Health inspection·November 11, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few said she would find another pain medication for her. Record review of Resident #1's progress notes dated 11/07/2025 revealed Pt called EMS complained of vaginal discomfort. EMS arrived, evaluated pt, spoke with this nurse, and decided pts concern is not an emergency and can be addressed by NP on next business day. This offered pt prn Tramadol but pt refused med. This nurse spoke with NP for the Doctor who stated she will call in triplicate for pts oxycodone. Record review of Resident #1's progress notes dated 10/26/2025 revealed Pt has new complaint stating the oxycodone medication she takes is making her sweat profusely. This nurse points out to pt she is not sweating, and she was dry, but pt persist she is sweating, and it is a side effect of oxycodone.Record review of Resident #1's progress notes dated 10/27/2025 revealed Pt continues with somatic complaints. Pt stating, she has neuropathy, brain malfunctions, kidney malfunctions, vaginal burning, excessive sweating, allergy to Oxycodone, allergy to adult briefs. Pt states psych Dr does not know what he was talking about, NP does not know what she is talking about, and medical drs do not know what they are talking about. Record review of Resident #1's progress notes dated 11/08/2025 revealed Pt complained of vaginal discomfort. This nurse Offered pt her prn Tramadol and Ibuprofen. Pt very adamantly refused with son present stating those medicines make her brain hurt. Pt agreed to take Tylenol only. Record review of Resident #1's progress notes dated 11/09/2025 revealed NP returned call, stated she sent request for refill over this morning. Record review of Resident #1's progress notes dated 11/09/2025 revealed Pt called her husband and asked him to call 911 because she is stating she stating something is wrong with her voice and she cannot talk. 911 dispatch call here to receive report on pt. Pt states her voice is not working. Pt is talking loud and clear without any s/s distress atthis time. Pt asked for her Claritin allergy medicine and received medication. Resident #2 Resident #2 face sheet dated 11/11/2025 revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #2's diagnoses included hip fracture, absence of left leg above the knee and Bifascicular block (impairment of electrical signals in two main fascicles of the heart's conduction system). Record review of Resident #2's admission MDS dated [DATE] revealed that Resident #2 had a BIMS of 15 indicating cognitive response. The MDS revealed Resident #2 received scheduled pain medication and PRN medications. Record review of Resident #2's care plan dated 11/04/2025 revealed, Resident #2 had the potential for pain. Interventions were Monitor/record/report to Nurse resident complaints of pain or requests for pain treatment. Notify physician if interventions are unsuccessful or if current complaint is a significant change from residents past experience of pain. Observe and report changes in usual routine, sleep patterns, decrease in functional abilities, decrease ROM, withdrawal, or resistance to care. Observe/document for probable cause of each pain episode. Remove/limit causes where possible. Observe/document for side effects of pain medication. Observe for constipation; new onset or increased agitation, restlessness, confusion, hallucinations, dysphoria; nausea; vomiting; dizziness and falls. Observe/record/report to Nurse any signs and symptoms of non-verbal pain: Changes in breathing (noisy, deep/shallow, labored, fast/slow); Vocalizations (grunting, moans, yelling out, silence); Mood/behavior (changes, more irritable, restless, aggressive, squirmy, constant motion); Eyes (wide open/narrow slits/shut, glazed, tearing, no focus); Face (sad, crying, worried, scared, clenched teeth, grimacing) Body (tense, rigid, rocking, curled up, thrashing).Record review of Resident #2's physician orders dated 10/27/2025 revealed Oxycodone HCl Oral Tablet 10 MG give 1 tablet by mouth every 4 hours as needed for Pain.Record review of Resident #2's MAR revealed that he got his Oxycodone at 6:00am and his pain level was documented as a 2 on a scale of 1 to 10. During an interview with Resident #2 on 11/11/2025 at 12:25p.m., revealed he asked staff for his pain medication he said he got the medication at the time he asked for it. He said staff told him that his oxycodone would be in by 1:00pm. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 2 of 5 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 11/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brush Country Nursing and Rehabilitation 6500 Brush Country Rd Austin, TX 78749 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete said that he did not know the facility was out of his pain medication. He said that his pain level was at a 4 and the pain was tolerable right now. During an interview with LVN A on 11/11/2025 at 11:14a.m., revealed, Resident #1 had been out of her Percocet for a few days. He said that Resident #2 was also out of his pain medication oxycodone. He said he called Resident #2's medication in this morning. He said Resident #2 had been out for less than 24 hours. He said he did not think there was a policy for ordering medication. He also said he would normally order medication three or four days in advance before the medication ran out. During an interview with the NP on 11/11/2025 at 1:29p.m. revealed she believed Resident #1 had been out of her Percocet since the weekend. She said the doctor sent the triplicate to the pharmacy on Sunday. She said the pharmacy said they did not get the triplicate. She said the doctor sent another triplicate today. She said she verified the pharmacy got the triplicate. She said that the medication was ordered for Stat. She said she expected the medication any time now. She said it was hard to tell with Resident #1 on how it would affect her not getting her Percocet because she usually had the same symptoms with or without the medication. She said the facility did have Resident #2's pain medication in the emergency cart.During an interview with the NP on 11/11/2025 at 2:00p.m., revealed that she had just met with Resident #1. She said Resident #1 now did not want the Percocet, she said she offered Tylenol, increasing her valium and Resident #1 did not want any of those options. She said Resident #1 wanted the Percocet as a PRN. She said she was working on finding another medication Resident #1 might take. During an interview with the ADM on 11/11/2025 at 2:15p.m., revealed the facility did not have a policy for ordering medications. During an interview with the ADM on 11/11/2025 at 3:48p.m., revealed, ordering medication should be ordered timely and if the medication was not received the nurse must follow up. She also said if there was an issue the nurse was to notify nurse management immediately. She said if a resident ran out of pain medication the resident could be in severe pain. she said nurse management was responsible for monitoring to ensure medication was ordered timely. She said she was not sure how nurse management monitored because she had only worked at the facility for two days. She said she knew about Resident #1 being out of medication but