Inspection·March 15, 2024

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a Comprehensive Assessment for 1 of 4 (Resident #22) residents for MDS review. The facility failed to do a Comprehensive Assessment upon admission for Resident #22 who was admitted to the facility for respite while on hospice. This deficient practice could contribute to the resident not receiving the care and services needed. The finding were: Record review of Resident #22's face sheet dated 3/14/2024 revealed she was admitted [DATE] for respite for five days with a discharge date of 9/5/2023. The resident had diagnoses that included: Parkinson's disease, Rhabdomyolysis, ( the breakdown of muscle tissue that releases a protein called myoglobin that can cause kidney damage) dementia with anxiety, and hypotension (low blood pressure). Record review of Resident #22's electronic medical record revealed the resident did not have a Comprehensive Assessment upon admission to the facility for respite. During an interview on 3/14/2024 at 9:38AM with Licensed Vocational Nurse Skilled Nursing Facility Minimum Data Set Coordinator A- stated the MDS should be done for respite on admission and discharge. Both should be done within 14 days. During an interview on 3/14/2024 at 9:46AM with LVN Long Term Care MDS Coordinator B confirmed Resident #22 was admitted to the facility on hospice for respite. LVN LTC MDS Coordinator B stated it was not done at the time of the resident's admission, it was missed. LVN LTC MDS Coordinator B stated a comprehensive assessment should be done within 14 days of admission and the same with the discharge. LVN LTC MDS Coordinator B stated it was important for comprehensive assessments to be completed for state reporting and for the building. LVN LTC MDS Coordinator B stated the demographics, the care provided, and the payor source were reported to the state. She agreed it was important that the comprehensive assessment should be done to coordinate with the Care Plan. Record review on of the facility's policy titled Comprehensive Assessments dated March 2022 stated in part, The admission assessment is a comprehensive assessment for a new resident and, [NAME] some circumstances, a return resident that must be completed by the end of day 14, counting the date of admission to the nursing home as day 1 if: a) this is the resident's first time in this facility, OR (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: 676353 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 676353 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coronado at Stone Oak 19638 Stone Oak Parkway San Antonio, TX 78258 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)