Health inspection·December 2, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Allegation: [Resident #1] reported that a tall black man came into her room and touched her vaginal area.Other Pertinent History: Resident has history of verbal aggression and making false accusations.Actions and Notifications.Review of facility's in-services reflected an in-service titled Abuse and Neglect Reporting dated 09/15/2025.Review of facility's investigation document reflected safety check of residents on the hall with Resident #1 was completed on 09/16/2025 and it reflected no concerns regarding abuse. A review of facility's Provider investigation Report dated 09/22/2025 reflected CNA B denied the allegation. Assessment: Complete skin assessment was performed by the ADON, and no injury, bruising or irritation was found.Were other parties notified? Example: physician, family, ombudsman: NP, RP, Admin, DON, MD.Provider Action Taken Post-Investigation: in services conducted abuse, neglect, reporting incidents, staff member suspended pending investigation.During an interview on 09/16/2025 at 11:30 am, Resident #1 stated the other night to the morning hours, there was a tall dark man in her room, he had grabbed her on her vagina, and she said NO! STOP! Resident #1 stated the tall dark man was wearing a tank top and a pajamas like pants with flag on it. Resident #1 said she had never seen the tall dark guy in the facility before, but he kept holding her vagina and about 10 minutes into it, another male voice came from her doorway. Resident #1 stated she did not see the other male because her bathroom door was opened and it prevented her from seeing the person at the door. Resident #1 stated she didn't tell anyone at the time of the incident because she thought the male voice that came from the doorway had taken care of it by reporting the incident. Resident #1 stated later that day she reported the incident and stated she was raped but that was not the right word to use, the right terminology was she was sexually molested. Resident #1 stated she had been raped before in the past that is why the word rape came out. Resident #1 stated RN A, the NP and the ADON came into her room and assessed her, and she explained what had happened. Resident #1 stated she also spoke with the DON and explained the incident. Resident #1 stated the DON had asked her to write a statement after she had already explained the incident to him and she refused to write the statement.During an interview on 09/16/2025 at 11:55 am RN A stated she was called by the MD to Resident #1's room due to Resident #1 having a concern. RN A stated she went into Resident #1's room while the MD was present and Resident #1 stated a black man touched her private part and she screamed. RN A stated she called the ADON and the DON and explained what Resident #1 had said. RN A stated the NP was in the facility and was notified. RN A stated she, the ADON and the NP went into Resident #1's room and assessed Resident #1. RN A stated there were no bruises, no indication of vaginal penetration so Resident #1 was not sent to the hospital. RN A stated when they went to assess Resident #1, Resident #1 said she was touched on the pubic area, not the vagina. During an interview on 09/16/2025 at 12:18 pm, LVN C stated she was the nurse assigned to Resident #1 on the night of the alleged abuse. LVN C stated her assigned CNA was CNA B. LVN A stated she was not made aware of the alleged abuse by Resident #1 who was usually vocal and was able to express her needs. LVN C stated CNA B was wearing scrub pants with the American flag and black t-shirt on the night of the alleged abuse. LVN A said she was called by the DON to come to the facility and write a statement regarding the incident. During an interview on 09/16/2025 at 2:11 pm CNA B stated he worked the hall with Resident #1 on the night of the alleged abuse. CNA B stated he worked with CNA D, they teamed up to provide care for the residents assigned to both of them. CNA B stated during his final shift rounds by about 4am in the morning, he checks on every resident to make sure they were still alive and breathing. CNA B stated he never went into Resident #1's room by himself, he was with CNA D.CNA B stated he did not have to check and change Resident #1 because she went to the restroom on her own. CNA B stated he was called by the DON to come and write a statement and that he was suspended pending investigation.During an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455799 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 455799 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few interview on 09/16/2025 at 2:41 pm the DON stated he heard about the alleged abuse on the afternoon of 09/15/2025. The DON stated the MD was rounding at the time when Resident #1 made the allegation. The DON stated RN A notified him and he immediately went to speak to Resident #1 to find out what had happened. The DON stated the female nurses (ADON, RN A and the NP) went and assessed Resident #1 and found nothing. The DON stated he then called HR to suspend CNA B because that was his assigned hall and Resident #1 had described the pants he was wearing the night of the allegation. The DON stated the Administrator was out on vacation and he was responsible for completing the investigation regarding the alleged abuse. The DON stated he had initiated an in-service on abuse and neglect, reported the alleged allegation to HHSC, completed head-to-toe assessment on Resident #1, spoke with the night nurse and so far, that was thorough and there was nothing else that needed to be done, even though Resident #1 has a history of false accusations. The DON stated he did not notify law enforcement/police because Resident #1 did not describe anything other than he was touching her there, on top of her stomach. The DON stated Resident #1 only wanted the facility to know what had happened and did not want to press charges. The DON later stated, it was hours later, the AP was not here, I didn't necessarily believe her [Resident #1]. During a