Northgate Health And Rehabilitation Center

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

revealed he had originally spoken with the rounding physician regarding Resident #6's need for a larger Bariatric bed and trapeze on 08/29/2025 and the physician had agreed with the recommendations and approved the orders along with the implementation of the equipment as soon as possible. He stated he had tried to follow up numerous times with the Administrator, DON and Corporate RVP to see if the order for the equipment had been placed but was unable to get either a purchase order or confirmation of purchase from any of these staff members. An interview with the DON on 11/20/2025 at 10:39AM revealed she had a copy of an order for the larger Bariatric bed and trapeze from the rounding physician bearing today's date. She stated she was unable to say why the bed and trapeze had not been purchased in August when the therapist and rounding physician had originally given the order due to Resident #6's medical necessity, other than the equipment was not available for purchase. The DON was unable to produce a purchase order for the equipment and stated today was the first time she had been notified of Resident #6's need for

the equipment. An interview with the DON on 11/20/2025 at 2:22PM revealed a purchase order for the equipment was placed on 11/14/2025 but review of the purchase order did not confirm the equipment had actually been ordered or paid for by the facility. The purchase order showed the equipment in the cart of the Administrator, but there was no indication of a credit card being utilized for the purchase. Review of facility policy entitled Resident Rights dated October 2024 revealed the following:You have a right to request reasonable accommodation, which is a change in policy or practice, communication, or the physical space needed for a person to have equal opportunity to use their home. Examples include requests to add a ramp to a building, adaptive equipment needed to maintain activities of daily living, allowing you to use a service animal, and making information about your care easy to understand.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northgate Health and Rehabilitation Center

5757 N Knoll San Antonio, TX 78240

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

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

F 0563 Level of Harm - Minimal harm or potential for actual harm

members are designated by the resident or resident representative. Immediate family is not limited to individuals related by blood, adoption, marriage or common law.4. Visitors may include, but are not limited to:a. spouses (including same-sex and transgender spouses).b. domestic partners (including same-sex and transgender domestic partners). c. other family members; andd. friends.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northgate Health and Rehabilitation Center

5757 N Knoll San Antonio, TX 78240

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

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

F 0576 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

using the phone. She was shown the phone with the wiring not plugged into a power source and the cords pushed into a hole behind the phone and stated the maintenance man would have to look at it. The maintenance man approached during the conversation and stated the phone had not worked for an undetermined period of time and he would inquire about getting a new phone for the hallway. He stated the residents could have walked to the 100/200 hall and used their cordless phone but was unable to say how

the bed bound residents were to access a phone if they did not possess a personal cell phone.An interview with the DON and Administrator on 11/21/2025 at 10:15AM revealed the DON thought the door alarm for

the front door was attached to the fire system, so the facility could not have a push button that could be used by families to enter through the front door at their leisure. She stated discussion had taken place regarding an on-call phone number being posted outside the front door for families to call to request entrance to the facility but had not been put into place by the leadership team. The Admn. stated the leadership team had discussed a schedule for the team to cover phone/door duty but the schedule had not been put into practice. She was unable to answer what families were to do when leadership team members were not in the building, particularly after regular business hours, but thought a solution might be to give one of the charge nurses a cordless phone so they could answer the phone or door if needed. Review of facility policy entitled Resident Rights dated February 2021 revealed the following: Policy Statement:Employees shall treat all residents with kindness, respect, and dignity.Policy Interpretation and Implementation1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the residents' right to:f. communication with and access to people and services both inside and outside the facility;aa. visit and be visited by others from outside the facility;bb. be informed of safety or clinical restrictions or limitations of visitation;cc. access to a telephone, mail and email;dd. communicate in person and by mail, email and telephone with privacy.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northgate Health and Rehabilitation Center

5757 N Knoll San Antonio, TX 78240

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

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

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

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

ability to smoke or chew tobacco safely will be re-evaluated quarterly, upon a significant change (physical or cognitive) and as determined by staff.9. Any smoking-related and smokeless tobacco use privileges, restrictions, and concerns shall be noted in the care plan and all personnel caring for the resident shall be alerted to these issues.10. Residents are not permitted to give smoking articles to other residents.11.

Residents may not keep or have any smoking articles, including cigarettes, tobacco, lighters, etc., except when they are under direct supervision.12. This facility maintains the right to confiscate smoking articles found in violation of our smoking policies.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northgate Health and Rehabilitation Center

