Health inspection·April 15, 2024

F 0689 Review of Resident #1's Change in Condition Evaluation, dated 04/10/24, reflected the following: Level of Harm - Actual harm Situation: skin wound or ulcer Residents Affected - Few Evaluation: lateral left lower extremity open with moderate amount of blood Pain Evaluation: [Resident #1] with a pain scale of 7 Summary: Moderate amount of blood noted to bandage covering laseration [sic], cleansed area, redressed wound, sent [Resident #1] to hospital Review of Resident #1's ER discharge instructions, dated [DATE], reflected the following: Discharge Diagnosis: Laceration of left lower extremity Patient Instructions: Follow up with (plastic surgeon) in one week, 04/17/24 Review of Resident #1's PRN/Weekly Skin Evaluation, dated 04/11/24, reflected a laceration to the front left lower leg, measuring 11 cm x 3.5 cm. During an observation and interview on 04/15/24 at 11:02 AM, revealed Resident #1 lying in bed. He stated he did remember the incident from 04/09/24. He stated he was done with physical therapy and two of the therapists were transferring him from his wheelchair to his bed. He pointed to a metal pole on the end of his bed and stated that the black cap that was covering the pole was not on there at the time. He stated his leg dragged against it during the transfer and it ripped his leg open. He stated he did not feel it when it happened, but after he was in a lot of pain. He stated he just had his right leg amputated and his doctor told him to not bear any weight on his left leg for three weeks due to the laceration. He stated it was frustrating and had caused him a lot of pain. During an interview on 04/15/24 at 11:46 AM, PTA C stated he and another therapist were transferring Resident #1 from his wheelchair to his bed on 04/09/24. He stated Resident #1 did not complain of pain during the transfer, but once he was on his bed, he stated that his leg felt funny. He stated he looked down and saw the wound/skin tear and a lot of blood. He stated he looked at the bed frame and saw there was a missing cap on one of the metal pipes. He stated that he compared the location of the pipe to the location of the tear and could tell that it was the pipe that caught his leg. He stated he felt the pipe and compared it to a pipe with the cap on and it was much sharper with the exposed metal. During an interview on 04/15/24 at 12:04 PM, the DON stated she was notified Resident #1 had sustained a skin tear on his left calf during a transfer from his wheelchair to his bed when his leg rubbed against the bed frame. She stated she was told a cap was missing on one of the pipes. She stated because Resident #1's skin was so fragile, his skin could have torn with or without the cap. She stated potential harm for someone who was diabetic and sustained a skin tear would be possible infection. A telephone message was left on 04/15/24 at 12:13 PM for LVN A. A response was not received prior to exit. During an interview on 04/15/24 at 12:44 PM, LVN B stated that she was informed that when therapy (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675651 If continuation sheet Page 2 of 3 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 04/15/2024 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 0689 Level of Harm - Actual harm Residents Affected - Few was transferring Resident #1 on 04/09/24, the metal part of the bed frame hit his left leg and opened it up. She stated his skin was so fragile that it would not have mattered if the cap was on it or not. She stated on 04/10/24 in the morning she noticed the gauze was covered in blood. She stated she assessed the wound and it was a nasty laceration and deep enough that she believed it needed to be sutured or glued shut . She stated she sent him to the ER but they did not do anything or send any new orders. During an interview on 04/15/23 at 12:56 PM, the MAINTD stated after Resident #1 acquired his skin tear, he was asked to inspect his bed and noticed the cap was missing on one of the rails. He stated it was everyone's responsibility to make sure the caps were on and secured. He stated the importance of the caps were to cover the pipes like a plug which helped with skin protection. He stated he conducted a sweep of the beds in the facility and found no others missing . He stated staff were aware that he had extras should one pop off. Review of the facility's Mechanical Equipment Policy, revised 07/2018, reflected the following: It is the policy of this facility to make safety a priority for both residents and staff. Potentially dangerous mechanical equipment will be handled to ensure safety. Procedure: 1. All recommended safeguards will be implemented for potentially dangerous mechanical equipment . 2. Potentially dangerous mechanical equipment will be properly installed, tagged, and inspected on a regular basis in order to avoid safety issues for residents and staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675651 If continuation sheet Page 3 of 3