Health inspection·September 1, 2023

F 0641 stated it is her expectation that assessments were reflected in the MDS appropriately. Level of Harm - Minimal harm or potential for actual harm Interview on 09/01/2023 at 3:57 PM, the ADM stated it was his expectation that the MDS for any resident is completed thoroughly and corrected based on the resident assessment tool. Residents Affected - Few Record review of the facility policy, Minimum Data Set (MDS) Policy for MDS Assessment Data Accuracy, undated, reflected, The purpose of the MDS policy is to ensure each resident receives and accurate assessment by qualified staff to address the needs of the resident who are familiar with his/her physical, mental and psychological well-being. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 2 of 10 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 09/01/2023 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 0759 Ensure medication error rates are not 5 percent or greater. 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 ensure their medication error rate was not 5 percent or greater and had a medication error rate of 30.77% percent with 26 medications administration opportunities observed with 8 errors for 2 of 5 residents (Residents #39 and #195) and 1 of 2 staff (RN A) reviewed for medication administration, in that: Residents Affected - Some 1. RN A administered the incorrect dosage of diltiazem to Resident #39. 2. RN A administered 4 medications to Resident #39 with no physician orders. 3. RN A crushed all of Resident #39's medications in the same bag, 2 medications were extended release (Do NOT Crush) and administered them to Resident #39. 4. RN A did not observe administration of 1 medication for Resident #195. 5. RN A allowed Resident #195 to self-administer a medication when the order did not allow for self-administration. These deficient practices could place residents at risk of not receiving therapeutic effects from their medications as intended by the prescribing physician order. The findings include: 1. Record review of Resident #39's faceshet, dated 8/31/23, revealed he was admitted on [DATE] with diagnoses which included acute kidney failure, syncope and collapse, and hypertensive emergency. Record review of Resident #39's admission MDS assessment, dated 7/31/23, revealed a BIMS score of 13 which indicated no cognitive impairment. Record review of Resident #39's orders, dated 08/31/23, revealed a physician order for, diltiazem HCl Oral Tablet 60 MG, give 1 tablet by mouth one time a day for HTN Hold for SBP <125, order date 08/30/23, start date 08/31/23, and no end date. An observation on 08/31/23 at 8:31 a.m. RN A dispensed (1) 120 mg tablet of diltiazem to Resident #39 and not the 60 mg prescribed. 2. Record review of Resident #39's orders, dated 08/31/23, revealed a physician order for Potassium Chloride ER Oral Tablet Extended Release 10 MEQ (Potassium Chloride) Give 1 tablet by mouth one time a day for Hypokalemia, with an order date of 07/27/23, a start date of 07/28/23, no end date, and an order status of DISCONTINUED. Record review of Resident #39's orders, dated 08/31/23, revealed a physician order for Lisinopril Oral Tablet 10 MG (Lisinopril) Give 1 tablet by mouth one time a day for Blood Pressure HOLD FOR SYSTOLIC BLOOD PRESSURE <110 OR HR <60, with an order date of 07/27/23, a start date of 07/28/23, no end date, and an order status of DISCONTINUED. Record review of Resident #39's orders, dated 08/31/23, revealed a physician order for Furosemide (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 3 of 10 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 09/01/2023 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Oral Tablet 20 MG (Furosemide) Give 1 tablet by mouth one time a day for Edema, with an order date of 07/27/23, a start date of 07/28/23, no end date, and an order status of DISCONTINUED. Record review of Resident #39's orders, dated 08/31/23, revealed a physician order for hydralazine HCl Oral Tablet 50 MG (Hydralazine HCl) Give 1 tablet by mouth every 8 hours for HTN Hold for B/P less than 110/70, with an order date of 08/24/23, a start date of 08/24/23, no end date, and an order status of DISCONTINUED. Record review of Resident #39's orders, dated 08/31/23, revealed a physician order for hydralazine HCl Oral Tablet 50 MG (Hydralazine HCl) Give 1 tablet by mouth three times a day for HTN Hold for B/P less than 120/70, with an order date of 08/25/23, a start date of 08/29/23, no end date, and an order status of DISCONTINUED. An observation on 08/31/23 at 8:31 a.m. RN A dispensed (1) 10 mEq ER tablet of potassium chloride (medication to treat and prevent low blood potassium), (1) 10 mg tablet of lisinopril (medication to treat high blood pressure), (1) 20 mg tablet of furosemide (This medication is known as a diuretic (like a water pill). It helps your body get rid of extra water by increasing the amount of urine you make. Getting rid of extra water decreases the strain on your heart and blood vessels, thereby lowering high blood pressure), and (1) 50 mg tablet of hydralazine (medication to treat high blood pressure) to Resident #39. 