Health inspection·February 17, 2023

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 the rights to reside and receive services in the facility with reasonable accommodation of resident needs and preferencesfor 2 of 28 residents (Resident #47 and Resident #50) reviewed for resident rights, in that: Residents Affected - Few Facility did not ensure the automated handicap push button, at the front lobby, to exit the facility allowed residents to easily exit the facility, while in a wheelchair. This deficient practice could place residents at risk for bodily injury while attempting to leave the facility by pushing the automated handicap button. The findings were: Record review of Resident #47's face sheet, dated 02/17/2023, revealed the resident was admitted to the facility on [DATE] with diagnoses that included: spinal stenosis, anxiety, asthma, shortness of breath, and recurrent depressive disorder. Record review of Resident #47's quarterly MDS, dated [DATE], revealed the resident had a BIMS of 10, which indicated the resident was moderate cognitive impairment. Record review of Resident #50's face sheet, dated 02/17/2023, revealed the resident was admitted to the facility on [DATE] with diagnoses that included: anxiety, major depressive disorder, and stage 5 chronic kidney disease. Record review of Resident #50's quarterly MDS, dated [DATE], revealed the resident had a BIMS of 15, which indicated the resident was intact cognitive impairment. During the resident group meeting on 02/15/2023 at 1:45 p.m., Resident #47 and Resident #50 stated that the automatic handicap button was not releasing the front door. During an observation and interview on 02/15/2023 at 6:00 p.m., revealed when the handicap button was pushed, to go out front, the front door did not automatically open. However, the front door made noises that it tried to open but something kept the door from automatically opening. The Maintenance Director stated the panic bar reengaged when the door came back after depressing the automatic actuator button which prevented the one releasing action required to open the front Lobby Exit door and he stated the panic bar probably needed to be replaced and would immediately fix the exit door. He further stated he was not aware that the front door was supposed to automatically open, without pushing the panic bar, after pushing the handicap button. Page 1 of 7 676353 676353 02/17/2023 Coronado at Stone Oak 19638 Stone Oak Parkway San Antonio, TX 78258

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 02/17/2023 at 2:51 p.m., Resident #50 stated he was stuck in the doorway upfront because the automatic handicap button did not release correctly. He stated it was early in the morning around 4 am and there was no one to tell. Resident #50 stated he felt helpless and had to wait for someone to come and help him. He was not able to recall how long ago this happened or how long it took for someone to come help him. Resident #50 stated he was not able to recall how long the handicap button was not working but knew it had been a long while since it did. During an interview on 02/17/2023 at 2:54 p.m., Resident #47 stated he was not able to remember how long the handicap button at the front door had not worked. He stated he feels helpless because that door is heavy and hard to open. Resident #47 stated he told the administrator at some point about it but was unable to remember how long ago he told him. During an interview on 02/17/2023 at 3:38 p.m., the DON stated she was not aware that the automated handicap button at the front door was not working properly. She stated the Maintenance Director was responsible for ensuring it worked correctly. The DON was not able to recall if it worked while she was at this facility. She stated she did not believe there was a potential harm to residents with the button not working. During an interview on 02/17/2023 at 3:58 p.m., the Administrator stated he was not aware that the automated handicap button at the front door was not working properly. He further stated he was not aware of why it was not working properly. The Administrator stated he did not believe there was a potential harm to residents with the button not working. Record review of the facility's policy titled, Resident Rights, revised 02/2021, revealed Federal and state laws guarantee certain basic rights to all residents of this facility. These rights included the resident's rights to: a. a dignified existence; b. be treated with respect, kindness, and dignity; [ .] e. self-determination; f. communication with and access to people and services, both inside and outside the facility; [ .] i. exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility. Record review of the facility's policy titled, Environmental/Safety, dated 01/2016, revealed 1. Environmental/safety monitoring tasks must be performed in accordance with the Environmental/Safety Monitoring Protocol. 676353 Page 2 of 7 676353 02/17/2023 Coronado at Stone Oak 19638 Stone Oak Parkway San Antonio, TX 78258

