Health inspection·December 3, 2025

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few or completed by an RN. She stated it is always done by the admitting nurse, and she was that person. LVN B stated Resident #1's admission occurred during day shift on regular weekdays. She stated there was an RN in the building when the admission occurred. During an interview on 12/03/2025 at 1:11 p.m. the DNS (Director of Nursing Services on facility records) that had been promoted but was still in the process of transitioning. She stated she was still providing oversite to the facility in an interim manner for a few more days. She stated her last day as DON was officially 11/21/2025 however she was remaining in the facility as interim DON until the new DON had completed training. She stated she was not sure when that would be. The DNS stated either a licensed or registered nurse was able to complete a new admission. She stated LVN B did conduct the initial assessment which included the baseline care plan for Resident #1. She stated an RN should go behind the LVN within 48 hours and review the assessment and baseline care plan and document the review. She stated on the last page of the baseline care plan and initial assessment there was a place to document the RN review. The DNS stated she did not consider a complete head-to-toe assessment to be a comprehensive assessment, rather each section was considered a focus assessment. The DNS stated there was a part of the initial baseline assessment/care plan that should only be done by an RN and that the care plan interventions. After reviewing Resident #1 care plan she stated acknowledgement that LVN B had completed the baseline care plan interventions, and the document was not signed as reviewed by an RN. The DNS stated the facility had an interdisciplinary team M-F, with a RN on staff should review it and make sure everything was covered. She stated she was not sure why Resident #1's was missed. She stated there was an RN in the building from 6 am to 10 p.m. She personally was in the building until 8 pm, most nights and many nights there was also an RN available for review. The DNS stated she LVN B was the admitting nurse so her completing the baseline care plan automatically triggered initiation of the comprehensive care plan, also by LVN B. She stated that was how the charge nurses were trained. The DNS stated the DON was responsible for ensuring nursing scope of practice was followed. During an interview on 12/03/2025 at 4:56 p.m., the new DON stated he had been the DON since last week and was not under the direction of DNS. He stated the DNS was still at the facility until he adjusted to the facility and learned the corporate ways. He stated he was the one communicating in morning meetings and the DNS was acting as his support person from the clinical aspect who also happened to be the previous DON/interim Director. The new DON stated he expected the LVN charge nurse to complete a full assessment upon admission, lock it and then he would review it, usually within 48-72 hours. He stated he was aware of all new admission residents, and he knew who is coming in to the facility. He stated in addition; he reviewed PCC daily. He stated it had been corrected (after surveyor intervention). He stated he ensured everything was transferred over from the initial assessment/baseline care plan to the comprehensive care plan. He stated this was important for the care of the resident. Record review of LVN B Licensed Nurse Competencies Checklist dated 6/12/2025 revealed: Admissions/Re-admissions: completion of nursing admission UDA (assessment) and initial plan of care upon admission was a category that was marked as successfully completed. Record review of LVN B nursing license revealed she held a current Licensed Vocational Nursing license in the state of Texas. Record review of the Texas Board of Nursing LVN Scope of Practice revealed: Board Rule 217.11(1)(A): Standards Specific to Vocational Nurses. The licensed vocational nurse practice is a directed scope of nursing practice under the supervision of a registered nurse, advanced practice registered nurse, physician's assistant, physician, podiatrist, or dentist. (i) collecting data and performing focuses nursing assessments. Assessment: the LVN collects data and information, recognizes changes in conditions and reports this to the RN supervisor or another appropriate clinical supervisor to assist in the identification of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675968 If continuation sheet Page 2 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 problems and formulation of goals, outcomes and patient centered plans of care that are developed in collaboration with the patients, their families and the interdisciplinary health care team. The LVN cannot perform independent assessments as the LVN has a directed scope of practice under supervision. The RN is responsible for overall coordination of care and performs comprehensive assessments, initiates the nursing care plan and implements and evaluates care of the client or patient. