Brodie Ranch Nursing And Rehabilitation Center

F-F684.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 5 of 13 676267 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 676267 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd Austin, TX 78748

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 0684 11. Summary of IJ and corrective action results will be reviewed by QAPI Committee monthly x 3 months beginning [DATE REDACTED] or until substantial compliance established to ensure ongoing compliance. Level of Harm - Immediate jeopardy to resident health or The Surveyor monitored the POR on [DATE REDACTED] as followed: safety

During interviews conducted on [DATE REDACTED] between 1:38 PM - 3:40 PM, two RNs and five LVNs from both shifts Residents Affected - Few stated they were in-serviced on falls, assessments, and aggressive behaviors before they worked their most recent shifts. They all stated if a resident was found on the floor, they would treat it as an unwitnessed fall which included a head-to-toe assessment, ROM, and neuro checks would be initiated. All stated they would complete an incident report and would document thoroughly in the resident's chart. They stated they would report the fall to the DON, family, and NP immediately after assessing the resident. They all stated they would not get a resident off the ground until they were assessed because they needed to make sure they were not injured before moving them. They stated if they were combative/resisting, they would stay with the resident because anything could happen quickly especially if they possibly hit their head. They stated they would call another nurse for assistance and if they still could not get the resident to comply, they would contact the NP. They all stated documentation was imperative because if you did not document, it did not happen, and it was important for the following nurses to know the details of the incident.

Review of the facility's Ad Hoc QAPI agenda, dated [DATE REDACTED], reflected the MD, ADM, DON, CRN, two ADMs from sister facilities, two DONs from sister facilities, and two Regional Nurses were in attendance.

Review of an Audit of Incident Reports, from [DATE REDACTED] - [DATE REDACTED] and conducted by the CRN, reflected all incident reports were reviewed to ensure residents had been assessed appropriately after their falls and the appropriate parties had been notified.

Review of an in-service entitled Falls and Documentation, dated [DATE REDACTED] and conducted by the CRN, reflected the ADM and DON were in-serviced on the following:

If a fall occurs or patient observed on floor, Nurse should complete a full head to toe skin assessment, including ROM to ensure no injuries immediately, if fall is unwitnessed neuro checks should be started, if neuro checks are already being conducted from prior incident, then new neuro checks should be initiated. Neuro checks should also be initiated for witnessed falls if patient has injury to head. An incident report should be completed, a pain assessment and fall risk assessment, if skin injury occurs then a skin assessment should be completed as well. If patient refuses assessment, document and call MD/NP/RP immediately.

Review of an in-service entitled Falls and Documentation, dated [DATE REDACTED] - [DATE REDACTED] and conducted by the CRN, reflected nurses from all shifts (Including RN H) were in-serviced on the following:

If a fall occurs or patient observed on floor, Nurse should complete a full head to toe skin assessment, including ROM to ensure no injuries immediately, if fall is unwitnessed neuro checks should be started, if neuro checks are already being conducted from prior incident, then new neuro checks should be initiated. Neuro checks should also be initiated for witnessed falls if patient has injury to head. An incident report should be completed, a pain assessment and fall risk assessment, if skin injury occurs then a skin assessment should be completed as well. If patient refuses assessment, document and call MD/NP/RP immediately.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 13 676267 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 676267 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd Austin, TX 78748

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 0684 Review of Post-Fall quizzes, dated [DATE REDACTED] - [DATE REDACTED], reflected all nurses took and passed a quiz on what to do after a resident had a fall. Level of Harm - Immediate jeopardy to resident health or Review of an in-service entitled Managing Behaviors in Persons with Dementia, dated [DATE REDACTED] - [DATE REDACTED] and safety conducted by the CRN, reflected nurses from all shifts (including RN H) were in-serviced on different ways of managing/approaching/caring for residents with Dementia and/or behaviors. Residents Affected - Few

Review of Managing Behaviors in Persons with Dementia quizzes, dated [DATE REDACTED] - [DATE REDACTED], reflected all nurses took and passed a quiz on how to care for residents with aggressive behaviors.

Review of a Counseling/Disciplinary Notice, dated [DATE REDACTED], reflected RN H received a written warning for the following:

[RN H] failed to conduct an assessment on a resident post-fall. [RN H] did not write a progress note nor an incident report. [RN H] will be counseled 1:1 on appropriate assessments and how to address residents with combative behaviors.

