Inspection·July 28, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm During an interview on 07/25/2023 at 11:05 AM LVN B, revealed she was the assigned LVN for Resident # 24. LVN B confirmed that Resident #24's call light was out of reach of Resident #24 and was in a chair next to Resident # 24, out of arms reach; LVN B confirmed that it was not normal nursing practice for a resident to be left without a call light. LVN B remarked that the absence of the call light could constitute potential harm leading to a possible fall if the call light were not within reach. Residents Affected - Few During an interview on 07/26/22 at 11:49 AM the DON, stated that the facility had a call light policy and staff has been in-serviced many times to keep call light within residents reach. The DON also confirmed that Resident # 24's care plan addressed the need for a call light within reach. She said she did not know why it was not within Resident #24's reach but would ensure all staff was in-serviced on this process again. The DON stated that the lack of call lights within reach risked possible negative patient outcomes . 2. Review of Resident #158's admission record, dated 7/28/23, revealed she was admitted to the facility on [DATE] with diagnoses including Heat Exhaustion and Major Depressive Disorder, recurrent (A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life). Review of Resident #158's initial admission record, dated 7/21/23, revealed she was alert to time, place and person and able to follow simple commands. Review of Resident #158's Care Plan, dated 7/21/23, revealed she had an ADL Self Care Performance Deficit and one approaches included to encourage to participate to the fullest extent possible with each interaction and encourage to use bell to call for assistance. Observation and interview on 07/27/23 at 4:40 PM revealed Resident #158 sitting up in her wheelchair in front of the TV. Resident #158 stated the remote she had did not work on the TV. She asked to change it out. Resident #158 was encouraged to use the call light to get help from staff. She stated she did not know where it was located. Further observation revealed the call light was wrapped around the side rail of the bed behind Resident #158. Surveyor triggered the call light. CNA H responded to the call light within minutes, untangled the call light from the side rail and clipped it to Resident #158's shirt sleeve. CNA H stated the call light was not within Resident #158's reach and should be so she could ask for assistance as needed. CNA H stated he reported to work at 2 PM and did not transfer Resident #158 into her wheelchair. Interview on 07/27/23 at 4:45 PM LVN I revealed she had worked at the facility for 18 months and worked from 2 to 10 PM on the rehabilitation hall. She stated the MA and CNA's moved Resident #158 from side A to side B shortly before Surveyor walked into the resident's room. LVN I stated she had not been in the resident's room since being moved. She stated Resident #158 would use the call light for staff assistance and stated the call light should be within the resident's reach. She stated every staff who entered the room should check for call light placement making sure the resident had access to the call light. Interview on 07/28/23 at 01:47 PM the DON revealed CNA's on the hall reported they had just moved Resident #158 from side A to side B in the room She stated the CNA's also removed all the linens and walked out to dispose of the linens when the Surveyor walked into Resident #158's room. The DON stated the morning nurse and LVN I both reported Resident #158 did not like the call light clipped on her but stated the CNA's should have made sure the call light was within reach. The DON further stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 2 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0558 Level of Harm - Minimal harm or potential for actual harm any staff who went into the resident's room should check call light placement and ensuring it was within reach. Record review of facility policy. Call Light / Bell, dated 5/2007, revealed, Place call device is within residents reach. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 3 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to conduct initially a comprehensive standardized reproducible assessment of each resident's functional capacity within 14 calendar days after admission for 1 of 6 residents (Resident #157) reviewed for comprehensive assessments. The facility failed to ensure Resident #157's comprehensive assessment was completed within 14 days. This deficient practice could place residents at risk of not having their needs met as needed. The findings were: Review of Resident #157's face sheet, dated 7/27/23, revealed she was admitted to the facility on [DATE] with diagnoses including Hypertensive Urgency and Type 2 Diabetes Mellitus without complications. Review of Resident #157's admission MDS assessment revealed it was completed on 7/27/23 revealed her BIMS was 3 out of 15 indicative of severe cognitive impairment. Interview on 07/28/23 at 11:39 AM the MDS Coordinator revealed a resident MDS assessment should be completed 14 days after admission. He stated Resident #157 was admitted to the facility on [DATE] and her admission MDS assessment was due on 7/17/23. The MDS Coordinator stated an MDS assessment identified Resident #157's personal historical information, care areas and services she would require and receive while in the facility. Interview on 07/28/23 at 02:00 PM the DON revealed the IDT and the MDS regional nurse's were responsible for