Inspection visit
Health inspection
3 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 3 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0624
Prepare residents for a safe transfer or discharge from the nursing home.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview, observation, and record review, the facility failed to ensure the correct the resident and their
family members had sufficient preparation and orientation to ensure safe and orderly discharge from the
facility to home for 1 (Resident #1) of 3 resident's reviewed for discharge rights.
Residents Affected - Few
The facility failed to ensure Resident #1 had the correct medications that were prescribed to her upon
discharge on [DATE]. Resident #1 was discharged on 12/15/2024 with a blister card of Furosemide 40mg
tablets, that were prescribed to Resident #3. Resident #1 was prescribed Furosemide 20mg tablets upon
discharge.
This failure could put the resident at risk for adverse reactions to a medication not prescribed to her
including worsening kidney function, low blood pressure, and hospitalization.
Findings included:
Review of Resident #1's face sheet dated 1/8/2025, revealed an [AGE] year-old female admitted on [DATE]
and discharged on 12/15/2024. Her Diagnoses include metabolic encephalopathy (a change in how the
brain works causing confusion, memory loss and loss of consciousness), malignant neoplasm of breast
(breast cancer), dementia (a progressive degenerative disorder of the brain causing memory loss and
confusion), aphasia (a difficulty in speech), dysphagia (difficulty swallowing), acute kidney failure (the
kidneys inability to function properly), depression, gastro-esophageal reflux disease (a chronic digestive
disease where the liquid content of the stomach refluxes into the throat), and hypertensive heart disease
(chronic high blood pressure that puts a strain on the heart and makes it harder for it to pump your blood).
Review of Resident #1's discharge MDS assessment, dated 12/14/2024, reflected a BIMS of 15 indicating
her cognition was intact.
Review of Resident #1's care plan date initiated on 10/15/2024 reflected:
1. Focus: Dx of hypertension and at risk for hyper/hypotensive (high/low blood pressure) episodes,
medication side effects with interventions: Provide medications as ordered.
Review of Resident #1's Resident Drug Release dated 12/14/2024 revealed Resident #1 discharged with
Furosemide 40mg tablet quantity of 13.
Record review of Resident #1's order summary dated 01/07/2025 revealed an order for Lasix(furosemide)
20mg 1 tablet by mouth one time a day for HTN.
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 18
Event ID:
675118
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0624
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Review of Resident #3's face sheet, dated 01/08/2025, revealed a [AGE] year-old male admitted on [DATE]
and discharge on [DATE]. His diagnoses include fracture of shaft of right tibia (break in the lower right leg),
malignant neoplasm of bladder(cancer), peripheral vascular disease (decreased circulation in the legs),
hypertensive heart disease with heart failure (inability for the heart to adequately pump blood throughout
the body due to damage sustained by high blood pressure), and diabetes mellitus (inability to regulate
blood sugar).
Review of Resident #3's discharge MDS assessment, dated 12/31/2024, reflected a BIMS of 15 indicating
his cognition was intact.
Review of Resident #3's care plan date initiated on 12/26/2024 reflected:
1.
Focus: At risk for fluid deficits due to taking diuretics for HTN and CKD with interventions: Provide
medications as ordered
Record review of Resident #3's Order Summary dated 01/08/2025 revealed an order for furosemide 40mg
Give 1 tablet by mouth one time a day for Edema.
Record review of Incident and Accident Reports dated 01/07/2025 for dates 07/07/2024 to 01/07/2025 had
no mentions of Resident #1 or Resident #3.
During an interview and observation on 01/07/2025 at 11:09 AM, family member stated when Resident #1
was discharged she got a blister card of Resident #3's medications. She stated that the error was
discovered after leaving the facility but before administering any medication. The family member provided a
picture of the blister card of medication Resident #1 was provide by the facility during the interview.
Observed across the top of the blister card was Resident #3's name, the name of the medication was
furosemide 40mg tablet, instructions for use state Give 1 tablet by mouth one time a day for edema. The
blister card appears to have 2 pills missing from blister #14 and blister #15.
