Health inspection·May 15, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation and interview on 5/12/2025 at 11:00 AM revealed Resident # 150 was dressed in a cloth double gown and was ambulating with a gait belt and wheelchair with PT G. PT G stated OTA F showered Resident #150 and dressed him in double gowns. During an interview on 5/12/2025 at 11:05 AM, LVN A stated she knew why Resident #150 had no clothes because his wife had not brought him any. Observation and interview on 05/12/25 11:18 AM revealed Resident #150 was lying in bed with gown on. Resident #150 presented as being anxious and irritable. During an interview on 5/12/2025 at 11:20 AM revealed Housekeeper Supervisor stated and demonstrated the laundry had lost and found clothes available for residents who needed clothes. She stated the laundry had a turnaround from 1 day to the next. Observation and interview on 05/14/25 at 03:20 PM revealed Resident #150 was in the therapy gym. Resident #150 was wearing a pair of faded sweat pants and shirt that appeared small for his height. During an interview on 5/15/2025 at 09:30 AM with the DOR revealed OTA F showered Resident #150 and dressed him in a double gown due to not having clothes that morning, on 5/12/2025. The DOR stated Resident #150 received treatment in his gown, in public hallway and therapy gym. Observation and interview on 05/15/25 at 11:02 AM with Resident #150 revealed he was sitting in a wheelchair by the bed. He was wearing a pair of sweat pants and a t-shirt. Resident was talkative during this visit. Asked him about his preference r/t wearing gowns vs. regular clothes. Resident #150 commented Well, I don't even know what I was wearing yesterday, but I hate those things. Asked what he meant and he stated the gowns, Hate those things. I would rather wear clothes. Interview on 05/15/25 at 03:01 PM with LVN A revealed she called Resident #150's family member the first day back on duty after Resident #150's admission. She let the family member know Resident #150 would need more clothes. She stated he only had 2 outfits. She was not sure if they were his own or if staff obtained them from lost and found. She stated the CNA's knew to look in the laundry for clothes for residents who needed clothes. She stated she did not give them instructions to get him some clothes and did not talk to the ADON about the fact Resident #150 had no clothes or limited clothes. However, she stated it came up during a morning meeting and the SW became involved. LVN A stated obtaining clothes for residents was not a priority once she made initial contact with a family member. She stated she had too many other residents and duties to perform. LVN A stated nursing staff worked together to obtain clothes as needed. She stated based on a reasonable person concept most people would want to wear clothes while receiving therapy out in public in a hallway. She stated it was a matter of preserving the resident's dignity. Interview on 05/15/25 at 3:31 PM with the DOR revealed Resident #150's rehabilitation was initiated on 5/5/25. Initially, rehabilitation staff met with him in his room because he was not able to tolerate getting out of bed because he had surgery prior to admission. She stated this was the first week Resident #150 started receiving therapy out of his room, in the hallway and in the gym. She stated rehabilitation staff got involved in looking for clothes that fit him but were not able to find any because he was such a big/tall man. Interview on 5/15/25 at 3:46 PM with the SSS revealed she learned about Resident #150 not having clothes during the morning meeting on 5/14/25. She stated Resident #150's family member was in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 2 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility on the same date, 5/14/25, and she talked with the family member about providing clothes. The family member commented she thought the facility would provide gowns. The SSS told her the facility preferred residents wore clothes during therapy. She stated the family member told her she would bring some clothes in a couple of days. Interview on 05/16/25 at 3:00 PM with the DON revealed he did not know Resident #150 did not have any clothes until the survey team entered on 5/12/25. He stated it was their policy residents wear clothes while receiving therapy especially out in public to preserve their dignity. He stated even though some residents might not have a problem with it, they would want the residents to wear clothes. The DON stated Resident #150 was cognitively impaired and might not be able to tell someone his preference but again it was their policy to maintain the dignity of the residents. Review of facility policy, Resident Rights, undated, read in relevant part POLICY: It is the policy of this facility that all resident rights be followed per state and federal guidelines as well as other regulative agencies. The Resident has the right: 1. To be treated with consideration, respect, and full recognition of his or her dignity and individuality. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 3 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0558 Reasonably accommodate the needs and preferences of each resident. 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 residents received services in the facility with reasonable accommodation of resident needs for 1 of 8 residents (Resident #8) who were observed for call light placement. Residents Affected - Few The facility failed to ensure the call light was within reach for Resident #8. This deficient practice could place residents at risk of keeping them from calling for help as needed. The findings were: Record review of Resident #8's face sheet, dated 05/15/2025, revealed she was admitted to the facility on [DATE] with diagnoses which included: unspecified dementia (a general term for a progressive decline in mental abilities, impacting memory, thinking, and reasoning to the point of interfering with daily life), unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, unspecified lack of coordination, unsteadiness on feet, unspecified diastolic (congestive) heart failure (occurs when the left ventricle, the heart's main pumping chamber, struggles to relax and fill with blood during the diastole phase of the heartbeat), heart failure, unspecified, pain in joints of right hand, pain in joints of left hand, and other abnormalities of gait and mobility. Record review of Resident #8's Annual MDS assessment, dated 03/31/2025, revealed the resident's BIMS score was 8, which indicated moderate cognitive impairment. The Annual MDS assessment further revealed Resident #8 required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, upper body dressing, lower body dressing, putting on/taking off footwear, personal hygiene, sit to lying, sit to stand, chair/bed-to-chair transfer, toilet transfer, and tube/shower transfer. Record review of Resident #8's care plan, target date of 06/30/2025, revealed Resident #8 did not reflect the use of the call light. Observation and interview on 05/12/2025 at 11:36 a.m. revealed Resident #8 sitting in her wheelchair next to her bed with over bed table in front of her and call light hanging down from the grab bar at the top of her bed resting on the floor behind Resident #8's wheelchair. Resident #8 stated she did not use her call light much, but if the staff do not get to her fast enough, she would use her call light. Resident #8 attempted to maneuver her wheelchair and reach her call light. Resident #8 stated she was not able to get to it. Observation and interview on 05/12/2025 at 11:45 a.m. revealed MA B and LVN D in Resident #8's room with MA B picking up the call light off the floor and discussed with LVN D the call light did not have a clip. MA B placed the call light on the side of the bed next Resident #8 near her wheelchair. LVN D stated resident did use her call light. LVN D further stated the call light should be placed right next to residents. LVN D stated the purpose of the call light was if residents needed anything it would notify the staff. LVN D stated it was everyone's responsibility to ensure the call lights were within reach of residents. MA B stated Resident #8's call light was on the floor behind her wheelchair when she entered the room and Resident #8 would not have been able to use the call light. MA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 4 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few B further stated the call light was for in case a resident needed anything, and Resident #8 was able to use her call light. During an interview on 05/15/2025 at 2:28 p.m. the DON stated the call lights were to alert the staff residents needed help. The DON stated anyone who was to go into the rooms was responsible for call light placement. The DON further stated by not having a call light could cause a delay in care. The DON stated as far as he was aware Resident #8 did typically use her call light and theoretically it could have dropped behind her chair. The DON stated a clip could be used to prevent the call light from falling. During an interview on 05/15/2025 at 2:55 p.m. the Administrator stated call lights needed to be within reach or they needed to be able to demonstrate they could get to the call light. The Administrator stated the purpose of the call lights were to alert staff of any needs that may arise with a resident. The Administrator state a resident could potentially attempt to perform the care themselves and fall or prolong them from receiving the care they needed. The Administrator further stated everyone was responsible for the placement of the call light. Record review of facility's Routine Procedures Call Light/Bell policy, revised 05/2007, read Policy: It is the policy of this facility to provide the resident a means of communication with nursing staff. Procedures: #5. Leave the resident comfortable. Place the call device within resident's reach before leaving room. If the call light/bell is defective, immediately report this information to the unit supervisor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 5 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0578 Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure the right for a resident to refuse or discontinue treatment for 1 of 6 Residents (Resident #155) whose records were reviewed for resident rights. LVN H/Treatment Nurse, failed to stop wound treatment after Resident #155 yelled out in pain multiple times for her to stop on 5/13/25. This