The Lev at San Antonio

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a registered nurse was designated to serve as the director of nursing on a full-time basis for 1 of 1 facility reviewed for nursing services. The facility failed to ensure a registered nurse was designated as the DON beginning June 15, 2026. This failure could lead to decreased quality of care for residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents who use psychotropic drugs receive gradual dose reductions in an effort to discontinue these drugs for 2 of 5 residents (Resident #1 and Resident #2) reviewed for psychotropic medications. The facility failed to s show evidence that a GDR had been attempted unless clinically contraindicated for Residents #1's clonazepam [a medication used to treat anxiety] and Resident #2's citalopram [a medication used to treat depression]. These failures could result in unintended effects of medications for residents.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents for 1 of 5 (Resident #4) residents reviewed for resident rights: The facility failed to have Resident #4's call within reach while he was in bed. This failure could affect residents who use their call light or desire to use the call light and place them at risk of not being able to notify staff of their needsThe

Inspectors wroteBased on interview and record review, the facility failed to ensure pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 2 of five residents (Resident #1 and Resident #2) reviewed for pharmacy services. The facility failed to ensure the indication for Resident #1's medication, clonazepam, was ordered for the accurate, intended diagnosis. The facility failed to ensure the indication for Resident #2's medication, finasteride, was ordered for the accurate, intended diagnosis. These failures could lead to improper monitoring of the therapeutic effects of residents' medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to help prevent the development and transmission of communicable diseases and infections for 1 of 5 residents (Resident #6) reviewed for infection prevention. The facility failed to ensure staff utilized proper infection control practices, including PPE, when providing care for Resident #6. This failure could lead to the spread of infection and illness.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all drugs and biologicals for 1 of 4 medication carts (MA Cart 500 Hall) reviewed for storage of drugs. The facility failed to ensure the cart for 500 Hall was locked and secured. This deficient practice could place residents at risk of medication misuse and diversion.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure to maintain all mechanical and electrical equipment in safe operating condition in 1 of 1 kitchen reviewed for equipment. The facility failed to ensure the temperature gauge on the dishwasher was working properly and the sanitation level was reaching between 50 PPM and 100 PPM to properly disinfect the dishware. 2. The DS failed to provide an updated water temperature and sanitation log for the dishwasher for documenting readings to ensure the equipment was working properly. These deficient practices could place residents at risk of not having equipment working in safe conditions.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all drugs and biologicals were stored in accordance with currently accepted professional principles for 2 of 7 medication carts reviewed for storage of drugs and biologicals. - The facility failed to ensure the treatment cart was locked and secured.- The facility failed to ensure the medication cart for the 400 hall was locked and secured. These failures could place residents at risk of medication misuse or drug diversion.

Inspectors wroteBased on observation, interview and record review the facility failed to store, distribute and serve food in accordance with professional standards for food service safety in 1 of 1 Kitchen reviewed for sanitary conditions. Dietary staff failed to ensure:a. the plastic bag of powdered milk was sealed stored in the stand-up refrigerator,b. the cookies they provided for snacks were not expired andc. the temperature logs were posted on the walk-in refrigerator, freezer and stand-up refrigerator and failed to record daily temperatures for all stated appliances. These deficient practices could place all residents at risk for food borne illnesses.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure each resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility and each resident was treated with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality, for 2 of 16 residents (Resident #77 and Resident #32) reviewed for a dignified existence. CNA D, who was bilingual and CNA E, who only spoke Spanish, provided incontinent care for Resident #77 while only speaking Spanish although Resident #77 could not understand Spanish and felt disrespected and demoralized. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to make choices about aspects of his or her life in the facility for 1 of 8 (Resident #4) reviewed for resident rights. Resident #4 was not informed of the care being provided to her regarding a cut on her face received during a surgical procedure. These failures could place residents at risk of not having choices regarding treatment. [...]

