Inspection·July 17, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An observation on 07/17/24 at 09:46 AM, during an initial walkthrough of the facility, Resident #1's door was observed 100% of the way opened; CNA B was observed performing incontinent care on Resident #1. The privacy curtain for Resident #1 was not drawn and was pulled behind Resident #1's bed making Resident #1's incontinent care completely visible from the hallway. An interview on 07/17/24 at 09:50 AM, CNA B stated the process she is supposed to take when performing incontinent care on a resident is to ensure the door is closed or the privacy curtain is pulled to offer the resident privacy. CNA B stated she saw Resident #1's roommate leave the room which is why the door was left opened. CNA B stated she did not have a reason as to why the curtain was not pulled to offer Resident #1 privacy and said that it should have been pulled closed before starting incontinent care. CNA B said that a negative outcome to failing to close the curtain or door is another resident could walk past Resident #1's room and see the resident exposed. An attempt was also made during this time to interview Resident #1; however, Resident #1 was not interviewable as she was unable to communicate due to her conditions. An interview on 07/17/24 at 10:32 AM, CNA C was asked about the process CNAs are to take when performing incontinent care. CNA C stated that when performing incontinent care, she would close the door and privacy curtain in order to provide privacy to the resident she was caring for. CNA C said failing to close the door and/ or curtain during incontinent care could cause the resident being cared for to feel embarrassed or agitated if they were not provided privacy. CNA C stated not providing privacy to a resident is a dignity issue. An interview on 07/17/24 at 01:53 PM, the DON stated it was her expectation that all residents who required incontinent care receive privacy and care staff were expected to close the door or privacy curtain. The DON said that residents would be uncomfortable if they did not get the privacy they needed. An interview on 07/17/24 at 02:10 PM, the RCN stated it was her expectation that all residents were provided privacy at all times and during incontinent care by having the door to the resident room or curtain to the resident bed closed. The RCN stated that failure to provide that privacy would result in the resident being exposed. The RCN was interviewed in place of the facility administrator who was out of the building on vacation and unavailable at the time of the investigation. Record review of the facility Nursing Facility Residents Rights last revised November 2021 revealed: Dignity and Respect; you have the right to be treated with dignity, courtesy, consideration, and respect. Record review of the facility Perineal Care policy implemented on 10/24/22 revealed: Policy Explanation and Compliance Guidelines: Provide privacy by pulling privacy curtain or closing room door if private room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455599 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Rehabilitation and Skilled Nursing C 2806 Real St Austin, TX 78722 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure all drugs were stored in locked compartments with access by authorized personnel only for 1 of 3 medication carts (300 hall cart) reviewed for storage of drugs and biologicals. RN A failed to secure the 300 hall medication cart leaving it unlocked and unsupervised. This failure could result in staff, visitors, or residents accessing medications not prescribed to them. Findings included: An observation on 07/17/24 at 10:06 AM, a medication cart was observed halfway down the 300-hall unsupervised and unlocked with 3 compartments that were able to be opened and accessed. An interview and observation on 07/17/24 at 10:10 AM, RN A stated that all medication carts are to be locked and secured before leaving them unattended. RN A stated the medication cart that was unlocked was her assigned cart at the time and she had stepped away to attend to a residents' needs away from the 300 hall completely. RN A said that she was supposed to lock the cart and take the keys with her to ensure nobody could access the unattended medications, she stated she believed she locked it before she left but thinks she may have not pressed the lock hard enough. RN A said that a negative outcome that could have happened from leaving the medication cart unlocked and unattended is a resident could get a hold of something they are not supposed to have. An observation was made of the cart with RN A at the time of the interview and the 3 drawers unlocked were assessed; drawer 1 contained residents routine medications (non-narcotics), drawer 2 contained respiratory treatments, and the 3rd drawer contained cleaning and sanitation items. RN A stated narcotics were kept in a separate locked drawer which was secured. No residents were observed near the medication cart at the time of this incident. An interview on 07/17/24 at 10:40 AM, MA D said when asked about the process taken when leaving a medication cart unattended she stated that anytime staff assigned to a medication cart are stepping away they were supposed to close the screen on the cart to secure resident information, ensure the cart is locked by pressing the lock on the cart until it clicks, and take the keys with them. CNA C said that a negative outcome of leaving a medication cart unlocked and unattended would be that medication could get stolen. An interview on 07/17/24 at 01:53 PM, the DON stated it was her expectation that all medication carts were locked and secured when not in use. The DON said that a negative outcome to carts being unlocked when unattended is someone can open the cart and get the medication. The DON stated she spoke with RN A about the incident, and she was in-serviced on the proper procedure. An interview on 07/17/24 at 02:10 PM, the RCN stated it was her expectation that all medication carts are locked for safety reasons when left unattended. The RCN stated she was made aware of the incident and completed an immediate in-service with RN A on the proper procedure. The RCN stated that a negative outcome to leaving medication carts unlocked when not in use is the potential for residents to access medication that is not theirs. The RCN was interviewed in place of the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455599 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Rehabilitation and Skilled Nursing C 2806 Real St Austin, TX 78722 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 administrator who was out of the building on vacation and unavailable at the time of the investigation. Level of Harm - Minimal harm or potential for actual harm Record review of the facility policy titled Medication Administration- Medication Carts and Supplies for Administering Meds last revised 10/01/19 revealed: Residents Affected - Few Procedure: The medication cart is locked at all times when not in use. Do not leave the medication cart unlocked or unattended in the resident care areas. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455599 If continuation sheet Page 4 of 4