Health inspection·July 27, 2025

F 0697 Level of Harm - Actual harm Residents Affected - Few of Resident #77's order summary report of active orders as of 07/23/25 revealed orders for: -Oxycodone HCL oral tablet 10mg every 12 hours at 9:00AM and 9:00PM for pain management, order date 07/10/25. -Oxycodone HCL oral tablet 5mg every 6 hours as needed for pain, order date 06/24/25. -Hydrocodone-Acetaminophen oral tablet 10-325mg one tablet every 6 hours as needed for pain, order date 07/02/25. -Methocarbamol 750mg every 12 hours at 9:00AM and 9:00 PM for muscle relaxer, order date 06/10/25 - May go to dialysis on: Monday, Wednesday, Friday at 7:00 AM, order date 06/10/25.Record review of Resident #77's completed orders revealed and order started 06/10/25 for taper dose of Oxycodone HCL 10mg: give 4 tablets by mouth every 12 hours for pain for 6 days, 1 tablet for 7 days; give 3 tablets by mouth every 12 hours for pain for 7 days, 1 tablet for 7 days; give 2 tablets by mouth every 12 hours for pain for 7 days, 1 tablet for 7 day; give 1tablets by mouth every 12 hours for pain for 7 days, 1 tablet for 7 day. The end date for the order was 07/08/25. Record review of Resident #77's June 2025 MAR/TAR revealed pain assessments were completed every shift and pain scores were zero to 5 out of 10. Record review of Resident #77's July 2025 MAR revealed the Oxycodone HCL 10mg to be given every 12 hours, due at 8:00 AM was not given on 7/2/25 and 7/14/25. Further review revealed the Methocarbamol 750mg tablet every 12 hours at 9:00 AM and 9:00 PM for muscle relaxer was not given at 9:00 AM on 07/02/25, 07/14/25 and 07/23/25 and to refer to the progress notes for both Oxycodone HCL 10mg and Methocarbamol 750mg. Record review of Resident #77's Administration progress note revealed on 07/02/25 at 8:29 AM, MA-E noted the resident was at dialysis. On 07/14/25 at 11:52 AM, CNA-H documented the resident was at dialysis. On 07/23/25 at 8:38 AM, CNA-B documented the resident was at dialysis. Record review of Resident #77's July 2025 MAR revealed from 7/01/25 to 07/24/25: Hydrocodone-Acetaminophen oral tablet 10-325mg one tablet every 6 hours as needed for pain was documented as administered 2-4 times per day. Pain levels were documented as 4 to 8 out of 10 (10 being the worst pain imagined). All administrations were documented as effective.-Oxycodone HCL 5mg every 6 hours as needed for pain was documented as administered 17 days, 1 to 3 times per day. Pain levels were documented from 4 to 9 out of 10. All administrations were documented as effective. -The scheduled Oxycodone 10mg twice a day was documented as administered. -Further review revealed Resident #77 was monitored for opioid adverse events every shift. Most entries revealed none was observed. Record review of Resident #77's Administration notes written by RN-A revealed on 07/23 25 at 8:38 AM it was noted the resident was at dialysis. On 07/23/25 at 9:00AM a note by RN-A revealed the follow up pain scale was 0 and effective. On 07/23/25 at 2:00 PM, RN-A documented the administration of Oxycodone HCL 5mg tablet by mouth every 6 hours as needed for pain: request for pain medication for breakthrough leg pain. Further review revealed there was no follow up pain assessment. Record review of Resident #77's July 2025 administration progress notes revealed on 07/23/25 at 3:00 PM, RN-D noted the administration of Hydrocodone/Acetaminophen 10-325mg every 6 hours as needed for pain: one tablet given as directed. Record review of Resident #77's July 2025 MAR revealed on 07/23/25 at 3:00 PM, the resident received Hydrocodone/Acetaminophen 10-325mg and RN-D noted the pain level of 5 and that it was effective. Record review of Resident #77's Administration progress note on 07/23/25 at 3:51 PM, revealed RN-A documented Hydrocodone/Acetaminophen 10-325mg follow up pain was: 0 and the administration was effective. Record review of Resident #77's History and Physical, date of service 7/2/25, by Physician-F revealed he had fracture pain and was still appropriate to continue for Hydrocodone-Acetaminophen 10-325mg and Oxycodone. Continued review indicated the resident was known to have alcohol abuse and very close monitoring would be needed in the facility for s/sx of intoxication and withdrawal. Record review of Resident #77's nurse note dated 07/02/25 at 5:11 PM and written by the ADON/IP indicated that the resident expressed that he had been drinking large amounts of alcohol the