Inspection·October 23, 2024

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure that residents who required dialysis received such services, consistent with professional standards of practice for 1 of 4 residents (Resident #1) reviewed for dialysis. Residents Affected - Few Resident #1's did not have vital signs checked prior to leaving for dialysis on 10/4/24. This deficient practice could affect residents who received dialysis treatments and could result in inadequate care of dialysis treatment. Findings included: Record review of Resident #1's admission Record, dated 10/22/24, revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Acute Kidney Failure (condition in which kidneys suddenly are unable to filter waste from blood), Type 2 Diabetes (condition in which the body has trouble controlling blood sugar and using it for energy), and Hypertension (high blood pressure). Record review of Resident #1's Order Summary, dated 10/22/24, revealed an order for dialysis treatment on 10/4/24. Further review revealed hemodialysis every Monday, Wednesday, and Friday, chair time 3:15 pm; vital signs pre dialysis. Record review of Resident #1's Blood Pressure Summary, dated 10/22/24, revealed the resident's blood pressure was 156/64 on 10/4/24 at 8:59 am. Record review of Resident #1's Pulse Summary, dated 10/22/24, revealed the resident's heart rate was 84 bmp on 10/4/24 at 8:59 am. Record review of Resident #1's Respiration Summary, dated 10/22/24, revealed the resident's respiratory rate was 18 breaths per minute on 10/4/24 at 10:48 am. Record review of Resident #1's Temperature Summary, dated 10/22/24, revealed the resident's temperature was 97.3 degrees Fahrenheit on 10/4/24 at 10:48 am. Record review of Resident #1's Nursing Dialysis Communication Record, dated 10/4/24 and signed by LVN C, revealed the resident's vital signs were BP 156/64, Temp 97.3, Pulse 84, and Resp 18. Record review of facility's 24-hour report, dated 10/4/24, revealed Resident #1 was picked up for (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: 676331 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 676331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hunters Pond Rehabilitation and Healthcare 9903 Hunters Pond San Antonio, TX 78224 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)