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675968 If continuation sheet Page 3 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on interview and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate dispensing and administering of all drugs and biologicals to meet the needs of each resident and determined that drug records were in order and that an account of all controlled drugs was maintained and periodically reconciled for 1 of 4 residents (Resident #1) reviewed for pharmacy services. The facility failed to ensure Resident #1's Lantus (insulin glargine- a long-acting insulin) was administered on 11/28/2025. This failure could place the residents at risk of hyperglycemia (elevated blood glucose levels) and poorly controlled diabetes. The findings included: Record review of Resident #1's face sheet dated 12/02/2025 revealed an admission date of 11/28/2025 with diagnosis which included: acute on chronic combines systolic congestive and diastolic heart failure (heart failure where both sides of the heart are compromised), type 2 diabetes mellitus without complications and primary open-angle glaucoma bilateral stage unspecified (symptomless vision loss due to elevated eye pressure when then eye drainage system fails). Record review of Resident #1's MDS assessments revealed she did not have a comprehensive assessment due to new admission status. Record review of Resident #1's baseline care plan dated 11/28/2025 revealed she had diabetes with an intervention to administer medications as recommended by her doctor. Record review of Resident #1's Order Summary Report revealed a physician order dated 11/28/2025 for Lantus Solostar subcutaneous (under skin into fat) solution pen-injector 100 unit/m. (insulin glargine), inject 35 units subcutaneously at bedtime for hyperglycemia (elevated blood sugar), hold if blood sugar under 60. Record review of Resident #1's November 2025 MAR revealed Lantus Solostar subcutaneous solution pen-injector 100/unit/ml (insulin glargine), inject 35 units subcutaneously at bedtime for hyperglycemia was documented as given by LVN A at bedtime on 11/28/2025. During an observation and interview on 12/02/2025 at 3:05 p.m. Resident #1 was observed in her room and was aware, alert and conversational. She stated she had been in the facility a few days. She stated she had a few rough days but things had started to improve. She stated she had diabetes that was controlled with shots she took before bed each night. She stated she did not think she got her insulin the first night she was at the facility although she had gotten it every night sense them. She stated she had no noticeable effects from not receiving her medication and had not felt ill. She stated she did tell staff, but she was not sure who she told or when. During an interview on 12/02/2025 at 4:42 p.m., LVN A stated she did not give Resident #1 Lantus subcutaneous injection on 11/28/2025 because the resident was a new admission and she assumed the medication had not yet arrived from the pharmacy. She stated she did provide an accuchecks that was documented. She stated she documented administration of Lantus inadvertently when she only meant to document that she had completed the accuchecks. LVN A stated Lantus (insulin glargine) was available in the facility emergency medication e-kit. She stated she did not access the e-kit to give the Lantus. She stated she did not know why. During an interview on 12/03/2025 at 1:11 p.m. the DNS (Director of Nursing Services on facility records) that had been promoted but was still in the process of transitioning. She stated she was still providing oversite to the facility in an interim manner for a few more days. She stated her last day as DON was officially 11/21/2025 however she was remaining in the facility as interim DON until the new DON had completed training. She stated she was not sure when that would be. The DNS stated Lantus was available in the facility e-kit. She stated the e-kit was a large metal medication cart with a computerized log in and password. She stated the nurse had to type in the resident's name, choose the medication listed to have access to the medication in the e-kit. She stated this was based on the physician order for the medication that had been entered into PCC based upon admission. The DNS stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675968 If continuation sheet Page 4 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #1 was a hospice respite admission from home. She stated the resident brought her home medication but was unsure what had happened. She stated on 12/02/2025 she discovered the Lantus had not been given as ordered on 11/28/2025 and spoke with LVN A who informed her she was not aware the family had brought the Lantus to the facility. The DNS stated LVN A should have accessed the e-kit if the Lantus was missing and administered the insulin to Resident #1. The DNS stated to administer insulin as ordered because the resident could have developed hyperglycemia. Record Review of the facilities policy titled Medication Administration dated January 2024 revealed: Resident medications are administered in an accurate, safe, timely, and sanity manner.6. Administer medication as ordered by the physician. Event ID: Facility ID: 675968 If continuation sheet Page 5 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interview and record review the facility failed to ensure medical records were maintained in accordance with accepted professional standards and practices for each resident, that were complete and accurately documented for 1 of 4 residents (Residents #1) reviewed for accuracy of medical records. The facility failed to ensure Resident #1's progress notes were documented accurately and according to professional standards of practice when LVN A documented she administered Lantus (insulin glargine-a long-acting insulin) on 11/28/2025 when she did not. This deficient practice could place residents at risk for errors in care and treatment and inaccuracies in documentation. The findings include:Record review of Resident #1's face sheet dated 12/02/2025 revealed an admission date of 11/28/2025 with diagnosis which included: acute on chronic combines systolic congestive and diastolic heart failure (heart failure where both sides of the heart are compromised), type 2 diabetes mellitus without complications and primary open-angle glaucoma bilateral stage unspecified (symptomless vision loss due to elevated eye pressure when then eye drainage system fails). Record review of Resident #1's MDS assessments revealed she did not have a comprehensive assessment due to new admission status. Record review of Resident #1's baseline care plan dated 11/28/2025 revealed she had diabetes with an intervention to administer medications as recommended by her doctor. Record review of Resident #1's Order Summary Report