Health inspection·August 27, 2023

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some turning side to side in bed and positioning self while in bed, and she was always incontinent of urine and bowel. Record review of Resident #2's Care Plan, entry effective 07/21/2023, revealed that resident required extensive assistance of one person to roll over in the bed. Resident #2 had an ADL (activities of daily living, including hygiene, toileting/continence, other activities) self-care deficit and required assistance of at least one person for assistance with ADL's. Record review of Form 3613-A, Provider Investigation Report, dated and signed by ADM on 07/24/2023, revealed On 07/17/2023, (Resident #2) made the following grievance: . The Investigation did find that (CNA A) circled around Monday morning (07/17/2023) to ask (Resident #2) what went wrong during the care and why a grievance was made. (Resident #2) had grievances regarding (CNA A) peri-care on the morning of 7/15/2023. revealed that head to toe assessment of Resident #2 was done on 07/17/2023 at 10:00 AM. revealed that provider investigation findings were inconclusive. Record review of 07/17/2023 provider investigation facility form entitled (Corporate Name) Incident Investigation Form - Applicable to Skilled Nursing, Timeline section, indicated that incident involving Resident #2 and CNA A occurred at 4:00 AM on 07/16/2023, that Resident #2 made grievance on 07/16/2023 at 7-8:00 AM, and that RN A followed up with Resident #2 regarding her grievance on 07/16/2023 in the evening. Record review of form entitled (Corporate Name) Incident Investigation Form - Applicable to Skilled Nursing, dated 07/17/2023, Timeline section, indicated that RN A discussed grievance with CNA A on 07/17/2023 day shift; this same document/Timeline section, revealed that CNA A followed up with Resident #2 regarding grievance on 07/17/2023 during the day shift. Record review of (Corporate Name) form entitled Incident Investigation Form - Applicable to Skilled Nursing, dated 07/17/2023 and signed by ADM, revealed that Resident #2 stated CNA A was 'rough' during peri-care and Resident #2 was scared of CNA A. Record review of (Corporate Name) Incident Investigation form, dated 07/17/2023, revealed quoted statements from CNA A and PT A regarding the grievance and reapproach of Resident #2 by CNA A and the reapproach of Resident #2 as witnessed by PT A. Date/time of statements was not indicated. In this document, CNA A stated I went in to change her brief and she never said there was a problem .She didn't want me to change her pad and I do not know why. I went and talked to her on Monday because I thought everything was okay .and I wanted to know what was/went wrong. PT A statement included I did witness CNA A approach Resident #2 on Monday. I wouldn't say it was aggressive but it was inappropriate .I do not think CNA A understood how she was coming off to Resident #2. I do not think CNA A was trying to intimidate Resident #2 but trying to figure out why Resident #2 complained about her. A statement that CNA C's memory and opinion was congruent with PT A's statement was included on this form. A statement which read Pending CNA B interview followed these statements. No statement for CNA B, nurse aide for Resident #2 when allegations were first verbalized after incident, per Timeline section on (Corporate Name) Incident Investigation Form - Applicable to Skilled Nursing, was documented at time of investigation. Record review of (Corporate Name) Incident Investigation Form - Applicable to Skilled Nursing, dated 07/17/2023, revealed in Immediate Actions Taken: Resident was evaluated and/or treated, Associate accused/suspected was suspended, Notification was made to (Corporate) District/Regional Administrative Officers, Responsible Party was notified, Physician was notified; this same form indicated that Post Investigation Actions included In-services/Associate Re-training and Other Action (specified without detailed description as Corrective Action: CNA A) was taken. Record review of (Corporate Name) Incident Investigation Form - Applicable to Skilled Nursing, dated 07/17/2023, Conclusion, indicated that Provider findings were inconclusive and unfounded, as indicated by checked boxes; boxes associated with Confirmed or Unconfirmed were left blank. Record review of the Provider Investigation indicated that four safe surveys were conducted on four residents on unknown (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 2 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0600 date by unknown person and there were no safety concerns expressed. Level of Harm - Immediate jeopardy to resident health or safety Record review of documents in Provider Investigation indicated that Abuse and Neglect in-service was held on 07/17/2023 at 4:35 PM and signed by 15 staff persons. a Peri-care in-service was held on 07/17/2023 at 3:00 PM and signed by 15 staff persons. In-service on customer service dated 07/17/2023 at 4:35 PM revealed sign-in sheet signed by 15 staff persons. CNA A's signature did not appear on in-service sign in sheets dated 07/17/2023. Residents Affected - Some During interview with Resident #2 on 08/23/2023 at 12:40 PM, Resident #2 stated that CNA A was rough with her on a night shift on 07/15/2023 or 7/16/2023. Resident #2 was able to identify CNA A by first name. Resident #2 stated that CNA A turned the light on in her room and woke her up and stated that she needed to change her brief and bedding as everything was wet. Prior to changing the brief, Resident #2 stated that CNA A had asked her to roll over. Resident #2 stated that she complied with CNA A request and rolled over. Resident #2 stated that CNA A then took her hands and shoved her over further, which indicated to Resident #2 that the CNA A was angry that she had not rolled over far enough on her own. Resident #2 stated she told CNA A that the action of shoving her over really hurt as this was her side (of her body) with fractures. Resident #2 stated she told CNA A not to change the wet pad that was underneath her on the bed as she just wanted CNA A to leave her room. Resident #2 stated CNA A left the wet pad under her and left the room. Interview with RN A on 8/23/2023 at 12:50 PM, revealed RN A was informed about the abuse allegation after Resident #2 reported it to morning CNA B when she came on duty on the morning shift of 07/16//2023 at approximately 7:00 