Health inspection·February 13, 2024

F 0657 Level of Harm - Potential for minimal harm Record review of Resident #2's medical diagnoses report, dated 02/12/24, reflected she had diagnoses including cellulitis of right lower limb, non-pressure chronic ulcer of other part of right foot with unspecified severity, unspecified rheumatoid arthritis (a chronic inflammatory disorder usually affecting small joints in the hands and feet), chronic pain syndrome, dependence on wheelchair, long term (current) use of opiate analgesic, long term (current) use of antibiotics, unspecified low back pain, and unspecified insomnia. Residents Affected - Some Record review of Resident #2's comprehensive MDS assessment, dated 12/22/23, reflected a BIMS score of 15, indicating she was cognitively intact. Resident #2 required supervision/touching assistance with eating, partial/moderate assistance with oral hygiene, substantial/maximal assistance with showering, personal hygiene, bed mobility and transfers, and dependent on toileting. Record review of Resident #2's clinical record reflected the comprehensive care plan was started on 12/22/23. There was no completion date, indicating the care plan was not completed. Record review of Resident #3's face sheet, dated 02/12/24, reflected a [AGE] year-old female who was admitted to the facility on [DATE] and was her own RP. Record review of Resident #3's medical diagnoses report, dated 02/12/24, reflected she had diagnoses including COVID-19, unspecified hypothyroidism (a condition in which the thyroid gland doesn't produce enough thyroid hormone), unspecified depression, morbid (severe) obesity due to excess calories, unspecified insomnia, weakness, unspecified edema (swelling caused by too much fluid trapped in the body's tissues), pain in left shoulder, pneumonia due to coronavirus disease, unspecified anxiety disorder, unsteadiness on feet, other lack of coordination, long term (current) use of anticoagulants, overactive bladder, and history of falling. Record review of Resident #3's comprehensive MDS assessment, dated 02/07/24, reflected a BIMS score of 15, indicating she was cognitively intact. Resident #3 required supervision/touching assistance with eating and oral hygiene, partial/moderate assistance with personal hygiene, substantial/maximal assistance with showering/bathing and bed mobility dependent on toileting and transfers. Record review of Resident #3's clinical record reflected the comprehensive care plan was started on 02/08/24. There was no completion date, indicating the care plan was not completed. Record review of Resident #4's face sheet, dated 02/13/24, reflected a [AGE] year-old male who was admitted to the facility on [DATE], discharged on 01/17/24, and was his own RP. Record review of Resident #4's medical diagnoses report, dated 02/12/24, reflected he had diagnoses including wedge compression fracture of T11-T12 vertebra subsequent encounter for fracture with wound healing, fall (on) (from) other stairs and steps subsequent encounter, other hypoglycemia, other postprocedural complications and disorders of digestive system, unspecified nausea with vomiting, type 2 diabetes mellitus without complications, unspecified asthma, generalized muscle weakness, essential (primary) hypertension, unspecified depression and anxiety disorder. Record review of Resident #4's comprehensive MDS assessment, dated 12/17/23, reflected no BIMS score was documented. Resident #4 was independent with bed mobility, required set-up/clean up assistance with eating and oral hygiene, supervision with personal hygiene, substantial/maximal assistance with showering, dependent on toileting, and did not attempt to demonstrate transfer functional status due to medical conditions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 2 of 4 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 02/13/2024 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 0657 Level of Harm - Potential for minimal harm Residents Affected - Some Record review of Resident #4's clinical record reflected the comprehensive care plan was started on 01/04/24. There was no completion date, indicating the care plan was not completed. During an interview on 02/12/24 at 11:35 a.m., the ADM revealed comprehensive care plans were completed and updated daily. The ADM also revealed the MDS nurse was responsible for preparing residents' comprehensive care plans. During an interview on 02/12/24 at 11:46 a.m., MDS Nurse A revealed she started working for the facility on either 01/28/24 or 01/30/24. MDS Nurse A also revealed residents' comprehensive care plans were completed by the MDS nurse. MDS Nurse A explained residents' comprehensive care plans were completed within 14-21 days after the MDS assessment was completed. MDS Nurse A revealed she knew the facility was behind with completing residents' comprehensive care plans and she was helping with catching them up. MDS Nurse A did not know why the