Inspection·June 13, 2025

F 0580 which caused her to dump all of the time. He stated her brief was always full of diarrhea. He stated he was not aware she was on a laxative as she had never been on one in her life. Level of Harm - Actual harm Residents Affected - Some During a telephone interview on 06/13/25 at 11:55 AM, Resident #1's NP stated she was not notified of her increased diarrhea or that she was still being administered a laxative. She stated if she had been notified, she would have discontinued the laxative to ensure she did not experience weight loss or an electrolyte imbalance. During an interview on 06/13/25 at 12:48 PM, CNA A stated he remembered Resident #1 having huge amounts of diarrhea every day and it got progressively worse. He stated it was so much that it would come out of her brief and drip down her wheelchair to the floor. He stated the staff were constantly changing her brief. He stated he knew the nurse was aware. During an interview on 06/13/25 at 1:01 PM, MA B stated Bisacodyl was for constipation. She stated she knew Resident #1 was having diarrhea, but she administered it to her because it was on her MAR. She stated she told LVN C about her concern, but she did not remember what she said about it specifically. She stated she thought LVN C would have reached out to the NP. During an interview on 06/13/25 at 1:27 PM, LVN C stated she was aware of Resident #1's increased diarrhea and that she was on a laxative. She stated she was admitted with the order for the laxative and did not think to notify the NP when her diarrhea increased, and she believed it was okay for her to be on a laxative with diarrhea since she had C. diff. During an interview on 06/13/25 at 1:45 PM, the DON stated she would expect the nurses to notify the NP immediately if a resident was experiencing excessive diarrhea. She stated the NP should have also known she was still being administered a laxative. She stated the NP could have adjusted Resident #1's treatment/medication plans accordingly. She stated a negative outcome of not notifying the NP was she (NP) not being involved of all aspects of a resident's care and possibly developing dehydration and/or malnutrition. Review of the facility's Notification of Changes Policy, dated 10/24/22, reflected the following : The purpose of this policy is to ensure the facility promptly informs the resident, consults with the resident's physician when there is a change requiring notification. Definition: Need to alter treatment significantly means a need to stop a form of treatment because of adverse consequences. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676299 If continuation sheet Page 2 of 5 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 06/13/2025 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)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one (Resident #1) of three residents reviewed for quality of care. Residents Affected - Some The facility failed to discontinue Resident #1's laxative when she was diagnosed with C. diff (a bacterium that causes diarrhea and inflammation of the colon) twice in May of 2025 which caused increased diarrhea, dehydration, elevated troponin (a protein that indicates heart damage or injury), and a weight loss of 25 pounds (27.8% weight loss) from 04/30/25 - 06/11/25. This failure placed residents at risk of an increased quality of life, weight loss, pain, and hospitalization. Findings included: Review of Resident #1's undated face sheet reflected an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including multiple fractures of pelvis, dementia, urinary tract infections, and muscle wasting and atrophy (wasting away). Review of Resident #1's admission MDS assessment, dated 05/05/25, reflected a BIMS score of 3, indicating she was severely cognitively impaired. Section H (Bladder and Bowel) reflected she was always incontinent of bowel. Review of Resident #1's admission care plan, dated 05/05/25, reflected she had a potential for fluid deficit with an intervention of notifying the physician if she had persistent symptoms of diarrhea. Review of Resident #1's lab results, dated 05/11/25, reflected she was diagnosed with C. diff. Review of Resident #1's lab results, dated 05/28/25, reflected she was diagnosed with C. diff. Review of Resident #1's physician order, dated 05/06/25, reflected Bisacodyl oral tablet delayed release - 5 MG - Give 2 tablets by mouth one time a day for constipation. Review of Resident #1's May 20205 and June 2025 MARs, reflected she was administered Bisacodyl every day of the month. Review of Resident #1's weights reflected the following: 04/27/25 - 109.7 lbs (at hospital) 05/01/25 - 107.8 lbs 05/05/25 - 108.0 lbs 05/22/25 - 103.0 lbs (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676299 If continuation sheet Page 3 of 5 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 06/13/2025 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)

