Health inspection·October 29, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few to go back to her room, left dining room ambulating via walker and returned to her room.[8:09 AM] Co-nurse reported to this nurse [LVN-E] that she assisted [Resident #1] to sit on the side of bed and served breakfast in her room.[8:30 AM] During routine med pass resident was not in assigned room. This nurse [LVN-E] looked down middle, east, and west hallways, in the foyer and outside by front entrance, then asked co-nurse and other staff members if they see resident. [8:36 AM] Weekend supervisor notified. Notified MOD who stated she will go to 2nd floor, inform staff, and look for [Resident #1]. Co-nurse left facility in her car to search for resident. This nurse [LVN-E] and 3rd nurse searched 1st floor in all rooms, toilets, closets, stairwell, shower rooms, and other miscellaneous rooms. 2nd floor ADON-B and multiple staff searched facility parameters and [Next Door].[8:40 AM] This nurse called [Resident #1] cell phone multiple times, no answer, left voicemail requesting call back. [8:44 AM] Notified DON who stated she will be in communication with weekend supervisor and administrator and update staff accordingly.[8:55 AM] This nurse [LVN-E] called [Family] who stated resident was not with her and possibly left with her friends. [Family] stated she will call her friends to confirm.[9:05 AM] Called administrator left voice mail requesting call back.[9:21AM] Received call back from administrator who instructed this nurse [LVN-E] to continue to search rooms, including 2nd floor. [9:25 AM] Received message from weekend supervisor who informed this nurse [LVN-E] that resident was with her [Family]. [9:27 AM] Overhead page from ADON-A to cancel search. Record review of World Weather for October 25, 2025, reflected, the weather was 64 degrees Fahrenheit in the city with southeast winds at a speed of 3.6.Record review of Google Maps revealed Resident #1 would have traveled through residential roads to arrive at the apartment complex. On 10/28/2025 the State Surveyor observed the video, on the computer at the facility, of Resident #1's elopement from the facility. The video revealed the following:Video dated Saturday 10/25/2025 between 8:05 AM and 8:07 AM, Resident #1 was observed walking out of her room using her walker. A man was observed walking behind Resident #1 and passed her in the hallway and walked to the front door. The man was observed standing in front of the door looking around and then he was observed pushing the buttons on the keypad next to the front door. After pushing the numbers on the keypad the man pushed the door and the door opened and he went out of the facility. The man was identified by the Administrator, as a delivery person. The resident arrived at the front door a short time after the delivery person exited, she looked around the door area, Resident #1 pushed the door two times, but the door did not open. Resident #1 then looked around the door, pushed some numbers onto the keypad and pushed the door and the door opened at about 8:12 AM. Observation of the video reflected no facility staff in the hallway during the time Resident #1 walked down the hallway to the front door. Resident #1 walked out of the facility at 8:12 AM, and a few minutes later out of the sight of the camera.In a face-to-face interview with the Administrator on 10/28/2025 at 9:43 AM, she stated the video on 10/25/2025 showed at 8:12 AM, Resident#1 punched in the code and exited the building. She stated that Resident #1 had a BIM of 12 (Moderately Impaired cognition). The Administrator said Resident #1 had been standing around in the front lobby area for the past few days, but that she had never expressed that she wanted to leave the facility. She stated the staff noticed Resident #1 was missing at 8:15 AM and searched the facility and called the family The Administrator stated that Resident #1 was taking antibiotics for a UTI and 10/25/2025 was supposed to be the last day of taking antibiotics. She stated that Resident #1 was at risk of being injured, she could have fallen, been kidnapped, or she could have gone to the wrong apartment or encountered the wrong person. In a confidential witness interview on an undisclosed date at an undisclosed time, the witness stated she made a staff member from the facility aware Resident #1 was at an apartment complex, at around 9:30 AM. The confidential witness stated the apartment was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455823 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 455823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treemont Healthcare and Rehabilitation Center 5550 Harvest Hill Rd Dallas, TX 75230 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 about 2 miles away from the facility. The confidential witness stated that when Resident #1 arrived she appeared to be stressed, lethargic, hungry, dehydrated, her blood sugar was low, and her blood pressure was elevated. The confidential witness stated that Resident #1 was being treated for a UTI at the facility and was still showing some signs of confusion and was taken to the hospital at around 5 PM on 10/25/2025.In an interview with ADON-A on 10/28/2025 at 2:45 PM, she stated if a person used the door code to open the door, it would not alarm. She stated that Resident #1 must have been watching someone use the door code to open the door. She stated that Resident #1 had been hanging around the front door the past week, but she had not tried to elope.In a telephone interview with the RN-C on 10/28/2025 at 4:26 PM, he stated on 10/25/2025 at breakfast, Resident #1 was sitting in the dining room and requested to go back to her room to eat. He stated that the LVN-W took Resident #1 and her food to her room. He denied he had seen Resident #1 leave out of her room because he was in the dining room serving other residents. He stated that later he was notified by RN-D Supervisor that Resident #1 was missing, and they began to look for her. He stated that Resident #1 had not showed any