Health inspection·March 3, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm During an interview on 03/02/2023 the ADON stated staff were verbally trained staff not to use words such as, honey, and, diaper, because it was a dignity issue. The ADON stated the facility did not have a policy that listed prohibited words. The ADON stated they had trained staff not to use the word, diaper, specifically and some residents did correct stated and say it was a diaper. The ADON stated for him personally he would not want someone to use the word diaper, he would prefer them say brief or depends. Residents Affected - Few Record review of Facility's policy titled, Dignity, dated 02/2021, revealed, policy statement: each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. 1. Residents are treated with dignity and respect at all times .8. Staff speak respectfully to residents at all times, including addressing the resident by his or her name of choice and not labeling more referring to the resident by his or her room number, diagnosis, or care needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 2 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on interview, and record review, the facility failed to ensure residents had a right to organize and participate in resident groups in the facility for 3 of 51 residents (Residents #9, #18, and #37) reviewed for resident groups, in that: Residents Affected - Some The facility failed to organize and allow Residents #9, #18, and #37 to participate in monthly resident council groups. This failure could place residents who reside at the facility at risk of not being feeling comfortable voicing concerns. Findings included: Record review of Resident Council Meetings, presented to the survey team by the Administrator, for a 12 month period, from February 2022 to February 2023, revealed attendees of the offered Resident Council meetings were attended by residents whom did not reside in the long term care facility exclusively and also included residents from an assisted living facility. Record review further revealed there were no Resident Council Meetings for either facility for a 3 month period (October, November, and December 2022) during the year preceeding the survey. During an interview with the Administrator on 03/01/2023 at 9:29 a.m., the Administrator stated the facility's resident council meeting was held monthly and combined with their sister facility, an assited living facility on the same campus, in their building. During an interview on 03/01/2023 at 2:07 p.m., located in an identified location by the facility Administrator as the most confidential setting available in the facility that was not completely behind closed doors, Residents #9, #18, and #37 stated they would like additional information about their current placement independent of the assisted living facility or other communities affiliated. Resident #9 stated she had previously lived at the assisted living facility, but it was very different from her current placement. During an interview on 3/03/2023 at 5:28 p.m., Activity Director H stated there were no resident council meetings held for either the assisted living facility or the long-term care facility during October 2022, November 2022, or December 2022, due to a shortage of staff. During an interview on 3/03/2023 at 6:56 p.m., the Administrator stated there were no resident council meetings for 3 months, for either facility, due to a staff members being on leave. The Administrator further stated the nursing facility did not have a resident council meeting that was independent of the assisted living facility's resident council meeting due to a lack of space and staffing. The Administrator stated all resident council meetings were held at the assisted living facility. During an interview with the the Administrator on 03/03/2023 at 6:56 p.m., the Administrator stated, the two facilities [the nursing facilty and the assisted living facility] have always had a joint resident council. Record revealed there was no facility policy regarding Resident Council provided by the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 3 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents have the right to formulate an advance directive for 1 of 13 residents (Resident #9) reviewed for advanced directives, in that: Resident #9's OOHDNR order did not contain a printed physicians name, the physician's license number, and date which made the advance directive invalid. This deficient practice could place residents at risk of not having their wishes known, which could affect whether they receive emergency medical treatment. Findings included: Record review of Resident #9's admission record, dated 03/03/23, reveled an original admission date of 09/09/21, and a current admission date of 08/01/2022, with diagnoses of fracture (broken bone) and muscle weakness. Record review of Resident #9's quarterly MDS, dated [DATE], revealed the resident had intact cognition. Record review of Resident #9's order summary, dated 03/03/23, revealed an order for DNR with an order date of 12/24/22 and no end date. Review of Resident #9's clinical record revealed an OOHDNR form contained resident and witness signatures. The form was blank in the section requiring a Physician signature and did not contain the Physician's printed name or license number. During an interview on 