Remington Transitional Care of San Antonio

Inspectors wroteBased on interview and record review, in accordance with accepted professional standards and practices, the facility failed to maintain medical records on each resident that are complete, accurately documented, readily accessible, and systematically organized for one (1) of five (5) residents (Resident #1) reviewed for clinical records. The facility failed to ensure RN A documented a repeat blood pressure level when the initial level was below the approved range to administer Metoprolol Succinate (a blood pressure medication). This failure could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure the MDS assessment accurately reflected the resident's status for 1 (Resident # 1) of 5 residents reviewed for MDS accuracy. Resident #1's re-entry MDS assessment from the hospital did not reflect the fall which resulted in a fracture and was the reason she went to the hospital. This failure affects residents who reside at the facility and could result in missed care.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for 1 (Resident #2) of 5 residents reviewed for implementation of care plans. Resident #2 did not have a floor mat on each side of his bed as was specified in his comprehensive plan of care for fall prevention. This failure affects residents at high risk for falls and could result in injury or disability.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 1 (Resident #28) out of 8 residents reviewed for environmental concerns. The facility failed on 06/03/2025 when Resident #28's window (1 of 2) would not close all the way in his room remaining open approximately 1-inch, which could have resulted in damage to the interior windowsill according to the Maintenance Director. The facility failed on 06/03/2025 when Resident #28's room refrigerator had not been functioning for an unknown amount of time resulting in Resident #28's RP not being able to bring in outside food for Resident #28. This failure could place residents at risk of a diminished quality of life due to exposure to an environment that was unpleasant, unsanitary, and unsafe.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that its medication error rate was not 5 percent or greater. The facility had a medication error rate of 17.24% based on 5 out of 29 opportunities, which involved 2 of 6 Residents (Resident #161 and Resident #171) reviewed for medication administration, in that: 1. The facility failed on 6/5/25 to ensure RN F observed if Resident #171 took her metoclopramide (used to treat various gastrointestinal conditions), pantoprazole (decreases the amount of acid produced in the stomach), and sucralfate (to treat an active duodenal ulcer. Sucralfate works mainly in the lining of the stomach and is not highly absorbed into the body.) medications. 2. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all drugs and biologicals were labeled and stored in accordance with currently accepted professional principles for 2 of 3 medication cart (200 hall east and west carts) reviewed for labeling and storage of drugs. 1. The facility failed to ensure Resident #31's furosemide package directions matched the physician orders blood pressure parameters on the 200-hall east cart. 2. The facility failed to ensure 200-hall west medication cart was not left unlocked and out of sight from the nurse. 3. The facility failed to provide change direction labels for Resident #161's medication package of allopurinol which had medication order change from 100 mg (1 tablet) to 150 mg (1.5 tablets) on the 200-hall west cart. This deficient practice could place residents at risk of medication misuse and diversion.

Inspectors wroteBased on interviews and record reviews the facility failed to ensure each resident received, and the facility provided food prepared in a form designed to meet resident choices for 2 of 8 residents (Resident #24 and #172) and 1 of 1 kitchen reviewed for dietary needs. The facility failed to ensure there was not a repetitive menu for the residents resulting in complaints about the lack of variety in food options. This deficient practice could place residents at risk for poor food intake, weight loss, and not having their religious nutritional preferences met. Record review of Resident #24's admission record, dated 06/03/25, reflected Resident #24 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses to include constipation. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen. The facility failed to label their food products with their respective discard dates. These failures could place residents at risk for food borne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 2 of 4 staff (RN F and LVN G) and 5 of 8 Residents (Resident #40, Resident #161, Resident #165, Resident #166, and Resident #217) reviewed for infection control: 1. The facility failed to ensure RN F sanitized the blood glucose monitor between use for Resident #166 and Resident #165. 2. The facility failed to ensure RN F did not touch pills with his bare hands and then administer the medication to Resident #40. 3. The facility failed to ensure RN F cleaned an insulin pen's rubber stopper with an alcohol swab prior to insulin administration for Resident #165. 4. [...]

Inspectors wroteBased on interviews and record reviews the facility failed to electronically transmit encoded, accurate, and complete MDS data to the CMS System, within 14 days, upon a resident's transfer, reentry, discharge, and death, for 2 of 2 residents (Resident #22 and #272) reviewed for transmitted MDS data to the CMS System. The facility failed to transmit a discharge MDS assessment to the CMS system for Resident #22 who discharged on 03/01/25 and #272 who discharged on 05/14/25 within 14 days of the discharge date . This failure could place residents at risk of not having assessments completed and submitted in a timely manner as required.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that included measurable objectives and time frames to meet a resident's medical, nursing, mental, and psychosocial needs that were identified in the comprehensive assessment for 2 (Residents #23 and 52) of 8 residents reviewed for care plans. The facility failed to update Resident #23's care plan, undated, included his need for set up and clean-up assistance with eating and Resident #52's care plan, undated, failed to include his ADL self-performance deficit for eating when Resident #52 needed extensive help and needed to be fed. [...]

