Memorial Medical Nursing Center

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

stated, if I lived in a room like this it would bother me because it's not dignified. Record review of the facility document titled Resident Rights with revision date 6/15/2025 revealed in part, .The resident has the right to

a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility.The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences.Safe environment.The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

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

Memorial Medical Nursing Center

307 W Cypress St San Antonio, TX 78212

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

for daily decision-making skills.Record review of Resident #7's comprehensive care plan with revision date 12/3/24 revealed the resident had heart failure and required respiratory therapy with interventions including oxygen as ordered and respiratory therapy as ordered.During an interview on 11/13/25 at 7:46 a.m. the Administrator stated the residents in the facility had been assessed to determine if they could self-medicate and stated there were no residents in the facility who could self-medicate. The Administrator stated, in reference to Resident #4 having self-administered the breathing treatment with the Ipratropium-Albuterol Inhalation Solution, it was her expectation for nursing to assess the resident before and after the treatment to check for effectiveness. The Administrator stated treatments with Ipratropium-Albuterol Inhalation Solution could increase heart rate and can cause an abnormality which would need to be reported to the physician.During an observation and interview on 11/13/25 at 8:09 a.m. with the Administrator, Resident #7 was observed sitting up in bed and a small jar of medicated mentholated ointment and the same product in

a roll-on stick was seen at the bedside. Resident #7 stated she used the ointment in the jar to rub on her feet and the roll-on stick for when she experienced cold symptoms. Resident #7 stated she had not used

the roll-on stick in a while because she was not experiencing any cold symptoms. The Administrator instructed an unidentified staff to remove the bedside medications.Record review of the facility document titled Storage of Medications dated 2018 revealed in part, .The facility shall store all drugs and biologicals in

a safe, secure, and orderly manner.2. The nursing staff shall be responsible for maintaining medication storage.8. Drugs shall be stored in an orderly manner in cabinets, drawers, carts, or automatic dispensing systems.10. Only persons authorized to prepare and administer medications shall have access to the medication room, including any keys.

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

Memorial Medical Nursing Center

307 W Cypress St San Antonio, TX 78212

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

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that were complete and accurately documented for 1 of 5 residents (Resident #5) reviewed for accuracy of records:The facility failed to ensure nursing staff documented Resident #5's admission nursing assessment.This failure could affect residents whose records were maintained by the facility and could place the residents at risk for errors in care and treatment.The findings included:Record review of Resident #5's face sheet dated 11/13/25 revealed a [AGE] year-old female admitted to the facility on [DATE REDACTED] with diagnoses that included cerebral infarction (type of stroke that occurs when blood flow to a part of the brain is blocked), acute respiratory failure with hypoxia (medical condition

in which the lungs suddenly cannot provide enough oxygen to the blood), diabetes (chronic medical condition in which the body has trouble regulating blood sugar), hematemesis (vomiting blood), lack of coordination, need for assistance with personal care, abnormalities of gait and mobility, hyperlipidemia (high cholesterol), epilepsy (chronic neurological disorder in which a person has recurrent, unprovoked seizures), and chronic obstructive pulmonary disease (long term lung disease in which the airways and air sacs become damaged, inflamed, and narrowed, making it difficult to breath).Record review of Resident #5's most recent comprehensive MDS assessment dated [DATE REDACTED] revealed the resident was moderately cognitively impaired for daily decision-making skills.Record review of Resident #5's History and Physical document revealed an admission physical assessment was completed by the physician on 10/29/25.During

an interview on 11/12/25 at 2:41 p.m., Resident #5 stated she could not recall having seen or checked by a doctor since she was admitted on [DATE REDACTED]. The resident stated she believed she did not receive her diabetes pills, insulin, or seizure medications the first couple of days after being admitted . During an interview on 11/14/25 at 10:56 a.m., the Administrator, who is also an RN, stated it was best practice for Resident #5's nursing admission assessment to be completed at the time of admission and no later than 72 hours. The Administrator stated at the time of Resident #5's admission on [DATE REDACTED], the admitting nurse had to leave the floor due to a family emergency and the Administrator and the ADON took over. The Administrator stated

she verified the physician orders and input the resident's medications into the electronic record. The Administrator stated the nursing admission assessment for Resident #5 was not in the electronic record and could not be found. The Administrator stated there was a problem with not having a complete nursing assessment because the assessment was used to develop the resident's care plan.

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

Memorial Medical Nursing Center

307 W Cypress St San Antonio, TX 78212

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

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

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

observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 1 of 5 residents (Resident #4) reviewed for infection control:The facility failed to ensure Resident #4's oxygen mask and tubing were stored properly when not in use.This deficient practice could place residents at-risk for infection due to improper care practices.The findings included:Record review of Resident #4's face sheet dated 11/12/25 revealed a [AGE] year old female admitted to the facility on [DATE REDACTED] with diagnoses that included sepsis (medical condition that happens when the body has an extreme, dysregulated response to an infection), hypertension (high blood pressure), and chronic obstructive pulmonary disease (a chronic progressive lung disease that makes it hard to breathe due to airflow obstruction that is not fully reversible).Record review of Resident #4's most recent comprehensive MDS assessment dated [DATE REDACTED] revealed the resident was moderately cognitively impaired for daily decision-making skills.Record review of Resident #4's Order Summary Report dated 12/12/25 revealed the following:- Ipratropium-Albuterol Inhalation Solution 0.5-2.5 (3) MG/3ML, 3ml inhale orally three times a day for SOB with order date 10/19/25 and no end date.On 11/12/25 at 10:01 a.m., Resident #4 was observed sitting up in bed and a nebulizer machine was on the resident's nightstand on the left of the bed. The nebulizer mask and tube were resting on the nightstand, not properly stored in a bag. Resident #4 stated she had a breathing treatment earlier in the morning but needed another breathing treatment because she had a history of asthma and knew she needed another breathing treatment. Resident #4 took an ampule of Ipratropium-Albuterol Inhalation Solution that was on

the nightstand and placed the nebulizer mask on her face to give herself a breathing treatment. During an

interview on 11/12/25 at 3:23 p.m., RN B stated Resident #4 received nebulizer breathing treatments and had given the resident the Ipratropium-Albuterol Inhalation Solution and should not have because the resident was not to self-medicate but got busy with a request for narcotics and pain medication for another resident. RN B stated, when the nebulizer mask and tubing were not in use they were supposed to be stored in a bag because spores were everywhere, and it was a break in infection control which could result

in the resident getting sick. RN B stated, the nebulizer mask and tubing were changed out every Sunday or as needed.During an observation and interview with the Administrator on 11/13/25 at 8:19 a.m. revealed Resident #4's nebulizer machine on the nightstand to the left of the bed had the nebulizer mask and tubing

on the counter and not stored in a bag. The Administrator stated it was her expectation for the nebulizer mask and tubing, when not in use, should be stored in a plastic bag to prevent cross contamination which could result in the resident developing an infection. The Administrator stated, since the nebulizer mask and

the tubing were not stored properly, they would have to be discarded.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet