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Complaint Investigation

Normandy Terrace Nursing & Rehabilitation Center

Inspection Date: August 18, 2025
Total Violations 2
Facility ID 675823
Location San Antonio, TX
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Inspection Findings

F-Tag F0609

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0609 Level of Harm - Minimal harm or potential for actual harm

hospital setting. During an interview on 8/18/25 at 8:45 am the RN Compliance Nurse stated she thought

the facility reporting time frame requirement for missing residents to the Complaint and Incident Intake Department was 24 hours. Record review of the Nursing Policy and Procedure Manual Section TG 03-1.0 titled, Abuse/Neglect that was undated, reflected, If the allegation involve abuse or result in serious bodily injury, the report is to be made within 2 hours of the allegation.

Residents Affected - Few

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

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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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Normandy Terrace Nursing & Rehabilitation Center

841 Rice Rd San Antonio, TX 78220

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)

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F-Tag F0689

Quality of Life and Care Deficiencies
Harm Level: Immediate Jeopardy

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

gates to be sure they were closed and alarmed. During an interview with RN J on 8/17/25 at 2:20 pm, RN J stated she had assisted in the elopement search for Resident #1. RN J stated that she had been re-in-serviced on abuse/neglect and elopement protocol including the steps to take to conduct an internal and external search for a missing resident as well as manually checking all exit doors and outside gates to be sure they were closed and alarmed. During an interview with CNA K on 8/17/25 at 2:25 pm, CNA K stated she had been re-in-serviced on abuse/neglect and elopement protocol including the steps to take to conduct an internal and external search for a missing resident as well as manually checking all exit doors and outside gates to be sure they were closed and alarmed. During an interview with RN L on 8/17/25 at 2:30 pm, RN L stated she had been re-in-serviced on abuse/neglect and elopement protocol including the steps to take to conduct an internal and external search for a missing resident as well as manually checking all exit doors and outside gates to be sure they were closed and alarmed. During an interview with CNA M

on 8/17/25 at 2:35 pm, CNA M stated she had been re-in-serviced on abuse/neglect and elopement protocol including the steps to take to conduct an internal and external search for a missing resident as well as manually checking all exit doors and outside gates to be sure they were closed and alarmed. During an

interview with CNA N on 8/17/25 at 2:40 pm, CNA N stated she had been re-in-serviced on abuse/neglect and elopement protocol including the steps to take to conduct an internal and external search for a missing resident as well as manually checking all exit doors and outside gates to be sure they were closed and alarmed. During an interview with CNA O on 8/17/25 at 2:45 pm, CNA O stated she had been re-in-serviced on abuse/neglect and elopement protocol including the steps to take to conduct an internal and external search for a missing resident as well as manually checking all exit doors and outside gates to be sure they were closed and alarmed. CNA O stated she had worked on the night shift in which Resident #1 had eloped on 8/16/25. CNA O stated she did not remember when she had last seen Resident #1 but that it could have been at 4:00 am, whenever Resident #1 received incontinent care in her room. During an

observation with the Administrator and Maintenance Director on 8/18/25 from 8:05 am until 8:30 am all of

the facility's exit doors and outside gates were checked for closure and alarm viability and found to be in good working order. The Administrator and Maintenance Director stated that all facility exit doors and outside gates would be checked twice a day seven days a week for closure function and alarm viability.

Record review of the facility's policy titled, Nursing Policy and Procedure Manual TG 03-1.0, undated, revealed that Neglect; is the failure of the facility, it's employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.

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📋 Inspection Summary

Normandy Terrace Nursing & Rehabilitation Center in San Antonio, TX inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in San Antonio, TX, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Normandy Terrace Nursing & Rehabilitation Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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