ensuring the resident's MDS assessments were completed timely. The DON stated they had missed the due date for Resident #157's assessment. The DON stated the purpose of the MDS assessments was to identify a resident's care needs, services and level of care they required during their stay at the facility. Therefore, it was important to complete it timely in order to understand and plan for the resident's care. Facility policy was requested from the DON on 07/28/2023. No policy was provided prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 4 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a comprehensive care plan was developed within 7 days after the completion of the comprehensive assessment and failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment; there was an update for 2 of 21 residents (Resident # 13 & #157) whose care plan was reviewed, in that: 1. The facility failed to update Resident #13's care plan when he started Depakote on 2/14/23. 2. The facility failed to develop Resident #157's comprehensive care plan within the required time frame. These deficient practices could place residents at risk of receiving incorrect care and cause health complications with subsequent illness. The findings were: 1. Record review of Resident #13's face sheet dated 7/26/2023 revealed the resident was an 86- year-old female who was admitted to the facility on [DATE] and had diagnoses that included: [Type 2 diabetes] condition in which your cells don't normally respond to insulin, [Atopic dermatitis] is a condition that causes dry, itchy, and inflamed skin and [anxiety disorder] persistent and excessive worry that interferes with daily activities. Record review of Resident #13's Quarterly MDS dated [DATE] revealed the resident had a BIMS score of 12, which indicated the resident was moderately impaired. Record review of Resident #13's physician orders, reviewed on 7/25/2023, revealed the resident had an order for Depakote written on 2/14/23. In an interview on 7/26/2023 at 9:39 a.m., MDS /RN D stated that at [facility name], we follow an interdisciplinary team approach to care plans, and all team members in nursing administration assist with care plans. MDS/ RN D confirmed that the care plan for Depakote should have been added when Resident # 13 started on the medication on 2/14/23. MDS/RN D reported the negative outcome with the care plan not added was staff would not know what side effects to look for. MDS/RN D did not know why the care plan was not added and referred the surveyor to the DON. In an Interview with DON on 7/27/23 at 10:35 a.m., the DON stated that the care plan had not been revised to include the medication Depakote for Resident # 13. The DON revealed that care plans are updated by the interdisciplinary team. She further revealed that the entire nursing leadership team is responsible for updating care plans, she was unsure of how the update to the care plan was missed. The DON stated that by not revising care plans nursing staff risked not being on the same page in regard to resident care. 2. Review of Resident #157's face sheet, dated 7/27/23, revealed she was admitted to the facility on [DATE] with diagnoses including Hypertensive Urgency and Type 2 Diabetes Mellitus without complications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 5 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0657 Review of Resident #157's comprehensive care plan revealed it was completed on 7/25/23. Level of Harm - Minimal harm or potential for actual harm Interview on 07/28/23 at 11:39 AM the MDS Coordinator revealed a resident comprehensive care plan should be completed 7 days after the completion of the admission assessment. He stated Resident #157 was admitted to the facility on [DATE]. Her care plan was due on 7/24/23 and was not completed until 7/25/23. The MDS Coordinator stated the care plan identified the residents care needs; goals and interventions to achieve the resident's goals to maintain or improve their current level of functioning. He stated a care plan was used as a tool to communicate the resident's care needs to nursing staff who all had access to it through their electronic software. Residents Affected - Few Interview on 07/28/23 at 02:00 PM the DON revealed the IDT and the MDS regional nurse's were responsible for ensuring the resident's Care Plans were completed timely. The DON stated they had missed the due date for Resident #157's Care Plan. The DON also stated the care plan was used as a communication tool for nursing staff which identified the resident's care needs and level of care they needed. Record review of Facility policy Care Planning, dated 5/2007, revealed the Interdisciplinary team shall develop a comprehensive care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 6 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure each resident received assistive devices to prevent accidents for 1 of 6 residents (Resident #157) reviewed for falls. The facility failed to ensure nursing staff used a gait belt when providing Resident #157 with assistance during a transfer. This deficient practice could place any resident who required assistance with transfers at risk for avoidable falls. The findings were: Review of Resident #157's face sheet, dated 7/27/23, revealed she was admitted to the facility on [DATE] with diagnoses including Acute Kidney Failure, Dehydration and unspecified Dementia (range of conditions that affect the brain's ability to think, remember, and function normally). Review of Resident #157's admission MDS assessment, dated 7/27/23, revealed her BIMS was 3 out of 15 