Health inspection·August 4, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility document titled, Release of Responsibility for Leave of Absence revealed Resident #1 signed out to go on pass on Friday, 7/11/25 at 12:09 p.m. The document had Resident #1's signature under the section which read, Signature of Person Accepting Responsibility.Record review of Resident #1's electronic record revealed a progress note dated 7/10/25 with time stamp 5:08 p.m. and authored by LVN B revealed, Resident #1 wanted to go AMA. LVN B's progress note indicated she provided the resident with an AMA form, provided patient teaching, and referred the resident to the Social Worker. LVN B's progress note indicated Resident #1's friend called and would be picking him up the following day, 7/11/25, to take the resident out on pass to lunch and shopping. LVN B's progress note revealed Resident #1 stated he would wait until the following day when his friend, who used to be his former home health aide, to decide about going AMA. Record review of Resident #1's electronic record revealed a progress note dated 7/11/25, with time stamp 12:15 p.m. and authored by the Administrator revealed, Resident #1 stated that he was going out on pass with friend. He [Resident #1] said he was planning on leaving and staying at her house overnight to attend church tomorrow for services. Patient signed himself out in the sign out book.Record review of Resident #1's electronic record revealed a progress note dated 7/11/25, with time stamp 1:55 p.m. and authored by the SW revealed, Patient [Resident #1] stated he was going out on pass with his friend. He stated that he would be leaving today and staying overnight at her house and would be going out to eat, shop, and attend church services tomorrow. Patient signed himself out in the sign out book.Record review of Resident #1's electronic record revealed a progress note dated 7/12/25 (Saturday), with time stamp 3:35 p.m. and authored by LVN A revealed Resident #1 was OOP (out on pass).Record review of Resident #1's electronic record revealed a progress note dated 7/14/25 (Monday), with time stamp 7:48 a.m., and authored by LVN A revealed Resident #1 was Out on pass.Record review of Resident #1's electronic record revealed a progress note dated 7/14/25, with time stamp 11:00 a.m. and authored by the Administrator revealed, spoke with [family member], of Resident #1, to inform her that ex-caregiver [friend] took [Resident #1] out on pass on Friday stating that they would return Saturday after church. Explained that [Resident #1's friend] didn't return with him and he was now considered discharging AMA. [Family member] understood and appreciated the call. During an interview on 7/30/25 at 2:43 p.m., LVN A stated Resident #1 was a double amputee and had vision problems that were being addressed by the facility. LVN A stated Resident #1 signed out on pass (Friday, 7/11/25) and never came back. LVN A stated, Resident #1 was picked up by the resident's friend who used to be his former caretaker. LVN A stated it was the first time that happened (the resident not coming back) and was not sure what our administrators did about it. During a telephone interview on 7/31/25 at 9:34 a.m., Resident #1's family member stated she was contacted by the Administrator and was told Resident #1 was missing in action after three days and never returned. The family member stated she was told by the Administrator the facility policy was if Resident #1 was gone from the facility for more than 3 days they had to start the re-admission process before allowing Resident #1 to return to the facility. Resident #1's family member stated she recalled the day the Administrator called her, Monday 7/14/25, because she had just got back home after being out of town. Resident #1's family member stated, the facility knew me well, and they should have called me. Resident #1's family member stated she was familiar with Resident #1's friend, who was his former caretaker from the group home, but only talked to her on the phone and never met her personally. Resident #1's family member stated Resident #1 was responsible for himself and she was not his POA. Resident #1's family member stated the resident was currently at another nursing facility receiving therapy related to care for kidney stone surgery.During an interview on 7/31/25 at 10:20 a.m., at the Administrator's request, he stated Resident #1 leaving the facility was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675890 If continuation sheet Page 2 of 7 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 08/04/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few considered an elopement but was considered leaving AMA because the resident was able to make his own decisions and was his own RP. The Administrator stated Resident #1 signed himself out to leave the facility, and did not answer his phone when the Administrator tried to call him the following day, Saturday 7/12/25, when he did not return. The Administrator stated Resident #1 did not sign any AMA paperwork. The Administrator stated, per Medicaid guidelines, if the resident did not return for three consecutive midnights, the resident was considered discharged . The Administrator was unable to provide telephone logs of the attempt at a telephone call to Resident #1 for Saturday, 7/12/25. During