Morningside Manor

F-F580 Notify of Changes.

3.) A corporate designee will audit compliance with orders weekly until stable and monthly for the next six months, quarterly thereafter if stable and report findings to the governing body.

During an interview on 06/09/2024 at 03:14 PM the Administrator stated the facility's Chief Operating Officer would have oversight and monitoring the facility's Plan of Removal for the following six months.

The Administrator and the DON was informed the Immediate Jeopardy was removed on 06/09/24 at 04:07 PM. The facility remained out of compliance at a severity level of potential harm and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0585 Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish

a grievance policy and make prompt efforts to resolve grievances. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 41937

Residents Affected - Few Based on observations, interviews, and record reviews the facility failed to ensure residents had the right to voice grievances to the facility or other agency or entity that hears grievances without discrimination or Note: The nursing home is reprisal and without fear of discrimination or reprisal. Such grievances include those with respect to care and disputing this citation. treatment which has been furnished as well as that which has not been furnished, the behavior of staff and of other residents, and other concerns regarding their LTC facility stay, for 1 of 8 residents (Resident #54) reviewed for their right to voice grievances to the facility.

CNA P failed to report and document Resident #54's complaint she was left without a call light, left unattended, and received rushed care.

This failure could place residents at risk for harm by not having their grievances addressed.

The findings included:

A record review of Resident #54's admission record dated 06/06/2024 revealed an admitted [DATE REDACTED] with diagnoses which included major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest), glaucoma (a condition where the eye's optic nerve, which provides information to the brain, is damaged and will cause gradual vision loss), atherosclerosis of the aorta (a condition characterized by the gradual buildup of plaque in the largest artery in your body).

A record review of Resident #54's annual MDS assessment dated [DATE REDACTED], revealed Resident #54 was a [AGE] year-old female assessed with an ability to hear as, Moderate difficulty - speaker has to increase volume and speak distinctly, with impaired vision, Impaired - sees large print, but not regular print in newspapers/books, and had clear speech, was attentive, and did not have disorganized thinking. Further

review of the assessment revealed Resident #54 had not refused any care provided. Resident #54 was assessed as always incontinent of bowel and bladder. Resident #54 was assessed as, Dependent - Helper does ALL the effort. Resident does none of the effort to complete the activity, Or the assistance of 2 or more helpers is required for the resident to complete the activity for the following abilities:

Eating, oral hygiene, toileting hygiene, personal hygiene, shower / bathing dressing, and transferring.

Manual wheelchair - Wheel 50 feet with two turns: Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns.

Manual wheelchair, Wheel 150 feet: Once seated in wheelchair/scooter, the ability to wheel at least 150 feet

in a corridor or similar space.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0585 A record review of Resident #54's care plan dated 06/06/2024 revealed, The resident has a potential for communication problem Hearing deficit .The resident will be able to make basic needs known on a daily Level of Harm - Minimal harm or basis through the review date .Be conscious of resident position when in groups, activities, dining room to potential for actual harm promote proper communication with others . Ensure/provide a safe environment: Call light in reach

Residents Affected - Few A record review of the facility's grievance report logbook revealed grievances for the last 8 months . A review of the grievances revealed no evidence for a grievance for Resident #54. Note: The nursing home is disputing this citation. During an observation and interview on 06/05/2024 at 11:05 AM revealed Resident #54 loudly calling out for attention. Resident #54 was observed seated in her wheelchair in her room positioned mid room equidistant from her bed and the entry door. Resident #54's call light rested upon her bed and out of her reach by an approximate 3 feet. Resident #54 stated she was brought into her room by a CNA and left there without an ability to call for assistance. Resident #54 stated she did not have a call light within her reach. Resident #54 stated she was angry that staff do not take time with their care, (they) rush with care and run off.

During an observation and interview on 06/05/2024 at 11:16 AM revealed CNA P entered Resident #54's room responding to Resident #54's loud vocalizations calling out for assistance. Upon CNA P's entrance Resident #54 began with a complaint alleging you left me here .you said you would be right back .I had to yell to get you here . Resident #54 continued in an irritable manner and would often over speak CNA P, .you all are always in a rush and leave CNA P stated she had assisted Resident #54 in her wheelchair to her room and placed Resident #54 where she sat in her wheelchair as observed. CNA P stated Resident #54's call light was on Resident #54's bed and out of reach from Resident #54. CNA P stated she positioned Resident #54 away from her bedside due to Resident #54's preference. CNA P stated she had not attempted to place Resident #54's call light at her side. CNA P then attempted to reposition Resident #54's call light and succeeded to place Resident #54's call light at Resident #54's side, secured to her wheelchair. Resident #54 continued to verbalize irritably, don't tell your stories .you left me here .without lunch .with the button over there CNA P stated she understood Resident #54 had made a complaint and was asked what do you do when a Resident makes a complaint? CNA P stated, I have explained to her (Resident #54) I cannot stay here; I have other work to do. CNA P stated Resident #54 had a desire for someone to stay with her and she could not due to her duties.

During an interview on 06/07/2024 at 09:04 AM the DON stated staff should assist residents with a grievance report.