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure residents had the right to voice grievances to the facility or other agency or entity that hears grievances without discrimination or reprisal and without fear of discrimination or reprisal. Such grievances include those with respect to care and treatment which had been furnished as well as that which had not been furnished, the behavior of staff and of other residents, and other concerns regarding their LTC facility stay, for 1 of 8 residents (Resident #77) reviewed for making a grievance. Resident #77 made a grievance to CNA D that she no longer wished for CNA E to provide care for her and CNA D did not initiate a grievance report nor did she report Resident #77's grievance to anyone. This failure could place residents at risk for not having their grievances heard and or resolved.

Inspectors wroteBased on interview and record review, the facility failed to coordinate assessments with the pre-admission screening and resident review (PASARR) program for residents with newly evident or possible serious mental disorder for 1 of 8 Residents (Resident #6) whose records were reviewed related to PASARR screenings. The facility failed to refer Resident #6 for Level I screening after being diagnosed with a mental disorder. This failure could place residents with new mental diagnoses at risk for not receiving services as identified by PASARR.

Inspectors wroteBased on interview and record review the facility failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment including both the comprehensive and quarterly review assessments to reflect the current condition for 1 of 6 residents (Resident #25) reviewed for care plan revisions. The facility failed to ensure Resident #25's care plan was comprehensive and reflected uncontrollable nausea and vomiting during the resident's menstrual cycles. This deficient practice could place residents at risk of not receiving appropriate interventions to meet their current needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice and the residents choices for 2 of 13 residents (Resident #4 and Resident #32) reviewed for quality of care. 1. Resident #4 did not receive wound care to a laceration on her face after voicing concerns over lack of wound care and potential scarring. 2. LVN B and LVN H failed to act upon Resident #32's change of condition when she reported her left arm and left leg were going numb and having chest pain. These failures could place residents at risk for not receiving appropriate care and treatment and/or a decline in their health.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each Resident for 1 of 8 residents (Resident # 47) reviewed for pharmacy services. LVN H did not document an SBAR to Resident #47's physician in which Resident #47 had dislodged her intravenous access and had not received her 1 dose of the prescribed antibiotic. LVN H administered Resident #47's physician ordered antibiotic without documenting the physician's order. This failure could place residents at risk for harm due to not receiving pharmacy services as ordered.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure a medication error rate below 5%, for 28 medication administration opportunities with 2 errors resulting in a 7.14% medication error rate, for 1 of 8 residents (Resident #57) reviewed for medication administration errors. Medication Aide J administered to Resident #57 his prescribed:Metoclopramide (a prescription medication used to treat and prevent nausea and vomiting, and to manage certain gastrointestinal issues.)Gabapentin (a prescription medication used to treat nerve pain and epilepsy.)Late by 51 minutes. These failures could place residents at risk for not receiving the therapeutic effects of their medications.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to establish an infection prevention and control program with written standards, policies, and procedures for standard and transmission-based precautions to be followed to prevent spread of infections for 1 of 3 residents (Resident #7 and Resident #28) reviewed for disinfecting the glucometer in between Residents. LVN G did not disinfected the glucometer after assessing Resident #28's blood sugar level and then attempting to assess Resident #7's blood sugar level. This failure could place residents at risk for blood borne pathogens and infections.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to post in a place readily accessible to residents, and family members and legal representatives of residents, the results of the most recent survey of the facility for 1 of 3 years of recertification surveys (2024) for survey results reviewed. The facility posted the results for annual recertification survey for 2023 and omitted the most recent survey results from 2024. This failure could deny residents, Resident representatives, and the public from examining the most recent survey results.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 1 of 1 facility reviewed for safe and clean environment clean medication-cart wheels. The facility failed to maintain the floors free from seeping adhesive glue used to secure the flooring and causing the wheels of the medication carts to become matted with hair and debris. This failure could place residents at risk for dirty floors and wheeled equipment.