prior (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675233 If continuation sheet Page 2 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0697 Level of Harm - Actual harm Residents Affected - Few night. Further review of the nurse note indicated ADON/IP educated the resident of the risks of drinking alcohol and taking medication regimen. Continued review indicated the resident verbalized understanding, and the NP/MD were made aware. Record review of Resident #77's behavior note dated 07/02/25 at 6:00 PM and written by LVN-G, indicated Resident #77 refused medication from the med aide and med aide reassured the medication would be provided, but he still refused. Further review revealed RN-D wrote on 04/25/25 at 7:06 AM, Resident #77 was upset because the Hydrocodone-Acetaminophen oral tablet 10-325mg could not be given at the time due to the fact the night time nurse had given a dose at 5:00 AM. Continued review of Resident #77's behavior notes dated 09/24/22 to 07/17/25 revealed no documentation regarding the resident crying out in pain. Record review of Resident #77's Administration progress notes on 07/02/25 at 8:29AM noted the resident went to dialysis. Continued review of the progress notes revealed an administration note on 07/14/25 at 7:32AM for Hydrocodone-Acetaminophen 10/325mg. The next entry was on 07/14/25 at 11:52, AM and noted the resident was at dialysis. There was no entry on 07/14/25 noting the resident was at dialysis at 9:00AM. Record review of Resident #77's Medical Professional Note, date of service 7/9/25 by Physician-F revealed in part: .Pain Management Continue Oxycodone 10 mg every 12 hours scheduled and 5 mg every 6 hours as needed for breakthrough pain. Also continue Hydrocodone-Acetaminophen 10-325 mg every 6 hours as needed. Monitor pain levels, effectiveness of regimen, and signs of sedation, constipation, or misuse. Consider simplifying opioid regimen to avoid overlapping narcotics if sedation or altered mental status arises. Observation and interview on 07/22/25 at 12:56PM, revealed Resident #77 was in the dining room, reclined in a specialized wheelchair. He had an external fixator/traction device, the pins were in his left leg. He had dressings to his feet. He was feeding himself and in no distress. Resident #77 stated he was hit by a truck and was in the hospital for surgery to his leg. Observation and interview on 07/23/25 at 6:55 AM, Resident #77 stated the transportation to dialysis would be arriving soon and that he was due for pain medications: Oxycodone and Hydrocodone-Acetaminophen 10-325mg at 7:30AM. He stated sometimes it may take 2.5 hours before he received pain meds after he asked for them. He stated because of the delay in receiving pain medication when he requested, it would disrupt his medication schedule preventing him from adequate pain control before going to dialysis. He stated it infuriated him and sometimes he cried when he ended up missing a dose of pain medication. He was observed scratching his skin and moving his upper body without any hesitation. At 7:15 AM Resident #77 turned on the call light. Nursing staff answered a few minutes later. Resident #77 requested his pain meds and told the nurse he was going to dialysis very soon. Resident #77 stated he usually asked multiple times to get what he needed before leaving for dialysis and at times he would not receive his pain meds. He stated his pain was in his leg and his back. At 7:35 AM RN-A assessed Resident #7, checked his vital signs then Resident #77 told her his pain level was 8 out of 10. Interview on 07/23/25 at 7:45 AM, RN-A stated Resident #77's Oxycodone was scheduled every 12 hours and was due at 9:00AM, the Hydrocodone-Acetaminophen 10-325mg was as needed for pain. RN-A stated she would need to wait closer to 8:00AM to administer the medications as the scheduled Oxycodone could only be given one hour before or one hour after 9:00 AM RN-A stated the plan was to wean down the amount of narcotics Resident #77 was taking and that he had history of drug seeking and that he was used to the drugs he was receiving while in hospital. Observation on 7/23/25 at 7:55 AM, revealed Resident #77 was in the gurney as transportation attendants wheeled the resident down the hall. Observation on 7/23/25 at 8:00AM revealed Resident #77 was taken back to his room. RN-A administered Oxycodone IR 10mg and Hydrocodone-Acetaminophen 10-325mg one tablet to Resident #77, attendants then wheeled him