Health inspection·September 11, 2024

F 0558 pressure reliving/reducing device on bed (low air loss mattress). Level of Harm - Minimal harm or potential for actual harm Observation on 09/11/2024 at 9:29 AM revealed Resident #1 asleep in bed with call light under fall mat and not within reach. Residents Affected - Some Observation on 09/11/2024 at 11:37 AM revealed Resident #1 laying in bed with call light under fall mat. Further observation revealed Resident #1's air mattress appeared to be deflated. Observation revealed that the pump for the air mattress was not on. Review of Resident #2 face sheet revealed a [AGE] year-old woman admitted on [DATE] with diagnoses of unspecified dementia, contracture of right hand, muscle weakness and anxiety disorder. Review of Resident #2 quarterly MDS dated [DATE] revealed no BIMS score. MDS revealed that Resident #2 has impairment on one side for her upper and lower extremities. Review of Resident #2 care plan dated 01/24/2023 revealed resident has alteration in musculoskeletal status related to contractures to right wrist and right hand with intervention to be sure call light is within reach and respond promptly to all requests for assistance. Review of care plan dated 01/24/2023 revealed Resident #2 has communication problem with intervention to ensure/provide safe environment with call light in reach. Review of care plan dated 12/13/2022 revealed Resident #2 was a risk for falls and intervention included to be sure the call light is within reach. Observation 09/11/2024 at 9:29 AM revealed Resident #2 asleep in bed with call light cord wrapped around bed from on right side with call button laying on the floor and not within reach. Observation on 09/11/2024 at 11:37 AM revealed Resident #2 awake in bed and call light button remained on floor next to her bed out of reach. Review of Resident #3 face sheet revealed a [AGE] year-old male admitted on [DATE] with diagnoses of Parkinsonism, unspecified dementia, unspecified intellectual disabilities and muscle weakness. Review of Resident #3 quarterly MDS date 07/01/2024 revealed BIMS score of 0 which indicated severe cognitive impairment. Review of Resident #3 care plan dated 03/22/2023 revealed Resident #3 was at risk for calls with interventions to be sure the call light was within reach. Further review of care plan dated 03/22/2023 revealed Resident #3 had potential for pressure ulcer development related to impaired mobility with intervention that Resident #3 required pressure relieving device. Review of Resident #3's physician orders dated 03/21/2023 to 09/11/2024 which revealed no order for monitoring function and placement or low air loss mattress. Observation on 09/11/2024 at 9:41 AM revealed Resident #3 was lying in bed on air mattress and the overhead light cord laid on his chest. Further observation revealed Resident #3's soft touch call light cord was wrapped around the bed rail and the call light button hung down. During an interview on 09/11/2024 at 9:42 AM, Resident #3 stated that he was unable to reach his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676246 If continuation sheet Page 2 of 4 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 676246 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 6801 E Riverside Dr Austin, TX 78741 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)

