Health inspection·May 26, 2024

F 0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Level of Harm - Actual harm Residents Affected - Some **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not provide pharmaceutical services to meet the needs of each resident for one (Resident #1) of four residents reviewed for pharmaceutical services, in that: The facility failed to ensure Resident #1 was administered her prescribed Clonazepam (for anxiety), Duloxetine (for depression), Zyprexa (for agitation), and Melatonin (for insomnia) for four days after admission on [DATE]. This caused her symptoms of confusion and agitation to exacerbate causing distress. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications and supplements or could result in worsening or exacerbation of chronic medical conditions. Findings included: Review of Resident #1's undated face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including agitation, anxiety disorder, depression, stroke, and cognitive communication deficit. Review of Resident #1's EMR, on 05/26/24, reflected her 5-day MDS assessment had not been completed. Review of Resident #1's BIMS, dated 05/23/24, reflected a BIMS of 11, indicating a moderate cognitive impairment. Review of Resident #1's admission care plan, dated 05/22/24, reflected it had nothing related to her diagnoses or behaviors. Review of Resident #1's hospital records, dated 05/18/24, reflected the following: Called by RN as [Resident #1] was throwing food, water, meds . security called . Zyprexa 2.5 mg IV ordered . AMS/Agitation . Zyprexa BID, E sitter ordered . Review of Resident #1's hospital records, dated 05/19/24, reflected the following: [Resident #1] with waxing/waning MS . change Zyprexa to 2.5 mg PO Q6 hours PRN . has E sitter (cannot go to SNF with E sitter) . Disposition - to SNF once MS improved . (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 3 Event ID: 676299 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 676299 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southpark Meadows Nursing and Rehabilitation Cente 9801 S 1st Street 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)