Deer Creek Of Wimberley

F-F684.

Review of an audit, dated 05/02/25 and conducted by the DON, reflected seven residents with skin integrity issues that had treatment orders in place and had no signs or symptoms of infection.

Review of an in-service, dated 05/01/25 - 05/03/25 and conducted by the DON, reflected all staff were in-serviced on their Abuse and Neglect Policy.

Review of In-Service Education Quiz, dated 05/01/25 - 05/03/25, reflected all licensed nurses and agency staff completed a quiz covering skin issues with no concerns.

Review of an in-service, dated 05/01/25 - 05/03/25 and conducted by the DON, reflected all staff were in-serviced on their Change of Condition Policy.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 19 of 20 455917 Department of Health & Human Services Printed: 08/27/2025 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 455917 B. Wing 05/05/2025

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

Deer Creek of Wimberley 555 Ranch Rd 3237 Wimberley, TX 78676

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 In-Service Education Quiz, dated 05/01/25 - 05/03/25, reflected all staff completed a quiz covering Notification of Changes with no concerns. Level of Harm - Immediate jeopardy to resident health or Review of eight resident's EMR, on 05/05/25, reflected they had a skin assessment conducted with no safety concerns on 05/02/25.

Residents Affected - Few The ADM and DON were notified on 05/02/25 12:46 that the IJ had been removed. While the IJ was removed, 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 20 of 20 455917