Inspection·January 19, 2024

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure portable space heating devices that heated above 212 degrees were prohibited for 29 of 229 resident rooms inspected for fire safety according to NFPA 101, 19.7.8. in that: Residents Affected - Some There were 29 occupied resident rooms which had portable space heaters in use in 100 and 200 Hall. This failure could affect the health of safety of resident's dependent on electrical appliance safety, in the event of electrical fire, exposing resident to smoke inhalation and other fire related injuries. Findings included: Observation on 1/17/24 at 9:52 a.m. to 10:35 a.m., revealed occupied resident rooms #126, #120, #117, and #213 had working portable space heaters plugged into the wall and in use. The portable space heater in #213 and #125 were labelled with the facility's name. During an interview on 1/17/24 at 10:00 a.m., the Maintenance Director stated the facility provided portal heaters to residents who had cold rooms. The Maintenance Director stated the facility purchased the portable heaters at a local department store. Observation on 1/17/24 at 10:37 a.m., revealed occupied resident room [ROOM NUMBER] had a portal heater plugged into the wall and in use. The resident was observed to be free from injury and in no acute distress. During an interview on 1/17/24 at 11:00 a.m., the Maintenance Director stated 2 of the facility's HVAC units stopped functioning on 1/15/24 after the recent rain and cold weather, which caused the coils in the HVAC units to freeze. The Maintenance Director stated the resident rooms had a separate unit, which was still functional but was not able to keep up with the current cold weather. The Maintenance Director stated, we don't use space heaters normally . but during the last rain and freezing weather, we had to because the rain froze the units. The Maintenance Director stated the Administrator authorized the use of the portal space heaters. The Maintenance Director stated the facility had approximately 17 [portable space heater] units currently in use. When asked why would the facility not use space heaters, the Maintenance Director stated, because people get careless. When asked what can happen if a space heater was used improperly, the Maintenance Director stated, it could cause a fire, someone might pull the cord. It could cause [an electrical] short. The Maintenance Director stated the ADON spoke to the staff about conducting rounds and checking on the residents. The Maintenance Director stated the facility monitored if the residents were safe, if the residents were not (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 675690 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 675690 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Estates Rehabilitation Center 130 Spencer LN San Antonio, TX 78201 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)