Inspection·June 17, 2022

F 0582 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a second interview on 06/17/2022 at 1:36 PM, Case Manger #3 confirmed she was responsible for providing Resident #174 with a NOMNC. She stated she was not aware that the resident had been discharged from therapy and was now privately paying but confirmed the information while viewing the information in the facility health record. She confirmed that she had not given Resident #174 a NOMNC. 2. A review of Resident #13's admission Record revealed the facility admitted the resident on 03/21/2022 with diagnoses of acute and chronic respiratory failure, pulmonary edema, congestive heart failure, lymphedema, and sepsis. The resident was discharged on 05/18/2022 and the last Medicare Part-A-covered day was 05/17/2022. Review of the SNF [Skilled Nursing Facility] Beneficiary Protection Notification Review form, completed by the facility for Resident #13, revealed the resident's last covered day of Medicare Part A service was 05/17/2022. The form indicated no NOMNC was provided. The explanation as to why the NOMNC was not provided indicated, Other. Explain: Overlooked. During an interview on 06/17/2022 at 12:21 PM, Social Worker #4 revealed she was the only social worker in the building and performed case-management duties as well. She indicated she served as the point of contact for residents and/or representatives, assisted with setting up home health services and durable medical equipment (DME), and updated residents and/or representatives on her progress. She reported the facility started discharge planning as soon as the facility admitted a resident. She stated the planning began with the completion of the social assessment upon admission. She confirmed that she and Case Manger #3 were responsible for providing residents with a NOMNC once therapy determined a resident had reached the maximum benefit of therapy. Social Worker #4 confirmed there was no NOMNC issued for Resident #13 and did not know how it was missed. 3. A review of Resident #175's admission Record revealed the facility admitted the resident to the facility on [DATE] with diagnoses of atherosclerotic heart disease, essential hypertension, major depressive disorder, dysphagia (difficulty swallowing), hyperlipidemia, dementia, and presence of a cardiac pacemaker. The resident was discharged on 03/16/2022 and the last Medicare Part-A-covered day was 03/15/2022. Review of the SNF Beneficiary Protection Notification Review form, completed by the facility for Resident #175, revealed the resident's last covered day of Medicare Part A service was 03/15/2022. The form indicated no NOMNC was provided. The explanation as to why the NOMNC was not provided indicated, Other. Explain: Overlooked. During an interview on 06/17/2022 at 12:21 PM, Social Worker #4 revealed she was the only social worker in the building and performed case-management duties as well. She indicated she served as the point of contact for residents and/or representatives, assisted with setting up home health services and durable medical equipment (DME), and updated residents and/or representatives on her progress. She reported the facility started discharge planning as soon as the facility admitted a resident. She stated the planning began with the completion of the social assessment upon admission. She confirmed that she and Case Manger #3 were responsible for providing residents with a NOMNC once therapy determined a resident had reached the maximum benefit of therapy. Social Worker #4 confirmed there was no NOMNC issued for Resident #175 and did not know how it was missed. During an interview on 06/17/2022 at 2:27 PM, the Executive Director stated the case managers were responsible for meeting with residents and/or representatives on admission, noting the case manager's responsibilities included reviewing the plan for the stay, discharge goals, setting up home health (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 2 of 8 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 676487 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717 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 0582 Level of Harm - Minimal harm or potential for actual harm and DME, and serving as the point of contact for residents and representatives. The Executive Director stated the case managers were both new, noting Social Worker #4 came from a long-term care background and was still learning the system, and Case Manger #3 was transferred from the business office. The Executive Director expressed disappointment that three NOMNCs were not provided to residents and noted staff would receive additional training. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 3 of 8 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 676487 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, interviews, and facility policy review, it was determined the facility failed to ensure all medications were stored in locked compartments to ensure safety. On three occasions, medication carts were unlocked and unattended by staff. This had the potential to affect all residents residing in the facility by allowing medications to be removed from the cart and used unsafely. Findings included: A review of facility policy titled, Storage of Medications, dated 02/08/2021, revealed the following: Medications and biologicals are stored properly, following manufacturer's or provider pharmacy recommendations, to maintain their integrity and to support safe effective drug administration. The medication supply shall only be accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. The policy further noted, In order to limit access to prescription medications, only licensed nurses, pharmacy staff, and those lawfully authorized to administer medications (such as medication aides) are allowed access to medication carts. Medication rooms, cabinets, and medication supplies should remain