Health inspection·July 15, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to, in response to allegations of abuse, neglect, exploitation, or mistreatment, ensure that all alleged violations are reported to the state survey agency immediately but not later than 2 hours after the allegation is made if the events that cause the allegation involve abuse for one (1) of five (5) residents reviewed for abuse and neglect. (Resident #1).The facility failed to report an alleged abuse incident reported by Resident #1 on 06/19/2025 to the State Agency when Resident#1 alleged CNA B pushed her. This deficient practice placed all residents at risk of harm from abuse due to not having a thorough investigation done for an alleged abuseFindings Include: Record review of Resident #1's face sheet, dated 07/15/2025, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included hypertension (high blood pressure), fall on the same level from slipping, muscle weakness, unsteady to the feet, history of falling, traumatic subdural Hemorrhage (a type of traumatic brain injury (TBI) where blood collects under the dura mater, the outer membrane covering the brain, due to a head injury) without loss of consciousness subsequent encounter. Record review of Resident #1's Quarterly MDS dated [DATE] revealed Resident #1 had a BIMS score of 10 indicating moderate cognitive impairment. Review of Resident #1's care plan initiated 05/30/2025 reflected Resident #1 had actual/potential decline in her ability to perform her activities of daily living, bowel/bladder incontinence, and need for assistance with transfers/toileting related to impaired mobility secondary to weakness and debility (physical weakness, especially as a result of illness.Most of the cases presented with general debility, muscle weakness, and weight loss.)Review of CNA B's written statement dated 06/19/2025 reflected: June 19, 2025 3:47 am Patient in [xx] had call light on upon entering the room the patient was sitting in her wheelchair and asked if I could help her unlock her brakes. I asked her why she didn't call before she transferred to the chair. She stated that she's not a 2-year-old and should not have to ask for permission to go to the bathroom. I explained to her the safety issue of calling before she transferred to her chair. She then stated that you've been a bitch since day one and won't let me do anything on my own. I proceeded to help her with her brakes and take her to the restroom, she refused to let me help her toilet. I explained to her that her chair is not locked and it's not safe for her to do this alone. I locked her chair and let her toilet herself while I stood outside of the restroom. I noticed she was struggling to pull up her underwear so I asked her if I could help with that, she then yelled at me to get away from her she does not need my help. She then accused me of throwing her up against the wall. I then exited the room and alerted the nurse of what the patient was saying. [room #] Statement [CNA B].Review of LVN A's written statement dated 06/19/2025 reflected: To: Abuse Coordinator Re: Statement regarding patient allegation Patient: [Resident #1]6/19/25 This date 6/19/25 this nurse called into the patient's, [Resident #1] room by [CNA B]. This nurse entered room, observed [CNA B] standing by restroom door, and patient [Resident #1] awake, Page 1 of 6 676487 676487 07/15/2025 The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few sitting in her wheelchair by the bed, no s/s of distress. [CNA B] informed this nurse that patient stated CNA had pushed her. This nurse asked CNA B to leave room, then asked patient to tell me what happened. Patient verbalized that while transferring to the toilet from the wheelchair, CNA B pushed her left shoulder against the wall. This nurse asked if I may check her for injury, patient agreeable. No visible sign of injury noted to back, shoulders or face. ROM per baseline, patient denied pain. This nurse reassured patient that the CNA would not return to room, and assisted patient back into bed safely, bed placed in low position, fall precautions in place, call light within reach. This nurse immediately notified abuse coordinator and spoke with DON. [LVN A]During an interview on 07/15/2025 at about 2:20 pm, the DON stated there was an allegation incident of abuse regarding Resident #1. The DON stated CNA B went to assist Resident #1 in her room on the overnight shift, CNA B did not touch Resident #1, and Resident #1 accused CNA B of pushing her. The DON stated LVN A notified her and both LVN A and CNA B left written statements.During an interview on 07/15/2025 at about 2:32 pm, LVN A stated on the morning of 06/19/2025 Resident #1 alleged that CNA B pushed her. LVN A stated CNA B called her [LVN A] to inform her that Resident #1 alleged she had pushed her. LVN A said she asked the CNA to leave the room while she spoke with Resident #1. LVN A stated Resident #1 stated CNA B had pushed her. LVN A stated she assessed Resident #1 and there was no evidence of injuries. LVN A stated she helped Resident #1 out of the restroom. LVN A stated she and CNA B wrote statements for the abuse coordinator, and she reported the incident immediately. During an interview on 07/15/2025 at about 3:13 pm the Administrator stated he had just found out about the incident today 07/15/2025 regarding Resident #1 when the State Surveyor asked due to him being on vacation at the time of the incident. The Administrator stated he would have interviewed Resident #1, if there was an allegation of abuse, and he would have reported it to the state. The Administrator stated in his absence, the DON was responsible to report to the state all allegations of abuse and neglect. The Administrator stated, when a Resident alleged abuse, it was reportable to the state. During an interview on 07/15/2025 at about 3:33 pm, the DON stated she attempted to interview Resident #1 and Resident #1 was dismissive, so she [DON] did nothing else regarding the allegation. The DON stated she did not