Inspection·February 14, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmacological services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 2 of 10 residents (Resident #1 and Resident #2 ) reviewed for pharmacy services. 1. LVN A administered Cefazolin (Antibiotic) 6 GM in 250 ML instead of Cefazolin 6 GM in 1000 ML to Resident # 1. The non-compliance was identified as past non-compliance. The noncompliance began on 06/11/2024 and ended on 06/12/24. The facility had corrected the non-compliance before the survey began. 2. The facility failed to ensure that controlled medications were secured. The non-compliance was identified as past non-compliance. The noncompliance began on 7/17/2024 and ended on 7/18/24. The facility had corrected the non-compliance before the survey began. These deficient practices could affect all residents who receive medication from the facility and place them at risk for adverse reactions, decline in physical health. Findings were : 1. Record review of Resident #1's face sheet, dated 02/11/25, revealed an initial admission date of 6/11/2024. Resident #1 had diagnoses that included: Post Traumatic Stress Disorder (a mental health condition that some people develop after they experience or witness a traumatic event), Depression. (persistent symptoms of sadness, and a loss of interest in daily activities) and Prosthetic joint infection (defined as infection involving the joint prosthesis and adjacent tissue). Record review of Resident #1's admission MDS assessment, dated 6/11/24, revealed a BIMS score of 15, which indicated intact cognition. Record review of Resident #1's Care plan, initiated on 06/11/2024 and revised on 7/28/2024, revealed a focus of: [residents name] is on antibiotic therapy related to orthopedic device, receiving Cefazolin via PICC line. Interventions: Administer medication Cefazolin as ordered. Record review of Resident #1's physician orders, dated 06/07/2024, revealed medication Cefazolin Sodium Injection Solution Reconstructed 3 GM (Cefazolin Sodium) use 6 grams intravenously every shift (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 676281 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 676281 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westover Hills Rehabilitation and Healthcare 9922 State Hwy. 151 San Antonio, TX 78251 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)