Inspection·January 26, 2024

F 0607 Review of Resident #11's Care Plan, revised date 01/25/24 reflected: Level of Harm - Minimal harm or potential for actual harm Focus: [Resident #11] is at risk for integument impairment. Resident had a history of a burn at right upper thigh from a hot liquids spill and is at risk for hot liquid spills. Goal: Resident will be free from skin breakdown through review date. Resident will be free from injury through the review date. Interventions: Resident requires set up/supervision with all meals to include ensuring a cap/lid are on all hot liquids. Residents Affected - Few Focus: Resident has dx of Parkinson's, she has impaired muscle strength and coordination due to Parkinson tremors. She is at risk for hot liquid injury from hot beverages ie tea/coffee/cocoa. Goal: Resident will have no injury from hot liquids through review date. Interventions: Provide lid on hot beverages to prevent spills, staff to assist in opening the lids, setting up the tray for patient as needed. Focus: Resident had a history of a burn at right upper thigh from a hot liquids spill and is at risk for hot liquid spills. Goal: Resident will be free from injury through the review date. Interventions: Resident requires set up/supervision with all meals to include ensuring a cap/lid are on all hot liquids. Educate resident/family/caregivers of causative factors and measures to prevent skin injury. Review of the facility Incident Log date range from 08/24/23 to 01/24/24 revealed the following: Person involved in Incident: Resident #11 Date of incident: 09/12/23 Name of Associate Assigned to Resident at the time of the incident: CNA K Location of Incident: Resident Room. Nature of Incident: Miscellaneous - Scalding Type of Injury/Impairment: Burn Part(s) of Body Injured: Hip (right) Initial Actions Take: Applied First Aid, Checked for Injury, Notify emergency contact. Severity Code: 2- Harm/Injury without outside treatment and/or observation Additional Facts not Refenced Above: On the night of 9/12/23, while assigned to CNA K and LVN X, Resident #11 requested a piece of pizza and tea between 4-5AM. CNA K obtained the water for the tea from the hot water dispenser in the kitchen. She delivered the food and tea to Resident #11and when exiting the room turned off the lights and closed the door per Resident #11's request. Resident #11 dropped her tea in bed which resulted in a burn on her right hip. CNA K answered the call light, observed the accident/spill and notified LVN X. First aid was provided, RP and physician were notified. During the investigation, it was determined that Resident #11 has a history of requesting her door to be closed and lights turned off during night hours. It was also discovered that Resident #11 CNA from 6-2 [6:00 AM-2:00 PM] that she had requested CNA K to close the door and turn off the lights. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 2 of 42 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 01/26/2024 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 0607 Level of Harm - Minimal harm or potential for actual harm Interventions: Resident #11 will be encouraged to keep light on when eating at night. Drinks to be served with a lid when drinking hot liquids. Follow up: (10/04/23 [Administrator]) During investigation - it was determined that the hot water dispenser has been dispensing water below the recommended serving temps for hot liquids. Residents Affected - Few Review of Resident #11's Hot Liquids Safety Data Collection dated 09/12/23 revealed resident was at risk of hot liquid injury. Task: Resident to use cup with lid. Review of Resident #11's progress note documented by LVN X on 09/12/23 at 5:24 AM revealed the following: Situation: The Change in Condition/s reported on this CIC Evaluation are/were: Skin wound or ulcer. Skin Status Evaluation: Skin tear. Pain Status Evaluation: Does the resident/patient have pain? Yes. Neurological Status Evaluation: Nursing observations, evaluation, and recommendations are: On observation and assessment, the skin tear looked like a blister that had popped. It would need some kind of ointment to rub on in order to heel. Review of Resident #11's progress note documented by LVN X on 09/12/23 at 17:00 [5:00PM] revealed the following: F/U hot liquid injury. alert and oriented x3, v/s stable. burn area to right hip. treatment completed as ordered. medicated x2 for pain and effective. no distress noted. Review of Resident #11's wound physician note dated 09/13/23 revealed the following: Patient present with a wound on her right hip. Burn wound of the right hip full thickness. Etiology (quality) Burn. Wound Size (L x W x D): 11.5 x 5.5 x 0.3 cm. Surface Area: 63.25 cm². Cluster Wound: open ulceration area of 37.95 cm². Exudate: Moderate Serous. Granulation tissue: 20%. Skin: 40%. Site 1: Surgical excisional debridement procedure: Indication for procedure: Remove Necrotic Tissue and Establish the Margins of Viable Tissue, Remove Thick Adherent Eschar and Devitalized Tissue. Consent for procedure: Treatment options-risks-benefits and the possible need for subsequent additional procedures on this wound were explained on 09/13/2023 to the patient who indicated agreement to proceed with the procedure(s). Procedure Notes: The wound was cleansed with normal saline and anesthesia was achieved using 2% lidocaine jelly. Then with clean surgical technique, 15 blade was used to surgically excise 6.32cm² of devitalized tissue including slough, biofilm and non-viable subcutaneous level tissues were removed at a depth of 0.3 cm and healthy bleeding tissue was observed. As a result of this procedure, the nonviable tissue in the wound bed decreased from 10 percent to 0 percent. Hemostasis was achieved and a clean dressing was applied. Post-operative recommendations and updates to the plan of care are documented in the Assessment and Plan section below. Plan of care reviewed and addressed: The best medical estimate of the time required for this wound to heal with continued physician evaluation and intervention is 109 days. This estimate is made with an 80% degree of certainty. Review of Resident #11's progress note from Physician on 09/15/23 at 13:30 [1:30PM] revealed the following: *** Chief Complaint ***Acute Issue Pt [patient] is seen lying in bed [with] NAD exhibited. Pain reported to R [right] hip. 1st>>2nd degree burn from hot tea this am appx 0500 to R [right] thigh. Mixed intact bulla [fluid blister] [with] ruptured bulla [fluid blister] areas and exposed skin. Area is dry. Entire irregular shaped area appx 15cmx4cm. Pt reports increased pain to the area. Discussed plan [with] Pt [patient] and [family member] on the phone. Initially- Cleanse [with] NS [normal saline] and apply bacitracin [ointment] bid [twice a day], LOTA for now [with] loose brief on that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 3 of 42 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 01/26/2024 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few time. If bullas rupture and wound begins to drain then we will need dressing. Dry at this time. Wound care team to f/u [follow-up] in am. Schedule her oxy 2.5mg q12h x 3 days and keep2.5mg q6h available, cont apap1000mg TID. Therapy Clarification from therapy regarding transfers/toileting. Going forward, the safest thing for [Resident #11] and the staff caring for her would be for [Resident #11] to be using a bed pan for toileting or a brief for incontinent episodes. She requires the hoyer lift for transfers, and it would not be feasible or safe to use the hoyer lift to transfer to the toilet or a bedside .Burn of skin - Onset: 09/12/2023. Review of facility Incident Investigation completed by Administrator, dated 09/15/23, revealed the following: Summary of Incident: On 09/12/23 between 3-5AM, [Resident #11] requested pizza and tea from [CNA K]. [CNA K] warmed up her leftover pizza and obtained her Tea from the kitchen. CNA K setup her tea (that had a lid) and pizza on her bedside table. [Resident #11], when attempting to grab her tea knocked it over and tea spilled on her right leg. This resulted in a second-degree burn. Investigation: 09/12/23 [Resident #11] expressed that her leg was hurting due to her spilling her tea on herself. On 09/15/23 [Resident #11] explained that [CNA K] brought her tea and she spilled it on herself. When asked what happened she said it spilled out of her hands when attempting to drink. She did mention that the room was dark and she could have grabbed the wrong end of the drink. Associated Interview: [CNA K] stated [Resident #11] requested that [I] bring her tea and pizza. [I] warmed up her left-over pizza and grabbed the water/tea bags. [I] placed it by her bed don the table and left the room. When [I] left she asked me to close the door and turn the light off. She did not call me back in the room until after she [split] the tea. [LVN X] stated [I] completed the incident report when [CNA K] came and got me telling me [Resident #11] spilled her tea. [I] notified the physician and family and performed the care as ordered. Visitor/Vendor Interview: 09/15/23 Spoke with resident family regarding the incident. She stated she did not have any concerns but wants to avoid the situation moving forward. [I] discussed interventions with her. She requested that we discuss next week as . she is pre-occupied. She was thankful that [I] I reached out and stated mom loves you and says [Administrator] will take care of me and knows we take good care of her mother. Timeline: Between 4-5:30AM: [Resident #11] request tea and pizza. Between 4-5:30AM: [CNA K] provides pizza and tea. Between 4-5:30AM: [Resident #11] spills her tea. Between 5:26AM: [CNA K] notifies [LVN X] Conclusion: Supporting statement. Unconfirmed After getting statements from all involved, [Facility] came to the conclusion that this was an accident that was the result of [Resident #11] request for her door to be closed and lights turned off (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 4 of 42 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 01/26/2024 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 0607 Level of Harm - Minimal harm or potential for actual harm potentially causing her to grab the wrong end of the cup/hands slipping. This is a consistent request of hers during night hours dating back to her days in assisting living. We are agreeance that staff should encourage [Resident #11] to leave a light on when eating/drinking. The water for the tea that [Resident #11] was drinking was obtained from our kitchen hot water brewer. The hot water brewer is set for 175 degrees. Dining Director reviewed brewing guidelines, confirmed brewer was within guidelines at 170. Residents Affected - Few Immediate Actions Taken: Resident Evaluation and/or Treatment. Notifications of District/Regional Nurse and RVP/DDO. Notifications of Responsible Party, Notifications of Physician Post Investigation Actions: Care Plan updates, In-serviced/Associate Re-training, Tasks Updated, Family Updated. Review of Resident #11's wound physician note dated 11/29/23 revealed the following: Burn wound of the right hip (resolved on 11/29/23) Duration > (greater than) 74 days. Wound progress: Resolved. Anatomic location of previously existing wound examined today: Epithelialized and Resolved. Follow up only as needed. Observation and interview on 01/23/224 at 11:20 AM revealed Resident #11 lying in bed. Resident #11 stated she was doing well. Observed Resident #11 to have a sippy cup that had tea. Resident #11 denied any concerns regarding her care. Review on 01/24/24 at 10:15 AM of facility Resident Council Notes dated 12/07/23 revealed an issue made by Resident#11, which reflected the following: Why am I being billed for wound care when I got burnt due to the negligence of the staff? Administrator visited [Resident #11] personally and spoke to her about the bill and that she would not be charged for wound care. Follow-up observation and interview on 01/24/24 at 10:20 AM revealed Resident #11 lying in bed. Resident #11 stated last year in September 2023 she had asked CNA K for tea; she stated it was early in the morning. She stated CNA K came in her room and placed the tea on her bedside table, she stated the bedside table was above her within reach. She stated the tea was in a white styrofoam cup with a lid on. She stated CNA K turned off her lights and closed the door when she left. She stated the room was dark and could not see. She stated she tried to get her tea when she spilled it. Resident #11 stated she felt pain right away and she pushed her call light for help and a few second later CNA K entered her room. She stated CNA K called LVN X for help and they cleaned her up. She stated the burn caused a blister to her right hip. Resident #11 stated had a cover over her when the tea spilled and it still cause a burn. Resident #11 stated she received wound care for a couple of months. She stated the burn had healed. Observed Resident #11's skin to the right thigh with no visible wound or scar. Resident #11 stated she could not recall if she asked CNA K to turn off the light or to leave them on. She stated the following day CNA K entered her room and that made her upset and she notified the Administrator she no longer wanted CNA K to enter her room. She stated since the incident she had not seen CNA K. Resident #11 stated she only drinks her hot tea in her special cup with a lid on. Interview on 01/24/24 at 12:48 PM with Resident #11's Family Member-1 revealed in September 2023 she received a call from the facility notifying them of the burn that Resident #11 sustained. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 5 of 42 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 01/26/2024 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #11's Family Member-1 stated she was informed Resident #11 had requested tea early in the morning and Resident #11 requested her lights to be turned off and when Resident #11 tried to get the tea it slipped on her. While on the phone with Resident #11's Family Member-1 another Family Member-2 got on the phone who stated when they asked the Administrator how hot the water was the Administrator responded with inappropriate temperature, Family Member-2 stated they were not satisfied with his response. Family Member-2 stated the water must had been really hot for it to cause a bad burn within second. Family Member-2 stated their concern is not just for Resident #11 but for all the resident in the facility who drink tea or coffee. Resident #11's Family Member-1 stated she did not make a big deal of the situation due to Resident #11 diagnosis of Parkinson and the incident could had been an accident. An attempt was made on 01/24/24 at 3:04 PM to contact LVN X; however, there was no response. Interview on 01/24/24/ at 3:28 PM with CNA K revealed she was the CNA assigned to Resident #11 when the burn incident happened. CNA K stated between 4:00 AM-5:00 AM in the morning Resident #11 requested hot tea. She stated she got the hot water from the 2nd floor service kitchen hot water brewer and then added the tea bag. She stated she placed a lid on the cup and took it to Resident #11 room. CNA K stated she placed the teacup on the resident bedside table, within reach. She stated she notified Resident #11 of the hot tea being placed on the bed side table. She stated Resident #11 requested for the door to be closed. She stated the room was not dark, there was natural light, Resident #11 had a bedside lamp on and the bathroom light was on and the door was slightly open. She stated she continued to do her rounds when Resident #11 pushed her call light on. CNA K stated she went in the room and Resident #11 told her she had spilled her tea. She stated she called for LVN X and they cleaned Resident #11. She stated Resident #11 sustained a burn. CNA K stated she could not recall how hot the water of the tea was. CNA K stated she was in-serviced on safety measure. CNA K stated they had a service kitchen on the 2nd floor and 3rd floor, and staff obtain hot water from the hot water brewer. She stated they used the hot water brewer to make hot beverages. She stated since the incident she had not worked with Resident #11, she stated she was moved to another hall. Interview on 01/25/24 at 1:39 PM with the DON revealed at first, she could not recall the incident regarding Resident #11 burn; however, after reviewing Resident #11 clinical records it appeared the burn was an accident. She stated at the time of the incident Resident #11 could state what happened and it was an accident. The DON stated they did the best they could to take care of Resident #11. The DON stated the administrator was responsible for reporting incidents to the State. Interview on 01/25/24 at 2:15 PM with the Administrator revealed after conducting his own investigation and consulting with all staff departments it was determined Resident #11 incident was an accident and it did not need to be reported to the state. He stated Resident #11 injury was not an injury of unknown origin due resident being able to state how the incident happened. The Administrator stated Resident #11 family was notified of the incident and they did not have any concerns. He stated the only complaint he had about the incident was in December 2023 when Resident #11 was upset about her wound care bill. He stated he spoke to Resident #11 and told her she would not be charged for the wound care supplies. The Administrator stated they had no issue covering a $60 charge for someone who pays $10,000 a month for her care. The Administrator stated he was responsible for reporting any abuse or neglect incidents to the state; however, this incident was not reportable due to them knowing what happened and due to them following Resident #11 wishes with turning off all of her lights when she requested it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 6 of 42 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 01/26/2024 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, which included injuries of unknown source and misappropriation of resident property, were reported immediately, but no later than 2 hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, or not later than 24 hours if the events that caused the allegation did not involve abuse and did not result in serious bodily injury, to the administrator of the facility and to other officials, which included the state survey agency, in accordance with State law through established procedures for 1 of 6 residents (Resident #11) reviewed for abuse and neglect. The facility did not report to the State Survey Agency when Resident #11 sustained a second degree burn after spilling hot tea on herself which required wound care from 09/13/23-11/29/23. This deficient practice could affect any resident and contribute to further resident neglect. Findings included: Review of Resident #11's Face Sheet dated 01/26/24 revealed she was a [AGE] year-old female who initially admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included Parkinson's disease (disorder that affects the nervous system) without dyskinesia (a movement disorder that often appears as uncontrolled shakes, tics, or tremor), abnormal posture, muscle weakness, pain, and other lack of coordination. Review of Resident #11's Significant change in status MDS assessment, dated 01/11/24, reflected a BIMS score of 13 indicating no cognitive impairment. Resident #11 required partial/moderate assistance of one person for eating. Review of Resident #11's Care Plan, revised date 01/25/24 reflected: Focus: [Resident #11] is at risk for integument impairment. Resident had a history of a burn at right upper thigh from a hot liquids spill and is at risk for hot liquid spills. Goal: Resident will be free from skin breakdown through review date. Resident will be free from injury through the review date. Interventions: Resident requires set up/supervision with all meals to include ensuring a cap/lid are on all hot liquids. Focus: Resident has dx of Parkinson's, she has impaired muscle strength and coordination due to Parkinson tremors. She is at risk for hot liquid injury from hot beverages ie tea/coffee/cocoa. Goal: Resident will have no injury from hot liquids through review date. Interventions: Provide lid on hot beverages to prevent spills, staff to assist in opening the lids, setting up the tray for patient as needed. Focus: Resident had a history of a burn at right upper thigh from a hot liquids spill and is at risk for hot liquid spills. Goal: Resident will be free from injury through the review date. Interventions: Resident requires set up/supervision with all meals to include ensuring a cap/lid are on all hot liquids. Educate resident/family/caregivers of causative factors and measures to prevent skin injury. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 7 of 42 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 01/26/2024 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 0609 Review of the facility Incident Log date range from 08/24/23 to 01/24/24 revealed the following: Level of Harm - Minimal harm or potential for actual harm Person involved in Incident: Resident #11 Date of incident: 09/12/23 Residents Affected - Few Name of Associate Assigned to Resident at the time of the incident: CNA K Location of Incident: Resident Room. Nature of Incident: Miscellaneous - Scalding Type of Injury/Impairment: Burn Part(s) of Body Injured: Hip (right) Initial Actions Take: Applied First Aid, Checked for Injury, Notify emergency contact. Severity Code: 2- Harm/Injury without outside treatment and/or observation Additional Facts not Refenced Above: On the night of 9/12/23, while assigned to CNA K and LVN X, Resident #11 requested a piece of pizza and tea between 4-5AM. CNA K obtained the water for the tea from the hot water dispenser in the kitchen. She delivered the food and tea to Resident #11and when exiting the room turned off the lights and closed the door per Resident #11's request. Resident #11 dropped her tea in bed which resulted in a burn on her right hip. CNA K answered the call light, observed the accident/spill and notified LVN X. First aid was provided, RP and physician were notified. During the investigation, it was determined that Resident #11 has a history of requesting her door to be closed and lights turned off during night hours. It was also discovered that Resident #11 CNA from 6-2 that she had requested CNA K to close the door and turn off the lights. Interventions: Resident #11 will be encouraged to keep light on when eating at night. Drinks to be served with a lid when drinking hot liquids. Follow up: (10/04/23 [Administrator]) During investigation - it was determined that the hot water dispenser has been dispensing water below the recommended serving temps for hot liquids. Review of Resident #11's Hot Liquids Safety Data Collection dated 09/12/23 revealed resident was at risk of hot liquid injury. Task: Resident to use cup with lid. Review of Resident #11's progress note documented by LVN X on 09/12/23 at 5:24 AM revealed the following: Situation: The Change in Condition/s reported on this CIC Evaluation are/were: Skin wound or ulcer. Skin Status Evaluation: Skin tear. Pain Status Evaluation: Does the resident/patient have pain? Yes. Neurological Status Evaluation: Nursing observations, evaluation, and recommendations are: On observation and assessment, the skin tear looked like a blister that had popped. It would need some kind of ointment to rub on in order to heel. Review of Resident #11's progress note documented by LVN X on 09/12/23 at 17:00 [5:00PM] revealed the following: F/U hot liquid injury. alert and oriented x3, v/s stable. burn area to right hip. treatment completed as ordered. medicated x2 for pain and effective. no distress noted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 8 of 42 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 01/26/2024 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 0609 Review of Resident #11's wound physician note dated 09/13/23 revealed the following: Level of Harm - Minimal harm or potential for actual harm Patient present with a wound on her right hip. Burn wound of the right hip full thickness. Etiology (quality) Burn. Wound Size (L x W x D): 11.5 x 5.5 x 0.3 cm. Surface Area: 63.25 cm². Cluster Wound: open ulceration area of 37.95 cm². Exudate: Moderate Serous. Granulation tissue: 20 %. Skin: 40 %. Site 1: Surgical excisional debridement procedure: Indication for procedure: Remove Necrotic Tissue and Establish the Margins of Viable Tissue, Remove Thick Adherent Eschar and Devitalized Tissue. Consent for procedure: Treatment options-risks-benefits and the possible need for subsequent additional procedures on this wound were explained on 09/13/2023 to the patient who indicated agreement to proceed with the procedure(s). Procedure Notes: The wound was cleansed with normal saline and anesthesia was achieved using 2% lidocaine jelly. Then with clean surgical technique, 15 blade was used to surgically excise 6.32cm² of devitalized tissue including slough, biofilm and non-viable subcutaneous level tissues were removed at a depth of 0.3 cm and healthy bleeding tissue was observed. As a result of this procedure, the nonviable tissue in the wound bed decreased from 10 percent to 0 percent. Hemostasis was achieved and a clean dressing was applied. Post-operative recommendations and updates to the plan of care are documented in the Assessment and Plan section below. Plan of care reviewed and addressed: The best medical estimate of the time required for this wound to heal with continued physician evaluation and intervention is 109 days. This estimate is made with an 80% degree of certainty. Residents Affected - Few Review of Resident #11's progress note from Physician on 09/15/23 at 13:30 [1:30PM] revealed the following: *** Chief Complaint ***Acute Issue Pt [patient] is seen lying in bed [with] NAD exhibited. Pain reported to R [right] hip. 1st>>2nddegree burn from hot tea this am appx 0500 to R [right] thigh. Mixed intact bulla [fluid blister] [with] ruptured bulla [fluid blister] areas and exposed skin. Area is dry. Entire irregular shaped area appx 15cmx4cm. Pt reports increased pain to the area. Discussed plan [with] Pt [patient] and [family member] on the phone. Initially- Cleanse [with] NS [normal saline] and apply bacitracin [ointment] bid [twice a day], LOTA for now [with] loose brief on that time. If bullas rupture and wound begins to drain then we will need dressing. Dry at this time. Wound care team to f/u [follow-up] in am. Schedule her oxy 2.5mg q12h x 3 days and keep2.5mg q6h available, cont apap1000mg TID. Therapy Clarification from therapy regarding transfers/toileting. Going forward, the safest thing for [Resident #11] and the staff caring for her would be for [Resident #11] to be using a bed pan for toileting or a brief for incontinent episodes. She requires the hoyer lift for transfers, and it would not be feasible or safe to use the hoyer lift to transfer to the toilet or a bedside .Burn of skin - Onset: 09/12/2023. Review of facility Incident Investigation completed by Administrator, dated 09/15/23, revealed the following: Summary of Incident: On 09/12/23 between 3-5AM, [Resident #11] requested pizza and tea from CNA K. CNA K warmed up her leftover pizza and obtained her Tea from the kitchen. CNA K setup her tea (that had a lid) and pizza on her bedside table. Resident #11, when attempting to grab her tea knocked it over and tea spilled on her right leg. This resulted in a second-degree burn. Investigation: 09/12/23 [Resident #11] expressed that her leg was hurting due to her spilling her tea on herself. On 09/15/23 [Resident #11] explained that CNA K brought her tea and she spilled it on herself. When asked what happened she said it spilled out of her hands when attempting to drink. She did mention that the room was dark and she could have grabbed the wrong end of the drink. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 9 of 42 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 01/26/2024 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Associated Interview: CNA K stated [Resident #11] requested that [I] bring her tea and pizza. [I] warmed up her left-over pizza and grabbed the water/tea bags. [I] placed it by her bed don the table and left the room. When [I] left she asked me to close the door and turn the light off. She did not call me back in the room until after she [split] the tea. LVN X stated [I] completed the incident report when CNA K came and got me telling me [Resident #11] spilled her tea. [I] notified the physician and family and performed the care as ordered. Visitor/Vendor Interview: 09/15/23 Spoke with resident family regarding the incident. She stated she did not have any concerns but wants to avoid the situation moving forward. [I] discussed interventions with her. She requested that we discuss next week as . she is pre-occupied. She was thankful that [I] I reached out and stated mom loves you and says [Administrator] will take care of me and knows we take good care of her mother. Timeline: Between 4-5:30AM: [Resident #11] request tea and pizza. Between 4-5:30AM: [CNA K] provides pizza and tea. Between 4-5:30AM: [Resident #11] spills her tea. Between 5:26AM: [CNA K] notifies LVN X Conclusion: Supporting statement. Unconfirmed After getting statements from all involved, [Facility] came to the conclusion that this was an accident that was the result of [Resident #11] request for her door to be closed and lights turned off potentially causing her to grab the wrong end of the cup/hands slipping. This is a consistent request of hers during night hours dating back to her days in assisting living. We are agreeance that staff should encourage [Resident #11] to leave a light on when eating/drinking. The water for the tea that [Resident #11] was drinking was obtained from our kitchen hot water brewer. The hot water brewer is set for 175 degrees. Dining Director reviewed brewing guidelines, confirmed brewer was within guidelines at 170. Immediate Actions Taken: Resident Evaluation and/or Treatment. Notifications of District/Regional Nurse and RVP/DDO. Notifications of Responsible Party, Notifications of Physician Post Investigation Actions: Care Plan updates, In-serviced/Associate Re-training, Tasks Updated, Family Updated. Review of Resident #11's wound physician note dated 11/29/23 revealed the following: Burn wound of the right hip (resolved on 11/29/23) Duration > (greater than) 74 days. Wound progress: Resolved. Anatomic location of previously existing wound examined today: Epithelialized and Resolved. Follow up only as needed. Observation and interview on 01/23/224 at 11:20 AM revealed Resident #11 lying in