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records that were complete and accurately documented in accordance with accepted professional standards and practices for 1 of 5 (Resident #1) residents reviewed for medical records. The facility failed to obtain Resident #1's hospital records and a hospital discharge summary on 7/5/2025 and when the resident returned to the facility and the computerized medical record on 8/13/2025 and 8/14/2025 revealed no evidence of a hospital record or hospital discharge summary from Resident #1's hospital discharge. This failure placed residents at risk for delayed or inaccurate information of hospital history which could result in lack of continuity of care and missed history of treatment.

Inspectors wroteBased on interview and record review the facility failed to document a resident's discharge to ensure that appropriate information is communicated to the receiving health care provider for 1 or 6 residents (resident #1) reviewed for transfer or discharge. The facility failed to ensure that: 1. Resident #1 did have a documented discharge order written by the resident's physician for the resident's discharge from the facility. 2. Resident #1 did have a documented discharge summary written by the resident's physician or nurse for the resident's discharge from the facility. This deficient practice could affect resident's planned discharge destination by contributing to a discharge from the facility that was not properly documented.

Inspectors wroteBased on interview and record review the facility failed to provide notification of a resident's discharge to ensure that appropriate information is communicated to the Office of the State Long-Term Care Ombudsman for 1 or 6 residents (Resident #1) reviewed for transfer or discharge. The facility failed to ensure that: 1. Resident #1's discharge notification was sent to the Office of the State Long-Term Care Ombudsman. This deficient practice could affect resident's safe discharge planning by missed notification to the proper authorities.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice that would meet the resident's physical needs for 2 of 6 (Residents #22 and #5) residents reviewed for quality of care, in that: 1. The facility failed to ensure Resident #22 had a follow-up appointment with a GI doctor within 4-6 weeks from 05/25/24 for a esophageal stent removal, as recommended. Resident #22 did not have an appointment until 10 weeks later where the stent had migrated into the stomach causing an unanticipated need for removal of the stent from the stomach. 2. The facility failed to ensure Resident #5 had a follow-up appointment with a cardiologist in 4 weeks from January 25th. Resident #5 did not see a cardiologist until her 07/17/24 hospitalization for heart health issues. [...]

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, in that: 1. The facility failed to ensure cases of cookies, shortening, and coffee filters were stored off the floor in the dry storage room. 2. The facility failed to ensure disposable condiment cups of salsa and butter were covered in the reach in cooler. 3. The facility failed to ensure a pan of cake, a bag of sliced turkey breast, a container of whipped topping and a bag of boiled eggs were covered/sealed and labeled with a use-by date in the walk-in cooler. 4. The facility failed to ensure two bags of food, contents unknown, were properly sealed and labeled with a use-by date in the walk-in freezer. [...]

Inspectors wroteBased on interviews and record reviews the facility failed to develop policies and procedures to ensure that before offering the influenza immunization, each resident or the resident's representative received education regarding the benefits and potential side effects of the immunization and each resident was offered an influenza immunization during October 1 through March 31 annually, for 3 of 70 residents (Resident #10, #22, and #28) reviewed for the influenza vaccine offered. The facility failed to provide education to Residents #10, #22, and #28 regarding the benefits and potential side effects of the influenza immunization. The facility failed to offer an influenza immunization to Residents #10, #22, and #28, during October 1, 2023, through March 31, 2024. These deficient practices could place residents at risk for harm, by contracting and spreading influenza.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure that the resident's needs and choices for how he spends time outside the facility, were not supported and accommodated, including making transportation arrangements, for 1 of 8 resident (Resident #54) whose care was reviewed, in that: Resident #54's requested help with transportation for a non-medical appointment to explore benefits he may qualify for due to his diagnoses of blindness, including help with medical appointments. This deficient practice could place residents with the ability to make choices at risk of having their rights violated, diminished quality of life and unmet needs.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure residents' rights to voice grievances to the facility or other agencies or entities that heard grievances without discrimination or reprisal and without fear of discrimination or reprisal for 1 of 8 residents (Resident #16) reviewed for grievances: 1. The facility failed to ensure Licensed Vocational Nurse A (LVN A) initiated a grievance report on behalf of Resident #16's grievance on 08/23/2024. 2. The facility failed to ensure Medication Aide O (MA O) and the ADON initiated a grievance report on behalf of Resident #16's grievance on 08/25/2024. This failure could place residents at risk by denying their right to make and have grievances heard and contributed to ill feelings of not being heard and unresolved issues.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents drug regiment was free from unecessary drugs (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 of 14 (Resident #1) residents reviewed for pharmacy services. The facility failed to monitor Resident #1's side effects and behaviors regarding the resident's olanzapine (antipsychotic medication) for schizoaffective disorder, busPIRone (antianxiety medication) for anxiety disorder, and Sertraline (antidepressant) for depression related to schizoaffective disorder from 11/17/2023 to 08/08/2024. This failure placed the residents at risk of side effects and adverse reactions to the medications as ordered by the physician and a delay in treatment and worsening of their condition.

