Inspection·October 14, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few cognitive impairment. Resident marked to use a [NAME] in the Mobility Devices sections of the MDS. Resident # 1 was assessed to not have long or short-term memory problems. Interviewed a Health Center staff member on 10/10/2025, at 7:25pm, she revealed that Resident #1 was found unsupervised outside in a hospital courtyard by a security guard, who reported the situation to hospital staff. They subsequently contacted the facility to inform them that no one was present to accompany or return the resident from her appointment. Record review of facility incident report on 10/11/2025, reflects a head-to-toe assessment that was performed on Resident #1 and no injuries or skin issues were noted. During an interview on 10/11/2025, at 1:28pm, Resident #1 stated, I was told I was supposed to have an appointment. I believe, I was dropped off by a new facility driver. She said she was not frightened but was hungry since she had not eaten breakfast. Interviewed Van Driver C on 10/11/2025, at 2:23pm, he revealed that on the morning of the incident, he arrived at 5:00 AM for a 6:00 AM transport assignment. After confirming the details with an overnight nurse who he does not recall the name of and gave no special instructions, he transported the resident to Health Center A at 5:30 AM. Upon arrival at 5:50 AM, he parked in the designated area, assisted the resident from the vehicle, and watched her enter the building before leaving. Later notified that the appointment was canceled, he returned to retrieve the resident. Later that day he was notified that he was suspended pending investigation. Interviewed the Director of Nursing on 10/11/2025, at 3:23pm, she confirmed that the facility requires staff to accompany residents to off-site appointments when supervision is indicated. The DON acknowledged that the staff involved did not follow this recommendation, which was inconsistent with the Resident #1 care plan requiring supervision during ambulation with a walker due to physical mobility needs. Interviewed the Administrator on 10/11/2025, at 3:45pm, he confirmed that the facility requires staff to accompany residents to off-site appointments when supervision is indicated, and that the staff involved did not follow this recommendation. The Administrator acknowledged that the Van Driver did not use proper protocols and would have been the aid responsible for monitoring the resident at the appointment. Record review of the facilities appointment book on 10/11/2025, reflects Resident #1 had a 6 am appointment at the Health Center. The appointment was written in the book in pencil. Record review of facility incident reports on 10/10/2025, reflects a handwritten note from Scheduler B indicating that Resident #1 was scheduled for a colonoscopy procedure on 10/10/2025. However, on 10/1/2025, the MDS coordinator informed her, following a conversation with the resident's Guardian, that the appointment had been canceled. Unfortunately, she neglected to notify the Van driver and update her appointment book, resulting in the resident being transported to a canceled appointment. Review of the facility's policy Abuse, Neglect and Exploitation reflects It is the policy of this facility to provide protection for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect. exploitation and misappropriation of resident property. Neglect means failure of the facility, its employees, or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Willful means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. This was determined to be an Immediate Jeopardy on 10/11/2025 at 06:08 PM. The ADM was notified. The ADM was provided with the IJ template on 10/11/2025, at 06:08 PM. The POR (Plan of Removal) was accepted on 10/12/2025 at 2:57 p.m., and included:The following Plan of Removal submitted by the facility was accepted on 10/12/2025 at 2:57 PM: Plan of RemovalImmediate Jeopardy LETTER OF CREDIBLE ALLEGATION FOR REMOVAL OF IMMEDIATE JEOPARDYOn October 11, 2025, at approximately 6:08 PM, the surveyor notified the Administrator that an Immediate Threat had been called for Resident #1. The facility respectfully (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455599 If continuation sheet Page 2 of 5 Printed: 05/15/2026 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 455599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Rehabilitation and Skilled Nursing C 2806 Real St Austin, TX 78722 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 submits this Letter for Plan of Removal pursuant to Federal and State regulatory requirements. The immediate Threat allegations are as follows:Issue: F-Tag: 600 Freedom from Abuse, Neglect and Exploitation Problem:The facility failed to ensure that Resident #1 was free from neglect when staff left the resident unattended at an off-site medical appointment without appropriate supervision or arrangements for return transportation. This deficient practice placed the resident at risk for physical harm, emotional distress, and feelings of abandonment for the affected resident. Immediate Actions Taken: *Residents were assessed for emotional distress by the Social Worker on 10/10/2025. Results of the assessment were no emotional distress noted. Resident in good spirits. *RN Treatment Nurse conducted a head to toes skin assessment with no abnormalities noted on 10/10/2025.*Resident reassessed for BIMS cognitive score by the social worker on 10/10/2025. BIMS assessed at 11.*Guardian aware of the incident, discussed with Care Management Nurse on 10/10/2025.*The physician was notified of the incident by the Director of Nursing on 10/10/2025.