3. Record review of Resident #39's orders, dated 08/31/23, revealed a physician order for Pantoprazole Sodium Oral Tablet Delayed Release (designed to delay release of a drug in the body (as through the use of enteric coatings) usually until it passes through the stomach into the small intestine) 40 MG (Pantoprazole Sodium) Give 1 tablet by mouth two times a day for GERD (Gastroesophageal reflux disease), with an order date of 07/27/23, a start date of 07/27/23, no end date, and an order status of ACTIVE. Record review of Resident #39's orders, dated 08/31/23, revealed a physician order for Potassium Chloride ER Oral Tablet Extended Release (designed to slowly release a drug in the body over an extended period of time especially to reduce dosing frequency) 10 MEQ (Potassium Chloride) Give 1 tablet by mouth one time a day for Hypokalemia, with an order date of 07/27/23, a start date of 07/28/23, no end date, and an order status of DISCONTINUED. An observation on 08/31/23 at 8:31 a.m. RN A removed Tamsulosin capsule 0.4 mg, potassium chloride extended-release tablet 10 meq, midodrine tablet 5 mg, diltiazem tablet 120 mg, lisinopril tablet 10 mg, pantoprazole tablet 40 mg delayed release, furosemide tablet 20 mg, and hydralazine tablet from their packages. RN A then placed all the pills in the same bag and crushed them all together. RN A then took the crushed pills, mixed them with apple sauce, and administered them to Resident #39. 4. Record review of Resident #195, dated 8/31/23, revealed she was admitted to the facility on [DATE] with diagnoses which included hyperkalemia, displaced trimalleolar fracture of left lower leg, and unspecified asthma with acut exacerbation. Record review of Resident #195's orders, dated 08/31/23, revealed a physician order for, Polyethylene Glycol 3350 Powder (Polyethylene Glycol 3350 (Bulk)) Give 1 tsp by mouth one time a day for Constipation Mix with 4 oz of juice or water, order date 08/30/23, start date 08/31/23, and no end date. During an observation on 08/31/23 at 8:42 a.m. RN A mixed 1 cap (about 3.5 tsp) full of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 4 of 10 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 09/01/2023 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some polyethylene glycol powder with a cup of water. RN A entered Resident #195's room and placed the cup on the counter across the room from Resident #195's bed. RN A administered other medications to Resident #195 and left the room. This surveyor asked RN A if he was done administering medications to Resident #195 and RN A stated yes. This surveyor asked about the polyethylene glycol mixture and RN A stated he forgot. RN A reentered Resident #195's room and moved the cup onto the Resident's bedside table and left the room. 5. Record review of Resident #195's orders, dated 08/31/23, revealed a physician order for, Fluticasone Propionate Nasal Suspension 50 MCG/ACT (Fluticasone Propionate (Nasal)) 2 sprays in each nostril one time a day for Nasal congestion, order date 08/26/23, start date 08/27/23, and no end date. During an observation on 08/31/23 at 8:42 a.m. RN A handed Resident #195 a bottle of Fluticasone Propionate Nasal spray and Resident #195 self-administered 2 sprays into each nostril. During an interview on 08/31/23 at 11:54 a.m. RN A stated he looks at the electronic medication administration record to verify medications when administering medications to residents. RN A then looked at the MAR and the physician orders and stated he could not find all the orders. RN A stated the potassium chloride he administered to Resident #39 was not an active order and that he should not crush extended-release pill or administered it. RN A stated he was trying to rush because he was being observed and did not check the medication orders. RN A stated when he checked Resident #39's blood pressure, it was good, so he administered the medication. RN A stated they do not hold the lisinopril when the residents blood pressure is good. RN A stated the resident cannot swallow the pills. RN B stated he crushed all the pills together because the resident would complain if he had to swallow an extended-release pill whole or if RN B crushed 10 pills separately. RN B stated you should not crush extended-release pills because it changes the absorption. RN B stated he spoke with the prescribing nurse practitioner, and they had discontinued