F 0558 call light. Level of Harm - Minimal harm or potential for actual harm Review of Resident #4's face sheet revealed a [AGE] year-old male admitted on [DATE] with diagnoses of spastic quadriplegic cerebral palsy, spinal stenosis, stiff-man syndrome and muscle weakness. Residents Affected - Some Review of Resident #4's quarterly MDS dated [DATE] revealed a BIMS score of 15 which indicated he was cognitively intact. Review of Resident #4 physician orders dated 11/02/2022 to 09/11/2024 which revealed no order for monitoring function and placement or low air loss mattress. Observation of Resident #4 on 09/11/2024 at 9:40 AM revealed Resident laying in bed with air mattress. Settings observed on pump for air mattress revealed they were turned up to if Resident weighed 1000 lbs. During an interview on 09/11/2024 at 9:40 AM Resident #4 stated that his bed deflates every two hours. Observation on 09/11/2024 at 11:30 AM revealed Resident #4's air mattress was still inflated, but observed staff adjusted settings on pump of air mattress. During an interview and observation on 09/11/2024 at 11:54 AM, CNA A stated that Resident #1's bed (air mattress) was not working. CNA A was observed to pick the plug up off the ground and stated that the bed was not plugged in. CNA A plugged the air mattress. CNA A was observed exiting the room and did not check call light placement for Resident #1 or Resident #2 before exiting the room. CNA A stated that Resident #1 and Resident #2's call lights were not within in reach and stated that residents should have their call light within reach. He stated that when doing rounds or assisting residents, staff should check that air mattresses are plugged in and that call lights are within reach. During an interview on 09/11/2024 at 11:57 AM, LVN B stated that residents who had a fall risk should have their bed in lower position and call lights in place. LVN B stated that staff should have checked that the call light was in place and that the air mattress worked. She stated that it was a problem if the air mattress was unplugged. She stated that depending on the health and nutrition status of the resident it could cause a pressure injury. She stated that setting for the air mattress were usually in the order and there should be an order for the air mattress because it is specialized equipment, and it is apart of the plan of care. During an interview on 09/11/2024 at 12:13 PM, CNA C stated that when you assist a resident you check to see if they are okay, wet and safe. She stated that staff should make sure they have their call light where they can reach. CNA C stated that if they have an air mattress staff should make sure its on the right setting and ensure its plugged in. She stated that if it is unplugged you should tell a nurse. During an interview and observation on 09/11/2024 at 12:23 PM, LVN D stated it was trial and error to get the correct settings with air mattresses and that the setting depends on the resident's preferences. She stated that Resident #4 wants his air mattress at a certain setting and prefers it to be firm. She stated there should be an order for the air mattress and usually there are settings on it. She stated that Resident #3 and Resident #4 should have an order for their air mattresses. During the interview, LVN D was observed viewing orders for Resident #3 and Resident #4. LVN D stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676246 If continuation sheet Page 3 of 4 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 676246 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 6801 E Riverside Dr Austin, TX 78741 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)

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some she did not see an order for the air mattresses for Resident #3 or Resident #4. LVN D stated that the setting should match the weight of the residents and if it is too firm it could be uncomfortable, and the pressure could stay in one place. During an interview on 09/11/2024 at 12:24 PM, LVN E stated that staff should look to see that call lights are within reach and supposed to ensure air mattresses are plugged in and working. During an interview on 09/11/2024 at 1:14 PM, LVN F stated that she was also the wound care nurse. She stated that the nurses should have checked the settings of air mattresses daily and the setting depended on what the resident wanted. She stated that nurses should have checked to ensure that air mattresses were plugged in and on the correct setting. She stated that air mattresses should have had an order to ensure that the air mattress is inflated. She stated that this was usually on the MAR so that nurses could check off that they checked the settings. She stated that it was important to have an order for air mattresses to ensure there is a need for it or if the resident had wounds or unable to reposition themselves. LVN F stated that if there was not an order for the air mattress the nurse would not be able to tell if it was functioning. LVN F stated that the potential for harm is that the would be no way to know if the resident had an air mattress in their room to see that it was functioning, and it could be misplaced or harm the resident's skin. During an interview on 09/11/2024 at 2:06 PM, LVN G stated that normally there should have been an order for an air mattress. She stated that there is an order for the resident to have the mattress and an order to check the function. LVN G stated that staff are supposed to check call light placement for residents when they go in and assist. She stated that she has completed in-services with staff on placement and it should have been within reach of residents. She stated that if it is not within reach the resident would be unable to ask for assistance. During an interview on 09/11/2024 at 2:20 PM, the DON stated that she expected that staff ensure residents are met, they have needed items within reach, that the call light was in reach and that devices are functioning. She stated that residents should have an order for an air mattress to ensure function and placement each shift. During an interview on 09/11/2024 at 2:37 PM, the ADM stated that he expects that residents are being care for properly. ADM stated that he expected call lights to be within reach of residents and that specialized equipment and adaptive equipment be functioning. He stated that he did expect air mattresses to be plugged in and that the residents should have had an order to check the functioning of the mattress. The ADM stated that there was not a facility policy regarding air mattresses. Review of in-service dated 06/04/2024 was completed regarding call light placement and that call lights should be within reach for all residents. Review of facility in-service dated 07/11/2024 with subject on call lights stated call lights should be placed in reach at all times. Review of facility policy dated 05/2007 titled Policy/Procedure - Nursing Clinical with subject of Call Light/Bell revealed It is the policy of this facility to provide a resident a means of communication with nursing staff. Further review revealed to leave the resident comfortable and place the call light device within resident's reach before leaving the room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676246 If continuation sheet Page 4 of 4