Inspection·April 29, 2025

F 0755 Review of Resident #1's MAR Audit, dated 04/22/25, reflected her Buspirone was scheduled for 8:00 AM but not was administered until 12:55 PM by the ADON. Level of Harm - Actual harm Residents Affected - Few Review of Resident #1's physician order, dated 04/17/25, reflected Keppra Oral Tablet - 250 MG - Give one tablet by mouth one time a day for anticonvulsants. Review of Resident #1's MAR Audit, dated 04/22/25, reflected her Keppra was scheduled for 8:00 AM but not was administered until 12:55 PM by the ADON. During an interview on 04/29/25 at 9:29 AM, Resident #1 stated medications were administered late very often. She stated she had not received her morning medications yet. She stated it was frustrating because not getting her medications on time, especially her Cerebral Palsy medications, truly affected her. She stated one day a week prior, morning medications were not administered until 1:00 PM. She stated she could not function or get out of bed. She stated she was in so much pain, was extremely anxious, and her legs would not stop jerking uncontrollably which was very uncomfortable. She stated she felt like she was going to have a panic attack just waiting for her medications. During a telephone interview on 04/29/25 at 1:04 PM, NP A stated some medications were not as time sensitive as others. She stated usually missing a dose by an hour or two would not be that big of a deal. She stated regarding Resident #1 and her diagnoses and the medications she was on, not getting her medications until five hours after they were scheduled could definitely cause her a lot of pain, anxiety, and for her legs to have increased jerking/spasming. She stated anxiety was one of her main issues and she hoped being administered medications that late was a rare occasion. During a telephone interview on 04/29/25 at 1:38 PM, NP B stated usually scheduled medications were to be administered within an hour before or an hour after the scheduled time. If a resident did not receive their medication until after a five-hour timeframe from the scheduled time she would expect for them to be in increased pain, primarily. During an interview on 04/29/25 at 2:15 PM, the ADON stated he did not normally pass medications. He stated he was new to the facility and did pass medications on 04/22/25. He stated he probably was late with administering the medications because he was training with the DON. He stated he was not running on time due to him explaining all the medications to the residents. He stated medications should be administered punctually. He stated normally the orders have a window (timeframe), but Resident #1's medications did not. He stated it was more important that she received the medications than not get the medications. He stated not getting the medications all together would be a more serious situation. During an interview on 04/29/25 at 2:47 PM, the DON stated her expectations on medication administration was that they were administered effectively per the residents' MAR. She stated she wanted to make all the medication times liberalized so that the timeframe would be, for example, between 7:00 AM and 12:00 PM for morning medications. She stated on 04/22/25 it was the ADON's first day being trained all the medication cart. She stated he was trying to explain all of the medications to the residents, and she realized they ran late with the administration . She stated a negative outcome of receiving medications late could be increased pain or anxiety. She stated, however, Resident #1 was always experiencing pain and anxiety. Review of the facility's Medication Administration Policy, revised 11/13/18, reflected the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676373 If continuation sheet Page 2 of 3 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 676373 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor Bee Cave 14058 Bee Caves Parkway, Bldg B Bee Cave, TX 78738 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 0755 Medications are administered as prescribed in accordance with good nursing principles and practices and only by persons legally authorized to do so. Level of Harm - Actual harm . Residents Affected - Few Medications are administered within (60 minutes) of scheduled time . Unless otherwise specified by the prescriber, routine medications are administered according to the established medication administration schedule for the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676373 If continuation sheet Page 3 of 3