did not know about Resident #2 until this morning. Event ID: Facility ID: 675118 If continuation sheet Page 3 of 5 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 11/11/2025 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 observation, interview, and record review, the facility failed make sure that drugs are stored properly and only authorized persons have access for 1 of 3 medication carts (MC #1) and the facility's only medication refrigerator reviewed for drug storage.The facility failed to ensure MC #1, was locked, medications secured, and not accessible to other staff, residents, or visitors. The facility failed to ensure the medication refrigerator was at the correct temperature for medications stored in the refrigerator. These failures could place residents at risk of having unauthorized access to medications, decreased effectiveness of medication, or missing medications. Findings included: 1.During an observation on 11/11/2025 at 1:26p.m., revealed medication refrigerator, had glycerin suppositories, Trulicity, Lantus, NovoLog, and Repatha. The temperature in the refrigerator was 52 F. During an interview with LVN A on 11/11/2025 at 1:57p.m., revealed she had been trained on medication storage. She said the policy for medication stored in the medication refrigerator was that staff were to check to daily to ensure the refrigerator was at the correct temperature. She said the night shift was responsible for checking the temperature on the medication refrigerator. She said if medication was not stored at the correct temperature the medication may not be efficient. She said she did not know who monitored to ensure the medication refrigerator was at the correct temperature. She said she did not know why the medication refrigerator was not at the correct temperature. During an interview with ADON on 11/11/2025 at 2:00p.m., revealed she had been trained on medication storage. She said the policy for the medication refrigerator was the temperature was to be checked daily on the night shift. She said the nurses who worked the night shift were responsible for checking the temperature on the MR. She said medication not stored at the correct temperature could cause unwanted side effects. She said she talked with maintenance and was told the facility recently got a new medication refrigerator. She also said 52 F was not acceptable temperature for the medication refrigerator and the facility was working on getting new medications to replace the ones that were not at the correct temperature in the medication refrigerator. During an interview with the DON on 11/11/2025 at 3:03p.m., the policy for storing medication in the medication refrigerator was the temperature was to be checked daily. She said the temperature range the medication refrigerator was supposed to be at was 36 F to 46 F. She said if the medication refrigerator was not within the correct temperature staff were to notify nursing management. She said the new company had not established who was to monitor the medication refrigerator. She said if the medication was not held at the correct temperature the medication would not be affective. She said the facility used the manufacturer's recommendations on the storage of the medication. She did not know why the medication refrigerator was not at the correct temperature. Record review of How to Use Your Lantus Solostar Pen: Lantus Storage not dated revealed Before opening store Lantus in the refrigerator (36 F to 46 F). Record review of Patient Information Repatha Injection not dated revealed Store REPATHA in the refrigerator between 36 F to 46 F.Record review of NovoLog Storage not dated revealed Store unused NovoLog pens and vials in refrigerator at 36 F to 46 F until expiration. 2.During an observation on 11/11/2025 at 3:24p.m., revealed MC #1, was on the 200-hall, was unattended and unlocked. MC #1 was near room [ROOM NUMBER]. There were no staff in sight of MC #1. MC #1 had residents' prescription medications, over the counter medications, and eye drops in MC #1. During an interview with MA B on 11/11/2025 at 3:27p.m., revealed she had been trained on medication storage. She said the policy for the MC was that the MC was to be locked any time staff were away from it. She said the nurses and medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675118 If continuation sheet Page 4 of 5 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 11/11/2025 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 FORM CMS-2567 (02/99) Previous Versions Obsolete aides were responsible for ensuring the MC were locked. She said the medication carts were to be always locked when not in use. She said if a MC was left unlocked and unattended a resident could get into the MC. She said all staff monitored to ensure staff were locking the MC. She said staff monitored by observations. She said she was going to see a resident, and she thought she had locked the MC. During an interview with the DON on 11/11/2025 at 4:08p.m., revealed she had been trained on medication storage. She said the policy for the MC was that it needed to be locked any time the nurses and medication aides stepped away from the cart. She also said if the cart is not within the nurses' eyesight it should be locked. She said if the medication was left unlocked and unattended a resident could get into the MC and ingest medication. She said leadership monitors to ensure staff are locking the medication carts. She said all managers monitored to ensure MC were locked. She said management monitored through observations. She said she did not know why the MC #1 was unlocked. During an interview with the ADM on 11/11/2025 at 3:48p.m., revealed she had been trained on medication storage. She said the policy for medication refrigerator was medications needed to be stored at the correct temperature. She said if the temperature was out of range staff were to notify nursing management immediately. She said the nurses on the night shift were responsible for ensuring the MR was at the correct temperature. She also said if medication was not at the correct temperature the medication may not be affective. She said the MC must be locked when the nurse or the medication aide walked away from the MC. She said if the MC was not locked someone could get into the MC and take medication that could harm them. She also said someone could take medication to sabotage an employee. She said nurse management monitored to ensure the MC were locked and the medication refrigerator was at the correct temperature. She said nurse management should monitor through observations for the MC being unlocked and checking the temperature log on the MR. Record review of Storage of Medication Policy dated 4/2019, revealed Drug and biologicals used in the facility are stored in locked compartments under proper temperature, light, and humidity controls. Compartments (including, but not 1imited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biologicals arc locked when not in use. Unlocked medication carts are not left unattended. Medications requiring refrigeration are stored in a refrigerator located in the drug room at the nurses' station or other secured location. Event ID: Facility ID: 675118 If continuation sheet Page 5 of 5