Start by browning the ground sausage in a large skillet over medium-high heat. Break the sausage into small pieces as it browns.

When the meat is cooked through, add the butter and almond flour to the pan and whisk it.

Add the heavy cream and whisk constantly until well combined. Season with salt and pepper, to taste. Turn the heat down to medium low, add the water as needed to thin out the gravy, and whisk. Simmer for 3-5 minutes, until thickened.