deficient practice could affect any resident and could result in residents believing their right to say stop does not matter. The findings were: Review of Resident #155's face sheet, dated 5/14/25, revealed she was admitted to the facility on [DATE] with diagnoses including Metabolic Encephalopathy (according to Cleveland Clinic: it is a change in how your brain works due to an underlying condition. It can cause confusion, memory loss and loss of consciousness) and Heart Failure. Review of Resident #155's, initial admission record, dated 5/8/25, revealed she was alert, but confused, oriented to person and able to follow simple commands. Review of Resident #155's Care Plan, initiated 5/9/25, included several risk factors: Resident #155 is at risk for impaired cognitive function/dementia or impaired thought processes r/t Metabolic Encephalopathy, anemia, CKD 3, CHF, OSA. Interventions included Identify yourself at each interaction. Face when speaking and make eye contact. Reduce any distractions Provide with necessary cues- stop and return if agitated. Social Services to provide psychosocial support as needed. Resident #155 has acute/chronic pain r/t metabolic encephalopathy, anemia, CKD 3, CHF, OSA. Interventions included Administer analgesia medication as per orders. Follow pain scale to medicate as ordered. Monitor/document for side effects of pain medication. Observe for constipation; new onset or increased agitation, restlessness, confusion, hallucinations, dysphoria; nausea; vomiting; dizziness and falls. Report occurrences to the physician. Monitor/record pain characteristics: Quality (e.g. sharp, burning); Severity (1 to 10 scale); Anatomical location; Onset; Duration (e.g., continuous, intermittent); Aggravating factors; Relieving factors. Monitor/record/report to Nurse any s/sx of non-verbal pain: Changes in breathing (noisy, deep/shallow, labored, fast/slow); Vocalizations (grunting, moans, yelling out, silence); mood/behavior (changes, more irritable, restless, aggressive, squirmy, constant motion); Eyes (wide open/narrow slits/shut, glazed, tearing, no focus); Face (sad, crying, worried, scared, clenched teeth, grimacing) Body (tense, rigid, rocking, curled up, thrashing). Observe and report changes in usual routine, sleep patterns, decrease in functional abilities, decrease ROM, withdrawal, or resistance to care. Further review of Resident #155's Care Plan revealed she had an actual fall with no Injury, on 5/12/25 related to poor communication/comprehension. Interventions included Floor mats, Neuro-checks as ordered. Therapy consult for strength and mobility and Vital signs as ordered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 6 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0578 Level of Harm - Actual harm Residents Affected - Few Review of Resident #155's physician orders for May 2025 revealed the following orders: Acetaminophen-Codeine Tablet 300-30 MG Give 1 tablet by mouth every 8 hours as needed for Severe Pain DNE 4 gm/24 hrs; and Gabapentin Oral Tablet 100 MG (Gabapentin) Give 1 capsule by mouth three times a day for neuropathy. Cefdinir Oral Capsule 300 MG (Cefdinir) Give 300 mg by mouth two times a day for increased wbc for 7 Days; and Monitor & Assess level of pain using the 0-10 scale: 0=No Pain, 1-3=Mild Pain, 46=Moderate Pain, 7-10=Severe Pain every shift -Order Date-05/08/2025 at 1815 (6:15 PM). Review of Resident #155's medication administration record and treatment administration record for May 2025 revealed she received Gabapentin the morning of 5/13/25; she refused the Cefdinir at 9:00 A< and the Acetaminophen-Codeine Tablet 300-30 MG at 10:35 AM. Further review revealed Resident #155's pain level on 05/13/25 was 5 of 10 in the morning. Review of a progress note dated 05/13/25 written by LVN H at 12:25 read Note Text: Treatment nurse followed up with patient for skin assessment. Upon attempting to remove the blanket, patient began yelling, stop, hurts. Explained to patient the need for a skin assessment. Noted DTI to left lateral heel. Patient continued to yell stop, hurts Upon initial touch. Was able to complete assessment, obtain measurements, and apply a skin barrier to the affected area. Offloading boots were also applied to relieve pressure. Review of facility document, Nursing Home to Hospital Transfer Form, dated 5/13/25 revealed LVN A sent Resident #155 to the hospital. Observation and interview on 05/13/25 at 10:05 AM revealed yelling coming from Resident #155's room. Resident #155 cried and yelled out loudly stop, it hurts, stop,several times. Upon entering her room, Resident #155 was lying in bed. LVN H/Treatment nurse was in the room with Resident #155. She introduced herself as the treatment nurse and stated rehabilitation staff noted a DTI on Resident #155's left heel. She stated she was trying to get measurements and apply skin prep. She stated she tried to assess Resident #155 yesterday but the Resident would stiffen up and told her, leave me alone. LVN H stated she left Resident #155 alone. LVN H stated she managed to get the measurement and apply skin prep. She then pointed to a scratch Resident #155 had on the back of her right ear. LVN H was not addressing Resident #155 during this discussion. LVN H pulled Resident #155's blanket back and Resident #155 quickly grabbed the blanket and covered herself back up and made a noise indicating she was agitated. LVN H let go of the blanket and put her hands up. Resident #155 never opened her eyes or engaged in conversation. LVN H stated she was barely touching her. Interview on 5/14/25 at 11 AM with LVN H/Treatment Nurse revealed the DOR texted her that one of the rehab staff noted Resident #155 had a DTI on her left lateral heel. She stated she went in to assess Resident #155 and as soon as she approached Resident #155 even before touching her,Resident #155 started yelling out. LVN H stated she tried to assess Resident #155 the day before and the Resident told her don't touch me so she left the Resident alone. LVN H stated she wanted to assess Resident #155's heel so that she could obtain an order and Resident #155 would receive treatment. LVN H stated she understood Resident #155 had the right to refuse treatment and she should have stopped when the Resident told her to stop. LVN H stated Resident #155 yelled out several times that it hurt and to stop. LVN H stated she was aware Resident #155 had a fall the weekend prior to the assessment and stated maybe Resident #155 was in pain. She stated during the assessment she noted bruising to Resident #155's upper extremities. LVN H stated she was not sure but guessed they were from the fall. She stated the DOR was supposed to assist during the assessment but the DOR was delayed with helping (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 7 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0578 Level of Harm - Actual harm Residents Affected - Few another resident. She stated she did not talk with LVN A about whether or not Resident #155 had received any PRN pain medications before she assessed Resident #155. She stated protocol required a resident receive pain medication prior to treatment as needed. Interview on 5/15/25 at 9:30 AM with the DON revealed he was made aware that Resident #155 was yelling out when LVN H/Treatment Nurse was assessing her left heel. He stated LVN H should have checked with the nurse to ensure Resident #155 received a PRN pain medication before assessing Resident #155. He stated LVN H should have also stopped when Resident #155 told her to stop. He stated Resident #155 had a right to refuse treatment. The DON further stated LVN H should have stopped and engaged other staff to help and could have attempted the assessment at a later time when Resident #155 was calmer. The DON stated LVN A attempted to give Resident #155 pain medication after LVN H assessed her but Resident #155 refused it. Interview on 05/15/25 at 03:13 PM with LVN A revealed therapy sent her a text message they found a reddened area on Resident #155's left heel. LVN A stated she heard Resident #155 yelling down the hallway the morning of 5/13/25 and went to her room to find out what was going on. She stated she heard Resident #155 say she hurt and to stop. LVN A stated after LVN H assessed Resident #155 she tried to give the Resident a Tylenol 3 PRN and a schedule antibiotic. She stated Resident #155 refused all medications. LVN A stated she found that as odd behavior. It appeared to her that Resident #155 was experiencing AMS, combination of anxiety and change in behavior from when she last worked with Resident #155 which was on Friday, 5/9/25. LVN A stated Resident #155 also did not want to eat her breakfast and was not wanting to wake up that morning either. LVN A stated she sent Resident #155 out to the hospital on 5/13/25. Telephone interview on 05/15/25 at 03:38 PM with Resident #155's RP revealed staff called to tell her Resident #155 had a fall early morning on 05/12/25 but did not sustain any injuries. The RP stated Resident #155 was still at the hospital with a UTI and that hospital staff took X-rays of her left and right side and a took a CT of her head. All findings were negative. The RP stated Resident #155 was supposed to have a left hip replacement months prior but was delayed due to other health complications. She stated Resident #155 often complained about pain around her left hip and would yell out when she did not want to be bothered usually related to having pain. Review of facility policy, Resident Rights, undated, read in relevant part POLICY: It is the policy of this facility that all resident rights be followed per state and federal guidelines as well as other regulative agencies. The Resident has the right: 1. To be treated with consideration, respect, and full recognition of his or her dignity and individuality. 14. To refuse medical treatment and to participate in experimental research. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 8 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews the facility failed to ensure the residents had the right to voice grievances to include those with respect to care and treatment which has been furnished as well as that which has not been furnished, the behavior of staff and of other residents, and other concerns regarding their LTC facility stay, for 1 of 8 residents (Residents #259) reviewed for grievances. On 5/10/2025 Resident #259 made a grievance to the cook to which he did not document and/or report the grievance. This failure could place residents at risk for harm by leaving residents with frustration and demoralization. The findings included: A record review of Resident #259's admission record dated 5/15/2025 revealed Resident #259 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses which included major depressive disorder, anxiety, and post-traumatic stress disorder (PTSD). A record review of Resident #259's care plan dated 5/8/2025 revealed, [sic(Resident #259)] is at risk for re traumatization related to history of trauma PTSD related to disasters . caregivers to provide opportunity for positive interaction, attention. Stop and talk with him as passing by. document behaviors and resident response to interventions. [sic(Resident #259)] has history of major depressive disorder encouraged to express feelings. monitor document report to nurse doctor signs and symptoms of depression . as potential nutritional problem . honor resident rights to make personal dietary choices A record review of the facility's grievance records for the month of May 2025 revealed no evidence of any grievance report for Resident #259 for the complaints made on 5/10/2025. During an observation and interview on 5/12/2025 at 11:59 AM revealed Resident #259 was in his room seated in his wheelchair. Resident #259 stated, that earlier in the day, he reported to the assistant food service manager (AFSM) that he was served raw chicken for lunch on 5/10/2025 and the [NAME] was rude and yelled. Resident #259 stated the Food Service Manager had come to speak with him that morning and heard his complaints. Resident #259 stated, I took a picture of the pink in the middle chicken breast and went to the kitchen and complained to the cook. he then came to my room and took the chicken in his hand and shredded the chicken and yelled 'I cooked the f***ing chicken myself and this is not raw,' . CNA E saw and heard him . During interview on 5/14/2025 at 1:38 PM the FSM stated the AFSM had reported to him on Monday 5/12/2025 that Resident #259 had complained he was served undercooked chicken on Saturday 5/10/2025. The FSM stated he spoke with Resident #259 and heard the report that the cook had served Resident #259 undercooked chicken. The FSM stated he began an in-service for his team to reinforce training for checking temperatures of meals served and had reviewed the temperature logs for Saturday's lunch and the temperatures were safe. The FSM stated he had not documented a grievance report and was not aware if anyone had documented a grievance report. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 9 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During interview on 5/14/2025 at 1:44 PM the AFSM stated she was approached by Resident #259 on the morning of Monday 5/12/2025 and was told Resident #259 was served raw chicken for lunch on Saturday 5/10/2025. The AFSM stated Resident #259 was upset and claimed the cook came to his room and shredded the chicken breast and was rude and yelled. The AFSM stated she spoke with the [NAME] and the FSM, and the cook stated he had not yelled and shredded the chicken to demonstrate the chicken was cooked thoroughly. The AFSM stated she had not documented the complaint on a grievance form and stated she was not aware of where the forms were kept nor how to use the form. During an interview on 5/14/2025 at 1:52 PM the [NAME] stated on Saturday during the lunch service Resident #259 came to the kitchen to complain the chicken was undercooked. The [NAME] stated he went with Resident #259 to his room to see the meal. The [NAME] stated he took the chicken and pulled it apart to reveal the chicken was fully cooked. The [NAME] stated he was accompanied by CNA E. The [NAME] stated he was not rude, nor did he raise his voice. The [NAME] stated he did not document a grievance report because he did not know about the form. During an interview on 5/15/2025 at 10:42 AM CNA E stated she was a witness to the Saturday 5/10/2025 incident where Resident #259 was in his room with the [NAME] and they were reviewing the lunch meal served. CNA E stated the [NAME] was not rude nor did he raise his voice. CNA E stated Resident #259 was upset and believed the chicken lunch was undercooked. CNA E stated she had not documented a grievance form and in retrospect she could have alerted the nurse to document a grievance form. During an interview on 5/15/2025 at 11:00 AM the Administrator stated the expectation was for any staff member who heard a complaint to document the complaint on a grievance form which would then be submitted to himself for review. The Administrator stated he was not aware of the complaint until the surveyor's investigation. The administrator stated the potential for harm to residents would be their grievances would go unheard, undocumented, and unreviewed for resolution. A record review of the facility's Grievances policy dated 12/2023, revealed, It is the policy of this facility to establish a grievance process that allows the resident(s) a way to execute their right to voice concerns or grievances to the facility or other agency/entity without fear of discrimination or reprisal. Such grievances include those with respect to care and treatment which has been furnished as well as that which has not been furnished, the behavior of staff and of other residents, and other concerns regarding their facility stay. The facility will make information on how to file a grievance available to the residents and make prompt efforts to resolve grievances that the resident may have FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 10 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations , interviews and record reviews the facility failed to ensure alleged violations involving abuse or mistreatment were reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involved abuse or not later than 24 hours if the events that cause the allegation do not involve abuse to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures, for 1 of 8 residents (Resident #259 ) reviewed for reporting alleged verbal abuse. On Monday 5/12/2025 Resident #259 reported to the assistant food service manager (AFSM) that on Saturday 5/10/2025 the cook was rude and yelled while in his room reviewing the lunch meal served. The AFSM did not report the alleged verbal abuse and or mistreatment. The failure could place residents at risk for verbal abuse. The findings included: A record review of Resident #259's admission record dated 5/15/2025 revealed Resident #259 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses which included major depressive disorder, anxiety, and post-traumatic stress disorder (PTSD). A record review of Resident #259's care plan dated 5/8/2025 revealed, [sic(Resident #259)] is at risk for re traumatization related to history of trauma PTSD related to disasters . caregivers to provide opportunity for positive interaction, attention. Stop and talk with him as passing by. document behaviors and resident response to interventions. [sic(Resident #259)] has history of major depressive disorder encouraged to express feelings. monitor document report to nurse doctor signs and symptoms of depression . as potential nutritional problem . honor resident rights to make personal dietary choices A record review of the facility's grievance records for the month of May 2025 revealed no evidence of any grievance report for Resident #259 for the complaints made on 5/10/2025. A record review of the Texas Unified Licensure Information Portal website accessed 5/14/2025 revealed no evidence for a facility related incident report on behalf of Resident #259. During an observation and interview on 5/12/2025 at 11:59 AM revealed Resident #259 was in his room seated in his wheelchair. Resident #259 stated, that earlier in the day, he reported to the assistant food service manager (AFSM) that he was served raw chicken for lunch on 5/10/2025 and the [NAME] was rude and yelled. Resident #259 stated the Food Service Manager had come to speak with him that morning and heard his complaints. Resident #259 stated, I took a picture of the pink in the middle chicken breast and went to the kitchen and complained to the cook. he then came to my room and took the chicken in his hand and shredded the chicken and yelled 'I cooked the f***ing chicken myself and this is not raw,' . CNA E saw and heard him. During interview on 5/14/2025 at 1:44 PM the AFSM stated she was approached by Resident #259 on the morning of Monday 5/12/2025 and was told Resident #259 was served raw chicken for lunch on Saturday (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 11 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 5/10/2025. The AFSM stated Resident #259 was upset and claimed the cook came to his room and shredded the chicken breast and was rude and yelled. The AFSM stated she spoke with the [NAME] and the FSM and the [NAME] stated he had not yelled and shredded the chicken to demonstrate the chicken was cooked thoroughly. The AFSM stated she had not reported to anyone that Resident #259 alleged he was yelled at by the [NAME] because, I know the [sic(Cook)] and he is not the kind of person to cuss or yell. During an interview on 5/15/2025 at 11:00 AM the Administrator stated the expectation was for any staff member who heard an allegation of abuse, neglect, and or exploitation (ANE) to immediately report the allegation to himself the Administrator. The Administrator stated he was not aware of the allegation until the surveyor's investigation. The Administrator stated the potential for harm to residents would be their allegations of ANE would go unheard, undocumented, and uninvestigated. A record review of the facility's undated Abuse: Prevention of and Prohibition Against revealed, Policy: it is the policy of this facility that each resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation. The facility will provide oversight and monitoring to ensure that its staff, who are agents of the facility, deliver care and services in a way that promotes and respects the rights of the residents to be free from abuse, neglect, misappropriation of resident property, and exploitation. all allegations of abuse, neglect, misappropriation of resident property, or exploitation should be reported immediately to the administrator FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 12 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations , interviews and record reviews the facility failed to have evidence that all allegations of abuse, neglect, exploitation, or mistreatment, were