Coral Rehabilitation And Nursing Of Austin

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

09/11/25 that CNA B notified her during the night of 09/10/25 that Resident #1 was moaning and groaning when CNA B was providing care. RN A stated Resident #1's mobile x-ray results revealed on 09/11/25 that

he had a right hip fracture. RN A stated Resident #1's fracture was an injury of unknown origin because the facility did not know how he sustained the fracture. RN A stated the ADM was responsible for reporting injury of unknown origin to the SSA. RN A stated she knew it was important to report injury of unknown origin to the SSA and said, So they can do appropriate and immediate investigation to see what happened.

Residents could be at risk of abuse and neglect and also for their safety. During an interview on 09/18/25 at 5:17 p.m., the ADM stated she was not notified that Resident #1 had a bruise on his buttocks. The ADM stated the surveyor's interview was the first time she was hearing Resident #1 had a bruise on his buttocks.

The ADM stated Resident #1's bruise on his buttocks was an injury of unknown origin because the facility did not know how he sustained the bruise. The ADM stated she expected staff to notify her and the DON if there was an injury of unknown origin. The ADM stated she was responsible for reporting injury of unknown origin to the SSA within two hours. The ADM stated the DON and CEO were responsible for ensuring she reported injury of unknown origin to the SSA. The ADM stated she knew it was important to report injury of unknown origin to the SSA and said, To rule out ANE and make sure residents were cared for and to ensure whoever caused harm was dealt with. Residents could be at risk of death, harm, and neglect.

Review of the facility's in-services, April-September 2025, reflected none related to reporting injuries of unknown origin to facility management and the SSA.Review of the facility's Reporting Abuse to Facility Management policy, revised December 2024, reflected, Policy Statement: It is the responsibility or our employees, facility consultants, Attending Physician, family members, visitors etc to promptly report any incident or suspected incident of neglect or resident abuse, including injuries of unknown source, and theft or misappropriation of resident property to facility management.Policy Interpretation and Implementation:g.

Injury of unknown source is defined as an injury that meets both of the following conditions:(1) The source of the injury was not observed by any person or the source of the injury could not be explained by the resident; and(2) The injury is suspicious because of: the extent of the injury; or the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma); or the number of injuries observed at one particular point in time; or the incidence of injuries over time.Review of the facility's Long Term Care Regulation Provider Letter, issued 08/29/24, reflected, A NF must report to CII the following types of incidents, in accordance with applicable state and federal requirements: suspicious injuries of unknown origin.Do Report: An incident that results in serious bodily injury that involves any of the following: injuries of unknown source immediately, but not later than two hours after the incident occurs or is suspected. Injuries of unknown source: Note: an injury should be classified as an injury of unknown source when ALL of the following conditions are met: The source of the injury was not observed by any person; and The source of

the injury could not be explained by the resident; and The injury is suspicious because of: the extent of the injury; or the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma); or the number of injuries observed at one point in time; or the incidence of injuries over time.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Coral Rehabilitation and Nursing of Austin

6909 Burnet LN Austin, TX 78757

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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

p.m. through 09/20/25 at 4:55 p.m., LVN F, RN A, LVN G, CNA H, CNA I, CNA J, and LVN L stated they were in-serviced and provided competency before their shifts by the DON/designee on identifying and immediately reporting requirements for injuries of unknown origin. They knew to immediately notify the ADM, DON, and Charge nurse. They also completed skin sweeps to assess each resident for any new injuries. During an interview on 09/21/25 at 12:15 p.m., the DON stated her and the ADM were in-serviced by the contracted consultant on reporting and investigating injuries of unknown origin within two hours of receiving report of the incident. The DON stated her and the signed an acknowledgement of the in-service received to demonstrate understanding the facility's policy and procedures. The DON stated her and the ADM received a flow chart as a visual aid in facilitating reporting to the SSA. The DON stated skin sweeps were completed by designated nurses to assess each resident for injuries and there were no abnormal findings reported to her and the ADM. The DON stated staff were also in-serviced and tested for competency on identifying and reporting requirements for injuries of unknown origin. The DON stated her and the ADM will discuss with IDT members during daily meetings all findings to ensure compliance was met and sustained. Review of the facility's In-Services, 09/18/25-09/20/25, reflected the ADM and DON were reeducated by a contracted consultant on reporting and investigating injuries of unknown origin within two hours of receiving report of the incident. The ADM and DON signed an acknowledgement of the in-service received. Staff were also in-serviced and tested for competency by the DON/designee on identifying and reporting requirements for injuries of unknown origin. Review of the facility's Reporting Abuse, Neglect, and Exploitation policy, reviewed on 09/18/25, reflected the policy was reviewed and explained in detail by the contracted consultant. A flow chart was provided as a visual aid for the ADM and DON in facilitating reporting to the SSA. Review of the facility's Skin Assessments completed by the DON and other charge nurses, 09/18/25-09/20/25, reflected all 70 residents were assessed and did not have injuries of unknown origin. The ADM was notified on 09/21/25 at 1:18 p.m. that the IJ had been removed.