During an interview on 06/08/2024 at 02:03 PM the Administrator stated she was unaware of Resident #54's grievance and would look into the event on 06/05/2024 with CNA P and Resident #54. The Administrator stated she would provide a grievance policy.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0585 A record review of the facility's Grievances, Resident / Responsible Party policy dated 08/01/2017, revealed, Policy Interpretation and Implementation: A resident has the right to voice grievances without discrimination Level of Harm - Minimal harm or or reprisal. Grievances include those with respect to treatment which has been furnished as well as that potential for actual harm which has not been furnished; and a resident has the right to prompt efforts by the facility to resolve grievances the resident may have, including those with respect to behavior of other residents. The resident Residents Affected - Few has the right to obtain a written decision regarding his or her grievance. Grievances are not limited to formal written grievances and may also include residents verbalized complaints to facility staff. It is the intent of this Note: The nursing home is facility to make prompt efforts to resolve including facility acknowledgment of complaints grievances. Staff disputing this citation. will work actively towards resolution of complaints and grievances

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 26869

Residents Affected - Some Based on observations, interviews and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights and that Note: The nursing home is includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and disputing this citation. psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following -The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 6 of 16 (#6 , #3, #38, #56, #57, #120) in that:

1. Resident #6 received honey consistency liquids instead of nectar thick liquids.

2. Resident #3 did not have her 1/4 bed [NAME] in her care plan.

2. Resident #38 did not have her indwelling catheter in her care plan.

3. Resident #57 did not have her 1/4 bed rails in her care plan.

4. Resident #120 did not have her 1/4 bed rails in her care plan.

5. Resident #56 did not have his dentures mentioned in his care plan.

The facility failed to ensure Resident #6's care plan was comprehensive and updated to reflect Resident #2's doctor's order of needing honey consistency liquids instead of nectar thick liquids. This failure could place residents at risk of not receiving appropriate interventions to meet their current needs.

The Findings were:

Record review of Resident #6's admission record dated 6/7/2024 revealed a male was admitted on [DATE REDACTED] with diagnoses that included dementia (loss of thinking, remembering, and reasoning skills), personal history of traumatic brain injury, dysphagia (a condition with difficulty in swallowing food or liquid), cognitive communication deficit, and muscle wasting and atrophy.

Record review of Resident #6's annual MDS, dated [DATE REDACTED], reflected Resident #6's BIMS score was 99, indicating resident was not able to complete the interview with short term and long-term memory problems and severely impaired cognitive skills for daily decision making. It further reflected Resident #6 was severely impaired-never/rarely made decisions. The MDS also indicated Resident #6 was on a mechanically altered diet, requiring change in texture of food or liquids.

Record review of Resident #6's care plan, accessed 05/23/24, reflected [Resident #2] has potential nutrition problem r/t mechanically altered diet, revised on 03/06/2024, with an intervention of Administer Nectar thick liquid as ordered., initiated 11/30/2021 with no revision date.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Record Review of Resident #6's Doctor's diet orders reflected honey consistency liquids since 08/30/22.

Level of Harm - Minimal harm or 1. Record review of Resident #3's Admission Record dated 6/7/2024 revealed she was admitted on [DATE REDACTED], potential for actual harm age 91 with diagnoses of polyneuropathy, heart failure, cognitive communication deficit, and dementia.

Residents Affected - Some Record review of Resident #3's consolidated physician's order 5/16/2023-TRANSFER ASSISTIVE DEVICE: X2, 1/4 rails up as per Dr's order while in bed, to assist with bed mobility. Observe for injury or entrapment Note: The nursing home is related to side rail use. Reposition PRN to avoid injury. disputing this citation.

Record review of Resident #3's Quarterly MDS dated [DATE REDACTED] revealed she had a BIMs of 2/15 (severely cognitively impaired), she used a wheelchair to mobilize, she was maximum assistance with transfers.

Record review of Resident #3's care plan dated 5/6/2024 revealed no care plan to address the 1/4 side rails.

Record review of Resident #3's Transfer Assist Device Assessment form dated 5/16/2023 revealed a recommendation of bilateral 1/4 [NAME].

Interview on 6/6/2024 at 4:10 PM LVN Q stated she just changed her bed on Monday of this week.

2. Record review of Resident #38's Admission Record dated 6/7/2024, age 99 revealed she was admitted on [DATE REDACTED] with diagnoses of altered mental status, acute kidney failure, cognitive communications deficit, dementia and retentions of urine.

Record review of #38's consolidated physician orders for June 2024 revealed she had an order for indwelling catheter with diagnoses of urine retention.

Record review of Resident #38's Quarterly MDS dated [DATE REDACTED] revealed her BIMS was 99, with short/long-term memory, she used a wheelchair to mobilize, she was dependent with toileting, and had an indwelling catheter.

Record review of Resident #38's care plan dated 3/28/2024 revealed she had an indwelling catheter for neurogenic bladder but had no interventions.

Observation on 6/5/2024 at 11:40 AM revealed Resident # 38 was in the dining room eating by herself. The indwelling catheter bag was under the wheelchair and had privacy bag.

Interview on 6/6/2024 at 6:18 PM with the DON revealed Resident #38 did not have interventions for her indwelling catheter. The DON stated the nursing department, nurse manager (DON, ADON) did the care plans for nursing section in resident care areas. The DON stated the resident interventions were to monitor for quinks, care, size, nursing staff would benefit from seeing care plan. The DON stated nurses look at the care plan for catheters.

3. Record review of Resident #57's Admission Record dated 6/7/2024, age 101 revealed he had a diagnosis of diabetes II, need for assistance with personal care, and history of falls.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Record review of Resident #57's Quarterly MDS dated [DATE REDACTED] revealed her BIMS score was 6/15 (severe cognitive impairment), used a manual wheelchair, and max assist with transfers. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #57's care plan dated 6/3/2024 revealed no care plan for 1/4 bed rails.

Residents Affected - Some Record review of Resident #57's Transfer Assist Device Assessment form dated 5/17/2023 revealed a recommendation of bilateral 1/4 [NAME]. Note: The nursing home is disputing this citation. Observation on 6/5/2024 at 11:30 AM revealed Resident #57 had 1/4 hand [NAME] in her bed. Resident # 57 was not in the room.

Observation on 6/5/2024 at 3:34 PM revealed two 1/4 handrails on Resident #57's bed. Observation of Resident #57 w as sitting in her wheelchair.

4. Record review of Resident #120's Admission Record dated 6/7/2024 revealed she was admitted on [DATE REDACTED], age 65 with a diagnoses of end stage renal disease, diabetes II, abnormal gait/mobility and heart failure.

