Health inspection·August 21, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete atrial fibrillation (irregular heartbeat that comes and goes), chronic obstructive pulmonary disease (chronic progressive lung disease), anxiety (feeling of uneasiness or worry), kidney disease, hypertensive heart disease with heart failure (damage to heart and heart failure due to chronic high blood pressure), hyperlipidemia (high cholesterol), abnormalities of gait and mobility, insomnia (difficulty sleeping) and cognitive communication deficit (problems with communication). Record review of Resident #80's Quarterly MDS assessment, dated 06/14/2025, revealed Resident #80 had a BIMS score of 15, which indicated intact cognitive response. Observation of halls on 08/20/2025 at 10:45a.m., revealed CNA A did not knock on Resident #80's door before entering her room. During an interview with Resident #80 on 08/19/2025 at 3:35 PM revealed staff did not always knock on the resident's door before entering. She said it bothered her when staff did not knock. She said she would like for staff to knock all the time before entering. During an interview with CNA A on 08/21/2025 at 1:16 PM revealed he was trained on resident rights. He stated the policy was to knock and introduce yourself before entering the resident's room because it was there home. CNA A stated staff should always knock on the door. He said anybody who wanted to go into the resident's room should be knocking. He said the residents did not like staff not knocking. He said it would be like just walking into the resident's house and that was not ok. He said no one monitored to ensure staff were knocking. He said they just had an in-service on knocking this week. He said he did not know why he did not knock on the residents' doors. During an interview with LVN B on 08/21/2025 at 1:30 PM revealed she was trained on resident rights. She said the policy was to knock and introduce yourself to the resident for dignity. She said staff did not just enter. Every time staff wanted to enter the resident's room staff should knock. There was no time staff did not have to knock. She said the resident may feel disrespected if staff did not knock. She said the team watched each other through observations. She said the staff would let each other know if someone forgot to knock. She said she did not know why she did not knock. She also said maybe the door was open but even then, she would have to knock. During an interview with the ADM on 08/21/2025 at 3:37 PM, revealed she and staff were trained on resident rights. She said the policy was staff should knock, announce themselves and let the resident know why the staff member was there. She said all staff were to always knock before going into the resident's room. She said if staff did not knock before entering the room the resident may feel scared or not know who is coming in the room. She said there was never a time when staff did not have to knock on the door before entering. She said knocking was monitored by the charge nurses and administration. She said knocking was monitored through observations and doing rounds. She said she did not know why staff did not knock on Resident #17, Resident #35, and Resident #80's door before entering. During an interview with the DON on 08/21/2025 at 3:40 p.m., revealed she and staff were trained on resident rights. She said the policy for knocking was staff should knock before entering, wait for a response, and let the resident tell the staff to come in. She said staff should knock any time they went into the residents' rooms. She said if staff did not knock on the resident's door the resident may feel bad because the facility was the resident's home. She said there was never a time staff did not have to knock on the resident's door. She said the charge nurses and the managers were responsible for monitoring to ensure staff were knocking. She said knocking was monitored by observations. She said she did not know why staff did not knock on Resident #17, Resident #35, and Resident #80's door before entering. Record review of the facility's, undated, Resident Rights Policy revealed employees shall treat all residents with kindness, respect, and dignity. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to privacy and confidentiality. Event ID: Facility ID: 675118 If continuation sheet Page 2 of 47 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 08/21/2025 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to ensure the resident had a right to personal privacy and confidentiality of his or her personal and medical records for 1 of 5 residents (Resident # 31) reviewed for medical record confidentiality.The facility failed to ensure RN D kept Resident # 31's medical information confidential.This failure could place residents at risk of their medical information being provided to unauthorized personnel, other residents, or visitors.Findings include: Observation on 08/20/2025 from 9:08 AM until 9:12 AM revealed RN D was not at the medication cart. The computer screen was left open and facing the hallway which exposed Resident confidential medical information which included name and medications. Interview on 08/20/2025 at 9:14 AM, RN D stated resident name and monitoring were on the open screen; however, he could not remember if his diagnosis was on the screen. He stated he received in-service to always lock the computer screen when not standing at the medication cart. He stated he did not recall the date he received the in-service on HIPPA. He stated he did not follow HIPPA protocol. RN D stated a visitor, another resident or anyone not an employee at the facility had access to a resident's medical information if they passed by the medication cart. He stated if another resident saw any information and shared with Resident #31, this may be embarrassing to the resident for other residents to see the resident's medical information. Interview on 08/21/2025 at 1:30 PM, the Administrator stated her expectation was for confidentiality of the residents to be protected. She stated computer screens should have been closed when not in use and any paperwork with the resident information should have been covered. She stated that was protected confidential information and it could have been a HIPAA violation.In an interview on 08/21/2025 at 2:50 PM, the DON stated resident information should be kept confidential and if it were not, it would be a HIPAA violation. She stated all computer screens were expected to be locked if a nurse was not viewing a resident's information. She said because if the screen is left open with the resident's information anyone could get that residents information. Record review of the facility's, undated, Policy on Protected Health Information, Safeguarding Electronic, reflected Electronic protected health information is safeguarded by administrative, technical, and physical means to prevent unauthorized access to protected health information. All workstations are protected from unauthorized access by physical barriers that discourage attempts to tamper with or violate security rules, including:a. Placing computer terminals and workstations away from high- traffic areas of the facility.Automatically locking computer screens. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 3 of 47 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 08/21/2025 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure assessments accurately reflected the resident's status for 3 of 3 residents (Resident #48, Resident #68, and Resident #93) reviewed for accuracy of assessments. 1. The facility failed to ensure Resident #48's admission MDS, dated [DATE], accurately reflected his smoking status.2. The facility failed to ensure Resident #68's quarterly MDS, dated [DATE], accurately reflected her smoking status. 3. The facility failed to ensure Resident #93's quarterly MDS, dated [DATE], accurately reflected her smoking status. These failures could place residents at risk of inadequate supervision due to an inaccurate assessment for smoking status. Findings include: 1. Record review of Resident #48's face sheet, dated 08/20/2025, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #48 had a diagnosis which included hemiplegia (paralysis and weakness on one side of the body that can affect the arms, legs, and facial muscles). Record review of Resident #48's admission MDS, dated [DATE], revealed Resident #48 had a BIMS of 14, which indicated intact cognitive response. The MDS also revealed current tobacco use was not checked. Record review of Resident #48's care plan, dated 8/14/2025, revealed Resident #48 was a smoker. The goal in place was the resident will not suffer injury from unsafe smoking practices through the review. Interventions were instructing resident about smoking risks and hazards and about smoking cessation aids that were available. Instruct resident about the facility policy on smoking: locations, times, safety concerns. Smoking assessment per facility Policy. Record review of Resident #48's Smoking Assessment, dated 8/15/2025, revealed Resident #48 required partial physical assistance with mobility and supervision during smoke break. 2. Record review of Resident #68's face sheet, dated 08/19/2025, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #68 had diagnoses which included cerebral infraction (stroke), major depressive disorder (mental health disorder characterized by persistent depressed mood), lack of coordination, viral hepatitis C (a bloodborne virus that causes liver inflammation), Parkinson's disease (a progressive disorder that affects the nervous system), anxiety (feeling of uneasiness or worry), muscle weakness and morbid obesity. Record review of Resident #68's quarterly MDS, dated [DATE], revealed Resident #68 had a BIMS of 15, which indicated intact cognitive response. The MDS also revealed current tobacco use was not on the MDS. Record review of Resident #68's care plan, dated 07/29/2025, revealed Resident #68 did not have her smoking status on the care plan. Record review of Resident #68's Smoking Assessment, dated 06/02/2025, revealed Resident #68 required supervision and one-on-one assistance. The resident needed to be supervised due to contractions. 3. Record review of Resident #93's face sheet, dated 08/20/2025, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #93 had diagnoses which included lack of coordination, anemia (not enough healthy red blood cells), Schizophrenia (mental disorder that affects a person's ability to think, feel and behave clearly), bipolar (extreme mood swings), anxiety (feeling of uneasiness or worry), depressive disorder (mental health disorder characterized by persistent depressed mood), hypertension (high blood pressure), insomnia (difficulty sleeping), muscle wasting, muscle weakness, and lack of coordination. Record review of Resident #93's admission MDS, dated [DATE], revealed Resident #93 had a BIMS of 15, which included intact cognitive response. The MDS also revealed current tobacco use was not checked on the MDS. Record review of Resident #93's care plan, dated 08/14/2025, revealed Resident #93 did not have her smoking status on the care plan. Record review of Resident #93's Smoking Assessment, dated 08/17/2025, revealed Resident #93 required supervision when smoking. The resident could light her own cigarette, but the facility would follow policy and have the resident supervised. During an interview with the MDSN on 08/21/2025 at 2:02 p.m., revealed she was Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 4 of 47 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 08/21/2025 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete trained on the MDS but not at the facility. She said the IDT was responsible for the MDS, but she completed most of the MDS's. She said information that was on the MDS were assessments, pain, and data collection from a resident's medical records. She said the MDS should be updated when there was a significate change, or a regulatory requirement. She said she had fourteen days from admission to complete the MDS. She said there was a question on the MDS about the resident's tobacco use and if the resident were a smoker, it would be checked yes. She said if the resident's smoking status were not coded correctly it would not get addressed. She said staff may not know who needs supervision. She said she was never told who smokers were did not answer why she did not know. She said the reason Resident #48, Resident #68, and Resident #93's smoking status was not on the MDS, was because she did not know who the smokers were. She also said she assumed there was not a list available or a clear way of knowing who the smokers were. During an interview with the SW on 08/21/2025 at 2:38 p.m., revealed she had not had any formal training on MDS's or care plans. She said she did not have anything to do with the MDS. Said then said she entered behavior notes and she did sections B, C, D, E and Q (section B covered hearing, vision and speech, section C covered cognitive patterns, section D covered mood, section E covered behavior and Q covered participation in assessment and goal setting). She said every department would have a part on the MDS and care plan. She also said she did not put the smoking status on the MDS. She said the MDS would make a list of things that needed to be done on the MDS, or care plan and staff would go through it daily. She said if a resident did not have their smoking status on the MDS the resident may not get the proper supervision. She said she did not know why Resident #48, Resident #68, and Resident #93's smoking status was not on the MDS. During an interview with the ADM on 08/21/2025 at 3:44 p.m., revealed she had not been trained on MDS's. She said the MDS nurse was responsible for doing the MDS. She said the resident's current smoking status was to be on the MDS. She said if the resident's smoking status were not on the MDS the information would be inaccurate and staff would not know the resident was a smoker. She said staff would not know if the resident needed an apron or supervision. She said she did not know why Resident #48, Resident #68, and Resident #93's smoking status was not on the MDS. During an interview with the ADM on 08/20/2025 at 4:17p.m., the MDS Policy and Accuracy of Assessments Policy was requested from the ADM and was not received on exit. Record review of the Smoking Residents provided on 08/19/2025 revealed that Resident #48, Resident #68, and Resident #93 were all smokers. Record review of the Smoking Residents list provided on 08/19/2025 revealed Resident #48, Resident #68, and Resident #93 were all smokers. Event ID: Facility ID: 675118 If continuation sheet Page 5 of 47 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 08/21/2025 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a new resident was not admitted with mental illness unless the state mental health authority determined, based on independent physical and mental evaluation performed by a person or entity other than the State mental health authority, prior to admission for 1 of 12 residents (Resident #17) reviewed for PASRR services. The facility failed to ensure a PASRR screening was completed for Resident #17. This deficient practice could place residents at risk for not obtaining the services needed to treat their mental health diagnoses.The findings include: Record review of Resident #17's admission sheet, dated 08/19/2025, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #17 had diagnoses which included cystitis without hematuria (inflammation of the bladder), somatization disorder (tendency to experience and express psychological distress as physical symptoms), fusion of the spine (surgical procedure that connect two or more parts in the spine), muscle weakness, congenital malformation of nervous system (birth defect that affects the structure and development of the brain and spinal cord), lack of coordination, anxiety disorder (feeling of uneasiness or worry) and hypertension (high blood pressure). Record review of Resident #17's admission MDS assessment, dated 06/23/2025, revealed Resident #17 had a BIMS score of 13, which indicated intact cognitive response. Resident #17's mood indicators were present which included little interest or pleasure in doing things, feeling down, depressed, or hopeless. The MDS also documented somatization disorder (tendency to experience and express psychological distress as physical symptoms), and anxiety disorder (feeling of uneasiness or worry) as active diagnoses. Record review of Resident #17's care plan, dated on 07/01/2025, noted the resident used an anti-anxiety medication r/t anxiety. The goal was Resident #17 would be free from discomfort or adverse reactions related to anti-anxiety therapy. The interventions were Administer anti-anxiety medications as ordered by physician. Monitor for side effects and effectiveness every shift. Monitor/document/report PRN any adverse reactions to anti-anxiety therapy: drowsiness, lack of energy, clumsiness, slow reflexes, slurred speech, confusion and disorientation, depression, dizziness, lightheadedness, impaired thinking and judgment, memory loss, forgetfulness, nausea, stomach upset, blurred or double vision. Unexpected side effects: Mania, hostility, rage, aggressive or impulsive behavior, hallucination. Record review revealed Resident #17 did not have a PASRR completed. During an interview with Resident #17 on 08/21/2025 at 11:02 a.m., Resident #17 said she was diagnosed with her mental disorders when she was [AGE] years old. She said she was taking anxiety medication. She said the only other service she was getting for her mental illness was seeing the psychiatrist. She said she did not know if there were other services she might want. During an interview with Marketing on 08/21/2025 at 11:30 p.m. revealed she had not been completely trained on PASRR. She said she was responsible for making sure the resident had a PASRR when they entered the facility. She said the only training she got on PASRR was the PASRR needed to be filled out. She said she could not answer the question of the process, or referrals. She also said she did not know when the PASRR should be done. She said all she knew was the resident needed a PASRR when the resident admitted to the facility for skilled. She said she did not know she needed a PASRR for long term care. She said she was confused on that part. She said she did not know what to do if a resident had a positive PASRR. She said her job was to go out and educate the community about the facility's services. She said when a referral came in, she would send an email the nursing team with the resident's clinical records. She said she did not know what could happen to the residents if they did not have a PASRR. She said she did not know why Resident #17 did not have the PASRR on admission. During an interview with the SW on 08/21/2025 at 2:38 p.m. revealed she had not been Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 6 of 47 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 08/21/2025 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 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete trained on PASRR. She also said she did not have anything to do with the PASRR's. During an interview with the MDSN on 08/21/2025 at 2:20 p.m. revealed she was trained on PASRR. She said she did not know what the policy was for PASRR. She said she knew she must have a PASRR before a resident was admitted . She also said if the resident was coming from the community a PASRR needed to be done prior to admission. She said marketing was responsible for ensuring each resident had a PASRR prior to admission. She also said she would ask for the PASRR level one to see if the resident had a qualifying diagnosis. She said if the resident had a qualifying diagnosis, she would submit to the portal so the mental health case worker could come do an assessment on the resident. She said the purpose of the PASRR was to make sure the resident got the services they required and were in the least restrictive environment. She said the facility would have an IDT meeting if the resident had a positive PASRR. She said in the IDT meeting it would discuss the services for the resident and did the referral for the services the resident wanted. She said if the PASRR was not done the facility could not bill Medicaid. She said she monitored the PASRRs on admission and looked at all referrals when she did an admission, and the resident had a qualifying diagnosis, she would do another PASRR. Said she did not know who ensured competency. She said she did not know why Resident #17 did not have a PASRR at admission. During an interview with the ADM on 08/21/2025 at 11:40 a.m., revealed she was trained on PASRR. She said the SW was responsible for doing PASRRs. She also said the SW was responsible for ensuring all residents had a PASRR. She said she did not have a policy for PASRR. She said the facility would get the PASRR for the resident from the hospital and if the resident were coming from the community, the facility would have the family fill the PASRR out. She said all residents were to have a PASRR completed prior to admission into the facility. She said the facility would identify residents with possible MI or ID through