back down the hall to transport in the ambulance to dialysis. IIn an Interview on 07/24 25 at 9:30AM, ADON-I stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675233 If continuation sheet Page 3 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0697 Level of Harm - Actual harm Residents Affected - Few she would expect a resident's pain to be addressed in a timely manner, get them the pain med, offer repositioning, if still not working she would notify the MD. ADON-I stated 2 hours is not acceptable for waiting on pain med and maybe 1-2 hours would be maximum, but she was unsure and would have to check the policy. ADON-I stated the pain level would depend on the individual resident's interpretation of pain. ADON-I stated if the pain level was a 4 or 5 and the resident was comfortable and wanted more pain medication, she would administer what was due, try repositioning or call the doctor. ADON-I stated she expected the nursing staff to do the same. ADON-I stated no one wants to be in constant pain, the resident may be grumpy and not want to do any ADLs. ADON-I stated it could worsen their health status. ADON-I stated medications can be given one hour before or one hour after scheduled order for time. ADON-I stated Resident #77 was followed by pain management doctor at one time, she was unsure but may be due to insurance. ADON-I stated Resident #77's pain management was under Physician-F who was the primary care physician. In an interview on 07/24/25 at 9:45 AM, the ADON/IP stated she was familiar with Resident #77. The ADON/IP stated if a resident asks for pain medication immediately, she expected nursing staff to check in 30minutes to see if the pain had subsided and if not, she would notify the MD for further instructions. The ADON/IP stated they[BR10] would try comfort measures as well to help manage pain. The ADON/IP stated if a resident had uncontrolled pain, she would contact the MD to adjust the meds. The ADON/IP stated most of the time medications would be scheduled around appointments, if not then the MD would be contacted to reschedule. The ADON/IP stated Resident #77 had a pain specialist and then pain management was transitioned to the provider. The ADON/IP stated transportation for dialysis would usually leave at 8:15am and as far as she knew he was receiving the 9:00AM meds before leaving. The ADON/IP stated Resident #77 does have breakthrough pain, she visits with him on multiple occasions and had not mentioned any issues about not getting his pain meds. The ADON/IP stated the medication aide was responsible for administering his 9:00AM medications and if they were missed, she expected to be notified so she can contact the MD and adjust the times. In a telephone interview on 07/24/25 at 12:40 PM, Physician-F stated he was very familiar with Resident #77 and that he was responsible for managing his pain meds. Physician-F stated Resident #77 was pain med seeking and that his subjective determination of pain can be different for everyone and his was a little bit off. Physician-F stated he does not use a pain scale but uses objective findings instead. Physician-F stated he received calls about his pain every week about his pain status and the nurses will also text him on his cell phone frequently. Physician-F stated he sees Resident #77 three days a week and would have complaints about pain. Physician-F stated Resident #77 can get his medications either before or after dialysis and he had already made the changes when ADON/IP notified him. In an observation and interview on 07/23/25 at 1:45 PM, revealed Resident #77 returned from dialysis and was in the dining room playing cards, no distress was noted. He stated normally it would take about one hour to receive his pain medications. When asked if he remembers what time he asked for pain medication this morning, he stated it was just before the surveyors entered his room around 7:00AM. He stated the ride in the ambulance was rough and his pain level was 8-9/10 at the time. He stated he would ask the drivers to avoid bumps in the road, but they could not promise that. In an Interview on 07/24/25 at 1:47 PM, LVN-C stated when Resident #77 requests pain medication, he reports his pain to be a 7 or 8 out of 10, she would then check which pain medication could be given. LVN-C stated she has seen Resident #77 cry or scream loudly in the last month when he did not get his pain medications when he asked. LVN-C stated she would address the