Gracy Woods Nursing Center

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

exceed 3gm of Acetaminophen in 24 hours. RP in facility at this time. Notified this writer that resident does have a fracture to the Rt Humerus from the unwitnessed fall that occurred on 10/16/25. Hospice telephoned for clarification of results of XRAY performed on 10/17/25. Hospice nurse stated resident does have a fracture and will send results via email to Administrator of facility. RP declined ER visit due to resident's decline in health and wishes for facility/hospice to keep resident comfortable at this time. Prn Morphine given at approx. 11:40 am. Review of Resident#1's quarterly MDS assessment dated [DATE REDACTED] reflected a BIMS score of 09, indicating moderate cognitive impairment. During an interview on 11/07/2025 at the DON stated the facility was aware of Resident #1's right humerus fracture due to a fall on 10/16/2025. The DON stated the X-ray was completed on 10/17/2025 on Resident #1's right arm and was positive for a fracture.

The DON stated Resident #1 was on hospice services and Resident #1's RP had declined aggressive treatment to the right humerus fracture. The DON stated Resident #1's right fracture should have been care planned to enable staff to know what interventions to provide for Resident #1. The DON stated the MDS nurse was responsible to update Resident #1's care plan to reflect right humerus fracture with interventions. During an interview on 11/07/2025 at 12:40 pm the MDS Nurse stated she was responsible for completing and updating comprehensive care plan and MDS assessment. The MDS Nurse stated the floor nurses were responsible for doing the acute care plan and they should have done an acute care plan for Resident #'s fracture. The MDS Nurse stated an acute care plan was for something that happened to the resident right away, and examples like falls, fractures and infections, interventions were listed right away.

The MDS Nurse stated comprehensive care plans were done whenever there was a resident's assessment, generally quarterly and annually. The MDS nurse stated the Administrator had just asked her to update Resident #1's comprehensive care plan to include risk for fall and fracture. The MDS Nurse later stated care plans were updated for significant changes and fracture was considered a significant change. The MDS Nurse stated, I agree with you. {Resident #1's] comprehensive care plan should have been updated to reflect fracture of her right humerus, but we have 14 days to update the comprehensive care plan for significant change. On 11/07/2025 at about 2:12 pm a request for acute care plans from the DON was made and there was no acute care plan for Resident #1 regarding the fracture of the right humerus. Review of the facility's policy revised December 2016 titled Care Plans, Comprehensive Person-Center reflected: Policy Statement: A comprehensive, person-center care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Policy Interpretation and Implementation: The Interdisciplinary Team (IDT),

in conjunction with the resident and his/her family or legal representatives, develops and implements comprehensive, person-centered care plan for each resident. The care plan interventions are derived from

a thorough analysis of the information gathered as part of the comprehensive assessment. Assessment of residents are ongoing, and care plans are revised as information about the residents and the residents' conditions change.The Interdisciplinary Team must review and update the care plan:--when there has been

a significant change in the residents' condition.--when the desire outcome is not met.--when the resident has been readmitted to the facility from a hospital stay; and --at least quarterly, in conjunction with the required quarterly MDS assessment.

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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

11/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Gracy Woods Nursing Center

12021 Metric Blvd Austin, TX 78758

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)

Federal health inspectors cited Gracy Woods Nursing Center in Austin, TX for a deficiency under regulatory tag F-F0728 during a complaint investigation conducted on 2025-11-24.

Category: Nursing and Physician Services Deficiencies

The facility was found deficient in the following area: Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 2 deficiencies cited during this inspection of Gracy Woods Nursing Center.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-11-28.