signs of wanting to leave the facility or trying to elope before 10/25/25.In a telephone interview with LVN-W on 10/28/2025 at 4:48 PM, she stated that Resident #1 was in the dining room when she stated she wanted to eat her breakfast in her room. She stated that she took Resident #1 and her food to her room, set her food up in the room for her to eat and went back to the dining room to serve the other residents at about 8:05 AM. She said about 30 minutes later; she was told by the RN-D supervisor and LVN-E they were looking for Resident #1. She said she did not see Resident #1 leave her room. She stated prior to 10/25/25 Resident # had not voiced that she wanted to leave the facility, she was always happy to do her PT. In an interview with the DON on 10/28/2025 at 4:50 PM, she stated that Resident #1 had left the facility during breakfast on 10/25/2025 by using the door code. She stated that the staff did not know the resident was missing and when it was discovered around 8:30 AM during medication pass they began to look for the resident and notified her and the Administrator. She stated that when they talked to the family member and the resident was not returning, they asked the family to sign an AMA. She stated that when the family member arrived, she refused to sign the AMA. She stated that the resident had been at risk of harm by someone, getting lost, falling or getting in the car with a stranger. In a telephone interview with LVN-E on 10/28/2025 at 5:03 PM, she said she was the person assigned to Resident #1 on 10/25/2025. She stated that she responded to the call light of Resident #1 at approximately 6:45 AM on 10/25/2025. She said when she went into the room Resident #1 asked for assistance getting dressed. LVN-E stated she assisted Resident #1 to the dining room where she sat at a table and was working on a puzzle. She stated while the food was being served Resident #1 stated she wanted to eat in her room. She stated Resident #1 would walk to the front of the building all the time, but she had not tried to leave. She stated Resident #1 was always friendly when she went to PT but she never attempted to leave the facility. She stated Resident #1 was assisted to her room between 7:15 AM and 8:00 AM. LVN-E stated that Resident #1's breakfast was set up at her bedside at approximately 8:09 AM. She stated that at around 8:30 AM she went to the room of Resident #1 to pass her routine medication and Resident #1 was not in her room. She stated she looked down the hallways and in the area of the front entryway, and outside of the building but did not see Resident #1. She stated that at that time she asked her co-workers, the LVN-W and the RN-C but they had not seen Resident #1, then she notified the RN-D Supervisor that she could not find Resident #1. She stated that at that time all staff were notified Resident #1 was missing and everyone was looking for her. On 10/28/2025 at 5:20 PM, attempted to call RN-D Supervisor , no response received by the time of exit. Record review of facility undated Elopement Response policy reflected, 2. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455823 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 455823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treemont Healthcare and Rehabilitation Center 5550 Harvest Hill Rd Dallas, TX 75230 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 Determination of missing resident either by routine nursing rounds or door alarms: A. A resident is determined missing when he/she leaves the facility without the staff's knowledge.C. A resident must demonstrate a free and willful intent to leave the facility without prior notification of staff or is a wandering, confused resident who leaves the facility unattended.5. Deployment Procedure:A. Charge Nurse on each unit send staff down each hall to check each room, including bathroom, closet and bed for correct resident.B. Check all rooms on the hall including tub and bathrooms, linen closets and any recreation rooms. Check all common areas and offices.An IJ was identified on 10/28/2025. The Administrator was notified of the IJ on 10/28/2025 at 04:38 PM and was given a copy of the IJ template and a POR was requested. The facility's POR for the IJ was accepted on 10/29/2025 at 9:21 AM and reflected the following: Facility: [Facility] Date: October 28, 2025Plan of Removal Problem: F689 Free of Accident/Hazards and Supervision Interventions:1. Resident #1 no longer resides in facility as of October 28, 2025.2. Resident was offered to return to the facility on [DATE] by the Administrator. Resident chose to remain with family member at the apartment. 3. All door codes will be changed by the Maintenance Director and will not be shared with residents or family members as of October 28, 2025. 4. All door alarms were checked for proper functioning and alarming by the maintenance director. All doors are alarming and function properly. Completed 10/28/25.5. Elopement risk assessments for all residents in the facility were completed and reviewed by the DON/ADON/Designee on 10/28/25. No additional residents were identified as exit seeking or expressing a desire to leave the facility. 6. All elopement risk care plan interventions were reviewed by the Regional Compliance Nurse, DON, and ADON. All interventions are in place and care planned for residents at high risk for elopement. No residents are currently expressing a desire to leave the facility. Completed 10/28/25.7. The Administrator, DON, and ADON were in-serviced 1:1 by the ADO and Regional Compliance Nurse on 10/28/25 on the following:a. Elopement Prevention Policy- to include that any resident attempting to leave the facility unassisted will be redirected back into the facility. Administrator and/or DON will be notified immediately. b. Elopement Response Policy c. Abuse and Neglect Policy- a missing resident must be reported to the administrator and DON immediately. Missing residents are reportable to the state immediately but within 24hrs. d. Door Codes - the door codes to enter and leave the facility will not be shared with residents and family members. Sharing the door code could aide in a resident leaving the facility unsupervised and place the resident at risk for a negative outcome. 