AM. RN A stated that he spoke with Resident #2 immediately after he was informed of the grievance which had been conveyed from Resident #2 to CNA B. RN A stated that Resident #2 stated to him on 07/16/2023 at approximately 7:00 AM that CNA A was rough with her care when she attempted to change Resident #2's brief and wet bed in the early morning hours of 07/16/2023 after entering the room and turning on the light. Resident #2 stated to RN A during grievance follow-up on 07/16/2023 that she felt scared of CNA A. RN A stated CNA A is very passionate about her work and gets offended when she is accused of improper care. RN A denied that CNA A had been accused of abuse prior to the event with Resident #2. RN A stated that CNA A approached Resident #2 in a common area the following day, 07/17/2023, and stated to her That isn't what I did, referring to grievance expressed by Resident #2. RN A stated that CNA A came across in the wrong way as she attempted to relay verbally to Resident #2 that she had not been rough. RN A stated that CNA A is very efficient, works fast, and any rough behavior would not have been intentional. Resident #2 is no longer assigned to receive care from CNA A per RN A. RN A stated that he reported the incident to ADM right away after speaking with Resident #2 on 07/16/2023. Interview with Family Member #1 on 08/23/2023 at 3:51 PM, revealed that Family Member #1 and Resident #2 had spoken to the ADM on unknown date, about the allegation, in the days following the allegation. Family Member #1 stated that Resident #2 had a palpable fear that she was being retaliated against when she overheard an unknown Nurse Aide asking another staff person Who would report my friend? Family Member #1 stated that the penalty for CNA A regarding incident with Resident #2 was attending an in-service and this concerned Family Member #1, as he stated he did not feel this was a sufficient response from the facility regarding the incident. Family Member #1 stated that he did not feel the facility response was adequate based on the treatment that Resident #2 received from CNA A, and that she was left feeling scared after she alleged the mistreatment. Interview with Physical Therapist by phone on 08/24/2023 at 1:00 PM, revealed that Physical Therapist was with Resident #2 providing therapy services when Resident #2 was approached by CNA A. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 3 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Physical Therapist stated that she does not remember the exact date/time. Physical Therapist stated during interview that CNA A approached Resident #2 during PT session and stated I heard you had a complaint about me, what did I do wrong?' to which Resident #2 replied 'I felt you were a little rough with me when you rolled me in the bed' . CNA A replied, according to Physical Therapist in interview, 'Well I have to roll you in order to change you' . Physical Therapist stated that she and Resident #2 felt this to be an uncomfortable situation and it caused Resident #2 distress, per Physical Therapist. Physical Therapist stated that Resident #2 told her that she did not want CNA A to come back in her room. Interview with CNA C on 08/24/2023 at 12:32 PM, revealed that she witnessed, on unknown date/time, Resident #2 as she was confronted by CNA A regarding grievance. CNA C stated that Resident #2 stated to her, at a time after she was approached by CNA A, 'She (CNA A) came up to me and accused me of reporting her' . CNA C stated that she told Resident #2 that wasn't very nice of her. CNA C stated that Resident #2 stated 'that scared me', in reference to the action of CNA A approaching her . CNA C stated that Resident #2 then stated 'I hope she doesn't come back to my room. I'm afraid of her roughing me up.' Interview with ADM on 08/24/2023 at 2:17 PM, by phone revealed that CNA A was suspended for a couple of days. ADM stated that when it came down to it, it was a he said-she said. ADM stated that CNA A was coached, after the incident on 07/17/2023, not to reapproach residents if they make accusations which involved her. ADM stated that in addition to a couple days suspension, beginning on 07/17/2023, CNA A was in-serviced on Customer Service, Peri Care (incontinent care), and Abuse/Neglect. A phone interview on 08/25/2023 at 10:52 AM with ADM, stated he was not made aware of grievance until 07/17/2023. ADM stated during phone interview on 08/24/2023 at 2:17 PM that he was made aware of Resident #2 grievance on 07/17/2023 and took action to investigate and address grievance beginning on this date. ADM stated that to his knowledge, RN A did not notify him of the grievance on 07/16/2023. ADM acknowledged that he is the facility Abuse Coordinator and that staff have been trained to report allegations of abuse or neglect to him immediately. Observation on 08/25/2023 at 2:31 PM, included incontinent peri-care and brief change for bed-bound resident by CNA G and CNA H. There were no concerns during observation. Record review of Resident #3's face sheet dated 08/11/2023 revealed a [AGE] year old female with diagnoses of depression, dementia without behavioral disturbance (decreased ability to remember without behavioral symptoms directed at others or oneself), psychotic disturbance, mood disturbance, and anxiety, among other diagnoses. Record review of Resident #3's MDS (standardized assessment tool that measures health status in nursing home residents dated 08/23/23 revealed a BIMS score of 7/15, which indicated severely impaired cognition (a deterioration or loss in intellectual capacity). Record review of Resident #3's Care Plan dated 08/11/2023 revealed that Resident #3 required staff assistance with bathing/showering, assistance with activities of daily living, and assistance to dress. The Care Plan indicated that Resident #3 had alteration in mood with interventions listed including administering medications, ordering behavioral health consults, and encouraging the resident to express feelings. Record review of Tulip submitted on 08/22/2023 at 4:12 PM, by ADM revealed that Resident #3 alleged (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 4 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some that a nurse aide was rough with her during a shower with facility first learning of incident on 08/22/2023 at 3:30 PM, the report indicated that the perpetrator was unidentified. Resident #3's allegation of abuse revealed