phone interview on 09/16/2025 at 2:59 pm CNA D stated he worked the night of the alleged abuse. CNA D stated usually he and CNA B would make rounds together on their shift but on the night of the alleged abuse, he did not make rounds with CNA B. CNA D stated he went to help CNA B on the morning of 9/15/2025 at about 4:30 am and CNA B was already done with Resident #1's room. CNA D stated he did not see CNA B when he entered Resident #1's room. During an interview on 09/25/2025 at 11:45 am, Resident #1 stated, they pull down my pants, they used multiple phones flashlights to assess me. I wanted to make a police report, but the police were not called. They did not offer or promise to call the police after being molested by a guy.During an interview on 09/25/2025 at 12:34 pm the NP stated she, RN A and the ADON assessed Resident #1 after Resident #1 alleged she was abused. The NP stated Resident #1 stated that someone had touched her in her peri area. The NP stated she looked for bruising and open areas and there were none, there was no sign that someone penetrated her, no discharge, no bruising, no marking, nothing internal, it was external. The NP stated Resident #1 stated she didn't want [CNA B] in her room anymore. The NP stated Resident #1 did not ask to talk to the police and she did not hear anything about the police.During an interview on 09/25/2025 at 12:41 pm the Social Worker stated she spoke with Resident #1 after the alleged abuse and Resident #1 stated she used the word rape which was a strong word to use but she was angry and upset of the incident, so she said rape. The Social Worker stated Resident #1 did not express wanting to talk to the police, if she [Resident #1], she would have called the police. The Social worker stated she completed a safety check on 09/16/2025 with all the residents on the hall with Resident #1 to ensure they all felt safe.During an interview on 09/25/2025 at 2:30 pm the Administrator stated if there was an allegation the staff needed to report to him, if he was not available, the staff needed to go to the DON. The Administrator stated, in his absence, the DON takes over investigations. The Administrator stated when Resident #1 alleged abuse, he was on vacation. The Administrator stated if there was an allegation of abuse, the expectation was to make sure the resident was safe, assess the resident, interview staff and anyone with knowledge of the incident, in-service staff, ask other Residents of anything in-appropriate, follow up on the investigation, monitor depending on what is going on, report to HHSC, complete the 5 days investigation report. The Administrator stated the facility follows the provider letter from HHSC regarding abuse and neglect and he was going to look at it to confirm if he was supposed to notify law enforcement. The Administrator stated he was made aware of Resident #1 allegation of abuse, but he did not participate in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455799 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 455799 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete investigation. The Administrator stated he spoke with Resident #1 on 09/18/2025, and Resident #1 stated she didn't say it right; it was not rape. The Administrator stated Resident #1 said a tall black man came in her room and touched her, she didn't see who it was, said she didn't like it. The Administrator stated he told Resident #1 the facility will provide female CNAs only for her care to be safe. The Administrator stated, for Resident #1 it was hard with her because of her delusion and hallucination. The Administrator stated the AP was suspended pending investigation. The Administrator stated, I was not here, I don't know who was notified, she [Resident #1] did not ask for the police, we want to investigate first before calling the police. I did not know we had to notify law enforcement The Administrator stated the DON completed the investigation, he looked at it after the DON had completed the investigation and he felt it was thorough. Review of facility's policy titled Abuse Prevention and Prohibition Program dated 08/2020 reflected: Purpose- To ensure the Facility establishes, operationalizes, and maintains an Abuse Prevention and Prohibition Program designed to screen and train employees, protect residents, and to ensure a standardized methodology for the prevention, identification, investigation, and reporting of abuse, neglect, mistreatment, misappropriation of property, and crime in accordance with federal and state requirements. Ill. The Administrator is responsible for coordinating and implementing the Facility's abuse prevention policies, procedures, training programs, and systems.VI. InvestigationA. The Facility promptly and thoroughly investigates reports of resident abuse, mistreatment, neglect, injuries of an unknown source, or criminal acts.i. The Facility has protocols for investigations of theft/misappropriation of resident property abuse. See Policy No. -AP - 11-Theft Prevention.B. If the Administrator receives a report of an incident or suspected incident of resident abuse, mistreatment, neglect, injuries of an unknown source or crime, the Administrator or designee may appoint a member of the Facility's management team (theInvestigator) to investigate the alleged incident.i. If the investigation is delegated, the Administrator provides the Investigator with any supporting documents related to the alleged incident.IX. Reporting/Response D. The Facility will report allegations of abuse, neglect, exploitation, mistreatment, injuries of unknown source, misappropriation of resident property, or other incidents that qualify as a crime. See AN - 01- Form E Initial Report - Facility Reported Incidents.i. Immediately, but no later than 2 hours after forming suspicion if the alleged violation involves abuse or results in serious bodily injury to the state survey agency, adult protective services, law enforcement, and the Ombudsman (if applicable per state regulation). Event ID: Facility ID: 455799 If continuation sheet Page 4 of 4