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to coordinate assessments with the pre-admission screening and resident review (PASARR) program, and failed to refer all residents with possible serious mental disorder for level II resident review for 1 (Resident #30) of 26 residents reviewed for PASARR program, in that: Resident #30 had a serious mental disorder and was not referred for level II review. This failure could result in residents with serious mental disorders not receiving support services. The findings were: Record review of Resident #30's face sheet, dated 02/17/2023, revealed the resident was admitted on [DATE] with diagnoses including: schizoaffective disorder bipolar type, generalized anxiety disorder, and pain unspecified. Record review of Resident #30's comprehensive MDS, dated [DATE], revealed a BIMS score of 15 which indicated intact cognition. [Resident #30] ineffective individual coping [related to] inability to manage internal and external stressors secondary to anxiety, depression, and schizophrenia. [Resident #30] currently takes anti-depressant, anti-anxiety, and anti-psychotic medication. Record review of Resident #30's physician orders as of 02/15/2023, revealed she had been prescribed Prozac for Generalized Anxiety Disorder, Buspirone for Generalized Anxiety Disorder, and Zyprexa for Schizoaffective Disorder Bipolar Type. Record review of Resident #30's PASARR Level I screening tool revealed, Is there evidence or an indicator this is an individual that has a Mental Illness? No. During an interview with LVN/MDS A on 02/17/2023 at 10:17 a.m., LVN/MDS A stated that Resident #30's PASARR Level I was incorrect when it was received by the facility, and should have been corrected by facility staff, but the incorrect PASSARR Level 1 was not found by facility staff. LVN/MDS A further stated that Resident #30 had not been referred to the local mental health authority for evaluation and should have been. LVN/MDS A confirmed that Resident #30 may have been eligible to receive specialized support services from the local mental health authority, if Resident #30 had been referred to the authority. LVN/MDS A stated she was responsible for ensuring PASARR documentation was complete and correct During an interview with the DON on 02/17/2023 at 2:17 p.m., the DON stated the MDS Department or SW are responsible for ensuring that PASARR documentation is complete and correct. The DON confirmed that Resident #30 may have been eligible to receive specialized support services from the local mental health authority, if Resident #30 had been referred to the authority. Record review of the facility policy, Assessments, dated November 2017, revealed, .Upon admission, each Patient/Resident's diagnoses must be reviewed with the physician to develop individualized care plan interventions . The care plan must include . PASRR recommendations if applicable. In addition, 676353 Page 3 of 7 676353 02/17/2023 Coronado at Stone Oak 19638 Stone Oak Parkway San Antonio, TX 78258

F 0644 the facility must provide or obtain the required services . to provide any rehabilitative services . for mental disorders . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 676353 Page 4 of 7 676353 02/17/2023 Coronado at Stone Oak 19638 Stone Oak Parkway San Antonio, TX 78258

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for each resident receiving hospice services, to ensure quality of care for the resident, ensuring communication with the hospice medical director, the resident's attending physician, and others participating in the provision of care for 3 of 6 residents (Resident #55, Resident #53, and Resident #22) reviewed for hospice services, in that: 1. Facility did not ensure Resident #55's Certification of Terminal Illness form was in the resident's records 2. Resident #53's Hospice Election form was completed incorrectly, the Certification of Terminal Illness form was missing, and the Hospice Plan of Care had expired. 3. Facility did not ensure Resident #22's hospice election form was in the resident's records This deficient practice could place residents who receive hospice services at-risk of receiving inadequate end-of-life care due to a lack of documentation, coordination of care and communication of resident needs. The findings were: 1. Record review of Resident #55's face sheet, dated [DATE], revealed the resident was admitted to the facility on [DATE] with diagnoses including Protein Calorie Malnutrition, Gastrostomy Status, and Colostomy Status. Record review of Resident #55's comprehensive MDS, dated [DATE], revealed a BIMS score of 03 which indicated severe cognitive impairment. Record review of Resident #55's care plan, effective [DATE] - Present ([DATE]), revealed, [Resident #55] requires hospice as evidenced by terminal illness of: . Protein Calorie Malnutrition. Record review of Resident #55's physician orders as of [DATE], revealed an order dated [DATE], Admit to [Hospice Company Name], Hospice [diagnosis]: Protein [Calorie] Malnutrition. Record review of Resident #55's facility clinical record as of [DATE] revealed his hospice Certification of Terminal Illness form was not included in the record. During an interview with the Medical Records Director on [DATE] at 3:22 p.m., the Medical Records Director confirmed Resident #55's hospice Certification of Terminal Illness form was not included in his facility clinical record and confirmed the form should have been in the record. The Medical Records Director stated the Social Worker was responsible for ensuring each resident's hospice documentation was complete and correct. During an interview with the DON on [DATE] at 9:30 am, the DON stated that the Social Worker was out of the country and unavailable for interview. 676353 Page 5 of 7 676353 02/17/2023 Coronado at Stone Oak 19638 Stone Oak Parkway San Antonio, TX 78258