that Actions and Notifications taken by the facility included: assessing resident, notifying family and physician, conducting safe surveys, taking statements, and conducting in-services regarding showers, customer service, abuse, neglect, and exploitation. Provider investigation documents were requested at entrance to facility on 08/23/2023 at 11:02 AM by email to Executive Director and ADM. Executive Director stated at entrance conference that RN A would be facility contact person for anything needed to investigate intakes and Executive Director would also be available. ADM would be available by phone, per Executive Director. Executive Director stated that although intake was reported one day prior, the investigation regarding was under way. ADM was interviewed by phone on 8/23/2023 at 10:50 AM. ADM stated that incident which involved Resident #3 was reported to State intake the day prior, on 08/22/2023. ADM stated that Nurse Aide, whom had perpetrated abuse on Resident #3 during a shower, remained unidentified. ADM stated that ADON was sent in to do physical assessment on Resident #3 after allegation of abuse was communicated to him as the result of a Care Plan Meeting on 08/22/2023. During Care Plan Meeting on 08/22/2023, Family Member #2 communicated that Resident #3 had stated to him that a nurse aide was rough with her during a shower on either 08/20/2023 or 08/21/2023. ADM stated during interview of 08/23/2023 that Resident #3 Family Member is not worried that abuse occurred. Interview with Resident #5 on 8/23/2023 at 1:00 PM, revealed her own experience in the facility, then she advised that her roommate, Resident #3, had verbalized a concerning incident to her that she felt Resident #3 would want to discuss with HHS representative. Resident #5 revealed that her roommate had told her that she had been mistreated during a shower. Because her roommate, Resident #3, had been upset about the event, Resident #5 verbalized that she thought her roommate would want to discuss the concern. Resident #5 stated that she did not witness alleged abuse but had heard about it from her roommate, Resident #3. Resident #5 did not witness the alleged perpetrator to her knowledge. Resident #5 stated that she did not know what day the alleged abuse had taken place or what date/time Resident #3 had first told her about the event. Interview with Resident #3 on 08/23/2023 at 1:15 PM revealed that Resident #3 did not know the name of the staff person who had showered her on date of alleged abuse and was unable to give the date or day of the week that the shower had been given. Resident #3 described the event which had occurred in the shower: alleged perpetrator was assisting Resident #3 with her shower and asked her to turn around as she stood; alleged perpetrator was going to wash off her back side. Resident #3 stated that when she did not turn around in a timely manner, the alleged perpetrator physically turned her body around, knocking her against the shower wall. Not able to recall the date/time of the incident, Resident #3 provided a verbal description of the alleged perpetrator which included: of African or Hispanic descent, female, curly dark hair, and wearing a copper-colored hair accessory. Resident #3 stated that she told her roommate and her son after the alleged abuse took place. Resident #3 stated that she had further seen the alleged perpetrator since the date/time of the incident; Resident #3 stated that one sighting occurred at the nurse's station (date/day of week unknown) and second sighting was in the dining room as alleged perpetrator poured drinks (date/day of week unknown). Resident #3 stated that when she saw alleged perpetrator in the dining room it made her cry, and some of the staff asked her what was wrong and attempted to console her. Resident #3 stated that she had not had another shower since the alleged abuse occurred. Resident #3 became teary as she recounted the shower event, during her interview. Resident #3 stated that the alleged abuse made her feel awful and that she never had anyone treat her the way that she was treated during that shower. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 5 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Request for Provider Investigation or documents which indicated progress toward investigation, , requested verbally from DON on 08/23/2023 at 3:00 PM. DON was unable to provide any investigation documents for review. CNA C was interviewed on 08/24/2023 at 12:45 PM. CNA C stated that she was aware of Resident #3 having a complaint about someone being rough with her in the shower. CNA C stated that she had no knowledge of a perpetrator or when the alleged abuse occurred, CNA C that Resident #3 is a day shower (showers on the 2:00 PM to 10:00 PM shift) and she had not showered Resident #3. Interview with RN B was held on 08/24/2023 at 1:40 PM. RN B stated that she had worked on 8/22/2023 and 08/23/2023 and was the primary nurse for Resident #3 on those days. RN B stated that she and ADON had done a skin assessment on Resident #3. RN B stated that an allegation had prompted the skin assessment but she did not know what was being alleged. RN B stated during interview on 08/24/2023 at 1:40 PM that she had heard that someone had been rough with Resident #3 during a shower and backed her up against the wall of the shower. RN B stated that she did not know who the assigned nurse aides were for Resident #3 on 08/22/2023 or 08/23/2023 or if she had had a shower on those dates. RN B stated that she had not witnessed abusive treatment toward Resident #3. Interview with ADON was done on 08/24/2023 at 2:08 PM and revealed that he and RN B did a head to toe skin assessment with Resident B on 08/22/2023. Resident #3 became agitated during skin assessment, ADON stated during 08/24/2023 interview, so skin assessment had to be done slowly and with measures taken to allow Resident #3 to calm during the procedure. ADON stated during 08/24/2023 interview that he and RN B were able to do a thorough skin assessment and did not find evidence of abuse. ADON stated that skin assessment was done at the end of the day on 08/22/2023 and he did not know who the alleged perpetrator was or who had showered Resident #3 when alleged abuse occurred. ADON stated that Nurse Aides do showers three times weekly per resident and that no Shower Aides are used in the facility. Provider Investigation documents requested on 08/24/2023 