Inspection·November 13, 2023

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to complete a discharge summary for three (Resident #1, Resident #2, and Resident #3) of five residents reviewed for transfer and discharge rights, in that: The facility failed to make arrangements for safe and orderly discharge through care planning completing a discharge summary for Resident #1, Resident #2, and Resident #3. This failure placed residents at risk of not receiving care and services to meet their needs upon discharge. Findings Included: Review of Resident #1's undated face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including congestive heart failure, hypertension (high blood pressure), type II diabetes, muscle wasting and atrophy (wasting away), dysphagia (difficulty with swallowing), and anxiety disorder. She was discharged from the facility on 11/01/23. Review of Resident #1's admission MDS assessment, dated 09/03/23, reflected a BIMS of 14, indicating no cognitive impairment. Review of Resident #1's admission care plan, dated 09/03/23, reflected she wished to return/be discharged to her private home with care takers with an intervention of establishing a pre-discharge plan with the resident, family/caregivers and evaluate progress and revise plan as needed. Review of Resident #1's Discharge summary, dated [DATE], reflected it had not been completed. There was documentation regarding her final summary of her status or her post discharge plan of care. Review of Resident #2's undated face sheet reflected an [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including personal history of traumatic brain injury, lower back pain, and pulmonary fibrosis (lung disease). He was discharged from the facility on 11/05/23. Review of Resident #2's census report in his EMR , on 11/13/23, reflected he had multiple respite (short) stays at the facility: 12/19/22 - 12/24/22, 05/17/23 - 05/21/23, 09/19/23 - 09/25/23, and 10/30/23 - 11/05/23. Review of Resident #2's admission MDS assessment, dated 10/30/23, reflected a BIMS had not been (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: 676095 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 676095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West Oaks Nursing and Rehabilitation Center 3200 W. Slaughter Lane Austin, TX 78748 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)