the furosemide and lisinopril or all the blood pressure medications because they wanted to monitor the Resident's blood pressure but because the blood pressure was excellent, he did not need to hold the medications. RN A stated he forgot to give Resident #195 her polyethylene glycol powder with a cup of water, but he went back in the room and observed her taking it. During an interview on 08/31/23 at 12:12 p.m. the DON stated staff is expected to verify any medications against the MAR or TAR, verify the identity of the patient, and they should be able to see the active medication orders. The DON stated staff is expected to remove any medication that have been discontinued and dispose of them. The DON stated she was not sure why Resident #39's medications had been discontinued and administering medication without an active physician's order could cause the resident to have adverse effects. During an observation on 08/31/23 at 1:52 p.m. a nurse took Resident 39's blood pressure. The blood pressure reading was 106/54. During an interview on 08/31/23 at 2:24 p.m. NP C stated they had discontinued Resident #39's blood pressure medications because he was having issues with hypotension. The NP stated she was notified discontinued medications were administered to Resident #39. The NP stated she instructed nursing staff to alert her if his systolic (top number) blood pressure dropped below 100. The NP stated since the resident had a history of a brain bleed she wanted the systolic blood pressure to stay under 140. During a follow up interview on 09/01/23 at 10:47 a.m. the DON stated Resident #39 had his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 5 of 10 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 09/01/2023 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 0759 Level of Harm - Minimal harm or potential for actual harm medications discontinued because he had been hypotensive (low blood pressure). The DON stated symptoms of hypotension could be dizziness, flush feeling, pale, and tachycardia (fast heart rate). The DON stated if a resident could self-administer medications, they put the order in and do a self-medication evaluation. The DON stated Resident #195 could not self-administer the nasal spray. The DON stated staff can leave medication at the bedside only If there is an order stating they can leave it at the bedside. Residents Affected - Some Record review of the facility's policy titled Medication Administration, dated 02/02/21, stated policy : it is the policy of the facility that medications are to be administered as prescribed by the attending physician. Procedures: 1. only licensed medical and nursing personnel or other lawfully authorized staff members may prepare, administer, and record medications. 2. Medications must be administered in accordance with the written orders of the attending physician. 3. All current drugs and dosage schedules must be recorded on the patient's medical administration record (MAT and TAR) .6. The staff administering the medication must record the administration on the patient's MAR/TAR. 7. Should a drug be withheld, refused, or given other than at a scheduled time it should be appropriately documented as such on the MAR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 6 of 10 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 09/01/2023 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of infections for 1 of 3 staff (LVN B) reviewed for infection control, in that: Residents Affected - Few LVN B did not sanitize her hands prior to setting up wound care supplies for Resident #19. These deficient practices could place residents who receive wound care or catheter care at-risk for infections. The findings included: During an observation on 08/31/23 at 09:22 a.m., LVN B prepared wound care supplies for Resident #19's pressure ulcers. LVN B washed her hands in the resident's bathroom. LVN B touched the resident's door upon returning to her nurse cart to get more supplies. LVN B reached in her pocket and grabbed out her keys to open the cart. LVN B then grabbed gauze from the cart with her bare hands and put the gauze into cups. LVN B then sprayed the gauze in the cups with wound cleaner. LVN B then returned to the resident's room, washed her hands, and used the gauze to clean Resident #19's pressure wound on his buttocks area. During an interview on 08/31/23 at 9:38 a.m. LVN B stated she returned to her cart for more supplies after dropping some. LVN B stated she wipes her keys down every day but did not wipe down her keys or cart before grabbing more gauze. LVN B stated she should have sanitized her hands before she touched the gauze because of infection control. She stated she could have contaminated the gauze with bacteria from the door, cart, or keys