Legend Oaks Healthcare And Rehabilitation - North

F 0600

scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place.

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

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

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

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Legend Oaks Healthcare and Rehabilitation - North

11020 Dessau Rd Austin, TX 78754

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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

in-service regularly on abuse. LVN B said the last time she had abuse training was 9-16-2025. LVN B said that get in-service training in person and videos. During an interview on 09/17/2025 2:06 PM, CNA 5 said

she has not witnessed abuse or neglect in the facility. CNA 5 said if she sees abuse in the facility, then she tells the ADM. CNA 5 said the last time she had in-service training on abuse was on 9-16-2025. CNA 5 said

she gets in-service training by video and in person. CNA 5 said that there is usually a test after. Training Monday, test Tuesday, and last week, and the video was at the beginning of the month. During an interview

on 09/17/2025 2:00 PM, ADON revealed that abuse should be reported immediately to the ADM. If the ADM is not available, then it would be reported to the DON ADON stated that they he has received training

on abuse regularly and the last time was on 9/16/2025. ADON stated he gets training in person, online, and

they watch videos. To prevent abuse Human Resources does a background check on new employees.

ADON said he has not witnessed any abuse or neglect in the facility. An IJ was identified on 09/15/2025.

The Administrator was notified and an IJ Template was provided on 09/15/2025 at 5:55 p.m. While the Immediate Jeopardy was removed on 09/17/2025 at 4:33 pm, the facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm and a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place.

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

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Legend Oaks Healthcare and Rehabilitation - North

11020 Dessau Rd Austin, TX 78754

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

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

incident and it was around 7 AM. Resident # 2 stated, there were 2 CNAs in the room that morning. She stated, the smaller one came in to help and that's when I heard a loud cry from Resident # 1 and I couldn't see anything because the curtain was pulled closed but, I knew Resident # 1 was in pain by the sound of her scream. Interview on 09/03/2025 @ 10:50 AM with CNA C. CNA C stated, I had cared for her the week

before on Thursday and Friday and she had no injuries then. He stated, on Monday, Resident # 1's hand looked very different than last week, so I knew something was wrong. I immediately told the Nurse about Resident # 1's hand. He stated, A Staff, Nurse came down to the room to see the resident's injury. He stated, They called EMS and took her to the hospital, and I didn't see her again until the next day.Interview

on 09/03/2025 at 12:29 PM with son of Resident # 1. He stated, we had a recording of the morning of the incident, but we could not see the incident because the Aids pull the curtain around the entire bed. He stated, all I could here is mother yelling and screaming and when they opened the curtain, you can see mom holding her hand. He stated, the family had put a screw on the curtain track to prevent the curtain from being pulled because the staff continued to try and hide from the camera. He stated his mom has dementia and that she doesn't remember details.Interview on 09/03/2025 @ 12:29PM with DON. She stated Resident # 1's son provided the video of the incident on 08/17/2025 but we could not see actual injury occurring, we just heard voices. Interview and observation of video on 09/03/2025 @ 1:15 PM. ED and DON provided a video recording of the incident on 08/17/2025. Video revealed CNA B rotated a privacy curtain all around the entire bed. Video did not reveal an incident of abuse. DON provided Police Report # Service request number 25-00281397.Call placed to [NAME] Policy Depart [PHONE NUMBER] was transferred to [PHONE NUMBER] Extension# 51038 requested copy of police report number 25-00281397.

DON stated, both CNA's involved in this incident have been put on suspension.Record review of the Facility's Abuse, Neglect, and Exploitation, dated 11/2017, reflects: each resident has the right to be free from abuse, neglect, misappropriation of resident property, exploitation and mistreatment. It is also the policy of this Facility to recognize the resident right to personal privacy and confidentiality of their physical body, personal care, and personal space or accommodations. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, and any physical or chemical restraint not required to treat

the resident's medical symptoms. This also includes the taking, keeping, using or distributing photographs or video recordings off residents in any manner that would demean or humiliate a resident, regardless of consent provided or the residents cognitive status. The Facility will provide oversight and monitoring to ensure that its staff, who are agents of the facility, deliver care and services in a way that promotes and respects the rights of the resident to be free from abuse, neglect, misappropriation of resident property, exploitation, or use of technology that would infringe on the residents right to personal privacy.and Abuse: Prevention of and Prohibition AgainstReporting reasonable suspicion of a crime against a resident in accordance with Section 1150B of the Social Security Act.