bed. Resident #11 stated she was doing well. Observed Resident #11 to have a sippy cup that had tea. Resident #11 denied any concerns regarding her care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 10 of 42 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 01/26/2024 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review on 01/24/24 at 10:15 AM of facility Resident Council Notes dated December 07,2023 revealed an issue made by Resident#11 stating, Why am [I] being billed for wound care when I got burnt due to the negligence of the staff? Administrator visited Resident #11 personally and spoke to her about the bill and that she would not be charged for wound care. Follow-up observation and interview on 01/24/24 at 10:20 AM revealed Resident #11 lying in bed. Resident #11 stated last year in September 2023 she had asked CNA K for tea; she stated it was early in the morning. She stated CNA K came in her room and placed the tea on her bedside table, she stated the bedside table was above her within reach. She stated the tea was in a white styrofoam cup with a lid on. She stated CNA K turned off her lights and closed the door when she left. She stated the room was dark and could not see. She stated she tried to get her tea when she spilled it. Resident #11 stated she felt pain right away and she pushed her call light for help and a few second later CNA K entered her room. She stated CNA K called LVN X for help and they cleaned her up. She stated the burn caused a blister to her right hip. Resident #11 stated had a cover over her when the tea spilled and it still cause a burn. Resident #11 stated she received wound care for a couple of months. She stated the burn had healed. Observed Resident #11 skin to the right thigh with no visible wound or scar. Resident #11 stated she could not recall if she asked CNA K to turn off the light or to leave them on. She stated the following day CNA K entered her room and that made her upset and she notified the Administrator she no longer wanted CNA K to enter her room. She stated since the incident she had not seen CNA K. Resident #11 stated she only drinks her hot tea in her special cup with a lid on. Interview on 01/24/24 at 12:48 PM with Resident #11's Family Member-1 revealed in September 2023 she received a call from the facility notifying them of the burn that Resident #11 sustained. Resident #11's Family Member-1 stated she was informed Resident #11 had requested tea early in the morning and Resident #11 requested her lights to be turned off and when Resident #11 tried to get the tea it slipped on her. While on the phone with Resident #11's Family Member-1 another Family Member-2 got on the phone who stated when they asked the Administrator how hot the water was the Administrator responded with inappropriate temperature, Family Member-2 stated they were not satisfied with his response. Family Member-2 stated the water must had been really hot for it to cause a bad burn within second. Family Member-2 stated their concern is not just for Resident #11 but for all the resident in the facility who drink tea or coffee. Resident #11's Family Member-1 stated she did not make a big deal of the situation due to Resident #11 diagnosis of Parkinson and the incident could had been an accident. An attempt was made on 01/24/24 at 3:04 PM to contact LVN X; however, there was no response. Interview on 01/24/24/ at 3:28 PM with CNA K revealed she was the CNA assigned to Resident #11 when the burn incident happened. CNA K stated between 4-5 in the morning Resident #11 requested hot tea. She stated she got the hot water from the 2nd floor service kitchen hot water brewer and then added the tea bag. She stated she placed a lid on the cup and took it to Resident #11 room. CNA K stated she placed the teacup on the resident bedside table, within reach. She stated she notified Resident #11 of the hot tea being placed on the bed side table. She stated Resident #11 requested for the door to be closed. She stated the room was not dark, there was natural light, Resident #11 had a bedside lamp on and the bathroom light was on and the door was slightly open. She stated she continued to do her rounds when Resident #11 pushed her call light on. CNA K stated she went in the room and Resident #11 told her she had spilled her tea. She stated she called for LVN X and they cleaned Resident #11. She stated Resident #11 sustained a burn. CNA K stated she could not recall how hot the water of the tea was. CNA K stated she was in-serviced on safety measure. CNA K stated they had a service kitchen on the 2nd floor and 3rd floor, and staff obtain hot water from the hot water brewer. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 11 of 42 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 01/26/2024 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated they used the hot water brewer to make hot beverages. She stated since the incident she had not worked with Resident #11, she stated she was moved to another hall. Interview on 01/25/24 at 1:39 PM with the DON revealed at first, she could not recall the incident regarding Resident #11 burn; however, after reviewing Resident #11 clinical records it appeared the burn was an accident. She stated at the time of the incident Resident #11 could state what happened and it was an accident. The DON stated they did the best they could to take care of Resident #11. The DON stated the administrator was responsible for reporting incidents to the state. Interview on 01/25/24 at 2:15 PM with the Administrator revealed after conducting his own investigation and consulting with all staff departments it was determined Resident #11 incident was an accident and it did not need to be reported to the state. He stated Resident #11 injury was not an injury of unknown origin due resident being able to state how the incident happened. The Administrator stated Resident #11 family was notified of the incident and they did not have any concerns. He stated the only complaint he had about the incident was in December 2023 when Resident #11 was upset about her wound care bill. He stated he spoke to Resident #11 and told her she would not be charged for the wound care supplies. The Administrator stated they had no issue covering a $60 charge for someone who pays $10,000 a month for her care. The Administrator stated he was responsible for reporting any abuse or neglect incidents to the state; however, this incident was not reportable due to them knowing what happened and due to them following Resident #11 wishes with turning off all of her lights when she requested it. Record review of the facility Abuse, Neglect & Exploitation policy, revised date 05/2021 revealed the following: The resident has the right to be free from abuse, neglect, mistreatment, misappropriation of resident property, and exploitation . Adverse Event: An untoward, undesirable, and usually unanticipated even that causes death or serious injury, or the risk thereof. Neglect: Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. External Reporting: All alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source and misappropriation of resident property shall be reported: a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involved abuse or results in serious bodily injury or no later than 24 hours if the events that cause the allegation do not involved abuse and do not result in serious bodily injury. c. Such alleged violation shall be reported to the State Survey Agency. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 12 of 42 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 01/26/2024 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a baseline care plan within 48 hours of admission for 2 of 6 residents (Resident #4 and Resident #209) reviewed for baseline care plans. The facility failed to ensure Residents #4 and Resident #209 had a baseline care plan, or conversely a comprehensive care plan, within 48 hours of admission. These failures could place the residents at risk of not having their needs and preferences met. Findings included: 1. Review of Resident # 4's admission Record dated 01/26/24 revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included Pulmonary Embolism with Acute Cor Pulmonale (enlargement and failure of the right ventricle of the heart/due to high blood pressure), muscle weakness, need for assistance with personal care, Type 2 Diabetes ( high blood sugar levels), hyperlipidemia (high level of fats/cholesterol), high blood pressure, heart attack, presence of coronary angioplasty implant and graft (treatment of narrowing arteries). Review of Resident #4's admission MDS, dated [DATE], revealed a BIMS score of 11, indicating no cognitive impairment. Her MDS indicated received oxygen therapy on admission and while a resident. Review of Resident #4's baseline care plan reviewed on 01/23/24 did not address oxygen use. Record review of Resident #4's physician orders dated 01/2024 did not address oxygen therapy. Record review of Resident #4's progress notes dated 01/1/24 at 6:18 PM revealed Evaluation Summary Note indicated arrived on stretcher status post hospitalization for pulmonary embolism. Denies chest pain or shortness of breath. Alert and oriented to person, place and time, lungs have clear breathing sounds. Shortness of Breath, on continuous oxygen 2 litters nasal cannula. Interview and observation on 01/23/24 at 12:18 PM with Resident #4 revealed she entered the facility with the use of oxygen. Resident #4 stated she had issues with breathing without the use of oxygen. Resident #4 stated she needed to use oxygen at all times so that she could be able to work with staff to build her strength for daily activities, therapy and to return home. 2. Review of Resident #209's admission Record dated 01/26/24 revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included surgery on the digestive system, need for assistance with personal care, obstructive and reflux uropathy (blockage of urine), gastro-esophageal reflux disease (contents of the stomach move back up your esophagus), intestinal obstruction, benign prostatic hyperplasia (enlarged prostate), retention of urine, ileostomy, high blood pressure. Review of Resident #209's admission MDS, dated [DATE], revealed a BIMS score of 15, indicating he was cognitively intact. His Functional Status indicated he required partial/moderate assistance with toileting, lower body dressing, and personal hygiene, supervision for upper body dressing. Bowel and Bladder indicated indwelling catheter and ostomy, always incontinent of urine and frequently (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 13 of 42 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 01/26/2024 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 0655 incontinent of bowel. Level of Harm - Minimal harm or potential for actual harm Review of Resident #209's baseline care plan reviewed on 01/23/24 did not address ostomy use. Record review of Resident #209's physician orders dated 01/2024 did not address ostomy use. Residents Affected - Few Record review of Resident #209's progress notes dated 01/11/24 revealed nursing admission note indicated Resident #209 alert and oriented to person, place, time, and situation, entered the facility with diagnosis large bowel obstruction post status Ileostomy. Long abdominal incision well approximated with staples in place. Interview on 01/23/24 at 3:26 PM with Resident #209 revealed he entered the facility with the colostomy bag. Resident #209 stated he had an issue of staff coming in to empty the bag. The resident stated, They did not empty my colostomy bag and it poured out. Why do I need to tell them to empty? They should know to check it to see if it needed to be emptied. According to Resident #209 he had visitors all the time and would not want to have this happen while visiting with friends and family. Observation and interview on 01/25/24 at 9:28 AM with LVN O revealed she could not find an oxygen orders for Resident #4. She stated she thought resident did have an order because she was on oxygen while in the hospital, which indicated she should have an order in the system upon admission. LVN O stated there should be an order for Resident #4 to receive oxygen. LVN O stated when Resident #4 entered the facility and nursing assessment was completed, the assessment was used to create the baseline care plan so that we are able to know how to best care for Resident #4. LVN O stated there were no risk to her receiving oxygen. She also stated Resident #4 required the oxygen due to exertion which caused her oxygen levels to drop, so it was helping her right now. LVN O stated the facility failed to have an order posted. LVN O stated it was the responsibility of the admitting nurse to enter the order for oxygen, so that she would have it and it could be properly maintained. Interview on 01/25/24 at 1:01 PM with RN P revealed Resident #209 entered the facility on the 2nd floor and was later moved to the 3rd floor. RN P stated when a resident was admitted to the facility it was the responsibility of the nurse that completed the admission to enter all critical information at that time, which will initiate Resident #209's baseline care plan. According to RN P, she was looking over orders and noticed he did not have orders for his ileostomy or the care for it. RN P stated the facility had a template in the clinical records for residents that come in the facility with diagnosis like ileostomy, so she did not have to get an order to complete care, she stated the facility expected us to carry out the care properly. RN P stated Resident #209 was not with any risks because the nursing staff was aware that he had the ileostomy. Interview on 01/25/24 at 1:36 PM with the MDS Coordinator revealed the admitting nurse was responsible to enter physician orders into the system and complete an assessment that would create an initial care plan that will populate focus, goals, and interventions for the baseline care plan. The MDS Coordinator stated once that baseline care plan was created, he then reviews it, interview the resident, and goes over it during their care plan meetings so that it could be implemented or updated in the comprehensive care plan. Interview on 01/25/24 at 1:47 PM with the MDS Coordinator Director revealed updates to baseline care plans are usually done within 7 days of admission. MDS Coordinator stated updates for both Resident #4 and Resident #209 should have taken place beginning 01/18/24 however due to the annual survey she redirected staff's responsibilities which put the care plan updates behind schedule. The MDS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 14 of 42 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 01/26/2024 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinator stated not having a complete baseline care plan placed residents at risks of receiving improper treatment and care; staff not being aware of resident needs. Interview on 01/25/24 at 04:32 PM with the DON revealed she was not aware there were no orders regarding Resident #4's oxygen use or Resident #209's ileostomy. The DON stated Resident #4 had care plan meeting which her need for oxygen was identified. The DON stated admitting nurses have authority to contact the physician or their Nurse Practitioners to get an order for oxygen. The DON stated not contacting the physician for an order placed the resident at risk of receiving oxygen with clarification or providing treatment without knowing why it was needed and could affects resident billing. The DON stated the concentrator and nasal cannula should be changed out every Sunday once a week by the 10:00 PM-6:00 AM nursing staff, not doing so would increase respiratory illness and infection. The DON stated the nursing staff that admitted Resident #209 was responsible for completing a skin assessment which would have indicated he had Ileostomy. The DON stated the admitting nurse was responsible for contacting the doctor for proper orders. The DON stated the MDS Coordinator was responsible for implementing an update to the care plan. The DON stated the facility failed to get a physician order for Resident #209 placing him at risks for receiving proper care. Review of the facility's Interim Care Plan Policy, last revised February 2023, reflected: An interim baseline are plan should be developed for each resident within forty-eight (48) hours of admission to the skilled healthcare community. Policy Detail: 1. Within forty-eight (48) hours of admission to the skilled healthcare community, an interim baseline care plan should be developed which includes the minimum healthcare information necessary to care for the resident's immediate health and safety needs. 