07/14/2025, reflected a [AGE] year-old male. He was originally admitted on [DATE] and re-admitted on [DATE]. Record review of Resident #4's Diagnosis Report, undated and accessed on 07/15/2025, reflected Resident #4 was diagnosed with type 2 diabetes mellitus, muscle weakness, and dysphagia (difficulty swallowing). Record review of Resident #4's Annual MDS Assessment, dated 04/30/2025, reflected Resident #4 had a BIMS score of 15 indicating he was cognitively intact. He was noted to be at risk of developing pressure ulcers/injuries but did not have any pressure ulcers/injuries, venous or arterial ulcers, or other ulcers, wounds, or skin problems. Record review of Resident #4's Care Plan, undated and accessed 07/15/2025, reflected a focus Has potential to skin integrity r/t Fragile skin, date initiated and revised 07/17/2025 with interventions to include Monitor/document location, size and treatment of skin injury. Report abnormalities, failure to heal, s/sx of infection, maceration etc. to MD. Record review of Resident #4's EMR Assessment tab, undated and accessed on 07/15/2025, did not reflect a LN- Skin Evaluation - PRN / Weekly or LN- Skin Ulcer Non-Pressure Weekly, assessment dated for the week of 05/15/2025 or for the week of 05/22/2025. Record review of Resident #4's Progress Notes, dated 05/01/2025 to 05/28/2025 did not reveal notes regarding Resident #4's skin status effective on the weeks of 05/15/2025 or 05/22/2025. During an interview on 07/15/2028 at 10:10 a.m., Resident #4 revealed he had not experienced any recent skin issues, and the facility staff had just recently completed his skin assessment without finding concerns. She stated he did not know how often his skin was assessment but believed it was more than once a month. During an interview on 07/14/2025 at 02:46 p.m., Treatment Nurse U stated she had been working as the Treatment Nurse for around 2 months. She stated the floor nurses and her were responsible for completing the weekly skin assessments. She stated she believed the floor nurses had a binder to notify them of the schedule for when the skin assessments were due. She stated she would often complete the weekly skin assessments for residents with wound care, such as those with surgical sites or pressure ulcers. During an interview on 07/15/2025 at 01:02 p.m., the DON stated the resident's skin assessments were to be done upon admission and then upon schedule weekly. She stated the treatment nurse would schedule the weekly skin assessments, and they were to document under the LN- Skin Assessments assessment. The DON stated, if an assessment was not listed under the assessments, the it might indicate there were no skin issues, the resident was out on pass, not available, or refused the assessment and there should be a progress note. The DON stated, if an assessment was not documented it might be due to a computer glitch, but she would have to investigate why the assessment was missed. She stated, if not documented then it (the assessment) didn't happen. She stated a missed skin assessment would result in the staff not having a full picture of the resident's status at that time. During an interview on 07/15/2025 at 02:43 p.m., the DON stated she still had not located Resident #4's skin assessments for the weeks of 05/15/2025 or 05/22/2025. Record review of the facility's policy, Skin and Wound Monitoring and Management, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 19 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete dated revised December 2023, reflected under Procedure, a. Resident Assessment.g. Ongoing Skin and Wound Assessments: A licensed nurse will assess/evaluate a resident's skin at least weekly.4. Documentation.b. Weekly Skin Check - Licensed nurse should document skin evaluations in accordance with this policy and document on the appropriate skin assessment/evaluation weekly/PRN form.6. Monitoring. d. Weekly skin check conducted by a licensed nurse - All resident will have a head to toe skin check performed at least weekly by a licensed nurse. - The licensed nurse should document the findings. Event ID: Facility ID: 675509 If continuation sheet Page 20 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 observations, interviews, and record reviews the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 2 residents (Resident #3 and Resident #5) and 2 of 2 staff (CNA S and CNA T) reviewed for infection control. 1. The facility failed to ensure CNA S properly secured her personal protective equipment during indwelling catheter and incontinent care for Resident #3 on 07/16/2025. 2. The facility failed to ensure CNA T wore appropriate PPE for EBP during indwelling catheter and incontinent care for Resident #5 on 07/16/2025. These failures could place residents at risk of exposure to infectious diseases due to improper infection control practices.Findings included: 1. Record review of Resident #3's admission Record, dated 07/16/2025, reflected Resident #3 was admitted on [DATE]. Resident #3 was noted to be [AGE] years old. Record review of Resident #3's Diagnosis Report, undated and accessed 07/16/2025, reflected Resident #3 was diagnosed with displacement of indwelling urethral catheter (also known as a foley catheter, a tube inserted in the urethra to drain urine), urinary tract infection, and type 2 diabetes mellitus (a condition that develops with the way the body regulates and uses sugar as fuel). Record review of Resident #3's admission MDS assessment, dated 04/29/2025, reflected Resident #3's had a BIMS score of 14, indicating he was cognitively intact. He was noted to have an indwelling catheter and always incontinent of bowel. Record review of Resident #3's Order Summary Report, dated active orders as of 07/16/2025, reflected the order, ENHANCED BARRIER PRECAUTIONS: PPE required for high resident contact care activities. Indication: Indwelling medical device every shift, order status noted as Active, order date and start date of 04/26/2025. During an observation on 07/16/2025 at 10:52 a.m., revealed CNA S was providing incontinent and foley catheter care to Resident #3. CNA S was observed to put on a personal protective gown but did not secure the back ties resulting in the gown falling forward off her shoulders several times, requiring adjustment. During an interview on 07/16/2025 at 11:58 a.m., CNA S stated she was distracted while performing incontinent and foley catheter care for Resident #3 because there was a lot going on, her gown kept falling off, and she was nervous. During an interview on 07/17/2025 at 09:45 a.m., Resident #3 stated he did not have any concerns about his foley catheter care. He stated the staff check and clean his foley catheter well. During an interview on 07/17/2025 at 09:46 a.m., CNA S stated for the gown, she put it on but didn't fasten it. She stated she usually would knot the top fastening of the gown prior to putting it over her head but didn't this time. She stated she was nervous. She stated the facility provided her training on PPE and she took an online PPE (personal protective equipment) training about donning and doffing (putting on and taking off) PPE last month. 