Inspection·June 7, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that each resident received adequate supervision and assistance devices to prevent accidents for 1 (Resident #1) of 6 residents reviewed for accidents. NA E failed to use an assistive device used for lifting and transfers on 4/30/24 when transferring Resident #1, resulting in Resident #1 experiencing pain to her Right ankle and requiring an x-ray. This failure could place residents at risk of injuries and a decline in quality of life. Findings include: Record review of Resident #1's Face Sheet dated 6/6/2024, revealed a [AGE] year old female who was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of muscle wasting, Diabetes Mellitus 2 , cognitive communicative disorder ,recurrent depression, history of fracture right femur(primary leg bone), hyperlipidemia(high cholesterol), and dementia without behaviors. Record review of Resident #1's MDS dated [DATE] revealed a BIMS score of 11 indicating cognitively intact. MDS reflected Resident #1 required 1 to 2 person transfers with lift. Record review of Resident #1's care plan dated 5/14/2024 revealed Resident #1 required assist of 1 or 2 staff members to transfer with a Total Lift(a lifting machine for transferring people). Record review of Resident #1's nursing progress notes dated 5/1/2024 revealed Resident #1 had complained of pain to her right foot and right ankle. There were no signs and symptoms of swelling or bruising at that time. Resident stated pain was 10/10. She was administered Tramadol 50 mg 2 tabs for pain. An x-ray was ordered to her right ankle and right foot. Record review of Resident #1's x-ray results dated 5/1/2024 of right ankle revealed no fracture. During an observation and interview on 6/6/2024 at 11:30 am revealed Resident #1 was lying in bed awake alert. Interview with Resident #1 resulted in her explaining NA E told her it was time to get up. Resident #1 told NA E to use the lift. Resident #1 stated NA E told her I can get you up quicker by myself and I won't hurt you. Resident #1 said NA E sat her up on side of bed and placed a gait belt on her then stood her up to transfer her to her wheelchair. Resident #1 stated she heard and felt her right ankle pop and she stated it hurt. Resident #1 stated she had an xray of her right foot and there was no fracture but it hurt for several days after. (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: 676425 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 676425 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Enclave 18803 Hardy Oak 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)