During an interview on 01/08/2025 at 2:30 PM with NP, she stated that the wrong medication was sent
home with Resident #1 in the past. She stated the furosemide was a larger dose than was originally
ordered though she couldn't recall the exact dosage. She stated that potential negative impacts if the
resident would have taken the medication include worsened kidney function and a HIPAA breach.
During an interview on 01/08/2025 at 3:26 PM with the DON, he revealed he had been filling in as the
interim DON for the past couple months. The DON stated his expectations for discharging a resident with
medication were checking the medications against their chart prior to dispensing them out. Make sure the
resident was getting the medications that were prescribed to them. He stated a potential negative impact for
residents not getting the medication that was prescribed to them could be and adverse effect, a HIPAA
violation, but I would hope that the family would read the names on the card.
During an interview on 01/08/2025 at 4:24 PM, the ADM stated her expectations for discharging a resident
was to ensure the resident has their medications. She stated she believed the name and quantity was
documented in the chart when a resident was discharged with medications. She stated they found out the
day after the resident was discharged and told the family member of the resident to bring back in the
incorrect card of medications and they would give her the correct one, but the family member never
returned. She stated they also sent a prescription for furosemide over to the pharmacy.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 2 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0624
Level of Harm - Minimal harm
or potential for actual harm
She stated the Resident #3 got his scheduled medication from the E-kit. The ADM stated the potential
negative impact on a resident would depend on circumstances. It is difficult to say. It depends. When
questioned about possible HIPAA violation she stated, The only thing I can think of it was just the resident's
name and the name of the medication.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 3 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0727
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on
a full time basis.
Based on interview, observation, and record review, the facility failed to use the services of a registered
nurse for at least 8 consecutive hours a day, 7 days a week for 8 (1/1/25, 1/2/25, 1/3/25, 1/4/25, 1/5/25,
1/6/25, 1/7/25, and 1/8/25) of 9 days reviewed for RN coverage.
The facility failed to ensure they had an RN charge nurse on duty for 8 days 01/01/2025 through
01/08/2025.
This failure could place residents at risk of missed nursing assessments, interventions, care, and treatment.
Findings included:
Review of hand written nursing hours for December 31, 2024, to January 8, 2025, by the DON, reflected
zero hours worked by an RN charge nurse on the following days:
01/02/2025,
01/06/2025, and
01/07/2025,
And less than 8 hours worked by an RN charge nurse on the following days:
01/01/2025,
01/03/2025,
01/04/2025,
01/05/2025, and
01/08/2025.
During an observation on 01/07/2025 at 11:35 AM and 01/08/2025 at 11:42 AM the staffing sign in sheet
revealed 12-hour shifts for charge nurses. There were no RNs listed as charge nurses on the sign in sheet
for 01/07/2025 and one nurse was listed on the sign in sheet for 01/08/2025 to work from 6:00 PM- 6:00
AM filling only 6 of the required 8 hours.
During a confidential interview a concern was mentioned about the number of nurses that worked on
January 1, 2025. They stated that there was only one nurse providing care to all the residents on the
morning of January 1, 2025.
During an interview on 01/08/2025 at 3:26 PM with the DON, he stated he was the only registered nurse
scheduled to work and that most days he was the registered nurse schedule to work. He stated there was
not a registered nurse dedicated as charge nurse today. The DON stated he was typically at the facility
throughout the week and if they need a registered nurse when he isn't in the building then
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 4 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0727
they utilize an outside telehealth service for triage.
Level of Harm - Minimal harm
or potential for actual harm
During an interview on 01/08/2025 at 4:24 PM with the ADM, she stated they do their best to ensure there
was a registered nurse in the building for 8 consecutive hours a day every day. She stated that all the floor
nurses in this building are referred to as charge nurses.
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 5 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to provide pharmaceutical services, including timely
administration of all drugs and biologicals to meet the needs for 2 (Resident #1 & #2) of 5 residents
reviewed for pharmaceutical services.