from RCS by text (her preferred method of contact for requesting documents per RCS, who was in facility on 08/24/2023 and 08/25/2023). Verbal request to RCS was made for Provider Investigation documents on 08/24/2023 at 2:02 PM. RCS stated advised investigator to speak with ADM regarding investigation documents and no Provider Investigation documents were obtained from RCS at this time. Provider Investigation documents for were requested from ADM by phone on 08/24/2023 at 2:10 PM. Email containing four safety surveys conducted with four residents on unknown date/time were received on 08/24/2023 at 2:13 PM. No other progress on investigation was submitted and a perpetrator remained unidentified for the alleged abuse regarding Resident #3. Executive Director was interviewed on 08/25/2023 at 09:55 AM and stated that the investigation regarding, Resident #3, had been started. Executive Director stated that interviews had been started with staff. Executive Director stated during interview on 08/25/2023 at 09:55 AM that there was no alleged perpetrator. Executive Director stated that Resident #3 is confused and unable to give a description of alleged perpetrator. ADM was interviewed on 08/25/2023 at 10:57 AM by phone regarding intake 445774. ADM stated that 5-day investigation report would be submitted to State intake on Tuesday, August 29, 2023. ADM stated that after initially receiving grievance on 08/22/2023, the facility staff began checking all other residents. ADM stated that family and physician were notified on 08/22/2023. ADM stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 6 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some in-services are being initiated and interviews are being completed on 08/25/2023. Resident identified perpetrator to ADM as African American female with short curly hair. ADM stated that CNA E had given Resident #3 a shower earlier in the week. ADM stated that he had spoken with various staff regarding incident or if there were any concerns regarding staff working on Resident #3's hall. Point Click Care software based electronic medical record was accessed on 08/23/2023 to aide in investigation. It was revealed in PCC that a shower had been documented on 08/22/2023, 2:00 PM to 10:00 PM shift. Shower entry in PCC was documented as Resident #3 requiring some assistance RN A was asked to identify the staff member that had documented the shower, along with their initials, on 08/22/2023 and RN A was unable to identify. Executive Director stated that he would be able to identify the staff member initials in PCC; it was requested to Executive Director that this staff member be identified and interviewed by HHS representative if they were present in the facility. CNA D was interviewed on 08/23/2023 at 2:19 PM. CNA D could not verify yes or no during interview if entry in PCC was her identification and entry when shown; CNA D stated that she was assigned to Resident #3 on date of Resident #3's last documented shower, which PCC documentation indicated to have occurred on 08/22/2023 on the 2:00 PM to 10:00 PM shift. CNA D stated that she had worked on 08/22/2023 and was assigned to Resident #3 on the 2:00 PM to 10:00 PM shift. CNA D stated that although a shower is documented as having been given, with codes 3, 2 documented in the entry (corresponding key indicated that Resident #3 required physical help in part of bathing activity, code 3, and by one person, code 2) she did not give a shower to Resident #3 as entry indicated. CNA D stated that Resident #3 had refused her shower on 08/22/2023. Two of three documented initials on entry matched CNA D. Shower entry in PCC prior to 08/22/2023 was on 08/19/2023 on the 2:00 PM to 10:00 PM shift; it was revealed that the 8,8 codes that were used in the entry indicated that the activity did not occur per documentation entry codes listed on same PCC page. Other shower entries for Resident #3 indicated that on 08/17/2023 on the 2:00 PM to 10:00 PM shift, Resident #3 was given a shower, required physical help in part of bathing activity by one person (codes 3 and 2) and that initials of person documenting belonged to a male nurse aide. Entry on 08/15/2023 indicated that activity did not occur for Resident #3 and entry on 08/14/2023 indicated that activity did not occur. There were no further shower entries in PCC electronic medical record for Resident #3 for August 2023. Second interview with Resident #3 occurred on 08/25/2023 at 10:10 AM. Resident #3 recounted the events verbally as she did during first interview; Resident #3 recounting of the shower event did not change from her first interview on 08/23/23 to her second interview on 08/25/25. Resident #3 description of the perpetrator did not change from the first interview to the second interview. During interview on 08/25/2023 at 10:10 AM, Resident #3 stated that DON had come by to see her (unknown day/date). Resident #3 stated that DON advised her to speak with ADM and find out if he had spoken with alleged perpetrator. Attempted to call Family Member #2 on 08/23/2023 at 3:30 PM. Sims message (digital phone number of caller) was only available option after Family Member #2 did not answer, and phone number was sent for call back. Attempted to interview Family Member #2 on 08/24/2023 at 10:39 AM, Sims message sent (call back number sent). Attempted to call Family Member #3 on 08/23/2023 at 4:09 PM. Message left requesting call back. Attempted to call CNA B for interview on 08/23/2023 at 3:37 PM as RN A had provided phone number for facility staff person who frequently worked with Resident #3; no answer; voicemail was not an option. Attempted to call CNA B a second time for interview on 08/23/2023 at 2:27 PM, no answer to phone call and voicemail was not an option. CNA B was not working in the facility on investigation days (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 7 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0600 per RN A. Level of Harm - Immediate jeopardy to resident health or safety Record review of facility's policy titled Abuse, Neglect, and Exploitation dated October 2022 reflected Residents have the right to be free from abuse, neglect, mistreatment, misappropriation, and exploitation. Residents Affected - Some Record review of facility's ANE Policy, dated October 2022, reflected The facility should attempt to take necessary steps to verify residents are protected from subsequent episodes of abuse. Upon