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Record review of Resident #53's face sheet, dated [DATE], revealed the resident was admitted to the facility on [DATE] with diagnoses including Dysphagia following Cerebral Infarction, Heart Failure, and Cerebral Infarction. Record review of Resident #53's quarterly MDS, dated [DATE], revealed a BIMS score of 07 which indicated severe cognitive impairment. Record review of Resident #53's care plan, effective [DATE] - Present ([DATE]), revealed, [Resident #53] requires hospice as evidenced by terminal illness of: . Dysphagia following Cerebral Infarction. Record review of Resident #53's physician orders as of [DATE], revealed an order dated, Admit to [Hospice Company Name], Hospice [diagnosis]: Dysphagia following Cerebral Infarction. Record review of Resident #55's facility clinical record as of [DATE] revealed his Hospice Election form was completed incorrectly, the Certification of Terminal Illness form was missing, and the Hospice Plan of Care had expired. Record review of Resident #55's Hospice Election Form, dated [DATE], had the name of the resident's responsible party in the box intended for the resident's name, and did not have the resident's name printed, written, or signed anywhere on the form. Record review of Resident #55's Hospice Plan of Care revealed that it expired [DATE]. During an interview with the Medical Records Director on [DATE] at 3:22 p.m., the Medical Records Director confirmed that Resident #53's Hospice Election form was completed incorrectly, the Certification of Terminal Illness form was missing, and the Hospice Plan of Care had expired. The Medical Records Director stated that the Social Worker was responsible for ensuring that each resident's hospice documentation was complete and correct. During an interview with the DON on [DATE] at 9:30 am, the DON stated that the Social Worker was out of the country and unavailable for interview. 3. Record review of Resident #22's face sheet, dated [DATE], revealed the resident was admitted to the facility on [DATE] with diagnoses that included: Parkinson's, anemia, bipolar, and major depressive disorder. Record review of Resident #22's quarterly MDS, dated [DATE], revealed the resident had a BIMS of 8, which indicated moderate cognitive impairment. Record review of Resident #22's hospice binder and EHR did not reveal a hospice election form. During an interview on [DATE] at 3:10 p.m., Mediccal Records stated Resident #22's hospice election form was not in her EHR. She further stated that this particular hospice company had access to the facility's EHR and was able to add all the required documentation in the EHR. Medical Records stated she was not aware of anyone at the facility was responsible for overseeing the hospice records. She was also not aware of a potential harm to resident's by not having the required documentation. During an interview on [DATE] at 3:33 p.m., the DON stated it was a team effort that was 676353 Page 6 of 7 676353 02/17/2023 Coronado at Stone Oak 19638 Stone Oak Parkway San Antonio, TX 78258

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some responsible for the hospice records. She further stated that no one specifically was responsible for ensuring the hospice records had all the correct documentation. The DON stated she did not believe there was a potential harm to residents by not having all the required documentation for the hospice records. During an interview on [DATE] at 3:10 p.m., the Administrator stated the MDS workers should be responsible for the hospice records, however, collectively with the help from the SW too. The Administrator stated he did not believe there was a potential harm to residents by not having all the required documentation for hospice in their records. Record Review of Residents #55, #53, and #22's Hospice provider contract, dated [DATE], revealed, Coordinated Plan of Care: Hospice and [Facility] shall coordinate, establish, and agree upon a coordinated plan of care for Hospice patients residing in the [Facility] . Record Review of the facility policy, Hospice Program, revised [DATE], revealed, Our facility has designated [blank] (Name) [blank] (Title) to coordinate care provided to the resident by our facility and the hospice staff . He or she is responsible for the following: . Obtaining the following information from the hospice: (1) The most recent plan of care specific to each [hospice] resident, (2) Hospice election form, (3) Physician certification and recertification of terminal illness . 676353 Page 7 of 7