Health inspection·January 20, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to treat each resident with respect and dignity and care in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life for 1 of 24 residents (Resident #12) reviewed for dignity. CNA D referred to an adult brief as diaper in the presence of Resident #12. This failure placed resident at risk of embarrassment, dignity, and diminished quality of life. The findings included: Review of Resident #12's Face Sheet dated 01/20/23 reflected a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of HTN (high blood pressure), CKD, heart failure, difficulty in walking, cognitive communication deficit (difficulty in thinking and using language), need for assistance with personal care, muscle weakness and anxiety disorder. Review of Resident #12's MDS dated [DATE] reflected a BIMS score of 12, indicating moderate cognition impairment. MDS reflected Resident #12 has indwelling catheter and frequent bowel incontinent. Review of Resident #12's Care Plan dated 01/09/23 reflected Resident #12 had an indwelling catheter related to obstructive and reflux uropathy (condition in which the kidneys are damaged by the backward flow of the urine into the kidney) with intervention to provide catheter care per policy. Observation on 01/19/23 at 1:40PM revealed CNA D was providing Foley catheter care to Resident #12 along with CNA A for assistance. During care CNA D asked CNA A to get the pad and diaper while in the presence of Resident #12. CNA D communicated to Resident #12 with a statement I am going to put the cream on the front and then will close the diaper. Interview on 01/19/23 at 2:21PM, CNA D stated she did not realized she was referring to the brief as a diaper. CNA D stated the word should not been used because it could make the resident felt they were babies. CNA D stated she had received in-service once a month from the ADON, DON, ADM, and/or HR. Review of CNA D's personal file reflected she did not complete resident rights training since year 2021. Certification of completion for understanding resident rights was completed on 01/20/23. Interview on 01/20/23 at 1:47PM, the ADON stated staff should not referred brief as a diaper (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 675533 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 675533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Juniper Village at Spicewood Summit 4401 Spicewood Springs Rd Austin, TX 78759 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)