learning of alleged abuse, neglect, mistreatment, or exploitation, the ADM or supervisor on duty should attempt to take necessary steps to verify residents are protected from subsequent episodes of abuse, neglect, mistreatment, or exploitation .and take necessary steps to protect the residents. If the investigation is conducted by a designee, the designee should report the results of the investigation to the ADM, no time frame for reporting to ADM is specified. On 8/25/23 at 05:50 PM, an Immediate Jeopardy (IJ) was identified. The ADM was notified and provided the IJ template, and a Plan of Removal (POR) was requested at that time The Facility Plan of Removal (POR) was accepted on 08/27/2023 at 10:45 AM. Monitoring of the plan of Removal included the following: Plan of Removal On 8/25/2023, at 5:45PM, [Facility] was notified of an immediate jeopardy for F600 (Free from abuse and neglect) regarding: - The facility failed to prevent further mistreatment of Resident #2 while the investigation was in progress - The facility failed to investigate a report of abuse by Resident #3 to prevent further abuse

F600 Abuse and Neglect 1. Two residents were identified as being affected by deficient practice. All residents have the potential to be affected. Resident #2 discharged on 8/24/2023. On 8/25/2023, Resident #3's alleged perpetrator was put on formal suspension pending further investigation. The CNA has not been in the community since noon on 8/24/23. On 8/25/2023, director of clinical services completed skin assessment and pain data collection. No concerns or pain noted. Beginning on 8/26/23 through 8/27/2023, the regional director of clinical services provided re-education to licensed nurses and CNAs regarding showers, customer service and abuse and neglect. Licensed nurses and CNAs not available will be re-educated prior to the next shift or during orientation for new hires by the DCS or designee. 2. Beginning on 8/25/2023 and continuing through 8/26/23, DCS and/or designee conducted interviews with all current residents regarding potential abuse and/or neglect. No additional allegations of abuse or neglect were identified. Beginning on 8/25/2023 and continuing through 8/26/23, DCS and/or designee conducted pain data collections on current residents, which includes verbal and non-verbal pain. Beginning on 8/25/2023 and continuing through 8/26/23, the administrator and designee reviewed current residents' last 45 days (8/25/2023 back through 7/11/2023) of progress notes, grievances, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 8 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0600 incidents/accidents to ensure all residents were free from abuse and neglect. No additional allegations of abuse or neglect were identified. Level of Harm - Immediate jeopardy to resident health or safety 3. On 8/25/2023 through 8/26/2023, licensed nurses and CNAs were re-educated by the director of clinical services/designee regarding: Residents Affected - Some o o Abuse, neglect, and exploitation policy including retaliation with post-test o o Reporting any suspected allegation of abuse-to-abuse coordinator (Administrator) and/or backup abuse coordinator (executive director) immediately o o Staff, residents, and/or visitors may file a formal grievance and/or concerns o o Completing a grievance form and providing to the administrator/executive director and/or designee o o When a resident voices pain during care, associates will halt care, and notify a licensed nurse to address the resident's concerns Licensed nurses and CNAs not available will be re-educated prior to the next shift by the DCS or designee. On 8/25/2023, the healthcare administrator and executive director completed re-education by Regional Director of Clinical Services (RDCS) regarding completing thorough investigations dealing with abuse, neglect, or exploitation, including suspension of alleged perpetrators pending completion of the investigation. On 8/26/2023, RN weekend supervisor was re-educated by executive director and/or designee on reporting potential allegations of abuse and/or neglect to the abuse coordinator and/or backup abuse coordinator immediately. 4. Starting on 8/25/2023, progress notes, incidents/accidents, and grievances will be reviewed daily Monday-Friday by an interdisciplinary team (executive director, healthcare administrator, DCS, ADCS, [TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 9 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that each resident receives adequate supervision and assistive devices to prevent elopement for one resident (Resident #4) of two reviewed with dementia who exhibited exit-seeking behaviors. Resident #4 was able to exit facility on 07/19/2023 around 1:00 PM and was left unsupervised and exposed to environmental hazards for a period of time. A past non-compliance Immediate Jeopardy was identified on 08/25/2023. The IJ was determined to have been removed due to the facility's implemented actions that corrected the non-compliance prior to the beginning of the investigation. This failure could place residents with dementia who have exhibited exit-seeking behaviors at risk for severe injury or death. Findings included: Record review of Resident #4's face sheet dated 07/20/2023 revealed an [AGE] year-old female resident admitted on [DATE] from acute care hospital with Diagnoses which included syncope and collapse, fall which required acute-care hospitalization in period just prior to facility admission date of 07/05/2023, dementia without behavioral, psychotic, mood, or anxiety disturbance, seizures and epilepsy, among other diagnosis. Primary language of Resident #4 was noted to be of Eastern European dialect per face sheet dated 07/20/2023. Record review of Resident #4's MDS dated [DATE] revealed BIMS score of 07/15, which indicated severe cognitive impairment (a deterioration or loss in intellectual capacity), wandering behavior had not been exhibited. Resident #4 required supervision level of assistance for walking in room, walking in corridor, locomotion on unit, and locomotion off unit. Resident #4 had not had any falls since 07/05/2023. Resident #4 had been admitted for OT and PT services and those services were provided during facility stay. Record review also revealed that no physical restraints were used during stay. Record review of Resident #4's Care Plan entry for Fall Risk revealed that Resident #4 focus area for fall risk was