Inspection·November 5, 2025

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident [#1] with taking her scheduled medications. Resident [#1] remains unable to be consoled Resident [#1] spit it out and continued yelling. Resident [#1] denied her coke zero, offered to assist Resident [#1] to the restroom. Resident [#1] refused assistance. Resident [#1] started screaming again. notified NP of her lab results as well. NP stated that since resident is non-verbal and can't really tell you what's wrong or pinpoint any specifics to send her out to ER to be evaluated and treated. ADON, DON notified, family notified. DNR, Medication list, labs, and face sheet sent with resident with EMS. Review of Resident #1's hospital records dated 10/26/2025 reflected: Problem list - Vascular Dementia with behavioral/agitation. Continue home Depakote. Depakote level noted to be low. If noted to have worsening behavioral disturbance, can consider titrating the dose. Review of Resident #1's hospital records dated 10/27/2025 reflected: Continue home Depakote. Depakote level noted to be low- increasing Depakote to BID. Review of Resident #1's hospital discharged orders dated 10/28/2025 reflected an order for Divalproex Sodium (Depakote) Oral Tablet Delayed Release 250 MG (Divalproex Sodium) Give 1 tablet BID. It also reflected blue checks on the right side of the medication and black checks on the left side of the medication listed on the scanned document. Review of Resident #1's NP's note dated 10/28/2025 reflected Divalproex Sodium Oral Tablet Delayed Release 250 MG (Divalproex Sodium) Give 1 tablet by mouth one time a day for mood stabilizer DO NOT CRUSH active 10/09/2025. Review of Resident #1's current physician's order dated 11/05/2025 reflected an order for Divalproex Sodium Oral Tablet Delayed Release 250 MG (Divalproex Sodium) Give 1 tablet by mouth one time a day for mood stabilizer DO NOT CRUSH dated 10/08/2025. Review of Resident #1's current MAR for 11/2024 reflected an order for Divalproex Sodium Oral Tablet Delayed Release 250 MG (Divalproex Sodium) Give 1 tablet by mouth one time a day for mood stabilizer DO NOT CRUSH dated 10/08/2025. It was noted there was no documented evidence that Resident #1 was started on Divalproex Sodium Oral Tablet Delayed Release 250 MG (Divalproex Sodium) Give 1 tablet BID as was ordered in the hospital. Review of Resident #1's clinical records reflected no documentation of the hospital order for Divalproex Sodium (Depakote) Oral Tablet Delayed Release 250 MG (Divalproex Sodium) Give 1 tablet BID being discontinue and why. During an interview on 11/04/2025 at 12:33 pm RN B stated she worked with Resident #1 on 10/25/2025 and she was the one who sent Resident #1 to the ER. RN B stated Resident #1 had behavior problems like screaming but on 10/25/2025 they were unable to calm Resident #1 down. RN B stated Resident #1 refused all attempts to be redirected. RN B stated she noticed Resident #1 was in her wheelchair all day, usually she would attempt to walk but not that day and was on one-on-one monitoring. RN B stated Resident #1 spit out her pain medication and no intervention was effective. RN B stated she called the on-call NP and notified her and told her [NP] that she [RN B] could not figure out what was wrong with Resident #1. RN B stated the NP ordered Resident #1 to be sent to the ER since she was non-verbal, not at baseline and was not able to say what was happening. During a phone interview on 11/04/2025 at 1:04 pm the NP stated she had no idea Resident #1's Depakote 250 mg was increased to BID while in the hospital. The NP then stated maybe Resident #1 was seen by the Psych NP after her hospital stay that was why her Depakote BID from the hospital was decreased to once a day. The NP stated she [NP] was looking at Resident #1's progress notes and it was noted Resident #1 was still on Depakote 250 mg PO daily and was dated 10/09/2025. The NP stated sometimes she and the MD made changes to psych medications as needed. The NP stated due to the clinical effect of sedation, she would want to keep Resident #1 on Depakote once a day, but she could not find where she made changes to Resident #1's hospital order from BID to once a day. The NP stated she understood if there were no orders to discontinue the Depakote 250mg BID order and order to resume Depakote 250 mg once a day, that was a medication errorDuring an interview on 11/04/2025 at 1:27 pm the DON stated on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676271 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 676271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Onion Creek Nursing and Rehabilitation Center 1700 Onion Creek Pkwy 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 10/25/2025 she received a call from RN B that Resident #1's yelling had increased and was not able to walk, the on-call was notified, and Resident #1 was sent to the ER. The DON stated that when a resident was admitted or re-admitted , the admitting nurse was responsible for verifying the medications with the NP and transcribe to the resident's clinical records. The DON stated typically, there would be a check mark by the medication that the NP wanted the resident to continue taking and no check mark to the medication they wanted to discontinue. The DON stated she did not know Resident #1's Depakote 250 mg was increased