1. The facility failed to ensure Resident #1's scheduled medications were administered in a timely manner
in accordance with professional standards. Resident #1 was not given her carvedilol (a medication to lower
blood pressure and regulate the heart rate) a total of 3 times, her hydralazine (a medication to lower blood
pressure) a total of one time, isosorbide dinitrate (a medication to lower blood pressure) a total of one time
and ciprofloxacin (an antibiotic) a total of one time. Resident #1 was given the following medications outside
of the one hour before and one hour after window that meets professional standards: sodium bicarbonate
(for acid indigestion) seven times, carvedilol (to lower blood pressure), Abilify (a mood stabilizer) eight
times, sertraline (an antidepressant) eight times, amlodipine besylate (to lower blood pressure) eight times,
lisinopril (to lower blood pressure) ten times, hydralazine (to lower blood pressure) thirteen times,
isosorbide dinitrate (to lower blood pressure) sixteen times, ciprofloxacin (an antibiotic) five times,
Acidophilus (a probiotic) four times, Vitamin D3 (a supplement) one time, Mirtazapine (an antidepressant)
two times, and Med pass (a calorie supplement) one time from October 15, 2024 to October 31, 2024
2. The facility failed to ensure Resident 2's scheduled medications were administered in a timely manner in
accordance with professional standards. Resident #2 was not given his armodafinil (a medication to treat
excessive daytime sleepiness) a total of 2 times and Omeprazole (a medication for acid indigestion) a total
of one time. Resident #2 was given the following medication outside of the one hour before and one hour
after window that meets professional standards: Jardiance (a medication for diabetes) seven times, Toprol
XL (a medication to lower blood pressure) five times, Cholecalciferol (a supplement) five times, Vitamin C (a
supplement) six times, senna-docusate (a stool softener) five times, torsemide (a medication to decrease
fluid retention and lower blood pressure) 5 times, citalopram (an antidepressant) five times, lactulose (a
medication given for constipation) a total of five times, ferrous sulfate (an iron supplement) five times,
potassium chloride ER (a supplement) a total of five times, Rivaroxaban (a medication to prevent blood
clots because of an abnormal heart rhythm) a total of two times, metformin (a medication to lower blood
sugar) a total of four times, and diltiazem (a medication to lower blood pressure and prevent chest pain)
one time within the first eight days of January 2025.
This failure could place residents at risk of not receiving their scheduled medications in an accurate and
timely manner to promote healing and to meet the needs and care of the residents.
Findings included:
1. Review of Resident #1's, face sheet dated 1/8/2024, revealed an [AGE] year-old female admitted on
[DATE] and discharged on 12/15/2024. Her Diagnoses include metabolic encephalopathy (a change in how
the brain works causing confusion, memory loss and loss of consciousness), malignant neoplasm of breast
(breast cancer), dementia (a progressive degenerative disorder of the brain causing memory loss and
confusion), aphasia (a difficulty in speech), dysphagia (difficulty swallowing), acute kidney failure (the
kidneys inability to function properly), depression, gastro-esophageal reflux disease (a chronic digestive
disease where the liquid content of the stomach refluxes into the throat), and
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 6 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Level of Harm - Minimal harm
or potential for actual harm
hypertensive heart disease (chronic high blood pressure that puts a strain on the heart and makes it harder
for it to pump your blood).
Review of Resident #1's discharge MDS assessment, dated 12/14/2024, reflected a BIMS of 15 indicating
his cognition was intact.
Residents Affected - Some
Review of Resident #1's care plan date initiated on 10/15/2024 reflected:
1. Focus: I use antidepressant medication to treat depression and poor appetite with interventions that
include: Administer antidepressant medications as ordered by physician. Monitor/document side effects and
effectiveness q shift.
2. Focus: I use psychotropic medications in conjunction with my antidepressant to control my depression
symptoms with an intervention: Administer psychotropic medications as ordered by physician. Monitor for
side effects and effectiveness q shift.
3. Focus: Dx of hypertension and at risk for hyper/hypotensive episodes, medication side effects with
interventions: Provide medications as ordered.
