Health inspection·March 27, 2024

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on [DATE] at 10:19 a.m., Medical Records stated whenever a resident or family member made request, the resident must fill out a medical request form which then goes to the Compliance Officer. The Compliance Officer will then decide whether the records are released. Medical Records stated the resident's representative was also able to request resident's records. Medical Records stated once the resident or the resident's representative requests information, it was disclosed as soon as possible, but it was dependent on whether or not the Compliance Office approved the request. Medical Records stated she knew that Resident #1's family had requested the documents in the past and it was denied by the Compliance Officer because Resident #1's RP's attorneys were speaking with the facility's corporate legal team. Medical Records stated she did not know exactly why Resident #1's family's request for records was denied. Medical Records stated she did not know if Resident #1 designated a responsible party. Medical Records stated she recalled Resident #1's RP's attorneys had send a letter of an independent administratrix, which she forwarded to the Compliance Officer. On [DATE] at 11:40 a.m., an interview was attempted with the Compliance Officer. The call went to voicemail and a voicemail was left with this surveyor's name and callback number. A return call was not received prior to the end of this investigation. During an interview on [DATE] at 12:14 p.m., the DON stated a resident's RP could request records if the resident's RP was the MPOA. The DON stated once the resident was deceased , the MPOA was no longer valid. The DON stated if a resident's family member was not the MPOA but was requesting records, they would follow the direction of the Compliance Officer. The DON stated he did not know Resident #1 designated a responsible party. The DON stated Resident #1's family had requested records and Resident #1's family's attorney was involved. The DON stated the facility had not disclosed records to Resident #1's family. The DON stated once the facility received a request for records, they submit the request right away to the Compliance Officer. When asked what sort of negative effects could occur to the residents if records were not disclosed within 48 to 72 hours, the DON stated, possibly the family was unaware of any follow-through that has to be happening to the resident in regards to the care. During an interview on [DATE] at 1:51 p.m., the Administrator stated the Compliance Officer provided oversight to the medical records office. The Administrator stated once a resident or responsible party requested records, the request was submitted to the Compliance Officer and the records are disclosed within 48 hours. The Administrator stated a resident's responsible party had the right to request verbal information and a responsible party had the right to request records if the responsible party was the POA. The Administrator stated once the resident passed away, the facility followed HIPAA guidelines. At this point, this surveyor requested a copy of the HIPAA guidelines that were being followed by the facility. The DON stated Resident #1's family requested records before, but were denied by the Compliance Officer, who stated the family needed TO be an executor of the state. The Administrator stated, [Resident #1] must have had an RP. I understand that. But that does not allow you to release medical records to an RP. They have to have documentation that they're acting on behalf of the resident. Like a power of attorney or a guardianship. When asked if the facility had a quality assurance process to ensure resident records were disclosed within 48-72 hours of request, the Administrator referred this surveyor to the compliance officer. When asked what sort of negative effects could occur to the residents if records were not disclosed within 48-72 hours of request, the Administrator stated, I wouldn't be able to answer that. During an interview and record review on [DATE] at 2:47 p.m., this surveyor and Medical Records reviewed the facility's electronic fax inbox and confirmed the facility received the email from Resident #1's RP's email dated [DATE], which is the same email that included the HIPAA-approved release of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675890 If continuation sheet Page 2 of 4 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 675890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Heights at Medical Center 3935 Medical Dr San Antonio, TX 78229 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 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few information and proof Resident #1's RP was now Resident #1's Administratrix of the estate. Medical Records stated she forwarded this email to the Compliance Officer. Record review of an email from the DON to this surveyor, sent on [DATE] at 1:38 p.m., revealed a release of information policy. Record review of this policy titled, Release of Information, not dated, revealed the following: All information contained in the resident's medical record is confidential and may only be released by the written consent of the resident or his/her legal representative (sponsor), consistent with state laws or regulations . Closed or thinned medical records are maintained in the Medical Records Department and are available only to authorized personnel. Authorized personnel include, but are not necessarily limited to: .Resident/Representative (Sponsor) . A resident may only obtain photocopies of his or her records by providing the facility with at least forty-eight (48) hour (excluding weekends and holidays) advance notice of such request. There was no record in this policy about any requirements for an administrator or executor of the resident's estate to obtain a resident's records. Record review of an email from the Administrator to this surveyor, sent on [DATE] at 2:19 p.m., revealed another release of information policy. Record review of this policy revealed a policy titled, Release of Medical Records, dated [DATE], revealed the following: Residents or Authorized Representative after discharge: .Medical records of a deceased resident may be requested by the personal representative (Administrator or Executor) of the resident's estate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675890 If continuation sheet Page 3 of 4 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 675890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Heights at Medical Center 3935 Medical Dr San Antonio, TX 78229 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to immediately notify a resident's representative when there was a significant change in the resident's physical, mental, or psychosocial status for 1 of 1 residents (Resident #1) reviewed for notification of changes in that: The facility failed to ensure Resident #1's RP was notified when Resident #1 was transferred to a local hospital on 7/27/23. This deficient practice could place residents at risk of not having their family or legal representative notified when having a change of condition. The findings were: Record review of Resident #1's electronic medical record, reviewed on 3/25/24, revealed Resident #1 was admitted to the facility on [DATE] with diagnoses of gastro-esophageal reflux disease without esophagitis [acid reflux], hypomagnesemia [high magnesium levels in the blood], other hyperlipidemia [high fat levels in the blood], and unspecified atrial fibrillation [an abnormal heartbeat]. There was no RP designated in this section of the electronic medical record. Record review of Resident #1's admission agreement, dated 7/26/23, revealed Resident #1 designated an RP. Record review of Resident #1's nursing progress note, dated 7/27/23 at 2:03 a.m. and written by RN A, revealed Resident #1 was sent to the hospital. There was no documentation indicating Resident #1's RP was notified. During an interview on 3/25/24 at 12:55 p.m., Resident #1's RP stated she was not informed when Resident #1 was transferred to the hospital in the early morning of 7/27/23. During an interview on 3/26/24 at 2:43 p.m., RN A stated she recalled notifying the DON and Resident #1's physician, but she did not recall if she notified the family when she transferred Resident #1 in the early morning of 7/27/23. RN A stated, I guess I didn't. RN A stated she should have notified the family. During an interview on 3/27/24 at 12:14 p.m., the DON stated the staff should notify the resident's responsible party for any change of condition. The DON stated he did not know if Resident #1's family was notified when Resident #1 was transferred to the hospital in the early morning of 7/27/23. When asked if the facility had a process to ensure a resident's responsible party was notified of any change in condition, the DON stated there was a morning meeting every weekday. The DON stated if there were any residents who had specific changes, then the facility followed guidelines on notifying the family and ensuring the documentation was done. Record review of a facility policy titled, Change in a Resident's Condition or Status, not dated, revealed the following: our facility shall promptly notify the resident . and representative (sponsor) of changes in the resident's medical/mental condition and/or status. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675890 If continuation sheet Page 4 of 4