Buena Vida Nursing And Rehab-san Antonio

F 0583 Level of Harm - Minimal harm or potential for actual harm

review of a facility document titled, Resident Rights, the document revealed, A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality.

The facility must protect and promote the rights of the resident.

Residents Affected - Few

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

10/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Buena Vida Nursing and Rehab-San Antonio

5027 Pecan Grove San Antonio, TX 78222

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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

Administrative Nurses and Corporate Compliance Nurses. All findings will be communicated to MD and orders transcribed in [EMR].The following in-services were initiated by Regional Compliance Nurse on 10/02/2025: Any nurse not present or in-serviced on 10/02/2025 will not be allowed to assume their duties until in-serviced. All new hires will receive education upon hire.Licensed NursesPressure ulcer prevention and treatment including providing treatment as ordered and Initialing/Dating dressing.Documentation and Accurate Assessment of Pressure UlcersInitiating wound orders per MD and upon admission/readmission.If a C.N.A reports to a charge nurse about a change in skin integrity/wound status,

the charge nurse must assess and notify MD of changes immediately.Notification of Physician with change of condition immediately.Admin Personnel Wound care monitoring will be reviewed in stand up and stand down (morning and afternoon meetings) WARS and TARs will be reviewed for holes/omissions daily in stand up and stand down All staffo Abuse, Neglect, Exploitation Policy in-service was initiated on 10/2/25 by Administrator and completed on 10/3/2025.o Inservice all staff that complaints or concerns from outside care teams are to be director [sic] to the administrator for initiation of investigation on 10/4/2025 by Regional Staff/Administrator Administratoro Inservice for Ensuring that Nursing Manager(s) review any new wound orders and validate that the orders were transcribed and entered into [EMR] on 10/4/2025 by Area Director of Operations by auditing the order listing report each day in stand up. DON/DESIGNEE INSERVICED TO ROUND WITH WOUND MD/NP STARTING 10/7/25 UNTIL INDEFINATLEY [sic] AND ENTER ORDERS IN [EMR]AS SOON AS THE ORDER IS VERBALLY GIVEN BY MD. ALL [Wound Care physician] PROGRESS NOTES WILL BE PRINTED WITHIN 24 HRS OF RECIEPT AND ORDERS WILL BE REVIEWED BY DON/DESIGNEE IN STAND UP TO ENSURE OR

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

10/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Buena Vida Nursing and Rehab-San Antonio

5027 Pecan Grove San Antonio, TX 78222

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 - Immediate jeopardy to resident health or safety Residents Affected - Some

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

describe on back of form and staff name. Record review of a monitoring document revealed, DON/Designee will assess all dressing to ensure date reflects current date. The document had 5 blocks for date, resident name, Dressing dated correctly YES/NO if no, describe on back of form and staff name.

Record review of a monitoring document revealed, DON/Designee will validate all wounds have treatment orders in place weekly x 4 weeks. The document had 5 blocks for date, resident name, treatment orders in place YES/NO If no, describe on back of form and staff name. Record review of an ADHOC QAPI meeting, dated 10/2/2025 revealed signatures including the Administrator, Interim DON, and ADON. The Administrator was informed that the Immediate Jeopardy was removed on 10/06/2025 at 2:24 p.m. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy and a scope of isolated due to the facility's need to evaluate

the effectiveness of the corrective systems that were put into place.

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

10/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Buena Vida Nursing and Rehab-San Antonio

5027 Pecan Grove San Antonio, TX 78222

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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

tracking spreadsheet revealed 16 CNAs received in person training and 6 CNAs had not worked on the schedule and had received a text message with training for reporting and identifying skin concerns. 4 CNAs had not worked on the floor and were unable to be contacted by phone or text. Record review of an in-service, dated 10/4/2025 and 10/06/2025, titled CNA- Report all new skin issued to nurse asap and documenting the findings/alert in the kiosk. CNAs in serviced on s/sx of skin breakdown, common pressure areas and prevention. The in-service had 16 signatures. Record review of staffing schedule for 10/04/2025 revealed all CNAs scheduled for 6 a.m.-6 p.m. and 6 p.m.-6 a.m. signed the CNA in-service and on 10/05/2025 6 a.m.-6 p.m. all CNA's had been in-serviced on abuse and neglect and identifying and reporting skin concerns. Record review of an employee roster revealed 73 total employees. Record review of an in-service, dated 10/04/2025, revealed an in-service, complaints or concerns form outside care teams are to be directed to the administrator for initiation of investigation. The in-service revealed 62 signatures.

Record review of an in-service, dated 10/4/2025, directed to Admin Personnel, read DON/Designee must round with MD/NP and enter orders in [EMR] as soon as the order is verbally given by MD. All [Wound care physician] progress notes will be printed within 24 hrs and orders will be reviewed to ensure orders match.

The in-service had 4 signatures including the Administrator, Interim DON, RN, and ADON/LVN. Record

review of an in-service, dated 10/2/2025, directed to Admin/Personnel, revealed the DON/designee will

review each wound weekly x 4 weeks. The DON/designee will audit all skin assessments and weekly ulcer assessments weekly to ensure all assessments match the resident's current condition weekly x 4 weeks.

