Health inspection·June 5, 2024

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (03:45 p.m.) created by LVN A stating, Note Text: Alert and it was reported to write that resident had thrown a cup of cold water on another resident. Resident admitted that she did throw a cup of water on the other resident (Resident #2) because she always talking sexual talk to her (Resident #1) and she (Resident #1) does not like it. Review of Resident #2's progress note, revealed a nursing note dated 05/27/2024 at 15:45 15:45 (03:45 p.m.) stating, Note Text: Alert and another resident (Resident #1) threw a small blue cup of cold water on this resident (Resident #2) because this resident was talking to the other resident. further note revealed, No c/o (complains of) pain/discomfort noted. No apparent injuries noted. Record review of the Facility's incident and accident report, dated 05/30/204, revealed Resident to Resident incident that listed Resident #1 and Resident #2 both dated and timed 05/27/2024 at 03:45 p.m. Interview on 05/31/2024 at 10:10 a.m., when asked if she was afraid of any staff or any residents, Resident #1 stated, no I'm (I am) not scared, I grew up tough, no one will mess with me. When asked if she could recall the events on 05/27/2024 with Resident #2. Resident #1 stated, no, no I don't (do not) really remember. Interview on 05/31/2024 at 11:17 a.m., LVN A confirmed she documented both Resident #1 and Resident #2's progress notes of the events on 05/27/2024 at 15:45 15:45 (03:45 p.m.). LVN A stated Resident #1 threw the cup at Resident #2, LVN A stated she completed an incident report, and she reported the incident to ADM. LVN A stated she was aware of reporting all ANE (Abuse, Neglect, and Exploitation) allegations and incidents to the ADM, LVN A stated that, if we don't (do not) report ANE, it places residents at risk. Interview on 05/31/2024 at 11:29 a.m., DON stated she was aware of Resident #1 throwing a cup of water to Resident #2, although she was not aware of the nature, cause, or reason. DON stated, I did not know she (Resident #2) did anything in an aggressive way, it was not reported to me in that nature, I did not know the reason had been anything sexual at all. DON stated it was not reported to her as an incident that involved abuse. DON stated it was not involved in the current self-reported incident that involved Resident #1 and another resident that occurred that same day. Interview on 05/31/2024 at 11:48 a.m., ADM stated LVN A never mentioned the incident involving Resident #1 and Resident #2 to him, ADM added, I was not aware the incident was rooted in a sexual comment, and this is the first time I had heard of it. ADM stated he does not recall having discussed this in the stand up meeting the following day. ADM stated, this should have been discussed with me (ADM), and that if the incident was brought to my (ADM) attention, I would have initiated an investigation and follow the investigation procedure for the facility's ANE policy. Interview on 05/31/2024 at 12:53 p.m., Psych stated she had services with Resident #1 related to another self-reported incident on 05/27/2024, Resident #1 had not display any signs of fear, or signs of verbal or sexual abuse. Psych stated that her diagnoses and conditions do involve episodes of paranoia, Psych stated that Resident #1 had not recall any incident that involved Resident #2. Psych did reiterate that Resident #1 did have generalize paranoia that could associated with her (Resident #1's) Dementia. Psych stated based on her assessment Resident #1 did not have any negative affects from that day based on her psychological assessment. Record review of the Facility's Resident to Resident incident, no date, revealed an incident that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676267 If continuation sheet Page 2 of 3 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 676267 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd 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)

F 0610 involved Resident #1, reported by LVN A, on 05/27/2024 at 15:45 (03:45 p.m.): Level of Harm - Minimal harm or potential for actual harm Nursing description: Reported that resident had thrown a small cup of cold water on another resident. Residents Affected - Few Resident Description: Resident stated that she did throw the water on the other resident because the other resident is always talking sexual talk to her. Immediate action taken: Assessment done. Family called. Resident on 1-1 intervention, no injuries noted, and staff intervened to prevent altercation. Other resident assisted away from area staff without injuries. Record review of the Facility Abuse: Prevention of and Prohibition Against Policy, revision/review date 10/2022, revealed a policy that each resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation. Further review of the Facility's policy revealed: Section F. Investigation, 1. All identified events are reported to the Administrator immediately. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676267 If continuation sheet Page 3 of 3