Health inspection·July 9, 2025

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 routine and emergency drugs and biologicals for 1 of 4 residents (Resident #1) reviewed for pharmacy services.1. The facility failed to ensure Resident #1's ciprofloxacin-dexamethasone (antibiotic ear drops) was acquired and administered according to physician's orders. These failures could place residents at risk for not receiving therapeutic dosages of their medications as ordered by the physician and a potential for decreased health status and decreased quality of life. Findings include:These failures could place residents at risk for not receiving therapeutic dosages of their medications as ordered by the physician and a potential for decreased health status and decreased quality of life. Findings include: Review of Resident #1 face sheet reflected a [AGE] year-old male admitted on [DATE] with diagnoses of impacted cerumen (earwax buildup), chronic atrial fibrillation (rapid or irregular heartbeat), anemia (condition where body does not have enough red blood cells to carry oxygen throughout the body), and abdominal aortic aneurysm (swelling in the main artery that carries blood from heart to abdomen).Review of physician orders for Resident #1 reflected ciprofloxacin-dexamethasone drops to be administered as four drops in left ear twice a day with a start date of 07/04/2025 through 07/09/2025. Review of prescription order for Resident #1 reflected order for ciprofloxacin-dexamethasone drops was received on 07/03/2025 to start on 07/04/2025 by LVN A. Review of Resident #1's baseline care plan dated 06/30/2025 reflected Resident #1 was alert/cognitively intact. Further review reflected resident was independent with transfers. Resident #1 required assistance of 1 staff with grooming and bathing. Review of the July 2025 MAR reflected Resident #1's ciprofloxacin-dexamethasone medication was not signed off/administered on 07/04/2025, 07/05/2025, 07/06/2025, 07/07/2025, 07/08/2025 and 07/09/2025. During an interview and observation on 07/09/2025 at 10:50 AM, Resident #1 stated his ear bled on 06/30/2025 and he was supposed to get medication for it on 07/04/2025 and on 07/05/2025 it was the weekend and someone told him he would have to wait for it until 07/07/2025. Resident #1 stated as of today (07/09/2025) he still has not received any medication for his ear. Resident #1 stated he had no pain or drainage continue, but he believed he should not have to wait this long for the medication. Resident #1 was observed with cotton in his year. There was no drainage or bleeding observed. Observation on 07/09/2025 at 1:58 PM, reflected there was no ciprofloxacin-dexamethasone ear drops available for Resident #1. During an interview on 07/09/2025 at 1:58 PM, MA B stated that Resident #1 does not have any ear drops available. She stated that the facility was not giving him any drops because he do not have the ear drops. MA B stated the ear drops have not come in. MA B stated that the ADON was supposed to put in any new orders. MA B stated she worked a few days and that she had not seen the ear drops for Resident #1. MA B stated she was supposed to tell the nurse if a medication was not available. MA stated she told the nurse last week, but Page 1 of 3 675918 675918 07/09/2025 Gracy Woods Nursing Center 12021 Metric Blvd Austin, TX 78758