Record review of Resident #120's consolidated physician orders for June 2024 revealed an order for 5/20/2024-TRANSFER ASSISTIVE DEVICE: X2, 1/4 rails up as per physician order while in bed, to assist with bed mobility. Observe for injury or entrapment related to side rail use. Reposition PRN to avoid injury.

Record review of Resident #120's Admission MDS dated [DATE REDACTED] revealed she was BIMS 15/15 (cognitively intact), mobilized in wheelchair, impairment on one side of lower extremity, and roll left and right required partial/moderate assistance.

Record review of Resident #120's care plan dated 5/13/2024 revealed no care plan for 1/4 bed rails.

Record review of Resident #120's Transfer Assist Device assessment dated [DATE REDACTED] recommendation left and right 1/4 side rails.

Observation on 6/4/20/24 at 11:29 AM revealed Resident #120 was in bed and had two 1/4 side rails on each side of her bed.

Interview on 6/7/2024 at 11:50 AM with the ADM stated the 1/4 bed rails risk would be staff does not know

the rails were in place. No other response.

5. Record review of Resident #56's Admission Record dated 6/9/2024 revealed he was admitted on [DATE REDACTED], age 89 with diagnoses of alcoholic cirrhosis of liver (impaired liver function caused by formation of scar tissue) and major depressive disorder.

Record review of Resident #56's Quarterly MDS dated [DATE REDACTED] revealed he had a BIMS of 8/15 (moderately cognitively impaired) and nothing noted in Section L- Oral/Dental Status.

Record review of Resident #56's care plan, undated, revealed no mention of dentures.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 During an interview on 06/06/24 at 02:00 PM, Resident #56's RP revealed Resident #56 had been going to

the dentist recently to get his dentures fixed. Level of Harm - Minimal harm or potential for actual harm During an interview on 06/06/24 at 01:47 PM, Resident #56's dentist revealed she was seeing Resident #56 to repair his dentures. Residents Affected - Some

During an interview on 06/07/24 at 12:13 PM, the DON revealed dentures should be care planned so the Note: The nursing home is CNAs know what to do for the resident's care when it comes to oral care. disputing this citation.

During an interview on 05/24/24 at 11:19 AM, Speech Therapist C (ST C) revealed if a resident was determined to need honey thickened liquids and received nectar thickened liquids there could be a chance of aspiration where a solid or liquids could get into the airways. She further revealed this could lead to aspiration pneumonia which could cause a resident to be hospitalized . She revealed if a resident was more compromised there could be more severe health consequences, including death. ST C revealed there had been times where a resident may refuse a liquid if they knew they could not tolerate it, which could cause dehydration. She further revealed she had not heard of a resident at this facility complaining about this scenario, however, you may not be able to know this if a resident was nonverbal.

During an interview on 05/24/24 at 03:23 PM, the RD revealed the facility was giving resident honey thickened liquids. She further revealed CNAs were providing liquids to Resident #2 in between meals but would have to ask the DON how the CNAs knew what liquids to give Resident #2.

During an interview on 05/24/24 03:54 PM, MDS nurse P and MDS nurse Q stated CNAs followed tasks that were developed from care plans. MDS nurse P confirmed Resident #2's care plan reflected an intervention of Administer Nectar thickened liquid as ordered. She further confirmed this would turn into a task on their POC dashboard for the CNAs to follow. MDS nurse Q confirmed Resident #2's POC Shift Dashboard record, accessed on 05/24/24 at 11:01 AM, revealed there was a directive to give Resident #2 Nectar Thick Liquids. MDS nurse P and MDS nurse Q revealed if resident was receiving Nectar thickened liquids and needed honey thickened liquids, this could cause aspiration.

Left VM for doctor and NP on 05/24/24 at 3:20 PM.

During an interview on 5/30/24 at 02:33 PM, the administrator and the DON revealed nursing staff received liquids from the kitchen, which would be honey thickened liquids. If the kitchen did not give these liquids, the DON would get involved and ensure the correct liquid was given.

Record review of the facility's policy, titled Care Plans, Comprehensive Person-Centered, revised March 2022, reflected, 7. The comprehensive, person-centered care plan: b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being .11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Record review of the facility policy dated 4/6/2009 revealed The care plan shall be used in developing the resident's daily care routines and will be available to staff personnel who have responsibility for providing Level of Harm - Minimal harm or care of services to the resident. Record Review of POC Shift Dashboard and interview with CNA D, dated potential for actual harm 05/24/24 at 11:01 AM, reflected Resident #2 received NUTRITION- Fluids: NECTAR THICK LIQUIDS QShift. CNA D revealed she was following this directive and giving Resident #2 Nectar thickened liquids. Residents Affected - Some There were no observations of Resident #2 receiving nectar thickened liquids. Meals and snacks included Note: The nursing home is honey thickened liquids. disputing this citation. 48366

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Immediate **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 26481 jeopardy to resident health or safety 26869

Residents Affected - Some 42402

Note: The nursing home is Based on interviews and record reviews the facility failed to immediately consult with the resident's physician disputing this citation. when there was a need to alter treatment significantly for 1 of 8 residents (Resident #6) reviewed for notification.

The facility failed to ensure Resident # 6 was assessed as ordered for neuro-checks every 4 hours x 3 days. Resident # 6 was sent to hospital and returned to the facility on [DATE REDACTED] with new diagnoses to include: cerebral infarction and hemiparesis following cerebral infarction affecting right dominant side, and slurred speech.

An Immediate Jeopardy was identified on 6/29/2024 . The IJ template was provided to the facility on [DATE REDACTED] . While the IJ was removed on 6/30/2024, the facility remained out of compliance at a scope of pattern and a severity level lowered to no actual harm that is not Immediate Jeaperdy due to the facility's need to monitor and evaluate the effectiveness of the corrective actions.