indicative of severe cognitive impairment, she required limited assistance by 1 person for transfers, was not steady and only able to stabilize and she had a fall in the last month prior to admission. Review of Resident #157's Care Plan, dated 7/25/23, revealed she had an ADL Self Care Performance Deficit r/t AKI , Insomnia , HTN, dementia , repeated falls, lack of coordination, need for assistance with personal care, weakness, incontinence and one of the interventions included she required limited assistance by 1 person with transfers. Review of Resident #157's transfer self-performance for July 2023 revealed she required limited to extensive assistance with transfers. Review of Resident #157's fall risk assessment, dated 7/3/23, revealed she was a medium risk for falling related to: 'she was disoriented x 2, had 1 to 2 falls in the past 3 months, was regularly incontinent and she required assistive devices with gait/balance/ambulation. Review of Resident #157's rehabilitation tab read PRECAUTIONS (OT) Present (OT) FALL RISK, confusion DX: 2 falls in 2 days and diagnosed with renal insufficiency, AKI, HTN, fever, frequent falls, dehydration, heat exposure, dementia. CT lumbar displayed multilevel spinal stenosis at L3-L4, L4-L5 (lumbar-spinal segment) PMH: renal insufficiency, dementia. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 7 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0689 Review of Resident #157's weight, dated 7/24/23, revealed she weighed 174 pounds. Level of Harm - Minimal harm or potential for actual harm Observation and interview on 07/26/23 at 12:30 PM revealed Resident #157 sitting in a chair watching TV. She requested assistance with toileting and was encouraged to use call light for staff assistance. Resident #157 triggered the call light and CNA J responded to the call light within minutes. CNA J asked Resident #157 what she needed and Resident #157 asked CNA J for help to go to the bathroom. CNA J asked the Resident if she needed assistance and the resident said yes. Further observation revealed CNA J positioned the wheelchair next to Resident #157. CNA J then held Resident #157's right hand with her hand and lifted the resident with her left hand while holding onto under the resident's left arm. Resident #157 was not able to fully stand upright; was doubled over and extremely shaky and unsteady when she took a few steps. Resident #157 pivoted and sat on the wheelchair and it rolled back. CNA J stopped the wheelchair with her foot and then pulled Resident #157 back in the wheelchair by her pants. CNA J proceeded to wheel Resident #157 to the bathroom. Residents Affected - Few Interview on 07/26/23 at 12:45 PM CNA J revealed she did not use a gait belt while assisting Resident #157 into the wheelchair because she thought Surveyor was going to tell her to do something else. When asked why she thought that she stated, I don't know. CNA J stated she should have used the gait belt for stability and safety to keep the Resident from falling. CNA J stated Resident #157 sometimes required assistance and sometimes she could help more. However, she stated regardless she should always use a gait belt which would help to prevent a fall or break the fall as needed. CNA J stated she engaged the brakes on the wheelchair but also noted the wheelchair rolled backwards when Resident #157 sat down. CNA J stated she would let the MS know about it because the wheelchair could need brakes. CNA J stated PT assessed all residents upon admission and would let the floor staff know what level of assistance the residents required. She stated PT provided training and she would also watch PT personnel while they transferred residents to learn proper techniques. Interview on 07/27/23 at 9:45 AM the DON revealed CNA J reported she did not use a gait belt while transferring Resident #157. The DON stated CNA J should use the gait belt for safety reasons and to prevent a fall in the event Resident #157 lost her balance. The DON stated CNA J also told her sometimes Resident #157 was sometimes more independent. However, she stated CNA J should always use a gait belt during a 1 person assist. The DON stated the CNA's were trained regularly on transferring techniques. Interview on 07/27/23 at 11:50 AM the ADM and DON revealed the ADM reiterated what CNA J reported previously. He stated the rehab depart assessed all residents upon admission to determine the level of assistance they required before staff were allowed to assist with any transfers. He stated residents were encouraged to do as much as they could on their own which was part of the rehab process. However, he stated a gait belt should be used for safety when the CNA's provided assistance during a 1 person transfer. The DON revealed she talked with the rehab department who told her Resident #157 had required supervision, stand by and extensive assistance with transfers at different times during her rehab process. Interview 07/27/23 at 11:30 AM the MS revealed he checked Resident #157's wheelchair. He stated the brakes were fine and when he engaged the brakes the wheelchair did not move. The MS stated he replaced the latch which engaged the brakes and tightened it up to ensure it was working properly. Review of a facility policy, Quality of Care, Transfer of a Resident, dated 05/2007, read It is the policy of this facility to transfer a resident in a safe manner. The procedures used to help residents during a transfer vary depending on the condition, abilities, and needs of the individual (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 8 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0689 Level of Harm - Minimal harm or potential for actual harm resident. The CNA should use the following guidelines to ensure safe and efficient transfers: 6. Use a gait belt for all transfers if gait belts are not contraindicated for the resident. 1. One-per transfers using a gait belt. B. Apply the gait felt around the resident's wait. D. Lock the wheelchair brakes. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 9 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure that a resident who needed respiratory care and services, including oxygen administration was provided such care, consistent with professional standards of practice for 1 of 1 residents (Resident #52) reviewed for respiratory therapy in that: Residents Affected - Few The facility did not obtain a signed physician's order prior to providing oxygen therapy for Resident #52. This deficient practice could affect residents who received oxygen therapy and could result in incorrect oxygen support and an increase in respiratory complications. The findings were: Record review of Resident #52's face sheet, dated 07/27/2023, revealed an original admission date of 12/02/2022, and current admission of 03/08/2023 with diagnoses that included: senile degeneration of brain (progressive loss of memory, mental abilities, and personality changes), malignant neoplasm of colon (colon cancer), Crohn's disease (chronic bowel disease that causes inflammation and irritation in the digestive tract), and thrombocytopenia (abnormally low levels of platelets in the blood). Record review of Resident #52's Quarterly MDS dated [DATE], revealed the resident's BIMS score was 11, which indicated moderate cognitive impairment. Further review revealed Resident #52 had not received oxygen therapy during the 14 day look back period for this assessment. Record review of Resident #52's Care Plan revealed a focus created on 03/28/2023, respiratory. [Resident] has altered respiratory status/difficulty breathing r/t hx of SOB on hospice services. Further review revealed an intervention to provide oxygen as ordered. Record review of Resident #52's electronic medical record Order Summary Report, Active Orders as of 07/27/2023, revealed no orders for oxygen. Further review revealed an order for 2-4 liters NC PRN SOB as needed, with a discontinued date of 06/05/2023. During an observation of Resident #52 using oxygen and interview at the same time on 07/26/2023 at 03:15 pm, Resident #52 revealed he doesn't always use the oxygen, I don't use it when I sleep, but that he uses it when I need it. During an interview and record review with LVN A on 07/27/2023 at 01:01 pm, LVN A revealed Resident #52 uses the oxygen at times. Reviewed Resident #52's electronic record with LVN A who was unable to find a current order for oxygen therapy. LVN A stated that Resident #52 had used oxygen in the past and then stopped, so the doctor had discontinued the order. LVN A revealed however that Resident #52 continued to use the oxygen from time to time and she had looked yesterday to see if there was an order, didn't find one and was going to get the order. During an interview with the DON on 07/27/2023 at 04:46 p.m., the DON confirmed there had been no order for oxygen for Resident #52 and it should have been in place for the resident to be receiving oxygen therapy. She stated LVN A had brought it to her attention and the MD was contacted for an order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 10 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0695 Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy titled, Oxygen Administration, revised 05/2007, revealed, It is the policy of this facility that oxygen therapy is administered, as ordered by the physician or as a nursing measure until the order can be obtained. Procedure: 1. Obtain appropriate physician's order. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 11 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were seen by a physician at least once every 30 days for the first 90 days after admission for 1 of 6 residents (Residents #51) whose care was reviewed. Residents Affected - Few Physician K did not conduct an initial visit with Resident #151 within the first 30 days after admission. This deficient practice could place any newly admitted residents at risk for not having their physician visit completed in a timely manner and could lead to a decline in health status or untreated conditions. The findings were: Review of Resident #151's face sheet, dated 7/28/23, revealed her admission date was 7/17/23 with diagnoses including Hypertensive Urgency and Type 2 Diabetes Mellitus without complications. Further review revealed Resident #151 was skilled with QHS (Quaque [NAME] somni) waiver (a temporary exemption from a 3-day hospitalization prior to a skilled stay) and had part A (Provides inpatient/hospital coverage, skilled nursing, and hospice services), B (Provides outpatient/medical coverage) & D (Provides prescription coverage) medicare coverage. Review of Resident #151's EMR revealed no assessment from Resident #151's PCP, Physician K, since her admission on [DATE]. Further review revealed there was only a progress note, dated , 7/22/23, from NP L, who was affiliated with Physician K. Observation on 07/26/23 at 12:05 PM revealed Resident #151 was lying in bed with the head of bed at about 30-degree incline and eating lunch. Resident #151 stated her appetite had not been good. Further observation revealed she received the alternate meal: rice, baked fish, green beans and strawberry shortcake. Resident #151's face was pale in