*Van Driver immediately suspended pending investigation by the Administrator/designee on 10/10/2025.*The scheduler immediately suspended pending investigation by Administrator/designee on 10/10/2025.*Charge Nurse immediately suspended pending investigation by Director of Nurses/designee on 10/10/2025. Identify residents who could be affected The facility Social Worker conducted Safe Surveys with residents that have recently attended appointments, and no issues were identified on 10/10/2025. Action Taken *Re-education began on 10/10/2025, 100% staff in services on Abuse, Neglect, and Exploitation was completed 10/11/25 by Administrator/Director of Nurse or designee. Re-education will be verified by roster by the Human Resource Coordinator. The re-education will be assessed by posttest provided to staff. New hires, staff out on leave, agency, and PRN staff will receive in-service training upon hire and return from leave.*The Administrator and Director of Nurses received in-service training on Abuse, Neglect, and Exploitation on 10/11/2025 by the Regional Clinical Specialist.*All facility back-up drivers were immediately re-educated by the Director of Nursing on 10/10/2025 and again on 10/11/2025 regarding the facility appointment process:*Confirm residents' appointment with nurse *Verify with charge nurse if resident requires to be accompanied by transportation aide based on BIMS score of greater than 12.*If residents do not require to be accompanied by transportation aide, the driver must physically escort resident to appointment location and have the resident sign in to the appointment location (i.e., MD's office, surgical centers). The driver will not leave the resident unaccompanied.*Ensure to obtain paperwork necessary for appointments from the nurse.*Verify that the appropriate assistive devices are transported with the resident to the appointment.*Meet with scheduler during weekdays to ensure accuracy of appointments.*The re-education will be assessed through question and response to the training. New hires, staff out on leave, agency, and PRN staff will receive in-service training upon hire and return from leave. Systemic Change *DON and/or ADONs will review and confirm appointments for the following day and assign residents escorts as deemed appropriate on 10/11/2025. *DON and ADONs will enter an order in PCC regarding the resident's scheduled appointment on 10/11/2025. Order(s) will include:* Reason for the appointment * Name of the MD/Practice *Address of appointment*Time of appointment*Assistive device notation *Escort requirement*The order will be scheduled to fire off the day before and the day of the appointment. *Charge nurses re-education on resident appointment process completed on 10/11/2025 by Director of Nurses/designee. *The scheduler re-educated by the Administrator/designee regarding posting the scheduled appointment list daily during stand down meeting by the scheduler. List will be posted at each nurse station by the scheduler.*Administrator/designee educated the newly identified scheduler to meet with van driver daily to review appointments scheduled to ensure cancelations are communicated on 10/11/2025. *Director of Nurses/designee re-educated Charge nurse verify (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455599 If continuation sheet Page 3 of 5 Printed: 05/15/2026 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 455599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Rehabilitation and Skilled Nursing C 2806 Real St Austin, TX 78722 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 appointment order in PCC prior to releasing the resident's paperwork to van driver. *Any new hire staff members that are involved in the resident transportation procedures will receive education related to the process for scheduling and transportation of facility residents. Monitoring *DON/Designee will monitor the appointment schedule and PCC orders to identify any residents with new appointments to ensure the following are completed: a physician order with time, address, MD/location, Escort requirements, and assistive device. Weekly for the next 90 days.*During clinical morning meetings Director of Nurse/designee will verify and confirm appointments for the following day with charge nurses and scheduler. *During standdown, the facility scheduler will review any schedule changes with Director of Nurses or designee, and the appointment order will be updated as needed and appointment list will be verified for the following day. *DON/ designee will report on the monitoring results to the QAPI Committee monthly x 3 months. The Survey Team monitored the Plan of Removal as follows: Interview on 10/12/2025, at 12:19pm, Van Driver J, stated that he was in-serviced on Abuse, Neglect, Exploitation & Misappropriation and received a staff individual in-service record on transporting residents to appointments on 10/11/2025. Interview on 10/12/2025, at 12:31pm Scheduler B, stated she received an email from the MDS nurse stating that Resident # 1's appointment was canceled by her guardian. However, Scheduler B failed to mark the cancellation in her calendar and, while notifying a nurse on Monday morning, forgot to inform the driver. Scheduler B admitted the facility's protocol requires recording appointments in a calendar book, documenting changes, and entering updates in the 24-hour report for shift continuity. Interview on 10/12/2025, at 12:59pm, LVN C, stated she was in-serviced on Appointment process, Appointment verification, Transportation when she arrived on shift. She stated the Assistant Director of Nursing (ADON) explained the facility's transportation procedures