The ADM and DON were notified on [DATE REDACTED] at 3:55 that the IJ had been removed. While the IJ was removed

on [DATE REDACTED] at 3:55 PM, the facility remained at a level of no actual harm at a scope of isolated that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 13 676267 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 676267 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd Austin, TX 78748

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 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Immediate jeopardy to resident health or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 42949 safety Based on interview and record review, the facility failed to ensure the residents environment remained as Residents Affected - Few free of accident hazards as is possible and ensure each resident received adequate supervision for one (Resident #1) of three residents reviewed for accidents and hazards.

The facility failed to ensure Resident #1 did not elope from the facility from an emergency exit door after CNA C utilized the exit code to the emergency door. LVN B observed the resident at a gas station after leaving work and did not stay with him until someone from the facility could assist. The temperature outside was a high of 95 degrees. He was later taken to the hospital where he tested positive for cocaine.

This deficient practice placed residents at risk for unsafe elopements, falls, injuries, dehydration, and hospitalization .

An Immediate Jeopardy (IJ) existed from 08/03/24 - 08/04/24. The IJ was determined to be at past noncompliance as the facility had implemented actions that corrected the deficient practice prior to the beginning of the investigation.

This deficient practice placed residents at risk for unsafe elopements, falls, injuries, dehydration, and hospitalization .

Findings included:

Review of Resident #1's undated face sheet reflected a [AGE] year-old male who was admitted to the facility

on [DATE REDACTED] with diagnoses including type II diabetes, pressure ulcers, schizophrenia (a serious mental illness that affects how a person thinks, feels, and behaves), acute kidney failure, and acquired absence of right leg below the knee.

Review of Resident #1's admission MDS assessment, dated 05/19/24, reflected a BIMS of 9, indicating a moderate cognitive impairment. Section E (Behavior) reflected he had not exhibited any wandering behaviors. Section GG (Functional Abilities and Goals) reflected he utilized a wheelchair.

Review of Resident #1's admission care plan, dated 06/21/24, reflected he was at risk for re-traumatization related to history of trauma and relocation stress syndrome or transfer trauma related to being homeless with

an intervention of monitoring behavior episodes and attempting to determine the underlying cause.

Review of Resident #1's Elopement/Wandering Evaluation, dated 06/16/24, reflected he was a low risk of elopement.

Review of Resident #1's psychologist assessment, dated 06/21/24, reflected the following:

[Resident #1] is new to this provider, introduced self as psychologist. Discussion focused on his desire to be outside of the facility. He reported I want to go out on pass .

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 13 676267 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 676267 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd Austin, TX 78748

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 0689 Review of Resident #1's progress notes, dated 06/26/24 and documented by the DON, reflected the following: Level of Harm - Immediate jeopardy to resident health or [Resident #1] began screaming that he wanted to be discharged . safety

Review of Resident #1's psychologist assessment, dated 07/22/24, reflected the following: Residents Affected - Few [Resident #1] approached provider in the common area. He as communicating a desire to understand how

he can sign out of the facility.

Review of Resident #1's progress notes, dated 08/03/24 at 4:11 PM and documented by the DON, reflected

the following:

Staff reported [Resident #1] left the facility and went to the store the staff verified that the resident was not in

the facility .

Review of Resident #1's progress notes, dated 08/03/24 at 6:09 PM and documented by the DON, reflected

the following:

Admin spoke with [Resident #1]'s [FM D] regarding the resident leaving. [FM D] reports that [Resident #1] frequents a store on (road), (store). Staff in route to location.

Review of Resident #1's progress notes, dated 08/03/24 at 6:19 PM and documented by the DON, reflected

the following:

Notified NP of [Resident #1] leaving the facility. The NP reports the resident has a history of leaving previous facilities.

Review of Resident #1's progress notes, dated 08/03/24 at 6:50 PM and documented by the DON, reflected

the following:

Clinical Resource found [Resident #1] at the store and the resident refusing to return to (facility). 911 was called per family request .

Review of Resident #1's progress notes, dated 08/03/24 at 10:34 PM (late entry) and documented by LVN A, reflected the following:

[LVN B] leaving work and noticed [Resident #1] at gas station next to facility. [LVN B] notified this writer [LVN B] stopped and spoke with [Resident #1] this notified ADON that [Resident #1] at gas station and that I was going to check on him when this writer arrived at gas station, [Resident #1] was not at location, returned to facility notified ADON and this writer and staff along with ADON started search throughout facility and surrounding facility after search this writer returned to gas station to research premises and bathroom at gas station drove around neighborhood to continue search then returned to facility to notify ADON, DON, and ADM. [sic]

Review of Resident #1's ER records, dated 08/03/24, reflected the following:

Acute Psychosis

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 13 676267 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 676267 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd Austin, TX 78748

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 0689 - Found by EMS yelling at pedestrians, UDS positive for cocaine.