This failure could result in assessments not being completed as ordered could result in residents' not receiving the necessary care resulting in a decline in health and or death. This could affect all resident with assistive devices and could result in no orders for resident care.

The findings included:

Record review of Resident #6's admission record, accessed 06/07/24, reflected the resident was admitted on [DATE REDACTED] with diagnoses that included dysphagia (difficulty swallowing food or liquid) following cerebral infarction (a type of stroke caused by impaired blood flow to the brain) and dementia (neurodegenerative disease that affects memory, thinking and interferes with daily life). It further reflected Resident #6 returned to the facility on [DATE REDACTED] with new diagnoses to include: cerebral infarction (a type of stroke caused by impaired blood flow to the brain), hemiplegia (weakness of one entire side of the body) and hemiparesis (complete paralysis of one side of the body) following cerebral infarction affecting right dominant side , ataxia (a loss of muscle coordination), and slurred speech.

Record Review of nursing progress note, authored by LVN A on 03/22/24 at 1:20 PM, reflected Resident #6's RP reported Resident #6 could not hold her beverage. This progress notes further revealed NP B ordered neuro checks Q 4 hrs x 3days, and to notify NP of any deficit. Record Review revealed Neuro-checks were not started until 4:00 pm.

Record review of Orders- Administration Note , authored by LVN C, reflected:

03/23/24 at 02:02 AM Neuro check was not done due to [Resident #6] being asleep.

03/23/24 at 04:55 AM Neuro check was not done due to[family member] refusal.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Record review of Orders- Administration Note , authored by LVN A, reflected:

Level of Harm - Immediate 03/23/24 at 09:06 AM Neuro check was not done due to family member refused since [Resident #6] was jeopardy to resident health or sleeping. safety

Record review of nursing notes from 03/23/24 revealed no documentation of NP Residents Affected - Some or MD being notified of neuro checks not being done per order. Note: The nursing home is disputing this citation. During an interview on 6/25/2024 at 6:35 pm LVN A revealed she did not explain what could happen if Resident #6 had a stroke to the family, because Resident #6 had a history of having a stroke, so the family knew information about strokes.

LVN A said when the resident/family refused neuro checks she did not go back and attempt to reassess the resident until the next 4-hour interval.

During an interview on 6/25/2024 at 6:49 pm, LVN C stated Resident #6's family member did not allow her to do one of the neuro checks (12 midnight) 3/23/2024 the resident was sleeping. The Resident refused neuro checks at 4:00 am. LVN C further revealed she did not contact NP B when neuro checks were not done. LVN C also revealed she did not explain what could happen if Resident #6 had a stroke because Resident #6 had

a history of having a stroke.LVN C said when the resident/family refused neuro checks she did not go back and attempt to reassess the resident until the next 4-hour interval. She further revealed she tried once, and

the resident hit me. The resident said leave me alone.

During a telephone interview on 6/28/2024 at 12:30 pm NP B stated she remembers the nurses calling her in March 2024 regarding stroke like symptoms, she doesn't recall the specifics, but she feels they let her know how the resident was based on their long-time knowledge of the resident. The nurses once they found the resident to have a change sent her to the hospital. She stated based on the statements of the nurses was how she was sent to the hospital.

Resident #6 was admitted to hospital on 3/23/24 and diagnosed with: cerebral infarction and hemiparesis following cerebral infarction affecting right dominant side, and slurred speech.

The plan of removal was submitted by the facility and was accepted on 06/29/24 at 10:07 AM. It was documented as follows:

Action to correct and remove IJ:

1.) Verify that all assessments were being followed as ordered by physician/NP. The DON and/or designee will complete this by noon 06/29/24.

2.) All licensed nurses will be in-serviced regarding the need to notify physician/NP

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 immediately of any refusals that keep us from following physician ordered assessments. The DON and/or designee will complete an in-service with the team by 06/30/24. Licensed Nurses on vacation, leave, or Level of Harm - Immediate unavailable will be trained prior to their next scheduled shift. A Licensed Nurse roster is being utilized to track jeopardy to resident health or the Licensed Nurses who have responded and have been in-serviced. The identified Licensed Nurses who safety were unavailable will attempt to be reached by phone call, text message, and email by the DON/Designee.

The DON/Designee will work with the scheduler and audit daily to ensure any Licensed Nurse will not be Residents Affected - Some scheduled until the necessary in-service has occurred.

Note: The nursing home is 3.) The DON/Designee will review 24-hour report daily for change of condition UDA (Unified Defined disputing this citation. Assessment-a change of condition assessment) including neurological checks for any refusals and review for medical provider notification. The Weekend Nurse Manager/Designee will review any refusals and contact

the DON/Designee immediately if a resident has a refusal to ensure the medical provider has been notified. Audits will be completed daily x14 days, weekly x4 weeks, monthly x3 months, and periodically thereafter.

4.) All residents have the potential to be affected by this alleged deficient practice. At risk residents will be identified by reviewing 24-hour report, changes of condition assessment and neurological checks.

Reviews:

1.) Weekly the DON and/or designee will pull all orders from the EHR for any refusals and review for physician and/or NP notification. The administrator will meet with the DON weekly to audit and verify this

review has been completed. This will be ongoing for the next two months.

2.) Reports to the QAPI committee regarding the reviews will be discussed with the team on an ongoing basis.

3.) A corporate designee will audit compliance with orders weekly until stable and monthly for the next six months, quarterly thereafter if stable and report findings to the governing body.

The facility's POR verification was as follows:

In an interview on 06/29/24 at 12:53 PM the DON stated all but 1 of the 24 nurses had been in-serviced to notify the physician immediately if a resident refused an assessment and the 1 nurse who had not been in-serviced would not be scheduled until they received the in-service.