thoroughly investigated, for 1 of 8 residents (Resident #259 reviewed for investigating alleged verbal abuse. Residents Affected - Few On Monday 5/12/2025 Resident #259 reported to the assistant food service manager (AFSM) that on Saturday 5/10/2025 the cook was rude and yelled while in his room reviewing the lunch meal served. The AFSM did not report the alleged verbal abuse and or mistreatment. The facility did not investigate the allegation of verbal abuse. The failure could place residents at risk for verbal abuse. The findings included: A record review of Resident #259's admission record dated 5/15/2025 revealed Resident #259 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses which included major depressive disorder, anxiety, and post-traumatic stress disorder (PTSD). A record review of Resident #259's care plan dated 5/8/2025 revealed, [sic(Resident #259)] is at risk for re traumatization related to history of trauma PTSD related to disasters . caregivers to provide opportunity for positive interaction, attention. Stop and talk with him as passing by. document behaviors and resident response to interventions. [sic(Resident #259)] has history of major depressive disorder encouraged to express feelings. monitor document report to nurse doctor signs and symptoms of depression . as potential nutritional problem . honor resident rights to make personal dietary choices A record review of the facility's grievance records for the month of May 2025 revealed no evidence of any grievance report for Resident #259 for the complaints made on 5/10/2025. A record review of the Texas Unified Licensure Information Portal website accessed 5/14/2025 revealed no evidence for a facility related incident report on behalf of Resident #259. During an observation and interview on 5/12/2025 at 11:59 AM revealed Resident #259 was in his room seated in his wheelchair. Resident #259 stated, that earlier in the day, he reported to the assistant food service manager (AFSM) that he was served raw chicken for lunch on 5/10/2025 and the [NAME] was rude and yelled. Resident #259 stated the Food Service Manager had come to speak with him that morning and heard his complaints. Resident #259 stated, I took a picture of the pink in the middle chicken breast and went to the kitchen and complained to the cook. he then came to my room and took the chicken in his hand and shredded the chicken and yelled 'I cooked the f***ing chicken myself and this is not raw,' . CNA E saw and heard him. During interview on 5/14/2025 at 1:44 PM the AFSM stated she was approached by Resident #259 on the morning of Monday 5/12/2025 and was told Resident #259 was served raw chicken for lunch on Saturday 5/10/2025. The AFSM stated Resident #259 was upset and claimed the cook came to his room and shredded the chicken breast and was rude and yelled. The AFSM stated she spoke with the [NAME] and the FSM and the cook stated he had not yelled and shredded the chicken to demonstrate the chicken was cooked thoroughly. The AFSM stated she had not reported to anyone that Resident #1 alleged he was yelled (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 13 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0610 at by the [NAME] because, I know the [sic(Cook)] and he is not the kind of person to cuss or yell. Level of Harm - Minimal harm or potential for actual harm During an interview on 5/15/2025 at 11:00 AM the Administrator stated the expectation was for any staff member who heard an allegation of abuse, neglect, and or exploitation (ANE) to immediately report the allegation to himself the Administrator. The Administrator stated he was not aware of the allegation until the surveyor's investigation. The Administrator stated he had not begun his investigation until 5/14/2025 and has not yet completed his report to the state regulatory agency. The Administrator stated the potential for harm to residents would be their allegations of ANE would go unheard, undocumented, and uninvestigated. Residents Affected - Few A record review of the facility's undated Abuse: Prevention of and Prohibition Against revealed, Policy: it is the policy of this facility that each resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation. The facility will provide oversight and monitoring to ensure that its staff, who are agents of the facility, deliver care and services in a way that promotes and respects the rights of the residents to be free from abuse, neglect, misappropriation of resident property, and exploitation. investigation: all identified events are reported to the administrator immediately. all allegations of abuse, neglect, this appropriation of resident property, end exploitation will be promptly and thoroughly investigated by the administrator for his her designee FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 14 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to transmit encoded, accurate, and complete MDS data to the CMS System for 1 of 24 residents (Resident #84) reviewed for MDS transmission. Residents Affected - Few Resident #84's discharge MDS assessment was completed but not transmitted within 14 days of completion. This failure could place residents at risk of not having assessments completed and submitted in a timely manner as required. The findings were: Review of Resident #84's face sheet, dated 05/15/2025, revealed an admission date of 12/15/2024 and a discharge date of 12/20/2024, with diagnoses that included: Type 2 diabetes mellitus (high level of sugar in the blood), Hyperlipidemia (Elevated level of any or all lipids(fat) in the blood), Post-traumatic stress disorder ( psychiatric condition that may occur in people who have experienced or witnessed a traumatic event or series of traumatic events). Review of Resident #84's Discharge MDS Assessment, dated 12/20/2024, revealed the assessment had been completed but not transmitted to CMS. During an interview on 05/15/2025 at 1:37 p.m. MDS Nurse B revealed the Discharge MDS assessment was completed for Resident #84, but it was not transmitted. MDS Nurse B further stated the Discharge MDS assessment should have been transmitted within 14 days after completion. MDS nurse B stated she did not really know how it was overlooked. MDS Nurse B stated it was the MDS Nurses' responsibility to complete and transmit the Discharge MDS assessment. During an interview on 05/15/2025 at 2:30 p.m. the DON stated the MDS Nurses were responsible for the accuracy and completion of MDS assessments. The DON was not sure why Resident #84's Discharge MDS assessment would have been missed. MDS Nurse B revealed she used the RAI as resource and could electronically access it on her laptop. Record review of Long-Term Care Facility Resident Assessment Instrument 3.0 User ' s Manual Version 1.19.1, dated October 2024, revealed 09. Discharge Assessment Return Not Anticipated (A0310F = 10) [ .] Must be submitted within 14 days after the MDS completion date (Z0500B + 14 calendar days). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 15 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to develop and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 2 of 4 Residents (Resident 150 and Resident #155) whose records were reviewed. 1. The facility failed to ensure Resident #150's baseline CP included the use of side rails. 2. The facility failed to ensure Resident #155's baseline CP included the use of side rails. This deficient practice could affect any resident and contribute to residents not having their needs met based on their assessment. The findings were: 1. Review of Resident #150's face sheet, dated 5/15/25, revealed he was admitted to the facility on [DATE] with diagnoses including Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, subsequent encounter and Cognitive communication deficit. Review of Resident #150's initial admission record, dated 5/4/25, revealed he was alert, oriented to time and able to follow simple commands. Review of Resident #150's Care Plan, initiated 5/5/25, revealed there was no indication he used side rails for bed mobility. Observation on 05/12/25 at 11:18 AM revealed Resident #150 was lying in bed with 1/4 SR's up on both sides of his bed. Resident #150 presented as being alert but confused. Interview on 05/15/25 at 04:13 PM with the DON revealed he wrote Resident #150's Care Plan. He stated Resident #150's Care Plan did not reflect he used side rails for bed mobility, but stated it should to ensure nursing staff understood Resident #150's needs. He stated nursing staff had access to the residents care plans and were supposed to follow them when providing assistance with ADL's. 2. Review of Resident 155's face sheet, dated 5/14/25, revealed she was admitted to the facility on [DATE] with diagnoses including Metabolic Encephalopathy (according to Cleveland Clinic: it is a change in how your brain works due to an underlying condition. It can cause confusion, memory loss and loss of consciousness and Heart Failure. Review of Resident #155's, initial admission record, dated 5/8/25, revealed she was alert, but confused, oriented to person and able to follow simple commands. Review of Resident #155's Care Plan, initiated 5/9/25, revealed there was no indication she used side rails for bed mobility. Interview on 05/15/25 at 04:20 PM with the DON revealed he wrote Resident #155's CP. He stated the CP did not reflect the use of side rails for mobility. He stated it was important so staff could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 16 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few know how to care for Resident #155. He stated the CP provided instructions on how Resident #155 used the side rails and would ensure nursing staff was using them appropriately. Review of facility policy, Comprehensive Person-Centered Care Planning, revised 08/2017, read in relevant part The IDT team will also develop and implement a baseline care plan for each resident, within 48 hours of admission, that includes minimum healthcare information necessary to properly care for each resident and instructions needed to provide effective and person-centered care that meet professional standards of quality care. PROCEDURES: 1. Within 48 hours of the resident's admission, the facility will develop and implement a baseline care plan that includes instructions needed to provide effective and personcentered care. 2. The baseline care plan will include minimum healthcare information necessary to properly care for a resident including, but not limited to: a) Initial goals based on admission orders, b) Physician orders, c) Dietary orders, d) Therapy services, e) Social services; and f) PASARR recommendations, if applicable. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 17 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0655 3. Level of Harm - Minimal harm or potential for actual harm The facility team will provide a written summary of the baseline care plan to the resident or resident representative by completion of the comprehensive care plan. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 18 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that included measurable objectives and timeframe's to meet a resident's medical and nursing needs for 1 of 6 Residents #Resident #21 whose records were reviewed. The facility failed to include the use of 1/2 side rails on Resident #21's Care Plan since his admission, 3/28/25. This deficient practice could affect any resident and contribute to residents not having their needs met according to their assessment. The findings were: Review of Resident #21's face sheet, dated 5/15/25, revealed he was admitted to the facility on [DATE] with diagnoses including Metabolic Encephalopathy (according to Cleveland Clinic: it is a change in how your brain works due to an underlying condition. It can cause confusion, memory loss and loss of consciousness}, Muscle weakness (generalized), Other lack of coordination and Other abnormalities of gait and mobility. Review of Resident #21's quarterly MDS assessment revealed his BIMS score was 14 of 15 reflective of minimal cognitive impairment; he required partial to moderate assistance with rolling left and right and required substantial to maximal assistance with from sitting to lying and from lying to sitting on side of bed. Review of Resident #21's Care Plan, initiated on 3/30/25 revealed there was no indication Resident #21 used SR's. Observation and interview on 05/13/25 at 09:45 AM revealed Resident #21 lying in bed with 1/2 SR's up on both sides of the bed. Interview with Resident #21 revealed he used the SR's for bed mobility. He stated the SR's were on the bed upon admission. Interview on 05/15/25 04:24 PM with the DON revealed he wrote Resident #21's Care Plan and stated he identified on this date, 5/15/25, the use of SR's was not on the CP. He stated it should be on the CP prior to implementing the use of side rails to ensure staff was aware Resident #21 was using side rails and the reason he was using them. This would ensure nursing staff provided the help needed when providing Resident #21 with ADL assistance. Review of facility policy, Comprehensive Person-Centered Care Planning, revised 08/2017, read in relevant part POLICY: It is the policy of this facility that the interdisciplinary team (IDT) shall develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframe's to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 19 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0656 PROCEDURES: Level of Harm - Minimal harm or potential for actual harm 4. Residents Affected - Few The comprehensive care plan will be developed by the IDT within seven (7) days of completion of the Resident Minimum Data Set (MDS) and will include resident's needs identified in the comprehensive assessment, any specialized services as a result of PASARR recommendation, and resident's goals and desired outcomes, preferences for future discharge and discharge plans. 7. The facility IDT includes, but is not limited to the following professionals: A. Attending Physician or Non-Physician Practitioner (NPP) designee involvd in resident's care; B. Registered Nurse responsible for the resident; C. Nurse Aide responsible for the resident; D. Member of the Food and Nutrition services staff; E. To the extent practicable, resident and/or resident representative; F. Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident. 8. The facility will provide the resident and resident representative, if applicable, advance notice of care planning conference to encourage resident and/or resident representative participation. Care conference may be in the form of face to face meeting, conference calls or video conferencing. If not practicable, reason will be documented in the medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 20 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 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 that the resident's environment remained as free of accident hazards as was possible for 1 of 7 Residents (Resident #80) whose environment was reviewed for safety hazards. Nursing staff failed to remove 3 razors from Resident #80's bathroom. This deficient practice could affect residents exposed to the razors and could contribute to avoidable accidents. The findings were: Review of Resident #80's face sheet, dated 5/15/25, revealed he was admitted to the facility on [DATE] with diagnoses including Vascular Dementia and Visual Hallucinations. Review of Resident #80's MDS assessment, dated 3/27/25, revealed his BIMS was 8 of 15 reflective of moderate cognitive impairment. Review of Resident #80's Care Plan, revised on 1/2/25 revealed he was at risk for impaired cognitive function/dementia or impaired thought processes r/t Dementia. Interventions included COMMUNICATION: Identify yourself at each interaction. Face when speaking and make eye contact. Reduce any distractionsturn off TV, radio, close door etc. Use simple, directive sentences. Provide with necessary cues- stop and return if agitated. Observation on 05/12/25 at 11:41 revealed 3 razors in a cup on top of the sink in Resident #80's bathroom. Interview on 05/12/25 at 11:50 AM with RN I revealed Resident #80 went OOP this past weekend and his family probably provided him with the razors. She stated staff should ensure Resident #80 did not have any sharps in his possession upon returning from being OOP. She stated nursing staff should also be on the look out during rounding. RN I stated she was the floor nurse on duty on this date, 05/12/25, and did not notice the razors because she had not been in the bathroom. She stated she was not sure if the residents were allowed to have razors in their possession but would check. She stated Resident #80 and his roommate were fairly independent but questioned their level of cognition. Follow up interview on 05/12/25 at 12:30 PM with RN I revealed residents were not able to have razors in their possession according to facility policy. She stated there were residents on the hallway that had Dementia, were confused and who wandered. She stated it would be a safety hazard for the residents so it was up to nursing staff to ensure the environment was safe. Interview on 05/14/25 at 11:50 AM with the DON revealed it was facility policy that residents were not allowed to have sharps in their possession or in their room to prevent accidents and to keep the residents environment safe. The DON stated he was not sure if there were residents who wandered who lived on the same hall as Resident #80. However, he stated there were Residents who were confused (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 21 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0689 and who had Dementia. Level of Harm - Minimal harm or potential for actual harm Review of facility policy, Accident Intervention, undated, read in relevant part, POLICY: Residents Affected - Few It is the policy of this facility that the resident environment remains as free of accident hazards as is possible and that each resident receives adequate supervision and assistance devices to prevent accidents PURPOSE: The purpose is to ensure that the facility provides an environment that is free from hazards over which the facility has control and provides appropriate supervision to each resident to prevent avoidable accidents. This includes systems and processes designed to: Identify hazard(s) and risk(s); Evaluate and analyze hazard(s) and risk(s); Implement interventions to reduce hazard(s) and risk(s); and Monitor for effectiveness and modify approaches as indicated FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 22 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 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, was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan for 1 of 6 Residents (Resident #80) whose records were reviewed for CPAP care. Residents Affected - Few Nursing staff failed to store Resident #80's CPAP mask in a plastic bag and failed to clean it per facility policy. This deficient practice could affect residents with respiratory needs and could contribute to upper respiratory infections. The findings were: Review of Resident #80's face sheet, dated 5/15/25, revealed he was admitted to the facility on [DATE] with diagnoses including Vascular Dementia (according to microsoft [NAME]: type of dementia caused by problems in the blood supply to the brain, resulting from a cerebrovascular disease) and Obstructive Sleep Apnea (People with obstructive sleep apnea repeatedly stop and start breathing while they sleep). Review of Resident #80's MDS assessment, dated 3/27/25, revealed his BIMS was 8 of 15 reflective of moderate cognitive impairment. Review of Resident #80's Care Plan, initiated on 11/12/24 revealed he was Resident #80 has ineffective breathing pattern r/t sleep apnea as evidence by loud snoring, choking episodes, frequent awakenings, and daytime fatigue. Interventions included CPAP at home settings at bedtime and remove per schedule. Educate and assist the resident or family with the use of the CPAP machine if necessary. Elevate HOB. Encourage sustained deep breaths by: Using demonstration (emphasizing slow inhalation, holding end inspiration for a few seconds, and passive exhalation); Using incentive spirometer (handheld medical device designed to help patients improve lung function by encouraging slow and deep breathing) (place close for convenient resident use); Asking resident to yawn. Ensure [Resident #80's] CPAP (Continuous Positive Airway Pressure) machine is functioning properly. HOB elevated when in bed due to shortness of breath when lying flat. Review of Resident #80's physician orders for May 2025 revealed an order Apply CPAP with home settings at bedtime and remove per schedule. Change Distilled Water in CPAP Nightly and as needed. Observation on 05/12/25 at 11:41 AM revealed Resident #80's CPAP mask on the top of his pillow. Resident #80 was not in the room. There was a plastic bag on top of the night stand but It did not have a date on it. Interview on 05/12/25 at 11:50 AM with RN I revealed Resident #80 used a CPAP every night for sleep apnea. She stated he had physician orders for it and also stated it was his personal machine. RN I stated nursing staff should ensure the mask was stored in the plastic bag so that it did not become contaminated in order to prevent infections. RN I staked the plastic bag should have a date on it to indicate the last time the mask was cleaned otherwise ther was no way to know for sure when it was last cleaned. RN I stated she did not know what days nursing staff should clean the mask. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 23 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 5/15/25 at 9:30 AM with the DON revealed nursing staff should secure a resident's CPAP mask in a plastic bag when not in use to prevent contamination and upper respiratory infections. He stated nursing staff should clean the mask weekly and write a date on the plastic bag to reflect the date the mask was cleaned. Review of facility policy, Bilevel Positive Airway Pressure (BIPAP)/ Continuous Positive Airway Pressure (CPAP), undated, read: POLICY: It is the policy of this facility to use BIPAP/CPAP for breathing by delivering two different levels of air pressure during inhalation and exhalation as ordered by physician. PROCEDURES: Equipment: BIPAP/CPAP Machine (per physician orders) Mask 1. Obtain appropriate physician's order. 2. Identify resident and explain procedure to resident. Provide privacy and wash hands. 3. Apply BIPAP/CPAP mask and ensure proper seal. 4. Turn on machine and ensure settings are as per physician orders. 8. Change distilled water in BIPAP/CPAP nightly and as needed 9. Empty and rinse the chamber prior to refilling 10. Clean mask after each use. 11. Mask to be kept in bag when not in use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 24 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - 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 pain management was provided to residents who required such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 6 Residents (Resident #155) whose records were reviewed for pain management. Residents Affected - Few LVN H/Treatment Nurse, failed to ensure Resident #155 received a PRN pain medication prior to assessment Resident #155 and then failed to stop wound treatment when Resident #155 yelled out in pain multiple times for her to stop on 5/13/25. This deficient practice could affect any resident experiencing pain and undue pain and mental distress. The findings were: Review of Resident #155's face sheet, dated 5/14/25, revealed she was admitted to the facility on [DATE] with diagnoses including Metabolic Encephalopathy (according to Cleveland Clinic: it is a change in how your brain works due to an underlying condition. It can cause confusion, memory loss and loss of consciousness) and Heart Failure. Review of Resident #155's, initial admission record, dated 5/8/25, revealed she was alert, but confused, oriented to person and able to follow simple commands. Review of Resident #155's Care Plan, initiated 5/9/25, included several risk factors: Resident #155 is at risk for impaired cognitive function/dementia or impaired thought processes r/t Metabolic Encephalopathy, anemia, CKD 3, CHF, OSA. Interventions included Identify yourself at each interaction. Face when speaking and make eye contact. Reduce any distractions Provide with necessary cues- stop and return if agitated. Social Services to provide psychosocial support as needed. Resident #155 has acute/chronic pain r/t metabolic encephalopathy, anemia, CKD 3, CHF, OSA. Interventions included Administer analgesia medication as per orders. Follow pain scale to medicate as ordered. Monitor/document for side effects of pain medication. Observe for constipation; new onset or increased agitation, restlessness, confusion, hallucinations, dysphoria (according to microsoft [NAME]: a state of unease or generalized dissatisfaction with life); nausea; vomiting; dizziness and falls. Report occurrences to the physician. Monitor/record pain characteristics: Quality (e.g. sharp, burning); Severity (1 to 10 scale); Anatomical location; Onset; Duration (e.g., continuous, intermittent); Aggravating factors; Relieving factors. Monitor/record/report to Nurse any s/sx of non-verbal pain: Changes in breathing (noisy, deep/shallow, labored, fast/slow); Vocalizations (grunting, moans, yelling out, silence); mood/behavior (changes, more irritable, restless, aggressive, squirmy, constant motion); Eyes (wide open/narrow slits/shut, glazed, tearing, no focus); Face (sad, crying, worried, scared, clenched teeth, grimacing) Body (tense, rigid, rocking, curled up, thrashing). Observe and report changes in usual routine, sleep patterns, decrease in functional abilities, decrease ROM, withdrawal, or resistance to care. Further review of Resident #155's Care Plan revealed she had an actual fall with no Injury, on 5/12/25 related to poor communication/comprehension. Interventions included Floor mats, Neuro-checks as ordered. Therapy consult for strength and mobility and Vital signs as ordered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 25 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0697 Level of Harm - Actual harm Residents Affected - Few Review of Resident #155's physician orders for May 2025 revealed the following orders: Acetaminophen-Codeine Tablet 300-30 MG Give 1 tablet by mouth every 8 hours as needed for Severe Pain DNE 4 gm/24 hrs; and Gabapentin Oral Tablet 100 MG (Gabapentin) Give 1 capsule by mouth three times a day for neuropathy (according to the center for Bone and Joint Surgery). Cefdinir Oral Capsule 300 MG (Cefdinir) Give 300 mg by mouth two times a day for increased wbc for 7 Days; and Monitor & Assess level of pain using the 0-10 scale: 0=No Pain, 1-3=Mild Pain, 4- 6=Moderate Pain, 7-10=Severe Pain every shift -Order Date-05/08/2025 at 1815 (6:15 PM). Review of Resident #155's medication administration record and treatment administration record for May 2025 revealed she received Gabapentin the morning of 5/13/25; she refused the Cefdinir at 9:00 AM. Review of administration of the Acetaminophen-Codeine Tablet 300-30 MG revealed Resident #155 recieved Acetaminophen-Codine tablet 300-30mg on 05/09/2025 at 06:24 AM, 05/10/2025 at 09:56 AM, 05/10/2025 at 11:46 PM, 05/12/025 at 04:05 AM, 05/12/2025 at 11:33 PM. Further review of medication administration record shows Resident #155 refused Acetaminoph-Codeine Tablet 300-30MG on 05/13/2025 at 10:35 AM. Further review revealed Resident #155's pain level on 05/13/25 was 5 of 10 in the morning. Review of a progress note dated 05/13/25 written by LVN H at 12:25 read Note Text: Treatment nurse followed up with patient for skin assessment. Upon attempting to remove the blanket, patient began yelling, stop, hurts. Explained to patient the need for a skin assessment. Noted DTI to left lateral heel. Patient continued to yell stop, hurts Upon initial touch. Was able to complete assessment, obtain measurements, and apply a skin barrier to the affected area. Offloading boots were also applied to relieve pressure. Observation and interview on 05/13/25 at 10:05 AM revealed yelling coming from Resident #155's room. Resident #155 cried and yelled out loudly stop, it hurts, stop, several times. Upon entering her room, Resident #155 was lying in bed. LVN H/Treatment nurse was in the room with Resident #155. She introduced herself as the treatment nurse and stated rehabilitation staff noted a DTI on Resident #155's left heel. She stated she was trying to get measurements and apply skin prep. She stated she tried to assess Resident #155 yesterday (5/12/25) but the Resident would stiffen up and told her, leave me alone. LVN H stated she left Resident #155 alone. LVN H stated she managed to get the measurement and apply skin prep. She then pointed to a scratch Resident #155 had on the back of her right ear. LVN H was not addressing Resident #155 during this discussion. LVN H pulled Resident #155's blanket back and Resident #155 quickly grabbed the blanket and covered herself back up and made a noise indicating she was agitated. LVN H let go of the blanket and put her hands up. Resident #155 never opened her eyes or engaged in conversation. LVN H stated she was barely touching her. Interview on 5/14/25 at 11 AM with LVN H/Treatment Nurse revealed the DOR texted her that one of the rehab staff noted Resident #155 had a DTI on her left lateral heel. She stated she went in to assess Resident #155 and as soon as she approached Resident #155 even before touching her, Resident #155 started yelling out. LVN H stated she tried to assess Resident #155 the day before (5/12/25) and the Resident told her don't touch me so she left the Resident alone. LVN H stated she wanted to assess Resident #155's heel so that she could obtain an order and Resident #155 would receive treatment. LVN H stated she understood Resident #155 had the right to refuse treatment and she should have stopped when the Resident told her to stop. LVN H stated Resident #155 yelled out several times that it hurt and to stop. LVN H stated she was aware Resident #155 had a fall the weekend prior to the assessment and stated maybe Resident #155 was in pain. She stated during the assessment she noted bruising to Resident #155's upper extremities. LVN H stated she was not sure but guessed they were from the fall. She stated the DOR was supposed to assist during the assessment but the DOR was delayed with helping another resident. She stated she did not talk with LVN A about whether or not Resident #155 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 26 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0697 had received any PRN pain medications before she assessed Resident #155. She stated protocol required a resident receive pain medication prior to treatment as needed. Level of Harm - Actual harm Residents Affected - Few Interview on 5/15/25 at 9:30 AM with the DON revealed he was made aware that Resident #155 was yelling out when LVN H/Treatment Nurse was assessing her left heel. He stated LVN H should have checked with the nurse to ensure Resident #155 received a PRN pain medication before assessing Resident #155. He stated LVN H should have also stopped when Resident #155 told her to stop. He stated Resident #155 had a right to refuse treatment. The DON further stated LVN H should have stopped and engaged other staff to help and could have attempted the assessment at a later time when Resident #155 was calmer. The DON stated LVN A attempted to give Resident #155 pain medication after LVN H assessed her but Resident #155 refused it. Interview on 05/15/25 at 03:13 PM with LVN A revealed therapy sent her a text message they found a reddened area on Resident #155's left heel. LVN A stated she heard Resident #155 yelling down the hallway the morning of 5/13/25 and went to her room to find out what was going on. She stated she heard Resident #155 say she hurt and to stop. LVN A stated after LVN H assessed Resident #155 she tried to give the Resident a Tylenol 3 PRN and a schedule antibiotic. She stated Resident #155 refused all medications. Telephone interview on 05/15/25 at 03:38 PM with Resident #155's RP revealed staff called to tell her Resident #155 had a fall early morning on 05/12/25 but did not sustain any injuries. The RP stated Resident #155 was supposed to have a left hip replacement months prior but was delayed due to other health complications. She stated Resident #155 often complained about pain around her left hip and would yell out when she did not want to be bothered usually related to having pain. Review of facility policy, Pain Recognition and Management, undated read Policy It is the policy of this facility to ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences. Purpose The facility assists each resident with pain management to maintain or achieve the highest practicable level of well-being and functioning by: Interviewing or observing the resident to determine if pain is present; Identifying circumstances when pain can be anticipated; Evaluating pain and working with the resident to develop a plan of care that considers their needs preferences and goals; Developing and implementing a plan, using non-pharmacologic and/or pharmacologic interventions to manage and/or prevent pain. Procedure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 27 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0697 1. Level of Harm - Actual harm The resident will be evaluated for pain upon admission, quarterly, and with any change in their status. Residents Affected - Few 2. Pain will be documented in the electronic health record (EHR) using a scale of 1 - 10. 3. For the resident who is unable to communicate verbally or understand abstract concepts, the PAINAD scale for the cognitively impaired will be used and documented in the resident's EHR. 4. Management: a. The Care Plan will include preventative or care interventions (pharmacological and non-pharmacological) for any resident admitted with pain. b. Medication(s) received, refused and response to medication will be documented on the Electronic Medication Administration Record (e-MAR). c. If the pain management program is not effective, the licensed nurse will contact the resident's physician. 5. Monitoring: a. Monitor pain status every shift using either the numerical pain rating (1-10) or PAINAD scale. (Pain Advanced Dementia scoring guide) b. Consult physician for additional interventions if pain is not relieved by current orders. c. The Interdisciplinary Care Plan will reflect the location and type of pain, pharmacological, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 28 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0697 non-pharmacological interventions, with evaluation and revision as indicated. Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 29 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to assess the resident for risk of entrapment from bed rails prior to installation. Review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation for 2 of 6 Residents (Resident #21 and Resident #153) whose records were reviewed for the use of side rails. 1. Nursing staff failed to obtain physician orders, a consent, and did not make other efforts prior to the implementing the use of SRs for Resident #21. 2. Nursing staff failed to obtain physician orders and a consent for the use of SRs for Resident #153. These deficient practices could affect any resident and could contribute to unavoidable accidents. The findings were: 1. Review of Resident #21's face sheet, dated 5/15/25, revealed he was admitted to the facility on [DATE] with diagnoses including Metabolic Encephalopathy (according to Cleveland Clinic: it is a change in how your brain works due to an underlying condition. It can cause confusion, memory loss and loss of consciousness), Muscle weakness (generalized), Other lack of coordination and Other abnormalities of gait and mobility. Review of Resident #21's quarterly MDS assessment revealed his BIMS score was 14 of 15 reflective of minimal cognitive impairment; he required partial to moderate assistance with rolling left and right and required substantial to maximal assistance with from sitting to lying and from lying to sitting on side of bed. Review of Resident #21's Care Plan, initiated on 3/30/25 revealed there was no indication Resident #21 used SRs. Review of Resident #21's physician orders for May 2025 revealed there was not an order for the use of SRs. Review of consents in Resident #21's EHR under the miscellaneous section revealed there was no indication there was a consent for use of SR's. Review of Resident #21's Restraint / Enabling Device / Safety Device Evaluation, dated 4/6/25 revealed Resident #21's use of 1/4 SRs to enhance bed mobility but there was no indication anything other efforts were implemented prior to the use of SRs. Observation and interview on 05/13/25 at 09:45 AM revealed Resident #21 lying in bed with 1/2 SR's up on both side of the bed. Interview with Resident #21 revealed he used the SRs for bed mobility. Interview on 05/15/25 04:24 PM with the DON revealed facility policy required that nursing staff obtain physician orders, an assessment, a consent which provided risks and benefits and should try (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 30 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few other methods prior to implementing the use of SRs. The DON stated the Resident's Care Plan should also reflect the use of SRs. The DON stated the primary reason for following protocol was to ensure Resident #21 used the SRs safely to avoid any accidents. 2. Review of Resident #153's face sheet, dated 5/15/25, revealed he was admitted to the facility on [DATE] with diagnoses including Traumatic Subdural Hemorrhage (according to Cleveland clinic: type of bleeding near your brain that can happen after a head injury) without loss of consciousness, subsequent encounter and Muscle wasting and atrophy. Review of Resident #153's admission MDS, dated [DATE], revealed his BIMS score was 14 of 15 reflective of minimal cognitive impairment, he had functional limited range of motion of his upper extremities and he was dependent on staff for roll rolling left and right in bed and changing positions, sitting to lying position in bed and from lying to sitting on side of bed. Review Resident #153's physician orders for May 2025 did not reveal orders for the use of SRs. Review of consents in Resident #153's EHR under the miscellaneous section revealed there was no indication there was a consent for use of SRs. OB and interview on 05/15/25 at 02:05 PM with Resident #153 revealed he was lying in bed in low position. mats and 1/4 SRs on both sides of the bed Resident #153 stated staff would help him with ADL's and he would use the SRs to hold on. Interview on 05/15/25 04:24 PM with the DON revealed facility policy required that nursing staff obtain physician orders, an assessment, a consent which provided risks and benefits for the use of SRs. The Resident's Care Plan should also reflect the use of SRs. The DON stated the primary reason for following protocol was to ensure Resident #153 used the SRs safely to avoid any accidents. Review of facility policy, Mobility bars/Side rails, undated read in relevant part POLICY: It is the policy of this facility to refuse to restrain residents for any cause. PROCEDURE: Mobility enabling bars or quarter side rails are used to aide in turning and repositioning. Consent will be obtained upon admission Assessment will be completed to identify need and safety upon admission and quarterly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 31 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 each resident's drug regimen must be free from unnecessary drugs without adequate indications for its use for 1 of 6 Resident (Resident #151) whose records were reviewed. Residents Affected - Few Nursing staff failed to obtain a consent from Resident #151's family representative for the use of Hydorxyzine (used for anxiety). This deficient practice could affect any resident who received psychotropic medications and could contribute to the use of unnecessary medications. Review of Resident #151's face sheet, dated 5/15/25, revealed she was admitted to the facility on [DATE] with diagnosis including unspecified Dementia. Review of Resident #151's physician orders for May 2025 revealed an order hydrOXYzine HCl Oral Tablet 25 MG (HydrOXYzine HCl) Give 1 tablet by mouth every 8 hours as needed for anxiety for 14 Days. Review of Resident #151's MAR for May 2025 revealed Resident #151 received HydrOXYzine from 05/12/25 to 05/15/25. Review of Resident #151's consent form for HydrOXYzine, dated 5/12/25 revealed it was not signed by Resident #151's representative. Interview on 05/15/25 at 02:35 PM with the DON revealed a consent for the use of psychotropic medication had to be signed by the resident or representative prior to administration. The DON stated the consent form for HydrOXYzine, dated 5/12/25 was not signed by Resident #151's representative. He stated it was not a valid consent. He stated the potential outcome was that the representative did not agree with the medication administration and the resident would receive a medication unnecessarily. Review of facility policy, Psychotropic Medications, revised on 12/23 read in relevant part It is the policy of this facility to ensure that residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record. Procedure: 1. Psychotropic medications shall not be administered for the purpose of discipline or convenience. They are to be administered only when required to treat the resident's medical symptoms and will be considered only after nonpharmacological interventions have been attempted and failed. 