Inspection·November 25, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 of 3 residents (Residents #1) reviewed for medications and pharmacy services, in that: The facility failed to ensure Resident #1's eMAR reflected when she received oxycodone as follows: 10/14 at 12:00 PM, 10/15 08:00 AM, 10/17 12:07 AM, 10/20 03:00 AM, 10/21 at 11:25 AM, 10/22 10:45 AM, 10/23 01:50 PM, 10/23 05:00 PM, 10/26 04:21 AM, 10/27 06:10 PM, 10/29 08:00 PM, 10/30 07:30PM, 10/31 04:30 PM, 11/01 04:30 PM, 11/03/24 01:58 AM, 11/04 08:00 PM, 11/5 08:00 PM, 11/8 08:00 PM, 11/11 08:00 PM, 11/12 08:00 PM, 11/14 08:00 PM, 11/14 (time illegible), and 11/19 12:15 AM, resulting in the missed requirement to assess the effectiveness of this medication. This deficient practice could put residents at risk for pain and anxiety. Findings include: Record review of Resident #1's admission record reflected a female admitted [DATE] with diagnoses to include major depressive disorder, encounter of other orthopedic aftercare, [left femur fracture], stage 2 pressure ulcer of sacral region. Record review of Resident #1's admission MDS, dated [DATE], reflected the resident had a BIMS score of 15 out of 15, indicating intact cognition. Record review of Resident #1's care plan, dated 11/22/24, reflected problem Nursing-Pain Management with interventions to include Assess and monitor pain medications are adequately managing pain and signs/symptoms of complications. Record review of Resident #1's doctor's orders, dated 11/22/24, reflected oxycodone-acetaminophen 5mg-325mg table (1) TABLET Oral for Pain 6-10 out of 10, as needed every four hours starting 10/14/24. Record review of Resident #1's eMAR, dated 11/22/24, reflected oxycodone-acetaminophen 5mg-325mg table (1) TABLET Oral As Needed Every Four Hours Starting 10/14/2024, Order Date: 10/14/2024 . FOR PAIN 6-10/10 Record review of Resident #1's Controlled Drug Receipt/Record/Disposition Form, the DON verbally (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 11/25/2024 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)