an interview on 7/31/25 at 11:23 a.m., the SW stated LVN B reported to her on 7/10/25 Resident #1 wanted to go AMA. The SW stated she spoke briefly to Resident #1, and he retracted his statement about wanting to leave AMA the same day because she informed him his friend was coming to pick him up to go out on pass the following day. The SW stated Resident #1's friend was picking him up and taking him overnight and then bringing him back to the facility the next day. The SW stated, when Resident #1 did not return the following day, she believed the Administrator reached out to the resident, but he did not answer and believed the Administrator then reached out to the resident's family member. The SW stated, I don't think the (family member) had anything to say, because he [Resident #1] was the RP. The SW stated Resident #1 was never an elopement risk and never known to exit seek and he was cognitively intact. The SW stated, the facility would have reached out to Resident #1 before the end of the third midnight, to explain that if he did not come back, he would have been discharged per the Medicaid guidelines. The SW stated, we were not concerned for his safety. The SW stated she assumed Resident #1 was with the person he left with, his friend.During a follow up interview on 7/31/25 at 11:33 a.m., LVN A stated, Resident #1 told him he was only going out on pass for a couple of hours and was coming back the same day (7/11/25), which was why he did not give the resident medications to take with him on pass. LVN A stated, if a resident was out of the facility for more than 72 hours, it was considered AMA. LVN A stated he reported to the Administrator on Monday 7/14/25 that Resident #1 had gone out on pass on Friday 7/11/25 and it was now Monday (7/14/25), and the resident was not back. LVN A stated he reported that information to the Administrator because it was more than three days. LVN A stated the Administrator took the information from him but did not say anything to him. During an interview on 7/31/25 at 12:35 p.m., the DON stated Resident #1 was leaving out on pass with a friend but was not aware the resident was going to leave overnight until she saw the SW's progress note the following working day, Monday 7/14/25. During an interview on 7/31/25 at 1:32 p.m., the RN Regional Support Nurse stated, Resident #1 had his rights and if he wanted to leave, we would have talked to the physician. The RN Regional Support Nurse stated she was aware Resident #1 made comments about leaving AMA, but the resident changed his mind. The RN Regional Support Nurse stated, Resident #1 told LVN A he was only going out for an hour, and he told the SW and the Administrator he was going out overnight. The RN Regional Support Nurse stated there was a miscommunication. During an interview on 7/31/25 at 4:55 p.m., Resident #1 stated he told the Administrator he was going out on pass on 7/11/25 and would return on Monday 7/14/25. Resident #1 stated he communicated with the DON about leaving out on pass and was referred to the nurse to sign out. Resident #1 stated he did not recall who the nurse was but stated he told the nurse he would be back on Monday 7/14/25. Resident #1 stated the facility tried to get me to sign an AMA before I left, but I wouldn't. Resident #1 stated the facility never called him or his friend about his whereabouts. Resident #1 stated, I was coming back in three days, not overnight. Resident #1 stated he did not return to the facility because he had a fall while at his friend's house and went to the hospital on 7/20/25. Resident #1 stated the hospital found a kidney stone and he required a laparoscopy (surgical procedure used to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675890 If continuation sheet Page 3 of 7 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 08/04/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few examine and operate on the organs inside the abdomen or pelvis) and was now receiving physical therapy at another nursing facility. An attempted interview on 8/1/25 at 8:28 a.m. with the MD was unsuccessful. A telephone message was left requesting an interview with the MD. During a telephone interview on 8/1/25 at 10:00 a.m., Resident #1's friend stated she contacted the facility to tell them she was picking up Resident #1 to take him to lunch on Friday 7/11/25. Resident #1's friend stated the Administrator followed them out to her vehicle and she overheard Resident #1 say under his breath, I don't think I'm coming back. Resident #1's friend stated she planned to take the resident out on pass for lunch and had no intention of keeping him overnight. Resident #1's friend stated the facility did not reach out to her while Resident #1 was with her about trying to get him back. Resident #1's friend stated she did not try to reach out to the facility to let them know the resident was with her because she knew Resident #1 did not want to go back to the facility. During a follow up interview on 8/1/25 at 10:21 a.m., LVN B stated she reported to the DON and the SW about Resident #1 requesting to leave AMA on 7/10/25. LVN B stated she, the DON and SW discussed the AMA document and what it meant to leave AMA with Resident #1, and the resident's only response was that he understood. LVN B stated after that conversation, the SW told her the resident's