revealed a physician order dated 11/28/2025 for Lantus Solostar subcutaneous (under skin into fat) solution pen-injector 100 unit/m. (insulin glargine), inject 35 units subcutaneously at bedtime for hyperglycemia (elevated blood sugar), hold if blood sugar under 60. Record review of Resident #1's November 2025 MAR revealed Lantus Solostar subcutaneous solution pen-injector 100/unit/ml (insulin glargine), inject 35 units subcutaneously at bedtime for hyperglycemia was documented as given by LVN A at bedtime on 11/28/2025. During an observation and interview on 12/02/2025 at 3:05 p.m. Resident #1 was observed in her room and was aware, alert and conversational. She stated she had been in the facility a few days. She stated she had a few rough days, but things had started to improve. She stated she had diabetes that was controlled with shots she took before bed each night. She stated she did not think she got her insulin the first night she was at the facility although she had gotten it every night sense them. She stated she had no noticeable effects from not receiving her medication and had not felt ill. She stated she did tell staff, but she was not sure who she told or when. During an interview on 12/02/2025 at 4:42 p.m., LVN A stated she did not give Resident #1 Lantus subcutaneous injection on 11/28/2025 because the resident was a new admission and she assumed the medication had not yet arrived from the pharmacy. She stated she did provide an accuchecks that was documented. She stated she documented administration of Lantus inadvertently when she only meant to document that she had completed the accuchecks. LVN A stated Lantus (insulin glargine) was available in the facility emergency medication e-kit. She stated she did not access the e-kit to give the Lantus. She stated she did not know why. During an interview on 12/03/2025 at 1:11 p.m., the DNS stated she was interim DON until the new DON finished training and orientation. She stated LVN A had informed her on 12/02/2025 she made an error in documentation and on 11/28/2025. She stated LVN A informed her she did not give Lantus to Resident #1 as documented. The DNS stated she it was important for staff to follow physician orders. She stated inaccurate documentation could lead others to believe that the medication had been administered when it was not. She stated documenting a med was given when it was not, did not meet the facilities expectations. Record review of a handwritten facility document (undated) indicated the facility did not have a policy for documentation or accuracy of documentation. Record Review of the facilities policy titled Medication Administration dated January 2024 revealed: Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675968 If continuation sheet Page 6 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 0842 medications are administered in an accurate, safe, timely, and sanity manner. The policy did not address documentation of medication. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675968 If continuation sheet Page 7 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 through effective communication for 1 of 2 residents (Resident #1) reviewed for hospice services.The facility failed to collaborate with hospice upon Resident #1 admission on [DATE] to ensure the resident received three glaucoma medications she was taking at home and were detailed on her preadmission home health pre-admission paperwork.This deficient practice could place residents who receive hospice services at risk of receiving inadequate care due to a lack coordination of care, and communication of resident needs and could lead in complications of eyesight. The Findings included: Record review of Resident #1's face sheet dated 12/02/2025 revealed an admission date of 11/28/2025 with diagnosis which included: acute on chronic combines systolic congestive and diastolic heart failure (heart failure where both sides of the heart are compromised), type 2 diabetes mellitus without complications and primary open-angle glaucoma bilateral stage unspecified (symptomless vision loss due to elevated eye pressure when then eye drainage system fails). Record review of Resident #1's MDS assessments revealed she did not have a comprehensive assessment due to new admission status. Record review of Resident #1's baseline care plan dated 11/28/2025 revealed the resident was a hospice respite patient. The section of the checklist care plan for vision impairment was not marked and was blank. Record review of Resident #1's Home Health Care IDG Meeting Review notes uploaded into the resident's medical record prior to her admission by the Admissions Coordinator and dated 11/18/2025 revealed a medication reconciliation list which included:1.Lantanoprost (PF) o.005% eye drops, I drop both eyes at hour of sleep for glaucoma effective 9/29/20252. brimonidine 0.2% eye drops, one drops both eyes two times daily for glaucoma effective 9/29/2025.3. Cospoft (PF) 2%-0.5% eye drops 2 drops two times daily in both eyes for glaucoma effective 9/29/2025. Record review of Resident #1's handwritten hospice orders dated 11/28/2025 (date of facility admission) did not include any of the three glaucoma eye drops. The order was signed by the hospice RN and an unknown facility staff member. Record review of Resident #1's Order Summary Report dated 12/02/2025 revealed: 1. Cospopt PF ophthalmic solution 2-0.5%, instill one drop in both eyes two times a day for glaucoma had an order and start date of 12/01/2025. 2. Brimonidine Tartrate ophthalmic solution 0.2%, instill one drop in both eyes, two times a day for glaucoma had an order and start date of 12/01/2025. 