03/03/23 at 5:02 p.m. the Social Worker stated she was responsible for ensuring the residents DNRs were filled out correctly. The Social Worker stated she had corrected Resident #9's OOHDNR and showed this surveyor a new copy dated 03/03/23 correctly filled out. During an interview on 03/03/23 at 2:10 p.m. the DON stated Resident #9's OOHDNR if EMS came, they would not take the DNR. The DON stated they would need to fix the DNR. The DON stated she did not review the DNRs before but would start doing this to be sure they were filled out correctly. During an interview on 03/03/23 at 6:54 PM the Administrator stated the Social Worker was responsible for the DNR paperwork. The Administrator stated the Social Worker had the discussions with the resident and their families and coordinated filling out the DNRs. The Administrator stated if the DNR was not filled out correctly for whatever reason then the DNR was not valid. The Administrator stated Resident #9's DNR needed to be corrected. Record review of the facility's policy titled, Do Not Resuscitate Order, dated 03/2021, revealed, Policy Statement: Are facility will not use cardiopulmonary resuscitation and related from emergency measures to maintain life functions on a resident when there is a do not resuscitate order in effect .2. A do not resuscitate (DNR) order form must be completed and signed by the attending physician and resident (or residence legal surrogate, as permitted by state law) and placed in the front of the residence medical record. A. use only state approved DNR forms . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 4 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview, and record review the facility failed to maintain the residents right to confidentiality in his or her personal and medical records for 7 (Resident #19, #22, #26, #31, #36, #37, #48) of 7 residents in that: Residents Affected - Some The facility failed to ensure a code status binder that included residents out-of-hospital do-not-resuscitate forms and face sheets were in a secure location. These failures could affect residents who reside at the facility and place them at risk of having personal and medical information accessible to the public. The findings included: Observation on [DATE] at 12:55 PM in the resident dining room revealed there was a binder labeled Code Status sitting below the daily menu board. When the binder was opened, the completed out-of-hospital do-not-resuscitate forms for residents, and resident face sheets were observed. In an interview on [DATE] at 1:00 PM, Dietary Manager stated the code status binder always sat on an entry table below the daily menu. The dietary manager stated the social worker was responsible for the binder. In an observation and interview on [DATE] at 1:03 PM, with the Social Worker the code status binder was no longer on the table in the dining room. The social worker stated she was responsible for the binder. When asked the reason for the code status binder being in the dining room, the social worker responded that it was in there in case of an emergency in the dining room. Record review on [DATE] at 9:45 AM of code status binder obtained from dining room held the following resident's out-of-hospital do-not-resuscitate form: Resident #19, Resident #22, Resident #26, Resident #31, Resident #37, Resident #48. Record review on [DATE] at 9:45 AM of code status binder obtained from dining room held complete face sheets for residents Resident #48 and Resident #36. Further review of Resident #48's face sheet in the Code Status binder revealed his face sheet contained the residents full name, social security number, date of birth , Medicare beneficiary identification number, as well as the resident's diagnosis. Further review of Resident #36's face sheet inside of the code status binder also revealed their full name, social security number, date of birth and their Medicare beneficiary identification number. In an interview and record review on [DATE] at 4:11 PM, th e Facility's Social Worker stated there were a total of three code status binders, one in the dining room, one in A wing behind the nurse's station, and one in B wing on top of the crash cart. SW stated that the code status book was kept in the dining room on the table as you walk in and is not locked up in the event of an emergency for the convenience of getting it immediately. The SW stated that family members eat in the dining room, and anyone is free to go into the dining room as they please. She then stated, to my knowledge, no one has opened the code status book except for me. The SW stated that the face sheet in the binder meant the resident was full code, while the DNR form in the binder meant they were not to perform CPR on the resident. When reviewing the face sheets, the social worker indicated that the face sheets do (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 5 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some have the resident's social security numbers on them. The social worker stated there is little to no risk for the face sheets to have the resident's social security numbers on them, and that there is no risk to the resident. When asked if this would be a HIPPA violation, the social worker stated that it would be. In an interview on [DATE] at 4:39 PM with the DON, the DON stated she and the social worker had created the