Review of Resident #1's Active order summary report dated 1/7/2025 revealed:
Abilify 15mg Give 1 tablet by mouth one time a day for depression
Acidophilus 100mg Give 1 capsule by mouth one time a day for GI health
Amlodipine Besylate 10mg Give 1 tablet by mouth one time a day for HTN Hold for SBP < 110, HR < 60
Carvedilol 25mg Give 1 tablet by mouth two times a day for HTN Hold for BP <110, HR <60
Hydralazine 100mg Give 1 tablet by mouth three times a day for HTN Hold for SBP <110, HR <60
Isosorbide Dinitrate 20mg Give 1 tablet by mouth every 8 hours for HTN Hold for SBP <110, HR <60
Lisinopril 10mg Give 1 tablet by mouth one time a day for HTN Hold for SBP <100, HR <60
Mirtazapine 15mg Give 2 tablet by mouth at bedtime for depression
Sodium Bicarbonate 650mg Give 2 tablet by mouth two times a day for acid indigestion
Vitamin D3 5000 unit Give 1 capsule by mouth one time a day for supplement/ vitamin D deficiency.
Sertraline 50mg Give 1 tab by mouth one time a day related to depression
Record review of Medication Admin Audit Report for Resident # 1 for the month of October 2024 revealed
late, and missing doses as follows:
1. Sodium Bicarbonate Oral Tablet 650mg Give 2 tablets by mouth twice daily for acid indigestion.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 7 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Due 10/15/2024 17:00(5:00PM) administered at 18:15(6:15PM)
Level of Harm - Minimal harm
or potential for actual harm
Due 10/16/2024 09:00(AM) administered at 10:20(AM)
Due 10/18/2024 09:00(AM) administered at 10:31(AM)
Residents Affected - Some
Due 10/19/2024 09:00(AM) administered at 10:13(AM)
Due 10/20/2024 09:00(AM) administered at 12:08(PM)
Due 10/25/2024 21:00(09:00PM) administered on 10/26/2024 at 04:45(AM)
Due 10/26/2024 09:00(AM) administered at 12:12(PM)
2. Carvedilol Tablet 12.5mg give 1 tablet by mouth two times daily for HTN hold for SBP 100, HR 60, take
with meals.
Due 10/15/2024 17:00(05:00PM) administered at 18:18(6:18PM)
Due 10/16/2024 09:00(AM) administered at 10:24(AM)
Due 10/18/2024 09:00(AM) administered at 10:36(AM)
Due 10/19/2024 09:00(AM) administered at 10:24(AM)
Due 10/20/2024 09:00(AM) administered at 12:07(PM)
Due 10/24/2024 17:00(05:00PM)-missed dose
Due 10/25/2024 17:00(05:00PM)-missed dose
Due 10/26/2024 09:00(AM) administered at 12:19(PM)
Due 10/29/2024 17:00(05:00PM)-missed dose
3. Abilify 15mg give 1 tablet by mouth one time a day for depression.
Due 10/16/2024 08:00(AM) administered at 10:20(AM)
Due 10/18/2024 08:00(AM) administered at 10:31(AM)
Due 10/19/2024 08:00(AM) administered at 10:13(AM)
Due 10/20/2024 08:00(AM) administered at 12:07(PM)
Due 10/21/2024 08:00(AM) administered at 09:56(AM)
Due 10/26/2024 08:00(AM) administered at 12:12(PM)
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 8 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Due 10/27/2024 08:00(AM) administered at 09:06(AM)
Level of Harm - Minimal harm
or potential for actual harm
Due 10/28/2024 08:00(AM) administered at 09:08(AM)
4. Sertraline HCl Tablet 100mg Give 1 tablet by mouth one time a day for depression
Residents Affected - Some
Due 10/16/2024 at 08:00(AM) administered at 10:20(AM)
Due 10/18/2024 at 08:00(AM) administered at 10:36(AM)
Due 10/19/2024 at 08:00(AM) administered at 10:13(AM)
Due 10/20/2024 at 08:00(AM) administered at 12:07(PM)
Due 10/21/2024 at 08:00(AM) administered at 09:57(AM)
