Inspection·August 21, 2025

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the shoulder and stated something in Spanish as he pointed out the window. Resident #2 stated she told him to leave her room, and he did. During an interview on 8/21/25 at 11:47 a.m. MDS C stated she was informed on 8/20/25 that Resident #1 had behaviors of looking for a family member and would require staff to reorient him. MDS C stated they would normally run a 24 hours report in the morning and filter for key words to find any resident with changes in condition. MDS C stated the ADONs also assist with looking over the 24 hour reports and updating any assessments or care plans. MDS C stated she had recently been out for personal reasons and was not aware the resident had a change in condition. MDS C stated by not updating changes in the resident's care plan staff would not be aware of how to treat the resident. The MDS C stated staff used the care plan to be aware of resident behaviors and would also prompt care areas in the point of care nursing aides used. During an interview on 8/21/25 at 12:09 p.m. ADON D they would run a 24-hour report and read the report to see if any residents had a change in condition. ADON D stated there were 3 ADONs who would split up the reports according to hallways. ADON D stated however 1 of the ADONs had recently started and another ADON had been out of FMLA. The ADON stated the DON was also helping her read the 24-hour reports daily. ADON D stated she was not aware of the nursing progress note from 8/5/25 where the resident was exhibiting exit seeking and wandering behaviors. ADON D stated had she seen that note she would have spoken to the resident to see what was going on, spoken to the nursing staff, and made the DON aware. ADON D stated they would also notify the doctor and see if they needed to update any orders. ADON D stated they would also need to look at his elopement and wandering assessment and update it. ADON D stated failing to update the resident assessments could cause someone to miss a new onset mental issue or condition, and implementing any interventions to protect other residents and respect their privacy. During an interview on 8/21/25 at 12:23 p.m. the DON stated the ADONs would look over the 24-hour reports, notify MDS, and bring up any changes in patient conditions during their morning meetings. The DON stated she became aware of Resident #1's nursing note from 8/5/25 on 8/20/25 while performing an audit. The DON stated they care planned the behaviors. The DON stated she was unaware the resident ever had wandering behaviors and no one ever reported to her he had any behaviors of being in other resident rooms. The DON stated the ADONs were responsible for reviewing the 24-report and updating the wandering assessment. The DON stated it was important to update care plans and assessments so staff could follow the residents plan of care and return him to his room safely. Record review of the facility's policy titled Resident Assessment, no date, stated Policy: It is the policy of this facility to perform resident assessment. Procedure: Each resident will be assessed by the licensed nurse. 2. Each time there is a change in the mental or physical condition of the resident that may significantly affect his or her ability to perform the activities of daily living 3. Every quarter. 4. If there is a significant change, it will be reported to physician and orders to carried out. Additional assessments will be performed as needed. (i.e., fall risk assessment, pain evaluations, enabling device assessment, etc). Event ID: Facility ID: 676281 If continuation sheet Page 2 of 4 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 08/21/2025 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)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment including both the comprehensive and quarterly review assessments to reflect the current condition for 1 of 4 residents (Resident #1) reviewed for care plan revisions. The facility failed to ensure Resident #1's care plan was comprehensive and updated to reflect Resident #1 had wandering and exit seeking behaviors. This deficient practice could place residents at risk of not receiving appropriate interventions to meet their current needs. The findings included: Record review of Resident #1's face sheet, dated 8/21/25, revealed an admission date of 3/7/25 with diagnoses including: cerebral infarction (when blood flow to a part of the brain is obstructed typically by a blood clot causing death to the brain cells), disorder of visual pathways in (due to) vascular disorders left side (the visual pathway consist of structures that carry visual information from the retina to the brain. Lesions in that pathway cause a variety of visual field defects), other abnormality of gait and mobility, and cognitive communication deficit. Record review of Resident #1's care plan, updated 8/20/25, revealed the resident would wander related to impaired safety awareness, unintentionally intrudes on the privacy of others or activity related to impaired cognition. An intervention to redirect resident from wandering by reorienting Resident #1 and direct/assist to his room was also added on 8/20/25. Record review of Resident #1's Quarterly MDS, dated [DATE], revealed a BIMS score of 10, indicating moderate cognitive impairment. Section E Behavior revealed he had no wandering behaviors. Record review of Resident #1's nursing progress notes, dated 8/21/25, revealed: -3/10/25 at 9:24 a.m. Resident wandering the hall, looking for his room. He is A/O x2 currently and does not remember why he is here. Easily redirected and compliant