Northeast Rehabilitation And Healthcare Center

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

resident received psych services on 04/07/2025, and the resident did not have any emotional distress due to this incident. The administrator notified this incident to Resident #3's medical doctor and responsible party and completed in-services regarding abuse to all staff on 04/05/2025. During interviews from 08/19/2025 to 08/21/2025 with CNA-A, CNA-B, MDS/LVN-C, CNA-D, CNA-E, ADON-F, ADON-G, LVN-H, hospital aide-I, RN-J, medication aide-K, CNA-L, CNA-M, CNA-N, CNA-O, housekeeper-P, housekeeper-Q, CNA-R, CNA-s, CNA-T, CNA-U, CNA supervisor, maintenance, director of rehab, and wound care nurse stated the completed taking in-services regarding abuse on 04/05/2025. During interviews from 08/19/2025 to 08/21/2025 with Resident #1, #2, #4, #5, #6, #7, #8, #9, #10, and #11 stated they did not see any abuse

in the facility. Record review of the facility policy, titled Resident Right - Abuse Prevention, undated, the facility had the policy of It is the policy of this facility that each resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation and if the suspected perpetrator is an employee: remove employee immediately from the care of any resident and suspend employee during the investigation. The noncompliance was identified as PNC (Past Non-Compliance). The noncompliance began on 04/04/2025 and ended on 04/05/2025. The facility had corrected the noncompliance before the survey began.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northeast Rehabilitation and Healthcare Center

603 Corinne St San Antonio, TX 78218

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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

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

lift. She stated the purpose of the Care Plan was to identify a Resident's care areas, needs, level of care and interventions the facility staff would provide while the Residents remained in the facility. The DON stated failure to identify that Resident #1 and Resident #2 required assistance with transfers via mechanical lift could contribute to an improper transfer and result in potential accidents and or injuries. Review of the facility policy Comprehensive Person-Centered Care Planning, revised on 12.2023, read It is the policy of

this facility that the interdisciplinary team (IDT) shall develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northeast Rehabilitation and Healthcare Center

603 Corinne St San Antonio, TX 78218

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

did. CNA A stated the wheels were not rolling and sometimes that would happen when there was hair build up around the wheels. She stated she did not check the wheels prior to using it which she should have.

CNA A stated she used force and was pushing the mechanical lift at an angle because of the lack of space as she was attempting to position the legs underneath the bed. CNA A stated if the mechanical lift became unbalanced it could have tilted sideways, Resident #1 would have fallen and she could have been hurt.

CNA A stated Resident #1 was a heavy woman, maybe about 300 pounds. She stated there was no way

she could have prevented the mechanical lift from tilting over. She stated it was dangerous, she knew better, and stated she had been in-serviced several times on operating a mechanical lift. CNA A stated she would have been responsible for the fall. Interview on 8/20/25 at 4:07 PM with the DON revealed transferring a resident using a mechanical lift required 2 staff. She stated one staff operated the mechanical lift while the second staff guided the resident. The DON stated neither should step away from the mechanical lift leaving one staff to operate the mechanical lift. The DON was provided with details of the

observation of CNA A and CNA B transferring Resident #1 via mechanical lift. The DON stated Resident #1 was a heavier lady. She stated CNA B should have never stepped away and stated she did not understand why CNA B was using force. She stated staff should check the mechanical lift prior to transferring a resident to ensure it was working properly. She stated no one had reported having any problems with the mechanical lift. She stated the MS was responsible for ensuring the mechanical lifts were functioning properly. The DON stated based on the description of the observation, the mechanical lift could have tilted sideways causing Resident #1 to fall and possibly being injured. It would have been a fall that could have been avoided. She stated CNA A should have stopped, locked the mechanical lift and asked for help if she was having problems maneuvering the mechanical lift. She stated it was not a safe transfer and one staff should never be left alone while operating the mechanical lift. Observation and interview on 8/20/25 at 4:30 PM revealed the MS, CNA A and the lead CNA standing in the hallway maneuvering the mechanical lift used to transfer Resident #1. The wheels were turning and rolling without any problems. The lead CNA stated she had experienced difficulties maneuvering the mechanical lift transferring a heavier resident. She stated it was difficult to maneuver when a resident was heavier. The MS stated he a local company had recently serviced the mechanical lift and did not find any problems with it. Observation and interview at 4:45 PM on 8/20/25 with the ADM revealed he reviewed the footage of CNA A when she pulled it back stepping out into the hallway. He stated the wheels on the back of the mechanical lift were rolling. He presented the video and the wheels were rolling. Further review of the footage showed CNA A using force and pushing

