The Heights Of Alamo

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

allowed to touch a resident's feeding tube or to feed them via their feeding tube. She said that task belonged to nursing staff.In an interview on 11/10/25 at 4:18 pm, LVN D said Resident #1 had a feeding tube and was not allowed to eat or drink anything by mouth. He said if a CNA had any questions regarding his plan of care they would ask a charge nurse. He said CNAs were not allowed to touch a resident's feeding tube, he said that tasked belonged to nursing staff only.In an interview on 11/12/25 at 9:00 am, MDS/RN F, said it was her responsibility to ensure a resident's care plan (Kardex), and MDS were individualized and accurate. She said Resident #1 had a feeding tube and was not able to eat or drink anything by mouth. She said Resident #1's Kardex included a bedtime snack which was not an appropriate task for him because he had a feeding tube. She said the task of bedtime snack auto populated on all resident's Kardex, she said it was her responsibility to remove it for residents that were not allowed to have one. She said she failed to remove the task of bedtime snack for Resident #1 when she completed his most recent care plan. She was observed as she checked Resident #1's task of bedtime snack for the past 30 days and said the CNAs had documented NA for bedtime snack which indicated a snack was not given.

MDS/RN F said there were no negative outcomes to Resident #1 having that task of a bedtime snack on his Kardex because he had not been given one. In an interview on 11/12/25 at 11:00, the DON said Resident #1 had been admitted with a feeding tube. She was observed as she checked Resident #1's Kardex and said a bedtime snack was a task that automatically populated but for him, it should have been removed because he was NPO. The DON said there were no negative outcomes to Resident #1 having his Kardex show a bedtime snack because he had not been given one. She said CNAs were trained to no give any food or drink to residents who were on continuous feed via a feeding tube and if they had any questions regarding a resident's plan of care to ask their charge nurse.Record review of the facility's Care Plans policy dated February 2017 and revised January 2024 reflected:Care Plans: The community develops a comprehensive care plan for each resident that includes measurable objectives to meet a resident's medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment. The care plan should be reflective of the identified problem or risk, a measurable outcome objective and appropriate intervention/interventions in relation to the identified problem or risk, outcome objective, and the resident's ability, needs, medical condition, preventative measures. The care plan may also include the expressed preferences. The care plan in conjunction with the plan of care throughout the medical record is developed and or recommended to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being.

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Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Heights of Alamo

1214 S. Alamo Road Alamo, TX 78516

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

#2's eMAR that she did not see an order for the medication Bisacodyl and since there was no order, it did not populate on Resident #2's 10/2025 eMAR. RN E said the facility's protocol would have been that as soon as LVN D received the order for Bisacodyl, he should have inputted an order and then it would have automatically populated on Resident #2's eMAR. RN E said, since LVN D did not create an order for Bisacodyl, it was not populate on Resident #2's eMAR and not alerted to sign off on it. RN E said there were no negative outcomes to Resident #2 not having the medication Bisacodyl listed and signed off on her 10/2025 eMAR because she had confirmed with CNA H and LVN D that it had been administered. She said

the medication had been written on Resident #2's Change in Condition. In an interview on 11/12/25 at 11:45 am, the DON said the facility's protocol for a nursing staff would have been that as soon as they receive an order to input it on the resident's electronic medical record. Once it was inputted as an order, it would populate on the resident's eMAR. After the nursing staff had administered the medication, it needed to be signed off on the eMAR. She said if the medication had been inputted and for some reason the nursing staff had forgotten to sign off on it, the system would have generated an alert. She said she had already discovered that on 10/03/25, LVN D had not inputted the medication Bisacodyl as an order and had not signed it off on Resident #2's eMAR. The DON said there were no negative outcomes to Resident #2 not having her medication Bisacodyl listed on her October 2025 eMAR and LVN D not signing off on it. She said the fact that what Resident #2's NP had ordered (Bisacodyl) had been documented on her Change in Condition report was sufficient. The DON said Resident #2's bowel movement task report indicated Resident #2 had a bowel movement on 10/03/25 after the administration of the Bisacodyl. Record review of

the facility's Professional Standard of Care policy dated February 2017 and revised in January 2024 reflected: Compliance Guidelines: The community provides services that meet professional standard of quality and are provided by appropriately qualitied persons (e.g., licensed, certified).Compliance with Professional Standards of Care Nursing: Practices-D: When a licensed nurse takes a verbal or telephone order from a medical provider (MD/NP/PA), podiatrist, or dentist, the nurse should sign the order.

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