and infected the resident's pressure wounds. During an interview on 09/01/23 at 10:34 a.m., the DON stated LVN B should have sanitized her hands before grabbing the gauze. The DON stated she could not say if the gauze was contaminated with anything because she doesn't know what the gauze could have been contaminated with. The DON stated staff is expected to sanitize their hands when they are visibly soiled, as needed, and between patient care. Record review of the facility's policy titled Infection Prevention, Control, & Immunizations, dated 02/08/21, Policy: the staff, employees, consultants, contractors, volunteers, and others who provide services and care to the patient's on behalf of the patients. Guidelines: .2. Staff will use standard precautions (hand hygiene and appropriate PPE equipment) 3. staff will follow appropriate hand hygiene practice 4. alcohol based hand rub is readily accessible and appropriate locations .6. Staff will wash hands and perform hand hygiene even when gloves are used in the following situation: before and after patient contact, after contact with blood, bodily fluids, or visibly contaminated or other objects or surfaces in patients environment, after performing procedures and removing PPE and catheter test (PICC line, CVC/dressing care) . Record review of the facility's policy titled Infection Prevention Wound Care Observation Checklist, dated 07/2019, stated Additional Evidence-Based Practice .2. proper hand hygiene is that which occurs at the right time, use of the right method, and uses correct technique and duration. Follow the CDC guideline for hand hygiene in health care settings available at https:www.cdc.gov/mmwr/PDF/rr/rr5116.pdf .3. Gloves should be changed and hand hygiene performed when moving from dirty to clean (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 7 of 10 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 09/01/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete wound care activities (e.g., after removal of soil dressings, before handling clean supplies). Debridement or irrigation should be performed in a way that minimizes cross contamination of surrounding surfaces from aerosolized irrigation solutions .6. Wound care supply cart should never enter the patient /residents immediate care area nor be accessed while wearing gloves or without performing hand hygiene first. These are important to preventing cross contamination of clean supplies and reiterates the importance of collecting all supplies prior to beginning the wound care. Event ID: Facility ID: 676487 If continuation sheet Page 8 of 10 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 09/01/2023 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 0944 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on interview and record review, the facility failed to include as part of its QAPI program, mandatory training that outlined and informed staff of the elements and goals of the facility's QAPI program, for 11 of the 11 staff members reviewed for mandatory training, in that: All eleven staff members reviewed for mandatory training had not received training regarding the facility's QAPI program. This failure could place residents at risk of receiving inadequate care from staff who are unfamiliar with the facility's QAPI program. The findings included: Record review of employee files reflected the following employees had not received training regarding the QAPI program: -ADM was hired on 05/09/2023 -DON hired on 02/17/2022 -RN E, hired on 10/27/2022 -LVN F, hired on 06/02/2022 -LVN G, hired on 06/17/2021 -DM, hired on 08/21/2023 -DOR, hired on 03/01/2022 -CNA H, hired on 02/09/2023 -CNA I, hired on 07/11/2023 -CNA J, hired on 01/30/2020 -CNA K, hired on 06/16/2022 Interview 08/31/2023 at 5:08 PM, the HRD stated she was not aware of staff being required to be trained in any manner related to QAPI and could not find training related to QAPI for any staff. The HRD stated corporate assigned training to the facility staff based on job code and staff completed training based on their corporate-assigned training plan. Interview on 09/01/2023 at 3:57 PM, the ADM stated he was the QA point-of-contact and was not aware any staff members, himself included, were required to be trained on QAPI and only receives training that is assigned to him from corporate. The ADM stated he believed the QA plan and associated processes related to QAPI were helpful to staff. The ADM stated he did not understand the risk associated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 9 of 10 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 09/01/2023 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 0944 with staff being untrained on QAPI. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 10 of 10