binders together, and it was the responsibility of the social worker to update the binders as needed. The DON stated there are code status binders in A hall, B hall, and in the memory care locked unit. According to the DON, the code status binder being reviewed during the interview was the code status binder from the dining room. The DON stated the code status binder should not be in the dining room in a public area, and it should be in a secure location. The DON stated it should not have been out so that anyone could access it. The DON stated there is potential for a HIPPA violation as it does have social security numbers for full code residents as well as their diagnosis. In an interview on [DATE] at 6:53 PM, The facility administrator stated she did not want to look in the binder, and that she knew what was in it. The facility administrator stated the purpose of the binder is to protect the residents and that it does have medical information. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 6 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on observation, interview, and record review the facility failed to ensure that all alleged violations involving misappropriation of resident property, are reported immediately, but not later than 24 hours after the allegation is made for 1 of 1 resident (Resident #23) reviewed for, reporting allegations of misappropriation of property, in that: The facility failed to report an incident to the State Survey Agency (HHSC), when Resident #23 reported a pair of earrings missing on 12/16/2022. This failure could place the residents at risk for unreported allegations of abuse, neglect, and injuries of unknown origin and misappropriation of resident property. The findings were: Record Review of a facility Concern Worksheet, completed by the Social Worker, revealed Resident #23 reported a pair of earrings missing with a value of $300.00 on 12/16/2022. During an interview on 3/03/2023 at 4:30 p.m. the Social Worker stated the Resident lost some earrings in Resident #23's room, the resident nor the family wanted to report the earrings missing to anyone outside the facility. The Social Worker further stated the family drove to the facility from out of town, to assist the resident in searching for the missing earrings, however the earrings were not found. During an interview on 3/03/2023 at 6:36 p.m. the Administrator stated Resident #23 did not want the facility to, report the incident to the state, and the resident did not consider the earrings to be of significant value; therefore, the facility did not report the missing property to the police or HHSC. Review of the records in the state on-line self-reporting website on 3/02/2023 revealed no record of a facility reported incident regarding Resident #23's missing earrings to the State Survey Agency within Texas, Health and Human Services Commission. Record review of the facility's policy titled, Abuse Investigations, undated, revealed, Purpose: It is the purpose of the Abuse Investigations Policy to ensure that there is a systematic means in place for investigating all reports of resident abuse and related incidents. Policy: It is the policy of [Facility Name] that all reports of resident abuse, neglect, mistreatment, and misappropriation of resident property will be promptly and thoroughly investigated by facility management. Should the investigation reveal that abuse occurred, the Administrator will report such findings to the local police department, the state licensing agency or other as may be required by state of local laws. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 7 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 observation, interview, and record review, the facility failed to ensure each resident who was incontinent of bowel/bladder received appropriate treatment and services to prevent urinary tract infections for 1 of 2 residents (Resident #22) reviewed for incontinent care, in that: CNA E did not use proper technique when providing incontinent care for Resident #22. This deficient practice could place residents at risk for infection and skin break down due to improper care practices. The findings were: Record review of Resident #22's face sheet, dated 03/03/2023, revealed an initial admission date of 11/05/2014 and a readmission date of 04/14/2020 with diagnoses that included generalized muscle weakness and unspecified pain in hip. Record review of Resident #22's MDS, a Quarterly assessment dated [DATE], revealed under Section C her BIMS (Brief Interview for Mental Status) score was 14 out of 15, which indicated her cognition was intact. Review of Section G functional status revealed the resident required extensive assistance and 1 person assist with toileting. Review of Section H urinary continence and bowel continence showed the resident was always incontinent. Record review of Resident #22's care plan, dated 02/26/2022, revealed a category for incontinence for urinary and bowel with a goal to maintain resident #22's dignity during episodes of incontinence and incontinent care by checking every 2 hours and providing care as needed, perineal cleansing and apply protective skin barrier after each incontinent episode, provide adult incontinent products and monitor for incontinence every 2 hours, assess and report signs of impaired skin integrity or breakdown, and encourage to turn