initiated on 07/05/2023, that a Goal of Resident #4 not sustaining serious fall injury was initiated on 07/19/2023, that fall interventions of OT eval (evaluate) and treat as ordered and PT evaluate and treat as ordered were established on 07/05/2023 and that other fall interventions were initiated on 07/19/2023. The Care Plan revealed wandering/elopement seeking behaviors with initiation of focus area, goal, and interventions added to Care Plan on 07/19/2023include the following: Ensuring the environment is clutter free and hazardous items are away from Resident #4, collaboration of staff to help with monitoring Resident #4, relocating Resident #4 to a room close to nurse's station, asking family members to come sit with Resident #4, providing one on one supervision. Use of wander guard (an electronic device worn as a bracelet or anklet which interfaces with an alarm if resident gets too close to an exit door) did not appear as an intervention for elopement risk on Care Plan. Resident #4 Care Plan revealed initiation of entry on 07/19/2023 with focus area of blisters to both left and right heel due to frequent ambulation; goal and interventions for blisters were initiated on 07/20/2023 and included intervention of encouraging Resident #4 to wear shoes and socks when ambulating, monitoring healing of the blisters, and monitoring feet for signs and symptoms of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 10 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few infection every shift, notification of medical provider if blisters opened. Care plan for Resident #4 focus area of ADL self-care performance deficit, initiated 07/05/2023 indicated an intervention initiated on 07/19/2023 of making sure shoes were comfortable and not slippery. Record review of Tulip intake revealed that on 07/19/2023 at 1:15 PM, the facility learned of an incident in which Resident #4 had eloped from the building. Resident #4 with no injuries found, completion of change of condition documentation, utilization of wander guard system/process and management of wander guard alarm, notification of physician and family, one on one care initiation, auditing like-residents, and providing hydration. The report indicated in-service of staff on change of condition process, utilization of elopement binder/procedure, wander guard system/process and management, and notifications. Record review of an e-mail (electronic mail) from the ADM dated 07/20/2023 at 12:57 PM, uploaded to Tulip, stated that Resident #4 was first noted to exit seek on 07/06/2023. Further information indicated that Resident #4 had been gone approximately 25 minutes, was a short term rehab (rehabilitation) resident, and had been wearing a wander guard. The e-mail stated that Charge Nurse (no name specified) and Aide (no name specified) saw her 15-20 minutes prior to being reported missing. Record review of PIR, submitted on 07/27/2023 at 5:08 PM, indicated that Resident #4 had a wander guard placed on 07/06/2023 when Resident #4 was initially identified as an exit-seeker. and that Resident #4 was first found to be missing by Social Services Director on 07/19/2023 (no stated time). Record review of facility Incident Investigation Incident report, Summary of Incident, dated 07/20/2023 reflected that Social Services Director had gone to Resident #4's room on 07/19/2023 (no time indicated) and did not find Resident #4 there. Social Services Director then (no time indicated) informed Charge Nurse A that Resident #4 was not in her room and a missing resident procedure was initiated (no time indicated). Record review of (facility) Incident Investigation report, Associate Interview section, dated 07/20/2023, Charge Nurse A statement indicated that Charge Nurse A, assigned to Resident #4, was notified around 1 PM that Resident #4 was missing and that Charge Nurse A had last seen Resident #4 approximately 20 minutes prior. Record review of facility Incident Investigation report, Associate Interview section, dated 07/20/2023, CNA F revealed that she has seen Resident #4 approximately 15-20 minutes prior (no time given) to the time that she was found missing (no time given). Record review of facility Incident Investigation report, Summary of Incident, dated 07/20/2023, indicated that Resident #4 was found outside the community (by not stated person) and was returned without any visible injuries (time not stated). Record review of facility Incident Investigation report, Resident Interview, dated 07/20/2023 indicated that Resident #4 was attempting to go home. Record review of facility Incident Investigation report, Post Investigation Actions, dated 07/20/2023 indicated that the following actions would be taken: care plan updates, in-services/associate retraining, audits (non-specified), wander guard system adjustment, 24/7 one on one care initiation with Resident #4. Record review of Form Scoring Report to identify residents at risk for elopement printed on 07/19/2023 at 14:23:54 CT indicted that elopement assessment for Resident #4 indicated Not at Risk for Elopement on 07/05/2023. No further assessment of elopement was indicated on this report for Resident #4. Record review of Form Scoring Report to identify a resident at risk for elopement printed 07/19/2023 at 14:25:51 CT indicated that Resident #4 was identified as Potential Elopement Risk on 07/06/2023 and on 07/19/2023. Record review of 07/19/2023 at 12:35 PM in-services included utilization of Elopement Binder to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 11 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few assist nursing staff familiarity with residents at risk for elopement, and Incident Reporting - Elopement. Sign in sheets reflecting date/time of in-service and nursing staff in attendance were contained with in-service content. Record review of 07/19/2023 at 4:20 PM in-service regarding resident Change of Condition related to Elopement/Missing Resident included nursing staff sign-in sheet and reference to attached policy. Instruction to notify administrative staff if an elopement/missing resident incident takes place was noted on staff sign-in sheet for this in-service. An in-service dated 07/20/2023 at 08:00 AM entitled Elopement Notifications to HCA was noted to be held for Therapy Department. Sign in sheet of this in-service reflected Therapy Department staff signatures and defined elopement, indicated presence/access of elopement binder at each