the PASRR screening. She said the resident with a qualifying diagnosis should be referred to the PASRR person and a meeting set up with PASRR people. She said the facility did not have anyone who ensured staff competency in PASRR. She said if a resident did not have a PASRR, the facility would not recognize if the resident were positive or not, and the resident could be missing services. She said Resident #17 did not have a PASRR because Marketing did not get the PASRR on admission. During an interview with the ADM on 08/21/2025 at 9:21am the ADM said the facility did not have a PASRR policy. Record review of, undated, Form 1012 Policy and Procedure with Instructions revealed the following: Purpose: Form 1012 assists nursing facilities (NF) in determining whether a resident with a negative Preadmission Screening and Resident Review (PASRR) Level I Screening form submitted into the Long-Term Care (LTC) Portal, needs further evaluation for Mental Illness (Ml). This form is used to determine whether the individual has a primary dementia diagnosis or if the individual has a mental illness diagnosis. This form also serves as the NF's documentation for the individual's medical record as to why further evaluation was or was not completed. Only a physician, which includes a psychiatrist, can complete Section D this form. A Nurse Practitioner or Physician's Assistant cannot complete Section D. Procedure When to Prepare The NF completes Form 1012 following: A determination that a resident with a negative PASRR level 1 screening form submitted into the LTC Portal needs further evaluation for Ml. An individual's diagnosis is changed. The PL 1 on file remains negative. The resident does not need a new PL 1 or further evaluation at this time. A new PL 1 is needed at this time. A full PASRR Evaluation will be conducted after the NF submits a new positive PL 1. After form submission on the LTC Online Portal, include the date of submission and the positive PL 1 document locator number (DLN) on this form. The NF staff completing Form 1012 will complete this section with their name, title, signature, and the date the form was signed. Maintain the completed 1012 form in the individual's medical record. Event ID: Facility ID: 675118 If continuation sheet Page 7 of 47 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 08/21/2025 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 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 and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that met professional standards of quality care for one of three residents (Resident # 29) reviewed for baseline care plans. The facility failed to complete a baseline care plan within 48 hours of admission for Resident #29. This failure could place residents at risk for not receiving care and services to meet their needs. Findings include: Record review of Resident #29's face sheet, dated 08/21/2025, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #29 had diagnoses which included tracheostomy status ( a resident's condition of having a surgically created opening in their windpipe with a tube inserted to help them breathe), nontraumatic intracerebral hemorrhage, unspecified (bleeding within the brain tissue that is not caused by a physical injury or trauma), and unspecified convulsions (involuntary spasms and contractions). Record review of Resident#29's admission MDS Assessment, dated 08/13/2025, reflected it was in progress. Record review of Resident #29's Baseline Care Plan, dated 08/07/2025, reflected the following sections were not completed: therapy services- physical therapy, occupational therapy, speech therapy, restorative therapy (the comment section under therapy was blank), and social services: social service provided, mental health needs, behavioral concerns, PASARR Level II ( a comprehensive assessment conducted after a positive Level I screening in the Preadmission Screening and Resident Review process) recommendations, social service goals, and depression screening. The section where the resident's preference for being notified of updates to Plan of Care was blank. The signature of the resident and Representative were not obtained for the baseline care plan. Signed by: Treatment Nurse. Interview on 08/21/2025 at 1:30 PM, the Administrator stated she expected the baseline care plan to be completed including the section on therapy and social services. She stated it was important for the staff to know any interventions needed if a resident had behaviors. She stated if a resident had triggers such as using certain words the staff would need to know this to prevent the resident from having anxiety or depression. She stated she expected the baseline care plan to be signed by the resident or family. The administrator stated therapy information needed to be documented on the baseline care plan and if the resident did not need therapy the staff was expected to document this information in the comment section. The Administrator stated the nurse supervisor who received the resident upon admission was responsible to begin the baseline care plan and it was to be completed within 48 hours upon admission date. She stated the DON, or the Treatment Nurse was responsible to review the baseline care plan after completion to ensure accuracy and completion within 48 hours. Interview on 08/21/2025 at 1:59 PM, the MDSN stated the charge nurse was responsible for the new admission and was in charge of completing the baseline care plan. She stated all the baseline care plans were to be completed in its entirety within 48 hours of the resident's admission date. The MDSN stated the social service section needed to be completed especially if a resident had any type of emotional or psychosocial needs the staff needed to be aware of to give care to the resident. She stated if a resident needed to be assessed by therapy the nurse completing the baseline care plan was expected to document this information within 48 hours of the admission date. Interview on 08/21/2025 at 2:24 PM, the Treatment Nurse, RN stated she did assess Resident # 29 upon admission. She stated she completed Resident #29's baseline care plan. She stated the social service section was vital information to provide to the staff. The Treatment Nurse, RN stated if a resident had any type of behaviors and needed special interventions the staff would not know how to care for the resident if the resident exhibited behaviors. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 8 of 47 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 08/21/2025 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete She also stated a resident may have PTSD (post-traumatic stress disorder) and the staff would need to know the residents' triggers to prevent any type of anxiety or depression. The Treatment Nurse stated the resident, or family was expected to sign the baseline care plan, and she did not review the baseline care plan with Resident #29's family or with Resident #29. She stated therapy information was expected to be documented on the baseline care plan to ensure the staff knew the resident would need to be assessed by therapy. She stated she did not recall the reason she did an incomplete baseline care plan on Resident #29. The Treatment Nurse stated it was her responsibility or the Director of Nurses responsibility to ensure all the baseline care plans were completed. She stated all baseline care plans were to be completed within 48 hours of the admission date. She stated if a charge nurse completed the baseline care plan, either she or the Director of Nurses would review the baseline care plan to ensure it was completed and accurate within 48 hours. Interview on 08/21/2025 at 2:50 PM, the Director of Nurses stated baseline care plans were to be completed within 48 hours of the resident's admission date. She stated it was the nurse in charge of the resident's responsibility to complete baseline care plan. The Director of Nurses stated it was reviewed by her or the treatment nurse once the baseline care plan was completed within 48 hours. She stated if a resident's social section and therapy section were not completed, there was a potential a resident may be depressed or have emotional issues. She stated the therapy section and social service section of the baseline care plan was pertinent information to ensure residents received the correct therapy and met their psychosocial needs. She stated if a resident had PTSD, their triggers would need to be added to the baseline care plan. Record review of facility's Baseline Care Plan Policy, dated 12/2016, reflected A baseline plan of care to meet the resident's immediate needs shall be developed for each resident within forty-eight (48) hours of admission. The Interdisciplinary Team will review the healthcare practitioner's orders (dietary needs, medications, routine treatments) and implement a baseline care plan to meet the resident's immediate care needs including but not limited to:a. Initial goals based on admission orders.b. Physician orders.c. Dietary orders.d. Therapy services.e. Social Services; andf. PASARR recommendations, if applicable. The baseline care plan will be used until the staff can conduct the comprehensive assessment and develop and interdisciplinary person-centered care plan. Event ID: Facility ID: 675118 If continuation sheet Page 9 of 47 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 08/21/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the residents rights, that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 8 of 16 (Resident #7, Resident #10, Resident #17, Resident #21 Resident #31, Resident #65, Resident #68 and Resident #86) reviewed for care plans. 1. The facility failed to ensure Resident #7's comprehensive care plan was updated after the code status was changed from full code to DNR on [DATE]. 2. The facility failed to ensure Resident # 10, Resident #17 and Resident #21's comprehensive care plan was updated with Resident #10, Resident #17, and Resident #21's in room activity needs. 3. The facility failed to ensure Resident #31's comprehensive care plan was updated with Resident #31's advance directive when the care plan was completed on [DATE].4. The facility failed to ensure Resident #65 and Resident #86's comprehensive care plan was updated to include contact isolation.5. The facility failed to ensure Resident #68's comprehensive care plan was updated with her smoking status when the care plan was completed on [DATE]. This deficient practice could place residents at risk of not being provided with the necessary care or services and the implementation of personalized plan of care developed to address their specific needs. The findings include: 1. Record review of Resident #7's face sheet, dated [DATE], revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #7 had diagnoses which included hemiplegia and hemiparesis following cerebral infraction affecting right dominant side (paralysis and weakness on right side after stroke), muscle weakness, dysphagia oropharyngeal phase (inability to empty from the throat to the esophagus), lack of coordination, adjustment disorder, hypertensive heart disease without heart failure (damage to heart due to chronic high blood pressure), repeated falls, cerebral infraction (long term effects of a stroke), and protein-calorie malnutrition (inadequate intake of both protein and calories). Record review of Resident #7's quarterly MDS, dated [DATE], revealed Resident #7 had a BIMS of 08, which indicated moderate impairment. The MDS did not document Resident #7's code status. Record review of Resident #7's care plan, dated [DATE], revealed Resident #7 was a full code. The Goal was Resident #7 would be provided with necessary resuscitative measures. Interventions were to advise MD, RP & family of any changes in condition per facility policy. Educate and discuss with resident/family about Full Code status versus OOHDNR code status on an annual basis or as needed. Review Advanced Directives with resident/family annually, upon change in condition andas needed. Record review of Resident #7's Advance Directive Order, dated [DATE], revealed Resident #7 was a DNR. Record review of Resident #7's OOHDNR, dated [DATE], had all the required signatures (doctor signature, RP signature and witness signatures). 2. Record review of Resident #10's face sheet, dated [DATE], reflected a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident#10 had a diagnosis which included depression (when a person experiences a persistent sad mood), cognitive communication deficit (communication skills that results from impaired memory, attention, reasoning, and problem-solving which are necessary for effective communication), and generalized anxiety disorder (excessive, persistent, and unrealistic worry about everyday things). Record review of Resident#10's admission MDS Assessment, dated [DATE], reflected Resident #10 had a BIMS score of 15, which indicated her cognition was intact. The following activities were very important to Resident #10: reading, music, being around animals, keep up with the news, going outside for fresh air and participating in religious practices. Record review of Resident#10's Comprehensive Care Plan, revised on [DATE], did not reflect Resident #10's activity (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 10 of 47 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 08/21/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some plan. 3. Record review of Resident #17's face sheet, dated [DATE], reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #17 had a diagnosis which included somatization disorder (a mental health condition characterized by excessive focus on physical symptoms, causing significant distress and functional impairment. Intense worry and preoccupation with these symptoms), congenital malformation of nervous system, unspecified (a birth defect affecting the structure or function of the brain, spinal cord, or other parts of the nervous system, but the specific type of malformation is not known), and anxiety disorder ( a mental health condition characterized by excessive and persistent fear, worry or tension that interferes with daily life causing distress). Record review of Resident #17's admission MDS Assessment, dated [DATE], reflected Resident #15 had a BIMS score of 13, which indicated her cognition was intact. The following activities were important to Resident#17: listening to music, being around animals, keep up with the news, go outside when the weather was good and participate in religious services and practices. Record review of Resident #17's Comprehensive Care Plan, dated [DATE], reflected the resident's current activity plan was not documented. 4. Record review of Resident # 21's face sheet, dated [DATE], reflected a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #21 had a diagnoses which included cognitive communication deficit (communication skills that results from impaired memory, attention, reasoning, and problem-solving which are necessary for effective communication), unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety ( it is a group of symptoms that can affect thinking, memory, and reasoning without behaviors), and adult failure to thrive ( a syndrome of general decline in an older adult's physical and functional capabilities, marked by symptoms like weight loss, poor appetite, and decrease in physical activity). Record review of Resident #21's admission MDS Assessment, dated [DATE], reflected Resident #21 had a BIMS score of 15, which indicated her cognition was intact. The following activities were very important to Resident #21: reading, listen to music, being around animals, keep up with the news, going outside to get fresh air when weather permits. Record review of Resident #21's Quarterly MDS Assessment, dated [DATE], reflected Resident #21 had a BIMS score of 11, which indicated her cognition was moderately impaired. Record review of Resident #21's Comprehensive Care Plan, dated [DATE], reflected Resident #21 did not have an activity care plan. 5. Record review of Resident #31's face sheet, dated [DATE], revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #31 had diagnoses which included muscle weakness, neurocognitive disorder with Lewy bodies (type of progressive dementia that leads to a decline in thinking, reasoning, and independent function), vascular dementia (lack of blood that carries oxygen and nutrients to a part of the brain), anxiety (feeling of uneasiness or worry), hypertensive heart disease without heart failure (damage to heart due to chronic high blood pressure), hyperlipidemia (high cholesterol), fall and anemia (not enough healthy red blood cells). Record review of Resident #31's quarterly MDS, dated [DATE], revealed Resident #31 had a BIMS of 12, which indicated moderate impairment. The MDS also did not have Resident #31's code status. Record review of Resident #31's care plan, dated [DATE], revealed Resident #31 did not have a code status documented on his care plan. Record review of Resident #31's Advance Directive Order, dated [DATE], revealed Resident #31 was a DNR. Record review of Resident #31's OOHDNR, dated [DATE], had all the required signatures (doctor signature, RP signature and witness signatures). 6. Record review of Resident #65's face sheet, dated on [DATE], reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #65 had diagnoses which included local infection of the skin and subcutaneous tissue, unspecified (a bacterial or fungal infection affecting a specific, limited area of the outer skin layers and the tissue beneath it), (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 11 of 47 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 08/21/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some non-pressure chronic ulcer of skin of other sites limited to breakdown of skin (an open ,non-healing sore on the skin, not caused by prolonged pressure), and hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (hemiplegia refers to paralysis- complete inability to move and hemiparesis - weakness). Record review of Resident # 65's admission MDS Assessment, dated [DATE], reflected Resident #65 had a BIMS score of 10, which indicated her cognition was moderately impaired. Resident #65 had stage 4 pressure ulcer. Record review of Resident #65's Comprehensive Care Plan, dated [DATE], reflected Resident #65 had stage 4 pressure ulcer to sacrum. The pressure ulcer was present upon admission. The care plan did not reflect Resident #65 required contact precautions. 7. Record review of Resident #68's face sheet, dated [DATE], revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #68 had diagnoses which included cerebral infraction (stroke), major depressive disorder (mental health disorder characterized by persistent depressed mood), lack of coordination, viral hepatitis C (a bloodborne virus that causes liver inflammation), Parkinson's disease (a progressive disorder that affects the nervous system), anxiety (feeling of uneasiness or worry), muscle weakness and morbid obesity. Record review of Resident #68's quarterly MDS, dated [DATE], revealed Resident #68 had a BIMS of 15, which indicated intact cognitive response. The MDS also revealed current tobacco use was not on the MDS. Record review of Resident #68's care plan, dated [DATE], revealed Resident #68 did not have her smoking status on the care plan. Record review of Resident #68's Smoking Assessment, dated [DATE], revealed Resident #68 required supervision and one-on-one assistance. The resident needed to be supervised due to contractions. 