Due 10/26/2024 at 08:00(AM) administered at 12:12(PM)
Due 10/27/2024 at 08:00(AM) administered at 09:06(AM)
Due 10/28/2024 at 08:00(AM) administered at 09:08(AM)
5. Amlodipine Besylate tablet 10mg Give 1 tablet by mouth one time a day for HTN hold for SBP 110, HR
60
Due 10/16/2024 at 08:00(AM) administered at 10:24(AM)
Due 10/18/2024 at 08:00(AM) administered at 10:35(AM)
Due 10/19/2024 at 08:00(AM) administered at 10:24(AM)
Due 10/20/2024 at 08:00(AM) administered at 12:06(PM)
Due 10/21/2024 at 08:00(AM) administered at 09:57(AM)
Due 10/26/2024 at 08:00(AM) administered at 12:18(PM)
Due 10/27/2024 at 08:00(AM) administered at 09:08(AM)
Due 10/28/2024 at 08:00(AM) administered at 09:08(AM)
6. Lisinopril tablet 5 mg Give 1 tablet by mouth one time a day for HTN hold for SBP 100, HR 60
Due 10/16/2024 at 08:00(AM) administered at 10:24(AM)
Due 10/18/2024 at 08:00(AM) administered at 10:36(AM)
Due 10/19/2024 at 08:00(AM) administered at 10:24(AM)
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 9 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Due 10/20/2024 at 08:00(AM) administered at 12:07
Level of Harm - Minimal harm
or potential for actual harm
Due 10/21/2024 at 08:00(AM) administered at 09:56(AM)
Due 10/26/2024 at 08:00(AM) administered at 12:19
Residents Affected - Some
Due 10/27/2024 at 08:00(AM) administered at 09:06(AM)
Due 10/28/2024 at 08:00(AM) administered at 09:09(AM)
Due 10/29/2024 at 06:30(AM) administered at 07:36(AM)
Due 10/30/2024 at 06:30(AM) administered at 07:53(AM)
7. Hydralazine HCl 50mg give 1 tablet by mouth three times a day for HTN Hold for SBP 110, HR 60
Due 10/17/2024 at 22:00(10:00PM) administered on 10/18/2024 at 05:48(AM)
Due 10/19/2024 at 06:00(AM) administered at 10:22(AM)
Due 10/20/2024 at 06:30(AM) administered at 12:05(PM)
Due 10/20/2024 at 14:30(02:30PM) administered at -16:55(04:30PM)
Due 10/21/2024 at 06:30(AM) administered at 09:56(AM)
Due 10/21/2024 at 14:30(02:30PM) administered at 16:15(04:15PM)
Due 10/22/2024 at 06:30(AM) administered at 08:30(AM)
Due 10/24/2024 at 14:30(02:30PM) missed dose
Due 10/25/2024 at 06:30(AM) administered at 07:51(AM)
Due 10/26/2024 at 08:00(AM) administered at 12:19(PM)
Due 10/26/2024 at 14:00(02:00PM) administered at 17:38(05:38PM)
Due 10/26/2024 at 20:00(08:00PM) administered at 21:25(09:25PM)
Due 10/27/2024 at 08:00(AM) administered at 09:06(AM)
Due 10/28/2024 at 08:00(AM) administered at 09:08(AM)
8. Isosorbide Dinitrate 20mg Give 1 tablet by mouth every eight hours for HTN hold for SBP 100, HR 60
Due 10/17/2024 at 22:00(10:00PM) administered on 10/18/2024 at 05:48(AM)
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 10 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Due 10/19/2024 at 06:00(AM) administered at 10:23(AM)
Level of Harm - Minimal harm
or potential for actual harm
Due 10/20/2024 at 06:30(AM) administered at 12:06(PM)
Due 10/20/2024 at 14:30(02:30PM) administered at 16:56(04:56PM)
Residents Affected - Some
Due 10/21/2024 at 06:30(AM) administered at 09:57(AM)
Due 10/21/2024 at 14:30(02:30PM) administered at 16:15(04:15PM)
Due 10/22/2024 at 06:30(AM) administered at 08:30(AM)
Due 10/24/2024 at 14:30(02:30PM) missed dose
Due 10/25/2024 at 06:30(AM) administered at 07:51(AM)
Due 10/25/2024 at 22:30(10:30PM) administered on 10/26/2024 at 04:45(AM)
Due 10/26/2024 at 06:30(AM) administered at 12:17(PM)