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

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Legend Oaks Healthcare and Rehabilitation - North

11020 Dessau Rd Austin, TX 78754

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

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review, the facility failed to ensure accurate resident identification before transport for outside medical appointments for 1 (Resident #10) of 3 sampled residents. The facility failed to ensure that Resident #10 made it to his scheduled surgical appointment, and

the facility sent the wrong resident in his place. This finding could place residents at risk for missing medical treatments. Record review Resident #10's medical diagnosis shows that Resident #10is diagnosed with hemiplegia and hemiparesis following cerebral infarction affecting the left non-dominant side (paralysis), heart failure, and major depressive disorder, recurrent moderate (depression). Resident #10 MDS showed that he had a BIMS of 10, which indicates moderate cognitive impairment. Resident #10.Interview on 9-17-2025 at 10:20 AM, an interview with Resident #10 said he did not make it to his cataract surgery, and

he doesn't know what happened. Resident #10 told staff that he was scheduled to have an appointment.

Resident #10 said that a CNA told him last night that the appointment was rescheduled. Resident #10 said

he was going to have cataract surgery on his left eye. Resident #10 said that he had already had the surgery on his right eye. Resident #10 said that things happen, and he will have it done when it is rescheduled. Interview on 9-17-2025 at 12:16 PM, an interview with DR said that he has been doing this job for a couple of weeks. DR said that Resident #10 had the first appointment of the day. DR said that he pointed at a resident and asked a CNA on the floor if that was Resident #10. DR said he thought the CNA responded that was Resident #10, so DR said he then took that resident and not Resident #10 to the appointment. DR stated that ADON called him and told him he had the wrong resident. DR said that he took that resident back to the facility. DR said he is supposed to look at the face sheet before taking a resident to their appointments, and he did not. DR said he was in-serviced on resident identification the day it happened. DR said it could negatively impact a resident by a resident having a procedure that should not have happened. Interview on 9-17-2025 at 2:00 PM, with the ADON said he realized that the driver took the wrong resident to the appointment. ADOON said he called the DR to let him know that he had the wrong resident. ADON said the DR returned the resident to the facility. ADON stated that the DR is supposed to bring the face sheet with the resident's information to the room to verify that it was the resident he was supposed to take to the appointment. On 9-17-2025 at 3:04 PM, an interview with the DON said that DR is supposed to have the face sheet of the resident when they are being taken to appointments. DON said the DR should check in PCC and check with the floor nurse. The DR is trained to get on PCC to verify the resident. DON said the DR asked the CNA in the hall if that was Resident #10, and the DR said that he thought the CNA told him it was Resident #10. DON said that DR should be asking a nurse on the floor if

they have the right resident, along with having the face sheet to verify he has the right resident. DON said that Resident #10 could have missed an important surgery. DON said that the procedure was rescheduled.

On 9-17-2025 at 2:00 PM an interview with the ADM said that DR should verify which resident they have with the face sheet to make sure he has the right resident. ADM said that staff are trained on PCC and should know where to find the resident's Face sheet. ADM said the ADON is the one who discovered that

the wrong resident was taken and called DR. ADM said that the DR will now be checking with the nurse in

the hall to verify. ADM said the resident could have had the wrong procedure. ADM said the DR was counseled and trained on making sure he has the right resident. The facility did not have a written Policy on what the driver was supposed to do when verifying they have the correct resident when taking residents to outside doctors' appointments.

Residents Affected - Few

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

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

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Legend Oaks Healthcare and Rehabilitation - North

11020 Dessau Rd Austin, TX 78754

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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

all have to help, if they see something they need to report it. The ADM stated that pest control services come out every other week. The ADM stated that the resident had spots on his body, and they sent him to

the ER to be checked for infectious diseases such as smallpox. The ADM stated that the resident #2 had bites/spots on his body and was unsure where it came from. The ADM stated he had not seen any ants in

the facility. RR of an undated document provided by the facility titled Pest Control the following information was included in the document:1. It is the policy of this facility to utilize pesticides and rodenticides in a safe and efficient manner to control pests with the least amount of contamination to the environment.2. When pests are sighted, determine why the infestation is occurring and advise department head on preventive measures.3. Report insect or pest sightings to the housekeeping/maintenance supervisor immediately.

Event ID:

Facility ID:

If continuation sheet