3. Latanoprost PF ophthalmic solution 0.005%, instill one drop in both eyes at bedtime for glaucoma had an order and start date of 12/01/2025. Record review of Resident #1's November 2025 MAR's revealed she did not receive any of the three-glaucoma eye drop medications on 11/28/2025, 11/29/20205, or 11/30/2025. Record review of Resident #1's December 2025 MAR revealed she received her first dose of all three-glaucoma eye drops on 12/01/2025 in the morning. During an observation and interview on 12/02/2025 at 3:05 p.m., Resident #2 was observed in bed, with her walker nearby. She was awake, alert, and conversational. She stated she had been in the facility for several days. She stated she had a rough start. She stated she had glaucoma and took three different medications to treat it. She stated she had the medications in her purse since arrival at the facility and had told the staff about it. She stated yesterday in the evening, she told a male nurse (unknown) and he took the medications from her and said he needed to talk to her doctor about them. She stated she thought she would get the medications that night, but she did not. She stated she did receive them yesterday. Resident #1 stated she did not notice any change in her vision from not receiving her eye drops. She stated she was able to get up by herself and use her walker to without assistance. During an interview on 12/02/2025 at 4:02 p.m., LVN B stated Resident #1 was a new admission on [DATE] at approx. 2:00 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675968 If continuation sheet Page 8 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 She stated she was not prepared for the admission. She stated she did not receive a report, and the resident did not have any paperwork with her. She stated Resident #1 came with medications in a little bag, some were over the counter and some were prescriptions. LVN B stated the admission Coordinator told her she was getting a new admission approximately one hour prior to Resident #1 arriving. LVN B stated she was told Resident #1 was a respite hospice patient. She stated the Admissions Coordinator told her the hospice nurse would come to the facility to do her admission. LVN B stated the hospice nurse did not arrive until near the end of the shift at approximately 4 pm. LVN B stated the hospice nurse wrote orders for medications from the hospice physician. LVN B stated she then called the facility NP just to notify them that the patient had arrived but not to reconcile medications. She stated she informed the NP that the hospice nurse wrote orders for medications, and she told her it was okay to accept those orders. LVN B stated she did have access to the medical records including the home health notes under miscellaneous in Resident #1's medical records or use the medication reconciliation against hospice medication orders. She stated she did not look under miscellaneous for them. She just asked the Admissions Coordinator what to do and she was told the hospice nurse would handle it. LVN B stated she was the admitting nurse. She completed an assessment. She stated she asked Resident #1 if she had any vision issues or if she wore glasses and she had said no, that was why she left the care plan blank and she did not consult with family for additional information. During an interview on 12/03/2025 at 11:20 p.m., the Admissions Coordinator stated when she received a referral for care when the resident was coming from home, she would let the people who inquired know she needed medical records from primary care, from home health or from hospice. She stated this information was then sent to the DON for approval. She stated once the approval processes were completed the admitting documents are already uploaded into the medical record. When the admitting nurse admits the resident, the documentation is already there, including the medication list under miscellaneous. The Admissions Coordinator stated she notifies the charge nurse of the admission, she stated she could not say for certain who it was, most likely LVN B. She stated the nurse did not ask any questions or express any concerns when she told them about Resident #1's pending admission. She stated LVN B did not ask for the documentation or medication list from her because she already knew it was in the computer. During an interview on 12/03/2025 at 12:08 p.m., the Hospice RN stated she was the nurse who came to the facility to admit Resident #1. She stated she asked the nurse (LVN B) for any medications the family had brought in. The Hospice Nurse stated she used the medications given to her by LVN B to write orders for the facility for the medications. The Hospice RN stated she did have access to the medication list of the medications Resident #1 used at home but did not review the list when writing the orders. She stated she relied on the charge nurse (LVN B) to provide her with the information. The Hospice RN stated if the family did not provide all the medications in physical form she would have missed those medications when writing orders. She stated she was unable to review the medications or orders written from hospice at the time of the interview. During an interview 12/03/2025 at 12:15 p.m., several members of Resident #1's family stated they were upset Resident #1 did not receive her glaucoma eye medication for several days. They stated the eye drops were given to facility staff upon admission in the bag with the rest of her medication. They stated they were told by the resident and staff (unknown name) that the eye drops were found in the basket of Resident #1's walker. During an interview on 12/03/2025 at 1:11 p.m. the DNS (Director of Nursing Services on facility records) that had been promoted but was still in the process of transitioning. She stated she was still providing oversite to the facility in an interim manner for a few more days. She stated her last day as DON was officially 11/21/2025 however she was remaining in the facility as interim (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675968 If continuation sheet Page 9 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 DON until the new DON had completed training. She stated she was not sure when that would be. The DNS stated she learned there was a concern for Resident #1's