Due 10/26/2024 at 14:30(02:30PM) administered at 17:39(05:39PM)
Due 10/27/2024 at 06:30(AM) administered at 09:07(AM)
Due 10/29/2024 at 22:30(10:30PM) administered on 10/30/2024 at 00:20(12:20AM)
Due 10/30/2024 at 06:30(AM) administered at 07:52(AM)
Due 10/30/2024 at 22:30(10:30PM) administered on 10/30/2024 at 20:04(08:30PM)
Due 10/31/2024 at 06:30(AM) administered at 08:20(AM)
9. Ciprofloxacin HCl Tablet 250mg Give 1 tablet by mouth twice a day for UTI for 7 days
Due 10/25/2024 at 09:00(AM)-missed dose
Due 10/26/2024 at 09:00(AM) administered at 11:04(AM)
Due 10/27/2024 at 09:00(AM) administered at 10:50(AM)
Due 10/28/2024 at 09:00(AM) administered at 13:17(01:17PM)
Due 10/29/2024 at 09:00(AM) administered at 11:10(AM)
Due 10/30/2024 at 09:00(AM) administered at 10:48(AM)
10. Acidophilus Capsule 100mg Give 1 capsule by mouth one time a day for GI health
Due 10/26/2024 at 06:30(AM) administered at 12;12(PM)
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 11 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Due 10/27/2024 at 06:30(AM) administered at 09:06(AM)
Level of Harm - Minimal harm
or potential for actual harm
Due 10/29/2024 at 06:30(AM) administered at 07:34(AM)
Due 10/30/2024 at 06:30(AM) administered at 07:46(AM)
Residents Affected - Some
11. Vitamin D3 capsule 5000units Give 1 capsule by mouth one time a day for supplement/Vitamin D
deficiency
Due 10/26/2024 at 09:00(AM) administered at 12:12(PM)
12. Mirtazapine 15mg 1 tablet by mouth at bedtime for depression
Due 10/15/2024 at 21:00(09:00PM) administered at 22:56(10:56PM)
Due 10/25/2024 at 21:00(09:00PM) administered on 10/26/2024 at 04:45(AM)
13. Med Pass 2.0 at bedtime for supplement for 6 weeks 120ml
Due 10/25/2024 at 21:00(09:00PM) administered on 10/26/2024 04:45(AM)
2. Review of Resident #2's face sheet, dated 01/08/2025, reflected a [AGE] year-old male who was
admitted to the facility on [DATE] with diagnoses encephalopathy (a change in how the brain works causing
confusion, memory loss and loss of consciousness), atrial fibrillation (a abnormal hearth rhythm),
dysphagia (difficulty swallowing), heart failure (the heart is unable to pump blood to the body effectively),
depression, diabetes mellitus (the inability to regulate blood sugars), edema (swelling), and hyperlipidemia
(high cholesterol).
Review of Resident #2's quarterly MDS, dated [DATE], reflected a BIMS of 12 indicating he had mild
cognitive deficits.
Review of Resident #2's care plan, date initiated on 09/23/2024 reflected:
1.
Focus: I have Congestive Heart Failure and at risk for SOB, fluid overload, and weight gain with
interventions that include Give cardiac medications as ordered.
2.
Focus: I have transient ischemic attacks (mini strokes) with interventions that include Give medication as
ordered by physician. Monitor/document side effects and effectiveness.
3.
Focus: I have a DX of Hyperlipidemia with interventions that include Provide medications as ordered.
4.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 12 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Focus: I have DX of A-fib and take an anticoagulant to treat it. I am at risk for easy bruising and prolonged
bleeding with interventions that include Provide medications as ordered.
5.
Focus: I have DX of Depression and at risk for adverse reaction side effect with interventions that include
Provide medications as ordered.
6.
