Health inspection·September 13, 2023

F 0551 Give the resident's representative the ability to exercise the resident's rights. 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 obtain documentation that the resident's representative has been delegated the necessary authority to exercise the resident's rights and must verify that a court-appointed representative has the necessary authority for the decision-making at issue as determined by the court. For example, a court-appointed representative might have the power to make financial decisions, but not health care decisions. Additionally, the facility must make reasonable efforts to ensure that it has access to documentation of any change related to the delegation of rights, including a resident's revocation of delegated rights, to ensure that the resident's preferences, are being upheld for 1 of 5 residents (Resident #1) reviewed for resident representative rights. Residents Affected - Few The facility failed to ensure Resident #1, who was cognitively impaired when admitted to the facility, had had a representative who had the authority to make decisions on his behalf. This failure could lead to the facility making decisions without the resident's right to designate a surrogate or representative to make treatment or transfer decisions for the resident; and could deny the resident through the resident representative their wishes and preferences. The findings included: Record review of Resident#1's face sheet, dated 09/12/23, and EMR (electronic medical record) revealed, the resident was re-admitted on [DATE] with diagnoses that included: anoxic brain damage (not enough oxygen to the brain causing brain damage), seizures, cerebral infarction (destructive blood flow in the brain) and PEG (Resident was a Male age [AGE]. RP (responsible party) was listed as the resident per the face sheet. Record review of Resident# 1's Care Plan, dated 02/08/23, revealed goals and interventions that included: ADL care, medications as ordered, Code status DNR, at risk for infection, cognitive deficits, and behaviors. Record review of Resident#1's MDS (minimum data set), dated 8/8/23 revealed: BIMS (brief interview of mental status) Score was zero (severely impaired in cognition). During an interview on 09/12/23 at 8:55 AM, Resident#1's family member stated there was no documented POA or guardianship. The family member stated that a family attorney informed the family a POA was not required because a family member signed the admission for the resident to the facility. The family member stated the facility refused to provide documents involving a resident fall (Resident#1) (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 2 Event ID: 676325 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 676325 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeside Nursing and Rehabilitation Center 8707 Lakeside Parkway San Antonio, TX 78245 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)