and reposition as tolerated. During an observation on 03/02/2023 at 4:07 p.m. CNA E provided incontinent care for Resident #22. CNA E washed his hands and explained the care he would be providing to Resident #22. CNA E cleansed Resident #22's anterior (front) perineal area and between the vaginal labia wiping front to back direction. CNA E then cleaned the posterior (back) perineal and buttocks area wiping from back to front direction stopping at the perineum (area between the vaginal opening and anus) area each time. During an interview on 03/02/2023 CNA E stated he wiped Resident #23 in a down and out direction. CNA E stated staff were trained this was acceptable as long as they turned in an outward direction before they got all the way to the front vaginal area. During an interview on 03/02/2023 at 4:32 p.m. with the DON and ADON stated staff were trained to wipe from front to back on a female. The DON and ADON stated there were no area staff should be wiping in a back to front direction during incontinent care, it should always be an front to back direction. The DON and ADON stated the risk to the resident would be an infection. Record review of document titled Skills Checklist- Peri Cre, no date, stated .Female peri care: wash perineal area of female from front to back, opening labia to cleanse. Use a new wipe with each (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 8 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 contact with skin, wipe from outer side to side closer to the attendant. (At least three wipes to clean perineal area.) Record review of facility provided CNA E skills check off list did not contain a check off list for Peri Care. Record review of facility's policy tiled Urinary Continence and incontinence- Assessment and Management, dated 08/2022, stated Policy statement: 1. The staff and practitioner will appropriately screen for, and manage, individuals with urinary incontinence. 2. Management of incontinent will follow relevant clinical guidelines. 3. The physician and staff will provide appropriate services and treatment to help residents restore or improve bladder function and prevent urinary tract infections to the extent possible . Event ID: Facility ID: 675697 If continuation sheet Page 9 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure their medication error rate was not 5 percent or greater and had a medication error rate of 32% percent with 28 medications administration opportunities observed with 9 errors for 4 of 5 residents (Residents #19, #28, #44, and #49) and 3 of 3 staff (MA B, MA C and LVN A) reviewed for medication administration, in that: Residents Affected - Some 1. Medication Aide B administered the incorrect dosage of a vitamin to Resident #44. 2. LVN A did not administered a medication to Resident #19. 3. LVN A did not administer the full dose of a medication to Resident #28. 4. Medication Aide C did not observe administration of 6 medications for Resident #49. These deficient practices could place residents at risk of not receiving therapeutic effects from their medications as intended by the prescribing physician order. The findings include: 1. Record review of Resident #44's orders, dated 03/01/23, revealed a physician order for, Glucosamine Chondroitin Maximum Strength 500 mg-400 mg capsule 1 capsule by mouth twice per day for joint health, start date 01/23/23, and no end date. An observation on 10/26/2022 at 9:20 a.m. MA B dispensed 1 tablet of 550 mg of Glucosamine Chondroitin which also contained 60 mg of vitamin C and 2 mg of manganese. 2. Record review of Resident #19's orders, dated 03/03/23, revealed a physician order for lubiprostone 24 mcg capsule one by mouth twice per a day for chronic constipation with a start date of 02/28/23 and no end date. During an observation on 03/02/23 at 8:59 a.m. LVN A stated she needed to go to the medication storage room to locate the lubiprostone 24 mcg for Resident #19. LVN A stated the resident had returned from the hospital the previous day and did not have the medication yet. LVN A stated she would mark the medication as pending from the pharmacy. The LVN A informed the ADON. The ADON stated the medication was pending at the pharmacy due to a prior authorization. 3. Record review of Resident #28's orders, dated 03/03/23, revealed a physician order for polyethylene glycol 17 grams/dose oral powder, 1 cap=17 grams by mouth everyday for constipation. Dissolve in 4 to 6 oz of water/juice with a start date of 10/13/22 and no end date. During an observation on 03/02/23 at 9:30 a.m. LVN A dissolved 17 grams of polyethylene glycol in a cup of water. LVN A administered medications to Resident #28. Resident #28 took a few sips of water from the mixture of water and polyethylene glycol. LVN A then took the cup with the mixture still present and threw the remainder of in the trash can. During an interview on 03/02/23 at 9:42 a.m. LVN A stated she forgot the water had medication in it. LVN A stated she could give Resident #28 more polyethylene glycol and water at lunch. LVN A stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 10 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0759 Level of Harm - Minimal harm or potential for actual harm the resident did not like to drink water. LVN A stated she was not sure how much of the dosage the resident had been administered and how much she discarded. LVN A stated she would monitor the resident for bowel movements. LVN A stated she did not think Resident #28 was currently constipated. 