8. Record review of Resident # 86's face sheet, dated on [DATE], reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #86 diagnoses which included infection following a procedure, superficial incision surgical site, subsequent encounter (a bacterial or other microorganism infection that develops in the top layers of skin at a surgical wound site, rather than a deep one, for a resident receiving later follow-up medical care for the infection), methicillin resistant staphylococcus aureus infection, unspecified site (a common bacteria enter the body through a cut or wound , causing symptoms like red, painful, swollen areas, possibly with pus. Methicillin resistant- the bacteria has developed a resistance to certain antibiotics which are normally used to kill staph), and chronic pain (a long lasting, continuous, or recurring pain that persists for at least three months, beyond the normal healing time). Record review of Resident #86's Quarterly MDS Assessment, dated [DATE], reflected Resident #86 had a BIMS score of 15, which indicated her cognition was intact. Resident #86 had open lesions and skin tears. She received treatment for skin and ulcer/ injuries (non-surgical dressings and ointments) Record review of Resident #86's Comprehensive Care Plan, dated [DATE], reflected Resident #86 was at risk for skin breakdown and pressure ulcer development due to decreased mobility and obesity. Resident #86 comprehensive care plan did not reflect Resident #86 being on contact isolation. During an interview on [DATE] at 1:00 PM the Activity Director did not respond why Resident #21, Resident#17, and Resident #10's activities plan for the next quarter was not documented on the comprehensive care plan. She did not respond why it was important to have the residents in room activities on their care plan. During an interview on [DATE] at 1:59 PM, the MDSN stated infection control protocol was to be followed especially if someone was on contact isolation. She stated touching anything with contaminated gloves was considered cross contamination. The MDS RN stated any time someone was on contact isolation it was expected to be care planned. She stated she would need to review Resident #86 and Resident # 65's care plan to determine if contact isolation were care planned and she would inform the state surveyor with the information she gathered from their medical records. She said that she was responsible for updating the care plans and the IDT developed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 12 of 47 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 08/21/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the care plan. She never reported any information to the state surveyor prior to exit. During an interview with the MDSN on [DATE] at 2:14 p.m., revealed she was trained on care plans. She said IDT was responsible for doing the care plan. She said the care plan had to be opened by the RN, but she did most of the care plan. She said smoking could be nursing or social services. She said the SW was responsible for doing the advance directives. She said she looked for special medication, diagnosis, and high-risk medication. She said she would also put the family dynamics on the care plan. She said the facility had 7 days to complete the care plan. She said the care plan should be updated when there was a change to the resident's care. She said the care plans were updated as needed or when the MDS was due. She said depending on the issue with the care plan depended on who was responsible. She said a resident's advance directive went on the care plan. She said if a resident changed their advance directive the care plan should be updated immediately. She also said smoking went on the care plan. She said if the advance directive and smoking status were not correct on the care plan the person looking at the care plan would not have the appropriate information. She said she assumed the SW did not update the care plans for Resident #7, Resident #31, and Resident #68. During an interview on [DATE] at 2:24 PM, the Treatment Nurse stated Resident #65, and Resident #86 were on contact isolation. She stated both residents had MRSA but in different areas. She stated she would need to review their medical charts and would give the areas on both residents (Resident #65 and Resident #86) and would report to state surveyor. The Treatment Nurse never reported this information to state surveyor prior to exit. She stated both residents were on contact isolation. The Treatment Nurse stated both residents required for gowns and gloves to be worn when giving care. She stated contact isolation was expected to be care planned. She stated if it was not care planned the staff would not have the information, they needed to know why the residents were on contact isolation. The Treatment Nurse stated if the staff had contaminated gloves on, picked up the call light, and placed it on the bed, the call light may become contaminated. She stated if a staff or family member visited the resident and had an open area on their fingers or hand the person may become contaminated with MRSA. he stated if there was a hole in the clear plastic bag and the staff carried the bag down the hall there was a potential if another resident had an open area on their arm and touched the contaminated gowns/gloves in the plastic bag, the resident may become contaminated with MRSA. She stated she had been in-service on infection control, and she was the infection control preventionist. She did not recall the date of her training. During an interview with the SW on [DATE] at 2:38 p.m., revealed she had not been trained on care plans. She said she did not know what the policy was for the care plans. She said she did not know who was responsible for updating the advance directives and smoking status. She said the code status was in the care plan. She said the resident's smoking status was also in the care plan. She said she was not responsible for put a resident's smoking status in the care plan. She said she did not know who put smoking status on the care plan. She also said if a resident changed their code status she would wait until she got the completed DNR back before she would update the care plan. She said she had two weeks to update the care plan. She said if the code status were not updated a resident who was a DNR could possibly be given CPR. She said she did not know why Resident #7's code status was not updated. She said she did not know why Resident #31's code status was not in the care plan or why Resident #68's smoking status was not in the care plan. During an interview on [DATE] at 2:50 p.m. The Director of Nurses stated anytime residents were on contact isolation this was required to be care planned. She stated anytime a resident had any type of infection the care plan was to reflect all interventions required to heal the infection. The Director of Nurses did not respond to other questions related to why it was important for infection and contact isolation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 13 of 47 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 08/21/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some needing to be care planned. During an interview with the ADM on [DATE] at 3:50 p.m., revealed she was trained on care plans. She said the IDT team, MDS nurse, therapy and nursing were responsible for doing the care plan. She said all the resident's information, goals, focus for the resident and the resident's discharge plans were on the care plan. She said the care plan had to be completed in 7 days and were updated quarterly. She said the care plan would also be updated in the event of a significate change. She said she thought nursing was responsible for putting a resident's smoking status on the care plan. She said the SW was responsible for updating the advance directives. She said the advance directives were to be updated immediately. She said if the care plan were not updated or did not have a resident's advance directive it could affect the outcome if something happened to the resident. She said if the smoking status was not on the care plan staff would not be able to identify the resident as a smoker. She said she did not know why Resident #7's advance directive was not updated. She also said she did not know why Resident #31's advance directive was not on the care plan. She said she did not know why Resident #68's smoking status was not on the care plan. During an interview with the DON on [DATE] at 4:17p.m., revealed she had not been trained on care plans. She said she was knowledgeable from working in PCC and knew how to do the care plans. She said the RN opened the care plan, the MDS followed up and the DON reviewed the care plan. She said the care plan had the resident's skin integrity, medication, if the resident refused medication, any chronic conditions, advance directives, and infections. She said she did not know how long the facility had to complete the care plan. She said the care plan was updated quarterly or as soon as a significate change happened. She said advance directives and smoking status went on the care plan. She said if a resident went from a full code to DNR the facility had to do a document and uploaded it. She said then the code status needed to be changed in the care plan. She said if an advance directive was not correct on the care plan, staff may do CPR on a resident who should not be getting CPR. She said if the smoking status were not on the care plan there was a possibility the resident would not be monitored or a new issue with smoking identified. She said she did not know why Resident #7's advance directive was not updated. She also said she did not know why Resident #31's advance directive was not on the care plan. She said she did not know why Resident #68's smoking status was not on the care plan. Record review of the facility's, undated, Care Plans, Comprehensive Person-Centered Policy reflected a comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident. The comprehensive, person-centered care plan includes measurable objectives and timeframes; describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. Record review of the facility's, undated, Advance Directives Policy reflected the plan of care for each resident will be consistent with his or her documented treatment preferences and/or advance directive. The Interdisciplinary Team will conduct ongoing review of the resident's decision-making capacity and communicate significant changes to the resident's legal representative. Such changes will be documented in the care plan and medical record. The Interdisciplinary Team will review annually with the resident his or her advance directives to ensure that such directives are still the wishes of the resident. Such reviews will be made during the annual assessment process and recorded on the resident assessment instrument (MDS). Changes or revocations of a directive must be submitted in writing to the Administrator. The Administrator may require new documents if changes are extensive. The Care Plan Team will be informed of such changes and/or revocations so that appropriate changes can be made in the resident assessment (MDS) and care plan. The Director of Nursing Services or designee will notify the Attending Physician of advance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 14 of 47 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 08/21/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete directives so that appropriate orders can be documented in the resident's medical record and plan of care. The Attending Physician will not be required to write orders for which he or she has an ethical or conscientious objection. Record review of the facility's Activity Director Job Description, dated [DATE], reflected this person provides for an ongoing program of activities designed to meet, following the comprehensive assessment, the interests, and the physical, mental, and psycho-social well-being of each resident. Contribute to facility efforts to maintain and/or improve quality of care through participation in care plan meetings. Assess resident needs and develop resident activities goals for the written care plan. Signed by: Activity Director on [DATE]. Event ID: Facility ID: 675118 If continuation sheet Page 15 of 47 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 08/21/2025 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure comprehensive care plans were developed within 7 days after completion of the comprehensive assessment for 2 of 7 residents (Resident #78 and Resident #37) reviewed for comprehensive assessments and timing. 1. The facility failed to ensure Resident #78's Comprehensive Care Plan was completed within seven days of the completion of the comprehensive assessment and no more than 21 days after admission. 2. The facility failed to ensure Resident #37's Comprehensive Care Plan was completed within seven days of the completion of the comprehensive assessment and no more than 21 days after admission. These failures could place residents at risk for not receiving necessary care and services or having important care needs identified and met.The findings include: 1. Record review of Resident #78's admission record, dated 08/21/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #78 had diagnoses which included Parkinson's disease (a progressive disorder that affects the nervous system), lack of coordination, muscle weakness, cognitive communication deficit (problems with communication), dementia (memory, thinking, difficulty), hypertensive heart disease (damage to heart due to chronic high blood pressure), depression, and anxiety (feeling of uneasiness or worry). Record review of Resident #78's care plan, undated and last revised 04/01/2025 reflected there was no information regarding self-care and requiring substantial/maximal assistance with putting on/taking off footwear. Record review of Resident #78's Nursing Home Part A PPS Discharge (NPE) MDS, dated [DATE], reflected a BIMS score of 11, which indicated moderate impairment. Further review of the MDS reflected the resident required substantial/maximal assistance with putting on/taking off footwear. Record review of Resident #78's care plan dashboard, dated 08/21/2025, reflected the care plan was generated for start date of 08/28/2025 with a target completion date of 09/10/2025. 2. Record review of Resident #37's admission record, dated 08/21/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #37 had diagnoses which included local infection of the skin, chronic kidney disease stage 4 (a serious condition where the kidneys are severely damaged), anemia (not enough healthy red blood cells), irritable bowel syndrome (a group of symptoms that occur together including repeated pain in your abdomen and changes in your bowel movements), and muscle weakness. Record review of Resident #37's admission assessment MDS, dated [DATE], reflected a BIMS score of 14, which indicated cognition was intact. Record review of Resident #37's initial baseline care plan, undated with date initiated 07/10/2025 and last revised 08/19/2025, reflected only one goal and need was implemented for Resident #37's care plan, actual falls. All other needs and goals for Resident #37 were implemented on the care plan on 08/19/2025, which included: full code status, limited physical mobility and requires staff assistance for ADLs, congestive heart failure, altered cardiovascular status, anemia due to chronic blood loss, on antibiotic therapy, potential unintentional weight loss/gain, risk for skin breakdown and pressure ulcer development due to decreased mobility, has occasional bowel and bladder incontinence, and has impaired visual function. During an interview on 08/21/2025 at 2:09 PM, the MDSN stated she did not know the last time she had training regarding care plans. She stated the IDT meeting was opened by the RN and completed the bulk of the care plans. She stated she reviewed the cause section B on the MDS and completed a chart sweep looking for special medication or diagnosis or high-risk medications, followed by a review of progress notes to get family dynamics and would care plan falls, pain, based on this information. She stated the charge nurses had 48 hours to complete the base line care plans, and she had 7 days after to complete the comprehensive care plans. She stated care plans were updated when there (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 16 of 47 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 08/21/2025 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete was any change to the resident's care, as needed or when the MDS was due. Depending on what needed to be updated on a care plan depended on which staff was responsible for completing. She said she did not know why Resident #78 and Resident #37 care plans were completed. During an interview on 08/21/2025 at 3:50 PM, the ADM stated she last received basic care plan training in January 2025. She stated training covered patient center care, the goal and discharge plan. She stated the IDT team, MDS, therapy, and nursing staff were all responsible for completing the care plans. She stated the baseline care plan was to be completed within 24 hours and comprehensive care plan was due 7 days after. She stated the care plan should be updated quarterly or if there was a significant event. During an interview on 08/21/2025 at 4:17 PM, the DON stated she was knowledgeable of completing care plans from PCC. She stated the RN opened the care plan, the MDS Coordinator followed up and the DON reviewed the care plan. She stated the care plan information included skin integrity, medication, if they refused medications, any chronic conditions, advance directives, and infections. She stated she was not sure of the timeframes to complete care plans, but the baseline care plan was to be completed within 48 hours. She stated the care plans should be updated quarterly and the MDS nurse was responsible for updating them. During an interview on 08/21/2025 at 6:15 PM, the MDSN stated she started employment on 07/7/2025 at the facility. She stated she was familiar with Resident #78's comprehensive assessments and care plans. She stated as she came on board recently into the MDS position, she worked through the resident care plans and discovered Resident #78's care plan was not developed and completed the initial one on 07/10/2025. She stated the quarterly care plan was now being worked on for him. She stated she was familiar with Resident #37's comprehensive assessments and care plans. She stated she revised Resident #37's care plan on 08/19/2025 to reflect all care areas as it was brought to her attention that it had yet to be completed. She stated she was not sure why the previous staff did not complete the entire care plans or within the required timelines, but she was now keeping track of these dates. She stated by not completing care plans could affect the resident as the direct care staff would not know what care was required for the resident. Record review of the facility's, undated, policy titled Care Plans, Comprehensive Person-Centered revealed A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident. Policy Interpretation and Implementation: 2. The comprehensive, person-centered care plan is developed within seven (7) days of the completion of the required MDS assessment (Admission, Annual or Significant Change in Status), and no more than 21 days after admission. 3. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. 7. The comprehensive, person-centered care plan: a. includes measurable objectives and timeframes; b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. Event ID: Facility ID: 675118 If continuation sheet Page 17 of 47 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 08/21/2025 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming and personal and oral hygiene for 1 of 12 residents (Resident #38) reviewed for Activities of Daily Living. The facility failed to ensure Resident #38 was provided her showers 3 times a week as scheduled. This failure could place residents at risk of not receiving services or care, diminished quality of life, and decreased self-esteem.Findings include: Record review of Resident #38's admission record, dated 08/21/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #38 had diagnoses which included hypertensive heart disease without heart failure (changes in the heart due to long term high blood pressure), hyperlipidemia (abnormally high level of fats in the blood), depression (a mood disorder with persistent feeling of sadness and loss of interest), and generalized muscle weakness. Record review of Resident #38's Quarterly MDS, dated [DATE], reflected a BIMS score of 13, which indicated cognition was intact. Section GG - Functional Abilities reflected Resident #38 required Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort for showers/bathing self. Record review of Resident #38's care plan, dated 09/16/2022 and last revised 12/02/2024, reflected the following I have an ADL self-care performance deficit r/t decline in cognition. Interventions reflected Personal Hygiene: I require assistance by 1 staff with personal hygiene and oral care. Record review of the, undated, shower schedule reflected the room/bed Resident #38 occupied on 08/21/2025 was scheduled for a shower on Tuesday/Thursday/Saturday. Record review of the task list in the electronic health record for the dates 07/22/2025-08/21/2025 reflected she was scheduled for ADL - Bathing (T-TH-Sat 6p to 6a). She was provided the following showers:07/24/2025,07/29/2025, 08/12/2025, 08/19/2025, and08/21/2025. Showers were scheduled but not documented as given on:07/22/2025,07/26/2025, 07/31/2025, 08/02/2025, 08/05/2025, 08/07/2025 (documented as refused), 08/09/2025, 08/14/2025, and08/16/2025 (documented as refused). Record review of Resident #38's nurses' notes, dated 07/22/2025-08/22/2025, reflected no documentation of refusal of care. Interview and observation on 08/19/2025 at 09:41 AM, Resident #38 stated she had not received a shower in weeks. Resident #38 appeared clean and well-groomed. Interview and observation on 08/21/2025 at 08:10 AM revealed Resident #38 propelled herself in her wheelchair, her hair was standing up in the back and appeared not brushed. Resident #38 stated she had not received her shower in 4 weeks. She stated she was unsure of her shower day, just that they [the staff] would come at night around 09:30 PM to give her a shower and she did not want to go to bed with her hair wet, so she refused. Interview on 08/21/2025 at 03:55 PM, CNA J stated he was working the hallway Resident #38 resided on. He stated he typically did not work the floor and was unable to access the electronic health record. CNA J stated Resident #38 was supposed to get showers in the morning despite her bed assignment. He stated the staff should know though shift report, but he did not know if it was documented anywhere. CNA J stated if a resident refused a shower, then