Inspection·September 17, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one (Resident #1) of three residents reviewed for quality of care. Residents Affected - Few The facility failed to check Resident #1's glucose level or A1C for five months after he was admitted to the facility with a diagnosis of type II diabetes and was recently discontinued from Metformin and Trulicity (medications utilized to manage high blood glucose levels with individuals with type II diabetes) at the hospital. These failures could place residents at risk of not receiving necessary medical care, harm, and hospitalization. Findings included: Review of Resident #1's undated face sheet reflected a [AGE] year-old male who was admitted to the facility on [DATE] and discharged on 08/25/24 with diagnoses including type II diabetes, stroke, hypertension (high blood pressure), and vascular dementia (a type of dementia caused by brain damage from impaired blood flow to the brain). Review of Resident #1's quarterly MDS assessment, dated 06/28/24, reflected a BIMS of 7, indicating a severe cognitive impairment. Section I (Active Diagnoses) reflected he had a diagnosis of diabetes. Review of Resident #1's quarterly care plan, dated 08/29/24, reflected he had Diabetes Mellitus with an intervention of fasting serum blood sugars as ordered by the doctor. Review of Resident #1's hospital discharge paperwork, dated from 02/29/24 - 03/23/24, reflected to stop taking the following medications: Metformin - 1 tablet twice a day by mouth, dulaglutide (Trulicity pen) - 0.75 Milligrams every week. Takes on Fridays. Last dose on 02/23/24. During his stay his BS readings were ranging 84 - 123. A1C: 5.4 (normal is below 5.7). Review of Resident #1's BS readings in his EMR, on 09/17/24, reflected his glucose level was never checked for the duration of his stay at the facility. Review of Resident #1's physician order, dated 04/08/24 and ordered by the MD, reflected the following: (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 2 Event ID: 676245 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 676245 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pflugerville Nursing and Rehabilitation Center 104 Rex Kerwin Court Pflugerville, TX 78660 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)