Castle Hills Rehabilitation And Care Center

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

exposed pipe beneath the handwashing sink and the plumbing beneath the dishwasher as the facility had undergone a kitchen audit by the city earlier in the week. He was also aware of the broken tiles and wall trim. He was not aware of the dirt/debris behind the refrigerator, in the walk-in refrigerator, or along the walls. He was aware of intermittent issues with insects in the facility but did not know that there were currently flying insects in the kitchen. He said his expectation was the kitchen would be cleaned thoroughly and free from pests.Record review of the facility policy titled Date Marking for Food safety (undated, received 11/14/2025) revealed the following: . The food shall be clearly marked to indicate the date or day by which the food shall be consumed or discarded .The individual opening or preparing a food shall be responsible for date marking the food at the time the food is opened or prepared . The marking system shall consist of a color-coded label, the date/date of opening, and the day/date the item must be consumed or discarded . Record review of the facility policy titled Maintaining a Sanitary Tray Line (date implemented 7/1/2025) revealed the following: . The facility prioritizes tray assembly to ensure foods are handled safely .

in order to prevent the spread of bacteria that may cause food borne illness.

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

11/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Castle Hills Rehabilitation and Care Center

8020 Blanco Rd San Antonio, TX 78216

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 0925

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

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 review, the facility failed to maintain an effective pest control program so that the facility is free of pests for 1 of 1 dining area and 1 of 4 (Resident #1) resident's rooms reviewed for physical environment. The facility failed to ensure Resident #1's room was free from flying insects. The facility failed to ensure the communal dining area was free from flying insects. These failures could lead to contamination and/or decreased quality of life. Findings included:1.Record review of Resident #1's face sheet dated 11/13/2025 revealed a [AGE] year-old male admitted to the facility on [DATE REDACTED]. Relevant diagnoses included end-stage renal disease (when the kidneys are badly damaged). Record review of Resident #1's quarterly MDS, submitted 9/25/2025, reflected a BIMS score of 15 which indicated intact cognition. In an observation and interview on 11/13/2025 at 3:15 PM, flying insects were noted in Resident #1's room. Resident #1 said he consistently had flies in his room, and he had observed them frequently in

the kitchen and dining areas as well. He felt the presence of the insects in his room and the kitchen/dining room was disgusting. 2. In an observation on 11/14/2025 at 12:30 PM, the facility was observed serving lunch to multiple residents in the communal dining area. Multiple flying insects were observed in the area, causing the residents to swat at the insects as they landed on their bodies and in their food.In an

observation and interview on 11/14/2025 at 12:35 PM, Resident #1 was observed to be eating in the communal dining area. He said there were always flies present in the dining room whenever he eats there, and that it is disruptive to his meal and dirty. In an interview with the Admin. on 11/14/2025 at 1:10 PM, he said he was aware of intermittent issues with insects in the facility, including residents' rooms. He was unaware of the flying insects observed in the dining area. He said the facility received scheduled pest control treatments.Record review of the most recent invoice dated 10/16/2025 from the pest control company reflected 90 fungus gnats and 12 dead fungus gnats were found at the facility by the technician

during the visit. The invoice detailed the chemical treatment used and recommendations for prevention, including removing standing water from the kitchen, repairing damaged floors/walls, and fixing faulty plumbing. A facility policy regarding pest control was requested from the DON on 11/14/2025 at 12:15 PM but not provided prior to exit.

Residents Affected - Some

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

Event ID:

Facility ID:

If continuation sheet