4. Record review of Resident #49's orders, dated 03/03/23, revealed physician orders for: Residents Affected - Some - Metoprolol succinate extended release 25 mg tablet 1 tab by mouth every day for hypertension (high blood pressure) with a start date of 01/24/23 and no end date. - Furosemide 20 mg tablet 1 tab by mouth twice per a day for COPD (Chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs) with a start date of 01/24/23 and no end date. - Eliquis 2.5 mg tablet by mouth twice per a day for Afib (A disease of the heart characterized by irregular and often faster heartbeat) with a start date of 01/24/23 and no end date. - Potassium chloride 10 mEq tablet extended release by mouth daily for hypokalemia (a condition where your blood has too little potassium, a mineral that helps your nerves, muscles, and heart function properly) with a start date of 02/01/23 and no end date. - Docusate 100 mg capsule 1 by mouth twice per a day for constipation with a start date of 02/02/23 and no end date. - Polyethylene glycol 17 grams/dose oral powder dissolve 17 gram/dose in 4-6 oz of water by mouth every day for constipation with a start date of 02/16/23 and no end date. During an observation on 03/03/23 at 8:29 a.m. MA C dispensed 25 mg of metoprolol, 20 mg of furosemide, Eliquis 2.5 mg, half a potassium chloride 20 mEq tablet, 100 mg docusate capsule, and mixed 17 grams of polyethylene glycol with water. MA C entered Resident #49's room and stated she usually left the medications in the room for the resident's family member to give to the resident. MA C left the medications in Resident #49's room and documented on the paper MAR that she administered the medications to the resident. During an interview on 03/03/23 at 8:50 a.m. MA C stated she technically was not supposed to leave the medications with the resident but because Resident #49's family member was in the room she could. MA C stated it had always been a verbal policy that they were allowed to leave the resident's medications in the room without administering them if the resident's family member was in the room. MA C stated she would go back within an hour and see if Resident #49 had taken the medications and if not she would help the resident take them at that time. During an observation on 03/03/23 at 9:04 a.m. this surveyor entered Resident #49's room. MA C was in the room standing at the bedside. MA C stated she returned to the room to correct the issue of not administering the medications. Resident #49 was sitting up in the bed with an albuterol inhaler in her hand and was coughing. The resident had liquid coming out of her mouth and continued to cough and the resident stated a medication was suck halfway. Resident #49's family member, who was present in the room, stated the resident was choking on a medication, and this had never happened before. During an interview on 03/03/23 at 2:26 p.m. the DON stated staff should not be leaving medications in residents' rooms for a family member to administer to the resident. The DON stated a family (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 11 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete member would encourage residents, but they should not be administering medications to the residents. The DON stated she was not aware Resident #49 had difficulty taking a medication earlier that day and placed a call to the RN on duty to go take the resident's vitals. Record review of the facility's policy titled, Medication and Preparation Administration, undated, revealed, staff should comply with facility policies, applicable by law, and the state operations manual in preparing medications period prior to the preparation of administering medications, staff should follow the facilities infection control policy . Medication administration: during medication administration, with the facility staff should observe the six rights, ensure that the resident is properly positioned, administer medications at the appropriate medication administration time, document federal medication administration per facility policy, reserve resident privacy rights per applicable law, observe manufacturer medication administration guideline, and confirm the resident consumption of the medication. Medications are administered within 60 minutes before or after scheduled time, except for orders to administer with meals which must be administered based on meal times period otherwise specifically by the prescriber, routine medications are administered according to the established medication administration schedule for the facility period to maintain the resident highest level of independence, residents who desire to self-administer medications are permitted to do so with the facilities interdisciplinary team has determined that the practice would be safer for the resident and other residents of the facility and if there is a prescribers order to self-administer . Event ID: Facility ID: 675697 If continuation sheet Page 12 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure food was prepared and served in a manner that prevented foodborne illness for 1 of 1 kitchen reviewed for food preparation and serving, in that: 1. Food temperatures for the several meal items were not checked or recorded properly prior to the serving of residents. 