locked when not in use or attended by persons with authorized access. An observation on 06/14/2022 at 11:00 AM revealed the medication cart stored in the 200 Hallway on the second floor was unlocked. The nurse was at the nurses' station, approximately 500 feet away. During an interview on 06/14/2022 at 11:02 AM, Licensed Vocational Nurse (LVN) #2 confirmed the medication cart was left unlocked. LVN #2 stated they just discharged a resident and was distracted. LVN #2 then locked the medication cart. An observation on 06/15/2022 at 9:38 AM revealed the medication cart stored in the 200 Hallway on the second floor was unlocked. The nurse was in a room assisting a resident, and the nurse did not have visual contact with the medication cart. The medication cart was on the same side of the hallway as the room the nurse was assisting in, and the door was shut to the resident's room. During an interview on 06/15/2022 at 9:38 AM, Registered Nurse (RN) #1 confirmed the medication cart was unlocked. RN #1 stated they had gone to a resident's room to provide assistance and forgot to lock the cart. An observation on 06/17/2022 at 10:32 AM revealed the medication cart stored outside of the Director of Nursing's (DON) office on the third floor was unlocked. There were multiple staff and visitors in the area at the time. During an interview on 06/17/2022 at 10:32 AM, the DON confirmed the medication cart was unlocked. The DON then locked the cart. During an interview on 06/17/2022 at 2:54 PM, the Executive Director stated the medication carts were to be locked and narcotics were to be maintained separately and locked as well. The Executive Director stated the unsecured medications could cause harm to residents who may take medications not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 4 of 8 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 676487 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717 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 0761 prescribed for them. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 5 of 8 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 676487 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and facility policy review, it was determined the facility failed to ensure food served to residents at the facility was prepared and stored under sanitary conditions. Specifically, the facility failed to ensure: 1. Food items stored in the refrigerator were labeled to indicate the open date and the use by date; 2. Dietary staff performed hand hygiene between tasks for two of five dietary staff; and 3. Temperatures of food items were obtained and logged as safe for serving before plating the meal for one of one meal service observation. Findings included: According to the facility policy titled, Food Storage Policy, last revised on 02/08/2021, The same day that food products are delivered to the facility, they are to be inspected for safety and quality. Each item is to be accurately dated upon receipt. When items are opened or in use, 'use-by-dates' are to be labeled upon them followed by storing the item in the proper area such as Refrigerator, Freezer, or Dry Storage area located in the kitchen. 1. During an initial tour of the kitchen with the Executive Chef on 06/14/2022 at 9:24 AM, 15 single-serve yogurts in a disposable lid cup were observed in a refrigerator. The tray containing the 15 yogurts had a label which recorded the preparation date of the yogurts as 06/08/2022. The use-by date portion of the label was not completed. The Executive Chef stated the facility adopted the idea of rechecking all food items in the refrigerator after 72 hours. He acknowledged there was no sign on the label indicative of any checks conducted after the 06/08/2022 preparation date. He acknowledged that 72 hours after 06/08/2022 was 06/11/2022. Further observation of the refrigerator revealed 11 cups of chopped fruit salads with preparation dates reported as 06/10/2022. The use-by date on the label was not completed. In addition, an opened bag of chopped potatoes was observed with no label to indicate when the chopped potatoes had been opened. There was also a bowl of stewed tomatoes with a preparation date of 06/09/2022. The bowl did not include a use-by date. Furthermore, there were seven pies in single-serve transparent packs without labels indicating when the pies were prepared or the use by date. During an interview with the Executive Chef on 06/17/2022 at 2:06 PM, he stated it was important to label every opened food item in the refrigerator in order to be able to monitor and ensure the food items were still safe to serve. The Executive Chef stated it was important for the facility to have a system for establishing how long opened food items were good for. According to the Executive Chef, the facility currently encouraged a first in, first out system. On 06/17/2022 at 3:10 PM, the Administrator stated he expected all food items in the refrigerator to be labeled to report their open date and how long they were good for. He stated it was important to record the information to let staff know how long the food items were good for. 2. According to The Centers for Disease Control and Prevention (CDC) Hand Hygiene Guidance, retrieved from www.cdc.gov/handhygiene/providers/ and retrieved on 06/21/2022, Multiple opportunities for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 6 of 8 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 676487 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some hand hygiene may occur during a single care episode. Following are the clinical indications for hand hygiene: Use an alcohol-based hand sanitizer immediately before touching a patient, before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices, before moving from work on a soiled body site to a clean body site on the same patient, after touching a patient or the patient's immediate environment, after contact with