The Heights of Alamo

Inspectors wroteBased on observation, 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 included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial need that were identified in the comprehensive assessment for 1 of 3 residents (Resident #1) reviewed for comprehensive person-centered care plans. The facility failed to develop an individualized comprehensive person-centered care plan for Resident #1 by including a bedtime snack when he was NPO. This deficient practice could place residents at risk of not being provided with the necessary care or services and not having personalized plans developed to address their specific needs.

Inspectors wroteBased on interviews and record reviews, the facility failed to maintain medical records in accordance with accepted professional standards and practices that were complete and accurately documented for 1 of 3 residents (Resident #2) reviewed for accuracy of records. The facility failed to ensure LVN C signed off Bisacodyl 10 mg PRN via rectal 1 dose on 10/03/25 after it was administered to Resident #2. This failure could place residents at risk of not receiving appropriate care through inadequate documentation resulting in deterioration in condition, exacerbation of disease process, overmedication, and increased risk of harm or injury.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure residents have the right to request, refuse, and or discontinue treatment and to formulate an advance directive for 1 (R#82) of 6 residents whose records were reviewed for OOH-DNR Order forms: The facility failed to have Resident #82's Out-of-Hospital Do Not Resuscitate (OOH DNR) on admission or in a timely manner. This failure could place residents at risk for not having their end of life wishes honored.

Inspectors wroteBased on interviews and record review, the facility failed to ensure the assessment accurately reflected the resident's status for 1 (Resident #45) of 8 residents reviewed for accuracy of assessments. The facility failed to ensure Resident #45 was coded in the MDS for Dialysis. This failure could place residents at risk for receiving inadequate care and services based on an inaccurate assessment.

Inspectors wroteBased on interview, and record review, the facility failed to ensure that the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment, for 1 resident (Resident #9) of 24 residents whose care plans were reviewed. 1) The facility failed to ensure Resident #9's comprehensive care plan was updated after the code status was changed from full code to DNR on 05/21/25. This deficient practice could place residents in the facility at risk of not being provided with the necessary care or services and the implementation of personalized plan of care developed to address their specific needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and restore continence to the extent possible for 1 of 1 resident (Resident#49) reviewed for indwelling catheters. The facility failed to prevent Resident#49's urinary catheter bag/tubing from touching the floor. This failure could place residents at risk of cross contamination and urinary tract infections.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents who needed respiratory care were provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences for 2 of 6 (Resident #68, Resident #67) residents reviewed for respiratory care. 1. The facility failed to ensure Resident #68's oxygen was administered at the correct setting of 2 liters per minute on 06/03/2025 as ordered by the physician. 2. The facility failed to ensure Resident #67's oxygen was administered at the correct setting of 2 liters per minute on 06/03/2025 as ordered by the physician. These deficient practices could place residents who receive respiratory care at an increased risk of developing respiratory complications and a decreased quality of care.

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 sanitation in that: The facility failed to ensure that 1 of 2 juice nozzles was clean. This failure could place residents at risk of foodborne illnesses.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program, including hand hygiene, designed to provide a safe, sanitary, and comfortable environment, and to help prevent the development and transmission of communicable diseases and infections for 2 (Resident #19, Resident #69) of 8 residents reviewed for infection control practices, in that: 1) The facility failed to ensure the WCN performed hand hygiene for at least 20 seconds prior to and after performing Resident #19's wound care. 2) The facility failed to ensure the CNA A performed hand hygiene for at least 20 seconds prior to and after assisting the WCN with Resident #19's wound care. 3) The facility failed to ensure LVN K followed enhanced barrier precautions while providing gastrostomy site care for Resident #69. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the resident environment remained as free of accident hazards as possible and each resident received adequate supervision to prevent accidents for 1 of 4 residents (Resident #3) reviewed for accidents and supervision, in that: The facility failed to ensure Resident #3 received adequate supervision to prevent him from falling off the bed fracturing his right distal femur on 07/30/2024. This deficient practice placed all resident as risk of injuries, such as falls, fractures, and death due to improper supervision.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents had the right to be free of misappropriation of property and exploitation for 2 of 2 residents (Resident #1 and Resident #2) reviewed for misappropriation and exploitation, in that: 1. The facility failed to ensure the BOM asked Resident #1 and Resident #2 RP's for permission to use their spending account card. 2. The facility failed to ensure the BOM gave the AD permission to use Resident #1 and Resident #2's spending account card for other residents. 3. The facility failed to ensure the AD did not use Resident #1 and Resident #2's spending account card for unauthorized transactions on 4 occasions. As a result, Resident #1 lost $318.64, and Resident #2 lost $313.72 from their spending account card. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury to the State Survey Agency for 1 of 2 Residents (Resident #2) who were reviewed for misappropriation of property, in that: The facility failed to report when the AD used Resident #2's Spending Account Card without her permission to purchase food items for Resident #2 and other residents. [...]