2. On admission, the admitting nurses will review the transfer orders for any psychotropic medications. All effort will be made by the Licensed Nurses (LN) to obtain as much history regarding these medications, including prior informed consents, from the previous facility or through resident or resident representative interview. Any information obtained will be documented in the resident's clinical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 32 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure all drugs and biological were stored in locked compartments for 1 of 24 residents (Resident #150) reviewed for medications storage. During medications administration, LVN A left medications at bedside of Resident #150. This deficient practice could place residents at risk of misappropriation of medications or harm due to accidental ingestion of medications. The findings included: Record review of Resident #150's face sheet, dated 05/14/2025, revealed an admission date of 05/04/2025, with diagnoses which included: Cirrhosis of liver (permanent scarring that damages the liver and interferes with its functioning) , Dysphagia (Difficulty swallowing), Hyperlipidemia (Elevated level of any or all lipids(fat) in the blood), Hypertension (High blood pressure), Chronic kidney disease stage 3 (gradual loss of kidney function). Review of MDS log revealed Resident #150's admission assessment was not due yet. Review of BIMS assessment, dated 05/05/2025, revealed Resident #150 had a BIMS score of 9 and was moderately cognitively impaired. Review of Functional abilities assessment, dated 05/08/2025, revealed Resident #150 required limited to extensive assistance with his activities of daily living. Review of Resident #150's physician orders for the month of May 2025 revealed REINSERT PERIPHERAL IV LINE. NOTIFY MD IF UNABLE TO REINSERT AFTER ATTEMPTS. as needed for INFILTRATION OR ACCIDENTAL REMOVAL and, Cefepime HCl (an antibiotic) Intravenous Solution Reconstituted 2 GM (Cefepime HCl) Use 2 gram intravenously one time a day for infection of the AICD site until 05/15/2025 23:59 (11:59 p.m.). Review of Resident #150's care plan, dated 05/05/2025, revealed a problem of At risk for impaired cognitive function/dementia or impaired thought processes r/t infection of cardiac device, liver cirrhosis, Hypertension, Chronic kidney disease stage 3 and a goal of Will remain oriented to (person,place, situation, time) through the review date. Observation on 05/14/25 at 9:06 a.m., revealed while administering IV Antibiotic for Resident # 150, LVN A went to the resident's bathroom to change her gloves and left the medication on the bed next to the resident therefore losing sight of the medication. While administering the flush before administering the medication by IV, the IV line came out and the LVN had to leave the room to get supply for a new IV insertion, She left the antibiotic in the room with the resident. During an interview with LVN A on 05/14/2025 at 9:30 a.m., LVN A stated she left the medications in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 33 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the room without supervision. She was under the impression since the resident was on enhanced barrier precaution she could not move the medication out of the room and was not sure how to proceed. She revealed she received Medication diversion prevention training within the year. During an interview with the DON on 05/14/2025 at 4:45 p.m., the DON stated medications should not be left resident's bedside without supervision. He stated the nursing staff had received training on medication administration and drug diversion. Record review of the facility's policy titled, Medications access and storage, dated 05/2017, revealed Only licensed nurses, the consultant pharmacist and those lawfully authorized to administer medications (e.g., medication aides) are allowed access to medications. Medication rooms, carts, and medication supplies are locked or attended by persons with authorized access. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 34 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews, and record reviews, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 2 of 5 residents (Resident #23 and #150) reviewed for infection control, in that: Residents Affected - Few 1. While administering medications for Resident #23, MA B did not sanitize the mobile blood pressure machine. 2. While Administering medications for Resident #150, LVN A did not sanitize of wash her hands between change of gloves. LVN A did not change her gloves prior to start care on Resident #150 These deficient practices could place residents at-risk for infection due to improper care practices. These findings included: 1. Record review of Resident #23's face sheet, dated 05/14/2025, revealed an admission date of 12/21/2021, and a readmission date of 09/22/2024, with diagnoses which included: Dementia (decline in cognitive abilities), Major depressive disorder (mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure), Hyperlipidemia (Elevated level of any or all lipids(fat) in the blood), Hypertension (High blood pressure), Acquired absence of left leg above knee. Record review of Resident #23's MDS Quarterly assessment, dated 04/01/2025, revealed the resident had a BIMS score of 4, indicating severe cognitive impairment. Resident #23 required extensive to total care with his activities of daily living, and was always incontinent of bowel and bladder. Record review of Resident #23's care plan revealed a care plan initiated 01/04/2022 with a problem of on Antihypertensive medications r/t hypertension.and, an intervention of Obtain blood pressure readings. Take blood pressure readings under the same conditions each time. Review of Resident #23's physician orders for May 2025 revealed Losartan Potassium Oral Tablet 50 MG (Losartan Potassium) (A blood pressure medication) Give 1 tablet by mouth one time a day for Hypertension hold systolic blood pressure <100 -Order Date-05/12/2025 Observation on 05/14/25 at 9:38 a.m., revealed while administering medications for Resident # 23, MA B used a mobile vitals machine used by other staff on hall 400. She did not sanitize the blood pressure cuff prior to take a blood pressure measure on the resident. She sanitize the machine and cuff after using it. During an interview on 05/14/2025 at 9:45 a.m. MA B stated she used a blood pressure machine used by others. She stated she did not sanitize the machine prior to using it but it was policy to sanitize after use. She agreed she had no way to know for sure the previous user had followed policy and sanitize the machine after using it. She stated she had received Infection control training within the year. During an interview on 05/14/2025 at 4:45 p.m., the DON stated the staff should sanitize the blood (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 35 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pressure machine prior to using it. He stated that not sanitizing the blood pressure machine and cuff between uses could cause a risk of cross contamination and infection for the resident. He revealed they provided training on infection control at least once a year and as needed. He revealed they checked the skills of the staff annually and as needed with the assistance of his ADONS. Review of facility policy, titled Cleaning & Disinfection of Resident Care Items & Equipment, undated, revealed Reusable resident items are cleaned and disinfected between residents. 2. Record review of Resident #150's face sheet, dated 05/14/2025, revealed an admission date of 05/04/2025, with diagnoses which included: Cirrhosis of liver (permanent scarring that damages the liver and interferes with its functioning) , Dysphagia (Difficulty swallowing), Hyperlipidemia (Elevated level of any or all lipids(fat) in the blood), Hypertension (High blood pressure), Chronic kidney disease stage 3 (gradual loss of kidney function). Review of MDS log revealed Resident #150's admission assessment was not due yet. Review of BIMS assessment, dated 05/05/2025, revealed Resident #150 had a BIMS score of 9 and was moderately cognitively impaired. Review of Functional abilities assessment, dated 05/08/2025, revealed Resident #150 required limited to extensive assistance with his activities of daily living. Review of Resident #150's care plan, dated 05/05/2025, revealed a problem of Has infection of the: AICD site, with an intervention of Maintain standard precautions when providing resident care. Observation on 05/14/25 at 9:06 a.m., revealed while administering IV Antibiotic for Resident #150, LVN A touched the resident's feet to assess them, changed her gloves before administering the IV but did not sanitize her hands. While preparing to insert the new IV for Resident #150, LVN A had to reposition the resident in his wheel chair. LVN A touched the brake of the wheel chair with her gloved hands and did not change her gloves or sanitize her hands before starting the procedure. During an interview on 05/14/2025 at 9:30 a.m., LVN A stated she did not use sanitizer between change of gloves and she should have. She stated she touched the brake of the wheel chair and did not change gloves before starting the procedure. She revealed she received Infection control training within the year. During an interview on 05/14/2025 at 4:45 p.m., the DON stated the staff should have used sanitizer between change of gloves and should have changed her gloves after touching the Resident's wheelchair's brake. He stated not sanitizing or washing your hands between change of gloves and not changing gloves if they are possibly infected could cause a risk of cross contamination and infection for the resident. The DON stated Resident #150 was on enhanced barrier precaution. He revealed they provided training on infection control at least once a year and as needed. He revealed they checked the skills of the staff annually and as needed with the assistance of his ADONS. Review of facility policy. titled Hand hygiene, dated 12/2023, revealed Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: [ .] k.After handling used dressings, contaminated equipment, etc.; l.After contact with objects (e.g., medical equipment) in the immediate vicinity of the resident; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676158 If continuation sheet Page 36 of 37 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 676158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sonterra Health Center 18514 Sonterra Place 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 0880 m.After removing gloves;. 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: 676158 If continuation sheet Page 37 of 37