2. The interim care plan should be developed by the admission nurse with the assistance of interdisciplinary team members. 3. The Interim care plan should use but not be limited to, the resident's initial goals of care, physician's orders, dietary orders and instructions, therapy orders, resident cognitive, physical, and psycho-social needs, and any PASRR recommendations if applicable. 4. The Interim care plan should be person-centered and include services and treatments administered by the community. 5. The interim care plan should be used until the completion of the comprehensive assessment and the comprehensive care plan is developed 9. The Interim Care Plan should be maintained and updated as needed until the Comprehensive Care Plan is developed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 15 of 42 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 01/26/2024 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 observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as is possible and that each resident received adequate supervision to prevent accidents for 1 (Resident #11) of 6 residents reviewed for accidents. The facility failed to ensure that the water used to prepare hot beverages for residents was maintained at a temperature appropriate to prevent scalding and burns. Water temperatures were taken on 01/24/24 from the coffee machine hot water Bunn dispenser the water temperature was 188 degrees Fahrenheit. On 09/12/23, Resident #11 spilled hot tea on herself, and she sustained a second degree burn to her right hip, which required wound care. An Immediate Jeopardy was identified on 01/25/24 at 11:50 AM. While the Immediate Jeopardy was removed on 01/26/24 at 12:50 PM, the facility remained out of compliance at a scope of pattern with no actual harm with a potential for more than minimal harm that is not immediate jeopardy, due to the facility's continuation of in-servicing and monitoring the plan of removal. These failures put residents at risk for serious injury when drinking hot beverages. Findings included: Review of Resident #11's Face Sheet dated 01/26/24 revealed she was a [AGE] year-old female who initially admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included Parkinson's disease (disorder that affects the nervous system) without dyskinesia (a movement disorder that often appears as uncontrolled shakes, tics, or tremor), abnormal posture, muscle weakness, pain, and other lack of coordination. Review of Resident #11's Significant change in status MDS assessment, dated 01/11/24, reflected a BIMS score of 13 indicating no cognitive impairment. Resident #11 required partial/moderate assistance of one person for eating. Review of Resident #11's Care Plan, revised date 01/25/24 reflected: Focus: [Resident #11] is at risk for integument impairment. Resident had a history of a burn at right upper thigh from a hot liquids spill and is at risk for hot liquid spills. Goal: Resident will be free from skin breakdown through review date. Resident will be free from injury through the review date. Interventions: Resident requires set up/supervision with all meals to include ensuring a cap/lid are on all hot liquids. Focus: Resident has dx of Parkinson's, she has impaired muscle strength and coordination due to Parkinson tremors. She is at risk for hot liquid injury from hot beverages ie tea/coffee/cocoa. Goal: Resident will have no injury from hot liquids through review date. Interventions: Provide lid on hot beverages to prevent spills, staff to assist in opening the lids, setting up the tray for patient as needed. Focus: Resident had a history of a burn at right upper thigh from a hot liquids spill and is at risk for hot liquid spills. Goal: Resident will be free from injury through the review date. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 16 of 42 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 01/26/2024 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 Interventions: Resident requires set up/supervision with all meals to include ensuring a cap/lid are on all hot liquids. Educate resident/family/caregivers of causative factors and measures to prevent skin injury. Review of the facility Incident Log date range from 08/24/23 to 01/24/24 revealed the following: Person involved in Incident: Resident #11 Residents Affected - Few Date of incident: 09/12/23 Name of Associate Assigned to Resident at the time of the incident: CNA K Location of Incident: Resident Room. Nature of Incident: Miscellaneous - Scalding Type of Injury/Impairment: Burn Part(s) of Body Injured: Hip (right) Initial Actions Take: Applied First Aid, Checked for Injury, Notify emergency contact. Severity Code: 2- Harm/Injury without outside treatment and/or observation Additional Facts not Refenced Above: On the night of 9/12/23, while assigned to CNA K and LVN X, Resident #11 requested a piece of pizza and tea between 4-5AM. CNA K obtained the water for the tea from the hot water dispenser in the kitchen. She delivered the food and tea to Resident #11and when exiting the room turned off the lights and closed the door per Resident #11's request. Resident #11 dropped her tea in bed which resulted in a burn on her right hip. CNA K answered the call light, observed the accident/spill and notified LVN X. First aid was provided, RP and physician were notified. During the investigation, it was determined that Resident #11 has a history of requesting her door to be closed and lights turned off during night hours. It was also discovered that Resident #11 CNA from 6-2 that she had requested CNA K to close the door and turn off the lights. Interventions: Resident #11 will be encouraged to keep light on when eating at night. Drinks to be served with a lid when drinking hot liquids. Follow up: (10/04/23 [Administrator]) During investigation - it was determined that the hot water dispenser has been dispensing water below the recommended serving temps for hot liquids. Review of Resident #11's Hot Liquids Safety Data Collection dated 09/12/23 revealed resident was at risk of hot liquid injury. Task: Resident to use cup with lid. Review of Resident #11's progress note documented by LVN X on 09/12/23 at 5:24 AM revealed the following: Situation: The Change in Condition/s reported on this CIC Evaluation are/were: Skin wound or ulcer. Skin Status Evaluation: Skin tear. Pain Status Evaluation: Does the resident/patient have pain? Yes. Neurological Status Evaluation: Nursing observations, evaluation, and recommendations are: On observation and assessment, the skin tear looked like a blister that had popped. It would need some kind of ointment to rub on in order to heel. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 17 of 42 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 01/26/2024 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 Review of Resident #11's progress note documented by LVN X on 09/12/23 at 17:00 [5:00PM] revealed the following: F/U hot liquid injury. alert and oriented x3, v/s stable. burn area to right hip. treatment completed as ordered. medicated x2 for pain and effective. no distress noted. Review of Resident #11's wound physician note dated 09/13/23 revealed the following: Patient present with a wound on her right hip. Burn wound of the right hip full thickness. Etiology (quality) Burn. Wound Size (L x W x D): 11.5 x 5.5 x 0.3 cm. Surface Area: 63.25 cm². Cluster Wound: open ulceration area of 37.95 cm². Exudate: Moderate Serous. Granulation tissue: 20 %. Skin: 40 %. Site 1: Surgical excisional debridement procedure: Indication for procedure: Remove Necrotic Tissue and Establish the Margins of Viable Tissue, Remove Thick Adherent Eschar and Devitalized Tissue. Consent for procedure: Treatment options-risks-benefits and the possible need for subsequent additional procedures on this wound were explained on 09/13/2023 to the patient who indicated agreement to proceed with the procedure(s). Procedure Notes: The wound was cleansed with normal saline and anesthesia was achieved using 2% lidocaine jelly. Then with clean surgical technique, 15 blade was used to surgically excise 6.32cm² of devitalized tissue including slough, biofilm and non-viable subcutaneous level tissues were removed at a depth of 0.3 cm and healthy bleeding tissue was observed. As a result of this procedure, the nonviable tissue in the wound bed decreased from 10 percent to 0 percent. Hemostasis was achieved and a clean dressing was applied. Post-operative recommendations and updates to the plan of care are documented in the Assessment and Plan section below. Plan of care reviewed and addressed: The best medical estimate of the time required for this wound to heal with continued physician evaluation and intervention is 109 days. This estimate is made with an 80% degree of certainty. Review of Resident #11's progress note from Physician on 09/15/23 at 13:30 [1:30PM] revealed the following: *** Chief Complaint ***Acute Issue Pt [patient] is seen lying in bed [with] NAD exhibited. Pain reported to R [right] hip. 1st>>2nddegree burn from hot tea this am appx 0500 to R [right] thigh. Mixed intact bulla [fluid blister] [with] ruptured bulla [fluid blister] areas and exposed skin. Area is dry. Entire irregular shaped area appx 15cmx4cm. Pt reports increased pain to the area. Discussed plan [with] Pt [patient] and [family member] on the phone. Initially- Cleanse [with] NS [normal saline] and apply bacitracin [ointment] bid [twice a day], LOTA for now [with] loose brief on that time. If bullas rupture and wound begins to drain then we will need dressing. Dry at this time. Wound care team to f/u [follow-up] in am. Schedule her oxy 2.5mg q12h x 3 days and keep2.5mg q6h available, cont apap1000mg TID. Therapy Clarification from therapy regarding transfers/toileting. Going forward, the safest thing for [Resident #11] and the staff caring for her would be for [Resident #11] to be using a bed pan for toileting or a brief for incontinent episodes. She requires the hoyer lift for transfers, and it would not be feasible or safe to use the hoyer lift to transfer to the toilet or a bedside .Burn of skin - Onset: 09/12/2023. Review of facility Incident Investigation completed by Administrator, dated 09/15/23, revealed the following: Summary of Incident: On 09/12/23 between 3-5AM, [Resident #11] requested pizza and tea from [CNA K]. [CNA K] warmed up her leftover pizza and obtained her Tea from the kitchen. [CNA K] setup her tea (that had a lid) and pizza on her bedside table. [Resident #11], when attempting to grab her tea knocked it over and tea spilled on her right leg. This resulted in a second-degree burn. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 18 of 42 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 01/26/2024 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 Investigation: 09/12/23 [Resident #11] expressed that her leg was hurting due to her spilling her tea on herself. On 09/15/23 [Resident #11] explained that [CNA K] brought her tea and she spilled it on herself. When asked what happened she said it spilled out of her hands when attempting to drink. She did mention that the room was dark and she could have grabbed the wrong end of the drink. Associated Interview: [CNA K] stated [Resident #11] requested that [I] bring her tea and pizza. [I] warmed up her left-over pizza and grabbed the water/tea bags. [I] placed it by her bed don the table and left the room. When [I] left she asked me to close the door and turn the light off. She did not call me back in the room until after she [split] the tea. [LVN X] stated [I] completed the incident report when [CNA K] came and got me telling me [Resident #11] spilled her tea. [I] notified the physician and family and performed the care as ordered. Visitor/Vendor Interview: 09/15/23 Spoke with resident family regarding the incident. She stated she did not have any concerns but wants to avoid the situation moving forward. [I] discussed interventions with her. She requested that we discuss next week as . she is pre-occupied. She was thankful that [I] I reached out and stated mom loves you and says [Administrator] will take care of me and knows we take good care of her mother. Timeline: Between 4-5:30AM: [Resident #11] request tea and pizza. Between 4-5:30AM: [CNA K] provides pizza and tea. Between 4-5:30AM: [Resident #11] spills her tea. Between 5:26AM: [CNA K] notifies [LVN X] Conclusion: Supporting statement. Unconfirmed After getting statements from all involved, [Facility] came to the conclusion that this was an accident that was the result of [Resident #11] request for her door to be closed and lights turned off potentially causing her to grab the wrong end of the cup/hands slipping. This is a consistent request of hers during night hours dating back to her days in assisting living. We are agreeance that staff should encourage [Resident #11] to leave a light on when eating/drinking. The water for the tea that [Resident #11] was drinking was obtained from our kitchen hot water brewer. The hot water brewer is set for 175 degrees. Dining Director reviewed brewing guidelines, confirmed brewer was within guidelines at 170. Immediate Actions Taken: Resident Evaluation and/or Treatment. Notifications of District/Regional Nurse and RVP/DDO. Notifications of Responsible Party, Notifications of Physician Post Investigation Actions: Care Plan updates, In-serviced/Associate Re-training, Tasks Updated, Family Updated. Review of Resident #11's wound physician note dated 11/29/23 revealed the following: Burn wound of the right hip (resolved on 11/29/23) Duration > (greater than) 74 days. Wound progress: Resolved. Anatomic location of previously existing wound examined today: Epithelialized and Resolved. Follow (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 19 of 42 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 01/26/2024 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 up only as needed. Level of Harm - Immediate jeopardy to resident health or safety Observation and interview on 01/23/224 at 11:20 AM revealed Resident #11 lying