facility fell behind. MDS Nurse A revealed she knew MDS Nurse B and her back-up, who were both part-time, were both sick for some time. MDS Nurse A did not know when and for how long MDS Nurse B and her back-up were sick or if there was a second back-up who worked on residents' comprehensive care plans. MDS Nurse A revealed she was able to reach out to MDS Nurse B if she needed additional assistance and training. MDS Nurse A also revealed departments (dietary, physical therapy, nursing, and social services) signed after they reviewed and revised their sections of the residents' comprehensive care plans. MDS Nurse A explained she followed-up with the assigned department personnel by email to ensure they finished reviewing their section of the residents' comprehensive care plans. MDS Nurse A did not know why department personnel were not assigned to review their sections of Residents #1, 2, 3, and 4's comprehensive care plans. MDS Nurse A revealed residents could not be at risk of any adverse outcomes if their comprehensive care plans were not completed in a timely manner. During an interview on 02/12/24 at 12:05 p.m., MDS Nurse B revealed she started working at the facility full-time at the end of August 2021 and became PRN status at the end of January 2024. MDS Nurse B also revealed residents' comprehensive care plans were completed by the MDS nurse. MDS Nurse B also revealed MDS Nurse A was responsible for ensuring residents' comprehensive care plans were completed within the required timeframes. MDS Nurse B explained residents' comprehensive care plans were completed within seven days after the MDS assessment was completed. MDS Nurse B did not know why Residents #1, 2, 3,and 4's comprehensive care plans were not completed with a completion date indicated. MDS Nurse B explained MDS Nurse A might have forgotten to indicate a completion date on Residents #1, 2, 3, and 4's comprehensive care plans. MDS Nurse B revealed departments who completed their review of their sections in residents' comprehensive care plan should be indicating with a date when their review was completed. MDS Nurse B also revealed residents might be at risk if their comprehensive care plans were not completed in a timely manner because of their condition. Record review of the undated MDS Coordinator's job description reflected the following, Purpose of job position: The primary purpose of this position is to conduct and coordinate the development and completion of the RAI, that is, the MDS, CAAs and care plan in accordance with state and federal requirements. The MDS Coordinator participates as part of the facility IDT in the systems and processes to manage patients receiving skilled services as assigned. Essential Functions: Coordinates the IDT in timely completion of the assessments. Completes care plan items and attends care plan meetings as assigned. Provides teaching and training for MDS item completion to IDT members that have responsibility for MDS item completion. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 3 of 4 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 02/13/2024 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 0657 Record review of the facility's care plan policy and procedure, revised 02/08/21, reflected the following, Level of Harm - Potential for minimal harm Policy: It is the policy of the facility to promote seamless interdisciplinary care for our residents by utilizing the interdisciplinary plan of care based on assessment, planning, treatment, service, and intervention. It is utilized to plan and manage resident care as evidenced by documentation from admission through discharge for each resident. The care plan will identify priority problems and needs to be addressed by the interdisciplinary team, and will reflect the patient's strengths, limitations, and goals. The interdisciplinary care plan will be developed through collaborative efforts of the IDT and other health care professionals. It is our purpose to ensure that each resident is provided with individualized, goal-directed care, which is reasonable, measurable, and based on resident needs. Residents Affected - Some Procedure: The Centers will develop, implement, and provide care in accordance with a comprehensive person-centered care plan for the resident consistent with regulatory requirements. The interdisciplinary team members will contribute towards the interventions and approaches needed to obtain the resident's desired and expected outcomes. The care plans will be modified when needed to meet the resident's current needs, problems, and goals. Any revision, additions, or deletion to the plan of care will be dated. All residents are discussed with the Interdisciplinary Team to provide continued updates, revisions, and discontinuation of interventions based on the resident's goals, care needs, and discharge planning. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676487 If continuation sheet Page 4 of 4