Interviews on 06/29/24 from 12:05 PM to 4:05 PM with 8 nurses (3 RNs and 5 LVNs), five of whom worked

the day shift (6 AM to 6 PM) and three of whom worked the night shift (6 PM to 6 AM), revealed they were in-serviced to immediately notify the resident's physician/NP if a resident refused to have an assessment completed, to document the resident refused the assessment in the nurse's progress notes and the physician was notified, and to notify the resident's responsible party.

In an interview on 06/29/24 at 4:01 PM, the DON stated she had printed out all the physician orders and verified the assessments had been completed.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 20 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 In a further interview on 06/29/24 at 4:20 PM, the DON stated there was only one resident who had orders for neurological checks that were initiated on 06/28/24 and completed 06/29/24 and the resident did not Level of Harm - Immediate refuse the neurological assessments. jeopardy to resident health or safety In an interview on 06/29/24 at 4:52 PM the DON stated she would review the 24-hour reports, the orders in

the EHR, and the change of condition reports daily for notation of change of condition in a resident. The DON Residents Affected - Some stated the Weekend Supervisor and the ADON would continue the monitoring when she was not in the facility. The DON stated an ad hoc QAPI meeting was held on 06/28/24 with the Medical Director and Note: The nursing home is department heads in reference to the IJ for not completing an ordered assessment. The DON stated the disputing this citation. Chief Operating Officer would conduct weekly audits of the facility's monitoring of compliance with ordered assessments.

In an interview on 06/29/24 at 5:09 PM the Administrator stated she reviewed the 24-hour reports with the DON for ordered assessments. The DON in-serviced the nurses on ensuring ordered assessments were completed and to notify the physician immediately if an assessment was refused by the resident. The Administrator stated they would obtain daily the 24-hours reports from the EHR to monitor ordered assessments. The Administrator said an ad hoc QAPI meeting was held on 06/28/24 and not notifying the physician when a resident refused an assessment was reviewed and discussed. The Medical Director, the DON, the ADON and other department heads were present at the ad hoc QAPI meeting. The Administrator stated the Chief Operating Officer would conduct the weekly audits of compliance with monitoring physician order assessments.

Record review of an undated, untitled list of nurses revealed 24 nurses were employed at the facility.

Record review of the In-Service Education Attendance Record dated 06/28/24, for Completing assessments as ordered per physician/NP, revealed 23 nurses had been in-serviced.

Record review of the facility's POR verification binder revealed there were daily, weekly, and monthly monitoring sheets for reviews of the 24-Hour report. The 24-Hour Report monitoring form had columns for

the resident's name, date, progress notes refusals, EMH refusals, order note refusals, and if it was care planned.

Record review of the facility's POR verification binder revealed on the 24-Hour Report daily monitoring sheets revealed on the first row was handwritten 06/29/24 no refusals (i.e., no refusal of care/medications/assessments). On the second row was handwritten a resident's name, date of 06/30/24, notation the resident refused a medication, it was care planned the resident would refuse the medication, and the physician was informed.

Record review of the facility's POR verification binder revealed there were daily, weekly, and monthly monitoring sheets for reviews of the E-Interact Change of Condition Assessment. The E-Interact Change of Condition Assessment monitoring form had columns for the resident's name, date, notification to family, notification to the physician, notification of refusal of treatment, notification of refusal of meds, and if it was care planned.

Record review of the Daily E-Interact Change of Condition Assessment form revealed residents who had a change of condition on 06/28/24 and 06/29/24 were listed, all the resident's physicians and RP's were notified and none of the residents refused care or assessments.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 21 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Record review of the facility's POR verification binder revealed there were daily, weekly, and monthly monitoring sheets for Neurological Checks audits. The Neurological Checks monitoring form had columns for Level of Harm - Immediate the resident's name, date, notification to family, notification to the physician, refusals of vital signs, jeopardy to resident health or notification of neurological assessments, and if it was care planned. safety

Record review of the Order Listing Report, dated 06/29/24, revealed there was only 1 resident with orders for Residents Affected - Some neurological checks to be completed in a 24-hour period.

Note: The nursing home is In an interview on 06/29/24 at 4:20 PM, the DON stated there was 1 resident who had orders for neurological disputing this citation. checks and there was another resident who had a fall on 06/28/24 that neurological checks were being done on. Both residents were listed on the Daily Neurological Checks monitoring sheet.

Record review of the Daily Neurological Checks monitoring sheet revealed 2 residents were listed on 06/28/24 for neurological checks, their physician's and RP's were notified, and the residents did not refuse

the assessment. On 06/29/24 there were no residents with orders for neurological checks.

Record review of an In-Service Education Attendance Record, dated 06/28/24, revealed an ad hoc QAPI meeting was held at 6 PM to discuss assessment documentation and all assessments were not being completed as ordered could result in residents not receiving the necessary care resulting in a decline in their health or even death. The meeting was conducted by the Administrator and in attendance were the Medical Director, the Activity Director, the ADON, the DON, the BOM, the dietitian, and the housekeeping director.

An Immediate Jeopardy was identified on 6/29/2024 . The IJ template was provided to the facility on [DATE REDACTED] . While the IJ was removed on 6/30/2024, the facility remained out of compliance at a scope of pattern and a severity level lowered to no actual harm that is not Immediate Jeaperdy due to the facility's need to monitor and evaluate the effectiveness of the corrective actions.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 22 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 41937

Residents Affected - Few Based on observations, interviews, and record reviews the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all Note: The nursing home is drugs and biologicals) to meet the needs of each Resident, for 1 of 7 residents (Resident #170) reviewed for disputing this citation. pharmacy services.

LVN U dispensed Resident #170's medications (11 pills) and stored them in a small pill cup in the medication cart with the intention of administering the medications at a later time and continued to dispense and administer medications for other residents.

This failure could place residents at risk for harm by medication administration errors.

