Health inspection·January 21, 2026

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to permit a resident to return to the facility after being hospitalized and failed to document sufficient preparation and orientation to residents to ensure a safe and orderly transfer or discharge from the facility for 1 (Resident #1) of 3 residents reviewed for transfer and discharge rights, in that:Resident #1 was issued a 30 day discharge letter on 12/01/2025 for nonpayment. Resident #1 was transferred to the hospital on [DATE] for a CT scan and was denied readmission to the facility. The facility did not document Resident 1's medical record the reason for not accepting Resident #1 to return to the facility.This failure could place residents at risk of not receiving care and services to meet their needs upon discharge.The findings included:Record review of Resident #1's undated face sheet revealed Resident #1 was a [AGE] year old female who admitted to the facility on [DATE] with diagnoses that included delusional disorder (a mental health disorder in which a person can't tell what's real from what's imagined), borderline personality disorder (a serious mental health condition characterized by intense emotional instability, impulsive behaviors and difficulties in interpersonal relationships), bipolar disorder (mental health condition characterized by significant mood swings) , dementia (syndrome characterized by a decline in cognitive function), depression (feeling of persistent sadness) and anxiety ( a feeling of worry, nervousness or unease). Date of discharge on the face sheet was 12/10/2025 and location was listed as an acute care hospital.Record review of Resident #1's annual MDS assessment dated , 11/15/2025, revealed a BIMS score of 13, indicating no cognitive impairment. Section Q - Participation in Assessment and Goal Setting revealed there was no active discharge planning occurring for Resident #1 to return to the community.Record review of Resident #1's comprehensive care plan revealed a care plan, date initiated 01/20/2026, revision 01/20/2026 and cancelled 01/20/2026, that revealed, Cancelled: [Resident #1]'s discharge planning will honor her personal wishes, The expectation, based on care plan meetings and talking with [Resident #1], is to stay in facility for LTC.Record review of Resident #1's nursing progress notes revealed a note, dated 11/24/2025 at 10:44 a.m. that read, Administrator and myself entered room to give notice to resident of discharge d/t nonpayment, Resident started yelling and cursing stating that she had a court order that says she does not owe [facility initials] anything.Record review of Resident #1's A/R payment statement, 12/01/2025, revealed Resident #1 owed the facility a total of $2017.60 and had not made a payment to the facility since April 2025.Record review of Resident #1's 30 day discharge letter, dated 12/01/2025, revealed the reason for discharge was, the resident has failed, after reasonable and appropriate notice, to pay for (or have paid under Medicare or Medicaid) stay at the facility. The letter revealed, Discharge to [address] or [Nursing facility name and address]. The effective discharge date was January 1, 2026. The letter revealed, To ensure a safe and orderly transfer or discharge from [Facility name] the facility will provide sufficient preparation and orientation. In addition, the letter revealed, You Page 1 of 4 676478 676478 01/21/2026 Harbor Valley Health and Rehabilitation 6211 Old Pearsall Road San Antonio, TX 78242

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few have the right to appeal the action as outline in Fair Hearing, fraud and Civile (sic) Rights Handbook of the Medicaid eligibility worker at the local Texas Department of Aging and Disability Services (DADS) office within 90 days. The facility Administrator signed the letter.Record review of Resident #1's nursing progress notes dated 12/10/2025 at 4:47 p.m. revealed a note, Resident p/u by [EMS company] x 2 EMS personnel, to be taken to [hospital] for CT and evaluation of neck and upper spine.During an interview with Resident #1 on 01/20/2026 at 11:22 a.m., Resident #1 stated the facility had attempted to discharge her 3 times in the past and she had a court order that stated the facility could not evict her. Resident #1 stated she was given a discharge letter on 12/01/2025 but told the Administrator that she would not be leaving and would appeal the discharge. Resident #1 stated she was sent to the hospital because of neck pain, and the facility did not allow her to return after her hospital visit. Resident #1 stated the hospital set up a group home for her, but she did not like it as soon as she admitted and tried to go back to the hospital and the hospital would not let her return. Resident #1 stated she went to another hospital and then was temporarily placed at another long-term care facility until she finds a facility she wants to reside in long term.During an interview with the facility Ombudsman on 01/20/2026 at 1:46 p.m., the Ombudsman stated the facility notified her that Resident #1 had been issued a discharge letter for nonpayment on 12/01/2025. The Ombudsman stated she had spoken to Resident #1 after the discharge letter was issued and stated Resident #1 expressed to the Ombudsman that Resident #1 planned to appeal the discharge. The Ombudsman stated Resident #1 was sent out to the hospital around 12/12/2025 and the facility would not let her return to the facility. The Ombudsman stated she attempted to reach out to the Administrator but received no responses back and stated she spoke to the BOM. The Ombudsman stated the BOM disclosed that the corporate office had given the directive that Resident #1 was not allowed to return. The Ombudsman stated she explained to the BOM that the facility could not do that, and Resident #1 had the right to appeal the discharge letter and the BOM stated it was a corporate decision. The Ombudsman stated Resident #1 was placed at another nursing facility in town. The Ombudsman stated Resident #1 was sent to a group home from the hospital and tried to return to the hospital the same day and the hospital refused to readmit Resident #1 so Resident #1 was sent to another hospital who found placement for Resident #1 in another long term care facility in town. The Ombudsman stated Resident #1 had been issued a 30 day discharge letter earlier in the year and the facility did not include a discharge location so Resident #1 won the appeal to that discharge letter. The Ombudsman stated she had tried to explain to Resident #1 that the appeal was not a court order, and the facility had the right to issue another discharge letter, but Resident #1 was fixated on the appeal letter from earlier in the year.During an interview with the BOM on 01/20/2026 at 2:14 p.m., the BOM stated a resident could be issued a discharge letter for nonpayment if a resident or resident representative was not paying the facility their monthly room and board payments. The BOM stated the Administrator was responsible for making the decision to issue a 30 day discharge letter to a resident and the Administrator signed the letter. The BOM stated the resident and/or representative were notified of the appeals process at the time the letter was issued. The BOM stated Resident #1 was issued a 30 day discharge notice on 05/01/2025 for nonpayment, Resident #1 appealed the letter and won the appeal because we left off a discharge address. The BOM stated Resident #1 was told that another discharge letter would be issued if Resident #1 continued to not pay her applied income payment of $257.60 a month. The BOM stated she delivered the discharge letter to Resident #1 on 12/01/2025 and Resident #1 told her that she planned to appeal the discharge. The BOM stated Resident #1 asked her twice about the last day to appeal and 676478 Page 2 of 4 676478 01/21/2026 Harbor Valley Health and Rehabilitation 6211 Old Pearsall Road San Antonio, TX 78242

