Asbury Care Center Of Alamo

F 0569

Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, the facility failed to convey within 30 days the resident's funds upon discharge for 1 of 3 residents (Resident #9) reviewed for personal funds. The facility failed to ensure Resident #9's personal funds were conveyed within 30 days of the resident's self-initiated discharge from the facility. This failure could result in loss of personal funds or decreased quality life to residents. Findings included: Record

review of Resident #9's face sheet, dated [DATE REDACTED], revealed an [AGE] year-old male admitted to the facility

on [DATE REDACTED] and discharged home on [DATE REDACTED]. Record review of Resident #9's discharge MDS, dated [DATE REDACTED] revealed a BIMS score of 15, indicating no cognitive decline. Record review of Resident #9's HHSC Form 3618, dated [DATE REDACTED] and printed on [DATE REDACTED], revealed Resident #9's notification to the state of discharge home (return not anticipated) was processed and accepted by HHSC and the Texas Medicaid and Healthcare Partnership on [DATE REDACTED]. Record review of Resident #9's transaction record of personal funds, dated [DATE REDACTED], revealed Resident #9's account had a positive balance of $1,030.01 from a deposit on [DATE REDACTED] with a description that read SSA Treas [number]. The Business Office Manager position at the facility was vacant at the time of survey, so no interview was performed. In an interview with the Admin. on [DATE REDACTED] at 1:50 PM, she stated she was not the Admin. of the facility when the resident discharged . She stated that when a resident is discharged and the notification of discharge (form 3618) is processed, Medicaid and the SSA are notified that the account is closed so no further funds would deposit into a resident's account. She said the deposit in Resident #9's account was likely his monthly direct deposit from

the SSA, and she explained that since Resident #9's form 3618 was processed after the deposit, he should have received a refund from the facility within 30 days. She was unsure why the refund had not been processed by the facility. She stated the facility's Business Office Manager had unexpectedly and suddenly died 3 days prior, and the facility was working with their corporate office to continue to operations of the Business Office. She stated she would ensure Resident #9 received a refund for the amount in the account.

In an interview with Resident #9 on [DATE REDACTED] at 2:10 PM, he stated he was not aware of the funds in the account at the facility. He stated he had not been notified by the facility that there was a deposit after he discharged home. He stated he spoke with the former Business Office Manager sometime in early August regarding home health care services, but she did not mention his personal funds account. She told him she would return his call regarding his issue, but he had not heard from her since then. Record review of the facility policy titled Resident Rights (dated 2025) revealed the following: The resident has the right to receive notices orally (meaning spoken) and in writing (including Braille) in a format and a language he or

she understands including: . required notices as specified in this section. The facility must furnish to each resident a written description of the legal which includes . a description of the manner in protecting personal funds.

Residents Affected - Few

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

Event ID:

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

08/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Asbury Care Center of Alamo

8223 Broadway San Antonio, TX 78209

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

herself on 08/14/2025. Record review of a progress note dated 05/14/2025 at 7:27 AM in Resident #1's EHR revealed the resident was found crying in her bedroom by a CNA. Resident #1 stated she did not want to live and did not want to be here anymore. The resident's RP and MD were contacted and the resident was transferred to the hospital. The resident returned to the facility on [DATE REDACTED] to the general population.

Record review of Resident #1's psychiatric evaluation dated 05/14/2025 during her hospital admission noted the resident was physically able to harm herself, was not supervised at her current facility, and would potentially be able to do so. The psychiatrist recommended a memory care facility with closer observation.

Record review of a progress note by LVN B dated 08/14/2025 at 5:00 PM in Resident #1's EHR dated 08/14/2025 at 5:00 PM revealed the resident was bleeding from her right wrist with a women's shaving razor on the bed beside her. The resident informed the nurse she wanted to die and to go to the hospital.

Pressure was applied to the site, the wound was cleaned, treated with antibiotic cream, and dressed with a dry dressing. The wound was superficial and approximately 2 cm long. The resident's vital signs were taken and within normal ranges. The DON was informed, the resident's physician and RP were notified, the resident was on 1:1 watch until transport arrived, and the resident was transported to the ER. The resident returned to the facility on [DATE REDACTED] to her previous room, which was not on the memory care unit. Record

review of a self-reported incident filed by the administrator of the facility on 08/16/2025 revealed: Brief narrative summary of the reportable incident: Resident sent out to hospital on [DATE REDACTED] due to suicidal ideation. Returned to facility today 08/16/2025 with hospital records that resident with acute fracture to right ulnar and a healing fracture of distal radius. During an interview on 08/22/2025 at 4:20 PM, the Administrator stated she had assumed the position of administrator on 08/04/2025. She was out of town the day Resident #1 attempted to injure herself. She received a call from the DON, who described the situation as the resident having a suicidal ideation but he did not say the resident had injured herself, and she did not believe the resident's attempt to injure herself with the razor was a suicide attempt and required reporting to

the state agency. During an interview on 08/22/2025 at 4:30 PM, the DON stated he called the Administrator on 08/14/2025 and told her Resident #1 was sent to the hospital. He recalled describing the resident cutting herself but did not recall if he used the term suicide attempt, as it was an ongoing situation.