8. The Medical Director was notified of the immediate jeopardy citation on 10/28/25 by the Administrator/DON. 9. An ADHOC QAPI meeting was completed on 10/28/25 to review the immediate jeopardy citations and subsequent plan of removal. In-services:1. The Regional Compliance Nurse, Administrator, DON, and ADON will in-service all staff on the following topics below. All staff not present for the in-services will not be allowed to work their next shift until the in-services are complete. All new hires will be in-serviced during orientation prior to working their shift. All agency staff will be in-serviced prior to assuming scheduled shift. Completed 10/28/25.a. Elopement Prevention Policy- to include that any resident attempting to leave the facility unassisted will be redirected back into the facility. Administrator and/or DON will be notified immediately. b. Elopement Response Policy a. Abuse and Neglect Policy- a missing resident must be reported to the administrator and DON immediately. Missing residents are reportable to the state immediately but within 24hrs. c. Door Codes - the door codes to enter and leave the facility will not be shared with residents and family members. Sharing the door codes could aide in a resident leaving the facility unsupervised and placing the resident at risk for a negative outcome. Monitoring of the Plan of Removal from 10/29/25 included the following:Interviews with PT-F, Housekeeper G, Housekeeper H, Dietary Aide I, [NAME] J, OT-K, PT-L, HR-M, BOM-N, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455823 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 455823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Treemont Healthcare and Rehabilitation Center 5550 Harvest Hill Rd Dallas, TX 75230 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 AD-O, Rehab Director, Med Aide-P, CNA-Q, CNA-R, CNA-S, ADM in Training, LVN-T, RN-U, LVN-V, and LVN-W on 10/29/2025 from 1:10 PM - 3:57 PM, reflected they were in-serviced that all people not employed by the facility must sign in when they enter the facility. They stated they were in-serviced that they should not share the door code with any family members, visitors, or vendors. They stated they were in-serviced that if a resident was missing, they would call a code orange, which would indicate to all staff that a resident was missing, everyone needed to look for the missing resident, and 911 would be called if a resident was missing for 30 minutes or more. They stated that they were in-serviced that residents who are cognitively intact could sign in/out of the facility. In an interview with the Maintenance Director on 10/29/2025 at 4:01 PM, he stated he had put a cover on the keypads and changed all the codes to the outside doors. He stated that the highlighted areas on the floor plan indicated the date all the changes were made to the door codes. He stated that the staff were not supposed to share the code with any visitors or family members. In an interview with the DON on 10/29/2025 at 4:07 PM, she stated that upon hiring new staff, they would be in-serviced on the importance of not giving residents and visitors the door code, she will be conducting elopement drills with all staff. In an interview with the Regional Compliance Nurse, Administrator, DON, and ADON on 10/29/25 at 4:35 PM, they stated their manager in-service included ensuring employees who were on leave or regular day off would be in-serviced on the new door codes privacy, elopement policy, conducting elopement assessments on all residents, and abuse, neglect, and supervision. The Administrator was notified that while the IJ was removed on 10/29/2025 at 4:57 PM, the facility remained out of compliance at a scope of Isolated and a severity level of no actual harm because the facility needed to evaluate and monitor the effectiveness of their corrective actions that were put into place. Observations of the exit doors revealed alarms were sounding, Maintenance Director observed changing the door code on the front exit door and adding a keypad cover 10/28/25 at 6:00 PM. Record review of elopement prevention policy undated Elopement Response reflected, Policy interpretation and implementation1. It is the responsibility of all personnel to report any resident attempting to leave the premises, or suspected of being missing, to the charge nurse as soon as practical.2. Determination of missing resident either by routine nursing rounds or door alarms:A. A resident is determined missing when he/she leaves the facility without the staff's knowledge. B. A resident having a wander guard warning system that sets off an alarm by stepping outside a door and is found immediately does not constitute an elopement. C. A resident must demonstrate a free and willful intent to leave the facility without prior notification of staff or is a wandering, confused resident who leaves the facility unattended. Record review of Resident #1's progress notes dated 10/25/25 reflected, the Administrator spoke with Resident #1 and the legal representative for a coordinated discharge to the community or a transfer to the prior facility, but it was declined.Record review of in-services on elopement prevention and response, privacy of door codes, and abuse and neglect dated 10/28/25 signed by the staff in all departments and shifts. Record review of facility elopement assessments dated 10/28/25 of the current census of 74 residents, reflected no additional residents were identified as exit seeking or expressing a desire to leave the facility Record review of the facility floor plan dated 10/28/25 on all of the exit doors confirmed with the Maintenance Director that the highlighted/dated exits reflected the change of door code or covered keypad.Record review of the Administrator and DON in-service completed 10/28/25. Event ID: Facility ID: 455823 If continuation sheet Page 5 of 5