Inspection·May 5, 2023

F 0727 Level of Harm - Minimal harm or potential for actual harm Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to designate an RN to serve as DON on a full-time basis in that: Residents Affected - Few The facility had no full time DON from 04/14/23 through present [05/05/23]. This failure could place all residents at risk for not receiving necessary care and services. Findings included: An interview on 05/05/23 at 11:45 AM with the ADON revealed she was an LVN. She stated there was no DON at the facility since 04/14/23. The ADON stated RCRN typically came to the facility at least once a week and accomplished DON related tasks. She said RCRN was also available for consultation over the phone anytime. The ADON said currently in the absence of a DON at the facility she consults RCRN when any nursing management issues occurred. Interview on 05/05/23 at 12:10PM with the RCRN who was present at the facility during the investigation revealed the facility had not employed a DON since 04/14/23. She stated they had been trying to hire someone for the DON position but had not been successful at this time. RCRN said since there was no full time DON at the facility, she was covering the facility as much as possible. She stated as she had three other facilities to supervise, she was unable to be on site all the time however made a point to visit this facility at least once a week. RCRN said the days when she was not onsite, she was available over the phone anytime of the day. During an interview on 05/05/23 at 12:45PM the Administrator (ADM) stated the facility did not employ a DON since the last DON left the facility's employment on 04/14/23. She said the facility hired another candidate on 04/03/23 however did last only till 04/12/23 and the facility was trying to recruit a DON ever since. The ADM stated few interviews were scheduled starting from 05/05/2023. When the investigator asked how the facility was managing without a DON, the ADM stated there are two or more experienced full time RNs who work as charge nurses and were capable of addressing most of the nursing management decision making. She said the facility already had RCRN as back up at any point of time, also could get the help of MDS nurse if necessary. When the investigator asked if the absence of a full time DON posed any risk to the residents, the ADM stated she did not feel that way as RNs or RCRN were available to the staff all the time, on site or on call for accomplishing the duties of the DON until a new full time DON was recruited. During an interview on 05/05/23 at 1:45pm RN A stated she was working at the facility for more than three years and this was the first time there was no DON at the facility. When the investigator (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 3 Event ID: 675914 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 675914 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gracy Woods II Living Center 12042 Bittern Hollow 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)