with directions. [NP] updated about patient status. Will continue to monitor. Written by RN A-8/5/25 at 12:07 a.m. Resident was up and walking around and going into other resident's rooms. Resident was redirected and got angry at staff, also attempted to walk to the front door, but redirected to go back to his room. Resident was screaming down the hallway not wanting to go to his room. Staff encouraged resident to stay in bed during the night and use his wheelchair while his OOB. Staff attempted to take resident back to his room and but refused, resident is sitting by the nurse's station being observed. Written by LVN B. Record review of Resident #1's Elopement and Wandering Evaluation assessment, dated 6/10/25, revealed answers to question revealed he had no history of, or current behavior of wandering and he was a low risk. Record review of Resident #1's assessment on 8/21/25, revealed two wandering assessments were completed in the past. One was completed on 3/7/25 with low risk and another on 6/10/25 with low risk. No other wandering/elopement assessment were found. During an interview on 8/20/25 at 1:44 p.m. RN A stated Resident #1 was known to go into other residents' room. RN A stated when other residents would complain about the resident being in their rooms she would go check and he would be taking products like toilet paper he already had in his room. RN A stated she would redirect him to retrieve the items from his room. During an interview on 8/21/25 at 10:35 a.m. interview with Resident #2 who's room was across the hall from Resident #1 stated once Resident #1 had come in her room. She stated she was coloring and facing her window when Resident #1 tapped her on the shoulder and stated something in Spanish as he pointed out the window. Resident #2 stated she told him to leave her room, and he did. During an interview on 8/21/25 at 11:47 a.m. MDS C stated she was informed on 8/20/25 that Resident #1 had behaviors of looking for a family member and would require staff to reorient him. MDS C stated they would normally run a 24-hours report in the morning and filter for key words to find any resident with changes in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676281 If continuation sheet Page 3 of 4 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 08/21/2025 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)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete condition. MDS C stated the ADONs also assist with looking over the 24-hour reports and updating any assessments or care plans. MDS C stated she had recently been out for personal reasons and was not aware the resident had a change in condition. MDS C stated by not updating changes in the resident's care plan staff would not be aware of how to treat the resident. The MDS C stated staff used the care plan to be aware of resident behaviors and would also prompt care areas in the point of care nursing aides used. During an interview on 8/21/25 at 12:09 p.m. ADON D they would run a 24-hour report and read the report to see if any residents had a change in condition. ADON D stated there were 3 ADONs who would split up the reports according to hallways. ADON D stated however 1 of the ADONs had recently started and another ADON had been out of FMLA. The ADON stated the DON was also helping her read the 24-hour reports daily. ADON D stated she was not aware of the nursing progress note from 8/5/25 where the resident was exhibiting exit seeking and wandering behaviors. ADON D stated had she seen that note she would have spoken to the resident to see what was going on, spoken to the nursing staff, and made the DON aware. ADON D stated they would also notify the doctor and see if they needed to update any orders. ADON D stated they would also need to look at his elopement and wandering assessment and update it. ADON D stated failing to update the resident assessments could cause someone to miss a new onset mental issue or condition and implementing any interventions to protect other residents and respect their privacy. During an interview on 8/21/25 at 12:23 p.m. the DON stated the ADONs would look over the 24-hour reports, notify MDS, and bring up any changes in patient conditions during their morning meetings. The DON stated she became aware of Resident #1's nursing note from 8/5/25 on 8/20/25 while performing an audit. The DON stated they care planned the behaviors. The DON stated she was unaware the resident ever had wandering behaviors and no one ever reported to her he had any behaviors of being in other resident rooms. The DON stated the ADONs were responsible for reviewing the 24-report and updating the wandering assessment. The DON stated it was important to update care plans and assessments so staff could follow the residents plan of care and return him to his room safely. Record review of the facility's policy titled Comprehensive [NAME]-Centered Care Planning, dated 12/23, stated 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 timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. 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.4. The facility IDT will develop and implement a comprehensive person-centered, culturally-competent, and trauma-informed care plan for each resident within seven (7) days of completion of the Resident Minimum Data Set (MOS) and will include resident's needs identified in the comprehensive assessment. 6. The resident's comprehensive plan of care will be reviewed and/or revised by the IDT after each assessment, including both the comprehensive and quarterly review assessments. Event ID: Facility ID: 676281 If continuation sheet Page 4 of 4