the CNA should notify the nurse. He stated Resident #38 should get 3 showers a week. He stated if a resident did not get their showers, then the resident could become sad, embarrassed, and dirty. Interview on 08/21/2025 at 04:15 PM, CNA H stated she was responsible for the hallway Resident #38 resided on. She stated showers were given per the residents' room assignment. She stated if a resident wanted a different schedule for their showers, then the CNA was responsible for reporting it to the nurse and the nurse would fix the schedule in the computer. CNA H stated if a resident refused a shower, then the CNA was responsible for reporting it to the nurse Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 18 of 47 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 08/21/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and completing a shower sheet that indicated the resident refused the shower. She stated she gave Resident #38 a shower during the day shifts a couple of weeks ago, but Resident #38 was scheduled for evening showers. CNA H stated all residents should be getting a shower three times a week. She stated if a resident did not get their shower, then they may feel sad or dirty. Interview on 08/21/2025 at 04:49 PM, the TN stated she was appointed to monitor shower sheets on 08/18/2025. She stated the policy for giving showers was three times a week and the CNAs were to follow the schedule on the handout. She stated if a resident wanted a shower other than what was listed on the handout then it should be documented in their electronic health record. The TN stated, if a resident were to refuse a shower, she expected the CNA to notify the nurse and the nurse to attempt to get the resident to take a shower. She stated if the resident continued to refuse then she expected the nurses to document the refusal in the resident's electronic health record and to notify the responsible party. The TN stated shower sheets should continue to be completed with a refusal documented on it. The TN stated if a resident did not get the showers they were scheduled, then the resident could end up with a fungal infection, moisture associated skin damage, or redness to their skin. Interview on 08/21/2025 at 05:18 PM, RN D stated he was responsible for the hall Resident #38 resided on. He stated policy was for residents to get showers 2-3 times a week according to their schedule in their electronic health record. RN D stated if a resident refused a shower, then the CNA needed to tell the nurse, and the nurse must attempt. He stated the policy was to attempt three times for any refusal of care. He stated if a resident requested a shower at any time, then they were to provide the shower at that time. RN D stated he was aware Resident #38 had refused showers in the past, but he was unsure as to the reason for the refusal. He stated the lack of charting for showers was due to a communication barrier with the CNAs being able to read the electronic health record and they were unable to click the correct box. RN D stated if a resident did not get their scheduled showers, then they could incur skin issues. Interview on 08/21/2025 at 05:36 PM, the DON stated she took over as DON approximately one month prior. She stated the policy for giving showers was the residents were scheduled for getting showers every other day. The DON stated the residents had the right to refuse, but the policy was for at least two different staff members attempt to provide the resident a shower. She stated if the resident continued to refuse a shower after two staff approached them, then the nurse was to notify the responsible party and document the refusal and notification in the resident's electronic health record. The DON stated if a resident requested to have a shower in the morning rather than the evening time, then staff were to attempt to find someone to switch with that resident, but the resident's preference was always honored. The DON stated if a resident was not getting their showers as scheduled, then they could have skin breakdown, they could become dirty and/or smelly and that could affect their psychosocial status. The DON stated, after a record review, Resident #38 received 3 showers from 07/22/2025-08/18/2025. She stated Resident #38 refused a shower 3 times during that same period according to her record review. The DON stated there was no documentation in the nurses' notes related to refusal of care. Interview on 08/21/2025 at 06:02 PM, the ADM stated she had worked at the facility for approximately 2 months. She stated the policy for a shower was, the residents were to get a shower every other day, unless specially requested or extenuating circumstances occurred (for example: diarrhea). The ADM reviewed the shower schedule and stated residents may miss their showers due to CNAs being stressed for time and she was in the process of making a shower aide position. She stated if a resident refused their shower, she expected the CNA to notify the nurse and the nurse to attempt again. She stated, if the resident continued to refuse their shower, she expected the nurse to notify the resident's responsible party and document in the nurses' notes. The ADM stated, if a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 19 of 47 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 08/21/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resident missed their showers, then they may incur impaired skin integrity, they could start to smell, also it could affect their psychosocial status and cause sadness. Record review of the facility's, undated, policy titled, Activities of Daily Living (ADLs), Supporting reflected: Policy StatementResidents will provide with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs).Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Policy Interpretation and Implementation.2. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. Hygiene (bathing, dressing, grooming, and oral care) .4. If residents with cognitive impairment or dementia resist care, staff will attempt to identify the underlying cause of the problem and not just assume the resident is refusing or declining care. Approaching the resident in a different way or at a different time or having another staff member speak with the resident may be appropriate. Record review of the facility's in-service titled Showers, dated 06/09/2025, reflected: -All residents are to be showered unless resident refuses.-If resident refuses to shower the nurse must be notified-The nurse must make an attempt to get the resident to shower-If resident still refuses to shower, the nurse must contact the resident's RP of the refusal-The nurse must document of the attempt make and that the RP was notified-The nurse must inform the DON; ADON; or WCN of the refusal. Event ID: Facility ID: 675118 If continuation sheet Page 20 of 47 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 08/21/2025 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed, to provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing activities program to support residents in their choice of activities, both facility sponsored group and individual activities, and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for three of six residents ( Resident #10, Resident #17, and Resident #21) reviewed for activities. The facility failed to provide Resident # 3, Resident #10, Resident #17, and Resident #21 in room activities during July 2025 and August 1st thru August 22, 2025.This failure could place residents at risk for boredom, depression, and a diminished quality of life.Findings include:Record review of Resident #10's face sheet, dated 08/21/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #10 had diagnoses which included depression (when a person experiences a persistent sad mood), cognitive communication deficit (communication skills that results from impaired memory, attention, reasoning, and problem-solving which are necessary for effective communication), and generalized anxiety disorder (excessive, persistent, and unrealistic worry about everyday things). Record review of Resident#10's admission MDS Assessment, dated 05/19/2025, reflected Resident #10 had a BIMS score of 15, which indicated her cognition was intact. The following activities were very important to Resident #10: reading, music, being around animals, keep up with the news, going outside for fresh air and participating in religious practices. Record review of Resident#10's Comprehensive Care Plan, revised on 08/28/2025 did not reflect Resident #10's activity plan. Record review of Resident #17's face sheet, dated 08/21/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #17 had diagnoses which included somatization disorder (a mental health condition characterized by excessive focus on physical symptoms, causing significant distress and functional impairment. Intense worry and preoccupation with these symptoms), congenital malformation of nervous system, unspecified (a birth defect affecting the structure or function of the brain, spinal cord, or other parts of the nervous system, but the specific type of malformation is not known), and anxiety disorder (a mental health condition characterized by excessive and persistent fear, worry or tension that interferes with daily life causing distress). Record review of Resident #17's admission MDS Assessment, dated 06/23/2025, reflected Resident #17 had a BIMS score of 13 which indicated her cognition was intact. The following activities were very important to Resident#17: listening to music, being around animals, keep up with the news, go outside when the weather was good and participate in religious services and practices. Record review of Resident #17's Comprehensive Care Plan, dated 07/01/2025 reflected Resident current activity plan was not documented. Record review of Resident # 21's face sheet, dated 8/21/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #21 had diagnoses which included cognitive communication deficit (communication skills that results from impaired memory, attention, reasoning, and problem-solving which are necessary for effective communication), unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, anxiety (it is a group of symptoms that can affect thinking, memory, and reasoning without behaviors), and adult failure to thrive (a syndrome of general decline in an older adult's physical and functional capabilities, marked by symptoms like weight loss, poor appetite, and decrease in physical activity). Record review of Resident #21's admission MDS Assessment, dated 04/24/2025, reflected Resident #21 had a BIMS score of 15, which indicated her cognition was intact. The following activities were very important to Resident #21: reading, Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 21 of 47 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 08/21/2025 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete listen to music, being around animals, keep up with the news, going outside to get fresh air when weather permits. Record review of Resident #21's Quarterly MDS Assessment, dated 07/25/2025, reflected Resident #21 had a BIMS score of 11, which indicated her cognition was moderately impaired. Record review of Resident #21's Comprehensive Care Plan, dated 08/08/2025 reflected Resident #21 did not have an activity care plan. Record review of in room activity participation records, dated July 2025 and August 1, 2025, thru August 22, 2025, reflected Resident # 10, Resident #17 and Resident #21 did not receive in room activities. Record review of residents to receive in room activities for the month of July 2025 and August 2025 reflected Resident #10, Resident #17, and Resident #21 names were on the in-room record. During an interview with Resident #17 on 08/19/2025 at 10:27 AM, revealed that she does not get any activities. She said staff do not give her any books, puzzles, or anything else. She said she is bed bound and her roommate does not like to talk so she felt like she was just lying there to die.Interview on 08/21/2025 at 1:00 PM, the Activity Director stated Resident #3 did not receive in room activities from 07/03/2025 thru 08/11/2025. The Activity Director stated she was expected to ensure all residents received activities based on their preferences and their physical abilities. She stated if residents were not coming out of their room, the residents were to be provided in room activities. The Activity Director stated she provided in room activities at least twice a week. She stated there was not an excuse why Resident #10, Resident #17 or Resident #21 did not receive in room visits. The Activity Director stated if a resident was not receiving activities on a consistent basis there was a potential a resident may become bored, depressed, or have a decline in their quality of life. She stated she was responsible for ensuring all residents received their activity needs including in room activities. Interview on 08/21/2025 at 1:30 PM, the Administrator stated she expected in room activities be provided to the residents needing these types of activities. She stated if a resident was not receiving in room activities there was a possibility a resident may become depressed, bored, and isolated. She stated the Activity Director was responsible for all activities in the facility. She stated she was responsible for monitoring the Activity Director. The Administrator stated it was very important for all residents to receive the activities they needed to enhance their overall quality of life. Record review of the facility's Activity Documentation Policy, not dated, reflected the Activity Director shall coordinate and supervise all documentation and be ultimately responsible for all areas of documentation, according to required timeframes and practice guidelines. The following areas are considered documentation responsibilities of the Activity Director and staff and should be completed in a comprehensive and timely manner such as: resident participation records. All documentation is completed in a manner consistent with health care center policy and applicable state and federal laws.Record review of the facility's Activity Director Job Description, dated 01/30/2025, reflected this person provides for an ongoing program of activities designed to meet, following the comprehensive assessment, the interests, and the physical, mental, and psycho-social well-being of each resident. Provide an activities program daily including evenings and weekends. Provide a plan of activities appropriate to the needs of the residents that includes but is not limited to one-to one attention. Encourage resident participation in activities and document outcomes. Signed by: Activity Director on 01/30/2025. Event ID: Facility ID: 675118 If continuation sheet Page 22 of 47 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 08/21/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to have sufficient nursing staff to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident as determined by considering the number, acuity, and diagnoses of the facility's resident population in accordance with the facility assessment for 4 (Residents #17, #37, #3, and #73) of 20 residents reviewed for sufficient staffing. The facility failed to ensure that the facility had sufficient staffing to meet the needs of Residents #17, #37, #3, and #73. This failure could affect and diminish the resident's quality of life by potentially placing the residents at risk of not receiving timely care or receiving nursing interventions to meet the resident's needs, risk of injury, risk of safety, and/or it can make the resident feel neglected affecting their mental health and overall psychosocial well-being not being met by facility staff.Findings include: Record review of Resident #17's admission record, dated 08/21/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #17 had diagnoses which included acute cystitis without hematuria (inflammation of the bladder), other benign neoplasm of uterus (noncancerous tumor in women and people assigned female at birth), somatization disorder (mental health condition characterized by significant distress and impairment related to physical symptoms that may not have a clear medical explanation), fusion of spine, muscle weakness, congenital malformation of nervous system (birth defects that affect the structure and function of the brain and spinal cord), lack of coordination, anxiety disorder, and aftercare following joint replacement surgery. Record review of Resident #17 admission MDS, dated [DATE], reflected a BIMS score of 13, which indicated cognition was intact. Section GG - Functional Abilities reflected Resident #17 required Dependent - Helper does ALL of the effort. Resident does none of the effort to complete the activity. Or the assistance of 2 or more helpers is required for the resident to complete the activity for toileting hygiene and chair/bed-to-chair transfer. Record review of Resident #17's care plan, dated 06/20/2025, reflected the following clean peri-area with each incontinence episode. Record review of Resident #37's admission record, dated 08/21/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #37 had diagnoses which included local infection of the skin and subcutaneous tissue, chronic kidney disease, stage 4 (severe), iron deficiency anemia, irritable bowel syndrome, and muscle weakness. Record review of Resident #37's admission MDS, dated [DATE], reflected a BIMS score of 14, which indicated cognition was intact. Section GG - Functional Abilities reflected Resident #37 Needed Some Help - Resident needed partial assistance from another person to complete any activities for self-care and Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort for showers/bathing self. Record review of Resident #37's initial baseline care plan, undated with date initiated 07/10/2025 and last revised 08/19/2025 reflected the following, Resident #37 has limited physical mobility and requires staff assistance for ADLs. Interventions reflected Provide supportive care, assistance with mobility as needed. Further review of Resident #37's initial baseline care plan reflected the following, Resident #37 has occasional bowel and bladder incontinence r/t impaired mobility and IBS (common condition that affects the stomach and intestines). Interventions reflected Clean peri-area with each incontinence episode. Record review of Resident #3's admission record, dated 08/20/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] with readmission on [DATE]. Resident #3 had diagnoses which included chronic obstructive pulmonary disease, unsteadiness on feet, cognitive communication deficit, pain in right (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 23 of 47 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 08/21/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some shoulder, mild cognitive impairment, difficulty in walking, major depressive disorder, insomnia, muscle weakness, heart failure, sleep apnea, morbid obesity. Record review of Resident #3's Quarterly MDS, dated [DATE], reflected a BIMS score of 15, which indicated cognition was intact. Section GG0115. Functional Limitation in Range of Motion reflected Resident #3 required Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half.the effort for toileting hygiene. Record review of Resident #3's care plan, dated 04/27/2021 and last revised 02/14/2025, reflected the following I have an ADL self-care performance deficit r/t lack of safety awareness and muscle weakness. Interventions reflected TOILET USE: requires assistance by (1) staff for toileting. Record review of Resident #73's admission record, dated 08/21/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #73 had diagnoses which included other sequelae of cerebral infarction (condition of brain swelling, blood clots, trouble swallowing, pneumonia, bladder and bowel problems, seizures, and headaches), muscle weakness, lack of coordination, depression, anxiety disorder, insomnia (common sleep disorder that can make it hard to fall asleep or stay asleep), polyneuropathy (condition characterized by damage to multiple peripheral nerves, leading to symptoms such as pain, weakness, and sensory loss), acute embolism (blood clot that blocks and stops blood flow to an artery in the lung) and thrombosis (condition that involves the formation of a blood clot in blood vessels) of unspecified deep veins, heart failure, obesity, and type 2 diabetes mellitus (condition that happens because of a problem in the way the body regulates and uses sugar as fuel). Record review of Resident #73's admission MDS, dated [DATE], reflected a BIMS score of 11, which indicated moderate cognitive impairment. Section GG - Functional Abilities reflected Resident #73 required Dependent - Helper does ALL the effort. Resident does none of the effort to complete the activity. Or the assistance of 2 or more helpers is required for the resident to complete the activity for toileting hygiene and chair/bed-to-chair transfer. Record review of Resident #73's care plan, dated 07/25/2025 and last revised 07/31/2025 reflected the following Resident #73 requires assistance from staff with ADLs such as Bed mobility, Transfers, Locomotion, Dressing, Toileting, Personal hygiene, and Bathing. Interventions reflected facility