Inspection·July 31, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to conduct initially and periodically a comprehensive person-centered care plan for each resident, consistent with the resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment condition for 1 of 5 residents (Resident #1) reviewed for comprehensive care plans, in that: The facility failed to ensure a comprehensive care plan for Resident #1 was completed since the resident's admission. This failure could place residents at risk for improper or incorrect care and services necessary for their physical, mental, and psychosocial well-being. Findings were: Record review of Resident #1's face sheet, dated 07/12/2023, revealed she had an admission date of 03/29/2023 and diagnoses that included: Nontraumatic Intracerebral Hemorrhage (bleeding inside the skull), Muscle wasting and Atrophy (decrease in a body part), and Hemiplegia (one-side muscle paralysis or weakness). Record review of Resident #1's Quarterly MDS, dated [DATE], revealed a BIMS score of 03, which indicated severe cognitive deficit. Record review of Resident #1's medical record revealed there was no comprehensive care plan for the resident. In an interview with ADON A and the Regional Nurse, dated 07/12/2023 at 11:44 AM, they both verified that no care plan was on file or had been completed since residents' admission. In an interview with the Regional Nurse, dated 07/14/2023 at 10:57 AM, the Regional Nurse stated the person who was responsible for writing the care plans at the time was no longer employed at the facility. The Regional Nurse stated the facility had a new MDS nurse they had recently assigned and the care plans were checked every morning and the Social Worker sent out care plan letters and the care plans were reviewed by the Interdisciplinary Team. Record review of the facility's policy titled, Comprehensive Care Plans, dated 02/10/2021, revealed, The comprehensive care plan will be developed within 7 days after the completion of the (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: 675883 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 675883 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southeast Nursing & Rehabilitation Center 4302 E Southcross Blvd San Antonio, TX 78222 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)