Health inspection·November 30, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents for 2 of 4 residents reviewed for call lights (Resident #s 1 and 2). Residents Affected - Few The facility failed to ensure Residents #s 1 and 2's call light was accessible and in reach. Resident #1's call light button was observed hanging behind her mattress on the floor. Resident #2's call light button was hanging over the side of her bed and touching the floor. These failures could affect residents who used their call light or desire to use the call light and place them at risk of not being able to notify staff of their needs. Findings included: Resident #1 Record review of Resident #1's electronic faces sheet revealed Resident #1 was [AGE] years old and was admitted on [DATE]. Resident #1's diagnoses included the following: History of Falling, Repeated Falls, Lack of Coordination, Major Depression, and Anxiety Disorder. Record review of Resident #1's MDS (Quarterly 10/5/2023) revealed a BIMS of 99 (interview not completed). Additionally, both the Mood Evaluation and ADLs Tab were disabled. Record review of Resident #1's Care Plan (7/22/2023) stated, (Resident #1) is High risk for falls r/t dementia, Alzheimer's with poor safety awareness. And had 3 falls during the month of August 2022. Interventions included: (Resident #1) needs a safe environment with even floors free from spills and/or clutter; adequate, glare-free light, a working and reachable call light, the bed in a low position at night; Slide rails as ordered, handrails on walls, personal items within reach. (Resident #1's) call light is within reach and encourage (Resident #1) to use it for assistance as needed. (Resident #1) needs prompt response to all requests for assistance. Observation on 11/30/2023 at 11:06 AM. Resident #1 was observed sleeping in her bed. During this observation, Resident #1's call light button was observed hanging behind her mattress on the floor. During an interview at this time, Charge Nurse, LVN A, confirmed Resident #1 would be unable to reach the call light button given her limited mobility. LVN A mentioned Resident #1 required a lot of monitoring and supervision given her fall history and level of confusion. LVN A indicated she was unsure if Resident #1 was alert enough to understand how to utilize her call light button. A photograph of (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: 745040 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 745040 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Sarah Roberts French Home 1315 Texas Ave San Antonio, TX 78201 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)