Inspectors wroteBased on interviews and record review, the facility failed to maintain clinical records on each resident that were complete and accurately documented in accordance with accepted professional standards and practices for 1 (Resident #3) of 14 residents reviewed for accuracy and completeness of clinical records. LVN C administered Resident #3's hydrocodone-acetaminophen 5-325 mg one tablet on 5/14/2024, 5/15/2024, 5/17/2024, and 5/23/2024 as ordered and documented the dates on Resident #3's narcotic counting sheet but did not document them on Resident #3's medication administration record. This failure placed facility residents at risk for incorrect medication administrations due to misinformation by incomplete and inaccurate medical record.

Inspectors wroteBased on interview and record review, the facility failed to ensure MDS assessments accurately reflected the resident's status for 1 of 14 Residents (Resident #1) whose MDS records were reviewed for accuracy. Resident #1's quarterly MDS assessment, dated 05/08/2024, reflected Resident #1 did not have physical behavioral symptoms directed toward others such as hitting, kicking, pushing, grabbing, and/or abusing others sexually. However, Resident #1's nursing note, dated on 05/03/24, indicated Resident #1 hit another resident's left arm on hallway 300. This failure could place residents at risk for inadequate care due to inaccurate assessments.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biological were stored in locked compartments for 1 of 1 medication room reviewed for storage, in that: The facility's narcotic box located inside a refrigerator in the only medication room was not permanently affixed compartment when Resident #2's Lorazepam was stored inside the narcotic box on 08/07/2024. This deficient practice could place residents at risk of misappropriation of medications or harm due to accidental ingestion of unprescribed mediations.

Inspectors wroteBased on interview and record review, the facility failed to ensure assessments accurately reflected the resident's status for 1 of 4 Residents (Resident #22) whose MDS records were reviewed for accuracy, in that: Resident #22's Quarterly MDS assessment, dated 1/10/2024, was incorrectly coded that the resident did not have a fall since admission/entry or reentry or the prior assessment, whichever was more recent. This failure could place residents at risk for inadequate care due to inaccurate assessments.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that all allegations involving abuse, neglect, and misappropriation were reported immediately, but no later than 2 hours after the allegation is made to the State Survey Agency for 1 of 4 residents (Resident #2) reviewed for abuse. The facility did not report to the State Survey Agency (HHSC) one incident of abuse following the allegation of CNA A providing Resident #2 with illicit drugs. This failure could place residents at risk for abuse and could lead to a diminished quality of life and psychosocial harm.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide a safe, clean, comfortable and homelike environment reviewed for safe water temperatures and homelike environment, in that; 1. Water temperatures at hand sinks and showers were out of safe parameters (100-110 degrees Fahrenheit) in public restrooms, resident restrooms and shower stalls, and in the communal shower room. 2. Cardboard screwed into air conditioning vent to prevent air flow in room [ROOM NUMBER]. 3. Rooms 409, shower water was 76.5/85.5 Degrees Fahrenheit, room [ROOM NUMBER] shower temperature was 85.5 Degrees Fahrenheit, and the 200 main shower water temperature was 75.7 Degrees Fahrenheit. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to establish and 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 1 of 1 facility, reviewed for infection control in that: 1. The DON exited a designated droplet transmission-based precautions room after doffing her N95 mask in the room. 2. The facility failed to ensure CNA F utilized appropriate infection control practices when entering a designated droplet transmission-based precautions room. 3. MA E did not sanitize bp cuff between residents. 4. CMA L did not have eye protection when entered a COVID positive room. This deficient practice could affect all residents, staff and visitors at risk for infection.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public when water temperatures were below 100 degrees Fahrenheit or above 110 degrees Fahrenheit at hand sinks, shower stalls, communal shower room and public restrooms reviewed for environment: in that: 1. Water temperatures at hand sinks, shower stalls, communal shower room, and public restrooms were outside safe parameters between 100 to 110 degrees Fahrenheit. 2. A brown cardboard could be observed secured with screws into the air conditioning vent in the ceiling over Resident #42's recliner. 3. Resident #6s shower water was cold. [...]

