Health inspection·January 23, 2024

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some am; d/c date 1/5/24 at 11:23 am. Further review of the record revealed no documentation that Resident #1 received wound care for the right toes on 1/1/24 and 1/4/24. Record review of Resident #2's admission Record, dated 1/21/24, revealed Resident #2 was admitted to the facility on [DATE], with the following diagnoses: Sepsis (life-threatening complication of an infection), Cellulitis (common bacterial skin infection) of BLE, UTI, Pneumonia (infection in the lungs) , Thrombocytopenia (low platelets in the blood), Hyperkalemia (high level of potassium in the blood) , Hypertension (high blood pressure), Heart Failure, Lymphedema (swelling in the extremities cause by a lymphatic blockage), GERD (digestive disease in which stomach acid or bile irritates the food pipe lining), Acute Kidney Failure. Record review of Resident #2's MDS assessment, dated 1/3/24, revealed Resident #2 had a BIMS of 15, suggesting no cognitive impairment . Further record review of this document revealed, under Section M Skin Conditions, Resident #2 had a pressure ulcer/injury, a scar over bony prominence, or a non-removable dressing/device; Other Problems - Skin tears; Pressure ulcer/injury care. Record review of Resident #2's physician orders (dated 12/29/23, start date 12/30/23) revealed: ammonium lactate external cream 12%; apply to bilateral lower legs topically ever day shift; every Tuesday, Thursday, Saturday. Record review of Resident #2's January 2024 TAR revealed: ammonium lactate external cream 12%; apply to bilateral lower legs topically every day shift; every Tuesday, Thursday, Saturday; order date 12/29/23. Further review of the record revealed no documentation that Resident #2 received wound care to bilateral lower legs on 1/4/24. Record review of Resident #2's physician order (dated 12/29/23) revealed: apply calcium alginate to left back thigh open wound area. Record review of Resident #2's January 2024 TAR revealed: apply calcium alginate to left back thigh open wound area; every day shift; every Tuesday, Thursday, Saturday; order date12/29/23; d/c date 1/18/24. Further review of the record revealed no documentation that Resident #2 received wound care to left back thigh open wound area on 1/4/24 or 1/11/24. During an interview on 1/20/24 at 5:06 p.m., Resident #2 said she had received wound care but not as directed by the physician . During an observation on 1/21/24 at 12:42 p.m., LVN D provided wound care for Resident #2's BLE. LVN D removed dressing, cleaned the leg with NS, applied ammonium lactate external cream 12%, applied bandage roll x2, secured with initialed/dated tape. After washing her hands, LVN D repeated the same treatment on the left leg. Wound care was completed using infection control practices and no concerns were noted. Record review of Resident #3's admission Record, dated 1/19/24, revealed Resident #3 was admitted to the facility on [DATE], with the following diagnoses: Metabolic Encephalopathy (problem in the brain caused by chemical imbalance in the blood), Acute Kidney Failure, Type 2 diabetes (chronic condition that affects the way the body processes blood sugar), Hyperlipidemia (high levels of fat in the blood), Hypertension (high blood pressure), and Dysphagia (difficulty swallowing) . Record review of Resident #3's MDS assessment, dated 1/16/24, revealed Resident #3 had a BIMS of 1, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676447 If continuation sheet Page 2 of 5 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 676447 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort San Antonio, LLC 6035 Eckhert Rd San Antonio, TX 78229 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)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some suggesting severe cognitive impairment. Further record review of this document revealed, under Section M - Skin Conditions, Resident #3 had a pressure ulcer/injury, a scar over bony prominence, or a non-removable dressing/device; Pressure ulcer/injury care; Applications of ointments/medications. Record review of Resident #3's physician orders (dated 1/10/24, start date 1/11/24) revealed: wound care to sacrum as follows: cleanse with wound cleanser/NS on gauze, pat dry with gauze, apply Medi honey and cover with dressing Q day and PRN. Record review of Resident #3's January 2024 TAR revealed: wound care to sacrum as follows: cleanse with wound cleanser/NS on gauze, pat dry with gauze, apply Medi honey and cover with dressing Q day and PRN; order date 1/10/24. Further review of the record revealed no documentation that Resident #3 received wound care to sacrum on 1/13/24 and 1/14/24. During an observation on 1/20/24 at 5:50 p.m., LVN C provided wound care for Resident #3's sacrum. LVN C removed dressing, wound was cleaned with wound cleanser and gauze, patted dry Medi honey applied, and initialed/dated dressing applied. Wound care was completed using infection control practices and no concerns were noted. Record review of Resident #4's admission Record, dated 1/20/24, revealed Resident #4 was admitted to the facility on [DATE], with the following diagnoses: Osteomyelitis (serious infection of the bone) of left ankle and foot, Methicillin Susceptible Staphylococcus Aureus (infection caused by bacteria found on the skin) Infection, Type 2 diabetes (chronic condition that affects the way the body processes blood sugar), Hyperlipidemia (high levels of fat in the blood), Hypertension (high blood pressure), Acute Kidney Failure, and UTI. Record review of Resident #4's MDS assessment, dated 1/4/24, revealed Resident #4 had a BIMS of 13, suggesting no cognitive impairment. Further record review of this document revealed, under Section M Skin Conditions, Resident has a pressure ulcer/injury, a scar over bony prominence, or a non-removable dressing/device; Pressure ulcer/injury care. Record review of Resident #4's hospital discharge instructions, dated [DATE], revealed: Wound/Dressing Care: Right foot: pack collagen with silver Hydrofera blue ready, cover with foam boarder, cut piece of Prisma, moisten with saline to activate, cut piece of Hydrofera blue ready to fit size of wound, place on top of collagen, cover with mepilex. Record review of Resident #4's January 2024 TAR revealed: R foot, cleanse with NS, apply collagen with silver to wound bed, cut piece