Level of Harm - Immediate - Likely 2/2 crack cocaine superimposed on schizophrenia. jeopardy to resident health or safety During an interview on 08/07/24 at 8:36 AM, the ADM and DON stated CNA C on the 300 hall left through

the emergency door using the door code on 08/03/24. The ADM stated he was not sure how she got the Residents Affected - Few code as only himself, the DON, and the MAINTD had the code. He stated this exit was to be used for emergencies only. He stated CNA C did not ensure the door was latched. He stated after staff realized Resident #1 was missing, he reviewed video footage and observed him leaving through the 300 hall door around 1:30 PM. The DON stated LVN B called LVN A around 2:30 PM and stated she saw Resident #1 at

the gas station near the facility. The DON stated LVN A went to the gas station but he was no longer there.

The ADM stated they had their clinical resources from other facilities assist with a search and he was found around 6 PM at a store his FM (D)'s suggestion. The ADM stated the Resident #1's FM (D) wanted him to be sent to the hospital for evaluation where cocaine was found in his system. The ADM stated although he had

a history of leaving facilities AMA, he had a low elopement risk and had never voiced wanting to leave or exhibited exit-seeking behaviors. The DON stated the emergency exit door codes were changed monthly and she had conducted an in-service regarding the codes when she first started in May (2024) and had re-in-serviced staff starting on 08/03/24 and going forward.

During an interview on 08/07/24 at 9:42 AM, CNA C stated Resident #1 had never voiced wanting to leave

the facility or exhibited exit-seeking behaviors. She stated the day he left (08/03/24), she last saw him around lunchtime (12:00 PM) when she asked him if he wanted to eat in the dining room or in his room. She stated

he ate in the dining room and she did not see him again before her shift ended. She stated around 1:40 PM,

she needed to take trash and dirty laundry outside to get ready for the on-coming shift. She stated she could not remember how she got the code to the emergency exit doors. She stated she should have not utilized it but she was trying to get everything cleaned up quick and it was easier to dispose of her trash and laundry outside of the door. She stated she wished the door had closed quicker so he had not been able to leave.

She stated she no longer had the code and she had been in-serviced on not utilizing emergency exit doors for any reason unless there was a true emergency.

During an interview on 08/07/24 at 11:26 AM, the LSRD stated he was notified on 08/03/24 that the exit door codes had possibly been compromised and he notified the ADM immediately because he knew how to re-set

the codes. He stated he knew the codes were re-set that day (08/03/24). He stated it was important for staff not to utilize emergency exit doors as they were for emergencies, such as fires, only.

During a telephone interview on 08/07/24 at 2:49 PM, Resident #1's FM D stated she believed the facility was aware Resident #1 had a history of leaving facilities. She stated she made it very clear that while at the facility he was not to be outside of the facility alone. She stated the NP was very familiar with his history. She was very tearful and stated it was very upsetting to her that he was able to leave. She stated when she received the call that he was missing, her heart dropped. She stated he was still in the hospital and being treated for dehydration and high kidney levels. She stated he also had drugs in his system. She stated he would not be discharged until a facility with a locked unit had an available bed for him.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 13 676267 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 676267 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd Austin, TX 78748

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 0689 During an interview on 08/08/24 at 1:45 PM, the ADMC stated she had been in-serviced on exit door codes and elopement. She stated she did not know the codes for the emergency exit doors and only the ADM and Level of Harm - Immediate MAINTD had the codes. She stated if they needed the code they could call them at any time, or just press on jeopardy to resident health or the bar for 15 seconds and the door would open. She stated the emergency exit doors were only for safety emergencies such as a fire. She stated if she saw a resident off-site, she would stay with the resident and call the ADM and/or DON immediately. She stated the only residents that could be outside alone were the Residents Affected - Few ones not in the elopement binders which were located at the nurses' station and Receptionist's desk.

During an interview on 08/08/24 at 1:52 PM, CNA E stated she was in-serviced on elopement procedures

before her shift several days prior. She stated if there was an elopement or a resident missing, a code green should be called. She stated residents that were a high-elopement risk were in the elopement binders located at the nurses' station and Receptionist desk. She stated as a CNA it was important to lay her eyes on each of her residents at least every hour. She stated no door codes should be given out to any families, residents, or vendors. She stated she did not know the codes to the emergency exit doors and they should not be used except during an emergency.