5757 N Knoll San Antonio, TX 78240

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

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

F 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

shape. The facility gets paid to house, feed us and take care of our needs, but out of greed, the facility is trying to cut corners.Photo #5 showed the dinner tray ticket from 11/04/2025 which indicated Resident #6 should have received 3 ounces of glazed meatloaf, 4 ounces of roasted red potatoes, 4 ounces of green beans, a roll, margarine, a 4-ounce gelatin parfait and an 8-ounce beverage of choice. Again, Double Protein and Vegetables is circled on the ticket.The accompanying photo of the dinner plate Resident #6 received (photo #6) depicted 2 slices of meatloaf, 2 scoops of mashed potatoes with gravy and a serving of what appeared to be cooked red cabbage. Resident #6 also received vanilla pudding and iced tea. There were no red potatoes, green beans, roll or parfait on Resident #6's tray.An interview with the Dietary [NAME] on 11/20/2025 at 9:45AM revealed he did not think that French fries or mashed potatoes qualified as a vegetable. He stated both are starches. He also stated residents could receive fried eggs, if requested.An interview with the Administrator and DON on 11/20/2025 at 9:52AM revealed the Administrator and DON did not think French fries or mashed potatoes were considered vegetables. The Administrator stated residents could have eggs prepared however they pleased, but there were no fresh eggs in the kitchen, due to the new management company did not allow fresh eggs to be served. The Administrator stated she would have to contact the corporate office to get a list of vegetables that could be served.Record review of the facility's Dining Master list of foods did not indicate what foods were considered to be vegetables, rather it showed serving sizes for various vegetables.Observation of the kitchen and the refrigerators on 11/21/2025 at 9:30AM reflected the following:7 heads of Romaine lettuce1 partial 10-pound box of fresh onions, and1 partial 10-pound box of fresh tomatoesObservation of the freezer reflected the following:(2) 2-pound bags of frozen green beans1 partial 20-pound box of frozen cut carrots, and1 partial 20-pound box of frozen Capri blend vegetables.There were no fresh fruit or eggs.An

interview with the Dietary Manager on 11/21/2025 at 9:42AM revealed the new management company had cut her food budget and she did not have enough money to purchase fresh items for the residents. She stated 6 heads of lettuce from their distributer cost $30 and she used to get an entire case of lettuce for that price. She stated she had spoken with the management team regarding the issue, but they were not concerned about the residents receiving fresh food. She stated, If my residents want something I should be able to give it to them. It breaks my heart to not be able to give them what they want. She stated she used to be able to offer a hamburger/cheeseburger plate and/or a chef salad as an alternative choice but had been told both were too expensive and would not be provided. She also stated there often was not enough food to provide what would be considered to be a double portion of food, as she was only allowed to cook for the number of residents in the building. She stated this number did not consider second helpings or double portions. If the recipe stated it was 50 servings, that was all she was allowed to prepare.Review of facility policy Therapeutic Diets dated 04/2021 reflected the following:Policy Statement:Therapeutic diets are an integral part of resident well-being and nutrition and shall be served accordingly.Policy Interpretation and Implementation: The Physician shall give an order for all therapeutic diets served to residents.

Physician orders shall be followed without exception.a. Substitutions can be made for resident allergies and preference according to the physician's order and review from the registered dietician. The facility will provide all necessary food to fulfill the physician's order, including protein shakes and fortified foodsThe registered dietician could not be reached for comment.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northgate Health and Rehabilitation Center

5757 N Knoll San Antonio, TX 78240

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

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

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

#4's Physician Orders reflected no physician's order for admission/annual TB screening. Resident #4 was admitted to the facility on [DATE REDACTED] and the orders reflected there was no TB screening done prior to or at admission, nor was there evidence of a screening being performed within the last year.Record review of Resident #6's Physician Orders reflected a physician's order for annual TB screening. Resident #6 was admitted to the facility on [DATE REDACTED] and progress notes from the date of admission reflected Resident #6 tested negative for TB at admission, but he had not been screened for TB annually.Facility policy for Infection Control related to showers dated 03/2024 revealed the following:Use Standard Precautions for the care of all residents when contact with blood or body fluids are likely. Standard Precautions should be used

during every interaction with a resident regardless of suspected or confirmed infection status.Standard Precautions include:Hand hygieneUse of Personal Protective Equipment, (PPE)Respiratory hygiene/cough etiquetteWaste disposalCleaning and DisinfectingStandard Precautions for:BloodBody fluids, secretions, and excretions (except sweat)Mucous membrane and non-intact skin (of resident or nurse aide)Contaminated items: Linen and equipment soiled with blood or body fluids should be handled carefully and discarded in biohazard bags that are puncture-resistant, leak-proof, and labeled with a biohazard symbol or red in color. Such items may also include used PPE and disposable rags and cloths.

Contaminated environmental surfaces should be cleaned and disinfected following facility policy. Disposal of biohazardous waste should be done following facility policy for proper handling, labeling and disposal of items contaminated with blood or body fluids.Contact Precautions: Use Contact Precautions as ordered (in addition to Standard Precautions) to control infections spread by direct or indirect contact with certain pathogens and parasites such as MRSA, head lice, scabies, and C-Diff.Wash hands and put on glove

before entering the isolation room. Wear a gown if your skin or clothing will have substantial contact with the resident or the environment.Remove and discard gloves and gown and wash hands (usually with antimicrobial soap) before leaving the shower room.Facility policy for Screening Residents for Tuberculosis dated August 2019 reflected the following: Policy Statement:This facility shall screen all residents for tuberculosis infection and disease (TB). Individuals identified with active TB disease shall be isolated from other residents and ancillary staff and transported to an appropriate care facility as soon as possible.Policy Interpretation and Implementation:1. The admitting nurse will screen referrals for admission and readmission for information regarding exposure to or symptoms of TB.2. Signs and symptoms of TB include:a. Coughing for > 3 weeks;b. Loss of appetite;c. Fatigue;d. Weight loss;e. Night sweats;f. Bloody sputum or hemoptysis;g. Hoarseness;h. Fever; and/[NAME]. Chest pain.3. Individuals with signs and symptoms of active TB disease shall be isolated from other residents and ancillary staff and transported to

an appropriate care facility as soon as possible.4. Screening of new admissions or readmissions for TB infection and disease is in compliance with state regulations.

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Facility ID:

If continuation sheet