Focus: I have a DX of Hypertension and at risk for hyper/hypotensive (high/low blood pressure) episodes,
medication side effects with interventions that include Provide medications as ordered.
7.
Focus: At risk for GI upset due to DX of GERD with interventions that include Provide medications as
ordered.
Review of Resident #2's Active order summary report dated 01/08/2025 revealed:
Jardiance 10mg Give 1 tablet by mouth one time a day for DM2
Toprol XL 50mg Give 1 tablet by mouth one time a day for Afib Hold for SBP <110, HR<60 ***DO NOT
CRUSH MEDICATION***
Cholecalciferol 125mcg Give 1 tablet by mouth one time a day for supplement
Vitamin C 500mg Give 1 tablet by mouth two times a day for wound healing
Senna-Docusate Sodium 8.6-50mg Give 1 tablet by mouth two times a day for constipation
Torsemide 20mg Give 1 tablet by mouth one time a day for fluid retention
Citalopram 20mg Give 1 tablet by mouth one time a day for depression
Lactulose 10Gm/15ml Give 30ml by mouth two times a day for constipation. Hold for loose stools.
Ferrous Sulfate 325mg Give 1 tablet by mouth one time a day for iron deficiency anemia. Monitor for
constipation
Potassium Chloride 20meq Give 1 tablet by mouth two times a day for hypokalemia (low potassium in the
blood)
Metformin 1000mg Give 1 tablet by mouth two times a day for DM2
Armodafinil 150mg Give 1 tablet by mouth one time a day for excessive daytime sleepiness
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 13 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Diltiazem ER 180mg Give 1 capsule by mouth at bedtime for high blood pressure. Hold for BP<110, HR
<60 ***DO NOT CRUSH OR OPEN THIS MEDICATION***
Omeprazole Delayed Release 20mg Give 1 capsule by mouth two times a day for GERD (reflux of liquified
stomach contents into the throat) ***DO NOT CRUSH OR OPEN MEDICATION*** give 30 to 60 min before
bkfst & HS
Record review of Medication Admin Audit Report for Resident # 2 for the month of January 2025 revealed
late, and missing doses as follows:
1.
Jardiance 10mg Give 1 tablet by mouth one time a day for DM2.
Due 01/01/2025 06:30(AM) administered at 10:26(AM)
Due 01/02/2025 06:30(AM) administered at 08:20(AM)
Due 01/03/2025 06:30(AM) administered at 11:11(AM)
Due 01/05/2025 06:30(AM) administered at 10:19(AM)
Due 01/06/2025 06:30(AM) administered at 11:27(AM)
Due 01/07/2025 06:30(AM) administered at 11:29(AM)
Due 01/08/2025 06:30(AM) administered at 08:42(AM)
2.
Toprol XL tab Extended Release 24-hour 50mg Give 1 tablet by mouth one time a day for A-fib Hold for
SBP 110, HR 60 **DO NOT CRUSH MEDICATION**
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
Due 01/03/2025 09:00(AM) administered at 11:12(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Due 01/07/2025 09:00(AM) administered at 11:30(AM)
3.
Cholecalciferol Tab 125mcg Give 1 tablet by mouth one time a day for supplement
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 14 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Due 01/03/2025 09:00(AM) administered at 11:11(AM)
Level of Harm - Minimal harm
or potential for actual harm
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Residents Affected - Some
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
4.
Vitamin C 500mg Give 1 tablet by mouth two times a day for wound healing
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
Due 01/01/2025 17:00(PM) administered at 18:29(06:29PM)
Due 01/03/2025 09:00(AM) administered at 11:12(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
5.
Senna-Docusate Sodium 8.6-50mg Give 1 tablet by mouth two times a day for constipation
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
Due 01/03/2025 09:00(AM) administered at 11:11(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
6.
Torsemide 20mg Give 1 tablet by mouth one time a day for fluid retention
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
Due 01/03/2025 09:00(AM) administered at 11:11(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 15 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
Level of Harm - Minimal harm
or potential for actual harm
7.
Citalopram 20mg Give 1 tablet by mouth one time a day for depression
Residents Affected - Some
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
Due 01/03/2025 09:00(AM) administered at 11:11(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
8.
