San Antonio West Nursing And Rehabilitation
Inspection Findings
F-Tag F0805
F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
regarding dietary orders. The family would bring regular textured candy and muffins to Resident #1, and the HN had given bolus feeding orders, so it was a battle to keep the feeding orders straight and keep everyone safe and happy.A phone interview with Resident #1's RR on 10/01/2025 at 2:40PM reflected the overall care of Resident #1 had been fair at the facility. She stated Resident #1 had not been eating solid foods for some time due to not wearing her dentures any longer. She stated the dining staff were forgetful and didn't follow the tray slips at every meal. The RR stated Resident #1 had never been denied food, but the staff seemed to forget she had a swallowing problem and would cough and vomit when fed solid foods. She stated staff did not help Resident #1 eat even though she could not sit upright on her own and was probably too weak to hold a utensil. The RR stated Resident #1 used to throw up a lot, so a swallow study was performed, and her diet was changed to pureed texture. The RR stated Resident #1 probably could have eaten the scrambled eggs with her hands this morning and would have been fine, but she had to have supervision at all times while eating.An interview with RN A on 10/01/2025 at 4:00PM reflected Resident #1 did not wear her dentures any longer and she should not have received any regular textured foods. He stated he was unaware of pleasure trays for Resident #1 and stated she could have eaten some finger foods on her own but needed assistance with any utensils due to being so weak and unable to sit upright
on her own. An interview with LVN C on 10/01/2025 at 4:14PM reflected Resident #1 should not have received any regular textured foods due to her bolus feedings, twice per day. She stated Resident #1 could not feed herself due to weakness and decline in health. LVN C stated Resident #1 received hospice services and should receive only bolus feedings, according to the hospice orders.An interview with the Administrator on 10/01/2025 at 4:20PM revealed the facility had no policy regarding therapeutic diets. She stated she was unaware Resident #1 was receiving a pleasure tray at every meal. Record review of facility policy entitled Serving a Meal dated 05/15/2025 reflected the following:Diets should be served in accordance with physician orders. Residents should be encouraged to eat in the dining room, however, requests to remain in the room should be honored. Prepare the room or serving area for mealtimes (decreased noise levels, adequate lighting, position comfortably) and make sure hands and face are clean.
Place the tray on the dining table or overbed table if the resident eats in their room. Remove dome lid from
the tray and check to be sure everything is included on the meal tray that is required by the diet card, and
the resident's preference. Arrange the dishes and silverware so the resident can reach them easily. It is often helpful to place a clean towel on the overbed tray prior to placing food, to prevent slippage of dishes and silverware. Open all cartons and give the napkin to the resident. Use clothing protectors as needed. Cut up meats and assist the resident as needed. Use adaptive utensils, when appropriate. Ensure the resident has everything they need before leaving the room. Check on the resident at regular intervals. Provide privacy by pulling the cubicle curtain, if desired by the resident. Place call light within reach if you are leaving the room. Residents are encouraged to feed themselves to the extent possible, and to consume all foods. Alternative foods, readily available foods, or supplements should be offered in accordance with diet restrictions, when a resident consumes less than half of the meal. Provide adequate time for resident to consume the meal and offer to reheat foods as needed. Use thickened liquids as provided by the dietary department.
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If continuation sheet
San Antonio West Nursing and Rehabilitation in San Antonio, TX inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 San Antonio West Nursing and Rehabilitation or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.