Health inspection·June 16, 2023

F 0558 or bang on the wall to get someone's attention. Level of Harm - Minimal harm or potential for actual harm An interview with CNA #A on 06/16/23 at 12:45 pm, revealed CNAs are required to make rounds at least every two hours. When CNAs make, rounds they should ensure call lights are in reach of all residents. CNA #A stated if call light was out of reach, then the resident wouldn't be able to notify staff for assistance. Residents Affected - Few An interview with DON on 06/16/23 at 12:55 pm, DON stated that call lights should be within reach of the resident. Call lights are often place on the bed, pillow, or clothing to ensure the resident can reach it for assistance. DON stated CNAs make round at least every two hours but most times more frequently. During the rounds the CNAs should be looking to see if the call light were in reach of the resident. If a call light was not in reach of a resident, then the resident may not be able to call for assistances when needed. An interview with ADM at 1:25pm, ADM stated that the call lights are typically pinned on the bed or sometimes the resident's wheelchair depending on the residents' preference. The ADM stated that CNAs are remind often to ensure call lights are in the reach of the residents. ADM stated that if a call light was out of reach of the resident than it would delay the resident getting care. Record review of the facility's policies revealed the facility had no policy regarding reasonable accommodations of needs and preferences. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675651 If continuation sheet Page 2 of 5 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 675651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Marcos Rehabilitation and Healthcare Center 1600 N I H 35 San Marcos, TX 78666 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident for one of 32 residents (Resident #32) reviewed for activities. Residents Affected - Few Resident #32 was receiving no activities in the facility. This failure placed Resident #32 at risk of boredom, depression, and diminished quality of life. Findings included: Review of the undated face sheet for Resident #32 reflected a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of rhabdomyolysis ( condition in which damaged skeletal muscle breaks down rapidly), symbolic dysfunctions (speech and language disorder), muscle wasting and atrophy, difficulty in walking, dementia, major depressive disorder, anxiety disorder, muscle weakness, Parkinson's disease (chronic and progressive movement disorder that initially causes tremor in one hand, stiffness or slowing of movement), unsteadiness on feet, cognitive communication deficit (difficulty with any aspect of communication that is affected by disruption of cognition), need for assistance with personal care, lack of relaxation and leisure, and chronic pain. Review of the annual MDS for Resident #32 dated 11/04/22 reflected a BIMS score of 10, indicating a moderate cognitive impairment. Review of the MDS section Preferences for Customary Routine and Activities. of the MDS reflected it was somewhat important to Resident #32 to have books, newspapers, and magazines to read, listen to music he liked, keep up with the news, do his favorite activities. Review of the care plan for Resident #32 dated 06/14/23 reflected the following (Resident #32) is at risk for depression r/t major depressive disorder diagnosis. He will engage in 1:1 at least 2 times a week through the review date. Attempt non-pharmacological interventions, such as redirecting, activities, relaxation, food, etc. Has little or no activity involvement r/t Disinterest. He will enjoy one-on-one visits with staff at least 2 times weekly. He will successfully entertain himself independently and was aware he was invited to attend all activities outside of his room. Will participate in activities of choice as he desires daily by review date. Explain the importance of social interaction and leisure activity time. Encourage participation by next review. Preferred activities are: talking to staff, watching TV, reading the (newsletter)/daily news. Review of the one-on-one activity logs for Resident #32 reflected no one-on-one activities from 05/16/23 to 06/16/23. Review of the independent activity log for Resident #32 from 06/03/23 to 06/16/23 reflected the following: TV/Radio/Movies on 06/05/23, 06/06/23, 06/08/23, 06/08/23, and 06/12/23; Reading/Audio Books on 06/11/23; and Observing Surroundings on 06/03/23, 06/04/23, 06/07/23, 06/10/23, 06/13/23, 06/14/23, and 06/15/23. During observation and interview on 06/14/23 at 08:30 AM, Resident #32 stated he was bored at that moment and was bored all the time. He stated he did not like television anymore, and there was nothing to do. His television was off, and his blinds were closed. He lay in bed in a hospital gown with no book, magazine, radio, or other obvious stimulus nearby. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675651 If continuation sheet Page 3 of 5 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 675651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Marcos Rehabilitation and Healthcare Center 1600 N I H 35 San Marcos, TX 78666 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 06/14/23 at 10:00 AM revealed the AA entered Resident #32's room with a cup of coffee and a piece of paper and exited the room less than one minute later. Observation on 06/14/23 at 10:30 AM, 11:09 AM, 12:30 PM, and 01:12 PM revealed no activity being provided to Resident #32. The only times staff entered his room during these periods was to provide nursing care or drop off/pick up meal trays. Observation on 06/15/23 at 09:18 AM, 10:40 AM, 11:32 AM, and from 12:50 PM to 2:10 PM revealed no activity being provided to Resident #32. The only times staff entered his room during these periods was to provide nursing care or drop off/pick up meal trays. He had a copy of the daily newsletter, which was one sheet of paper, on his overbed table. Observation on 06/16/23 from 08:47 AM to 11:08 AM, Resident #32 was in his bed with the television off and the blinds closed. No staff went into his room specifically to visit with him. During an interview on 06/16/23 at 11:08 AM, Resident #32 stated he was still bored. When asked what activities he enjoyed, he stated he liked volleyball but had four hip replacements so could not play real volleyball. He