nurse's station, and the statement that wander guards should be disabled by a licensed nurse only. An example of elopement followed the definition of elopement on 07/20/2023 at 08:00 AM in-service sign-in sheet for Therapy Department. The written example of elopement reflected Leaving skilled nursing to first floor AL without signing out/notifying staff. Elopement was defined on Therapy Department in-service sign in sheet dated 07/20/2023 at 08:00 AM as A situation in which a resident leaves the premises or a safe area without the community's knowledge and supervision which may represent a risk to the resident's health and safety. Concierge staff in-service sign-in sheet dated 07/20/2023 at 08:00 AM entitled Elopement Notifications to HCA reflected the same items covered in meeting as those of Therapy Department. In-service dated 07/20/2023 at 08:00 AM entitled Elopement Notifications to HCA with sign-in sheets was held for House (miscellaneous staff working in the facility) and for Dining Department and reflected items covered as: elopement definition, elopement example, elopement binder access and utilization, notification of administrative staff if an elopement occurs, and disabling of wander guard system by licensed nurse only. Record review of hard copies of 7/19/2023 and 07/20/2023 in-service sign in sheets were reviewed during investigation on 08/23/2023 through 08/25/2023. Record review of Nursing Progress Note dated 07/06/2023 at 8:55 PM by Charge Nurse B revealed that Resident #4 was exit-seeking and that wander guard had been applied to right wrist. Record review of Nursing Progress Note dated 07/14/2023 at 2:16 PM by Charge Nurse C revealed that Resident #4 made several attempts to elope, requires redirection, and has a wander guard in place. Record review of Nursing Progress Note dated 07/15/2023 at 9:21 PM by Charge Nurse D revealed that Resident #4 was wandering around the unit, wander guard in place at all times. Record review of Nursing Progress Notes of 07/16/2023 at 9:14 PM by Charge Nurse E revealed that Resident #14 had attempted to elope six times (period of time not stated). Record review of Nursing Progress Note dated 07/18/2023 at 6:30 PM revealed that Charge Nurse A had been contacted by receptionist from the first floor stating that she noted resident in the parking lot and brought her back into the building, and that resident continued exit-seeking behaviors that evening. Record review of Progress Note dated 07/20/2023 from APRN revealed that Resident #4 had an episode of elopement today and was found in a housing community nearby. She was brought back to her room and vitals were stable. Her face was flushed and she was given cold towels and ice water. She denies pain. She did have some blisters on her feet from where her shoes rubbed but no injuries. Patient reported that she was trying to get home. She had a wander guard in place that was functioning but was still able to elope. Patient (Resident #4) to get 24-hour sitter and plans to dc (discharge) home tomorrow with family. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 12 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Record review of Missing Resident Drill Forms and sign-in sheets reflected drills conducted on 07/20/2023 at 12:30 PM, day shift, and 3:20 PM, evening shift. Record review of Missing Resident Drill Form reflected drill done on night shift at 07/21/2023 at 11:25 PM. Missing Resident Drill Forms Summary reflected that wander guard alarms were ignored and that wander guard alarms were not loud enough/staff reporting trouble hearing alarms. Residents Affected - Few Record review of Root Cause Analysis developed during facility ad hoc (when necessary) QAPI meeting on 07/20/2023 at 1:00 PM indicated root cause analysis of elopement to be the need for wander guard enhancements. Interview with RN A on 08/23/2023 at 3:07 PM, revealed that RN A was working on day of Resident #4 elopement on 07/19/2023. RN A stated that Resident #4 was wearing a wander guard at time of elopement. RN A stated that Resident #4 had been placed on one-to-one supervision on several occasions during facility stay for exit-seeking. RN A stated that prior to elopement incident on 07/19/2023, staff would silence wander guard alarms. Since the elopement incident of 07/19/2023, RN A stated that only licensed nurses can now silence alarms. RN A stated that he believed that Resident #4 had been gone 5-10 minutes before she was found outside on 07/19/2023. Interview with CNA F was done on 08/24/2023 at 11:18 AM. CNA F stated that she was working on 07/19/2023 when elopement incident with Resident #4 occurred. CNA F stated that everybody was looking for her (Resident #4). CNA F stated that she did not know how Resident #4 got outside. CNA F stated that Resident #4 was not gone long but was not able to state how long Resident #4 was gone. Interview with Social Worker on 08/25/23 at 1:17 PM revealed that Resident #4 was found by a neighbor (unknown name) that lived near the facility. The neighbor realized that Resident #4 was confused and called the facility to report her location. It was then that she was brought back to the facility by two staff members who went to pick her up and walk her back to facility. Social Worker stated that she did not believe that Resident #4 was injured during incident, Social Worker stated that she felt that Resident #4 was just dehydrated, flushed, and sweating. Social Worker stated that Resident #4 was given water when she returned to facility. Social Worker stated that police were not involved in search and that Resident #4 was gone for about 15-20 minutes. Interview with Family Member #4 was conducted on 08/23/2023 at 5:26 PM. Family Member #4 stated that she was made aware on 07/19/2023 afternoon that Resident #4 had left the facility. Family member #4 stated that facility had called her three times during Resident #4's stay from 07/05/2023 to 07/20/2023 to report that resident was missing. Resident #4 Family Member #4 stated that Resident #4 worn a bracelet, applied by facility staff, that would help prevent elopement. Family Member #4 stated that Resident #4 had a strong will to leave the facility and on the fourth attempt she got outside. Resident #4 Family Member #4 stated that facility offered to find placement for Resident #4 in a Memory Care Unit after 07/19/2023 elopement incident. Family Member #4 stated that she brought Resident #4 to her house