F 0684 06/06/25 - 100.4 lbs Level of Harm - Actual harm 06/11/25 - 84.7 lbs (at hospital) Residents Affected - Some Review of Resident #1's hospital records, dated 06/11/25, reflected an onset date of 06/11/25 for diagnoses of an AKI, dehydration, uremia, and a UTI. - Troponin levels were elevated at .94 ng/ML (reference range: <=0.04 ng/mL). Likely result of demand ischemia from volume depletion - Recent C Diff infection - Elevated Creatinine - 2.3 mg/dL (reference range: .59 - 1.04 mg/dL) Likely prerenal due to volume depletion. Resident #1 presented with profound hypotension that corrected after 1 L fluid bolus. - Acute Kidney Injury - Prerenal, secondary to dehydration. Improved with IV fluids. - BMI - 16.53 kg/m2 (reference range: 18.5 - 24.9) During a telephone interview on 06/13/25 at 9:04 AM, Resident #1's RP stated he was aware she had been diagnosed with C. diff twice while at the facility. He stated she had increased stomach issues which caused her to dump all of the time. He stated her brief was always full of diarrhea. He stated he took her home on [DATE] and later that day her blood pressure dropped so he took her to the ER where she was diagnosed with a UTI and dehydration. He stated Resident #1 lost a lot of weight and he was not sure if it was due to her not liking the facility's food or the increased diarrhea. He stated he did not know she was on a laxative or why they would continue administering it to her when she was having diarrhea. During an interview on 06/13/25 at 11:38 AM, the SC stated she conducted the weekly weights for the residents. She stated she gave the weights to the ADONs, she did not notify the NP of any weight loss herself. She stated if a resident lost eight pounds in a month, that would be a lot. She stated anything over three pounds in a month she would consider to be too much. During a telephone interview on 06/13/25 at 11:55 AM, Resident #1's NP D stated she was not notified of her increased diarrhea or that she was still being administered a laxative. She stated if she had been notified, she would have discontinued the laxative to ensure she did not experience weight loss or an electrolyte imbalance. She stated in the geriatric population, she would consider losing 8-10 pounds in a month to be a lot and would expect to be notified by the facility within a month. She stated if a resident lost over 20 pounds in a month, her first thought would be, we need to re-weight them. She stated that would be a very significant weight loss but knew that scales were not always accurate. She stated a negative outcome of losing that amount of weight so quickly could cause dehydration, a decline in health, or organ failure. She stated Resident #1 had diarrhea and lot of fluid loss coupled with poor nutrition so she could understand if she had lost weight. She stated losing that kind of weight that fast even from diarrhea could cause troponin levels to elevate. During an interview on 06/13/25 at 12:48 PM, CNA A stated he remembered Resident #1 having huge amounts of diarrhea every day and it got progressively worse. He stated it was so much that it would come out of her brief and drip down her wheelchair to the floor. He stated the staff were constantly changing her brief. He stated he knew the nurse was aware. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676299 If continuation sheet Page 4 of 5 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 06/13/2025 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)

F 0684 Level of Harm - Actual harm During an interview on 06/13/25 at 1:01 PM, MA B stated Bisacodyl was for constipation. She stated she knew Resident #1 was having diarrhea, but she administered it to her because it was on her MAR. She stated she told LVN C about her concern, but she did not remember what she said about it specifically. She stated she thought LVN C would have reached out to the NP. Residents Affected - Some During a telephone interview on 06/13/25 at 1:08 PM, NP E stated she was covering for NP D while she was on vacation. She stated if a resident had C. diff/diarrhea for a month, she stated that could definitely cause a 20-plus pound weight loss. She stated she would want to check for dehydration their electrolyte level. She stated losing that much weight in such a short timeframe could cause troponin levels to be elevated because it was an inflammatory response. During an interview on 06/13/25 at 1:27 PM, LVN C stated she was aware of Resident #1's increased diarrhea and that she was on a laxative. She stated she was admitted with the order for the laxative and did not think to notify the NP when her diarrhea increased, and she believed it was okay for her to be on a laxative with diarrhea since she had C. diff and that was normal. She stated she was not aware Resident #1 was losing weight. She stated if a resident lost between 3-5 pounds in a week, she would notify the NP. During an interview on 06/13/25 at 1:45 PM, the DON stated she would expect the nurses to notify the NP immediately if a resident was experiencing excessive diarrhea or weight loss. She stated the NP should have also known she was still being administered a laxative. She stated the NP could have adjusted Resident #1's treatment/medication plans accordingly. She stated a negative outcome of not notifying the NP was she not being involved of all aspects of a resident's care and possibly developing dehydration and/or malnutrition. She stated if she would have known Resident #1 was on a laxative while she had C. diff, she would contacted the NP to get it discontinued as it could cause more diarrhea which could put a resident a risk of dehydration or weight loss. She stated she was not aware of her weight loss but could see her weight fluctuating due to the diarrhea she had been experiencing. During a telephone interview on 06/17/25 at 9:15 AM, Resident #1's PCP stated the laxative may have contributed but it was not the cause of all of her ER diagnoses. He stated it had not been a negligence situation on the facility's part. He stated she had a history of IBS with diarrhea and constipation and was on a long-term laxative to manage those symptoms. He stated the laxative should have been stopped, but it was not the cause of what was already going on with her. Review of the facility's Notification of Changes Policy, dated 10/24/22, reflected the following: The purpose of this policy is to ensure the facility promptly informs the resident, consults with the resident's physician when there is a change requiring notification. Definition: Need to alter treatment significantly means a need to stop a form of treatment because of adverse consequences. Review of the facility's undated Weight Monitoring Policy reflected the facility will ensure that all residents maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676299 If continuation sheet Page 5 of 5