to BID while in the hospital. The DON stated the ADON was responsible for auditing new admission and readmission medications after the medications had been transcribed to ensure the resident was taking the right medications as were ordered in the hospital. The DON stated if Resident #1's medication list indicated the medications were approved, checked, and not carried over, then that was medication error, except there was something else written beside the medication. The DON stated if the MD/NP decided to change Resident #1's Depakote 250 mg BID to once a day on a later date, it should have been documented. The DON reviewed Resident #1's hospital discharge orders and the check marks next to the medications and stated it should have been Depakote 250 mg BID.During an interview on 11/04/2025 at 1:55 pm the ADON stated the nurses were supposed to verify medication with the NP before transcribing to the resident's clinical records. The ADON stated she couldn't remember if she was in the facility when Resident #1 was re-admitted to the facility, but she was made aware by LVN A that the NP was present and reviewed Resident #1's hospital discharge orders. The ADON stated she remembered Resident #1's Depakote was changed to 250 mg BID. The ADON stated she verified /audited Resident #1's orders and she remembered seeing Resident #1's Depakote 250 mg BID. The ADON looked at the resident's orders in the computer and stated the BID orders were not there, only the once-a-day order and it showed the order from 10/09/2025 and not the order from readmission on [DATE]. The ADON stated it was a medication error, but there was no medication error report because she did not realize until being asked. During a phone interview on 11/04/2025 at 2:16 pm LVN A stated she was the nurse working when Resident #1 was re-admitted to the facility on [DATE]. LVN A stated they usually verified the medications for admission and re-admission with the NP before transcribing the orders in the resident's clinical records. LVN A stated she verified Resident #1's hospital discharge orders with the NP while the NP was in the facility on the day of re-admission. LVN A stated she could not remember Resident #1's exact discharge order for Depakote but if there was a check mark on the order sheet, that was what the NP verified and approved. LVN A stated every medication with the check mark meant to go ahead and give to the residents. LVN A stated sometimes the NP would make changes to medications upon admission and there would be a note indicating that. During another phone interview on 11/04/2025 at 2:45 pm the NP called back and stated the blue check mark on Resident #1's discharge orders from the hospital was done by her [NP]. The NP stated she approved Resident #1's order from the hospital for Depakote 250 mg BID and later intended to decrease to Depakote 250 mg daily but did not write the order. The NP stated she and the MD were discussing Resident #1 coming back to the facility on palliative care with hospice and was thinking about discontinuing some medications. The NP later sent a text message exchange between she and the MD dated 10/28/2025 at 6:05 pm indicating discontinuing some of Resident #1's medications once Resident #1 got on hospice services on 10/29/2025. It was also noted in the text message exchange that the MD stated to change Resident #1's medication to crushed to enable Resident #1 to be compliant with medication administration. Review of Resident #1's clinical records reflected no order to discontinue medications or to change Depakote 250 mg bid to once a day. Review of the facility's policy titled Medication Orders, undated reflected: POLICY: It is the policy of this facility that medications are administered only (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676271 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 676271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Onion Creek Nursing and Rehabilitation Center 1700 Onion Creek Pkwy 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete upon the clear, complete. and signed order of a person lawfully authorized to prescribe. Verbal orders are received only by licensed nurses or pharmacists and confirmed in writing by the prescriber within forty eight (48) hours.2. Documentation of the Medication Order.A. Each medication order is documented in the resident's medical record with the date, time, and signature of the person receiving the order. The order is recorded on the physician order sheet, or the telephone order sheet if it is a verbal order and the medication Administration Record (MAR). Call (or fax) the medication order to the provider pharmacy. Transcribe newly prescribed medications on the MAR or treatment record. When a new order changes the dosage of a previously prescribed medication, discontinue previous entry by writing DC'd and the date and yellowing through the entry. Enter the new order on the MAR. After completion, document each medication order noted on the physician's order form with the date, time, and signature. Review of the facility's policy titled Medication Errors and Adverse Reactions revised 12/2019 reflected: POLICY:It is the policy of this facility that medication errors and adverse drug reactions must be reportedto the resident's attending physician. Event ID: Facility ID: 676271 If continuation sheet Page 4 of 4