document her attempt to interview Resident #1. The DON stated the Administrator was on vacation at the time and so she made contact with the Administrator's Boss and told him about the incident. The DON stated she did not report the incident to the State Agency. The DON stated allegations of abuse and neglect were reportable to the State Agency.During an interview on 7/15/2025 at 3:45 pm, CNA B stated on the morning of 06/19/2025, she went to assist Resident #1 and Resident #1 was already in the wheelchair. CNA B stated she was trying to explain to Resident #1 that she had to call for help before getting out of bed. CNA B stated she never got to help Resident #1, she did not touch Resident #1 when Resident #1 accused her [CNA B] of pushing her. CNA B said she immediately walked out of the room and notified LVN A. CNA B stated LVN A went to Resident #1 and assessed her. CNA B stated LVN A called the Administrator, but she [CNA B] told LVN A that the Administrator was not available, so LVN A called the DON. CNA B said she wrote a statement and gave to LVN A.Review of facility's policy titled Abuse and Neglect Prohibition revised 10/12/2022 reflected: PolicyEach resident has the right to be free from abuse, neglect, mistreatment, injuries of unknown origin, misappropriation of resident property, exploitation, corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms. The facility does not allow involuntary seclusion. Any observations or allegations of abuse, neglect or mistreatment must be immediately reported to the Administrator.Abuse Prevention Coordinator The facility administrator is the Abuse Prevention Coordinator. Abuse means the willful infliction of injury, unreasonable confinement, 676487 Page 2 of 6 676487 07/15/2025 The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few intimidation, or punishment with resulting physical harm, pain, or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse, including abuse facilitated or enabled through the use of technology. Injuries of unknown origin may occur as a result of abuse. Alleged violation is a situation or occurrence that is observed or reported by staff, resident, relative, visitor, another health care provider, or others but has not yet been investigated and, if verified, could be noncompliance with the Federal requirements related to mistreatment, exploitation, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property.PreventionReporting and ResponseSTATE REPORTING OBLIGATIONS: The facility will report all allegations and substantiated occurrences of abuse, neglect, exploitation, mistreatment including injuries of unknown origin, and misappropriation of property to the administrator, State Survey Agency, and law enforcement officials and adult protective services (where state law provides for jurisdiction in long-term care). What to Report1. All alleged violations of abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property2. The results of all investigations of alleged violationsWho is Required to Report----The FacilityWhen to Report the Incident----2 hours if the alleged violation involves abuse or results in serious bodily injury. 676487 Page 3 of 6 676487 07/15/2025 The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to, in response to allegations of abuse, neglect, exploitation, or mistreatment, have evidence that all alleged violations are thoroughly investigated and report the results of all investigations to the state survey agency within five working days of the incident for one (1) of five (5) residents reviewed for abuse and neglect. (Resident #1).The facility failed to thoroughly investigate an alleged abuse incident reported by Resident #1 on 06/19/2025 when Resident #1 alleged being pushed by CNA B. This deficient practice placed all residents at risk of harm from abuse due to not having a thorough investigation done for an alleged abuse.Findings Include: Record review of Resident #1's face sheet, dated 07/15/2025, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included hypertension (high blood pressure), fall on the same level from slipping, muscle weakness, unsteady to the feet, history of falling, traumatic subdural Hemorrhage (a type of traumatic brain injury (TBI) where blood collects under the dura mater, the outer membrane covering the brain, due to a head injury) without loss of consciousness subsequent encounter. Record review of Resident #1's Quarterly MDS dated [DATE] revealed Resident #1 had a BIMS score of 10 indicating moderate cognitive impairment. Review of Resident #1's care plan initiated 05/30/2025 reflected Resident #1 had actual/potential decline in her ability to perform her activities of daily living, bowel/bladder incontinence, and need for assistance with transfers/toileting related to impaired mobility secondary to weakness and debility (physical weakness, especially as a result of illness.Most of the cases presented with general debility, muscle weakness, and weight loss.)Review of CNA B's written statement dated 06/19/2025 reflected: June 19, 2025 3:47 am Patient in [xx] had call light on upon entering the room the patient was sitting in her wheelchair and asked if I could help her unlock her brakes. I asked her why she didn't call before she transferred to the chair. She stated that she's not a 2-year-old and should not have to ask for permission to go to the bathroom. I explained to her the safety issue of calling before she transferred to her chair. She then stated that you've been a bitch since day one and won't let me do anything on my own. I proceeded to help her with her brakes and take her to the restroom, she refused to let me help her toilet. I explained to her that her chair is not locked and it's not safe for her to do this alone. I locked her chair and let her toilet herself while I stood outside of the restroom. I noticed she was struggling to pull up her underwear so I asked her if I could help with that, she then yelled at me to get away from her she does not need my help. She then accused me of throwing her