in bed. Resident #11 stated she was doing well. Observed Resident #11 to have a sippy cup that had tea. Resident #11 denied any concerns regarding her care. Residents Affected - Few Review on 01/24/24 at 10:15 AM of facility Resident Council Notes, dated 12/07/23, revealed an issue made by Resident#11 stating, Why am [I] being billed for wound care when I got burnt due to the negligence of the staff? Administrator visited Resident #11 personally and spoke to her about the bill and that she would not be charged for wound care. Follow-up observation and interview on 01/24/24 at 10:20 AM revealed Resident #11 lying in bed. Resident #11 stated last year in September 2023 she had asked CNA K for tea; she stated it was early in the morning. She stated CNA K came in her room and placed the tea on her bedside table, she stated the bedside table was above her within reach. She stated the tea was in a white styrofoam cup with a lid on. She stated CNA K turned off her lights and closed the door when she left. She stated the room was dark and could not see. She stated she tried to get her tea when she spilled it. Resident #11 stated she felt pain right away and she pushed her call light for help and a few second later CNA K entered her room. She stated CNA K called LVN X for help and they cleaned her up. She stated the burn caused a blister to her right hip. Resident #11 stated had a cover over her when the tea spilled and it still cause a burn. Resident #11 stated she received wound care for a couple of months. She stated the burn had healed. Observed Resident #11 skin to the right thigh with no visible wound or scar. Resident #11 stated she could not recall if she asked CNA K to turn off the light or to leave them on. She stated the following day CNA K entered her room and that made her upset and she notified the Administrator she no longer wanted CNA K to enter her room. She stated since the incident she had not seen CNA K. Resident #11 stated she only drinks her hot tea in her special cup with a lid on. Interview on 01/24/24 at 12:48 PM with Resident #11's Family Member-1 revealed in September 2023 she received a call from the facility notifying them of the burn that Resident #11 sustained. Resident #11's Family Member-1 stated she was informed Resident #11 had requested tea early in the morning and Resident #11 requested her lights to be turned off and when Resident #11 tried to get the tea it slipped on her. While on the phone with Resident #11's Family Member-1 another Family Member-2 got on the phone who stated when they asked the Administrator how hot the water was the Administrator responded with inappropriate temperature, Family Member-2 stated they were not satisfied with his response. Family Member-2 stated the water must had been really hot for it to cause a bad burn within second. Family Member-2 stated their concern is not just for Resident #11 but for all the resident in the facility who drink tea or coffee. Resident #11's Family Member-1 stated she did not make a big deal of the situation due to Resident #11 diagnosis of Parkinson and the incident could had been an accident. An attempt was made on 01/24/24 at 3:04 PM to contact LVN X; however, there was no response. Interview on 01/24/24/ at 3:28 PM with CNA K revealed she was the CNA assigned to Resident #11 when the burn incident happened. CNA K stated between 4-5 in the morning Resident #11 requested hot tea. She stated she got the hot water from the 2nd floor service kitchen hot water brewer and then added the tea bag. She stated she placed a lid on the cup and took it to Resident #11 room. CNA K stated she placed the teacup on the resident bedside table, within reach. She stated she notified Resident #11 of the hot tea being placed on the bed side table. She stated Resident #11 requested for the door to be closed. She stated the room was not dark, there was natural light, Resident #11 had a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 20 of 42 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 01/26/2024 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 bedside lamp on and the bathroom light was on and the door was slightly open. She stated she continued to do her rounds when Resident #11 pushed her call light on. CNA K stated she went in the room and Resident #11 told her she had spilled her tea. She stated she called for LVN X and they cleaned Resident #11. She stated Resident #11 sustained a burn. CNA K stated she could not recall how hot the water of the tea was. CNA K stated she was in-serviced on safety measure. CNA K stated they had a service kitchen on the 2nd floor and 3rd floor, and staff obtain hot water from the hot water brewer. She stated they used the hot water brewer to make hot beverages. Interview on 01/24/24 at 3:36 PM with the ADON revealed when Resident #11 had the burn incident, she was not the nurse on duty. The ADON stated the incident happened during the night shift. She stated she was told Resident #11 requested hot tea and when Resident #11 tried to get the cup it spilled on her. The ADON stated she could not recall if she had been in-serviced on the incident; however, they put interventions in place. She stated the interventions were if Resident #11 request any hot liquids it should be given in a special cup with a lid (sippy cup). The ADON stated Resident #11 required wound care for a couple of months. She stated the wound had healed. She stated staff obtain hot water from the kitchen coffee machine hot water brewer. She stated she was unsure who was supposed to check for hot beverage temperatures. She stated they had not been told to check temperatures for hot liquid beverages. The ADON stated upon admission they complete a hot liquid assessment on any new admission residents. The ADON stated Resident #11 was the only resident who required interventions. Interview on 01/24/24 at 3:51 PM with CNA N revealed Resident #11 told her about the hot tea spilling on herself. CNA N stated Resident #11 sustained a burn. She stated when Resident #11 told her about the incident she went and spoke to CNA K. She stated CNA K stated she provided hot tea to Resident #11 and the resident spilled it on herself. CNA N stated they were in-serviced on ensuring Resident #11 gets her special cup when she requests hot beverages. She stated the 2nd floor and 3rd flood had a service kitchen which had a coffee machine with hot water Bunn dispenser. She stated they all get the hot water from the hot water Bunn dispenser when they prepare hot beverages. She stated the water that comes from the hot water Bunn dispenser was hot. She stated when someone request hot liquid beverages and she gets hot water from the hot water Bunn dispenser she waits about 10-15 minutes to let it cool down. Observation of facility 2nd floor service kitchen on 01/24/24 at 4:00 PM with the RD revealed a coffee machine with a Bunn hot water dispenser was observed. The RD stated staff obtain hot water from the coffee machine (Bunn hot water dispenser) to prepare hot beverages. The RD stated she had been checking the hot water temperature today (01/24/24) every 30 minutes due to the hot water valve being replaced today (01/24/24). Observed the RD grabbed a coffee mug and poured hot water inside the coffee mug from the Bunn hot water dispenser. Then grabbed the facility thermometer, it took her about 5 to 10 seconds to place the thermometer inside the hot water. The hot water temperature was 188 degrees Fahrenheit. The RD stated dietary staff had not been told to check Bunn hot water dispenser or hot beverage temperatures. She stated they only checked food temperatures when serving. Observed 2nd floor service kitchen temperature logbook revealed no temperature checks for hot beverages. Interview on 01/24/24 at 4:13 PM with LVN B stated she was the nurse assigned to Resident #11 the day after the incident. She stated she could not recall the dates. LVN B stated she observed Resident #11 burn the 1st day and it had a blister to the right hip. LVN B stated they did not start wound care until the blistered popped. She stated Resident #11 did complain of pain and they provided her with pain medication. She stated Resident #11 did not go to the hospital, she stated she was treated inhouse. She stated they provided wound care for a month or two until it healed. She stated she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 21 of 42 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 01/26/2024 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 not sure how Resident #11 burned herself; however, it happened during the night shift, she stated the night nurse on duty completed an incident report. LVN B stated she was in-serviced on how to prevent hot liquids incidents. She stated the interventions they put in place for Resident #11 was to provide her with her special up with a lid, make sure Resident #11 was able to hold the cup and make sure the water was not hot. LVN B stated she tests the hot water by placing a drop on her skin. LVN B stated she was unsure of any hot water dispenser temperature log and believed it was the dietary staff responsibility to check and log the temperatures. Interview on 01/24/24 at 4:25 PM with the DON revealed Resident #11 requested hot tea during the 10:00 PM-6:00 AM shift. She stated CNA K gave Resident #11 her tea and turned off the lights and closed the door. The DON stated when Resident #11 tried to drink the tea she spilled it over her. She stated staff immediately assisted Resident #11 and cleaned her up. She stated Resident #11 sustained a burn to her right hip. She stated Resident #11 received wound care and was on pain medication. She stated Resident #11 wound had healed and no longer required wound care. The DON stated they educated the staff on how to protect resident with hot liquid beverages, to check water temperatures and provide Resident #11 sippy cup to prevent any spills. She stated they also educated Resident #11 to not drink hot beverages in the darkness. The DON stated the hot beverages should be within temperatures and if hot beverages are too hot the CNAs must notify the dietary staff. The DON stated dietary staff should be logging hot beverages temperatures. The DON stated the water temperatures had been controlled and they had hot liquid temperature logs in each service kitchen. Interview on 01/24/24 at 4:46 PM with the Administrator revealed in September 2023 during the night shift Resident #11 requested pizza and hot tea from CNA K. He stated CNA K obtained the tea from the service kitchen hot water dispenser. He stated CNA K provided the tea in a cup with a lid and turned off the light and closed the door per Resident #11 request. The Administrator stated Resident #11 grabbed the cup of tea and spilled it on herself and resulted on a burn. He stated Resident #11 pushed the call button, CNA K came in and she called for the nurse and they performed care. He stated Resident #11 required wound care and further stated the wound had healed. The Administrator stated he conducted a full investigation and it was determined it was an accident. He stated they in-serviced all staff on using lids when drinking hot beverages, hot beverages to be monitor by the dietary department. He stated the dietary department kept a log of the temperatures. Observation and interview on 01/24/24 beginning at 4:51 PM with Dining Service Director revealed the dietary staff were not required to check the temperatures from the coffee machine hot water Bunn dispenser. She stated the maintenance staff conduct a monthly check; however, she was notified by the RD today (01/24/24) that dietary staff should monitor the hot water Bunn dispenser much closer. Observed 3rd floor service kitchen with the Dining Service Director, a coffee machine with hot water Bunn dispenser was observed. The Dining Service Director was observed to check the hot water Bunn temperature. She grabbed a coffee mug and poured hot water inside the coffee mug from the coffee machine hot water Bunn dispenser. Then grabbed the facility thermometer, it took her about 5 to 10 seconds to place the thermometer inside the hot water. The hot water temperature was 173 degrees Fahrenheit. The Dining Service Director stated she was unsure if dietary staff had been in-serviced on hot beverages, she stated she would have to ask. She stated the dietary did not have a log for the hot beverage temperature. Follow-up temperature check of facility 2nd floor service kitchen on 01/24/24 at 5:00 PM with the RD revealed the hot water temperature was 176 degrees Fahrenheit. The RD stated it was within the brewing temperatures but not serving temperatures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 22 of 42 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 01/26/2024 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 Interview on 01/24/24 at 5:16 PM with the Administrator revealed his expectations were for hot beverages to be within the serving guidelines 175-180 degrees Fahrenheit. A few minutes later the Administrator returned to the conference room and stated he misunderstood the question and stated hot beverages should be within the brewer temperatures 175-180 degrees Fahrenheit and serving guidelines temperatures would be 155 degrees Fahrenheit. Interview on 01/24/24 at 5:25 PM with the Maintenance Director revealed the facility had a third-party contractor who checks the facility hot water. He stated the commercial kitchen hot water are inspected quarterly. He stated they have not been told to kitchen hot water dispenser daily, he further stated it was not a requirement for the maintenance department to check temperatures. He stated normally the Dietary Manager would notify them if they had an issue in the kitchen and he would contact the third-party contractor to come inspect the issue. He stated the service kitchen on the 2nd and 3rd floor hot water dispensers had temperature fluctuations. He stated he was not asked to adjust the hot water brewer temperatures in September 2023 or as of today (01/24/24). The Maintenance Director asked if he needed to adjust the hot water brewer temperatures, because he was able to adjust them. Interview on 01/25/25 at 9:10 AM with the Administrator revealed he could not locate the in-services they completed on 09/12/23. He stated he had begun in-servicing all staff starting today (01/25/24). The Administrator stated the dietary staff did not have a log for the hot beverage temperature. Review of The American Burn Association Scald Injury Prevention Educator's Guide, https://ameriburn.org/wp-content/uploads/2017/04/scaldinjuryeducatorsguide.pdf reflected the following: .Time and Temperature Relationship to Severe Burns Water Temperature Time for a third degree burn to occur 155 degree F 1 second 140 degrees F 5 seconds Based upon the time of the exposure and the temperature of the water, the severity of the harm to the skin is identified by the degree of burn, as follows . Second- degree burns involved the first two layers of skin. These may present as deep reddening of the skin, pain, blister, glossy appearance from leaking fluid, and possible loss of some skin. Review of the facility's Safe of Hot liquids policy, revised February 2020, reflected the following: Residents shall be evaluated for safety concerns and potential for injury from hot liquids upon admission, readmission, quarterly and on change of condition. Appropriate precautions shall be implemented to maximize choice of beverages while minimizing the potential for injury. A. The potential for burns from hot liquids is considered an ongoing concern among residents with weakened motor skills, balance issues, impaired cognition, and nerve or musculoskeletal conditions. B. Residents who prefer (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 23 of 42 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 01/26/2024 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 hot beverages with meals (i.e., coffee, tea, soups, etc.) will not be restricted from these options. Instead, associated shall conduct regular Hot Liquids Safety Data Collections as indicated, and document the risk factors for scalding and burns in the care plan. D. Once risk factors for injury from hot liquids are identified, appropriate interventions shall be implemented to minimize the risk from burns. Such interventions may include: 1. Maintaining a hot liquid serving temperature of not more than 155 degrees Fahrenheit; 2. Serving hot beverages in a cup with a lid; 3. Encourage residents to sit at a table while drinking or eating hot liquids; 4. Providing protective lap covering or clothing to protect skin from accidental spills; and 5. Associate supervision or assistance with hot beverages Review of the facility's Safe Holding and Serving Temperature for Hot Beverages policy, revised 03/01/16, provided by the Administrator on 01/25/24 reflected the following: . 