2. Record review of Resident #5's admission Record, dated 07/16/2025, reflected Resident #5 was initially admitted on [DATE] and readmitted on [DATE]. Resident #5 was noted to be [AGE] years old. Record review of Resident #5's Diagnosis Report, undated and accessed 07/16/2025, reflected Resident #5 was diagnosed with fluid overload, chronic obstructive pulmonary disease (a type of progressive lung disease), and type 2 diabetes mellitus. Record review of Resident #5's Quarterly MDS assessment, dated 06/04/2025, reflected Resident #5 had a BIMS score of 13, indicating he was cognitively intact. He was noted to have an indwelling catheter and always incontinent of bowel and bladder. Record review of Resident #5's Order Summary Report, dated active orders as of 07/16/2025, reflected the order, ENHANCED BARRIER PRECAUTIONS: PPE required for high resident contact care activities. Indication: Catheter/ wounds every shift, order status noted as Active, order date and start date of 04/15/2025. During an observation on 07/16/2025 at 11:18 a.m., revealed CNA T was providing Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675509 If continuation sheet Page 21 of 22 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 675509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parklane West Healthcare Center 2 Towers Park LN San Antonio, TX 78209 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 FORM CMS-2567 (02/99) Previous Versions Obsolete incontinent and foley catheter care to Resident #5. CNA T was observed to not put on a personal protective gown during care. An EBP (enhanced barrier precaution) sign was noted on Resident #5's door prior to entering room. During an interview on 07/16/2025 at 11:29 a.m., CNA T stated she did not wear a protective gown for enhance barrier precautions. She stated she should have read the sign but missed it. She stated she normally looks for the boxes of PPE outside of the resident room to tell her the resident was on precautions, but did not see one for Resident #5's room. CNA T stated she was new to the facility, did not know anything about EBP, and had never been told. During an interview on 07/17/2025 at 09:50 a.m., Resident #5 stated he did not have any concerns about his foley catheter care. He stated the staff provided good care with emptying and cleaning his catheter. During an interview on 07/17/2025 at 02:58 p.m., CNA T stated the facility had provided her training on perineal and foley catheter care. CNA T stated the perineal and foley catheter care she provided the day prior, 07/16/2025, that was observed was not the best. She stated she forgot to put on her protective equipment. She stated she was not aware that if a resident had a catheter, the staff member automatically needed to wear the equipment. She stated she thought that if a resident had the equipment outside their door, then that indicated you needed to wear the equipment. She stated she was told that if they have a catheter and any injectables, the staff member was to wear PPE automatically. She revealed she was very overwhelmed during the perineal and foley catheter care observation on 07/16/2025. She stated she did not recall the facility going over EBP during training, but did go over infection prevention. She stated the training was more over the computer, not in person with clinicals. Record review of staff trainings from May to July 2025 revealed an undated training on Enhanced Barrier Precautions. The training list included admissions staff, the discharge coordinator, department supervisors for dietary and housekeeping, activities staff, various clinical support staff, and all the nursing staff. 52 staff were noted as trained out of 54. The HR Manager and Maintenance Director did not initial, or sign as having had received the training. CNA S and CNA T were not noted on the training document. During an interview on 07/17/2025 at 03:34 p.m., the DON stated staff were trained upon hire, annually, and as needed on enhanced barrier precautions. She revealed the facility had a recent training on donning and doffing (putting on and taking off) personal protective equipment for residents on EBP and isolation precautions. The DON revealed the staff training included a list of residents on EBP, catheters, IVs (Intravenous, within a vein), and peg tubes (tube to provide nutrition directly to the stomach). She revealed staff also trained to know a resident was on precautions through identifiers on posted signs. The DON stated she expected staff when wearing a gown to secure it themselves, for it to always be tied. She revealed the protective gown was primarily to protect the resident from exposure passed from us, the staff, to them, the resident. She stated the impact of not wearing the protective gown or not properly securing the gown was possible exposure to the resident to open areas of their body. Record review of the facility's policy, IPCP Standard and Transmission-Based Precautions, dated revised March 2024, reflected under Procedure, 1. Standard Precautions. include: a. Proper selection and use of PPE, such as gowns.3. Enhanced Barrier Protection (EBP):.a. PPE: The use of gown and gloves for high-contact resident care activities is indicated, when Contact Precautions do not otherwise apply, for nursing home residents with: i. Wounds and/or indwelling medical devices Indwelling medical devices include, but are not limited to . urinary catheters,. Event ID: Facility ID: 675509 If continuation sheet Page 22 of 22