would Provide devices for mobility and assist as indicated. Staff will encourage resident to participate with ADLs as able. Staff to assist with/provide ADLs as needed. Further review of Resident #73's care plan reflected Resident #73 has bowel and bladder incontinence r/t CVA. Interventions reflected Check resident every two hours and assist with toileting as needed. During an interview and observation on 08/19/2025 at 3:40 PM, Resident #73 stated there was not enough staff and he stays wet often and must call his wife to call up to the nurse's station to get staff to answer his call light. He stated he wants staff to figure out to help him get up as he was supposed to be up and out of bed daily. He stated he presses the call light and at times will come into his room to turn it off and leave and do not return. Resident #73's wife was observed reaching behind his bed on the floor to pick up the call light that was out of reach for resident.During an interview on 08/19/2025 at 4:10 PM, Resident #37 stated call light response depends on the day, and at night he must wait 3 hours for a brief change. He stated he is concerned with having to lay in filth for so long. During an interview on 08/20/2025 at 8:40 AM, Resident #17 stated that staff do not answer the call light and when they do, they will come in and turn it off and not come back. During an interview on 08/20/2025 at 9:41 AM, Resident #3 stated call light response time depends on who is working on the shift. She stated call light response times can take more than 30 minutes during the overnight shifts. She stated she does not like to make waves so she would not speak up about the problem and would wait for staff. In an observation on 08/20/2025 at 10:27 AM revealed Resident #17 pressed the call light to ask for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 24 of 47 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 08/21/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some assistance with peri care. At 10:53 AM staff responded to call light, shut it off, and asked Resident #17 if she needed assistance. Resident #17 informed her that she needed to be changed. Staff stated she would get the supplies and return. At 10:58 AM, 31 minutes after the call light was originally pressed, staff returned with peri care supplies and stated she was back to change Resident #17. During an interview on 08/21/2025 at 3:30 PM, CNA J stated he has been in-serviced on resident rights and call lights are to be answered by available staff on the hall. He stated call lights are to be answered within a reasonable timeframe of less than 5 minutes. He stated if staff did not answer call lights in a reasonable timeframe this could cause the residents to become upset and could cause them to feel bad. During an interview on 08/21/2025 at 3:42 PM, CNA G stated she receives continuous in-services on resident rights and call lights. She started the expectation of call lights is to be answered right away, with a reasonable timeframe of 2 minutes or less. She stated if a staff cannot provide care immediately then a reasonable time to return is within 5 minutes to provide the necessary care. She stated 20 minutes or more to answer a call light would make the resident feel neglected. She stated that rounding, peri-care and change motion, rotation should be every 2 hours. She stated if rounding and peri-care is not provided for a resident they can develop bed sores. During an interview on 08/21/2025 at 6:31 PM, CNA I stated she has been in-serviced on call light response times and staff should respond within 1-5 minutes. She stated if staff is unable to provide care immediately the reasonable time to return would be 5-10 minutes. She provided an example requiring 2 staff for transfer, the coordination of staff can take time. She stated 20 minutes or more to answer a call light is unreasonable, and anything could happen in this time. She stated unreasonable response times could cause the residents to feel frustrated and neglected or mad. She stated staff are to provide rounding and per-care every two hours and to ensure resident is clean, as that area is a danger area and needs to stay clean, as resident can develop an infection. During an interview on 8/21/2025 at 6:55 PM, LVN K stated he has been employed one month with this facility and was in-serviced on neglect during orientation and it addressed call lights. He stated call lights are expected to be answered within a reasonable time and are not to be ignored. He believes ASAP is reasonable. He stated call lights should not take more than 10-15 minutes to answer and provide care. He stated 15 minutes is usually when staff is with another resident providing care. He stated not answering call lights is neglectful to residents can cause them mental distress. He stated the expectations for rounding and peri-care is to be thorough, make sure area is clean, brief fits, make sure resident is comfortable before, after, and during the change of their brief. He stated if the resident were not provided rounding and peri-care it could affect their wellbeing and can cause infections, infection control concerns if not staying clean and comfortable. He stated he was unfamiliar with Resident #73 and Resident #3's care as he is new to the facility, but he is working on it. Review of facility policy, undated titled Routine Resident Checks & Call Lights Revised July 2013 revealed Staff shall make routine resident checks to help maintain resident safety and well-being. 1. To ensure the safety and well-being of our residents, nursing staff shall make a routine resident check on each unit at least every 2 hours. 2. Routine resident checks involve entering the resident's room and/or identifying the resident elsewhere on the unit to determine if the resident's needs are being met, identify any change in the resident's condition, identify whether the resident has any concerns, and see if the resident is sleeping, needs toileting assistance, etc.4. The Nursing Supervisor/Charge Nurse shall keep documentation related to these routine checks, including the time, identity of the person making checks, and any outcomes of each check. (Note: CNAs may also record this information and provide it to the Nurse Supervisor/Charge Nurse.)5. This also includes answering the call light in a timely manner. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 25 of 47 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 08/21/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Review of facility policy, undated, titled, Resident Rights revealed Employees shall treat all residents with kindness, respect, and dignity: 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to:a. a dignified existence.b. be treated with respect, kindness, and dignity.c. be free from abuse, neglect, misappropriation of property, and exploitation.f. communication with and access to people and services, both inside and outside the facility. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 26 of 47 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 08/21/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure drugs and biologicals were stored in locked compartments, under proper temperature controls, and labeled in accordance with currently accepted professional principles for 1 of 1 medication storage room refrigerator and 1 of 3 (200 hall) medication carts reviewed for medication storage. 1. The facility failed to ensure the 200-hall medication cart was locked and medications were secured and not accessible to other staff, residents, or visitors. 2. The facility failed to ensure the refrigerator maintained the adequate temperature to store medications (35 40 degrees Fahrenheit) that required refrigeration prior to opening. These failures could place residents at risk of having unauthorized access to medications, decreased effectiveness of medication, or missed medications.Findings included: Observation on 08/20/2025 at 9:08 AM revealed an unlocked medication cart beside room [ROOM NUMBER]. The medication cart was between room [ROOM NUMBER] and room [ROOM NUMBER]. The front of the medication cart was facing toward the end of the hall. The locking mechanism was protruding outward on the medication cart. The state surveyor opened drawers and captured pictures. RN D was in room [ROOM NUMBER] with the door closed. Observation on 08/20/2025 at 9:12 AM RN D exited room [ROOM NUMBER] and went to the unlocked medication cart. Interview on 08/20/2025 at 9:14 AM RN D stated the medication cart was to always be locked except when he was dispensing medications from the medication cart. He stated it was his responsibility to ensure the medication cart was locked and secure. RN D stated the key to the medication cart was in his pocket. He stated if residents had accessed the medication cart they could have overdosed, taken wrong medication, had an allergic reaction, and could require admission to the hospital. He stated he had previously been in-serviced on locking the medication carts and could not recall the specific date. He stated he was aware the medication cart should have been locked. He stated the narcotics were locked and were not accessible. RN D stated there was PRN medications and some medical equipment such as blood pressure and glucometer that were not locked. Interview on 08/20/2025 at 9:30 AM the DON stated her expectation was for all medication carts to be locked when the nurse was not administering medications. She stated the staff had been in-serviced on securing the medication carts when not in use. The DON stated she did not know the exact date of the in-service. She stated residents, other staff, and visitors would have access to the medications in the unlocked medication cart. She stated if a resident ingested medications not prescribed to them, there was a potential the resident may have an allergic reaction or may need to be admitted to the hospital. She stated it was the nurse's responsibility to ensure the medication cart was locked when not dispensing a resident's medication. The DON stated she was responsible for monitoring the nurse supervisor. Interview on 08/22/2025 at 1:30 PM the ADM stated her expectations was for the medication carts to be locked when the nurses were not administering medications from the carts. She stated there was a possibility a resident may get medications out of the medication cart. The ADM stated if a resident did take the medications by mouth there was a possibility a resident may have an allergic reaction. She stated it depended on the medication the resident ingested. She stated the nurse assigned to the medication cart was responsible for locking the medication cart after administering medications to a resident. The ADM stated the DON was responsible to monitor the nurse supervisor. Observation and interview on 08/21/2025 at 10:14 AM in the medication storage room with the TN revealed the one medication storage refrigerator with 2 thermometers sitting on the top shelf, one thermometer read 51 degrees, and the other thermometer read 47.5 degrees. The log on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 27 of 47 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 08/21/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few refrigerator door did not have a reading for that day, at the bottom of the log page was handwritten Refrigerator temp 35 F - 40 F. The TN stated the temperature in the refrigerator should be lower and turned the dial inside the refrigerator to adjust the temperature. The medication refrigerator contained multiple medications including: Lantus Solostar (an insulin for diabetes), Insulin Lispro, Insulin Glargine, Wegovy (a medication used for diabetes or weight loss), Humulin 70/30 Kwikpen (an insulin for diabetes), Trulicity (a medication used for diabetes), Acetaminophen suppositories (a medication used for fever and pain when medication cannot be taken by mouth), Glycerin suppositories (a medication used for constipation), Bisacodyl Suppositories (a medication used for constipation), Brimonidine-Timolol (an eye drop used to decrease eye pressure), Latanoprost (an eye drop used to decrease eye pressure), a vaccine for the respiratory syncytial virus (a common respiratory virus that is highly contagious), and Acidophilus (a probiotic). The refrigerator was not at correct temperature. Observation on 08/21/2025 at 10:28 AM revealed the medication storage room one of one refrigerator thermometers with temperature readings of 49.3 degrees and 55 degrees. The TN then notified the ADON, and another medication storage refrigerator was immediately brought into the medication storage room by the ADON. Interview on 08/21/2025 at 10:37 AM with the ADON, he stated all medications would be destroyed.Observation on 08/21/2025 at 10:40 AM revealed the ADON on the phone attempting to reorder all the medications that were stored in the refrigerator in the medication storage room. Interview on 08/21/2025 at 02:49 PM the CP stated she had been informed about all the medication in the refrigerator being outside of the recommended storage range. She stated each different manufacturer would need to be contacted to determine each medication's excursion range (the amount of time and at what temperatures each medication can tolerate). She stated all medications that were in the medication storage room's refrigerator had been destroyed and all medications had been reordered at the facility's expense. The CP stated she was unable to say how the medication would be affected because it varied depending on the medication and manufacturer. She stated the nurses were responsible for completing the temperature monitoring log daily. The pharmacist stated she had visited the facility a week ago and the temperature log was completed at that time and no temperatures were out of range. She stated she was scheduled to visit the facility monthly, and she reviewed the refrigerator during her visits. Interview on 08/21/2025 at 04:49 PM the TN stated the nurses that worked the night shift were responsible for checking the temperature in the medication refrigerator. She stated the DON monitored the temperature log form to ensure it is being completed each day. The TN stated if medications were outside of the recommended storage temperature, then the medication may lose potency.Interview on 08/21/2025 at 05:18 PM RN D stated the nurses that worked the night shift were responsible for checking the temperature in the medication refrigerator. He stated if medications were stored outside of the recommended temperature ranges, then the potency of the medication may be affected, and the resident may not get the intended dose of the medication.Interview on 08/21/2025 at 05:36 PM the DON stated she had been the DON for about a month. She stated she expected the night shift nurses to check the medication storage refrigerator and document the temperature. She stated she monitored to ensure the temperature log was completed daily. The DON stated if medication was not kept within the manufacturers recommended range, then the use of the medication could be affected. Interview on 08/21/2025 at 06:02 PM the ADM stated the temperature of the medication room refrigerator was checked daily by the charge nurse. She stated if the medications in the medication room refrigerator were stored out of range, then the medication could lose its effectiveness. Record review of the facility's Policy on Storage of Medications, not dated, reflected the facility stores all drugs and biologicals in a safe, secure, and orderly manner. Unlocked medication carts are not left unattended.Record (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 28 of 47 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 08/21/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm review of the facility's, undated, Policy titled Medication Storage and Administration Quick Reference Guide reflected Med carts are locked when not visible to nurse or qualified staff. Temperature of refrigerator should consistently be maintained at 36-46 F. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 29 of 47 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 08/21/2025 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review, the facility failed to serve foods that were palatable and attractive and prepare food by methods that conserve nutritive value, flavor, and appearance for 1 of 1 kitchen observed. 1. The two test tray for lunch meal included foods that were bland, and unappealing. 2. The lunch meal trays being delivered to 300 hall residents were unappealing with small side portions. 3. The meal delivery cart doors left open during delivery of hallway meals and reducing the food temperatures. 4. Watery and mushy vegetables served to residents on 08/20/2025. These failures could place residents at risk of decreased food intake, hungry, unwanted weight loss, and diminished quality of life. Findings included: Observation on 08/19/2025 at 12:00 PM revealed unappealing meal trays with poor arrangement of food and small portions of okra being delivered to hallway 300.Food test tray #1 was received at 12:29 PM on 08/19/2025 and was well-presented and arrangement of food was appealing. The tray contained a large white serving plate with an adequate portion of fried okra placed in a small bowl for appearance, corn bread, chili with beans was arranged in a bowl, 2 portions of shredded cheese, donut holes, tea, water, salt, pepper, butter, and utensils wrapped in napkin.Observation and interview on 08/20/2025 at 11:15 AM revealed the broccoli was sitting in a large steal pan filled with water. CK L was observed monitoring food temperatures and stated the broccoli and water remain in the deep pan until meal service and it is drained before serving.Observation on 08/20/2025 at 11:42 AM revealed CDM instructing CK M to drain out as much water from the steal pan of broccoli. CK M used a perforated portion spoon to remove water from the broccoli pan in a slow pace. He was then instructed to stop and to drain as much water when portioning on plate. Broccoli was served on resident plates.Observation on 08/20/2025 at 12:15 PM revealed the meal delivery cart transporting resident meals to hallway 100 was left wide open. The meal delivery cart doors were left open for several minutes exposing resident meal trays and reducing the food temperatures.Food test tray #2 was received at 1:03 PM on 08/20/2025 and the boiled broccoli was mushy and watery. Surveyor tested the tray, and the broccoli was overcooked, soft and squashy, without any seasoning, and dull. The food was warm.During an interview on 08/21/2025 at 10:00 AM, ADM stated the CDM was responsible for maintaining hot, appealing, and flavorful food. She stated she had not heard of complaints regarding food and would ensure the DM was aware of complaints and working with the dietician to improve meals. During an interview on 08/21/2025 at 3:57 PM, CK L stated that vegetables should not sit in water until they were served. She stated she does not leave water in her vegetables and will drain them. She stated if the vegetables remained in water for too long, she would throw it away, because they become mushy. CK L stated this is not the common practice in the kitchen; however, CK M is a new cook in training, and she is trying to teach him good practices as she knows the residents do not like mushy and flavorless foods and would complain about it. CK L stated she hears a lot of complaints when other cooks prepare food as there is no flavor, and limited seasoning of only salt and pepper is used. She stated residents want meals to look forward to. CK L stated using the correct measuring scoops and spoons for serving is necessary for residents to maintain weight and nutrition. She stated following recipes and seasoning required is necessary for meals to be flavorful.During an interview on 08/21/2025 at 4:18 PM, CDM stated she has received complaints from the resident council regarding food being served cold. She stated she believes food may be cold if not delivered to table immediately or to the resident's room in a reasonable time. She stated she does not understand why food becomes cold quickly but will look into this. She stated the broccoli left in water should have been drained before putting the tray on the serving steam table. She stated she was distracted with training a new cook that she overlooked the broccoli staying in water too long and becoming Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 30 of 47 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 08/21/2025 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete mushy. She stated vegetables are the last food cooked for any meal as they require less time. She stated residents receiving unflavored and mushy vegetables could affect the resident by reducing their nutrition as they may not eat. CDM stated cooks are expected to use the correct portion sized serving tools when serving plates as anything less could affect the residents with weight loss. She stated that all plates served either in the dining room or in the resident rooms should all be uniformed and be appealing so the resident will want to eat it.Review of facility policy undated, titled Food and Nutrition Services revealed Each resident is provided with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident. 