Inspection·August 1, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection and prevention control program that included, at a minimum, a system for preventing and controlling infections for 2 of 6 residents (Residents #1, and #2) reviewed for infection control, as indicated by: Residents Affected - Few The facility failed to ensure MA A cleaned and disinfected the wrist blood pressure monitor while using it on Residents in Hall 6 of the facility; on Resident #1 and Resident # 2. This failure could place the residents at risk of transmission of disease and infection. Findings included: Review of Resident #1's face sheet dated 08/01/24 reflected, Resident #1 was admitted to the facility on [DATE]. She was a [AGE] year-old female diagnosed with Type 2 Diabetes, Legal Blindness, Muscle weakness, Reduced Mobility, Hypertension, and Retention of Urine. Record review of Resident #1's MDS assessment dated [DATE], reflected her BIMS score was 03, indicating her cognition was severely impaired. Record review of Resident #1's care plan dated 07/05/24 revealed she had hypertension with the potential for abnormal blood pressures and the relevant intervention was monitoring the hypertension. Review of Resident # 1's MAR for August 2024, reflected: Amlodipine Besylate Oral Tablet 10 MG (Amlodipine Besylate): Give 10 mg by mouth one time a day related to Essential (primary) Hypertension. Notify NP of SBP >165. Review of Resident #2's face sheet, dated 08/01/24, reflected Resident #2 was admitted to the facility on [DATE]. She was an [AGE] year-old female diagnosed with Pain, COPD, Muscle Weakness, Dysphagia (Difficulty to swallow), Need for Assistance with Personal Care, and Cognitive Communication Deficit. Record review of Resident #2's quarterly MDS dated [DATE], reflected her BIMS was 03, indicating her cognition was severely impaired. Record review of Resident #2's care plan dated 06/20/24 revealed, she was potential for fluid volume deficit related to diuretic use and the relevant intervention was monitoring /documenting/reporting PRN any sign and symptoms of dehydration. (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 2 Event ID: 676327 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 676327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Springs Healthcare and Rehabilitation 1500 Cottonwood Creek Trail Cedar Park, TX 78613 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)