The findings included:

A record review of Resident #170's admission record dated 06/07/2024 revealed an admitted [DATE REDACTED] with diagnoses which included hypertension (high blood pressure), diabetes type II (a condition where the body's cells cannot readily accept sugars from the blood), hyperlipidemia (a condition where the blood too much fat (lipids)).

A record review of Resident #170's admission MDS assessment dated [DATE REDACTED] revealed Resident #170 was

a [AGE] year-old male assessed with a BIMS score of 15 out of a possible 15 which indicated no cognitive impairment.

A record review of Resident #170's physicians' orders dated 06/07/2024, revealed Resident #170 was prescribed the following medications to be administered daily at 08:00 AM:

1. Amlodipine 5mg (used to trat high blood pressure).

2. Aspirin 81mg (used to prevent heart attacks).

3. Fish oil capsule 1000mg (used for dietary supplement).

4. Lisinopril 40mg (used to treat high blood pressure).

5. Multivitamin (used for a dietary supplement).

6. Sertraline 100mg (used to treat depression).

7. Vitamin C (used as a dietary supplement).

8. Donepezil 10mg (used to treat dementia (a general decline in cognitive abilities that affects a person's ability to perform everyday activities)).

9. Gabapentin 600mg (used to treat nerve pain).

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 23 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0755 10. Hydralazine 50mg (used to treat high blood pressure).

Level of Harm - Minimal harm or 11. Sennosides-Docusate Sodium 8.6-50mg (used to treat constipation). potential for actual harm

During an observation and interview on 06/07/2024 at 08:12 AM revealed LVN U attended her medication Residents Affected - Few cart and was preparing medications for another Resident. Observations of LVN U opening drawers of the medication cart revealed the top drawer had a small clear plastic cup with pills. LVN U stated the cup Note: The nursing home is contained Resident #170's morning medications. LVN U stated she had dispensed Resident #170's disputing this citation. medications and attempted to administer Resident #170 his medications and was unable to do so due to Resident #170 was not available and was in the shower. LVN U stated she had stored the loose pills in their pill cup for a later attempt to administer. LVN U stated she then proceeded to dispense and administer medications to other residents.

During an observation and interview on 06/07/2024 at 08:20 AM revealed the DON approach the medication cart and inquire of LVN U here status on medication administration and the surveyor reported to the DON that LVN U had Resident #170's medications in a pill cup. The DON inquired of LVN U the nature of the pills

in the cup and LVN U reported the pills were dispensed for Resident #170 however Resident #170 was in the shower. The DON stated LVN U should have disposed the medications and would need to re-dispense the medications when Resident #170 became available.

During an interview on 06/07/2024 at 0859 AM the DON stated medications should be dispensed and administered prior to dispensing and administering medications for the next Resident.

A record review of the facility's policy titled Storage of Medications dated April 2009, revealed, Policy Interpretation and Implementation: Drugs and biologicals shall be stored in the packaging, containers, or other dispensing systems in which they were received. Only the issuing pharmacy is authorized to transfer medications between containers. The nursing staff shall be responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner

A record review of the American Association of Post-Acute Care Nursing's website: Resident Safety and Nurse Workarounds - AAPACN accessed 06/11/2024, titled, Resident Safety and Nurse Workarounds, revealed, Nurse workarounds defined .Nurse workarounds are actions that nurses take to deliver care and accomplish the work assigned to them, despite those actions' deviating from protocol and policy . workarounds occur in SNFs (Skilled Nursing Facility's) .For example, a nurse who pops medication from a multi-dose card and pre-pours pills or places them in medication cups to be administered later, for one or more residents, does not intend to cause harm. Nurses do this so they can dispense medications quickly, saving precious time and allowing them to move on to the next task they must complete. But the intended time-saver exposes patients to the risk of harm. While an error probably will not occur every time a workaround is used, when one does occur, the harm is likely to be significant

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 24 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0808 Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 48366

Residents Affected - Few Based on observations, interviews and record reviews, the facility failed to ensure a therapeutic diet was prescribed by the attending physician for 1 of 8 residents (Resident #6) reviewed for food and nutrition Note: The nursing home is services. disputing this citation.

The facility failed to ensure Resident #6 had a physician's order for a pureed diet with nectar thickened liquids. The resident was prescribed a pureed diet with thin liquids and was provided a pureed diet with nectar thickened liquids.

This deficient practice could place residents who are provided a modified texture diet at risk poor intake, and weight loss and diminished quality of life.

The findings were:

Record review of Resident #6's admission record, accessed 06/07/24, revealed the resident was admitted on [DATE REDACTED] with diagnoses that included dysphagia (difficulty swallowing food or liquid) following cerebral infarction (a type of stroke caused by impaired blood flow to the brain) and mild protein-calorie malnutrition.

Record review of Resident #6's significant change in status MDS, dated [DATE REDACTED], reflected a BIMS score of 99, indicating resident was unable to complete the interview. Further review of this MDS reflected Resident #6's cognitive skills for daily decision making was severely impaired with short term and long-term memory problems. Resident #6's MDS assessment further revealed resident was on a mechanically altered diet- require change in texture of food or liquids while a resident.

Record review of Resident #6's physician's orders for May 2024 revealed the following diet order: Special Diet: REGULAR diet Consistency: PUREED texture, Liquid: THIN consistency with an order date of 04/01/2024.

Record review of Resident #6's comprehensive person-centered care plan, undated, revealed the following focus area: [Resident #6] has swallowing problems r/t cerebral infarction, dysphagia with interventions to include Special diet: REGULAR diet, Consistency: PUREED texture, Liquid: THIN consistency, initiated 04/01/2024.

Record Review of Resident #6's weight loss history revealed no weight loss since 04/01/2024.