6. Food and nutrition services staff will inspect food trays to ensure that the correct meal is provided to each resident, the food appears palatable and attractive, and it is served at a safe and appetizing temperature. a. If an incorrect meal is provided to a resident, or a meal does not appear palatable, nursing staff will report it to the Food Service Manager so that a new food tray can be issued. Event ID: Facility ID: 675118 If continuation sheet Page 31 of 47 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 08/21/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review the facility failed to store, prepare, and serve food in accordance with professional standards for food service safety for the facility's only kitchen and the facility's only nourishment room reviewed for food and nutrition services. 1. The facility failed to label and date food items in the only walk-in refrigerator. 2. The facility failed to label and date food items in the only nourishment refrigerator.3. The facility failed to maintain the proper temperature of the refrigerator in the nourishment room.4. The facility failed to ensure that the walk-in freezer was maintained at acceptable temperatures which resulted in frozen foods thawing out and then re-freezing without being discarded. 5. The facility failed to ensure that foods were stored away from leaks of malfunctioning cooling fans in the walk-in refrigerator. 6. The facility failed to ensure food products are discarded on or before the expiration date. 7. The facility failed to maintain temperature logs to monitor the nourishment refrigerator to ensure that it is functioning properly. These failures could place residents at risk for health complications, weight loss, foodborne illnesses, and decreased quality of life. Findings include: Observation and interview on 08/19/2025 at 4:30 PM revealed a large metal tray containing opened cooked ham with lid and label of prepared date 08/10/2025 and use by date 08/17/2025 stored in the walk-in refrigerator. The CDM stated the discard date for this food item should be within 7 days of prepared date. She stated it was now 9 days after prepared date and should not be in the refrigerator. She was observed removing the metal tray from the refrigerator to discard food item. Observation on 08/19/2025 at 4:37 PM revealed the walk-in freezer thermometer panel mount temperature was reading 3 . Observation on 08/20/2025 at 10:59 AM revealed the walk-in freezer thermometer panel mount temperature was reading 3 . Observation and interview on 08/20/2025 at 11:00 AM revealed a slow steady water leak from the bottom of the refrigerator cooling fans dripping into a large black plastic bin positioned directly underneath. CDM stated this was a new leak that has been reported to the maintenance staff for immediate repairs. She stated the black plastic bin is to keep the water from leaking onto the food stored on the shelf. She stated all packaged food was removed from this shelf temporarily awaiting repairs. She stated she believes the walk-in freezer temperature is above 0 as staff have been in and out of it this morning prepping foods for the day and organizing frozen foods. Observation on 08/20/2025 at 11:33 AM revealed salad plates with plastic wrap and plastic salad bowls with lids unlabeled and undated in the walk-in refrigerator. CDM immediately grabbed food items and went to add labels to them. During an interview on 08/20/2025 at 1:13 PM, MAIN stated kitchen work orders are handled by him and one other staff. He stated he will reach out to 3rd party contractors if unable to make a repair himself, such as the walk-in refrigerator and walk-in freezer. He stated the leak was reported to him last week some time, the refrigeration contractor visited the facility last week to look at it. He stated there was a delivery last week and staff had the refrigeration doors open, and a lot of condensation was building up when the contractor was assessing. He stated the contractor recommended for him to look at adding some fans to the refrigerator, so it does not create condensation. He stated he also believed since the freezer doors were open for delivery it caused the temperature to rise. He stated kitchen staff are emptying the black plastic bin during morning and night shifts. He stated he has been researching how to run fans for the condensation build up, and he will have to put in an electrical system to install the fans. He stated it would be best if he looked at the inside of the refrigerator, not draining, not sure about the water build up, and look at air curtains for the doors. He stated he has requested invoices and estimates for this work. MAIN stated if water were to leak onto the stored food, staff should not use it as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 32 of 47 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 08/21/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many this could affect the residents and make them sick. Surveyor requested work orders submitted for temperatures and water leak concerns, invoices, and estimates from contractors regarding recommendations and repairs and recommended plan to repair the refrigeration systems. These items were not provided prior to exit. Observation on 08/21/2025 at 9:00 AM revealed the walk-in freezer thermometer panel mount temperature was reading 15 and the 2 dial freezer thermometer located in the walk-in freezer was reading 30 . Observation on 08/21/2025 at 9:07 AM revealed the walk-in freezer thermometer panel mount temperature was reading 15 and the 2 dial freezer thermometer located in the walk-in freezer was reading 18 . Observation and interview on 08/21/2025 at 9:11 AM revealed the large black plastic bin positioned directly underneath the cooling fans in the walk-in refrigerator was filled with dirty water that has leaked into it. CDM stated the black bin fills throughout the day and is dumped out every morning and evening shift. She removed the plastic bin to drain water, and the piping of the refrigerator was exposed and had rust and black tape wrapped around the hinges. Observation and interview on 08/21/2025 at 9:12 AM revealed the left side of the cooling fans also had a very slow leak and had dripped into the black large plastic bin that contained cheese blocks. The CDM stated the leak had not been a concern to the left side of the cooling fans and she was not aware of any additional leaks. She stated the cheese is unopened and did not leak into it but believes it would be best to discard. She was observed removing the cheese from walk-in refrigerator. During an interview on 08/21/2025 at 9:14 AM KH N stated she has been employed a year at this facility and the black plastic bin has been there the entire time and staff have been tasked with emptying the water out daily. She stated MAIN has been notified numerous times of this concern. She stated residents can become ill if the food is contaminated with leaking water. She stated all staff are responsible for reporting any faulty equipment to the CDM to submit work orders for repairs. During an interview on 08/21/2025 at 9:16 AM, CDM stated she has been employed at the facility since March 2025. She stated the MAIN has been notified numerous times of the walk-in refrigerator leak and walk-in freezer temperatures. She stated she has entered work orders in TELS (software to manage work orders), and MAIN would have access to these workorders. She stated this was a concern that the dietician had addressed with her during her last visit and quality assurance evaluation on 08/08/2025. She stated she is aware this malfunction can be harmful to residents and insisted she has notified the MAIN and ADM of the concerns. During an interview on 08/21/2025 at 9:30 AM, KH O stated labeling and dating food items are required for every food opened or stored in the walk-in refrigerator and freezer. She stated if food is not labeled it can be expired, be no good and can cause residents to become ill if used. She stated that she has been aware of the walk-in refrigerator leak for 2-3 months now. She stated the CDM is aware of the problem. She stated foods can become dangerous for residents if water drips onto it. During an interview on 08/21/2025 at 9:38 AM, CK L stated she has been employed for 1 year and 8 months at this facility and she has many different duties which include the CDM's right hand as she is new. She stated kitchen labeling and dating training occurred a few months back. She stated the purpose of wrapping and labeling food is to know if the food is good. She stated food can go bad if not labeled, not sure if expired and could make the residents sick if used. CK L stated the leak in the walk-in refrigerator has been ongoing for some time and has not been repaired. She could not recall timeframe but believes a few months. She stated maintenance has assessed the issue and has tried to repair a few times now, but no success. She stated the leak could damage the food stored in the walk-in refrigerator and could make residents sick if water is leaking onto the food. She stated the freezer temperatures have also been reported to CDM and MAIN. She stated MAIN will come in and check the temperature and state the freezer door remains open too long and causes the temperature to go (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 33 of 47 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 08/21/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many above 0 . She stated the dietitian also addressed this concern a few times during visits. During an interview on 08/21/2025 at 9:53 AM, MAIN stated he talked to a contractor for an estimate to repair the walk-in refrigerator. He stated the parts were not ordered as he had mentioned in an earlier interview. He stated parts have yet to be ordered as the contractor has yet to provide him with an estimate and timeframe to repair the walk-in refrigerator. He stated if the leaking water were to get onto the food stored in the refrigerator it could become contaminated and can cause the residents to become ill. During an interview on 08/21/2025 at 10:00 AM, ADM stated that she was aware of the walk-in refrigerator leak and freezer temperature gauge was having adjustment concerns that were brought to her attention around the 7th or 11th of August 2025. She stated the dietician visited the facility for her monthly evaluations and this concern was discussed and a work order was submitted immediately. She stated KH N is a disgruntled employee and told staff she would be getting people in trouble with the State and is giving an inaccurate timeframe of the walk-in refrigerator leak concerns. She stated her MAIN has been on top of these repairs and it seems to have reached the pinnacle and now needs a contractor that is knowledgeable in repairing refrigeration systems. She stated the MAIN was working on this work order and was trying to get the contractor to provide an estimate for repairs. She stated she was not sure why the delay in getting this estimate to begin the repairs. She stated she will be contacting the contractor herself today to let him know their walk-in refrigerator is a priority and he needs to be here today to repair the leaking refrigerator and the temperature gauge for the walk-in freezer or she would be canceling his contract with the facility. Observation and interview on 08/21/2025 at 11:34 AM, CNA F stated the kitchen staff deliver snacks to the only nurse's station three times a day (10 AM, 2 PM, 6 PM). He stated snacks that are not eaten after 2 hours are returned to the kitchen or discarded. He stated the evening snacks are stored behind a locked door in a small refrigerator. He stated without labels the snacks could be expired, but staff would not know. He stated this could cause the residents to become sick. Observation of the locked nourishment room containing the resident snack refrigerator revealed the refrigerator contained a tray of milk cartons without a label or date, cottage cheese with label with date of 8/12/2025 AM Snack for a specific resident, cartons of Mighty Shakes, Vanilla with label and date of 8/12/2025, pitcher with tape label nectar H2O without date, orange juice with lid without label or date. Also stored in the refrigerator was an unlabeled gallon of ice cream, birthday cake, bag of sodas, and bag of juices. All resident items were unlabeled. The refrigerator did not have a thermometer gauge, there was no temperature log in site, and the refrigerator needed cleaning and to discard expired food. CNA F stated the snack refrigerator stores all resident snacks and items brought in by family to store for a resident. He stated there is no temperature log for the refrigerator that he is aware of, and housekeeping is responsible for cleaning out the refrigerator and getting rid of the expired snacks not eaten. Observation of the freezer on 08/21/2025 at 12:22 PM revealed two 2 dial freezer thermometers were reading 2 and the other reading 36 . During an interview on 08/21/2025 at 3:30 PM, CNA J stated he is the staffing coordinator, he purchases central supplies and is responsible for updating the staffing board daily. He stated he is not aware of a specific staff assigned to the resident snack refrigerator. He believes maintenance is responsible for the temperature logs and housekeeping would be responsible for the upkeep of the refrigerator, and the kitchen staff would be responsible for labeling food. During an interview on 08/21/2025 at 4:40 PM, MAIN stated he is not aware of a temperature log for the resident refrigerator and was not aware that it required one. He stated there is no policy for the nutrition refrigerator specifically. He stated facility staff usually will clean out and discard food items from the nutrition refrigerator but no assigned staff. Review of Work Order (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 34 of 47 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 08/21/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many #1930 created on 08/11/ 2025 titled, Condensation walker in cooler revealed it was submitted for the kitchen and requested by CDM with a medium priority. Status was set to in-progress by MAIN. No details as to the work order progress. Review of third-party contractor email, 08/20/2025 1:32 PM, titled WIC (walk in cooler) revealed correspondence from contractor to MAIN, Per our recent conversation about our site visit last week, I am still working with the manufacture on upgrading the drainage system and installing additional ventilation. I will reach back out for an update and circle back to you shortly. Review of third-party contractor email, 08/21/2025 10:35 AM, titled Walk in cooler and Freezer revealed correspondence from contractor to MAIN, Touching base again, I was able to produce a resolution with the manufacturer on your Walk In cooler Issues. I have a tech that will be on site today between 3-5, He will also be addressing any temporary issues with your freezer while on site also. Review of facility report, 08/20/2025, titled Work Order revealed closed work orders submitted for repairs from 05/15/2025 to 08/20/2025: Work order #1811 submitted on 06/26/2025 by CDM, summary request adjust temperature of freezer. Work order #1933 submitted on 08/13/2025, no staff listed, summary request sealed cooler cracks. Review of facility reports, 06/10/2025 to 08/08/2025, titled QA I Monitor revealed the kitchen underwent monthly quality assurance evaluations conducted by the facilities' licensed dietician and results were reviewed and shared with the CDM and ADM. Areas of non-compliance and comments provided by dietician include: 08/08/2025 Section 5: Food Storage: Refrigerators (32-41 ) and freezers (0 or lower) at proper temperature; logs complete, internal thermometers present in each cooler/freezer.All other food items covered, labeled, and dated. Received dates present on all items. Foods free from freezer burn, dried out appearance, or other signs of quality change. Shelves, interior fans, gaskets, floors, walls clean and in good repair, shelves not lined with paper. Section 8: General Comments and Progress from Last Report: Fridge/freezer temperatures prefilled for PM; condensation continues with fresh produce continually stored beneath despite RD encouragement to relocate - this is significant contamination risk. Improvement on labeling/dating, must remember to place open dates on all opened items both fridge/dry stock. 07/10/2025 Section 5: Food Storage: Coolers and freezers not overstocked to promote air circulation.Foods free from freezer burn, dried out appearance, or other signs of quality change. Section 6: Meal Service Observation Recipes followed.Nourishment room: clean, not out of date foods, temporary logs in use; N/A Section 8: General Comments and Progress from Last Report: significant condensation in fridge dripping into pan but also outside onto RTE foods - RD encouraged placing in TELS (software to manage work orders) and removing open RTE food from the area. Encouraged organizing freezer and labeling and dating items appropriately. 06/10/2025 Section 5: Food Storage:All other food items covered, labeled, and dated. Received dates present on all items. Food not expired or spoiled. Section 6: Meal Service Observation Nourishment room: clean, not out of date foods, temporary logs in use; N/A Section 8: General Comments and Progress from Last Report: Items addressed with CDM. RD to provide In-services on glove use, labeling and dating. Review of facility spreadsheet, undated, untitled, revealed dietician outlined problem areas in the kitchen, goals to correct, and specific tasks to successfully meet goals: 08/08/2025 Condensation leakage continues onto ready to eat foods despite RD encouragement for relocation of high-risk foods; interior of refrigerators/freezers are clean, and parts are in good repair; REMOVE ALL OPEN/READY TO EAT FOODS FROM BELOW CONDENSER. Comments: improvements in labeling/dating, ensure storage of ready to eat items are free from condensation - no changes in last 3 visits with this issue. Review of facility policy undated, titled Refrigerators and Freezers revealed, This facility will ensure safe refrigerator and freezer maintenance, temperatures, and sanitation, and will observe food expiration guidelines. 1. Refrigerators and/or freezers are maintained in good working (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 35 of 47 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 08/21/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete condition. 4. The supervisor takes immediate action if temperatures are out of range. Actions necessary to correct the temperatures are recorded on the tracking sheet, including the repair personnel and/or department contacted. 5. All food is appropriately dated to ensure proper rotation by expiration dates. Received dates (dates of delivery) are marked on cases and on individual items removed from cases for storage. Use by dates are completed with expiration dates on all prepared food in refrigerators. Expiration dates on unopened food are observed and ''use by dates are indicated once food is opened. 7. Supervisors are responsible for ensuring food items in pantry, refrigerators, and freezers are not past use by or expiration dates. Event ID: Facility ID: 675118 If continuation sheet Page 36 of 47 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 08/21/2025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to establish and 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 infection for 4 of 6 residents (Resident #29, #65, #70 and #86) reviewed for infection control. 1. The facility failed to ensure CNA C doffed gloves after giving care to Resident #65 and #86 disposed of PPE properly on 08/19/2025. 2. The facility failed to ensure staff wore PPE while providing high contact resident care (transfers and medication administration through a gastrostomy tube) to Residents #29 and #70 on 08/21/2025. These failures could place residents at risk for infection, hospitalization, or death.Findings included: 1. Record review of Resident #65's face sheet, dated on 08/21/2025, reflected a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included local infection of the skin and subcutaneous tissue, unspecified (a bacterial or fungal infection affecting a specific, limited area of the outer skin layers and the tissue beneath it), non-pressure chronic ulcer of skin of other sites limited to breakdown of skin (an open ,non-healing sore on the skin, not caused by prolonged pressure), and hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (hemiplegia refers to paralysis- complete inability to move and hemiparesis - weakness). Record review of Resident # 65's admission MDS Assessment, dated 07/31/2025, reflected Resident #65 had a BIMS score of 10, which indicated her cognition was moderately impaired. Resident #65 had stage 4 pressure ulcer. Record review of Resident #65's Comprehensive Care Plan, dated 08/04/2025 reflected Resident #65 had stage 4 pressure ulcer to sacrum. The pressure ulcer was present upon admission. The care plan did not reflect Resident #65 being on contact precautions. 