blood, body fluids or contaminated surfaces, and immediately after glove removal. Wash with soap and water when hands are visibly soiled, after caring for a person with known or suspected infectious diarrhea, and after known or suspected exposure to spores. During an initial tour of the facility's kitchen on 06/14/2022 at 9:14 AM, the surveyor observed Dietary Aide (DA) #10, DA #11, and the Executive Chef in the kitchen. The observation revealed the dietary staff were not wearing masks. The surveyor called to staff's attention the lack of mask use. While DA #10 could be observed performing hand hygiene after putting on her mask and before returning to the food preparation area, DA #11 applied her mask and, without performing hand hygiene, returned to her task of wrapping silverware in a napkin. The surveyor intervened and had DA #11 take out the silverware she had wrapped without performing hand hygiene. During a follow-up observation in the kitchen on 06/17/2022 at 11:25 AM, DA #12 was wearing his mask below his nose while on the serving line. He was responsible for placing packed snacks (potato chips and crackers) on the meal trays. DA #12 did not perform hand hygiene after adjusting his mask. During an interview with the Executive Chef on 06/17/2022 at 2:06 PM, he stated that dietary staff should have performed hand hygiene after they wore their masks and possibly touched their faces before they returned to their tasks. During an interview with the Administrator on 06/17/2022 at 3:10 PM, he stated he expected dietary staff to perform hand hygiene between tasks to ensure food was prepared under sanitary conditions. 3. According to the facility policy titled, Food Temperatures, revised on 02/08/2021, The temperature of all food items will be taken and properly recorded prior to service of each meal. The policy also indicated 2. All cold food items must be stored at a temperature of 41 [degrees] F [Fahrenheit] or below. 3. Temperatures should be taken periodically to assure hot foods stay above 135 [degrees] F and cold foods stay below 41 [degrees] F during the holding and plating process and until food leaves the service area. During a follow-up observation in the kitchen on 06/17/2022 at 11:33 AM, the facility's posted meal menu revealed the facility was to serve turkey, bacon, lettuce, and tomato sandwiches. Dietary Aide (DA) #10, who was also the cook, brought out already-prepared sandwiches from the facility's walk-in refrigerator. DA #10 did not obtain the temperature of the sandwiches after she brought them out of the refrigerator. At 11:43 AM, DA #10 plated the first sandwich. DA #10 still did not take the temperature of the meal before she plated the first meal. The surveyor asked about the temperature of the sandwiches, and staff obtained the temperature and recorded it as 60.3 degrees Fahrenheit. During an interview on 06/17/2022 at 11:45 AM, the Executive Chef stated the cook was supposed to have taken the temperature of the sandwiches immediately after she brought them out of the walk-in refrigerator. He stated the holding temperature was supposed to be at 40 degrees or below for the sandwiches to be considered safe to serve. He stated food temperature logs should be completed in real time. He ordered that the sandwiches be returned to the walk-in refrigerator. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 7 of 8 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 676487 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some At 12:18 PM, the sandwiches were brought back out from the refrigerator. At that time, the temperature was taken of the sandwiches and measured 34 degrees Fahrenheit. Further observation revealed the facility placed the ready-to-serve sandwiches on a flat aluminum tray and then placed the tray on the steam table. The steam table bowls were prefilled with ice. However, the flat tray containing the sandwiches was not submerged in the steam table bowl containing the ice to help keep the temperature of the sandwiches down. The first meal left the kitchen at 12:25 PM. Continued observation at 12:43 PM (mid-way into the meal service) revealed the Executive Chef took the temperature of the sandwiches again, which measured 51.3 degrees Fahrenheit. During an interview with the Executive Chef on 06/17/2022 at 2:06 PM, he stated the cold sandwiches served at lunch (on 06/17/2022) were prepared at 9:00 AM that day. He stated they were placed on a tray, wrapped with plastic, and placed in the walk-in refrigerator. He stated the process before meal service should include dietary staff obtaining and recording food temperatures. He stated for cold meals, the temperature should measure 40 degrees Fahrenheit or below. He stated the turkey and bacon had been cooked. He stated it was important to keep the bacon and turkey out of the danger zone. Per the Executive Chef, the danger zone was a temperature between 40- and 135- degrees Fahrenheit. He acknowledged the temperature log was not completed before the meals were plated. He stated his expectation was for staff to record the temperature of a meal when it went from the preparation phase to the holding phase. He stated the preparation phase to the holding phase was particularly important because it was the phase food items were more susceptible to be contaminated if they dropped temperature. He added it was the phase bacteria could go out of control. The Executive Chef stated he had completed in-services with dietary staff following the identified concerns. On 06/17/2022 at 3:10 PM, the Administrator stated he expected food temperatures to be kept within the safe range to ensure residents did not suffer from foodborne illnesses. He added that food temperatures should be taken after preparation and when placed on the steam table and recorded on the log in real time to ensure the food was at safe serving temperatures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 8 of 8