the next day and has hired 24-hour caregivers for Resident #4. Family Member #4 stated that after the elopement incident, she was told that the facility gave her water right away because it was hot outside and facility staff believed that Resident #4 may have been dehydrated. Family Member #4 stated that she was not aware of any other harm caused by the elopement. Family Member #4 stated that staff accounts of incident led her to believe that Resident #4 was missing for 15-30 minutes at approximately 1:30 PM on 07/19/2023. Interview with ADM on 08/25/2023 at 10:57 AM, revealed that Resident #4, during her stay from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 13 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 07/05/2023 to 07/20/2023, had eloped to the outside of building one time and another time was found in a stair well. Actions taken after 07/19/2023 elopement incident included: root cause development, routine checks of wander guard when placed on residents and during duration of use by residents (order to check appears every shift on resident's treatment record to prompt nurses to check), and weekly door checks, with documentation log kept by maintenance, for properly working delayed egress mechanism. Per interview with ADM on 08/25/2023 at 10:57 AM, further actions taken after 07/19/2023 elopement incident included Missing Resident drills in immediate days following elopement and initiation of monthly Missing Resident drills. ADM stated that radios were now kept at nurse's station for enhanced communication. ADM stated that Security Guard now has a golf cart to check the premises when a resident is reported missing, and an emergency response warning is sent out to law enforcement officials when a resident is missing. ADM stated in interview on 08/23/2023 at 10:57 AM interview that elopement binders which include a copy of resident face sheet with photograph would be kept at each nurse's station and receptionist desk at entrance to facility. ADM further stated during 08/25/2023 at 10:57 AM interview that wander guard enhancements had been made which increased the alarm volume for staff when a resident wearing a wander guard gets close to the exit doors. Observations were conducted of live Missing Resident Drills on 08/23/2023 at 1630 (430pm) on floor 2 and on floor 3 with DON. No facility staff were observed silencing alarm. Two staff members on one floor were observed to continue other tasks during alarm period and drill and DON acknowledged that all staff should stop what they are doing and participate when there is a missing resident. DON stated on 08/24/2023 that a facility-wide elopement drill had been conducted since investigator observed drills of day prior, with good results. No sign-in sheet of this drill was produced when requested from DON for record review. Record review of facility Elopement Risk Policy dated 10/2022 defined elopement as a situation in which a resident leaves the premises or a safe area without the community's knowledge and supervision which may represent a risk to the resident's health and safety. Policy detail revealed that residents accepted for admission should be assessed upon admission into the Community and appropriate interventions should be established to respond to the resident's potential exit/elopement seeking behavior. Policy detail included completion of Elopement Risk Data sheet with photograph and placement in Elopement Risk Binder at Nurses Station, communication elopement risk to associates, elopement risk assessment on admission, quarterly, and as needed, and interventions will be documented in resident's Plan of Care. Policy on initiating wander guards, Resident Monitoring System policy, dated 10/2022, stated that Physician Orders should be placed for use of monitoring system, notification of Resident/Legal Representative, application according to manufacturer's instructions, monitoring of resident's comfort related to the device, verification of proper functioning. Policy revealed that placement of device should be checked every shift and documented, monitoring system should be inspected monthly and documented, and that recommendation will be made to physician for discontinuance of it has been determined that less restrictive measures can be accommodated. Record review of Elopement System Alarm Activation Policy, dated 10/2022, for wander guard alarms was reviewed. Policy stated that staff should go immediately to site of activation, alarmed door should remain alarming, the unsupervised resident should be identified or every resident with an elopement device should be accounted for, alarm will be reset by designated personnel, and if resident is unable to be located, Missing Resident policy will be enacted. Record review of Missing Resident Policy, dated 06/2017, revealed that a missing resident requires immediate attention. Missing Resident Policy, dated 06/2017, revealed that the following steps should be taken: verify if resident has signed out, obtain the time of last sighting, determine clothing that resident was wearing as well as cognitive and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 14 of 15 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 455866 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Westlake Hills 1034 Liberty Park Dr Austin, TX 78746 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few emotional status, obtain height and weight and other descriptive characteristics of missing resident. Missing Resident Policy, dated 06/2017, stated that the Missing Resident Response Worksheet should be initiated followed by a thorough interior search of the building. Security would then be notified to begin search of outside grounds, using security vehicle if needed. ADM and DON are to be notified as well medical provider. Lastly, provide the Missing Resident Profile with a picture of resident to local law enforcement. When a resident is located, per Missing Resident policy, dated 06/2017, the resident should be reviewed for injuries, an incident report should be completed, medical provider should be notified and resident will be transferred to higher level of care if needed. Resident will be assigned one-on-one supervision until reassessment determined future placement needs. On 08/25/2023 at 05:50 PM, a past non-compliance IJ was identified. The ADM was notified and provided the IJ template. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 15 of 15