Health inspection·February 6, 2026

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews the facility failed to ensure a comprehensive care plan was developed within 7 days after completion of the comprehensive assessment and reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments for 67 of 105 (1, 2, 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25, 26,27,28,29,30, 31, 32, 33, 34, 35, 36, 37, 38, 39,40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 ) residents reviewed for IDT meetings/ care plans in that:The facility failed to complete a quarterly assessment for Residents 1, 2, 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25, 26,27,28,29,30, 31, 32, 33, 34, 35, 36, 37, 38, 39,40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 very 3 months (08/01/2025 through 12/012025).This failure could lead to residents not receiving necessary, complete, or correct care due to lack of current information.Findings include:Record review of Residents 1, 2, 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25, 26,27,28,29,30, 31, 32, 33, 34, 35, 36, 37, 38, 39,40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 MDS dated [DATE] revealed that 67 residents have not had an updated quarterly care plan for longer than 3 months.During an interview with the DON on 02/06/2026 at 12:15 p.m., the DON stated that she expected the IDT to complete a new care plan for every newly admitted resident within 14 days of admission to the facility. The DON stated she expects staff to reassess each resident on a quarterly basis. The DON stated the Social Worker was responsible for coordinating the quarterly care plan meetings. She stated that the facility does not have a Social Worker at this time and Residents #'s 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26,27,28,29,30, 31, 32, 33, 34, 35, 36, 37, 38, 39,40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 quarterly care plans have not been updated Since 8/2025.During an interview with the MDS Case Manager on 02/06/2026 at 12:47 p.m., the Case Manager confirmed the IDT Team was expected to meet on a quarterly basis to initiate and complete quarterly Care Plans assessments for each resident. The MDS Case Manager stated it was the responsibility of the facility's Social Worker to coordinate the quarterly care plan meetings. She revealed the facility has not had a social worker for most of 2025 and that the facility has hired a new Social Worker and that position will be filled soon.During an interview with the ADM on 02/06/2026 at 3:25 p.m., the ADM stated he expects the IDT to follow the RAI manual regarding the frequency of the Care Plan meetings. He stated the care plan meetings should be held on a quarterly basis.Record review of the CMS RAI Version 3.0 Manual, 4.7 The RAI and Care Planning As required at 42CFR 483.21(b), the comprehensive care plan is an interdisciplinary communication tool. It must include measurable objectives and time frames and must describe the services that are to be furnished to attain or maintain the residents' Page 1 of 2 676245 676245 02/06/2026 Pflugerville Nursing and Rehabilitation Center 104 Rex Kerwin Court Pflugerville, TX 78660

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many highest practicable physical, mental, and psychosocial well-being. The care plan must be reviewed and revised periodically, and the services provided or arranged must be consistent with each resident's written plan of care.Record review of CMS Appendix PP Issued: 11-22-17, Implementation: 11-28-17 Reveals: Note: The quarterly MDS does not require the completion of Care Area Assessments. However, the resident's care plan must be reviewed and revised by the interdisciplinary team after each assessment as required at 483.21(b)(2)(iii). 676245 Page 2 of 2