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F0908
E

Failure to Maintain Elevators in Safe Operating Condition

San Antonio, Texas Survey Completed on 05-19-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain both of its elevators in safe operating condition, as evidenced by repeated issues with bouncing, slow travel, and unusual noises during operation. Surveyors observed both elevators exhibiting multiple bounces when moving between floors, with elevator #2 displaying more severe and frequent bouncing, as well as creaking, groaning, and popping sounds. No current inspection certificates were posted in either elevator at the time of observation, although records indicated that both had passed their last annual inspection. Review of service records revealed a pattern of recurring problems with the elevators, including multiple service calls for issues such as bouncing, being stuck, and slow operation. The facility's Maintenance Director acknowledged that one of the elevator shocks was not working and that the issue had been ongoing for an unknown period. He also stated that repairs required corporate approval and that documentation of service calls and repairs was lacking, with no invoices or detailed records available for parts ordered or work completed. Interviews with staff confirmed that the elevators had been bouncing for several months and that residents regularly used them. The Maintenance Director and DON both recognized the potential for falls due to the elevator issues, although no injuries had been reported. The facility's elevator maintenance policy did not address the specific issue of car movement or bouncing, only stating that inoperable elevators should be shut down and serviced.

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