up against the wall. I then exited the room and alerted the nurse of what the patient was saying. [room #] Statement [CNA B].Review of LVN A's written statement dated 06/19/2025 reflected: To: Abuse Coordinator Re: Statement regarding patient allegation Patient: [Resident #1]6/19/25 This date 6/19/25 this nurse called into the patient's, [Resident #1] room by [CNA B]. This nurse entered room, observed [CNA B] standing by restroom door, and patient [Resident #1] awake, sitting in her wheelchair by the bed, no s/s of distress. [CNA B] informed this nurse that patient stated CNA had pushed her. This nurse asked CNA B to leave room, then asked patient to tell me what happened. Patient verbalized that while transferring to the toilet from the wheelchair, CNA B pushed her left shoulder against the wall. This nurse asked if I may check her for injury, patient agreeable. No visible sign of injury noted to back, shoulders or face. ROM per baseline, patient denied pain. This nurse reassured patient that the CNA would not return to room, and assisted patient back into bed safely, bed placed in low position, fall precautions in place, call light within reach. This nurse immediately notified abuse coordinator and spoke with DON. [LVN A]During an interview on 07/15/2025 at about 2:20 pm, the DON stated there was an allegation incident of abuse Residents Affected - Few 676487 Page 4 of 6 676487 07/15/2025 The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few regarding Resident #1. The DON stated CNA B went to assist Resident #1 in her room on the overnight shift, CNA B did not touch Resident #1, and Resident #1 accused CNA B of pushing her. The DON stated LVN A notified her and both LVN A and CNA B left written statements.During an interview on 07/15/2025 at about 2:32 pm, LVN A stated on the morning of 06/19/2025 Resident #1 alleged that CNA B pushed her. LVN A stated CNA B called her [LVN A] to inform her that Resident #1 alleged she had pushed her. LVN A said she asked the CNA to leave the room while she spoke with Resident #1. LVN A stated Resident #1 stated CNA B had pushed her. LVN A stated she assessed Resident #1 and there was no evidence of injuries. LVN A stated she helped Resident #1 out of the restroom. LVN A stated she and CNA B wrote statements for the abuse coordinator, and she reported the incident immediately. During an interview on 07/15/2025 at about 3:13 pm the Administrator stated he had just found out about the incident today 07/15/2025 regarding Resident #1 when the State Surveyor asked due to him being on vacation at the time of the incident. The Administrator stated he would have interviewed Resident #1, if there was an allegation of abuse, and he would have reported it to the state. The Administrator stated in his absence, the DON was responsible to report to the state all allegations of abuse and neglect. The Administrator stated, when a Resident alleged abuse, it was reportable to the state. During an interview on 07/15/2025 at about 3:33 pm, the DON stated she attempted to interview Resident #1 and Resident #1 was dismissive, so she [DON] did nothing else regarding the allegation. The DON stated she did not document her attempt to interview Resident #1. The DON stated the Administrator was on vacation at the time and so she made contact with the Administrator's Boss and told him about the incident. The DON stated she did not report the incident to the State Agency. The DON stated allegations of abuse and neglect were reportable to the State Agency.During an interview on 7/15/2025 at 3:45 pm, CNA B stated on the morning of 06/19/2025, she went to assist Resident #1 and Resident #1 was already in the wheelchair. CNA B stated she was trying to explain to Resident #1 that she had to call for help before getting out of bed. CNA B stated she never got to help Resident #1, she did not touch Resident #1 when Resident #1 accused her [CNA B] of pushing her. CNA B said she immediately walked out of the room and notified LVN A. CNA B stated LVN A went to Resident #1 and assessed her. CNA B stated LVN A called the Administrator, but she [CNA B] told LVN A that the Administrator was not available, so LVN A called the DON. CNA B said she wrote a statement and gave to LVN A.Abuse Prevention Coordinator The facility administrator is the Abuse Prevention Coordinator. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse, including abuse facilitated or enabled through the use of technology. Injuries of unknown origin may occur as a result of abuse. Alleged violation is a situation or occurrence that is observed or reported by staff, resident, relative, visitor, another health care provider, or others but has not yet been investigated and, if verified, could be noncompliance with the Federal requirements related to mistreatment, exploitation, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property.Prevention3. Facility supervisors will immediately investigate and correct reported or identified situations in which abuse, neglect, injuries of unknown origin, or misappropriation of resident property is at risk for occurring.4. Staff will be instructed to report any signs of stress from employees, family and other individuals involved with the resident that may lead to abuse, neglect, injuries of unknown origin, or misappropriation of resident property, and to intervene as appropriate.Investigation1. The facility will timely conduct an investigation of any alleged 676487 Page 5 of 6 676487 07/15/2025 The Center at Parmer 13800 N Fm 620 Rd Sb Austin, TX 78717

F 0610 Level of Harm - Minimal harm or potential for actual harm abuse/neglect, exploitation,mistreatment, injuries of unknown origin, or misappropriation of resident property in accordance with state law.2. Any employee alleged to be involved in an instance(s) of abuse and/or neglect will be interviewed and suspended immediately, and will not be permitted to return to work unless and until suchallegations of abuse/neglect are unsubstantiated. Residents Affected - Few 676487 Page 6 of 6