of Hydrofera blue ready to fit size of wound, and apply to wound bed, cover with mepilex dressing; per hospital d/c instructions; every shift for R foot wound; order date 12/30/23, d/c date 1/12/24. Further review of the record revealed no documentation that Resident #4 received wound care to R foot on 1/7/24. During an interview on 1/21/24 at 12:10 p.m., Resident #4 said she had an infection in her left ankle. She said when she was admitted to the facility, she did not receive wound care every day as ordered by the physician . Resident #4 said she now received wound care to her ankle every day by LVN D. During an interview on 1/22/24 at 5:35 p.m., RN B said the floor nurses were responsible for ensuring wound care was completed during the weekends. RN B said she might have completed wound care for Resident #4 on 1/7/24 at the end of her shift and might not have documented it. She added the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676447 If continuation sheet Page 3 of 5 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 676447 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort San Antonio, LLC 6035 Eckhert Rd San Antonio, TX 78229 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)

F 0684 facility policy was to complete and document all treatments ordered. Level of Harm - Minimal harm or potential for actual harm During an interview on 1/20/24 at 1:03 p.m., LVN D said she worked Monday - Friday and the floor nurses and nurse supervisors were responsible for ensuring wound care was completed on the weekends. LVN D said she was not aware of the missed treatments for Residents #1, #2, #3, and #4 or if these missed treatments were reported to the physicians. LVN D said the admissions nurse was responsible for reviewing and transcribing hospital discharge orders when residents are admitted to the facility. Residents Affected - Some During an interview on 1/21/24 at 3:36 p.m., the wound care physician said she had not been notified of the missed treatments for Residents #1, #3, and #4. She added that Resident #4 was not on her panel of residents. Attempts to contact Resident #4's physician was unsuccessful. During an interview on 1/20/24 at 6:09 p.m., the CNO said residents are discharged from the hospital with wound care orders those orders were then verified, transcribed, and implemented at the facility by the admissions nurse. She added the clinical team, which included: the CNO, 3 ACNOs, and the MDS coordinators, reviewed orders daily to ensure orders were transcribed and implemented. The CNO said LVN D provided wound care Monday - Friday and the floor nurses during the weekends. The CNO said daily reports were run and reviewed during clinical meetings as well as the TARs to ensure wound care was provided as ordered. She added she and the ACNOs were responsible for ensuring coordination of care and this was important to avoid infections and worsening of wounds. The CNO said she was not aware of the missed treatments for Residents #1, 2, 3, and 4 and that these missed treatments must not have been captured on the daily reports. The CNO said she was not sure if the physician was notified of the missed treatments. Attempts to contact LVN E, Admissions Nurse, were unsuccessful. Record review of a facility policy titled, Wound Policy & Procedure revised May 2023, revealed: Policy: The facility is committed to providing a comprehensive wound management program to promote the resident's highest level of functioning and well-being .Any resident with a wound receives treatment and services consistent with the resident's goals and treatment .A commitment to the Wound Management Program is demonstrated by implementation of processes founded on accepted standards of practice .Wound Management Principles .Maintenance of physiologic local wound environment including, and not limited to: .Cleansing wound . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676447 If continuation sheet Page 4 of 5 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 676447 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort San Antonio, LLC 6035 Eckhert Rd San Antonio, TX 78229 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure all drugs and biologicals were stored in locked compartments in 2 of 9 medication carts (third floor treatment cart and medication cart) reviewed for medication storage, in that: The facility failed to ensure the third-floor treatment cart and medication cart were locked when left unattended in the hallway. This deficient practice could place residents at risk of medication misuse or drug diversion. Findings included: During an observation on 1/19/24 at 11:30 a.m., the treatment cart on the third floor was unlocked and unattended. The treatment cart contained prescription and over the counter medications related to skin and wound care, and suture removal kits. There were visitors and non-nursing staff walking up and down the hallway and there were no nurses at the nurses' station or in the hallways. The treatment cart was again observed unlocked on 1/20/24 at 5:21 pm. The CNO was notified by the surveyor. During observation and interview on 1/19/24 at 11:43 a.m., LVN A was observed returning to the third floor. At 11:47 a.m., LVN A said the treatment cart was not supposed to be left unlocked because it contained medications. LVN A was observed locking the treatment cart at 11:51 a.m. During an observation on 1/20/24 at 5:16 p.m., the medication cart on the third floor, outside room [ROOM NUMBER], was unlocked and unattended. During an interview on 1/20/24 at 5:18 p.m., RN A said she was aware that the medication cart was unlocked. She said the facility policy was that medication carts be locked when unattended. RN A said there were ambulatory residents on the third floor; she added it was important to keep medication carts locked so that residents, visitors, and staff did not have access to medications. During an interview on 1/20/24 at 6:09 p.m., the CNO said all medications carts and treatments carts were to be locked when unattended. She added staff were expected to lock their medication carts and keep the keys with them or hand them to the charge nurse. Record review of facility policy titled Medication Labeling and Storage, dated January 2020, did not address the storage of medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676447 If continuation sheet Page 5 of 5