Inspection·August 15, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the assessment accurately reflected the resident's status for 1 of 8 residents (Resident #2) whose assessments were reviewed. he facility failed to accurately document Resident #2's dental status on the resident's admission assessment dated [DATE]. This failure could place residents at risk for inadequate care due to inaccurate assessments. The findings were:Record review of resident #2's face sheet dated 08/12/2025 revealed the resident was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including hypertensive heart disease without heart failure, unspecified dementia without behavioral disturbance, major depressive disorder, and legal blindness. Record review of Resident #2's comprehensive care plan, revised 07/24/2025, revealed the resident was on a No Added Salt diet, Minced and Moist texture, thin liquid consistency, served in a divided plate. There was no focus area indicating the resident's dental status. Record review of Resident #2's quarterly MDS assessment dated [DATE] revealed in Section C - Cognitive Patterns a BIMS score of 11/15, indicating the resident had moderately impaired cognition. Record review of Resident #2's admission MDS assessment dated [DATE] revealed in Section L - Oral/Dental Status there was no check mark next to, B. No natural teeth or tooth fragments (edentulous) or D. Obvious or likely cavity or broken natural teeth, indicating there were no deficiencies with the resident's dental status. Observation on 08/12/2025 at 12:05 PM revealed Resident #2's lips were sunken inside her mouth, indicating a possible lack of dentition (missing teeth).During an interview on 08/14/2025 at 12:02 PM, the Administrator stated Resident #2 had some upper teeth but no lower teeth. She had dentures but sometimes did not use them. The resident's admission MDS was coded incorrectly. She did not know why and deferred to the MDS coordinator.During an interview on 08/14/2025 at 12:15 PM, the MDS LVN stated he knew the resident was missing teeth but was confused when completing the MDS, since there was no problem with her denture (it was not broken or loosely fitting). The MDS LVN understood that an MDS coded incorrectly could potentially lead to inaccurate resident care. The MDS LVN stated the facility used the RAI manual as their policy for coding resident assessments Residents Affected - Few 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 4 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 08/15/2025 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)