Inspection·November 25, 2025

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete rights and that not doing so might lead the residents to feel that strangers were looking at them or feel devalued. Record review of the facility's policy, titled Resident Rights, undated, revealed: The resident has a right to a dignified existence. A facility must treat each resident with respect and dignity.The resident has a right to personal privacy.Personal privacy includes accommodations, medical treatment. Record review of the facility's validation checklist, titled Wound Care, dated 2022, revealed: .Upheld dignity principles for entry, permission to proceed, and privacy. Event ID: Facility ID: 675823 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 675823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Normandy Terrace Nursing & Rehabilitation Center 841 Rice Rd San Antonio, TX 78220 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 and to help prevent the development and transmission of communicable diseases and infections for 2 of 2 residents (Resident #2 and Resident #3) reviewed for infection control. The facility failed to ensure RN A followed infection control policy/procedures during wound care for Resident #2 and Resident #3. This deficient practice could place residents at risk for infection. Findings included: Record review of Resident #2's admission Record, dated 10/23/25, revealed the resident was admitted to the facility on [DATE] with diagnoses which included: right femur fracture, Alzheimer's Disease (disease affecting memory and other important mental functions) , Dementia (group of thinking and social symptoms that interferes with daily functioning). An interview was attempted on 10/22/25 at 2:06 pm, Resident #2 did not respond to the state investigator's questions. During observation of wound care to Resident #2's right second toe, on 10/22/25 beginning at 4:44 pm, RN A entered the room and explained the procedure. RN A then placed the wound care supplies on Resident #2's bedside table without sanitizing it. RN A began to don a gown when Resident #2's roommate removed her covers and night gown, exposing her breasts. RN A approached Resident #2's roommate and replaced her covers, during which RN A's gown touched the resident and her bed. After assisting Resident #2's roommate, RN A continued to tie the ties on the gown and donned gloves without performing hand hygiene. RN A then pulled Resident #2's chair close to the resident, who was sitting in her wheelchair, sat down, placed a trash bag on the floor next to her (used to dispose of used wound care supplies) and removed Resident #2's sock. RN A then touched Resident #2's wound to the right second toe with her gloved hand without changing gloves or performing hand hygiene. After cleaning the wound, RN A removed her gloves, donned clean gloves without performing hand hygiene and applied the treatment to Resident #2's right second toe. RN A removed her gloves and washed her hands for 13 seconds. RN A exited Resident #2's room, removed her gown and placed the trash bag that was on the floor on top of the treatment cart. RN A then walked with the state investigator to the conference room without sanitizing the top of the treatment cart. During an interview on 10/23/25 at 9:35 am (translated from Spanish), Resident #2 said she did not have any wounds. During an interview on 10/23/25 at 2:07 pm, RN A said she should have removed her PPE after assisting Resident #2's roommate. RN A further stated she should have then washed her hands and donned new PPE before providing wound care to Resident #2's right second toe to avoid the spread of infection and cross contamination between residents. RN A said she should have made sure her hands were clean prior to touching Resident #2's wound. RN A further stated she must wash her hands the right way every time otherwise it put everyone at risk for infection. RN A said the trash bag should not have been placed on top of the treatment cart because the trash bag had germs and she was transferring germs from one surface to another, placing residents at risk for infection. RN A further stated all staff were responsible for following infection control policies and procedures. Record review of Resident #3's admission Record, dated 10/23/25, revealed the resident was re-admitted to the facility on [DATE] with diagnoses which included: Cerebral Infarction/CVA (stroke - disrupted blood flow to the brain), Major Depressive Disorder (mental health disorder characterized by persistently depressed mood or loss of interest in activities), Generalized Anxiety Disorder (severe and ongoing that is ongoing and interferes with daily activities), and Aphasia (disorder that affects a person's ability to communicate. During an interview on 10/22/25 at 2:00 pm, Resident #3 shook her head when asked if she had any wounds and was receiving wound care. During observation of wound care to Resident #3's left heel, on 10/22/25 beginning at Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675823 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 675823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Normandy Terrace Nursing & Rehabilitation Center 841 Rice Rd San Antonio, TX 78220 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 4:21 pm, RN A entered the room and explained the procedure. RN A washed her hands for 4 seconds, removed Resident #3's boot from her left foot and donned a gown without performing hand hygiene. RN A then placed the wound care supplies on top of the bedside table without sanitizing it and moved the table close to the foot of the bed with her bare hands. RN A donned gloves without performing hand hygiene. RN A set Resident #3's left foot on top of a plastic trash bag, removed the dressing, placed it in the trash bag under the resident's foot and set Resident #3's left foot on the trash bag containing the dirty dressing. After RN A cleaned Resident #3's wound and set the resident's foot on top of the trash bag containing the dirty dressing and liquid used to clean the wound. RN A removed her gloves, leaned out the door to get a clean pair of gloves from the treatment cart without performing hand hygiene and donned the gloves. RN A then applied the ointment to Resident #3's wound and set the resident's foot on trash bag containing the dirty dressing and liquid used to clean the wound, and then RN A applied the calcium alginate dressing to Resident #3's wound and set the resident's foot on the trash bag containing the dirty dressing and liquid used to clean the wound. RN A opened the adhesive dressing and applied it to Resident #3's left heel. After removing her gloves and washing her hands, RN A exited the resident's room, removed her gown, and placed it on top of the treatment cart before disposing it. An interview was attempted on 10/22/25 at 4:39 pm, Resident #3 did not respond to the state investigator's questions. During an interview on 10/22/25 at 5:05 pm, RN A said she was expected to wash her hands for Happy Birthday twice, about 30 seconds to avoid the spread of infection. RN A further stated she should have donned the gown before removing Resident #3's boot to avoid spreading any bacteria that may have been on the boot onto her clothing. RN A said she should have sanitized her hands after removing the boot to avoid cross contamination. RN A said she had not sanitized the bedside tables before placing the wound care supplies on them before providing wound care to Resident #2 and Resident #3. RN A further stated she had not thought about it because she made sure the supplies were on top of the trash bag, so the supplies were on a clean surface. RN A further stated she was expected to sanitize the bedside tables before and after use because any germs that might on the bedside table can cross contaminate the items placed on top of the table. During an interview on 10/23/25 at 2:07 pm, RN A said when she provided wound care for Resident #3, on 10/22/25, she should not have set the resident's foot back on top of the bag after she removed the dressing, cleaned the wound, and after she applied the calcium alginate (material used as a wound dressing), adding she should have set her foot on a clean surface. RN A further stated she set a clean wound on a dirty surface which could put the resident at risk for infection. RN A said she was expected to perform hand hygiene before donning gloves and after doffing gloves to reduce the risk of spreading infection. RN A said PPE should be removed before exiting the residents' rooms to avoid taking germs outside the room. RN A said gowns should be placed in a bag and disposed after removal to avoid spreading anything that was on the gown onto other surfaces and avoid the spread of infection. During an interview on 10/23/25 at 2:31 pm, the DON said Resident #3's wound should not have been touched after the chair was moved without changing gloves and performing hand hygiene and Resident #3's foot should not have been set on a trash bag with dirty dressings. The DON further stated bedside tables should be sanitized before and after use, and trash bags should not be placed on top of the carts at any time after being on the floor or other surfaces. The DON said these items (chair, trash bag, and bedside table) were contaminated and in turn would contaminate the treatment cart, wound, and gloves. The DON further stated they did not know what might have been on the resident's bedside table. The DON said this cross contamination puts the residents at risk for infection. The DON said when providing wound care, staff were expected to perform hand hygiene, gather supplies, enter the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675823 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 675823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Normandy Terrace Nursing & Rehabilitation Center 841 Rice Rd San Antonio, TX 78220 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 resident's room, wash their hands, sanitize the surface they used to place supplies, set up supplies, perform hand hygiene, apply gloves, remove dressing, remove gloves, sanitize hands, apply new gloves, clean the wound, apply treatment, remove gloves, and wash hands. The DON said staff were expected to perform hand hygiene any time they had contact with a resident, before donning gloves, after removing gloves, and before leaving the residents' rooms. The DON said hands should be washed for at least 30 seconds, or Happy Birthday twice. The DON further stated it was important for staff to wash their hands for the recommended amount of time to kill any bacteria/microbes that might be on the hands and avoid cross contamination. The DON said she expected staff to remove PPE and don clean PPE between residents due to possible cross contamination, putting the residents at risk for infection. The DON said PPE should be removed before exiting the resident rooms to avoid bringing possible infections out of the room and putting residents at risk for infection. The DON further stated that used gowns should not be placed on any surfaces once removed because they were contaminated. The DON said it was everyone's responsibility to ensure infection control practices were followed to prevent infection. The DON further stated as the IP, she was responsible for ensuring staff followed infection control policies/procedures. The DON further stated she was responsible for ensuring nurses provided care according to professional standards. Record review of the facility's validation checklist, titled Wound Care, dated 2022, revealed: .Cleaned bedside table as needed.Maintained supplies as sterile/clean as indicated, avoiding contamination.Cleansed wound thoroughly with prescribed cleansing agent, taking care to not contaminate other skin surfaces or other surfaces of the wound.Discarded disposable items and gloves into appropriate receptacles. Cleaned bedside stand. Record review of the facility's policy, titled Wound Care, updated 3/2024, revealed: .The following is a list of some situations that require hand hygiene.Before and after changing a dressing .Upon and after coming in contact with a resident's intact skin.After removing gloves.Recommended techniques for washing hands with soap and water include.rubbing hands together vigorously for at least 20 seconds. Record review of CDC webpage at https://www.cdc.gov/clean-hands/about/index.html, dated 2/16/24, reflected: .Germs can spread from person to person or from surfaces to people when you.Touch surfaces or objects that have germs on them.Key times to wash hands Before and after treating a cut or wound.Scrub your hands for at least 20 seconds.you can use an alcohol-based hand sanitizer. Record review of CDC Infection Control webpage at chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cdc.gov/infection-control/media/pdfs/Strive-PPE101-508 The Basics of Standard Precautions, undated, reflected: Remove gown and perform hand hygiene before leaving the patient's environment.Do not wear the same gown between patients.A gown should not be worn in hallways or corridors, or between patients, as pathogens can be transferred on the gown from one patient to another. Event ID: Facility ID: 675823 If continuation sheet Page 5 of 5