Health inspection·May 3, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 assured the accurate acquiring, receiving, dispensing and administering of all drugs and biologicals, to meet the needs of each resident for one of four residents (Resident #1) reviewed for pharmaceutical services. The facility failed to ensure Resident #1 received her Furosemide (given to help treat fluid retention) on 04/06/25 at 7:00 AM and 04/11/24 at 5:00 pm, Spironolactone (used to treat high blood pressure) on 04/06/25 at 7:00 AM and 05/11/25 at 5:00 PM, alprazolam (used to treat anxiety disorders) on 04/11/25 at 5:00 PM and 04/12/25 at 5:00 PM, Metronidazole (used to treat infections) on 04/11/25 at 5:00 PM, and Midodrine HCl (used to treat low blood pressure) on 04/11/25, 04/14/25, 04/19/25 and 04/20/25 at 5:00 PM. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications and supplements, which could result in worsening or exacerbation of medical conditions. Findings included: Record review of Resident #1's face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included spontaneous bacterial peritonitis (a bacterial infection of the ascitic fluid, the fluid that accumulates I the abdominal cavity, without a clear intra-abdominal cause), streptococcal infection (caused by bacteria in the Streptococcus [NAME]), and generalized anxiety disorder . Record review of Resident #1's, undated, care plan reflected a focus of resident was receiving antianxiety medications with intervention, administer anti-anxiety medications as ordered by physician. Record review of Resident #1's, undated, care plan reflected a focus of resident was receiving antianxiety medications with intervention, administer anti-anxiety medications as ordered by physician. Record review of the care plan reflected no care plan for refusal of medication or care. Record review of Resident #1's admission MDS dated [DATE] reflected a BIMS score of 15, indicating intact cognition. Record review of Resident #1's orders reflected Furosemide (given to help treat fluid retention Page 1 of 3 676440 676440 05/03/2025 Ignite Medical Resort Round Rock, LLC 16219 Ranch Road 620 North Austin, TX 78717

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some [edema]) and swelling that is caused by congestive heart failure, liver disease, kidney disease, or other medical conditions) Oral Tablet 40MG give one table by mouth two times a day for Lasix (for the treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome) order date 04/05/25 no D/C date. Record review of Resident #1's MAR for April 2025 reflected Furosemide oral Tablet 40MG give one table by mouth two times a day for Lasix was not administered on 04/06/25 at 7:00 AM and 04/11/24 at 5:00 PM. Record review of Resident #1's orders reflected Spironolactone (used in combination with other medicines to treat high blood pressure [hypertension] and heart failure) oral Tablet 100 MG give 1 tabled by mouth two times a day for potassium sparring (medications that increase urine output without causing a lot of potassium in the urine) order date 04/05/25 no D/C date. Record review of Resident #1's MAR for April 2025 reflected Spironolactone Oral Tablet 100 MG give 1 tabled by mouth two times a day for potassium sparring was not administered on 04/06/25 at 7:00 AM and 05/11/25 at 5:00 PM. Record review of Resident #1's orders reflected alprazolam (used to treat anxiety disorders and panic disorder) oral tabled 0.5 MG give 1 tablet by mouth three times a day for anxiety order date 04/05/25, D/C date 04/12/2025. Record review of Resident #1's MAR reflected alprazolam oral tablet 0.5 MG give 1 tablet by mouth three times was not administered on 04/11/25 at 5:00 PM. Record review of Resident #1's orders reflected Metronidazole (used to treat skin infections, rosacea, and mouth infections, including infected gums and dental abscesses) oral tabled 500 MG give 1 tabled by mouth three times a day for antibiotic for 7 days. Record review of Resident #1's MAR reflected Metronidazole oral tablet 500 MG give 1 tablet by mouth three times a day was not administered on 04/11/25 at 5:00 pm. Record review of Resident #1's orders reflected Midodrine HCI (used to treat low blood pressure [hypotension]) oral tablet 10 MG give 1 tablet by mouth three times a day for hypertension (a condition where the force of blood pushing against your artery walls is consistently too high) order date 04/05/25 no D/C date. Record review of Resident #1's MAR reflected Midodrine HCI oral tablet 10 MG Give 1 tablet by mouth three times a day for hypertension was not administered on 04/11/25, 04/14/25, 04/19/25 or 04/20/25 at 5:00 PM. Interview on 05/03/25 at 2:51 PM with RN A revealed it was the responsibility of the charge nurse to make sure residents got their medications, and it was the responsibility of the person who administered the medications to indicated in the resident EMAR the medication was given. She said the negative effects of not showing the medications were the resident could potentially get the wrong dose if it was not documented properly. The negative effect of residents not getting the medication would be they would not receive the effects of the medication they needed. She said if there was a reason the medication was not administered to the resident, the reason should be documented either in the MAR or the resident's progress notes. 676440 Page 2 of 3 676440 05/03/2025 Ignite Medical Resort Round Rock, LLC 16219 Ranch Road 620 North Austin, TX 78717

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 05/03/25 at 3:07 PM with LVN B revealed she administered Resident #1 her medications and she was aware Resident #1 suffered from anxiety. She said after she administered the resident's medications, she recorded it in the EMR. She revealed if the EMAR did not indicate the medication was administered in the EMAR, it could not be 100 percent confirmed the resident received the medication . She said if it was not documented, it was not administered. She said a negative effect of not giving a resident medication would depend on what medication was not given. She said if a resident was taking a scheduled blood pressure medication, and they did not receive their blood pressure medication, it could affect the resident's blood pressure. She said it was the facility's policy that when you were administering medication to a resident the administration of the medications were documented in the resident's EMAR. She said it was the responsibility of the person who administered the medication to make sure the resident got the medication. Interview on 05/03/25 at 4:18 PM with MT C revealed it was the responsibility of the medication aide or the person administering the medication to the resident to make sure the medication was administered. He said the negative effect if a medication was not administered was the resident could be sick. He said if residents did not receive their prescribed antibiotics, they would not get better. He said the negative effect if there was a blank on the EMAR indicated the medication was not administered and there was no proof the resident got the medication . Interview on 05/03/25 at 3:36 PM with CNO revealed it was the responsibility of the charge nurse to double check and confirm residents received their prescribed medications. He said if it was not documented the resident received the medication there was no way to confirm it was administered because the documentation was the primary source of confirmation. He said the possible negative effect if the resident did not receive the medication would depend on the type of medication that was not administered. If the medication was a pain medication that was no administered, the resident could be in pain but with routine medications, there would be minimal negative effects. He said it was the policy of the facility when medications were given, the administration of the medication was documented in the resident EMAR . Record review of the facility's Administration Medications, October 2024, reflected all medications are administered safely and appropriately to aid residents to help overcome illness, relieve, and prevent symptoms and help diagnosis. Hit 'prep' on the EMAR as the medication is prepared. Hit 'confirm on the EMAR once the medication is popped out. Remain with the resident to ensure that the resident swallows the medication. Once resident takes the medication, hit 'save' on the EMAR. If medication is not administered, record reason on the EMAR and notify physician or nurse practitioner. If the medication is given at a time different from the scheduled time, indicate the reason in the 'comment' section of the EMAR. 676440 Page 3 of 3