pain by offering available pain medication, repositioning such as moving him into his wheelchair and if that did not work, she would contact the MD for further instructions. Interview on 07/24/25 at 2:00 PM, RN-D stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675233 If continuation sheet Page 4 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0697 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #77 received all his scheduled and PRN pain medications. RN-D stated his tolerance to pain medications was high, however with his illness and injury he was often in pain and that his pain level was a 7 or 8 out of 10. RN-D stated she would use non-pharmacological interventions to help him with the pain. RN-D stated he did well when up in the wheelchair with activities for distraction. RN-D stated she would contact the physician after two to three episodes of no pain relief for further instructions. Interview on 7/25/25 at 9:40 AM, RN-A stated on dialysis days she was aware Resident #77 would be gone for at least 6 hours and that he would need the pain coverage so that was why she gave both the Oxycodone and Hydrocodone-Acetaminophen oral tablet 10-325mg at 8:00 AM on 07/23/25. RN-A stated sometimes it could take a little time to get what Resident #77 needed especially when in the middle of doing something for another resident and could not always respond as quickly as he would like but she tried to get to him in an hour or less. Record review of the facility policy and procedure for Administering Pain Medication, revised October 2022, revealed in part: The purpose of this procedure is to provide guidelines for assessing the resident's level of pain prior to administering analgesic pain medication.General Guidelines 1. The pain management program is based on a facility-wide commitment to appropriate assessment and treatment of pain, based on professional standards of practice, the comprehensive care plan, and the resident's choices related to pain management. 2. Pain management is defined as the process of alleviating the resident's pain based on his or her clinical condition and established treatment goals.5. Acute pain (or significant worsening of chronic pain) should be assessed every 30 to 60 minutes after onset and reassessed as indicated until relief is obtained.7.a. Any resident who uses opioids for long-term management of chronic pain is at risk for opioid overdose.9. Re-evaluate the resident's level of pain 30-60 minutes after administering. Event ID: Facility ID: 675233 If continuation sheet Page 5 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 of 4 residents (Resident #77) reviewed for pharmacy services.MA-B failed to administer Sevelamer (a phosphate binder used to control high phosphorus levels in residents on dialysis) as instructed on the pharmacy label.This failure could place residents who receive medications at risk of not receiving the intended therapeutic benefit of the medications. Findings included:Record review of Resident #77's face sheet dated 07/23/25 revealed a [AGE] year-old male readmitted to the facility on [DATE], initially admitted on [DATE] and originally admitted on [DATE]. His diagnoses included fracture of the shin bones of left and right leg, end stage renal disease (kidneys no longer function adequately requiring dialysis or transplant), Osteoarthritis (degeneration of joint cartilage and bone), anxiety, and dependence on renal dialysis.Record review of Resident #77's quarterly MDS dated [DATE] revealed a BIMs score of 14 out of 15 indicating intact cognition. Section I - Active Diagnoses included renal failure.Record review of Resident #77's undated care plan indicated a plan of care that included: Focus - Resident #77 was receiving dialysis for ESRD and at risk for symptoms including dry/itchy skin. Interventions included to give medications as ordered.Record review of Resident #77 active orders as of 07/23/25 revealed an order for Sevelamer HCL 800mg, take 3 tablets by mouth with meals for phosphorous control.Record review of Resident #77's July 2025 MAR/TAR indicated MA-B administered Sevelamer 800mg, 3 tablets on 07/23/25 at 8:00 AM. Further review revealed the MAR included give 800mg by mouth with meals for control of phosphorous level, take 3 tablets.Observation and interview on 07/23/25 at 6:55 AM, revealed Resident #77 was scratching his back and front of body using a back scratcher. His skin was dry. He stated he takes the phosphate binder