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the BOM told her it was 01/01/2026 and Resident #1 knew she had 30 days to appeal the discharge. The BOM stated, she could have appealed anytime between 12/1 and 12/31 to stop us from discharging her. The BOM stated Resident #1 had been accepted at another long term care facility and that facility was listed as the discharge location on the discharge letter. The BOM stated she was not sure what the facility policy stated regarding resident discharges. The BOM stated Resident #1 was sent to the hospital in December and was not allowed to return to the facility and stated when the hospital began calling report for the resident to return, the Administrator told her Resident #1 was not allowed to return and all calls regarding Resident #1 were to be directed to the Administrator. The BOM stated it was important for residents to have the right to appeal and discharge and not be discharged until an organized discharge plan was in place, to make sure we are being fair, and a third party can hear both sides.During an interview with the DON, 01/21/2026 at 12:19 p.m., the DON stated Resident #1 was sent to the hospital on [DATE] for a CT scan due to Resident #1 complaining of neck pain. The DON stated the physician had given the order for the CT a week or two prior to Resident #1 going to the hospital for the CT scan but Resident #1 kept cancelling the appointment or refusing to go to the scan. The DON stated she was notified on 12/12/2025 that the hospital was calling to give report to send Resident #1 back to the facility and the DON was told by the Administrator that Resident #1 was not allowed back to the facility because the facility could not meet her needs. The DON stated she was unaware that when Resident #1 went to the hospital that the facility would not be taking her back and stated the hospital was not notified, when Resident #1, was sent to the hospital on [DATE], that the facility would not be taking her back.During an interview with the Administrator, 01/21/2026 at 1:55 p.m., the Administrator stated Resident #1 was issued a 30 day discharge letter on 12/01/2025 for nonpayment and Resident #1 had up to 30 days to appeal the discharge. The Administrator stated he did not believe the facility could discharge a resident who appealed a 30 day discharge and stated Resident #1 had appealed her previous discharge letters. The Administrator stated Resident #1 was not notified prior to her transfer to the hospital that she would not be allowed to readmit, and the Administrator stated the thought the DON informed the hospital when she was transferred that the facility was not allowing Resident #1 to readmit. The Administrator stated the corporate office made the decision that Resident #1 would not be readmitted to the facility and stated he educated the corporate office that the resident had 30 days to appeal the discharge notice and that it was against resident rights to discharge a resident without a discharge plan. The Administrator stated, it was the direction I was given, and she was in a safe place at the hospital. The administrator stated it was important for a resident to have the right to return back to the facility and to appeal the discharge, so she can be heard by the state or appeals process and it was important that the hospital send her to the right place for the right treatment because we are not a psych hospital.Record review of a facility policy titled, Notice of a Transfer and/or Discharge, policy revised date 11/28/2016 and 09/13/2017, revealed, 1. The facility will notify the resident, and/or his or her representative (sponsor) of an impending transfer or discharge from our facility for the following criteria: .e. The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. 2. The facility may not transfer or discharge the resident while an appeal is pending, when a resident exercised his or her right to appeal a transfer or discharge notice from the facility, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document that failure to transfer or discharge would pose 4. If the information in the notice changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon 676478 Page 3 of 4 676478 01/21/2026 Harbor Valley Health and Rehabilitation 6211 Old Pearsall Road San Antonio, TX 78242

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few as practicable once the updated information becomes available.Record review of a facility policy titled, Documentation of Transfers/Discharges, revision date 09/13/2017, revealed, When a resident is transferred or discharged his or her medical record shall be documented as to the reasons why such action was taken. Policy Interpretation and Implementation revealed, 1. All documentation concerning the transfer or discharge of a resident must be recorded in the resident's medical record. The documentation must include: a. The basis for the transfer. B. If transferring/discharging for the resident's welfare and the resident needs cannot be met, or the resident's health has improved sufficiently so that the resident no longer needs the care and/or services of the facility, the following must be documented by the Resident's Physician: 1. The specific resident need(s) that cannot be met; 2. Facility attempts to meet the resident needs; and 3. The service available at the receiving facility to meet the need (s). 676478 Page 4 of 4