stated he liked golf, but he could not stand up to play golf. He stated he was aware there was a putting green on the back porch of the facility, but he had not been out there in a long time. He stated he would like to do more and have something to do, but the staff did not come around and check in with him about activities very often. He stated he had not received enough one-on-one visits with the activities staff. When asked how many would be enough, he stated any visits at all would be better than none. During an interview on 06/15/23 at 12:15 PM, CNA B stated she did get residents up for activities, and that was a part of her responsibilities. She stated Resident #32 liked to watch television and nap, but mostly he liked to talk with the staff when they had time. CNA B stated she had good conversations with Resident #32 sometimes, and she thought therapy worked with him. She stated she had not seen the activity director or aide spend much time in his room. During an interview on 06/16/23 at 12:14 PM, the SW stated she had not seen Resident #32 in activities. She stated she had not seen the activity director visit Resident #32. The SW stated she had seen the AA drop off coffee and newsletter but not going in for a longer visit. She stated she did not have any hand in the activities program at the facility. During an interview on 06/16/23 at 12:32 PM, the AA stated the primary activity director was on vacation. The AA stated the activity director did one-on-one visits when she was working. The AA stated most of what she did was dropping off coffee and newsletter to all the residents each morning, and in the activity director's absence, she and the entire team were pulling together for group activities. The AA stated when she dropped off coffee and newsletter, she usually only stayed for a moment to say hello. The AA stated for Resident #32, she knew they used to put his television on for him, but he had not been able to use it as much lately. She stated they would turn it on for him, but he was unable to change the channel and would just push buttons until it did not work anymore. The AA stated he would usually just turn it off, because he could not handle those circumstances. The AA stated Resident #32 mostly likes to chat with staff. She stated he was very educated, and they had to be more patient with him due to speech issues, but he would talk if he was given the time. The AA stated she did not have a role in planning activities. She stated the activity director sometimes asked her for input on what the AA thought certain residents might like, but she did not do the activity assessments or plan any resident-centered activities. When asked how the concept of Observes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675651 If continuation sheet Page 4 of 5 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 675651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Marcos Rehabilitation and Healthcare Center 1600 N I H 35 San Marcos, TX 78666 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Surroundings as an independent activity applied to Resident #32, she stated she did not think his surroundings were interesting, and that was the best she could do to describe what he had been doing. During an interview on 06/16/23 at 02:31 PM, the DON stated Resident #32 used to be up and about, and now he preferred to be in his bed. The DON stated he was a social worker before and knew he had the right to refuse to get up and participate in group activities. The DON stated he liked television, and that was his primary activity. She stated he also enjoyed the morning coffee rounds. The DON stated she saw him watching television that morning. She stated she had been helping serve breakfast, was sure he had his television on when she went in his room and was not aware that he was no longer interested in television. When asked what the plan was to meet his recreational needs if he did not watch television, she stated they could always ask him about what interests him. When asked if Observes Surroundings was an adequate independent activity for someone who stayed in his bed with the blinds closed, she stated that would not be adequate as his surroundings were not stimulating at all. The DON stated the concept of Observes Surroundings as an activity was for residents who enjoyed watching people or nature. During an interview on 06/16/23 at 02:52 PM, the ADM stated the procedure for new and changing activity needs to be identified began when they (usually clarified the nursing staff) noticed a change in what a resident was able to do or if the resident provided any feedback. The ADM stated if a resident was having a decline, there might have been a change in their attendance to activities or the type of activities they preferred, and this might trigger a new assessment. The ADM stated he monitored for compliance with the process of identifying changes in activity needs and preferences by visiting with staff and sometimes the residents themselves. The ADM stated Resident #32 used to go get coffee and that was his primary activity along with maybe arguing with other residents on the way back to his room. The ADM stated when they had a resident someone who was not interested in group activities, they should have figure out what he liked to do. The ADM has gotten some feedback that Resident #32 liked it when the AA went by Resident #32's room and poked her head in to say hello. The ADM stated when a resident like Resident #32 was not satisfied with the activities he was offered, they should not have stopped trying to find something he enjoyed. The ADM stated a potential impact on Resident #32 could be that he would not be able to live out the rest of his life in as fruitful a way as possible. The ADM stated they did not want Resident #32 to be bored for the rest of his life but rather wanted to make what time he had left as comfortable and appropriate as possible. Review of undated facility policy titled Activities Program reflected the following: It is the policy of this facility to ensure each resident has access to daily, social, recreational, or rehabilitative activities, provided and available to them. Activities are planned according to the residents, preferences, needs, and abilities. Every resident will be interviewed for preferences. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675651 If continuation sheet Page 5 of 5