the mechanical lift sideways when attempting to position the legs under the bed. The ADM stated the resident rooms had limited space. The ADM stated he wanted to ensure the residents were transferred safely and based on the details he learned about Resident #1's transfer, it was not a safe transfer. He stated there should always be 2 staff when providing a transfer using a mechanical lift and the staff should stop and get help if it was not properly working. Review of the mechanical lift User Manual, undated, read in relevant part, 2. Safety Operating the Lift: Although [name of company] recommends two assistants be used for all lift preparation, transferring from and transferring to procedures, our equipment will permit proper operation by one assistant. The use of one assistant is based on the evaluation of the health care professional for each individual case. Review of the facility policy, Routine Procedures, Hydraulic Lift, undated, read in relevant part, It is the policy of the facility to either provide Hydraulic lift transfers when necessary for safety measures. Procedures: Equipment: Hydraulic lift: 2 person at all times.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northeast Rehabilitation and Healthcare Center

603 Corinne St San Antonio, TX 78218

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 interviews and record reviews, the facility failed to maintain medical records in accordance with accepted professional standards and practices for one (Resident #4) out of seven residents reviewed for documentations. The facility failed to document wound care dressing changes on the Treatment Administration Record (TAR) for Resident #4 on 08/15/2025, 08/16/2025, and 08/17/2025. These failures placed residents at risk for missed treatments and care which could result in the wound deterioration, and development of infection.Findings included: Record review of Resident #4's face sheet, dated 08/21/2025, revealed the resident was [AGE] years old male and admitted to the facility on [DATE REDACTED] with diagnoses of surgical after care following surgery, muscle wasting and atrophy (loss of skeletal muscle mass), depression (lowering of a person's mood), old myocardial infarction (blockage of blood flow to the heart muscle), and muscle weakness. Record review of Resident #4's admission MDS assessment, dated 05/05/2025, revealed the resident's BIMS was 11 out of 15, indicated the resident had moderate cognitive impairment and required partial/moderate assistance (helper does less than half the effort) to sit to stand and chair to bed transfer, and supervision or touching assistance (helper provides verbal cues or touching /steadying and /or contact guard assistance as resident completes activity) to toilet transfer. Record review of Resident #4's comprehensive care plan, dated 05/01/2025, revealed [Resident #4] has a stage 3 pressure ulcer to coccyx - buttock area. For interventions - Administered treatment as ordered and monitor for effectiveness. Record review of Resident #4's physician orders, dated 05/01/2025, revealed the resident had the orders of cleans coccyx - buttock area - with normal saline and apply Triad paste and leave open to air, one time a day for wound care. Record review of Resident #4's treatment administration record, from 08/01/2025 to 08/31/2025, revealed there were empty blanks (no nurses' initials) on 08/15/2025, 08/16/2025, and 08/17/2025 for wound care to Resident #4's coccyx - buttock area - once a day. During an

interview on 08/21/2025 at 9:00 a.m. with Resident #4 stated he did not have any pain at this time and received wound cares from nurses. During an interview on 08/19/2025 at 3:59 p.m. with RN-J stated she provided wound care to Resident #4 on 08/15/2025, 08/16/2025, and 08/17/2025 as ordered, but she forgot documenting on Resident #4's treatment administration record because she was very busy at those dates.

Further interview with the RN-J stated she should have documented on Resident #4's treatment administration record after providing wound care on 08/15/2025, 08/16/2025, and 08/17/2025. It was RN-J's mistake, and the resident might have improper wound care due to lack of documentations. During an

interview on 08/19/2025 at 4:00 p.m. with DON stated RN-J should have documented on Resident #4's treatment administration record after she provided wound care to the resident. It was basic nursing responsibility, and if they did not document correctly, it might cause improper wound care to Resident #4 due to lack of communications. Record review of the facility policy, titled Nursing Documentation, date 10/2024, revealed The following items should be noted in the resident chart - medication and/or treatment administration.

Event ID:

Facility ID:

If continuation sheet