Huebner Creek Health & Rehabilitation Center

F 0558

placement during every staff meeting.

Level of Harm - Minimal harm or potential for actual harm 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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Huebner Creek Health & Rehabilitation Center

8306 Huebner Rd San Antonio, TX 78240

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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review the facility failed to ensure each resident had the right to observe resident's religious beliefs in the facility that were significant to the resident for one (Resident #5) of twelve residents reviewed for self-determination. The facility failed to promote Resident #5's self-determination by not honoring his choice to practice his religion. This failure could place residents at risk for poor self-esteem and decreased self-worth due to their needs and preferences not being met. Findings included:Record

review of Resident #5's admission record, dated 10/23/25, reflected an [AGE] year-old male initially admitted [DATE REDACTED] and re-admitted [DATE REDACTED] with diagnoses to include dementia (loss of cognitive functioning that interferes with daily life and activities), need for assistance with personal care, and depression. Record

review of Resident #5's quarterly MDS assessment, dated 09/09/25, reflected Resident #5 had a BIMS of 9 out of 15, indicating moderate cognitive impairment. Record review of Resident #5's care plan, undated, reflected no mention of his religion in his care plan to include activities, except a focus .Due to religious beliefs, the resident is on a selective menu for breakfast/dinner. Interview on 10/22/25 at 01:52 PM, Resident #5 revealed he was Muslim, and he let the facility know. He revealed he was not given any alternatives to practice his religion, and the staff were aware of this. He further revealed it made him feel left out because other residents were able to attend Bible study, and he could not practice his religion. He revealed he would like to watch a religious program on his TV, but his TV had not been working. Resident #5 could not recall how long his TV had not been working and the facility was aware of this issue. Interview

on 10/23/25 at 02:34 PM, LVN H revealed she was not aware of Resident #5's preferences regarding religion. She revealed it was important to respect people's religion and beliefs. Interview on 10/24/25 at 08:37 AM, Resident #5 revealed he wanted staff to know he was Muslim because if they did not know how

they would be able to care for him accordingly. He revealed he did not have food before his fasting during [NAME] but did not want to ask because the facility gave meals 3 times a day at certain times and did not think they could accommodate him. Resident #5 revealed he told everyone about his religion to include staff because he was proud to be Muslim. He revealed he felt upset because this was not his home because he could not practice his religion Interview on 10/24/25 at 09:07 AM, the Activities Director revealed she thought it was important for Resident #5 to practice his religion. She revealed she had tried various activities to support his religion and tried getting his family involved, but her attempts did not meet Resident #5's expectations. Interview on 10/24/25 at 09:55 AM, the DON revealed it was important to offer activities to residents for their mental well-being. She revealed it was important for staff to know about Resident #5's religion so they could support him in his religion. Interview on 10/24/25 at 11:25 AM, the ADM revealed they had been trying to fix Resident #5's TV. (Evidence to support this was requested and has not been provided) Record review of facility's policy Resident Rights, revised 11/28/16, reflected 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.

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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Huebner Creek Health & Rehabilitation Center

8306 Huebner Rd San Antonio, TX 78240

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

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

religion was not care planned because the resident did not want anyone to know. He revealed he was not sure if Resident #2 had PTSD, but he revealed if he saw Resident #2 triggered, he would let the nurse know if he was not able to calm Resident #2 down. Interview on 10/24/25 at 08:37 AM, Resident #5 revealed he wanted staff to know he was [Religion] because if they did not know how they would be able to care for me accordingly. He revealed he did not have food before his fasting during [Religious event] but did not want to ask because the facility gave meals 3 times a day at certain times and did not think they could accommodate him. Resident #5 revealed he told everyone about his religion to include staff because he was proud to be [Religion]. He revealed he felt upset because this is not his home because he can't practice his religion Interview on 10/24/25 at 09:07 AM, the Activities Director revealed she thought it was important for religion to be on the care plan for Resident #5 so that the staff can care for him appropriately.