2. Coffee needs to be brewed at (recommended temperature per machine) 195 to 205 degrees Fahrenheit to extract the full flavor 4. Skin on the arms and legs - being less sensitive than the mouth - can suffer a burn before the danger is realized. The elderly who are immobilized in a wheelchair and confused resident are more susceptible. 5. Because of this susceptibility, follow these safety precautions: a. Serve the hot beverages between 140-155 degrees Fahrenheit. Dietary should record hot beverage temperatures for every meal c. Residents should be supervised while drinking hot beverages. d. A staff member should pour the hot beverages, in a manner that protects the resident's safety. Fill hot beverage mugs to 75% of less of their capacity. An Immediate Jeopardy was identified on 01/25/24. The Administrator was notified of the Immediate Jeopardy on 01/25/24 at 11:50 AM. The facility was asked to provide a Plan of Removal to address the Immediate Jeopardy. The Facility's Plan of Removal for Immediate Jeopardy was accepted on 01/25/24 3:39 PM and reflected the following: -1. On 1/25/2024, the Director of Clinical Services (DCS) completed a new hot risk data collection for resident # 1 [Resident #11]. The DCS reviewed the plan of care and no additional interventions were needed. On 1/24/2024, the Dining Service Director took the hot water/coffee dispenser out of service. On 1/25/2024, the Maintenance Director contacted a third-party vendor to complete an onsite preventative maintenance check. On 1/25/2024, a Registered Dietician revised the Meal Inspection-Test Trays Form that is completed at minimum 3 times a month to include the serving temperature of coffee and hot water. -2. All residents have the potential to be impacted. On 1/25/2024 a dining service manager completed rounds to temp current serving temperatures for hot coffee and hot water on current operating dispenser in the main kitchen. This was documented on a log. -3. On 1/25/2024, a Registered Dietician completed re-education to Dining Service associates the food temperature log to include the hot coffee and hot water temperature log. On 1/25/2024, a third party Registered Dietician completed re-education to the in-house Registered Dietician and Dining Service Manager on the revised Meal Inspection- Test Trays Form that includes the hot coffee and hot water serving temperature. On 1/25/2024 to 1/26/2024, the Registered Dietician and/or designee re-educated Dining Services, Certified Nursing Assistants (C.N.As), and Nurses on the Safe Holding and Serving Temperatures for Hot Beverages and Service of Hot Beverage Guidelines. The dining service associates, C.N.A and Nurses not available on 1/25/2024 will receive re-education by the registered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 24 of 42 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 01/26/2024 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 dietician or designee before their next scheduled shift and this will include new hires hired after 1/25/2024. Competency will be validated on a post-test. -4. The Certified Dining Manager (CDM) or designee will audit the food temperature log 5 x a week for 90 days to verify that serving temps of hot water and hot coffee are being documented and do not exceed 155 degrees. The CDM or des[TRUNCATED] Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 25 of 42 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 01/26/2024 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 0691 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who enters the facility with a colostomy receive such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences for 1 of 1 resident (Resident #209) reviewed for colostomies. The facility failed to have physician orders and a care plan for Resident #209's colostomy. These findings place resident at risk of complications related to a colostomy. Findings included: Review of Resident #209's admission Record dated 01/26/24 revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included surgery on the digestive system, need for assistance with personal care, obstructive and reflux uropathy (blockage of urine), gastro-esophageal reflux disease (contents of the stomach move back up your esophagus), intestinal obstruction, benign prostatic hyperplasia (enlarged prostate), retention of urine, ileostomy, high blood pressure. Review of Resident #209's admission MDS, dated [DATE], revealed a BIMS score of 15, indicating he was cognitively intact. His Functional Status indicated he required partial/moderate assistance with toileting, lower body dressing, and personal hygiene, supervision for upper body dressing. Bowel and Bladder indicated indwelling catheter and ostomy, always incontinent of urine and frequently incontinent of bowel. Review of Resident #209's baseline care plan reviewed on 01/23/24 revealed it did not address ostomy use. Record review of Resident #209's physician orders dated 01/2024 did not address ostomy use. Record review of Resident #209's progress note dated 01/11/24 written by LVN C revealed nursing admission note indicated Resident #209 alert and oriented to person, place, time, and situation, entered the facility with diagnosis large bowel obstruction post status ileostomy. Long abdominal incision well approximated with staples in place. Interview on 01/23/24 at 3:26 PM with Resident #209 revealed he entered the facility with the colostomy bag. Resident #209 stated he had an issue of staff coming in to empty the bag. The resident stated, They did not empty my colostomy bag and it poured out. Why do I need to tell them to empty? They should know to check it to see if it needed to be emptied. According to Resident #209, he had visitors all the time and would not want to have this happen while visiting with friends and family. Interview on 01/25/24 at 1:01 PM with RN P revealed Resident #209 entered the facility on the 2nd floor and was later moved to the 3rd floor. RN P stated when a resident was admitted to the facility it was the responsibility of the nurse that completed the admission to enter all critical information at that time. According to RN P she was looking over orders and noticed he did not have orders for his ileostomy or the care for it. RN P stated the facility had a template in the clinical records (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 26 of 42 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 01/26/2024 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 0691 Level of Harm - Minimal harm or potential for actual harm for residents that come in the facility with diagnosis like ileostomy, so she did not have to get an order to complete care, she stated the facility expected us to carry out the care properly. RN P stated there was a situation that occurred after unknown staff cleaned and cleared the bag, did not clip the ring securely back in place. RN P stated Resident #209 was not with any risks because the nursing staff was aware that he had the ileostomy. Residents Affected - Few Interview on 01/25/24 at 1:36 PM with the MDS Coordinator revealed the admitting nurse was responsible to enter physician orders into the system and complete an assessment that would create an initial care plan that will populate focus, goals, and interventions for the baseline care plan. The MDS Coordinator stated once the baseline care plan was created, he then reviewed it, interviewed the resident, and goes over it during their care plan meetings so that it could be implemented or updated in the comprehensive care plan. Interview on 01/25/24 at 1:47 PM with the MDS Coordinator Director revealed updates to baseline care plans are usually done within 7 days of admission. The MDS Coordinator stated not having a complete baseline care plan placed residents at risks of receiving improper treatment and care; staff not being aware of resident needs. Interview on 01/25/24 at 04:32 PM with the DON revealed she was not aware there were no orders Resident #209's ileostomy. The DON stated the nursing staff who admitted Resident #209 was responsible for completing a skin assessment which would have indicated he had ileostomy. The DON stated the admitting nurse was responsible for contacting the doctor for proper orders. The DON stated MDS was responsible for implementing an update to the care plan. The DON stated the facility failed to get a physician order for Resident #209 placing him at risks for receiving proper care. The DON stated she was aware of the situation where staff did not secure the colostomy bag to prevent spillage. The DON stated Resident #209 had just received care and staff returned quickly to ensure it was secure. The DON stated there were no other incidents regarding proper care for Resident #209 ileostomy. Review of the facility's policy Interim Care Plan Policy, last revised 02/2023, reflected: An interim baseline are plan should be developed for each resident within forty-eight (48) hours of admission to the skilled healthcare community. Policy Detail: 1. Within forty-eight (48) hours of admission to the skilled healthcare community, an interim baseline care plan should be developed which includes the minimum healthcare information necessary to care for the resident's immediate health and safety needs. Record review of the facility's Physician Order Chart Audit policy and procedure, revised July 2015, reflected: The resident's physician order section of the medical record and electronic orders will be reviewed every twenty-four hours for accuracy on a designated shift. The charge nurse on the designated shift will review the physician order section of the residents' medical record and electronic orders, back to the previous completed, physician order chart audit. In reviewing each order, the charge nurse will verify the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 27 of 42 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 01/26/2024 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 0691 1. Level of Harm - Minimal harm or potential for actual harm Order has been written correctly. 2. Residents Affected - Few All medications, treatments, etc., are transcribed accurately to the electronic Medication Administration Records, Treatment Administration Records, behavior monitoring sheet. 3. Documentation is completed in the medical record related to the new orders . 4. Each nurse will sign their name, date, and time on the 24-Hour Physician Order Audit Form 5. Notify physician with any discrepancies. No policy was provided for physician orders, care or use of colostomy/ileostomy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 28 of 42 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 01/26/2024 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who was fed by enteral means received appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding which included but not limited to aspiration, pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities and nasal-pharyngeal ulcers for one of four residents (Resident #221) reviewed for feeding tubes. The facility failed to follow physician's orders to change Resident #221's enteral feeding bag and tubing every 24 hours to provide with her 20 hours of feeding. This failure could place residents at risk for a decline in health or adverse effects due to inappropriate management of enteral feeding care. Finding included: Record review of Resident #221's face sheet, dated 01/26/24, reflected the resident was a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included Dysphagia following Cerebral Infarction and following Cerebrovascular Disease (conditions that affect the flow of blood to the brain most common is stroke), muscle weakness, cognitive communication deficit (difficulty with communication), need for assistance with personal care, unspecified atrial fibrillation (abnormal heart rhythm), pleural effusion (excessive fluid in space around lungs), swelling mass lump under limb, bacteriuria (bacteria in urine), history of transient ischemic attack (mini stroke). Record review of Resident #221's MDS assessment, dated 01/11/24, revealed a BIMS score of 11, indicating moderate cognitive impairment. Resident #221's functional abilities indicated she was dependent on staff for eating, and all daily living activities. Resident #221 also indicated a swallowing disorder with coughing or choking during eating or swallowing medications, provided a feeding tube while a resident. Record review of Resident #221'a care plan, reviewed 01/24/24 revealed the following care areas: [Resident #221] has dysphagia and required tube feeding. Resident was dependent with tube feeding and water flushes. See physician orders for current feedings orders. Nurses auscultated lung sounds as needed. Hold feeding as ordered for large residuals. Nurses provide local care to G-Tube site as ordered and monitor for signs and symptoms of infection. Monitor caloric intake, estimate needs. [Resident #221] has potential for dehydration or fluid deficit related to hydration via PEG. Goal: Resident will be free of symptoms of dehydration and maintain moist mucous membranes, good skin turgor. Intervention: Notify physician of significant abnormalities. Record review of Resident #221's physician's orders reflected: change G-Tube enteral feeding bag and tubing every 24 hours for G-Tube with a start date of 01/04/24. Record review of Resident #221's Medication Administration Record dated 01/2024 revealed order to indicate [Change G-Tube Enteral Feeding bag and tubing every 24 hours for G-Tube feeding]. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 29 of 42 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 01/26/2024 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Medication Administration Record indicated the G -Tube feeding bag and tubing had been changed on 01/22/24, 01/23/24, 01/24/24 and 01/25/25. Observation on 01/23/24 at 12:36 PM of Resident #221 revealed her tube feeding machine was on and running at 52 mL for 20 hours and 24 mL water flush every hour. The resident's family member was visiting and stated Resident #221 was nonverbal; however, the resident could respond to yes or no questions. The family member revealed she had concerns with the resident's weight and was waiting to speak with the Nurse Practitioner. Observation and interview on 01/24/24 at 8:45 AM-9:51 AM of Resident #221 revealed her tube feeding machine was not on. Resident #221 was not able to answer any questions. Interview with LVN O revealed she turned Resident #221's machine off at 7:30 AM so that she could have 4 hours of down time per physician's order. Observation and interview on 01/24/24 at 11:27 AM with LVN O revealed Resident feeding bag was dated 01/22/24 04:00 AM indicating when the last feeding bag had been administered. LVN O she did not realize the bag was dated 01/22/24, she was not sure why the feeding bag had not been changed. LVN O stated the feeding bag should have been changed on the overnight shift prior to her coming on shift. LVN O stated usually staff would notify her of any issues or reasons feedings should be delayed, LVN O stated she was told the machine was running, she calculated 20 hours from the last time the bag was changed and by her calculations indicated Resident #221 should start her down time at 7:30 AM and would begin a new feeding bag at 11:30 AM. Observation of LVN O revealed she hung a new feeding bag dated 01/24/24 11:30 AM. LVN O indicated not replacing the feeding bag could result to resident vomiting, too full, or having a bloated stomach. According to LVN O she failed to identify the over dated feeding bag, LVN O stated it was the responsibility of the nurses to follow physician orders. Observation and interview on 01/24/24 at 1:00 PM with the DON revealed Resident #221 had physician orders to have feeding bags changed every 24 hours on the evening shift. The DON stated she was not aware Resident #221's feeding bag had not been changed since 01/22/24. The DON stated her expectation was for nursing staff to follow physician orders. The DON stated not following the orders placed Resident #221 at risk of being feed old formula, which could create stomach issues. Interview on 01/24/24 at 1:40 PM with the RD revealed she reviewed Resident #221 yesterday for weight concerns, she was not notified feeding bag had not been changed. The RD stated Resident #221 had orders to have the feeding bag changed daily on the overnight shift. The RD revealed nurses are responsible for changing out the feeding bag. The RD stated there was no negative impact to resident not having bag changed due to her still having formula, but if the bag was empty this could have caused a risk. Record review of facility's Physician Order Chart Audit policy and procedure, revised July 2015, reflected: The resident's physician order section of the medical record and electronic orders will be reviewed every twenty-four hours for accuracy on a designated shift. The charge nurse on the designated shift will review the physician order section of the residents' medical record and electronic orders, back to the previous completed, physician order chart audit. In reviewing each order, the charge nurse will verify the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 30 of 42 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 01/26/2024 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 0693 1. Order has been written correctly. Level of Harm - Minimal harm or potential for actual harm 2. All medications, treatments, etc., are transcribed accurately to the electronic Medication Administration Records, Treatment Administration Records, behavior monitoring sheet. Residents Affected - Few 3. Documentation is completed in the medical record related to the new orders . 4. Each nurse will sign their name, date, and time on the 24-Hour Physician Order Audit Form 5. Notify physician with any discrepancies. The Administrator was asked to provide the facility's policy on enteral feedings and following physician orders; however, the policy was not provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 31 of 42 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 01/26/2024 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received parenteral fluids administered consistent with professional standards of practice and in accordance with physician orders for 1 of 2 resident (Resident #156) reviewed for peripheral intravenous care. Residents Affected - Few The facility failed to ensure Resident #156's PICC line dressing was dated on 01/20/24. This failure placed residents at risk of developing an infection. Findings included: Review of Resident #156's face sheet, dated 01/26/24, reflected the resident was a [AGE] year-old male who admitted to the facility on [DATE]. His diagnoses included infection and inflammatory reaction due to unspecified internal joint prosthesis, aftercare following join replacement surgery. Review of Resident #156's admission MDS assessment, dated 01/13/24, reflected a BIMS score of 15 indicating no cognitive impairment. Review of Resident #156's care plan, dated 01/06/24, reflected Focus: the resident [has] infection of the right lower extremity. Goal: The Resident will be free from complications related to infection through the review date. Interventions/Tasks: Administer antibiotic as per MD orders. Vital signs as ordered report abnormalities to MD. Review of Resident #156's physician's orders as of 01/23/24 reflected an order for Change valved PICC needless connector and transparent dressing 24 hours post insertion or on admission and weekly/PRN. Document upper arm circumference in cm and external catheter length in cm with each dressing change. Compare to previous measurements. Notify physician if the length has changed since the last measurement. as needed for PICC Line Maintenance/Measurements if soiled or not intact. The order start date was 01/06/24. Review of Resident #156's physician's orders as of 01/23/24 reflected an order for Observe PICC Site and Document in progress notes as indicated: Every 2 hours during continuous therapy every shift with intermittent therapy every shift when not in use before and after administration of intermittent medications during dressing changes as needed for infiltration/extravasation every shift for PICC site observation. The order start date was 01/06/24. Review of Resident #156's physician's orders as of 01/23/24 reflected an order for Change valved PICC needless connector and transparent dressing 24 hours post insertion or on admission and weekly/PRN. Document upper arm circumference in cm and external catheter length in cm with each dressing change. Compare to previous measurements. Notify physician if the length has changed since the last measurement. every day shift every 7 day(s) for PICC Line Maintenance/Measurements The order start date was 01/12/24. Review of Resident #59's January MAR/TAR revealed the dressing was changed on 01/13/24 and 01/19/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 32 of 42 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 01/26/2024 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation and interview on 01/23/24 at 10:32 AM with Resident #156 revealed he was lying in his bed and stated he was doing well. Observed Resident #156 had a PICC line in his right upper arm covered with a transparent dressing. The transparent dressing was not dated. There was no redness, drainage, or swelling to the resident's left arm. Resident #156 stated he was on antibiotics due to an infection on his right hip, he stated she had surgery. Resident #156 stated his dressing was last changed either Friday (01/19/24) or Saturday (01/20/24). He stated he could not recall who the staff who changed it. Resident denied any pain or discomfort. Interview and observation on 01/23/24 at 1:47 PM with LVN A revealed he was the nurse assigned to Resident #156. LVN A stated Resident #156 had a PICC-line and was on antibiotics. LVN A stated Resident #156 PICC-line dressing was changed every 7 days. He stated Resident #156 PICC-line dressing should had a date on. Observed LVN A entered Resident #156's room and observed Resident #156' PICC line. LVN A was observed to date the dressing 01/20/24. LVN A stated the dressing was not dated. LVN A stated he dated the dressing 01/20/24 because he knew that was the date it the PICC line dressing was changed. LVN A was asked if he changed the PICC line dressing on 01/20/24, he stated no, only RNs can change the PICC-line dressings. LVN A stated he was unsure of who changed the dressing. LVN A stated there was no risk to the resident for not dating the dressing due to no signs of pain or redness. Interview on 01/23/24 at 1:58 PM with the ADON revealed her expectations are for PICC-line dressing to be changed and dated per physician orders. The ADON stated only RNs staff are able to change dressing and measure PICC-lines. The ADON stated she had not changed any PICC-lines dressings in the past week. She stated she had worked with Resident #156 before and she changed his PICC-line dressing on 01/13/24 and dated the dressing. She stated Resident #156 dressing should be changed every 7 days and the weekend RN Supervisor should had changed it on 1/20/24. The ADON review Resident #156 January MAR/TAR and stated LVN A singed the MAR/TAR on 1/19/24 as completed. The ADON stated she was unsure why LVN A signed the MAR. The ADON stated it was the nurse on duty's responsibility to date the dressing after every dressing change. She further stated the potential risk of not dating the PICC line dressing could cause them to leave the dressing longer or could cause an infection to the site. Interview on 01/23/24 at 2:15 PM with the DON revealed her expectation was for nurses to be checking the PICC-lines every shift, flush before and after medication, every shift, and to change the dressing once a week. The DON stated the PICC-line dressing should be dated. She stated the RNs who changed the dressing was responsible for changing and dating the dressing. The DON stated she had not changed any PICC-lines dressing in the last week; however, they have a Weekend Supervisor who was also the wound care nurse who changes PICC-lines during the weekend. The DON stated the ADON were responsible for ensuring PICC line dressings were being changed and dated. The DON further stated PICC line dressings should be changed accordingly to prevent chances of infection and dressing should be dated so staff are aware if the dressing had been changed. Interview on 01/24/24 at 9:47 AM with RN W revealed he was the weekend Nurse for 01/20/24. RN W stated he changed Resident #156 PICC-line dressing on 01/20/24. He stated when he changed Resident #156 PICC-line dressing on 01/20/24 he did not have a black pen at the time to date the dressing. RN W stated he left the room to get a pen; however, he forgot to return to the room to date the dressing. He stated it was his mistake. RN W stated he forgot to document Resident #156 dressing change. RN W stated the risk of not dating the PICC line dressing could cause them to leave the dressing longer or could cause an infection to the site. Record review of facility's Central Vascular Access Device (CVAD) Dressing Change policy, revised (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 33 of 42 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 01/26/2024 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 0694 date 06/01/21, reflected: .If transparent dressing is dated, clean, dry and intact, the admission dressing change may be omitted and scheduled for 7 days from the date on the dressing label. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 34 of 42 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 01/26/2024 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that a resident who needs respiratory care was provided such care, consistent with professional standards of practice for 1 of 3 residents (Resident #4) reviewed for oxygen. Residents Affected - Few 1. The facility failed to have physician orders for oxygen use. 2. The facility failed to ensure Resident #4's concentrator and nasal cannula was with changed out on a weekly basis. This failure could place residents who received oxygen therapy at risk for inadequate or inappropriate amounts of oxygen delivery and possible infection. Findings included: Review of Resident #4's admission Record dated 01/26/24 revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included Pulmonary Embolism with Acute Cor Pulmonale (enlargement and failure of the right ventricle of the heart/due to high blood pressure), muscle weakness, need for assistance with personal care, Type 2 Diabetes (high blood sugar levels), hyperlipidemia (high level of fats/cholesterol), high blood pressure, heart attack, presence of coronary angioplasty implant and graft (treatment of narrowing arteries). Review of Resident #4's admission MDS, dated [DATE], revealed a BIMS score of 11, indicating moderate cognitive impairment. Her MDS indicated received oxygen therapy on admission and while a resident. Review of Resident #4's baseline care plan reviewed for 01/2024 revealed Resident's physician orders or care plan did not address oxygen use. Record review of Resident #4's progress notes dated 01/1/24 at 6:18 PM revealed Evaluation Summary Note indicated arrived on stretcher status post hospitalization for pulmonary embolism. Denies chest pain or shortness of breath. Alert and oriented to person, place and time, lungs have clear breathing sounds. Shortness of Breath, on continuous oxygen 2 litters nasal cannula. Interview and observation on 01/23/24 at 12:18 PM with Resident #4 revealed she entered the facility with the use of oxygen. Resident #4 stated she had issues with breathing without the use of oxygen. Resident #4 stated she needed to use oxygen at all times so that she could be able to work with staff to build her strength for daily activities, therapy and to return home. Resident's nasal cannula and water bottle concentrator (with low water level) both were dated 01/15/24 delivering 2 liters per minute. Observation on 01/24/24 at 2:55 PM of Resident #4 revealed she was in room, sitting in wheelchair, Resident #4 was with the same water concentrator and nasal cannula dated 01/15/24. Interview and observation on 01/25/24 at 9:28 AM with LVN O revealed Resident #4 with nasal cannula not properly placed in her nose, machine running at 2 liters, Resident's nasal cannula and water bottle concentrator (with low water level) both were dated 01/15/24. According to LVN O she could not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 35 of 42 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 01/26/2024 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few reveal oxygen orders for Resident #4, she stated she thought resident did have an order because she was on oxygen while in the hospital, which indicated she should have an order in the system upon admission. According to LVN O there are no risk to her receiving oxygen, she also stated Resident #4 requires the oxygen due to with exertion her oxygen levels will drop so it was helping her right now. LVN O stated the facility failed to have an order posted and change out the nasal cannula. LVN O stated it was the