San Antonio West Nursing And Rehabilitation

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

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

resident stated he was not happy with the ceiling light being turned on at night when the nursing staff wanted to provide care or services to Resident#1. Resident #2 stated he complained to the Administrator, and nothing had been done to fix Resident #1's non-working bedside light fixture. Resident #2 stated the turning of the ceiling light on and off at night disturbed his sleep. During an interview on 8/15/25 at 4:34 PM,

the DON stated: she observed today 8/15/25 at 2:50 PM that Resident #1's bed light fixture had no light bulbs and did not operate, and the blind was broken. The DON stated she was not aware of the latter environmental issues in Resident #1's room. The DON stated that by nursing practice the operation of the bed overhead light was important for the provision of nursing care and services. The DON stated the turning on of the ceiling light could interfere with the sleeping habit of the roommate [Resident #2]. The DON stated she was not aware of the roommate complaining. The DON stated by nursing practice the window blinds needed not to be broken to improve on a resident's quality of life. During an interview on 8/18/25 at 9:38 AM, the Administrator stated the facility hired a new maintenance director a month ago [July 2025] who had been attempting address the back log of work orders. The administrator stated she prioritized plumbing issues, and the work order for Resident #1 had not been addressed. [at time of the abbreviated survey the Maintenance Director was not available for an interview, nor the old maintenance director was available for a telephone interview] Record review of facility's Work Order log dated 6/17/25 reflected work a work order to replace/fix Resident #1's window blind and another work order dated 6/17/25 to fix LIGHT NOT WORKING.Record review of facility's Resident Rights policy dated 2018 read: .Employees shall treat all residents with kindness, respect, and dignity. Thes rights include the resident's right to.a dignified existence. Record review of the facility's Safe and Homelike Environment, dated 2025, read: .In accordance with resident's rights, the facility will provide a safe, clean, comfortable and homelike environment.

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

San Antonio West Nursing and Rehabilitation

636 Cupples Rd San Antonio, TX 78237

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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

served cold eggs and sausages for breakfast on 8/15/25 because of the risk of bacteria build up and food borne illnesses to residents. The DON stated as the IP that she preferred not to answer the question why

she did not advise the facility not to serve cold foods to the residents from 8/12/25 to 8/15/25. The DON stated that no resident suffered food borne illnesses from the cold food. During telephone interview on 8/15/25 at 11:10 AM, the Dietician stated she last visited the facility on Wednesday (8/13/25) and became aware of the non-working steam table. The Dietician stated cold food should not be served to residents because of the danger of food borne illnesses. The Dietician stated she took the temperature of the lunch meal on 8/13/25 and the temperatures met regulation. The Dietician stated she recommended to the facility to place boiling water in the non-working steam table and hold hot foods on the stove or oven until the meal was to be served from the steam table. The Dietician stated the facility did not inform her that the food was cold on Thursday (8/14/25) and the Friday (8/15/25) breakfast meals. The Dietician stated on 8/15/25 [arrival of surveyor] she again became aware of the issue of cold foods and made the recommendations to serve a cold lunch and buy roasters or thermal plates until the steam table was delivered. The Dietician stated catering was her last option. Record review of facility's Temperature Log dated 8/15/25 reflected that

the food cooked met the minimum temperature of 165F before placed on the non-working steam table.

Record review of the facility's 14-day menu for Week 3 reflected the breakfast menu for 8/15/25 included: eggs. cheese taco, and sausage. Record review of facility's list dated 8/15/25 of residents on tube feeding reflected that 3 residents did not eat from the kitchen. Record review of facility's 24 report dated 8/15/25 reflected no residents with food borne illnesses. Record review of facility's Food Preparation and Service dated 2001 read, .The ‘danger zone' for food temperature is between 41 ‘F' and 135 ‘F'. This temperature range promotes the rapid growth of pathogenic microorganisms that cause foodborne illnesses.

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

San Antonio West Nursing and Rehabilitation

636 Cupples Rd San Antonio, TX 78237

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

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

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Based on observation, interview, and record review, the facility failed to store, prepare, and distribute and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen observed for food service safety. The food temperature logs were incomplete. This failure could place residents who ate meals from the kitchen at risk for spread of infections, food contamination, and food borne illness. The findings included: Record review of facility's July Food Temperature log dated July 2025 reflected the lunch meal's temperatures not documented from 7/9/25 to 7/21/25 and 7/23/25 to 7/31/25. Further record review reflected the breakfast meal from 7/24/25 to 7/31/25 and the dinner meal from 7/30/25 to 7/31/25 were not documented. During an interview on 8/15/25 at 8:25 AM, The FSS stated that the July Food Temperature Log for the lunch meal from 7/9/25 to 7/21/25 and 7/23/25 to 7/31/25 were not documented. The FSS stated that the breakfast meal from 7/24/25 to 7/31/25 and the dinner meal from 7/30/25 to 7/31/25 were not documented. The FSS did not have an explanation for the lack of documentation involving food temperatures on the latter dates. During telephone interview on 8/15/25 at 11:10 AM, the Dietician stated that she was aware of the lack of documentation on the July 2025 Food Temperature log. The Dietician stated she verbally counseled the kitchen staff on documentation and provided an in-service on documentation of the food temperature logs. The Dietician stated her negative findings for the July 2025 documentation was written in the Sanitation Report given to the facility on 8/13/25 with a rating of unsatisfactory. Record review of facility's Quality Assurance Evaluation-Dining report dated 8/6/25 authored by the Dietician reflected a rating of unsatisfactory for incomplete food temperature logs. Record review of facility's Food Preparation and Service dated 2001 read, .The ‘danger zone' for food temperature is between 41 ‘F' and 135 ‘F'. This temperature range promotes the rapid growth of pathogenic microorganisms that cause foodborne illnesses. Record review of facility's dietary polices did not reveal a policy on documenting food temperatures on a daily base per meals prepared. [Surveyor on 8/15/25 at 8:00 AM requested from the Administrator a policy on documenting food temperatures. At exit on 8/18/25 at 3:00 PM, the Administrator had not provided the surveyor with a policy on documenting food temperatures.]

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

San Antonio West Nursing and Rehabilitation

636 Cupples Rd San Antonio, TX 78237

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)

Federal health inspectors cited RETAMA MANOR NURSING CENTER/SAN ANTONIO WEST in SAN ANTONIO, TX for a deficiency under regulatory tag F-F0908 during a complaint investigation conducted on 2025-08-18.

Category: Environmental Deficiencies

The facility was found deficient in the following area: Keep all essential equipment working safely.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 4 deficiencies cited during this inspection of RETAMA MANOR NURSING CENTER/SAN ANTONIO WEST.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-08-19.