DON/Designee will review WAR for completion of ordered wound treatments 5 x weekly.

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

10/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Buena Vida Nursing and Rehab-San Antonio

5027 Pecan Grove San Antonio, TX 78222

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 0732

Post nurse staffing information every day.

Level of Harm - Potential for minimal harm

Based on observation, interview and record review, the facility failed to post the daily nursing staffing formation that included the facility name, the current date, the total number and actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: registered nurses, licensed practical nurses, certified nurse aides and resident census in a prominent place readily accessible to residents, staff, and visitors for 61 residents in that: The facility failed to post the daily staff posting information on 10/01/2025 and 10/02/2025. This failure could place residents and visitors at risk of not being able to review the facility's daily staffing hours. The findings included: During an

observation, 10/01/2025 at 8:28 a.m., a daily staffing poster was observed on top of the receptionist desk in

a plastic display holder that was titled, Daily report of nursing staff directly responsible for resident care and was dated 09/10/2025. During an observation, 10/02/2025 at 12:02 p.m., the daily staffing poster display was observed to be empty with no staffing poster observed. During an observation, 10/02/2025 at 4:00 p.m., the daily staffing poster display was observed to be empty with no staffing poster observed. Record

review of a facility staff schedule, dated 10/01/2025, revealed the facility had 5 licensed nurses, 2 MAs and 11 CNAs scheduled throughout the day. Record review of a facility staff schedule, dated 10/02/2025, revealed the facility had 5 licensed nurses, 2 MAs and 10 CNAs scheduled throughout the day. During an

interview with the Administrator, 10/03/2025 at 1:36 p.m., the Administrator stated the ADON was responsible for updating the daily staffing posters daily and the ADON had received a directive to complete

the daily staffing form and post it daily at the reception desk. The Administrator said it was important to post

the daily staffing posters because it gives families and visitors the ability to know how many staff are present for the patients and gives us a visual number of staff available and it is part of our regulatory requirements. The Administrator stated the facility did not have a policy on posting staffing information daily but followed the regulatory guidelines.

Residents Affected - Some

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

10/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Buena Vida Nursing and Rehab-San Antonio

5027 Pecan Grove San Antonio, TX 78222

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

undated face sheet revealed Resident #8 was a [AGE] year-old male who admitted to the facility in 07/11/2025 with diagnoses that included spastic quadriplegic cerebral palsy (a disorder that causes muscle stiffness in all four limbs), dysphagia (difficulty swallowing) and epilepsy (a disorder causing seizures).Record review of Resident #8's quarterly MDS assessment, dated 09/05/2025, revealed Resident #8 had a BIMS score of 00, indicating a severe cognitive impairment. Section GG - Functional Abilities revealed Resident #8 was dependent on staff for eating, transfers, and bed mobility. Section K Swallowing/Nutritional Status revealed Resident #8 had a feeding tube. Record review of Resident #8's undated comprehensive care plan revealed a care plan, dated 07/11/2025 and revised 07/30/2025, [Resident] is on enhanced barrier precautions in relation to the gastric tube placement and the intervention, posting at the residents room entrance indicating the resident is on enhanced barrier precautions.During an

observation, 10/01/2025 at 1:52 p.m., Resident #8's room had PPE supplies outside of the room door and no EBP sign posted to indicate that Resident #8 was on EBP.During an interview with LVN C, 10/01/2025 at 1:58 p.m., LVN C stated Resident #8 had a peg tube and stated Resident #8 had a PPE cart outside of his room because he had a peg tube. LVN C stated she was not sure if there was a EBP sign indicating Resident #8 was on EBP. LVN C stated she had training on EBP precautions not too long ago but it was not recent and stated she did not know who was responsible for posting the EBP signs. LVN C stated it was important to post the signs, I guess so we know what to put on.During an interview with the Administrator, 10/03/2025 at 1:36 p.m., the Administrator stated EBP was to be used for a list of reasons and for anything that can be contagious when contacting the patient. The Administrator stated residents on EBP would have

a PPE container outside of the resident room and would have a sign on the resident door indicating they were on EBP. The Administrator stated staff had received training on EBP and it was important for residents

on EBP to be identified with a sign because We have residents with suppressed immune systems and if

they were in contact with someone who has something that is contagious, they could get infected and put them at greater risk. The Administrator stated catheter tubing should not touch the floor Because there is debris on the floor and particles can get in the peri area and it is an infection control concern. Floors are unsanitary and stated staff had received training on keeping foley tubing off of the floor. Record review of a facility policy titled, Enhanced Barrier Precautions revealed, Enhanced Barrier Precautions (EBP) refer to

an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employ targeted gown and glove use during high contact resident care activities. The policy revealed, Communication to Staff: The facility will utilize postings outside the room and [EMR] to communicate to staff is a resident requires EBP.

Event ID:

Facility ID:

If continuation sheet