Health inspection·September 19, 2024

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to act upon the pharmacist's drug regimen review irregularity reports for two of (Residents #1 and #2) of seven residents reviewed for medication consents. 1. The facility failed to respond to the pharmacist's notification that Resident #1's Trazodone (an antidepressant and sedative medication used to treat depression and may also be used for other conditions) consent was missing and needed to be obtained and uploaded. The facility had an unsigned written consent from Resident #1's RP before administering Trazodone. 2. The facility failed to respond to the pharmacist's notification that Resident #2's Lorazepam (a medication used to treat anxiety) consent was missing and needed to be obtained and uploaded. The facility had an unsigned written consent from Resident #2's RP before administering Lorazepam. This failure could place residents at risk of not having their preferred RP represent them in medical and care decisions, their preferred RP being unaware of the care, treatment, and treatment alternatives they are being provided, and not having pharmacist's notifications and recommendations for their medications and treatments followed. Findings included: Resident #1 Review of Resident #1's admission record, dated 09/19/24, reflected a [AGE] year-old female who was admitted to the facility on [DATE], had a POA/RP , and with diagnoses including burns involving 20-29% of body surface with 0%-9% third degree burns, bipolar disorder current episode depressed mild or moderate severity unspecified, generalized anxiety disorder, and cognitive communication deficit. Review of Resident #1's quarterly MDS, dated [DATE], reflected a BIMS score of 3, indicating she had severe cognitive impairment. Section N (Medications) reflected Resident #1 was receiving an antipsychotic and antidepressant. Review of Resident #1's quarterly care plan, dated 08/19/24, reflected she had a mood problem related to bipolar disorder, anxiety, and history of alcohol abuse with an intervention to monitor, record, and/or report to MD as needed any signs or symptoms of depression, anxiety, or sad mood. Resident #1's care plan also reflected she used antipsychotic medications (Seroquel) related to bipolar disorder with an intervention to monitor/document/report as needed any adverse reactions of antipsychotic medications, such as insomnia. (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: 675956 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 675956 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Nursing and Rehabilitation Center of Duval 5301 W Duval Rd Austin, TX 78727 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)