responsibility of the admitting nurse to enter the order for oxygen so that she will have it and it could be properly maintained. LVN O stated concentrator and nasal cannula were to be changed weekly by night shift. Interview on 01/25/24 at 04:32 PM with the DON revealed she was not aware there were no orders regarding Resident #4's oxygen use. The DON stated admitting nurses have authority to contact the physician or their Nurse Practitioners to get an order for oxygen. The DON stated not contacting the physician for an order placed the resident at risk of receiving oxygen with clarification or providing treatment without knowing why it was needed and could affects resident billing. The DON stated the concentrator and nasal cannula should be changed out every Sunday once a week by the 10:00 PM-6:00 AM nursing staff, not doing so would increase respiratory illness and infection. A policy on oxygen/respiratory treatment was requested on 01/26/24 at 11:17 AM; however, the policy was not provided prior to exit. The facility also failed to provide a policy on following physician orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 36 of 42 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 01/26/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen; specifically, the facility failed to ensure dishware were appropriately sanitized. The facility failed to ensure the dishwasher reached minimum wash and rinse temperatures of 140 degrees to wash and 180 degrees or final rinse. This failure could place residents at risk for food contamination and food borne illness. Findings included: Observation and interview, on 01/23/24 at 8:40 AM revealed Dishwasher Aide Y ran the dishwasher stating the machine was a high temp machine washing at 140-degree temperature and rinse at 180- degree temperature. Dishwasher Aide Y was not able to show the high temperature dishwasher reached the minimum wash and rinse temperatures. Dishwasher Aide Y stated it took the machine a while to reach max temperatures. Dietary Aide Y stated when he entered the facility in the mornings, he had to run the machine several times before the temperatures are reached. When Dishwasher Aide Y was asked about the dishes that he had ran prior to observation and currently running, he stated he needed re-run the dishes he had done so far. After 10 minutes the dishwasher temperatures reached no more than 140 degrees for wash, 170 degrees for rinse. Dishwasher Aide Y stated the commercial company came at least twice a week and when called on, the provider was out last Friday 01/19/22 to repair spouts, hand sink and temperatures at the dishwasher. Dishwasher Aide Y stated when temperatures are not at accurate levels this failure could place residents at risk of contamination. Dishwasher Aide Y stated the machine was not working correctly, he was responsible to alert the Chef so that he could call for a repair. Dishwasher Aide Y stated he would stop using the dishwasher until provider could be called out repair temperatures. Review of the Dish Machine Temperature Log indicated Dish machine temperatures and chemical levels must be monitored and recorded every meal period. Wash cycle must be 150-165 degrees. Final rinse temperature must be at least 180 degrees. Record review for the month of January 2024 wash cycle ran at various temperatures between 135-150 degrees, the rinse cycle ran between 175-182 degrees. Interview and observation on 01/23/24 at 8:50 AM the Executive Chef revealed commercial company comes out to provide maintenance to the dishwasher on a weekly basis and when they are called out for repairs. The Executive Chef stated the dishwasher was a high temperature machine and must run at 140 for wash and 180 for rinse. The Executive Chef stated his expectations are for the Dishwasher Aides to let the machine run to reach appropriate temperatures prior to use. The Executive Chef stated there has been in-services to remind all dishwashers to monitor the temperatures before use, record in the log, and notify him immediately with any issues. The Executive Chef further stated at this time staff will stop using the dishwasher and wash equipment by hand until provider comes out to check the dishwasher. The Executive Chef was communicating with repair company, reviewed a text which indicated the dishwasher was a high temperature machine and must reach 140 for wash cycle and 180 for rinse. Observation and interview on 01/23/24 at 11:15 AM with the Dining Service Director revealed the dishwashing staff was using the dishwasher. During observation, the dishwasher was reaching wash (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 37 of 42 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 01/26/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some temperatures of 140, however did not reach adequate temperatures for rinsing. When asked why the dishwasher was in use both Dishwasher Aide Y and the Dining Service Director stated the machine takes several cycles to reach appropriate temperatures, and that staff ran the machine until temperatures are were met. During observation of Dishwasher Aide Y running the machine he was not observing the temperatures while the machine was running. Dishwasher Aide Y stated he had been working at the facility for 16 years and knows how to run the dishwasher. According to the Dining Service Director the machine did not usually take this long to reach appropriate temperatures therefore request for repairs would be called in. The Dining Service Director stated she expected staff to use the dishwasher properly by waiting until the appropriate temperatures are reached and to contact the Executive Chef if there was a problem so repairs could be initiated. The Dining Service Director stated they were using the dishwasher at inappropriate working temperatures. Interview on 01/25/24 at 4:42 PM with the Administrator revealed when the dishwasher was not running at its best, his expectation was to contact the provider and have them come out to repair or look at the machine (if they do not know how to fix it themselves) to ensure temperatures are reached prior to use. Staff should be checking for appropriate temperatures and sanitation prior to use. The Administrator stated not using the machine as directed could cause contamination and illness among all residents which could create an outbreak. The Administrator further stated staff should be logging accurate temperatures in the logbook and Dietary Managers should review the logbook to ensure staff are using equipment and documenting at each meal. The Administrator stated he would check with kitchen staff for any repairs for the visit on 01/23/24. He then stated they were waiting on documentation from the provider. Record review of the last repair visit dated 12/30/23 at 7:51 PM revealed regular service call The report reflected: Kitchen Results: Good ensuring wares ae safe and up to cleanliness standards. Wash Temperature 155 Fahrenheit Rinse 185 Fahrenheit monitoring wash temperature for compliance to protect guest, reputations, and machine efficiency. Rinse additive 1.5ml validating rinse additive levels. Machine Condition Good inspection machine health. Request for record review of repair visit from 01/19/24 or 01/23/24 was not provided. Record review on 01/26/24 at 8:05 AM revealed regular service call Kitchen Results: Good ensuring wares ae safe and up to cleanliness standards. Wash Temperature 145 issue found; parts replaced: Door Glides. Fahrenheit Rinse 190 Fahrenheit monitoring wash temperature for compliance to protect guest, reputations, and machine efficiency. Rinse additive 1.5ml validating rinse additive levels. Machine Condition issue found inspecting machine for health Comments: Adjusted wash paddle machine would run with no rack in the machine. After adjustment machine works properly. Also replaced door glides. Record Review on 01/26/24 at 8:09 AM Training Call, Training topic: hot water sanitation procedure. Trained on how to take rinse temperature for proper procedures and safety. Record review of the facility's Washing and Sanitizing Dishes policy and procedure, revised February 2018, reflected: .All dishes/utensils will be washed and sanitized using appropriate machine-washing procedures. Machine washing: If a commercial dishwasher is used, the following procedures should be followed: .3.Ensure that the machine reaches the proper temperatures. For high temperature dish machines, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 38 of 42 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 01/26/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete the wash water temperature must be a minimum of 150° F and the rinse water must reach 180° F. Appropriate ppm's must be measured, Chlorine levels: between 50-100 ppm, Quat levels: between 180-200 ppm. 4.Low and High temperature dish machine temperatures must be taken and recorded on the temperature log. In addition, surface temperatures are required within Skilled Nursing communities. Event ID: Facility ID: 455866 If continuation sheet Page 39 of 42 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 01/26/2024 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations and interviews the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 3 of 9 sharps containers, and 1 of 6 staff (CNA D) reviewed for infection control. Residents Affected - Some 1. The facility failed to monitor sharps containers to prevent them from being over filled. 2. The facility failed to ensure CNA D disinfected the blood pressure cuff in between blood pressure checks for Residents #32, #34, #42 and #45. These findings could result in residents being exposed to infections and bloodborne pathogens. Findings included: 1.Observation on 1/23/24 at 11:00 AM the sharps container in the shower room on the 2nd floor was over filled to the point that the safety flap could not function. Observation on 1/23/24 at 11:10 AM the sharps container on the Wound Care Nurse procedure cart was over filled to the point that the safety flap was not functioning and a used butterfly needle, with blood in the tubing, was found on the floor beneath the sharp's container. Observation on 1/24/24 at 9:48 AM the sharps container on the medication aide cart was passed the Do Not Fill line of the container. The safety flap was still operational. Interview on 1/24/24 at 10:20 AM the Wound Care Nurse stated the risk of having an exposed needle on the floor was injury to a resident with exposure to any bloodborne pathogens that might be in the blood contained in the needle. Interview on 1/24/24 at 11:02 AM the DON stated all nurses are responsible for changing our sharps containers before they reach the Do Not Fill line. CNAs and Medication Aides were responsible for letting the nurses know when one of their sharp's boxes needed to be changed. 2. Observation on 1/23/24 from 3:20 PM to 3:31 PM of CNA C was observed checking residents vitals. CNA C used the same blood pressure cuff to check the blood pressure and pulse on Residents #32, #34, #42 and #45 without disinfecting the cuff and pulse oximeter between each resident. Interview on 1/23/24 at 4:17 PM with CNA C revealed he was the CNA assigned to the 3rd floor D Hall. He stated he completed vital checks on residents on D Hall about 30-40 minutes ago. He stated he checked for pulse, temperature, and blood pressure. CNA C stated if any of the vitals are not within range, he would notify the charge nurse. CNA C stated reusable equipment, like blood pressure cuffs, and pulse oximeter should be disinfected with wipes between each resident use (before and after use on each resident). He stated he did not observe the disinfecting wipes on the cart and he forgot to ask prior to checking vitals. He stated the risk of not disinfecting reusable equipment would be cross contamination from one resident to another. Interview on 1/25/24 at 9:16 AM with the ADON revealed she was also the Infection Preventionist at the facility. She stated her expectation was that staff would disinfect all reusable equipment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 40 of 42 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 01/26/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some between each resident use. The ADON stated staff should wipe down monitor, blood pressure cuff and any other equipment used after each resident. The ADON stated she was responsible for training staff on infection control. She stated it was the DON and her responsibility to ensure staff are disinfecting equipment's. She stated the risk would be cross contamination. Interview on 1/25/23 at 2:01PM with the DON revealed her expectation was that staff would disinfect all reusable equipment between each resident use. The DON stated failure to disinfect the blood pressure placed residents at risk of cross contamination from one resident to another. Review of the facility policy Sharps Disposal revised date 11/2019 revealed the following: This community shall discard contaminated sharps into designated containers. 1. Whoever uses contaminated sharps shall discard them immediately or as soon as feasible into designated containers. 4. Contaminated sharps containers shall be closed and placed in designated medical waste container in accordance with state and federal regulation. Record review of facility's Cleaning and Disinfecting Non-Critical Resident-Care Items policy, revised date June 2011, reflected: .non-critical items are those that come in contact with intact skin but not mucous membranes. 1. Non-critical resident-care items include bed pans, blood pressure cuffs .Reusable items are cleaned and disinfected or sterilized between residents FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 41 of 42 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 01/26/2024 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 0914 Provide bedrooms that don't allow residents to see each other when privacy is needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to equip rooms to assure full visual privacy for each resident in 5 of 16 rooms reviewed for privacy. Residents Affected - Some The facility failed to install curtains to ensure the residents in the A bed would have full visual privacy when needed. This failure could cause the resident to be exposed to anyone entering the room during cares. Findings included: Observations on 1/23/24 from 10:31 AM to 3:50 PM revealed rooms 208, 210, 223, 226, and 310 had railing on the ceiling to hold a privacy curtain but no curtains had been hung. All rooms were double occupancy rooms and the B bed had curtains to ensure full visual privacy. room [ROOM NUMBER] had a privacy curtain installed for the B bed; however, it did not extend all the way around the bed. Interview on 1/24/23 at 11:02 AM the DON stated each bed had to have curtains suspended from the ceiling that provided full visual privacy for each resident in the room. The DON stated she was unaware the A bed of each room was not equipped with privacy curtains; it had never been mentioned to her. The DON stated maintenance was responsible for hanging privacy curtains, and nursing staff were responsible for notifying them when a curtain needed to be replaced or hung. The Administrator was unable to provide a policy regarding privacy curtains. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455866 If continuation sheet Page 42 of 42