Inspection·April 19, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observation, interview, and record review, the facility failed to in accordance with accepted professional standards and practices, the facility must maintain records that are complete, accurately documented temperature for 1 of 1 kitchen reviewed. 1. The facility failed to ensure temperatures were taken and accurately logged for the 04/13/25 Breakfast and Lunch meals 2. The facility failed to ensure temperatures were taken and accurately logged for meals on 04/15/25 3. The facility failed to ensure temperatures were taken and accurately logged for for breakfast milk or juices from 04/13/2025 through -04/19/2025 These deficient practices could place residents at risk of serious illness related consuming meals that are prepared in an unsanitary manner. The findings were: Observation on 04/19/25 at 11:44 AM, [NAME] A did temperature checks before lunch meal service. Interview with [NAME] B on 04/19/2025 revealed revealed Dietary Aide E missed the temperatures on 04/13/25 and [NAME] D was supposed to put the temperatures in on 04/15/25. [NAME] B revealed the dietary supervisor oversaw this and knew there were blanks in the temperature log. [NAME] B revealed it was important to take temperatures before meal service to make sure residents did not get sick if foods were at incorrect temperatures. [NAME] B revealed the kitchen did not check temperatures for milk or juice, but she would throw out the milk if it was not at a proper temperature. Interview with [NAME] A on 04/19/2025 revealed it was important to take temperatures before meal service to make sure residents did not get sick if foods were at incorrect temperatures. Interview with Dietary Aide E was unsuccessful. Voicemail left on 04/19/25 at 04:16 PM Interview with Dietary Supervisor was unsuccessful. Voicemail was left on 04/19/25 at 05:15 PM Interview on 04/19/25 at 07:40 PM, Dietary Aide C revealed she had been working at the facility for 2 years as a dietary aide and she only helped serve food in the kitchen. She revealed she was not trained to check temperatures in the kitchen and the cook was supposed to do this. (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: 676418 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 676418 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Heights of Bulverde 384 Harmony Hills Spring Branch, TX 78070 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)