Inspectors wroteBased on observations, interviews and record reviews the facility failed to ensure each resident was treated with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility mustfailed to protect and promote the rights of the resident for 1 of 10 (Resident #57) residents in that: CNA J was standing up while assisting with feeding Resident #57 her meal. This could place residents at risk for diminished quality of life, loss of dignity and self-worth.

Inspectors wroteBased on observation, interview and record review, the facility failed to complete an assessment which accurately reflected the resident's status for 2 of 8 (Resident #21 and #4) residents reviewed, in that: 1. Resident #21's diagnosis of Generalized Anxiety Disorder was not included in the resident's quarterly MDS assessment. 2. Resident #4 did not have his mobiliezed wheelchair with seat belt was not included in his in quaterly MDS assessment. This failure could result in inadequate care due to an incomplete assessment of her psychological condition.

Inspectors wroteBased on interview and record review, the facility failed 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 mental, nursing, and psychosocial needs that were identified in the comprehensive assessment, for 1 of 10 Residents (Resident #123) reviewed for care plans, in that: a. The facility failed to fully develop a comprehensive person-centered care plan that was specific for Resident #123 to address code status information, details of care provided and coordination of services. b. The facility failed to fully develop a comprehensive person-centered care plan that was specific for Resident #123 to address Dialysis Service and Treatment, details of care provided and coordination of services. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming and personal and oral hygiene for 1 of 10 (Resident #4) residents in that: Resident #4 requested his beard be shaved and staff did not respond to him. This could result and could place risk for not receiving necessary care to maintain grooming.

Inspectors wroteBased on interview and record review the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Bbased on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices forresident for 1 of 4 (#123) residents on dDialysis in that: Resident #123 did not have an order for Ddialysis services. This could place residents at risk for not receiving appropriate care and treatment.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to store all drugs and biologicals in locked compartments under proper temperature controls, for 1 of 1 medication room refrigerator and freezer, reviewed for security and medication storage and labeling, in that: Medication room refrigerator and freezer did not have up to date temperature logs. This deficient practice could place residents at risk of adverse effects and ineffective therapeutic effects of their medications that require refrigeration.

Inspectors wroteBased on observations, interviews and record review the facility failed to ensure Food safety requirements. The facility must distribute and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen in that: Administrative Assistance walked into and out of kitchen without a hairnet and delivered 2 ice bags to the freezer approximately 5 feet from the back door. This could place residents at risk for food contamination.

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records that were complete and accurately documented for 1 of 8 (Resident #21) residents reviewed in that: Resident #21's diagnosis of Generalized Anxiety Disorder was not listed on her face sheet. This failure could result in inadequate care due to incomplete and inaccurate medical records.