Health inspection·January 12, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident. The facility failed to provide a system of medication records that enabled periodic accurate reconciliation and accounting for all controlled medications for 2 (300 Hall and 400 Hall) of 2 medication carts that were reviewed for pharmacy services. The facility failed to remove narcotic medications from medication carts once the order was discontinued. This failure could place the residents at risk for not receiving the therapeutic effects from controlled narcotics due to from controlled narcotics did not reconcile every shift. The findings included : During an observation and record review on [DATE] at 12:29 pm, an inspection of the medication cart for 300 Hall, revealed a form titled, Controlled Drugs-Count Record (Narcotic count sheet at each change of nursing shift), was missing signatures for [DATE]. On the aforementioned sheet, there was no signature present for the off-going night shift staff, nor the staff coming on for the morning shift. Further review revealed a form titled Shift Change Controlled Substance Inventory Log which revealed no signatures were present for [DATE]. The form was blank for the off-going night shift staff, and the staff coming on for the morning shift. Further review of the binder revealed that no signatures were present on the narcotic sheets for residents who had scheduled narcotics that should have been administered already on [DATE]. Resident #1 had a sheet that reflected she should get 3 hydrocodone per day, one every 8 hours, and none were documented on the sheet as administered [DATE] . Resident #2 had a sheet that reflected she should get pregabalin at 8 am and it was not signed as administered on [DATE]. In addition, she should have been given tramadol according to the sheet and it was not signed as administered either. Further review revealed that Resident #3 had a sheet for hydrocodone reflected to take 1 tab every 4 hours as needed for pain for 10 days and was written [DATE]. The sheet was still in the binder . On the same medication cart was the binder labeled 400 Hall and review of that binder revealed a form titled, Controlled Drugs-Count Record (Narcotic count sheet at each change of nursing shift), was missing signatures for [DATE]. There was no signature present for the off-going night shift staff, nor the staff coming on for the morning shift. Further review revealed a form titled Shift Change Controlled Substance Inventory Log and no signatures were present for [DATE]. The form was blank for the off-going night shift staff, and the staff coming on for the (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: 675862 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 675862 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Park Bend 2122 Park Bend Dr Austin, TX 78758 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)