2. An unknown staff member walked into the kitchen and failed to wash their hands before retrieving ice out of the ice machine. These failures could affect residents who reside at the facility and place them at risk of foodborne illness. These findings include: A full kitchen observation of food preparing, temperature checking, and serving was performed on 3/1/2023 between approximately 11:45 AM and 1:00 PM. The Dietary Manager and Dietician were present. 1. In an interview and observation on 3/1/2023 at 11:45 AM, the Dietician stated the food was cooked at a different kitchen and brought to the kitchen that served the residents residing in the skilled nursing facility sector of the community. The Dietitian further stated food temperatures were taken at the time of cooking, as well as on the truck used to bring over the food. The Dietician then explained the food should be checked for appropriate temperature again on the steam tables before serving to residents. Observation of the temperature logs for the food before and during transport were appropriate. In an observation on 3/1/2023 at 11:58 AM, mechanical soft chicken was not checked for the holding temperature in steam tables before serving. In an observation on 3/1/2023 at 12:03 PM, mechanical soft broccoli was not checked for the holding temperature in steam table before serving. In an observation on 3/1/2023 at 12:18 PM, the soup was not checked for holding temperature in the steam table before serving. In an interview with the Dietary Manager on 3/1/2023 at 12:20 PM, the Dietary Manager stated that all temperature must be taken and written down in their temperature log binder before serving. In an interview with the Dietician and Dietary Manager on 3/1/2023 at 12:20 PM, the Dietician stated she was full-time at the facility and helped out the Dietary Managers. The Dietician stated she had to leave the kitchen because she did not feel like things were going well with service. The Dietitian stated that all staff members going into the kitchen must wash their hands, regardless of whether they are kitchen staff. 2. In an observation on 3/1/2023 at 12:31 PM, an unknown staff member walked into the kitchen, past the hand washing station approximately 50 feet to the ice machine, got ice out of the ice machine, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 13 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0812 Level of Harm - Minimal harm or potential for actual harm and walked back out a different exit approximately 100 feet from the ice machine without washing their hands. In an interview with the Dietician on 3/3/2023 at 11:00 AM, the Dietician stated the Dietary Manager was not available for interview, as she was working as food service staff as the kitchen was understaffed. Residents Affected - Many Review of the Food Code, U.S. Public Health Service, U.S. FDA, 2017, U.S. Department of H&HS, revealed, 4-204.112, Temperature Measuring Devices.cold or hot holding equipment used for time/temperature control for safety food shall be designed to include and shall be equipped with at least one integral or permanently affixed temperature measuring device that is located to allow easy viewing of the device's temperature display. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 14 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for each resident receiving hospice services, to ensure quality of care for the resident, ensuring communication with the hospice medical director, the resident's attending physician, and others participating in the provision of care for 2 of 2 (Residents #30 and #17) reviewed for hospice services, in that: 1. The facility did not have Resident #30's hospice election form and the physician certification of terminal illness from the Resident's hospice provider. 2. The facility did not have Resident #17's hospice election form and the physician certification of terminal illness from the Resident's hospice provider. These failures could place the resident who received hospice services at-risk of receiving inadequate end-of-life care due to a lack of documentation, coordination of care and communication of resident needs. The findings were: 1. Record review of Resident #30's face sheet, dated 02/28/2023, revealed and original and current admission date of 04/17/2020 and revealed the following diagnoses: Unspecified Dementia without behavioral disturbance, hypothyroidism, Senile Degeneration of the Brain, Essential Hypertension, and Other Depressive Episodes. Record review of Resident #30's quarterly MDS, dated [DATE], indicated the resident was receiving hospice services, however did not contain HHSC Form 2189 (Nursing Facility Palliative Care) or a HHSC Form 3074 (Physician's Certification of Terminal Illness). Record review of Resident #30's most recent care plan indicated the resident had a terminal prognosis related to Dementia with a start date for hospice services of 10/13/2022. Record review of Resident #30's physician orders, dated 3/01/2023, revealed a physician's order for hospice services on 9/05/2022 with an additional date of 5/28/2020 indicating a need to contact hospice services for, concerns and changes in condition. 