friend was coming to take him out on pass the following day, 7/11/25 and Resident #1 changed his mind about leaving AMA. LVN B stated Resident #1 did not sign the AMA document.During a follow up interview on 8/1/25 at 10:31 a.m., the DON stated she recalled the conversation held with Resident #1 about his request to leave AMA. The DON stated Resident #1 was provided with education and offered the AMA paperwork. The DON stated Resident #1 would let whoever was picking him up to go out on pass know about the AMA paperwork and that was the end of the conversation. The DON stated Resident #1's friend picked him up the following day, Friday 7/11/25, to go out on pass, and not that he was leaving AMA. The DON stated she did not know how long Resident #1 was going to be gone.During a follow up interview on 8/1/25 at 11:36 a.m., the SW stated she recalled LVN B reporting to her and the DON about Resident #1 wanting to leave AMA. The SW stated the resident was provided education, acknowledged he understood and then Resident #1 stated he was not leaving AMA. The SW stated, after Resident #1 did not return to the facility at the designated time, she believed the Administrator tried to contact the resident and the resident's friend but was not successful. The SW stated, because Resident #1 was alert and oriented, and able to sign himself out, it was not considered an elopement but was considered leaving AMA. During a follow up interview requested by the Administrator on 8/1/25 at 11:44 a.m., he stated he wanted to be clear Resident #1 leaving the facility on pass and not returning was considered a discharge and not AMA. The Administrator stated, Resident #1 went out on pass and chose not to return and as per Medicaid guidelines after being out 3 consecutive nights without returning to the facility meant he was discharged . The Administrator stated, Resident #1 made that choice as his own RP and tried to reach out to the resident on Saturday, 7/12/25 but was unable to provide the telephone logs to prove he had attempted to call the resident. A request made to the DON for a facility policy on residents going out on pass was requested on 8/4/25 at 10:43 a.m. but was not provided.Record review of the facility document titled, Statement of Resident Rights with revision date January 2023 revealed in part, .The community should educate, encourage, and honor the rights of those we serve.Further, the community should assist a resident/patient fully to exercise their rights as applicable.Resident/Patient Rights include.To go out on pass by means of self-coordinated outings, with family, representative and to attend structured outings.To not be discharged from the community, except as provided in the nursing community regulations.Residents will have the right to exercise their rights as residents of the community and as citizens.The community will provide autonomy and choice to all residents, to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675890 If continuation sheet Page 4 of 7 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 08/04/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete maximum extent possible, about how they wish to live their everyday lives and receive care, subject to the communities' rules, as long as those rules do not violate regulatory requirement.Record review of the facility document titled, Activities Program with revision date January 2025 revealed in part, .Self-determination and participation.The resident has the right to interact with members of the community, both inside and outside the community, and to make choices about aspects of his or her life.In order to ensure the resident's continuity of care, the resident and/or their representative or family should collaborate with the nursing team to coordinate medical care, support needs, and services accordingly. Event ID: Facility ID: 675890 If continuation sheet Page 5 of 7 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 08/04/2025 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure sufficient nursing staff with appropriate competencies and skills set to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plan of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment for 1 of 3 nursing staff (LVN A) reviewed for nursing services. LVN A did not notify the DON or the Administrator until Monday 7/14/25 when Resident #1 went out on pass on Friday 7/11/25, and the resident did not return. Resident #1 was scheduled to return to the facility on Saturday 7/12/25.This failure could place residents at risk of staff not providing nursing or related services to meet the residents' needs safely and in a manner that promotes each resident's rights, physical, mental and psychosocial well-being.The findings included:Record review of Resident #1's face sheet dated 7/30/25 revealed a [AGE] year-old male admitted to the facility on [DATE] and re-admitted on [DATE] and 4/16/25 with diagnoses that included heart failure, seizures (sudden, uncontrolled electrical disturbance in the brain that may cause changes in behavior, movements, feelings, or levels of consciousness), diabetes (chronic medical condition in which the body either doesn't produce enough insulin or doesn't use insulin effectively which helps regulate blood sugar levels), chronic kidney disease stage 3 (moderate stage of kidney damage