He remembered Resident #1 being hospitalized in May 2025 for a suicidal ideation but was unaware of the recommendation by the hospital psychiatrist to have the resident admitted to a secure unit. The DON did not believe the resident needed a secure unit and could be managed with increased supervision. Record

review of the facility's policy, Abuse, Neglect and Exploitation, updated 2025, revealed, It is the policy of this facility to provide protections for the health, welfare, and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation, and misappropriation of resident property. VII. Reporting/Response. A. The facility will have written procedures that include: 1. Reporting of all alleged violations to the Administrator, state agency, adult protective services and to all other required agencies (e.g., law enforcement when applicable) within specified timeframes:a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause

the allegation involve abuse or result in serious bodily injury, orb. Not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury.

Event ID:

Facility ID:

If continuation sheet

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

08/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Asbury Care Center of Alamo

8223 Broadway San Antonio, TX 78209

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

blanket that was on her lap, speaking Spanish at times, was not agitated and did not try to get out of the geriatric chair.

Observation on 08/23/2025 from 9:24 AM to 9:45 AM revealed Resident #8 was sitting in the geriatric chair that was pushed up to the dining room table next to the nurses’ station and the chair was not reclined. The resident was dipping a spoon into a bowl of oatmeal that was on the table. She was not trying to get out of the chair and would speak in Spanish to other residents who walked by her, she was not agitated.

In a telephone interview on 08/23/2025 at 11:53 AM, Hospice RN A stated Resident #8 was provided a geriatric chair from Hospice A on 07/29/2025, but she did not know the reason the chair was provided as

she was the weekend on-call nurse and did not provide care to Resident #8.

In an interview on 08/23/2025 at 3:41 PM, ADON stated Hospice A provided Resident #8 with the geriatric chair after she came back from the hospital after she had a fall. ADON stated she thought Resident #8’s family member wanted the resident to be up so hospice felt the geriatric chair was better for the resident so she wouldn’t fall.

In an interview on 08/23/2025 at 4:09 PM, CNA F stated the geriatric chair was used as a measure to prevent Resident #8 from falling but the resident could get herself out of the geriatric chair when it was reclined and had done so the previous weekend when CNA F worked on the secured unit, so staff would be near Resident #8 when she was in the geriatric chair to ensure this did not happen.

In an interview on 08/23/2025 from 3:27 PM to 3:38 PM, MDS Nurse stated Resident #8’s Risk for Falls care plan was updated on 08/06/2025 when the interventions of having the resident up at the nurses’ station when anxious and scheduled care plan with family and hospice were added. The MDS Nurse stated she did not know when Resident #8 was provided with the geriatric chair, the chair was used as in intervention for positioning to calm her down and because of her fall risk. The MDS Nurse verified the geriatric chair was not listed as an intervention and she didn’t not have a reason why it was not added to the care plan.

Record review of the facility’s undated Care Plan Revisions Upon Status Change policy revealed “The purpose of this procedure is to provide a consistent process for reviewing and revising the care plan for those residents experiencing a status change. …1. The comprehensive care plan will be reviewed, and revised as necessary, when a resident experiences a status change. 2. Procedure for reviewing and revising the care plan when a resident experiences a status change: a. Upon identification of change in status, the nurse will notify the MDS Coordinator, the physician, and he resident representative, if applicable. b. The MDS Coordinator and the Interdisciplinary Team will discuss the resident condition and collaborate on intervention options…d. The care plan will be updated with the new or modified interventions…f. Care plans will be modified as needed by the MDS Coordinator or other designated staff member…”.

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

Event ID:

Facility ID:

If continuation sheet

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

08/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Asbury Care Center of Alamo

8223 Broadway San Antonio, TX 78209

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 0689

resident suicidal and self-harm behaviors for Residents #1 and Resident #10.

Level of Harm - Immediate jeopardy to resident health or safety

1. 11. Record review 8/22/2025 at 3:50 PM of staff roster provided by Admin on 8/22 indicating staff that

received in-service training/were asked about elopement behaviors. RN/LVN = 11; CNA = 18; Dietary = 8; Housekeeping/Laundry/Maintenance = 5; PT/OT = 7; Admin = 8. Staff not interviewed will be interviewed prior to beginning work from 08/22 - 08/25/2025.

Residents Affected - Few

2. 12. Record review revealed facility included in Resident Welcome Packet section on Restricted Items which

included unsafe items.

3. 13. Called the facility's medical director on 08/22/2025 at 12:35 PM; left voice message requesting return

call. Record review of QAPI sign-in roster revealed Psych NP was present and the medical director participated by phone.

4. 2. Record review of Resident #2's face sheet, dated 8/19/2025, revealed a [AGE] year-old female admitted

to the facility on [DATE REDACTED] and discharged home on 7/8/2025. Relevant diagnoses included senile degeneration of the brain (progressive memory and cognitive decline), schizophrenia (a mental health illness that causes difficulty distinguishing reality from their own thoughts and delusions), and dementia (a progressive disorder affecting cognition and behavior).

Record review of Resident #2's physician orders revealed an order dated 7/3/2025 indicating the resident was admitted to the facility for a planned, five-day hospice-respite stay.

Record review of Resident #2's discharge MDS, dated [DATE REDACTED] revealed a BIMS score of 00, indicating severe cognitive decline.

Record review of Resident #2's baseline care plan, date printed 8/19/2025, revealed the following: Resident demonstrates wandering and/or exit-seeking behavior placing self at risk for elopement or injury, had elopement on 7/4/2025.

Record review of Resident #2's progress notes revealed the following documentation, dated 7/4/2025 at 1:12 PM by LVN D: Resident was seen 5 Minutes before this nurse went into nurses station restroom, after

this nurse

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

Event ID:

Facility ID:

If continuation sheet