During an interview on 06/04/24 at 12:10 PM and record review of Resident #6's lunch meal ticket revealed it stated: DIET: Pureed, *Regular, Nectar, Resident #6's RP 1 revealed there was a nectar thickener packet on Resident #6's lunch meal tray and they had to add it to the V8 to make it nectar thickened. Resident #6's RP 1 further revealed she was unaware of the nursing staff thickened the liquids, because it has been their job to thicken the liquids for their mom.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 25 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0808 During an interview on 06/04/24 at 12:19 PM, LVN U revealed Resident #6 should have nectar thickened liquids, according to her meal tray ticket. He further revealed the kitchen was supposed to thicken her fluids Level of Harm - Minimal harm or to be nectar thickened. potential for actual harm

During an interview on 06/05/24 at 10:33 AM, Resident #6's RP 2 revealed the family comes to lunch with Residents Affected - Few Resident #6 and had to thicken Resident #6's liquids to nectar consistency. This family member was able to describe the process of thickening Resident #6's liquids. It was later observed that Resident #6 received a Note: The nursing home is nectar thickening packet on her 06/05/24 lunch meal tray ticket to thicken the liquids on her tray ticket. disputing this citation.

During a combined interview on 06/06/24 at 10:52 AM, the RD revealed Resident #6's family requested for Resident #6 to have nectar thickened liquids. She further revealed she was allowed to downgrade diets from thin to nectar thickened liquids on Point Click Care and meal tray cards. The CDM revealed the kitchen did not thicken liquids to the nectar consistency, because by the time they would get to the resident, the liquids that were thickened in the kitchen would be too thickened and hard to drink. The CDM further revealed the trays that need to have liquids thickened to nectar consistency were sent with packets of thickening agents for the nursing staff to add to liquid when they put the residents' trays down. They both revealed residents needed to have the right consistency as a safety precaution to prevent adverse reactions such as coughing or choking.

Record review of the facility's policy Thickened liquids, revised 1/24, reflected the following:

Thickened liquids will be available for those who have difficulty swallowing thin liquids. Liquids will be thickened to the degree specified in the physician or designee's orders.

Physician/designee orders thickened liquids in medical record.

Food and Nutrition Department ensures resident nutrition profile is updated with thickened liquid order and provides thickened liquids per community approved diets.

Record review of the facility's policy, Physician delegated diet and nutrition orders, revised 01/24, reflected A resident's attending physician may delegate the task of writing diet orders to a qualified dietitian .

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0809 Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to Level of Harm - Minimal harm or eat at non-traditional times or outside of scheduled meal times. potential for actual harm 26869 Residents Affected - Some Based on interview, and record review, the facility failed to ensure there were no more than 14 hours Note: The nursing home is between a substantial evening meal and breakfast the following day, except when a nourishing snack was disputing this citation. served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span for 3 of 9 residents (confidential residents in group) reviewed for frequency of meals.

The facility failed to ensure residents were offered snacks at bedtimes as required due to mealtimes being more than 14 hours apart.

This failure could affect all residents who received meals served from the facility's only kitchen by placing residents at risk for, unplanned weight loss, and side effects from medication given without food, and diminished quality of life.

Findings included:

Record review of the resident snack list (undated), was provided by the DM. There were 4 residents that received three times a day, to include HS snacks. The snack list provided by the DM were residents that had dialysis. There was no resident list with HS snacks provided.

Record review of the resident roster dated 6/4/2024 reflected a census of 79 residents.

Record review of the posted Meal Service Times in the dining room revealed the following:

Breakfast - 7:20 -8:00 AM

Lunch - 11:35-12:00 AM

Evening meal - 4:20 -5:00 PM- There is no posting to advise any resident a snack or availability of type of snack after specified times.

During interview on 6/6/2024 at 1: 00 PM with residents in group of 9 residents, it was brought to the attention of the state surveyors that they have not been made aware of options of a snack which were available to residents. Residents said they were not offered any HS snacks by staff.

During interview on 6/6/2024 at 2:29 PM with Restorative Aide/CNA R stated she worked (7-3:30pm) stated there was a snack box in the nursing station refrigerator.

During interview on 6/6/2024 at 4:17 PM with LVN Q stated she worked 6AM-6PM. LVN Q stated resident came to staff if they wanted some snacks, such as cookies, chips, sandwiches. LVN Q stated the diabetic resident were able to have snacks for the nursing refrigerator that were low in sugar.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 27 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0809 During interview on 6/06/2024 at 6:15 PM with CNA S stated she worked for 31 yrs., on the 6PM-6AM shift. CNA S stated she provided HS snacks to residents if they asked her. CNA S stated she did not go around Level of Harm - Minimal harm or and offer residents a snack. potential for actual harm

During interview on 6/6/2024 at 6:29 PM CNA T stated she worked for 1 year at the in facility. CNA T stated Residents Affected - Some there were resident snacks in the refrigerator behind the nurse's station . CNA T stated she had not offered HS snacks to every resident, only if residents asked her. Note: The nursing home is disputing this citation. During interview on 6/6/2024 at 6:33 PM the CDM, director of culinary services, stated she only had a dialysis snack list. CDM stated no other snacks go out from the kitchen.

During interview on 6/6/2024 at 6:35 PM with the DM stated they place resident snacks in the nursing station refrigerator.

During interview on 6/7/2024 at 11:32 AM with the ADM stated snacks were offered at bedtime to residents, nursing department and anytime a resident request a snack. The ADM stated the bedtime snacks were offered after dinner. The ADM stated if resident were not offered snacks, resident will be hungry and diabetic residents could have an effect on their blood sugars. The ADM stated resident can ask for snacks and nursing department can provided snacks. The ADM stated the Activities department had snacks when they have functions throughout the day. No other response.

Record Review of the Facility Policies and Procedures for Resident Food Services dated 5/95 revealed, SNACKS- Procedures: Nursing offers bedtime snacks.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 28 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food

in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm 48366

Residents Affected - Some Based on observations, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen Note: The nursing home is sanitation. disputing this citation. 1. There were approximately 5 boxes that appeared to be less than 18 inches from the ceiling, in the walk-in fridge.