She revealed she believed the Social Worker was in charge of care planning a resident's religion.

Combined interview on 10/24/25 at 09:55 AM, the DON revealed she was unaware of Resident #5's religion. She revealed it would be beneficial for staff to know because there were specific things to follow for religion like food preferences. MDS Coordinator F revealed he did not specifically document that Resident #2 had PTSD, but they did document that Resident #2 had a TBI, which caused PTSD. MDS Coordinator F revealed the Social Worker would have to care plan about Resident #5's religion, but the only time it was care planned was under dietary preferences. MDS Coordinator F revealed he oversaw that care plans were up to date and correct. Interview on 10/24/25 at 02:15 PM, the Social Worker revealed she knew Resident #5 was Muslim, but it was up to activities director to care plan about his religion. Record review of facility's policy, Comprehensive Care Planning, undated, reflected, Each resident will have a person-centered comprehensive care plan developed and implemented to meet his other preferences and goals, and address the resident's mental, physical, mental, and psychosocial needs. Person-centered care includes making an effort to understand what each resident is communicating, verbally and nonverbally, identifying what is important to each resident with regard to daily routines and preferred activities, and having an understanding of the resident's life before coming to reside in the nursing home. Residents' goals set the expectations for the care and services he or she wishes to receive.

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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Huebner Creek Health & Rehabilitation Center

8306 Huebner Rd San Antonio, TX 78240

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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

puzzle. She revealed she enjoyed doing puzzles, drawing, and painting. She revealed the activities room was closed after 4:30PM and on the weekends. She revealed she liked doing her puzzles after 4:30PM because it was more relaxing for her. She revealed at night there was nothing to do so she mainly wandered in the hallways, feeling lost. She said it was comforting to be in the activities room at night. She revealed she did not like watching TV. She revealed she did more complex puzzles so it was hard to transport her puzzle so she would need to be in the activities room. Interview on 10/22/25 at 02:30 PM, Resident #2 revealed he enjoyed doing puzzles in the activities room. He revealed he had PTSD due to TBI and doing puzzles in the activities room at night allowed him to get lost in the puzzle and he forgot about his problems and past trauma. He revealed when he wanted to continue his puzzle he could not. Interview

on 10/23/25 at 02:21 PM, LVN E revealed residents did complain about not having access to activities room but had no specific names of residents. She revealed on the weekends, the residents had the television to watch but the residents wanted to have access to what was in the room. When the activities rooms were closed, they had access to simple puzzles and books. Interview on 10/24/25 at 09:07 AM, the Activities Director revealed she individualized activities for each resident. She revealed the main problem for the residents had been not being able to use the activities room when it was closed. She revealed she tried her best to meet all the residents' needs, but she can't move all the individualized activities to the private dining room to include the more complex puzzles. She revealed residents were upset and, in the beginning, it was

a big shock, but they had adjusted to the circumstances. She revealed not having access to the activities room at night or on weekends may not be good for the residents because they could stay in their rooms, which can lead to depression and sadness. She revealed having it open can improve their quality of life because this was their home. Interview on 10/24/25 at 09:34AM, MDS Coordinator F revealed PTSD should be care planned for Resident #2 because it was one of his diagnoses. He revealed it was important because it could affect the resident like they could have flashbacks. Interview on 10/24/25 at 09:55 AM, the DON revealed she had not heard any complaints about activities from residents themselves. She revealed initially residents were upset but the Administrator addressed it at the resident council meeting, and the residents understood. She revealed it was important to offer activities for residents' mental well-being. She revealed if residents' preference was the activities room, then they'd have to adjust to this. Interview on 10/24/25 at 11:25 AM, the ADM revealed he wished residents would have told him they were upset about

the activities room being closed, because he would have done something about it to ensure they were not negatively affected by this. A policy for activities was requested on 10/24/2025 at 09:56 AM and no policy was provided.

Event ID:

Facility ID:

If continuation sheet