medication on 12/01/2025. She stated Resident #1 stated she had not gotten her eye drops. The DNS stated she told the resident she needed to check her orders. She stated they did not see any orders for them. She then got the hospice orders, and they were not there. The DNS stated she then went back to Resident #1 for more information. She stated Resident #1 told her there were three medications. She did not know the names of the medications but could remember the first letter of each one. The DNS stated she asked the resident if she had given the medications to the nurse and she said no, they are right here. The DNS stated she opened her walker (basket) and they were sitting right there. She stated she asked Resident #1 if she could take them and call hospice so they could start administering them. The DNS stated she called hospice, got a verbal order and then told Resident #1 they would start administering the eye drops. She stated she also notified the family about the eye drops and they did not express any concerns. The DNS stated the facility did not go by the medication reconciliation list provided by hospice home health because it was uploaded/dated 11/20/2025 and the resident was not a patient here at that time. She stated they go by what orders the hospice company (hospice RN) writes. The DNS stated the hospice RN was responsible for calling and verifying with her hospice company/physician. She stated what the hospice company writes proceeds anything written prior to it. The DNS stated they were coordinating services with the hospice company ensuring the hospice nurses come in and greet the patient, goes over their home meds with them, then comes to our nurse with their orders. She stated the hospice nurses' orders are the ones they follow. The DNS stated her admitting nurse and the facility nurses had no responsibility to review the med reconciliation list. She stated they do not refer to that. She stated their responsibility was what was in front of them. She stated the purpose of the medication reconciliation list was to refer to if they had questions. During an interview on 12/03/2025 at 4:56 p.m., the new DON stated he had been the DON since last week and was not under the direction of DNS. He stated the DNS was still at the facility until he adjusted to the facility and learned the corporate ways. He stated he was the one communicating in morning meetings and the DNS was acting as his support person from the clinical aspect who also happened to be the previous DON/interim Director. He stated the facility coordinated care with hospice ensuring the Admissions Coordinator coordinated the admission. He stated the admission was communicated on PCC dashboard that a patient was coming and what room they were assigned. The new DON stated that after the patient arrived, the nurse should greet them and settling them into their new home. He stated the hospice nurse reconciles medications with the charge nurse. He stated they obtain all the medications with the patient and write out the orders. The hospice nurse reviews them with the facility nurse quickly and the facility nurse was responsible for putting the orders into PCC. The new DON stated the facility nurse did not have any responsibility for review of information provided prior to admission including a list of medications taken at home. He stated this was extra information, in case something was missing and was meant more for the leadership team. He stated members of the IDT team including himself found the missing medication, added it to the orders and she was given her eye drops the same day. The new DON stated he sent the DNS to talk to Resident #1 and address any concerns she had, and she was happy. He stated the facility found Resident #1 had the medications on her walker. The new DON stated no one from the IDT team or management had reviewed Resident #1's medications on the date of her admission. He stated it was hospices responsibility to review the reconciliation list, write an order and give it to the facility charge nurse. He stated it is them the facilities responsibility to assume care. He stated when a resident comes from the hospital the nurses review their paperwork. He stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675968 If continuation sheet Page 10 of 11 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 675968 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stone Oak Care Center 505 Madison Oak Dr San Antonio, TX 78258 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 FORM CMS-2567 (02/99) Previous Versions Obsolete difference with an admission when it is hospice is that hospice is doing the admitting, not the facility. Record review of a contract between the hospice company and facility referred to as Center in the contract dated 10/23/2019 revealed: 5.6 Cooperation with Hospice Staff: Center (facility) shall cooperate with Hospice staff members in carrying out each patients POC (plan of care).Section 6 Mutual Rights, Duties, and Obligations of the Parties 8.1 Development and Implementation of Plan of Care. When a Center resident is authorized by Hospice for admission program, or when the Center admits a Hospice patient to the Center. Hospice and Center shall jointly develop and agree upon the patients POC. Hospice shall retain overall professional management of and responsibility for directing the implementation of each patient's plan of care. Center shall be responsible for implementing those portions for the patient's plan of care that qualify as room and board services, inpatient services or respite services. Record review of the facilities policy titled End of Life Care and Coordination-Hospice/Palliative Care dated January 2023 revealed: 1. Physician orders should be obtained to clarify specific treatments, procedures and activity. 2. The resident and family should participate in developing the plan of care, where appropriate. Event ID: Facility ID: 675968 If continuation sheet Page 11 of 11