where the kidneys aren't functioning as well as they should to filter waste and fluids from the blood), atrial fibrillation (irregular heartbeat rhythm where the heart beats rapidly and irregularly), hypertension (elevated blood pressure), and pain.Record review of Resident #1's most recent quarterly MDS assessment dated [DATE] revealed the resident was moderately cognitively impaired for daily decision-making skills, utilized a wheelchair for mobility, was dependent on staff with transfers, and was always incontinent of bowel and bladder.Record review of Resident #1's comprehensive care plan with revision date 1/28/25 revealed the resident had a self-care deficit related to poor mobility, debility, weakness, and seizures with interventions that included to assist the resident with bed mobility, required the use of a wheelchair, and required assistance with transfers with use of a mechanical lift. The comprehensive care plan revealed Resident #1 was at risk for falls related to debility, weakness, amputation, and seizures. Record review of the facility document titled, Release of Responsibility for Leave of Absence revealed Resident #1 signed out to go on pass on Friday, 7/11/25 at 12:09 p.m. The document had Resident #1's signature under the section that read, Signature of Person Accepting Responsibility.Record review of Resident #1's electronic record revealed a progress note dated 7/11/25, with time stamp 12:15 p.m. and authored by the Administrator revealed, Resident #1 stated that he was going out on pass with friend. He (Resident #1) said he was planning on leaving and staying at her house overnight to attend church tomorrow for services. Patient signed himself out in the sign out book.Record review of Resident #1's electronic record revealed a progress note dated 7/11/25, with time stamp 1:55 p.m. and authored by the SW revealed, Patient (Resident #1) stated he was going out on pass with his friend. He stated that he would be leaving today and staying overnight at her house and would be going out to eat, shop, and attend church services tomorrow. Patient signed himself out in the sign out book.Record review of Resident #1's electronic record revealed a progress note dated 7/12/25 (Saturday), with time stamp 3:35 p.m., and authored by LVN A revealed Resident #1 was OOP (out on pass).Record review of Resident #1's electronic record revealed a progress note dated 7/14/25 (Monday), with time stamp 7:48 a.m., and authored by LVN A revealed Resident #1 was Out on pass.During an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675890 If continuation sheet Page 6 of 7 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 08/04/2025 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete interview on 7/31/25 at 11:33 a.m., LVN A stated, Resident #1 told him he was only going out on pass for a couple of hours and was coming back the same day (7/11/25), which was why he did not give the resident medications to take with him on pass. LVN A stated he reported to the Administrator on Monday 7/14/25 that Resident #1 had gone out on pass on Friday 7/11/25 and it was now Monday (7/14/25), and the resident was not back. LVN A stated he reported that information to the Administrator because it was more than three days. LVN A stated the Administrator took the information from him but did not say anything to him. During an interview on 7/31/25 at 12:35 p.m., the DON stated Resident #1 was leaving out on pass with a friend but was not aware the resident was going to leave overnight until she saw the SW's progress note the following working day, Monday 7/14/25. During an interview on 7/31/25 at 4:55 p.m., Resident #1 stated he told the Administrator he was going out on pass on Friday 7/11/25 and would return on Monday 7/14/25. Resident #1 stated he communicated with the DON about leaving out on pass and was referred to the nurse to sign out. Resident #1 stated he did not recall who the nurse was but stated he told the nurse he would be back on Monday 7/14/25. Resident #1 stated he did not leave with any medications.During a follow up interview on 8/1/25 at 9:49 a.m., LVN A stated, when Resident #1 did not return on Saturday, 7/12/25, I don't remember telling administration, I only passed on that information at report with the nursing staff. LVN A stated, I was like he (Resident #1) didn't come back and he's not getting his medications and insulin, and he was still out on pass, what could I do about it. He's out on pass, so. LVN A stated he could not recall talking to the DON or ADON about it and was off on Sunday, 7/13/25, and when he returned on Monday 7/14/25 he informed the Administrator about it and probably mentioned it to the ADON or DON, because at that point I was like is he coming back? During a follow up interview on 8/4/25 at 12:45 p.m., the DON stated it was her expectation, when a resident went out on pass and did not return at the designated time, the nursing staff were supposed to have some sort of follow up, notify the representative, and the resident themselves. The DON stated nursing staff were supposed to notify her and the Administrator when the resident did not return at the designated time. The DON stated, if they (nursing staff) didn't report to us, we would not know the resident didn't return. Event ID: Facility ID: 675890 If continuation sheet Page 7 of 7