Lactulose 10Gm/15ml Give 30ml by mouth two times a day for constipation. Hold for loose stools.
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
Due 01/03/2025 09:00(AM) administered at 11:11(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
9.
Ferrous Sulfate 325mg Give 1 tablet by mouth one time a day for iron deficiency anemia. Monitor for
constipation
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
Due 01/03/2025 09:00(AM) administered at 11:11(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
10.
Potassium Chloride 20meqGive 1 tablet by mouth two times a day for hypokalemia
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 16 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
Due 01/01/2025 09:00(AM) administered at 10:26(AM)
Level of Harm - Minimal harm
or potential for actual harm
Due 01/03/2025 09:00(AM) administered at 11:11(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Residents Affected - Some
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
11.
Metformin 1000mg Give 1 tablet by mouth two times a day for DM2
Due 01/03/2025 09:00(AM) administered at 11:12(AM)
Due 01/05/2025 09:00(AM) administered at 10:19(AM)
Due 01/06/2025 09:00(AM) administered at 11:27(AM)
Due 01/07/2025 09:00(AM) administered at 11:29(AM)
12.
Armodafinil 150mg Give 1 tablet by mouth one time a day for excessive daytime sleepiness
Due 01/04/2025 at 08:00AM missed dose
Due 01/05/2025 at 08:00AM missed dose
13.
Diltiazem ER 180mg Give 1 capsule by mouth at bedtime for high blood pressure. Hold for BP<110,
HR<60 ***DO NOT CRUSH OR OPEN THIS MEDICATION***
Due 01/03/2025 21:00(09:00PM) administered at 22:32(10:32PM)
14.
Omeprazole Delayed Release 20mg Give 1 capsule by mouth two times a day for GERD ***DO NOT
CRUSH OR OPEN MEDICATION*** give 30 to 60 min before bkfst & HS
Due 01/06/205 at 05:30AM missed dose
Interview on 01/08/2025 at 02:30 PM with the NP revealed she has received complaints from some
residents in the past related to late medications. When a resident has brought up any concerns to her, she
relayed it to the nurse in charge of the resident at that time. The NP stated to her knowledge there has not
been any adverse outcomes at this time due to late or missing medications. She stated a negative impact
on residents for missing or late medications depended on the medication in question.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 17 of 18
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
675118
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/08/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Brush Country Nursing and Rehabilitation
6500 Brush Country Rd
Austin, TX 78749
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 0755
There could be a change in vital signs and lab work or even a decline in condition.
Level of Harm - Minimal harm
or potential for actual harm
Interview on 01/08/2025 at 03:26 PM with the DON revealed his expectations for medication administration
was medications are to be given within an hour before to an hour after the medication due time. He stated
there was a common issue with the internet going down and the medication aide's have gone back to sign
off on medications they gave while the internet was down. The DON stated the times may not be accurate.
He stated they contacted the internet company, but the issue has not been resolved. He stated the internet
was down for sometimes 30 minutes or more and sometimes it was only a few minutes.
Residents Affected - Some
Interview on 01/08/2025 at 04:25 PM with the ADM revealed his expectations for medication administration
was for staff to do everything possible to follow guidelines in the policy. She stated, but I'm sure as we all
understand, there are times and circumstances that affect our ability to do that. She stated that the impact
to the resident for late or missing medications all depending on the medication and the patient.
Facility undated policy titled Administering Oral Medications revealed no specific information in relation
medication timing
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675118
If continuation sheet
Page 18 of 18
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Back to topCitations
3 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F727 - Except when waived under paragraph (f) or (g) of this section, the
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F624 - Transfer and discharge-
Prepare residents for a safe transfer or discharge from the nursing home.
FAQ · About this visit
Common questions about this visit
What happened during the January 8, 2025 survey of Brush Country Nursing and Rehabilitation?
This was a inspection survey of Brush Country Nursing and Rehabilitation on January 8, 2025. The surveyor cited 3 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Brush Country Nursing and Rehabilitation on January 8, 2025?
Yes, 3 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full tim..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.