While the IJ was removed, the facility remained at a scope level of isolated and a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of their corrective systems.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Coral Rehabilitation and Nursing of Austin

6909 Burnet LN Austin, TX 78757

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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

consistency and accuracy x's 3 months. This process will be reviewed monthly in the QAPI meeting for compliance and sustainability. Start date 9/18/25 Completion date 9/20/25 Responsible for POR - Director of Nursing Services Targeted Audience - IDT team The surveyor monitored the POR on 09/20/25 as followed:During interviews from 09/20/25 at 1:58 p.m. through 4:55 p.m., CNA E, LVN F, RN A, LVN G, CNA H, CNA I, CNA J, the MDS Nurse, the ADON, LVN K, and LVN L stated they were in-serviced and provided return demonstrations before their shifts by the DON/designee on accessing and utilizing residents' EMR and physical records at the nursing station as a guide for resident care needs. They also knew the MDS nurse updated residents' EMR and physical records. They also knew any change in residents' condition was to be immediately reported to the DON or designee. They also completed skin assessments to ensure all resident did not have injuries of unknown origin. They also completed transfer checkoffs and return demonstrations of utilizing gait belt and Hoyer lift methods with physical therapy personnel/designees.

During observations from 09/21/25 at 9:30 a.m. through 09/21/25 at 9:45 a.m., CNA M, CNA N, and CNA O utilized residents' EMR and proper gait belt and Hoyer lift transfer techniques during resident transfers.

During an interview with the DON on 09/21/25 at 12:15 p.m., she stated in-services staff before their shifts regarding utilizing residents' EMR as a guide for residents' care needs and demonstrated how to access and utilize the system. The DON stated she then had each staff member provide a return demonstration on how to access and interpret the system. The DON stated she and the other charge nurses completed skin assessments to ensure all 70 residents did not have injuries of unknown origin. The DON stated her, the MDS Nurse, and the ADM were auditing residents' care plans and Kardex weekly for consistency and accuracy for the next three months and reviewing monthly in QAPI for compliance and sustainability.

Review of the facility's In-Services, 09/18/25-09/20/25, reflected the DON/Designee educated and demonstrated to staff on accessing and utilizing residents' EMR as a guide for residents' care needs.

Review of the facility's Audit of Residents' Care Plans and EMR, 09/18/25-09/20/25, reflected residents were assessed on their transfer ability and were ensured to be accurate. There were 20 residents who required a Hoyer lift 2-person transfer. Review of the facility's Skin Assessments, 09/18/25-09/20/25, completed by the DON and other charge nurses reflected all 70 residents were assessed and did not have injuries of unknown origin. Review of the facility's Transfer Checkoffs, 09/18/25-09/20/25, utilizing Gait Belt and Hoyer lift methods completed by physical therapy personnel/designees reflected all staff successfully checked off and returned demonstration of techniques before reporting to their shift. Review of Kardex's at each nursing station reflected residents' EMR were available should the computer system go down. Review of the Audit Care Plans and Kardex reflected it was consistently and accurately reviewed weekly and monthly for compliance and sustainability by the DON, MDS Nurse, ADM and QAPI. The ADM was notified

on 09/21/25 at 1:18 p.m. that the IJ had been removed. While the IJ was removed, the facility remained at a scope level of isolated and a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of their corrective systems.

Event ID:

Facility ID:

If continuation sheet