color. Interview on 7/28/23 at 3:45 PM with the DON and the ADM confirmed the initial medical assessment after Resident #151's was on 7/22/23 by NP L. The DON stated if Physician K had seen Resident #151, there would be a document in Resident #151's EMR titled, History and Physical. The Administrator and DON refuted the NP L was not allowed to conduct the initial physical assessment because NP L did not work for the facility. The ADM and DON stated Resident #151 had managed care part B coverage. Review of facility policy, Resident Services, Physician/NP Assessment, dated 05/2017, read: It is the policy of this facility to have written policies and procedures governing when the facility will require a physician assessment be conducted upon a resident. The Community shall require a physician assessment upon the following events: 2. New admission to physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 12 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen, in that: Residents Affected - Many 1. There was a zipper-sealed bag in the reach in cooler filled with cut lettuce leaves that were brown. 2. There was a clear plastic storage container of food thickener in the dry storage room that was not properly sealed. These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness. The findings included: 1. Observation on 07/25/2023 at 2:55 p.m. in the reach in cooler revealed a zipper-sealed bag that was filled with cut Romaine lettuce leaves. Most of the lettuce leaves had brown parts and there was a green slimy substance at the bottom of the bag indicating some of the lettuce was in a rotten state. There was a label on the bag that read, 7/10. During an interview on 07/25/2023 at 2:56 p.m. with the DS, she stated the date on the lettuce bag was the date it was stored in the cooler. The DS agreed that the bag of lettuce had been in the cooler for 15 days and was not fit to serve the residents because it could make them sick. The DS further stated all dietary staff members had been trained on when to discard produce no longer fit to serve both by her and the consultant dietitian. 2. Observation on 07/25/2023 at 3:00 p.m. in the dry storage room revealed a clear plastic food storage container on a rack containing food thickener. The container was approximately ¼ full and was loosely covered with a green plastic lid. The lid did not completely cover the container, leaving an area approximately 2 x 2 exposed. Further observation revealed when the DS attempted to seal the container with the lid, the lid did not fit on the container and the DS could not seal the container. The DS reached over to an adjacent rack, retrieved a lid from the rack, placed it on the container and sealed it. During an interview on 07/25/2023 at 3:02 p.m. with the DS she stated the the lid covering the container of food thickener the wrong one. She further stated dietary employees were likely in a hurry and grabbed the wrong lid to cover the container. The DS stated that all dietary staff store food in the dry storage room, were trained on how to properly store food, and failing to ensure containers were properly sealed could result in deterioration in food quality and potential contamination from rodents and pests, resulting in food borne illness. During a later interview on 07/25/2023 at 3:30 p.m. with the DS she stated the facility used the Texas Food Establishment Rules (TFER) dated October 2015 as its policy manual. Review of the TFER dated October 2015, §228.2 (143) revealed, Time/Temperature Controlled for Safety (TCS) food (TCS) - (formerly Potentially Hazardous Food) A food that requires (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 13 of 14 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 676113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation Center - 2003 W Hutchins Place San Antonio, TX 78224 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many time/temperature controlled for safety to limit pathogenic microorganism growth or toxin formation .a plant food that is heat-treated or consists of raw seed sprouts, cut melons, cut leafy greens, cut tomatoes or mixture of cut tomatoes that are not modified in a way so that they are unable to support pathogenic microorganism growth or toxin formation . Review of the TFER dated October 2015, §228.66 (a)(1)D, revealed Preventing food and Ingredient Contamination. Packaged and unpackaged food - separation, packaging and segregation. Food shall be protected from cross contamination by: storing the food in packages, covered containers or wrappings. Review of the U.S. FDA Food Guidance & Regulation (Food and Dietary Supplements) Program Information Manual Retail Food Protection: Recommendations for the Temperature Control of Cut Leafy Greens during Storage and Display in Retail Food Establishments, current as of 03/07/2022, revealed: Storage and Display. If fresh leafy greens are cut or chopped within the food establishment, the cut product must be discarded if not sold or served within 7 days of the time the product was cut (3-501.18). The product must be marked to indicate the date by which disposal is required, unless the cut product is held less than 24 hours from the time it was cut. (3-501.17). Review of the Food Code, U.S. Public Health Service, U.S. FDA, 2017, U.S. Department of H&HS, revealed, 3-305.1, Food Storage, (A) Food shall be protected from contamination by storing the food: (1) in a clean, dry location; (2) Where it is not exposited to splash, dust, or other contamination. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676113 If continuation sheet Page 14 of 14