2. Record review of Resident # 86's face sheet, dated on 08/21/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. Resident #86 had a diagnoses which included infection following a procedure, superficial incision surgical site, subsequent encounter (a bacterial or other microorganism infection that develops in the top layers of skin at a surgical wound site, rather than a deep one, for a resident receiving later follow-up medical care for the infection), methicillin resistant staphylococcus aureus infection, unspecified site (a common bacteria enter the body through a cut or wound, causing symptoms like red, painful, swollen areas, possibly with pus. Methicillin resistant- the bacteria has developed a resistance to certain antibiotics which are normally used to kill staph), and chronic pain (a long lasting, continuous, or recurring pain that persists for at least three months, beyond the normal healing time). Record review of Resident #86's Quarterly MDS Assessment, dated 07/26/2025, reflected Resident #86 had a BIMS score of 15 which indicated her cognition was intact. Resident #86 had open lesions and skin tears. She was receiving treatment for skin and ulcer/ injuries (non-surgical dressings and ointments) Record review of Resident #86's Comprehensive Care Plan, dated 08/08/2025, reflected Resident #86 was at risk for skin breakdown and pressure ulcer development due to decreased mobility and obesity. Resident #86 comprehensive care plan did not reflect Resident #86 being on contact isolation. 3. Record review of Resident #29's admission record, dated 08/21/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included acute and chronic respiratory failure with hypoxia (a condition where there is not enough oxygen in the blood), tracheostomy status (a surgical opening in the neck directly to the breathing tube/trachea), hypotension (low blood pressure), gastrostomy status (a surgical opening directly to the stomach through the abdomen), nontraumatic intracerebral hemorrhage (bleeding within the brain without any external injury), and hemiplegia and hemiparesis (weakness and inability to move half of the body). Record review of Resident #29's medical record Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 37 of 47 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 08/21/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some on 08/21/2025 reflected no submitted and accepted MDS due to Resident #29's recent admission on [DATE]. Record review of Resident #29's care plan, dated 08/19/2025, did not mention Enhanced Barrier Precautions Record review of Resident #29's order summary, dated 08/21/2025, reflected, Enhanced Barrier Precaution: PPE required for high resident contact care activities. Indication: TRACHEOSTOMY AND G-TUBE. 4. Record review of Resident #70's admission record, dated 08/21/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included spina bifida (a birth defect that occurs when the neural tube, which forms the spine and spinal cord, does not close completely during early development in pregnancy), syndrome of inappropriate secretion of antidiuretic hormone (a condition where the body makes too much antidiuretic hormone causing water retention and low sodium levels), elevated white blood cell count (diagnosis can indicate infection, inflammation, or immune system disorders), hypertension (high blood pressure), pressure ulcer of sacral region, stage 4 (a wound that extends through all layers of skin, exposing underlying muscle, tendon, or bone caused by pressure to the lower triangular area of the spine), neuromuscular dysfunction of bladder (when there is a problem with the brain, nerves, or spinal cord that affects bladder control), and colostomy status (a surgical opening for the colon through the abdomen). Record review of Resident #70's comprehensive admission MDS, dated [DATE], reflected a BIMS score of 15, which indicated no cognitive impairment. It reflected she had an indwelling catheter, an ostomy, and a pressure ulcer/injury. Record review of Resident #70's care plan, dated 08/15/2025, reflected [Resident #70] has a documented Pressure Ulcer that was present on admission. Care plan also reflected [Resident #70] is at risk for infection related to foley catheter. Care plan had no mention of Enhanced Barrier Precautions. Record review of Resident #70's order summary dated 08/21/2025 reflected, Enhanced Barrier Precaution: PPE required for high resident contact care activities. Indication: open wounds, catheter, colostomy every shift.Observation on 08/19/2025 at 9:39 AM Resident #65 and Resident #86's room (room [ROOM NUMBER]) had signs outside the door reflecting contact isolation signs. The signs had the proper PPE to wear when giving care and how to don (place gowns and gloves on prior to giving care) and doff (removing gowns and gloves after giving care) the PPE. There was a container outside the room with red bags for disposing PPE, gowns, and gloves. Observation and interview in Resident #86's room on 08/19/2025 at 9:45 AM revealed CNA C doffed her gown and placed it in a clear plastic bag. She was wearing same gloves after giving care to Resident# 65. CNA C pulled back the privacy curtain to speak to Resident # 86. CNA C picked up the call light off the floor and placed it on Resident # 86's bed sheets. Resident #86 stated she accidently knocked it off the bed. CNA C touched Resident #86's left hand while wearing same gloves. CNA C picked up the clear plastic garbage bag with several gowns and gloves in the bag. There was a hole to the right side of the clear plastic garbage bag. CNA C placed the contaminated gowns and gloves in the clear plastic bag on the seat of Resident #86's wheelchair. Interview on 08/19/2025 at 9:58 AM CNA C stated she did not follow the infection control rules. She stated she was to doff the gloves and wash her hands prior to touching the call light and Resident #86's arm. She stated if another staff or visitor came into the room and had a scratch or open area on their fingers or hand, there was a possibility they may become contaminated with MRSA if they touched the call light. She stated the wheelchair was also contaminated after she placed the clear plastic bag in the wheelchair. CNA C stated there was a hole to the right side of the bag and she was going to hold it together as she carried the bag to the dirty utility room. She stated she had been in-serviced on contact isolation and infection control. CNA C stated she did not recall the exact date or time of the in-service.Observation on 08/21/2025 at 09:32 AM revealed LVN E did not wear a PPE gown when administering medication through Resident #29 gastrostomy tube. Observation outside of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 38 of 47 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 08/21/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the room revealed a 3-drawer tote filled with PPE and 2 signs that indicated the use of EBP precautions was needed for Resident #29. Interview on 08/21/2025 at 09:51 AM, LVN E stated she forgot to wear a gown to give medications to Resident #29. She stated EBP were to protect the resident from infection. She stated by not wearing a gown during medication administration through a gastrostomy tube then the resident could be exposed to bacteria and contract an infection. Observation on 08/21/2025 at 12:57 PM revealed CNA F and CNA G transferred Resident #70 using a mechanical lift from the wheelchair to the bed, but the CNAs did not wear a gown for EBP PPE. Observation outside of the room revealed a 3-drawer tote filled with PPE and 2 signs that indicated the use of EBP precautions was needed for Resident #70.Interview on 08/21/2025 at 01:33 PM, CNA G stated resident #70 required PPE including a gown for any direct patient care including transfers with a mechanical lift. She stated she forgot to wear a gown when providing care to Resident #70. She stated the resident could be exposed to bacteria and get an infection if EBP PPE was not used when providing direct resident care. Interview on 08/21/2025 at 01:36 PM, CNA F stated he did not wear PPE including a gown while providing direct care during a mechanical lift transfer for Resident #70. He stated he did not normally work with Resident #70 and did not know she required EBP. CNA F stated he did not see the drawers with PPE or the signs outside the door. He stated he was unsure why a resident would require EBP, but he stated by not wearing PPE he could make the resident sick by transmitting bacteria. Interview on 08/21/2025 at 1:59 PM the MDSN stated infection control protocol was to be followed especially if someone was on contact isolation. She stated touching anything with contaminated gloves was considered cross contamination. The MDSN stated any time someone was on contact isolation it was expected to be care planned. She stated she would need to review Resident # 86 and Resident # 65's care plan to determine if contact isolation were care planned and she would inform the surveyor with the information she gathered from their medical records. She never reported any information to surveyor prior to exit. Interview on 08/21/2025 at 2:24 PM the Treatment Nurse stated Resident #65, and Resident #86 was on contact isolation. She stated both residents had MRSA but in different areas. She stated she would need to review their medical charts and would give the areas on both residents (Resident #65 and Resident #86) and would report to surveyor. The treatment nurse never reported this information to surveyor prior to exit. She stated both residents were on contact isolation. The treatment nurse stated both residents required for gowns and gloves to be worn when giving care to both residents. She stated contact isolation was expected to be care planned. She stated if it was not care planned the staff would not have the information, they needed to know why the residents was on contact isolation. The treatment nurse stated if a staff had contaminated gloves on, picked up call light, and placed it on the bed the call light may become contaminated. She stated if a staff or family member visited the resident and had open area on their fingers or hand the person may become contaminated with MRSA. She stated the staff was not to place clear garbage bag full of contaminated gowns and gloves in a wheelchair. She stated the wheelchair would be considered contaminated. She stated if there was a hole in the clear plastic bag and the staff carried the bag down the hall there was a potential if another resident had open area on their arm and touched the contaminated gowns/gloves in the plastic bag, the resident may become contaminated with MRSA. She stated she had been in-serviced on infection control and she was the infection control preventionist. She did not recall the date of her training. Interview on 08/21/2025 at 2:50 the DON stated the staff was to doff gloves and wash hands prior to doing anything for a resident. She stated the staff did contaminate the call light and possibly the resident's hand. She stated if another staff or visitor touched the call light and had an open area on their hand there was a possibility the staff or visitor may become contaminated with MRSA. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 39 of 47 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 08/21/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated Resident #65 and Resident #86 both had MRSA. The DON stated the staff was expected to follow infection control protocol. She stated the staff did not follow infection control protocol when she did not remove her gloves when she picked up the call light. She also stated the staff was not to place the clear plastic bag of gowns and gloves in a resident's wheelchair. She stated this was cross contamination. The DON stated anytime residents were on contact isolation this was required to be care planned. She stated anytime a resident had any type of infection the care plan was to reflect all interventions required to heal the infection. The DON did not respond to other questions related to why it was important for infection and contact isolation needed to be care planned. Interview on 08/21/2025 at 04:49 PM, the TN (who is also the infection preventionist) stated she had worked at the facility for 3 weeks. She stated the purpose of EBP was to prevent transmission of bacteria from staff to the resident who may be immunocompromised (their immune system was not functioning properly). She stated that all residents who have any open wounds or surgical/artificial openings, including a foley catheter and gastrostomy tube, required EBP. The TN stated she expected anyone, including staff and family, to wear PPE, including a gown, when providing direct care to residents with indications for EBP. She stated there were signs up and PPE in drawers outside of the residents' rooms that required EBP. The TN stated staff that were administering medication through a gastrostomy tube or using a mechanical lift to transfer a resident with a catheter or wound to wear a gown when they provided the care. She stated not wearing a gown while providing care to the residents that required it could lead to infection, deterioration of condition, sepsis (a severe infection), or even death. The TN stated she had just taken the role that week to monitor for compliance among staff. She stated she provided monthly in-services and quarterly checkoffs related to infection prevention.Interview on 08/21/2025 at 05:18 PM, RN D stated PPE was used when providing direct care to residents who have a gastrostomy tube or foley catheter. He stated EBP required the use of gown and gloves. RN D stated using such precautions protected the resident from getting an infection. He stated anyone who provided care to the resident was responsible for wearing gown and gloves. Interview on 08/21/2025 at 05:36 PM, the DON stated she took over as DON on 07/21/2025. She stated residents that had open wounds, tracheostomies, catheters, or other invasive lines required EBP. The DON stated she expected anyone who provided direct care to residents with those conditions to wear PPE, which included gown and gloves, when they provided care to the resident. She stated that the charge nurses, the ADON and herself were responsible for monitoring for compliance with using the correct PPE. The DON stated not wearing PPE for the residents that required it could introduce infection to those residents. Interview on 08/21/2025 at 06:02 PM, the ADM stated she took over as ADM approximately 2 months prior. She stated residents that have a catheter, a colostomy, a tracheostomy, or a gastrostomy tube required EBP. She stated that any staff that provide direct care for those residents are required to wear a gown and gloves. The ADM stated nursing management monitored proper usage of EBP during their quality-of-life rounds. She stated not using the correct PPE while providing direct care to those who require it could introduce infection to the resident. Record Review of facility's Policy on Isolation- Initiating Transmission- Based Precautions, dated October 2018, reflected Transmission- Based Precautions are initiated when a resident develops signs and symptoms of a transmissible infection; arrives for admission with symptoms of an infection; or had a laboratory confirmed infection; and is at risk for transmitting the infection to other residents. Transmission - Based Precautions may include Contact Precautions, Droplet Precautions, or Airborne Precautions. The facility makes every effort to use the least restrictive approach to managing individuals with potentially communicable infections. Transmission-Based Precautions are used only when the spread of infection cannot be reasonably (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 40 of 47 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 08/21/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete prevented by less restrictive measures. Record review of, undated, facility policy titled, Monitoring Compliance with Infection Control reflected: Policy StatementRoutine monitoring and surveillance of the workplace will be conducted to determine compliance with infection prevention and control policies and practices.Policy Interpretation and Implementation1. The infection preventionist or designee shall monitor the effectiveness of our infection prevention and control work practices and protective equipment. This includes, but is not limited to: .f. Effective use of disposable gloves and other personal protective equipment to prevent spread of infection. Record review of facility in-service titled Enhance Barrier Precaution, dated 06/09/2025, reflected: Enhanced Barrier Precautions (EBP) are an infection control intervention that expands the use of gowns and gloves, beyond standard precautions, during high-contact resident care activities to prevent the spread of multi drug-resistant organisms (MDROs). Use gown and glove specific examples of high-contact activities requiring EBP.TransferringDevice care or use (central line, urinary catheter, feeding tube, tracheostomy) . Event ID: Facility ID: 675118 If continuation sheet Page 41 of 47 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 08/21/2025 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review the facility failed to maintain essential kitchen equipment in safe operating conditions and according to manufacturers' specifications for the facility's one walk-in refrigerator and one walk-in freezer. 1. The facility failed to ensure that the walk-in freezer temperature was in safe operating conditions of 0 . 2. The facility failed to ensure the walk-in refrigerator's cooling fans were in safe operating conditions. These failures could place residents at risk for health complications, foodborne illnesses, and decreased quality of life. Findings include: Observation in the kitchen on 08/19/2025 at 4:37 PM revealed the walk-in freezer thermometer panel mount temperature was reading 3 . Observation in the kitchen on 08/20/2025 at 10:59 AM revealed the walk-in freezer thermometer panel mount temperature was reading 3 . Observation and interview in the kitchen on 08/20/2025 at 11:00 AM revealed a slow steady water leak from the bottom of the refrigerator cooling fans dripping into a large black plastic bin positioned directly underneath. CDM stated this was a new leak that has been reported to the maintenance staff for immediate repairs. She stated the black plastic bin is to keep the water from leaking onto the food stored on the shelf. She stated all packaged food was removed from this shelf temporarily awaiting repairs. She stated she believes the walk-in freezer temperature is above 0 as staff have been in and out of it this morning prepping foods for the day and organizing frozen foods. During an interview on 08/20/2025 at 1:13 PM, MAIN stated kitchen work orders are managed by him and one other staff. He stated he will reach out to 3rd party contractors if unable to make a repair himself, such as the walk-in refrigerator and walk-in freezer. He stated the leak was reported to him last week some time, the refrigeration contractor visited the facility last week to look at it. He stated there was a delivery last week and staff had the refrigeration doors open, and a lot of condensation was building up when the contractor was assessing. He stated the contractor recommended for him to look at adding some fans to the refrigerator, so it does not create condensation. He stated he also believed since the freezer doors were open for delivery it caused the temperature to rise. He stated kitchen staff are emptying the black plastic bin during morning and night shifts. He stated he has been researching how to run fans for the condensation build up, and he will have to put in electrical system to install the fans. He stated he looked at the inside of the refrigerator not draining. He said he was not sure about the water build up. He said he was looking getting air curtains for the doors. He stated he has requested invoices and estimates for this work. MAIN stated if water were to leak onto the stored food staff should not use as this could affect the residents and make them sick. Surveyor requested work orders submitted for temperatures and water leak concerns, invoices, and estimates from contractors regarding recommendations and repairs and recommended plan to repair the refrigeration systems. These items were not provided prior to exit. Observation on 08/21/2025 at 9:00 AM revealed the walk-in freezer thermometer panel mount temperature was reading 15 and the 2 dial freezer thermometer located in the walk-in freezer was reading 30 . Observation on 08/21/2025 at 9:07 AM revealed the walk-in freezer thermometer panel mount temperature was reading 15 and the 2 dial freezer thermometer located in the walk-in freezer was reading 18 . Observation and interview on 08/21/2025 at 9:11 AM revealed the large black plastic bin positioned directly underneath the cooling fans in the walk-in refrigerator was filled with dirty water that has leaked into it. CDM stated the black bin fills throughout the day and is dumped out every morning and evening shift. She removed the plastic bin to drain water, and the piping of the refrigerator was exposed and had rust and black tape wrapped around the hinges. Observation and interview on 08/21/2025 at 9:12 