for resident appointments. Orders must include doctor information, address, appointment type, and escort requirements, scheduled one day prior. The scheduling coordinator creates weekly appointment lists with resident names, times, and addresses. Charge nurses are responsible for providing necessary assistive devices like wheelchairs, canes, or walkers before transport. Interview on 10/12/2025, at 1:42pm, with Van Driver D, stated that she has served as backup van driver and also a CNA at the facility for three years. Her transport responsibilities include reviewing appointment schedules, confirming with nurses, notifying residents, and ensuring necessary assistive devices are available. She will determine if all residents need someone to accompaniment them before each trip. Van Driver B completed official safety transfer training approximately six months ago and has received abuse and neglect prevention training, demonstrating knowledge of various abuse types including financial, physical, verbal, social media, and sexual abuse. Interview on 10/12/2025, at 2:20pm with Medical Director E, affirmed that Resident# 1 requires supervision and always needs her assistive device. He also acknowledged the facility's protocol gap and confirmed Heritage Park is implementing a new policy ensuring supervised patients receive continuous support, including warm handoffs for appointments. The Medical Director expressed commitment to preventing similar incidents through this policy. Interview on 10/12/2025 at 3:00pm with Regional Clinical Specialist F, stated she in serviced the Administrator and DON on Abuse, Neglect, and Exploitation. She stated she in serviced them related to the incident that occurred related to resident transfer on 10/10/2025. Record review on 10/12/2025, revealed in-services provided to staff by the DON with class attendance records for Abuse, Neglect, Exploitation & Misappropriation. Additionally, records revealed in services for the Appointment process, Appointment verification, Transportation and staff individual in-service records. Record review of Resident #1's progress notes dated 10/12/2025, revealed that following the incident the resident was followed up for emotional distress, Resident# 1 was in bed stable, even unlabored breathing call light (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455599 If continuation sheet Page 4 of 5 Printed: 05/15/2026 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 455599 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Park Rehabilitation and Skilled Nursing C 2806 Real St Austin, TX 78722 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 in place no complaint of pain or distress. No refusal of care. Calm and cooperative with staff and residents. Observations and interviews on 10/14/2025, at 2:55pm revealed Resident# 1 lying in bed watching Tv. Resident # 1 was dressed for the day and told me she had just completed her daily smoke break. She had lunch in her room and stated that she preferred to eat later in the evening. Interview on 10/14/2025, at 8:59am with Guardian G, stated Resident #1 was mistakenly transported Resident # 1 to an unscheduled appointment without her walker. Security found her outside at 7:00am after being dropped off at 6:00am. The facility acknowledged their error and implemented corrective measures. Family Elder Care has served as Resident # 1's court-appointed Guardian since 2020 due to dementia. Despite these lapses, the respondent notes Resident# 1, generally remains content at Heritage Park, which she considers home. Interview on 10/14/2025, at 12:14pm, CNA H, stated that she had only been working for the facility for two years. She stated she recently attended in-service training covering procedures for doctor appointments and the requirement to always remain with residents during appointments. She stated the training emphasized completing all documentation and contacting facility nurses or supervisors with any questions. CNA H also stated she received abuse and neglect training and explained that leaving residents unattended poses serious risks including wandering, falls, and undetected health deterioration. Additionally, residents attending appointments without assistive devices face increased risks from falls or accidents, potentially worsening their medical conditions. Interview on 10/14/2025, at 1:27pm with LVN I, stated she discovered her former hospice patient Resident # 1 had been improperly transported to a canceled medical appointment. The facility failed to verify the appointment status before allowing transport, leaving Resident # 1 unattended outside the building without staff supervision, and sent her without her required walker despite her wandering history and cognitive impairment. LVN I, learned from Guardian A that Resident # 1 had been waiting alone since early morning. The night shift failed to remove the canceled appointment from the schedule. Record review of Resident #1's progress notes dated 10/14/2025, at 1:08 pm revealed Resident # 1 continues behavior monitoring for emotional distress. Resident # 1 alert and oriented to person, place and situation, no signs of distress notes. Resident #1 is currently in her room awaiting lunch, denies pain or discomfort. An IT was identified on 10/11/2025at 06:08 pm. The ADM was notified of the IT, and the IT Template was provided to the facility on [DATE] at 5:23p.m. While the IT was removed on 10/14/2025, the facility remained out of compliance at a scope of isolated and a severity of no actual harm with the potential for more than minimal harm that is not immediate threat. Event ID: Facility ID: 455599 If continuation sheet Page 5 of 5