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality for 3 (Residents #25, #104 and #253) of 24 residents reviewed for baseline care plans. 1. Resident #25's baseline care plan dated 04/04/2024 did not reflect he received antibiotic therapy at dialysis. 2. Resident #104's baseline care plan dated 04/18/2024 did not reflect she received an antipsychotic medication. 3. Resident #253's baseline care plan dated 04/22/2024 did not reflect she was on oxygen therapy. This deficient practice could affect residents admitted to the facility and result in missed or inadequate care.

Inspectors wroteBased on interview and record review, the facility failed to employ staff with the appropriate competencies and skill sets to carry out the functions of the food and nutrition service, taking into consideration resident assessments, individual plans of care, and the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required for one of one facility, in that: The Food Service Supervisor (FSS) did not have the appropriate certification, education, or qualifications to serve as the Director of Food and Nutrition Services. This deficient practice could place the residents who consume food prepared from the kitchen at risk of food borne illness and not receiving adequate nutrition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation. 1. There were two cases of vegetables and one case of beef patties open with their interior bags open in the walk-in freezer. 2. The tabletop can opener blade, bar, and base were covered in sticky black and brown grime. These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure at the time each resident is admitted , the facility must have physician orders for the resident's immediate care for 1 (Resident #253) of 24 residents reviewed for admission physician orders. The facility failed to get oxygen orders from the physician for Resident #253, who was admitted on [DATE], and did not until 04/26/2024. This deficient practice affects residents admitted on oxygen therapy and could result in respiratory distress.

Inspectors wroteBased on interviews, and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objective and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 (Resident #3) of 24 residents reviewed for care plans. Resident #3's anticoagulant therapy was not address in her comprehensive care plan dated 04/24/2024. This deficient practice could affect residents who required specific care, services and interventions and could result in missed care or harm.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the resident's goals, and preferences for 1 (Resident #253) of 4 residents reviewed for oxygen therapy. The facility failed to get oxygen orders from the physician for Resident #3, who was admitted on [DATE] and did not until 04/26/2024. This deficient practice affects residents admitted on oxygen therapy and could result in respiratory distress.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to follow menus for 1 of 1 resident meals (lunch meal on 04/25/2024) reviewed for menus in that: The facility failed to follow the menu for residents on regular and modified diets for the lunch meal on 04/25/2024. This failure could place residents who consume food prepared by the facility kitchen at risk of not having their nutritional needs met and/or weight loss.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 1 of 3 residents (Resident #3) reviewed for infection control, in that: The facility failed to ensure Resident #3 received wound care to the sacrum (triangular shaped area over a bone in the lower back just above the intergluteal cleft) and left arm utilizing appropriate hand hygiene and infection control principles. Treatment Nurse B did not perform both hand hygiene and glove changes and did not sanitize the work surface prior to use. This deficient practice could place residents at risk of infection for transmission of communicable diseases and a decline in health.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 8 residents (Resident #216, #49 and #56) observed for infection control in that: 1. During the medication pass, LVN E did not sanitize the wrist blood pressure cuff used between Resident #216 and Resident #49. 2. LVN Treatment Nurse F placed several gloves in his pant pocket and used them during wound care for Resident #56. These deficient practices could place residents at risk of infection.

Inspectors wroteBased on observation, interview and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biological's) to meet the needs of each resident, for 3 of 8 Residents (Resident #58, #49 and #113) reviewed for medication administration in that: 1. LVN D administered Humalog (insulin) to Resident #58 without priming the insulin pen (removing air bubbles from the needle) prior to administering. 2. a. LVN E dropped 1 medication prescribed to Resident #49 on the medication cart counter and dispensed it to the resident. b. LVN E dropped 2 medications prescribed to Resident #113 on the medication cart counter and dispensed them to the resident. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 2 ice makers reviewed for food handling sanitation. 1. The facility failed to ensure the nutritional room ice machine was clean. These failures could place residents at risk for cross-contamination and foodborne illnesses.

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records on each resident that are complete, accurately documented, readily accessible and systematically organized for 1 of 15 residents (Resident #4) reviewed for accuracy of medical records in that: 1. Resident #4 did not have a physician's order for code status (the type of emergent treatment a person would or would not receive if their heart or breathing were to stop). This deficient practice could affect residents whose records were maintained by the facility and place them at risk for errors in care and treatment.