AM revealed the left side of the cooling fans also had a very slow leak and had dripped into the black large plastic bin that contained cheese blocks. The CDM stated the leak had not been a Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 42 of 47 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 08/21/2025 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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some concern to the left side of the cooling fans and she was not aware of any additional leaks. During an interview on 08/21/2025 at 9:12 AM KH N stated she has been employed a year at this facility and the black plastic bin has been there the entire time and staff have been tasked with emptying out daily. She stated MAIN has been notified numerous times of this concern. She stated residents can become ill if the food is contaminated with leaking water. She stated all staff are responsible for reporting any faulty equipment to the CDM to submit work orders for repairs. During an interview on 08/21/2025 at 9:12 AM, CDM stated she has been employed at the facility since March 2025. She stated the MAIN has been notified numerous times of the walk-in refrigerator leak and walk-in freezer temperatures. She stated she has entered work orders in TELS (software to manage work orders), and MAIN would have access to these workorders. She stated this was a concern that the dietician had addressed with her during her last visit and quality assurance evaluation on 08/08/2025. She stated she is aware this malfunction can be harmful to residents and insisted she has notified the MAIN and ADM of the concerns. During an interview on 08/21/2025 at 9:30 AM, KH O stated that she has been aware of the walk-in refrigerator leak for 2-3 months now. She stated the CDM is aware of the problem. She stated foods can become dangerous for residents if water drips onto it. During an interview on 08/21/2025 at 9:38 AM, CK L stated the leak in the walk-in refrigerator has been ongoing for some time and has not been repaired. She could not recall timeframes but believes a few months. She stated maintenance has assessed the issue and has tried to repair a few times now, but no success. She stated the leak could damage the food stored in the walk-in refrigerator and could make residents sick if water is leaking onto the food. She stated the freezer temperatures have also been reported to CDM and MAIN. She stated MAIN will come in and check the temperature and state the freezer door remains open too long and causes the temperature to go above 0 . She stated the dietitian also addressed this concern a few times during visits. During an interview on 08/21/2025 at 9:53 AM, MAIN stated he talked to a contractor for an estimate to repair the walk-in refrigerator. He stated the parts were not ordered as he had mentioned in an earlier interview. He stated parts have yet to be ordered as the contractor has yet to provide him with an estimate and timeframe to repair the walk-in refrigerator. He stated if the leaking water were to get onto the food stored in the refrigerator it could become contaminated and can cause the residents to become ill. During an interview on 08/21/2025 at 10:00 AM, ADM stated that she was aware of the walk-in refrigerator leak and freezer temperature gauge was having adjustment concerns that were brought to her attention around the 7th or 11th of August 2025. She stated the dietician visited the facility for her monthly evaluations and this concern was discussed and a work order was submitted immediately. She stated KH N is a disgruntled employee and told staff she would be getting people in trouble with the State and is giving an inaccurate timeframe of the walk-in refrigerator leak concerns. She stated her MAIN has been on top of these repairs and it seems to have reached the pinnacle and now needs a contractor that is knowledgeable in repairing refrigeration systems. She stated the MAIN was working on this work order and was trying to get the contractor to provide an estimate for repairs. She stated she was not sure why the delay in getting this estimate to begin the repairs. She stated she will be contacting the contractor herself today to let him know their walk-in refrigerator is a priority and he needs to be here today to repair the leaking refrigerator and the temperature gauge for the walk-in freezer or she would be canceling his contract with the facility. Observation on 08/21/2025 at 12:22 PM revealed two 2 dial freezer thermometers were reading 2 and the other reading 36 . Review of Work Order #1930 created on 08/11/ 2025 titled, Condensation walker in cooler revealed it was submitted for the kitchen and requested by CDM with a medium priority. Status was set to in-progress by MAIN. No details as to the work order progress. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 43 of 47 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 08/21/2025 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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Review of third-party contractor email, 08/20/2025 1:32 PM, titled WIC (walk in cooler) revealed correspondence from contractor to MAIN, Per our recent conversation about our site visit last week, I am still working with the manufacture on upgrading the drainage system and installing additional ventilation. I will reach back out for an update and circle back to you shortly. Review of third-party contractor email, 08/21/2025 10:35 AM, titled Walk in cooler and Freezer revealed correspondence from contractor to MAIN, Touching base again, I was able to produce a resolution with the manufacturer on your Walk In cooler Issues. I have a tech that will be on site today between 3-5, He will also be addressing any temporary issues with your freezer while on site also. Review of facility report, 08/20/2025, titled Work Order revealed closed work orders submitted for repairs from 05/15/2025 to 08/20/2025: Work order #1811 submitted on 06/26/2025 by CDM, summary request adjust temperature of freezer. Work order #1933 submitted on 08/13/2025, no staff listed, summary request sealed cooler cracks. Review of facility reports, 06/10/2025 to 08/08/2025, titled QA I Monitor revealed the kitchen underwent monthly quality assurance evaluations conducted by the facilities' licensed dietician and results were reviewed and shared with the CDM and ADM. Areas of non-compliance and comments provided by dietician include: 08/08/2025 Section 5: Food Storage: Refrigerators (32-41 ) and freezers (0 or lower) at proper temperature; logs complete, internal thermometers present in each cooler/freezer.Foods free from freezer burn, dried out appearance, or other signs of quality change. Shelves, interior fans, gaskets, floors, walls clean and in good repair, shelves not lined with paper. Section 8: General Comments and Progress from Last Report: condensation continues with fresh produce continually stored beneath despite RD encouragement to relocate - this is significant contamination risk. 07/10/2025 Section 5: Food Storage: Coolers and freezers not overstocked to promote air circulation.Foods free from freezer burn, dried out appearance, or other signs of quality change. Section 8: General Comments and Progress from Last Report: significant condensation in fridge dripping into pan but also outside onto RTE foods - RD encouraged placing in TELS (software to manage work orders) and removing open RTE food from the area. Review of facility spreadsheet, undated, untitled, revealed dietician outlined problem areas in the kitchen, goals to correct, and specific tasks to successfully meet goals: 08/08/2025 Condensation leakage continues onto ready to eat foods despite RD encouragement for relocation of high-risk foods; interior of refrigerators/freezers are clean, and parts are in good repair; REMOVE ALL OPEN/READY TO EAT FOODS FROM BELOW CONDENSER. Comments: ensure storage of ready to eat items are free from condensation - no changes in last 3 visits with this issue. Review of facility policy undated, titled Refrigerators and Freezers revealed, This facility will ensure safe refrigerator and freezer maintenance, temperatures, and sanitation, and will observe food expiration guidelines. 1. Refrigerators and/or freezers are maintained in good working condition. 4. The supervisor takes immediate action if temperatures are out of range. Actions necessary to correct the temperatures are recorded on the tracking sheet, including the repair personnel and/or department contacted. 8. Maintenance will inspect refrigerators and freezers for gasket condition, fan condition, presence of rust, excess condensation, and any other damage or maintenance needs. Necessary repairs are initiated immediately. Review of facility policy, undated, titled Maintenance Service revealed, 1. The Maintenance Department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. 2. Functions of maintenance personnel include but are not limited to: f. Establishing priorities in providing repair service. h. Providing routinely scheduled maintenance service to all areas. Event ID: Facility ID: 675118 If continuation sheet Page 44 of 47 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 08/21/2025 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 0940 Develop, implement, and/or maintain an effective training program for all new and existing staff members. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews the facility failed to develop, implement, and maintain an effective training program for all new and existing staff; individuals providing services under a contractual arrangement; and volunteers, consistent with their expected roles, for 2 of 3 (SW, and Marketing) staff reviewed for training in Care Plans and PASRR services in that:The facility failed to train the Social Worker in the assigned SW areas in the PASRR, and updating the Care Plans for advance directives. The facility failed to train the Marketing person about ensuring a PASRR was received at admission.This failure could place residents at risk for harm by not having a complete and accurate care plan or having a PASRR completed to support the residents needs and preferences. The finding included:Resident #7 Review of Resident #7's face sheet dated [DATE] revealed an [AGE] year-old male who was admitted on [DATE] with diagnoses including hemiplegia and hemiparesis following cerebral infraction affecting right dominant side (paralysis and weakness on right side after stroke), muscle weakness, dysphagia oropharyngeal phase (inability to empty from the throat to the esophagus), lack of coordination, adjustment disorder, hypertensive heart disease without heart failure (damage to heart due to chronic high blood pressure), repeated falls, cerebral infraction (long term effects of a stroke), and protein-calorie malnutrition (inadequate intake of both protein and calories). Review of Resident #7's quarterly MDS dated [DATE] revealed Resident #7 had a BIMS of 08 indicating moderate impairment. The MDS also did not have Resident #7's code status. Record review of Resident #7's care plan dated [DATE] revealed Resident #7 revealed that Resident #7 was a full code. Goal was Resident #7 would be provided with necessary resuscitative measures. Interventions were to advise MD, RP & family of any changes in condition per facility policy. Educate and discuss with resident/family about Full Code status versus OOHDNR code status on an annual basis or as needed. Review Advanced Directives with resident/family annually, upon change in condition andas needed. Record review of Resident #7's Advance Directive Order dated [DATE] revealed Resident #7 was a DNR. Record review of Resident #7's OOHDNR dated [DATE] had all the required signatures. Resident #17 Record review of Resident #17's admission sheet, dated [DATE], revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including cystitis without hematuria (inflammation of the bladder), somatization disorder (tendency to experience and express psychological distress as physical symptoms), fusion of the spine (surgical procedure that connect two or more parts in the spine), muscle weakness, congenital malformation of nervous system (birth defect that affects the structure and development of the brain and spinal cord), lack of coordination, anxiety disorder (feeling of uneasiness or worry) and hypertension (high blood pressure). Record review of Resident #17's admission MDS assessment, dated [DATE], revealed Resident #17 had a BIMS score of 13, indicating intact cognitive response; mood indicators were present including little interest or pleasure in doing things, feeling down, depressed, or hopeless. The MDS also had somatization disorder (tendency to experience and express psychological distress as physical symptoms), and anxiety disorder (feeling of uneasiness or worry) as active diagnoses. Record review of Resident #17's care plan, dated on [DATE] noted the resident used an anti-anxiety medication r/t anxiety. The goal was that Resident #17 would be free from discomfort or adverse reactions related to anti-anxiety therapy. The interventions were Administer anti-anxiety medications as ordered by physician. Monitor for side effects and effectiveness every shift. Monitor/document/report PRN any adverse reactions to anti-anxiety therapy: drowsiness, lack of energy, clumsiness, slow reflexes, slurred speech, confusion and disorientation, depression, dizziness, lightheadedness, impaired thinking and judgment, memory loss, forgetfulness, nausea, stomach upset, blurred or double Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 45 of 47 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 08/21/2025 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 0940 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some vision. Unexpected side effects: Mania, hostility, rage, aggressive or impulsive behavior, hallucination. Record review revealed that Resident #17 did not have a PASRR completed. Resident #31 Review of Resident #31's face sheet dated [DATE] revealed an [AGE] year-old male who was admitted on [DATE] with diagnoses including muscle weakness, neurocognitive disorder with Lewy bodies (type of progressive dementia that leads to a decline in thinking, reasoning, and independent function), vascular dementia (lack of blood that carries oxygen and nutrients to a part of the brain), anxiety (feeling of uneasiness or worry), hypertensive heart disease without heart failure (damage to heart due to chronic high blood pressure), hyperlipidemia (high cholesterol), fall and anemia (not enough healthy red blood cells). Review of Resident #31's quarterly MDS dated [DATE] revealed Resident #31 had a BIMS of 12 indicating moderate impairment. The MDS also did not have Resident #31's code status. Record review of Resident #31's care plan dated [DATE] revealed Resident #31 revealed that Resident #31 did not have a code status on his care plan. Record review of Resident #31's Advance Directive Order dated [DATE] revealed Resident #31 was a DNR. Record review of Resident #31's OOHDNR dated [DATE] had all the required signatures. During an interview with the SW on [DATE] at 2:38p.m., revealed that she had not been trained on care plans. She said that she did not know what the policy was for the care plans. She said that she did not know who was responsible for updating the advance directives. She said the code status is in the care plan. She also said that if a resident changed their code status she would wait until she got the completed DNR back before she would update the care plan. She said she had two weeks to update the care plan. She said if the code status were not updated a resident who was a DNR could possibly be given CPR. She said she did not know why Resident #7's code status was not updated. She also said she did not know why Resident #31's code status was not in the care plan. She also stated that she did not have anything to do with PASRR. During an interview with Resident #17 on [DATE] at 11:02 a.m., Resident #17 said that she was diagnosed with her mental disorders when she was [AGE] years old. She said that she is taking anxiety medication. She said that the only other service that she is getting for her mental illness is seeing the psychiatrist. During an interview with Marketing on [DATE] at 11:30pm revealed that she had not been completely trained on PASRR. She said that she was responsible for making sure that the resident had a PASRR when they entered the facility. She said the only training she got on PASRR was that the PASRR needed to be filled out. She said she could not answer the question of the process, or referrals. She also said she did not know when the PASRR should be done. She said all she knew was that the resident needed a PASRR when the resident admitted to the facility for skilled. She said she did not know that she needed a PASRR for long term care. She said she was confused on that part. She said she did not know what to do if a resident had a positive PASRR. She said that her job was to go out and educate the community about the facility's services. She said when a referral came in, she would just send an email with the resident's clinical records. She said she did not know what could happen to the residents if they did not have a PASRR. She said she did not know why the Resident #17 did not have the PASRR on admission. During an interview with the ADM on [DATE] at 11:40 a.m., revealed that she had been trained on PASRR. She said that the SW was responsible for doing PASRRs. She also said that the SW was responsible for ensuring all residents had a PASRR. She said she did not have a policy for PASRR. She said that the facility would get the PASRR for the resident from the hospital and if the resident were coming from the community the facility would have the family fill the PASRR out. She said all residents were to have a PASRR completed prior to admission into the facility. She said the facility would identify residents with possible MI or ID through the PASRR screening. She said the resident with a qualifying diagnosis should be referred to the PASRR person and a meeting set up with PASRR people. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 46 of 47 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 08/21/2025 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 0940 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete She said the facility did not have anyone who ensured staff competency in PASRR. She said if a resident did not have a PASRR the facility would not recognize if the resident were positive or not and the resident could be missing services. She said Resident #17 did not have a PASRR because Marketing did not get the PASRR on admission. During an interview with the ADM on [DATE] at 3:50p.m., revealed that she had been trained on care plans. She said the IDT team, MDS nurse, therapy and nursing were responsible for doing the care plan. She said all the resident's information, goals, focus for the resident and the resident's discharge plans were on the care plan. She said the care plan had to be completed in 7 days and was updated quarterly. She said the SW was responsible for updating the advance directives. She said the advance directives were to be updated immediately. She said if the care plan is not updated or did not have a resident's advance directive it could affect the outcome if something happened to the resident. She said that the SW knew that she was supposed to update the Advance directives. She said she did not know why Resident #7's advance directive was not updated. She also said she did not know why Resident #31's advance directive was not on the care plan. During an interview with the DON on [DATE] at 4:17p.m., revealed she had not been trained on care plans. She said she was knowledgeable from working in PCC and knew how to do the care plans. She said that the RN opened the care plan, the MDS followed up and the DON reviewed the care plan. She said the care plan had the resident's skin integrity, medication, if the resident refused medication, any chronic conditions, advance directives, and infections. She said she did not know how long the facility had to complete the care plan. She did say that the baseline care plan had to be updated within 48 hours. She said that the care plan was updated quarterly or as soon as a significate change happened. She said advance directives did go on the care plan. She said if a resident went from a full code to DNR the facility had to do a document and uploaded. She said then the code status needed to be changed in the care plan. She said if an advance directive was not correct on the care plan staff may do CPR on a resident who should not be getting CPR. She said she did not know why Resident #7's advance directive was not updated. She also said she did not know why Resident #31's advance directive was not on the care plan. Record review of Marketings employee training dated [DATE] revealed she did not have any documentation for PASRR training. Record review of SW employee training dated [DATE] revealed she did not have any documentation of training for PASRR or Care Plans. Staff Training Policy was requested from the ADM on [DATE] at 11:13am. The policy was not provided upon exit. Event ID: Facility ID: 675118 If continuation sheet Page 47 of 47