During an interview on 08/08/24 at 2:18 PM, the SW stated she had been in-serviced several days prior on

the elopement process, how to determine which residents were at a higher risk, and their code status (code green was for elopement). She stated residents that were at a higher risk were in elopement binders located that the nurses' station and Receptionist desk. She stated there were also elopement assessments in their charts. She stated if a resident was missing, it was important to determine if they were out on pass. She stated if they still could not be located, she would notify the ADM and DON immediately. She stated if she saw a resident out in the community, she would stay with them and call the ADM/DON to ensure they got back to the facility safely. She stated she did not know the code to the emergency exit doors and only the ADM and MAINTD did, but if there were an emergency, the handle could always be pressed for 15 seconds until the door unlocked.

During an interview on 08/08/24 at 2:31 PM, the ADON stated he was in-serviced on elopement. He was able to state where the elopement binders were located. He stated floor staff should be laying eyes on their residents at a minimum of every two hours. He stated if a resident could not be found, the ADM and DON should be notified immediately. He stated if he saw a resident out in the community, he would stay with them to make sure they were safe and would contact the ADM and DON. He stated he did not know the code to

the emergency exit door and they should never be used except for emergencies.

During an interview on 08/08/24 at 2:55 PM, LVN F stated she had been in-serviced on elopements several days ago. She stated there were elopement binders at the nurses' station and Receptionist desk which contained the residents that were at a high-risk of elopement. She stated elopement assessments were completed when they were admitted and she always asked if they had a history of it. She stated it was important to notice if a resident was continuing to go to the front door all the time to ensure they did not leave with a visitor going in/out. She stated she did not know the code to the emergency exit doors and those doors should only be utilized for an emergency. She stated if a resident was missing, code green would be called, which was their code for an elopement.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 13 676267 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 676267 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd Austin, TX 78748

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 0689 During an interview on 08/08/24 at 3:04 PM, LVN G stated he was with agency but had been in-serviced on elopements prior to his shift that day. He stated residents that were a high-risk of elopement had behaviors Level of Harm - Immediate such as wandering aimlessly. He stated there also was an elopement binder with residents at high risk at the jeopardy to resident health or nurses' station and the Receptionist desk. He stated if a resident could not be found he would call a code safety green. He stated he would then immediately notify the ADM and DON. He stated he did not know the code to

the emergency exit doors and any other door cods were not to be given out to any residents, family Residents Affected - Few members, or vendors.

Review of an in-service, dated 05/02/24 and conducted by the DON, reflected all stat were in-serviced on the exit doors at the end of resident halls were for emergencies only and that the codes had been changed.

Review of an in-service, dated 08/03/24 and conducted by the CRN, reflected the ADM and DON were in-serviced on their Elopement Policy.

Review of the facility's IDT meeting notes, dated 08/03/24, reflected all residents' wandering/elopement assessments were reviewed and/or updated as necessary.

Review of the facility's Ad Hoc QAPI meeting agenda, dated 08/04/24, reflected the ADM, DON, ADON, SW, MD, and CRN were in attendance.

Review of an invoice from a door company, dated 08/04/24, reflected all doors were tested for working alarms/wander guard systems to ensure they were in working order.

Review of a Counseling/Disciplinary Notice, dated 08/04/24, reflected CNA C received a written warning for

the following:

[CNA C] was counseled regarding improper use of emergency exit due to safety. [CNA C] used emergency exit door to take out trash after lunch.

Review of a Counseling/Disciplinary Notice, dated 08/04/24, reflected LVN B received counseling/written warning for not staying with Resident #1 when she saw him at the gas station.

Review of in-services, from 08/03/24 - 08/04/24, reflected all staff were in-serviced on emergency exits, reporting elopements, door codes, notifying the ADM/DON, and staying with a resident until help arrived if seen off the facility premises.

Review of the facility census, from 08/03/24 - 08/07/24, reflected daily head counts were being conducted for all residents.

Review of the facility's Elopement/Unsafe Wandering Policy, revised 01/2022, reflected the following:

It is the policy of this facility to provide a safe environment for all residents through appropriate assessment and interventions to prevent accidents related to unsafe wandering or elopement.

.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 13 676267 Department of Health & Human Services Printed: 09/13/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 676267 B. Wing 08/08/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Brodie Ranch Nursing and Rehabilitation Center 2101 Frate Barker Rd Austin, TX 78748

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 0689 Elopement occurs when a resident leaves the facility premises or a safe area without authorization (i.e. an order for discharge, appointment, or leave of absence) and/or any necessary supervision to do so. Level of Harm - Immediate jeopardy to resident health or An Immediate Jeopardy (IJ) existed from 08/03/24 - 08/04/24. The IJ was determined to be at past safety noncompliance as the facility had implemented actions that corrected the deficient practice prior to the beginning of the investigation. Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 13 676267