2. Record review of Resident #17's face sheet dated 2/28/2023, revealed the resident was initially admitted on [DATE] with a most recent admission date of 11/29/2018 and included the following diagnoses: senile degeneration of the brain, age related physical debility and adult failure to thrive. Record review of Resident #17's quarterly MDS, dated [DATE], revealed the resident was receiving hospice services, however did not contain HHSC Form 2189 (Nursing Palliative Care), the last HHSC Form 3074, (Physician's Certification of Terminal Illness) was completed certification, 12/02/2018, with no recertification date indicated on the provided form. Record review of Resident #17's most recent care plan indicated the resident had a terminal prognosis related to senile dementia with a start date for hospice services on 3/14/2019. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 15 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #17's physician orders dated 3/01/2023, revealed the resident was admitted to hospice for senile dementia of the brain with a start date of 9/05/2022. During an interview with the ADON on 03/03/2023 at 3:06 p.m., the ADON stated the facility was not able to locate any completed, hospice forms, for Resident #30, prior to the surveyor inquiring about the documents, including the hospice election form and the physician certification of terminal illness, in addition to the hospice care plan. The ADON further stated there were no, hospice state forms, for Resident #17 in the current electronic medical record, he went on to explain he believed they may be in another portion of the chart, which financial services controlled, however was unable to locate those forms prior to the survey team exit. The ADON further stated the Social Worker was responsible for ensuring any forms needed for hospice services. During an interview with the Social Worker on 3/03/2023 at 4:11 p.m., the Social Worker stated, I have nothing to do with hospice forms at the facility. During an interview with the Administrator on 3/03/2023 at 6:40 p.m., the Administrator stated the facility did not have to complete the state hospice election form or the physician's certification of terminal illness form because the facility did not accept residents whose payer source was Medicaid. The facility's hospice policy was requested prior to exit, however it was not provided prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 16 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of infections for 3 of 3 residents (Residents #5, #22, and #28) reviewed for infection control, in that: Residents Affected - Some 1. MA B dropped a glove on the floor, put the glove on, and dispensed medications for Resident #5. 2. LVN A touched a medication with her hand while dispensing medication for Resident #28. 3. CNA D used the same paper towel to dry her hands, turn off the sink faucet, and dry her hands again prior to incontinent care for Resident #22. These deficient practices could place residents who receive medication or incontinent care at-risk for infections. The findings included: 1. Record review of Resident #5's face sheet, dated 03/03/23, revealed an initial admission date of 03/11/21 and a current date of 04/28/22 with diagnoses that included: osteoarthritis (a degenerative disease with joint pain and stiffness that worsens over time, often resulting in chronic pain), hypothyroidism (underactive thyroid is a condition in which your thyroid gland does not produce enough of certain crucial hormones), and dementia (a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life). During an observation on 03/01/23 at 11:41 a.m. MA B was dispensing medications for Resident #5. MA B went into Resident #5's room to obtain a pair of gloves from a box on the wall inside the resident's room. MA B was observed picking a glove up off the floor. MA B returned to the medication cart and put the glove on that had fallen on the floor. MA B then opened a capsule of medication for Resident #5 and dumped the contents into a medication cup with other crushed medications for Resident #5. During an interview on 03/01/23 at 11:49 a.m. MA B stated she did not know if she dropped an item. MA B stated she may have dropped a glove on the floor, but she was not sure. MA B stated she should not use a glove that fell on the floor because it could be contaminated. 2. Record review of Resident #28's face sheet, dated 03/03/23, revealed an initial admission date of 06/19/17 and a current admission date of 07/15/21 with diagnoses that included: chronic kidney disease (a condition characterized by a gradual loss of kidney function) and chronic respiratory failure with hypercapnia (Presence of higher-than-normal level of carbon dioxide in the blood). During an observation on 03/02/23 at 9:27 a.m. LVN A was dispensing medications for Resident #28. LVN A placed a pill in a pill splitter to cut it in half. LVN A touched the pill with her bare hands, cut the pill, and placed it in a medication cup to give to the resident. During an interview on 03/02/23 at 9:42 a.m. LVN A stated she should have put gloves on when splitting the pill in half. LVN A stated she should put on gloves when touching medications to prevent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 17 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 contamination of the medication. Level of Harm - Minimal harm or potential for actual harm 3. Record review of Resident #22's face sheet, dated 03/03/2023, revealed