2. There was a chocolate pie that was not fully covered in the walk-in fridge.

These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness.

The findings included:

During observations and an interview in the initial tour of the kitchen with the CDM on 06/04/24 at 09:02 AM, there were approximately 5 cardboard boxes filled with various food products that appeared to be less than 18 inches from the ceiling, in the walk-in refrigerator. It was also observed there were 2 chocolate pies that were not completely wrapped, and their pie crusts were exposed. The CDM revealed the boxes should not be stored this close to the ceiling and the chocolate pies will be thrown away because she would not be able to serve these food products now. The CDM was not able to identify who could have done this, but the staff were trained on covering food products appropriately for storage and items should be stored more than 18 inches away from the ceiling.

Record review of the facility's policy Food storage, revised 02/23/24, reflected All food, non-food items and supplies used in food preparation shall be stored in such a manner as to prevent contamination to maintain

the safety and wholesomeness of the food for human consumption., Cover label and date unused portions and open packages., and Store items 6 inches above the floor and 18 inches below sprinklers.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 29 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 26869

Residents Affected - Few Based on interview and record review the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the Note: The nursing home is residents' choices for 2 of 17 (Residents #25 and #57) residents in that: disputing this citation. 1. Resident #25 did not have an order or care plan for diabetic shoes in her record.

2. Resident #57 did not have an order or care plan for diabetic shoes in her record.

This failure could result in assessments not being completed as ordered could result in residents' not receiving the necessary care resulting in a decline in health and or death. This could affect all resident with assistive devices and could result in no orders for resident care.

The findings included:

1. Record review of Resident #25's Admission Record dated 6/7/2024 revealed the resident was admitted on [DATE REDACTED], readmitted on [DATE REDACTED] with diagnosis of Diabetes II.

Record review of Resident #25's consolidated physician orders for June 2024 revealed no order in her

record for diabetic shoes.

Record review of Resident #25's Quarterly MDS dated [DATE REDACTED] revealed she had a BIMS score of 12/15 (cognitively intact) and diagnosis of Diabetes Mellitus.

Record review of Resident #25's Care Plan dated 6/5/2024 revealed she had a diagnosis of diabetes mellites, risk of complications. There was no care plan for diabetic shoes.

Record review of Resident #25's comfort feet assessment revealed she had a history of poor circulation. This was signed by physician dated on 4/12/2024.

2. Record review of Resident #57's Admission Record dated 6/7/2024, age 101 revealed he had a diagnosis of diabetes II, need for assistance with personal care, and history of falls.

Record review of Resident #25's consolidated physician orders for June 2024 revealed no order in her

record for diabetic shoes.

Record review of Resident #57's Quarterly MDS dated [DATE REDACTED] revealed her BIMS score was 6/15 (severe cognitive impairment) and was diabetic.

Record review of Resident #57's care plan dated 6/3/2024 revealed the resident has diabetes mellitus, risk for complications. There was no care plan for diabetic shoes.

Record review of Resident #57's comfort feet assessment revealed she had a history of poor circulation and history of pre-ulcerative callus. This was signed by physician dated on 4/12/2024.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 30 of 31 455523 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 455523 B. Wing 06/30/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Morningside Manor 602 Babcock Rd San Antonio, TX 78201

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 Interview on 6/5/2024 at 11:33 AM with Resident #25, she stated, and Resident #57 had been waiting in their diabetic shoes and not sure they were coming. Level of Harm - Minimal harm or potential for actual harm Interview on 6/05/24 at 3:32 PM Resident #57 said she had not received her diabetic shoes and it's been about 2-3 weeks. Residents Affected - Few

Interview on 6/6/2024 at 3:44 PM with Social Worker (SW) stated she had a company come into the facility, Note: The nursing home is stating they were giving residents with diabetes free shoes. The SW stated she had residents interested in disputing this citation. the diabetic shoes and made an order and will be delivered tomorrow.

Interview on 6/7/2024 at 4:30 PM with the DON, she stated she was not aware residents were getting diabetic shoes delivered today. The DON expected the physician to know, have an order and care plan.

Interview on 6/7/2024 at 4:23 PM the ADM stated the shoe company came in and was offering free diabetic shoes to residents. The ADM stated she was not aware that residents were going to have diabetic shoes delivered today.

Interview on 6/7/2024 at 4:28 PM the ADM stated the SW did not bring up that the shoe company had assessed and ordered diabetic shoes for residents. The ADM stated she will find a policy.

Interview on 6/7/2024 at 4:35 PM with shoes representative stated he had a list resident who were diabetic from the facility. The shoes representative stated they completed an assessment that included to measure residents' feet and if the residents' met criteria, they will send the prescription and will get the orders signed by the physician. The shoe representative stated then they would order the shoes for residents. Once the diabetic shoes were ready, they would deliver the diabetic shoes to the residents. The diabetic shoe company delivered 10 resident's shoes today, 6/7/2024. The shoe representative stated they had 4 more residents that needed approval from insurance.

Interview on 6/7/2024 at 4:39 PM with the ADM stated she was not sure why the diabetic shoe company had

the original physician orders for the diabetic shoes. ADM stated the orders for the Diabetic shoed for Resident #25 and #57 and should be in resident chart. The ADM stated the SW never discussed in morning meetings or with ADM, that residents had ordered the diabetic shoes from the comfort shoes.

Interview on 6/7/2024 at 5:03 PM the ADM/DON stated Resident #57 and Resident #25 did not have orders for diabetic shoes in the facility records. The DON/ADM were not aware that residents #25 and #57 were getting diabetic shoes, today.

Interview on 6/9/2024 at 1:06 PM with ADM and DON stated they did not have a policy on diabetic shoes/DME/resident devices.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 31 of 31 455523