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some she was unsure who the nurse was. During an interview on 07/09/2025 at 2:04 PM, LVN C stated that written or telephone orders may be on paper. LVN C stated that the nurse that received the order should have sent it to the pharmacy and the pharmacy delivered the medication. LVN C checked the medication cart and stated there was no ear drops available for Resident #1. LVN C reviewed Resident #1's ordered an confirmed there was an order for ciprofloxacin-dexamethasone. LVN C stated that she was not sure if medication was delivered on the holidays or weekends. LVN C stated that nurse managers was supposed to ensure that orders were put in. LVN C stated that if a medication was not available, first the nurse should have checked the e-kit and call pharmacy for an update and notify the on-coming nurse. LVN C stated that she was not made aware that the ear drops was not available today. LVN C stated that potential harm for not receiving antibiotic ear drops could be increased pain. LVN C stated that Resident #1 did not complain of pain today. During an interview on 07/09/2025 at 2:16 PM, the ADON stated that new orders taken by the nurse was handed off to nursing management to ensure they medications was put into the resident's chart. The ADON stated that the order was faxed to the pharmacy by the nurse. The ADON stated the next morning the new order would be reviewed. The ADON stated that 5:00 PM was the cut off and if medication order was not faxed by 5:00 PM the medication would not be delivered until the following day. Medications was also delivered on the weekends. The ADON stated that someone from nursing leadership was present on Saturday and Sunday as well. The ADON stated that if a medication had not been delivered the first option was to check the e-kit if the medication was available and if not, the prescriber should have been notified. The ADON was not aware of Resident #1's antibiotic ear drops not being available. During an interview on 07/09/2025 at 2:31 PM, the NP stated that she provided orders for Resident #1 to receive antibiotic ear drops. Resident #1 stated she spoke with the ADON yesterday and he communicated there was an issue with the contract and medication was supposed to come from a different pharmacy. The NP stated prior to 07/08/2025 no one from the facility notified her that the medication had not been delivered. The NP stated she saw Resident #1 on 07/03/2025 and that he complained of pain and drainage from his ear. The NP stated she saw drainage on Resident #1's pillow and decided to prescribe ear drops. The NP stated she expected that the facility would have reached out sooner. The NP stated she assumed Resident #1 had started the medication because no one from the facility called to say otherwise. The NP stated that Resident #1 had chronic ear infection because of fluid collection and Resident #1 reported to her that he had issues with this prior to his admission to the facility. The NP stated that this could have been the reason Resident #1 had hearing problems and it may have gotten better with the antibiotic ear drops. During an interview on 07/09/2025 at 2:37 PM, the DON stated that for Resident #1 the NP was supposed to put the new order into their system and it would be picked up from the hospital by facility staff. The DON stated that the ADON and nurse managers were supposed to follow up and ensure that the medications were delivered. The DON stated she expected that the nurse would have notified the DON that the medication had not been delivered. The DON stated that extensive in-servicing has been conducted and the nurse should have called the pharmacy to ask about the medication and called the provider to update them as well. The DON stated that the prescription can also be sent to a community pharmacy and facility staff could pick up the medication if needed. The DON stated that the MA should have notified the nurse immediately so that the nurse could take care of it immediately. The DON stated that if the medication were not delivered after a day, she expected to be notified immediately. The DON stated that she was not sure why the medication was ordered for Resident #1, but like any other medication ordered, Resident should have received it and the right thing to do was to make sure the medication was available. During a telephone interview on 07/09/2025 at 2:49 PM, LVN A 675918 Page 2 of 3 675918 07/09/2025 Gracy Woods Nursing Center 12021 Metric Blvd Austin, TX 78758

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated that she put in the order for the ear drops for Resident #1 that she received from the NP. LVN A stated that protocol for new medication orders was to fax it to the pharmacy and LVN A stated she faxed Resident #1's order for ear drops to the pharmacy on 07/03/2025. LVN A stated that the afternoon of 07/03/2025 she asked the medication aide if the ear drops had arrived for Resident #1, but did not recall if the ear drops had arrived. LVN A stated the protocol was to call the pharmacy if medication had not been delivered to verify and to notify the NP. LVN A stated potential risk for not receiving ear drops if there were an infection it may not go away. LVN A stated that the facility had two pharmacies and was unable to recall which the order was faxed to. During an interview on 07/09/2025 at 3:15 PM, LVN D stated that new orders were put into the resident's chart by the nurse and faxed to the pharmacy. LVN D stated that the initial dose can be pulled from the e-kit if needed, but the nurse should have called the pharmacy to ask why the medication had not been delivered. LVN D stated the nurse should have also notified the DON and NP. During an interview on 07/09/2025 at 4:53 PM, the ADM stated she was not aware of a specific timeframe on ordering medications from the pharmacy and when medications should have been delivered. The ADM stated if there were issues with medication should expected staff to reach out to the NP for instructions on if medications were not at the facility. Review of facility in-service dated 05/12/2025 reflected topic was reviewed with nurses on phone orders. Review of facility in-service dated 05/23/2025 reflected topic of reorder medication was reviewed with nurses. Review of facility in-service dated 06/11/2025 reflected topic of order receipt and entry was reviewed with nurses. Information included upon receipt of new order, place order in resident's chart, document new order on 24-hour report and verify any concerns or question with prescriber. Review of facility in-service dated 06/17/2025 reflected topic of telephone order receipt and entry by charge was reviewed with nurses. Review of facility policy titled Administering Medications with revision date of April 2019 reflected medications are administered in accordance with prescriber orders, including any required time frame. 675918 Page 3 of 3