an initial admission date of 11/05/2014 and a readmission date of 04/14/2020 with diagnoses that included: generalized muscle weakness and unspecified pain in hip. Residents Affected - Some Record review of Resident #22's MDS, a Quarterly assessment dated [DATE], revealed under Section C her BIMS (Brief Interview for Mental Status) score was 14 out of 15, which indicated her cognition was intact. Review of Section G functional status revealed the resident required extensive assistance and 1 person assist with toileting. Review of Section H urinary continence and bowel continence showed the resident was always incontinent. Record review of Resident #22's care plan, dated 02/26/2022, revealed a category for incontinence for urinary and bowel with a goal to maintain resident #22's dignity during episodes of incontinence and incontinent care by checking every 2 hours and providing care as needed, perineal cleansing and apply protective skin barrier after each incontinent episode, provide adult incontinent products and monitor for incontinence every 2 hours, assess and report signs of impaired skin integrity or breakdown, and encourage to turn and reposition as tolerated. During an observation on 03/02/23 at 4:07 p.m. CNA D washed her hands at a sink inside Resident #22's bathroom to prepare for incontinent care. CNA D washed her hand with soap and water, grabbed a few paper towels, dried her hands, used the same towels to turn off the handle to the faucet, dried her hands again with the same paper towel, and discarded the paper towel into a trash can in the bathroom. During an interview on 03/02/23 at 4:22 p.m. CNA D stated she should wash her hands for at least 20 seconds, grab a paper towel to dry her hands, use the same towel to turn off the sink, and discard to paper towel into the trash. CNA D stated it was acceptable to use the same paper towel to dry her hands and turn off the sink. CNA D stated she did not think she dried her hands again with the same paper towels after touching the sink handle. CNA D stated she dried her hands before touching the sink handle with the same paper towel to prevent contamination of germs. During and interview on 03/02/23 at 4:32 p.m. the DON and ADON stated staff should adjust the water temperature, soap and lather hands for 20 seconds, rinse hands, once they rinse their hands leave the water running, grab a paper towel, dry their hands till dry, grab a new paper towel and turn off the sink, The DON and ADON stated if staff used the same paper towel to dry their hands and turn off the sink they had the potential to catch germs from the sink handle. The DON and ADON stated staff had done an inservice with glo germs and a black light to demonstrate to staff how to perform hand washing appropriately. Record review of document titled, In Service, dated 01/01/23, revealed, Glo Germ Handwashing, for 15 minutes. Objective at the end of the in-service the employee will understand infection control transmission prevention and hand washing protocol use the glo-germ solution. Further review revealed CNA D's information was not present on the in-service. Record review of document titled, Skills checklist: Handwashing, dated 09/17/22, revealed CNA D had met handwashing requirements. Record review of document titled, Skills checklist: Handwashing, no date, revealed, turn on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675697 If continuation sheet Page 18 of 19 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 675697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Army Residence Community Health Care Center 7400 Crestway Dr San Antonio, TX 78239 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete water, wet hand, applied skin cleanser or soap to hand, rum hands together for at least 20 seconds, wash all surfaces of the hands at least up to the wrist, rinse hands thoroughly under running water, dry hands on clean towel, turn off faucet with dry towel and avoid contact with sink or other dirty surfaces during rinsing, and discard wet towel appropriately. Record review of facility's policy titled, Medication and Preparation Administration, no date, revealed, . before you staff should comply with facility policy, applicable law, and the state operations manual prior to administering medications. Facility staff should insert the six rights and verify right resident, right drug, right base, right row and right time and right documentation for each medication being administered. Hand washing and hand sanitization: the person administering the medication appears to good hand hygiene, which includes washing or sanitizing hands thoroughly: before beginning a medication pack, prior to handling any medication, after coming into direct contact with a resident, before and after administering an ophthalmic, topical, vaginal, rectal, and parenteral preparation, and before and after administration of medication via internal tubes. A. examination gloves are worn in necessary. B. hand sanitization is done with an approved sanitizer. between hand washing, and returning to the medication or preparation area [assuming hands have not touched a resident or potentially contaminated surface]. that regular intervals during medication pass such as after each drink, again assuming hand washing is not indicated. Event ID: Facility ID: 675697 If continuation sheet Page 19 of 19