Health inspection·August 8, 2025

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some reflected a [AGE] year-old female originally admitted to the facility 11/12/19, and readmitted [DATE]. Her diagnoses included other frontotemporal neurocognitive disorder (a group of conditions that weaken a person's mental functions), dementia, unsteadiness on feet, and other lack of coordination. Review of Resident #2's quarterly MDS, dated [DATE], reflected the resident was not able to participate in a BIMS process. Staff assessed the resident with impaired short- and long-term memory impairment. The MDS reflected Resident #2 required substantial/maximal assistance for toilet hygiene. The MDS reflected Resident #2 was frequently incontinent of bladder and bowel. Review of Resident #2's comprehensive care plan, revised 1/29/25, reflected in part, Focus - Resident has an ADL self-care performance deficit r/t dementia. Goal - Resident will maintain current level of function. Interventions/Tasks - Toilet Use - Resident is total dependent for toilet use/incontinent care. An observation on 08/07/25 at 10:22 AM revealed CNA B as she prepared to perform incontinent care for Resident #2. Resident #2 was lying supine (on her back) in bed. CNA B explained her intention to perform incontinent care, but the resident did not verbalize a response. CNA B went into the bathroom, and washed her hands, then came out and donned clean gloves. CNA B tucked the front of the soiled brief between the resident's legs. CNA B performed incontinent care using one cleaning wipe for one swipe, front to back. CNA B assisted Resident #2 to turn to her left side, where the resident's buttocks were now exposed. CNA B removed her soiled gloves, and without hand hygiene, put on clean gloves. CNA B used three more clean wipes, each for one swipe, swiping from back to front. CNA B positioned a clean brief under the resident. CNA B removed her soiled gloves and without hand hygiene, donned clean gloves. She placed the soiled brief in the trash then assisted the resident to position and finished applying the clean brief. She positioned the resident and lowered the bed. CNA B, without hand hygiene, changed her gloves and gathered the trash. She removed her gloves then went to the bathroom and washed her hands. During an interview on 08/07/25 at 10:32 AM, CNA B stated she was recently in-serviced on infection control. She stated she learned about wearing the right PPE when providing care. She stated she was trained to wash her hands at before providing care and when she finished care. She stated she usually used sanitizer on her hands every time she changed gloves, but she had forgotten to take her bottle of sanitizer into the room today. CNA B stated not performing proper hand hygiene or not wearing proper PPE could cause you to get or spread infection. During an interview on 08/07/25 at 10:35 AM, policies for incontinent care, hand hygiene, and the use of gloves were requested from the DON. The DON stated he would look for the policies. During an interview on 08/07/25 at 11:08 AM, the ADM provided a policy for perineal care. He stated the policy said to wash hands after removing gloves before putting on new gloves. He also said the policy reflected the correct procedure was to wipe from front to back. He stated they had already started to in-service the staff. 3. Review of Resident #3's face sheet, dated 08/07/25, reflected a [AGE] year-old female originally admitted to the facility 04/18/25 and readmitted on [DATE]. Her diagnoses included benign neoplasm (a noncancerous tumor) of pituitary gland (a gland that releases hormones that control multiple body functions), type 2 diabetes (a condition that affects the way the body processes blood sugar), muscle weakness, and cognitive communication deficit (problem with communication caused by cognition rather than a language or speech deficit). Review of Resident #3's quarterly MDS, dated [DATE], reflected a BIMS score of 9 which indicated moderately impaired cognition. The MDS reflected Resident #3 required partial/moderate assistance with toileting hygiene. The MDS reflected Resident #3 was always incontinent of bladder and bowel. Review of Resident #3's comprehensive care plan, revised 04/05/25, reflected in part, Focus - The resident has bowel incontinence. Goal - The resident will have less than two episodes of incontinence per day through the review date. Interventions/Tasks - Provide peri care after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455799 If continuation sheet Page 2 of 3 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 455799 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Austin Wellness & Rehabilitation 11406 Rustic Rock Drive Austin, TX 78750 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete each incontinent episode. During an observation on 08/07/25 at 11:14 AM, Resident #3 stated LVN C could provide incontinent care. LVN C washed her hands and donned clean gloves. LVN C adjusted the bed height and the covers. LVN C opened the front of the brief and pushed the brief between the resident's legs. LVN C used one wipe for each swipe, cleaning from front to back. LVN C assisted Resident #3 to roll to her left side. LVN C continued and cleaned the resident's back side, wiping from front to back. LVN C rolled up the soiled brief leaving it next to the resident's buttocks. LVN C doffed (removed) her gloves, sanitized her hands then donned clean gloves. She placed a clean brief between the resident's buttock and the soiled brief. The clean brief touched the soiled brief. LVN picked up the soiled brief and placed it in the trash. Without changing the now soiled gloves, LVN C applied the clean brief. LVN C doffed the gloves and washed her hands. CNA B assisted LVN C as they repositioned Resident #3 in the bed. During an interview on 08/07/25 at 11:21, LVN C stated she had been trained on infection control sometime in the middle of the last month. She stated hand hygiene was required before and after providing care. She stated hand hygiene was performed with each glove change. LVN C stated gloves should be changed when going from dirty to clean. She stated not performing hand hygiene or wearing proper PPE could lead to the spread of infection. During an interview on 08/07/25 at 11:37 AM, the ADM stated he expected staff to perform proper hand hygiene and to follow the policies and procedures. The ADM stated the nurses were responsible for monitoring the CNAs to ensure they followed the correct procedures. He stated the DON also monitored the CNAs and the nurses. During an interview on 08/07/25 at 11:48, the DON stated he expected appropriate care, and that staff followed the infection control guidelines. He stated he expected that staff understood why things like peri-care were done a particular way. He stated they did annual competencies, and all staff were checked off during orientation when hired. The DON stated he made observations of care periodically but mostly the nurses monitored the CNAs. The DON stated not following infection control guidelines could transfer bacteria and cause infection including sepsis. No policies for Hand Hygiene or the use of gloves were received prior to exit from the facility. Review of the facility Perineal Care, revised 06/2020, reflected in part, Purpose - To maintain cleanliness of the genital area, to reduce odor, and to prevent infection or skin breakdown. Procedure - I. Wash hands. V. put on gloves. VI. Wash the pubic area. A. For female residents: i. Wash with soapy washcloth/cleansing wipe, moving from front to back, on each side. ii. Rinse area, moving from front to back. VII. Wash, rinse and dry buttocks and peri-anal area without contaminating perineal area . XII. Remove gloves. Wash hands or use alcohol-based hand sanitizer. Note: Do not touch anything with soiled gloves. XII. Put on clean gloves. Placed soiled linen in proper container. Event ID: Facility ID: 455799 If continuation sheet Page 3 of 3