Inspection·December 11, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate administering of all drugs and biologicals) to meet the needs of each resident for one (Resident #1) of three residents reviewed for pharmaceutical services. The facility failed to administer Resident #1's Amlodipine and Metoprolol (blood pressure medications) for eight days after being admitted to the facility on [DATE]. This failure could affect residents by putting them at risk of exacerbation and/or deterioration of their health conditions. 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 atrial fibrillation (irregular/rapid heart rhythm), history of stroke and heart attack, and hypertension (high blood pressure). Review of Resident #1's admission MDS assessment, dated 11/13/24, reflected a BIMS was not completed. Section I (Active Diagnoses) reflected she had hypertension. Review of Resident #1's admission care plan, dated 11/11/24, reflected she had altered cardiovascular status r/t acute stroke, hyperlipidemia (high cholesterol), hypertension, and A-fib with an intervention of administering medications per MD orders. Review of Resident #1's hospital discharge paperwork, dated 11/11/24, reflected orders for the following medications: Amlodipine Besylate Oral Tablet - 2.5 MG - once a day; Metoprolol Succinate ER Oral Tablet - take 25 MG once a day. Review of Resident #1's physician order, with a start date of 11/12/24 and a D/C date of 11/12/24 reflected Amlodipine Besylate Oral Tablet - 2.5 MG - give one tablet by mouth one time a day for HTN and Metoprolol Succinate ER- 25 MG Tablet - Give 1 tablet by mouth at bedtime related to HTN. . Review of Resident #1's November 2024 MAR, reflected she was administered Amlodipine and Metoprolol (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 12/11/2024 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)