Sevelamer with meals.Observation of medication pass on 07/23/25 at 7:45 AM, revealed MA-B administered Sevelamer Carbonate 800mg, three tablets to Resident #77. The pharmacy label instructions were to take with meals. MA-B did not administer with food.In a telephone interview on 7/25/25 at 9:40AM, RN-A was the nurse in charge of Resident #77 on 7/23/25 and was unaware that Resident #77 received the Sevelamer without food and that the orders should have been followed.A telephone interview was attempted on 07/26/25 at 9:00AM with MA-B. A message was left on voicemail to return surveyor call. Received no call back.Record review of the facility policy and procedure for Administering oral medications, revised October 2010, read in part: The purpose of this procedure is to provide guidelines for the safe administration of oral medications. Preparation 1. Verify that there is a physician's medication order for the procedure.Steps in the Procedure.6. Check the label on the medication and confirm the medication name and dose with the MAR. Event ID: Facility ID: 675233 If continuation sheet Page 6 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that residents were free of significant medication error for 1 of 6 residents (Resident #77) reviewed for medication administration.The facility failed to ensure Resident #77 received the correct controlled substance for pain medication as ordered by the physician leading to multiple opioid administrations between 06/12/25 and 07/26/25.-Resident #77's narcotic sheets for Oxycontin ER 10mg contained documented sign out dates from 06/12/25 to 07/26/25. There were no physician orders for Oxycontin ER 10mg.-Resident #77's narcotic sheet for Oxycodone IR 10mg one tablet every 12 hours contained documented sign out dates that did not match the instructions on the pharmacy label. These failures could place other residents at risk of medication errors, opioid overdose, CNS depression, respiratory distress and death.Findings included:Record review of Resident #77's face sheet dated 07/23/25 revealed a [AGE] year-old male readmitted to the facility on [DATE], initially admitted on [DATE] and originally admitted on [DATE]. His diagnoses included fracture of the shin bones of left and right leg, COPD (chronic obstructive pulmonary disease) (a lung condition caused by damage to the airway, end stage renal disease (kidneys no longer function adequately requiring dialysis or transplant), cirrhosis of the liver (abnormal liver function), Osteoarthritis (degeneration of joint cartilage and bone), hypotension, heart failure, depression, anxiety, chronic pain syndrome and dependence on renal dialysis. Record review of Resident #77's quarterly MDS dated [DATE] revealed a BIMs score of 14 out of 15 indicating intact cognition. He had no behaviors or rejection of care. He used a wheelchair for mobility. Pain intensity over the last 5 days was rated at a 6 out of 10, with zero being no pain and 10 being the worst pain ever imagined. Further review revealed he was taking antianxiety and opioid medications. Record review of Resident #77's order summary report of active orders as of 07/23/25 revealed orders for: -Oxycodone HCL oral tablet 10mg every 12 hours for pain management, order date 07/10/25. -Oxycodone HCL oral tablet 5mg every 6 hours as needed for pain, order date 06/24/25. -Hydrocodone-Acetaminophen oral tablet 10-325mg one tablet every 6 hours as needed for pain, order date 07/02/25. - Resident #77 had no documented orders for Oxycodone ER 10mg.-Hydrocodone/Acetaminophen 10/325mg, one tablet every 6 hours as needed for pain-Methocarbamol 750mg, one tablet every 12 hours for muscle relaxer-Gabapentin 100mg, 2 tablets every Monday, Wednesday, Friday after dialysis for neuropathy (condition that damages nerves and can cause pain) Record review of Resident #77's completed physician's order for tapering of Oxycodone HCL(IR) 10mg ordered on 06/10/25 revealed: - 4 tablets every 12 hours for 7 days, start date 06/11/25. - 3 tablets every 12 hours for 7 days, start date 06/17/25. - 2 tablets every 12 hours for 7 days, start date 06/24/25. - 1 tablet every 12 hours for 7 days, 07/01/25 and end date 07/08/25. Record review of Resident #77's Pharmacy Controlled Substance Prescriptions revealed: - 06/09/25 a prescriber from the hospital ordered Oxycontin (Oxycodone) ER 10mg to start on 6/09/25 included taper orders. -On 06/10/25 the pharmacy dispensed Oxycontin ER 10mg and this was used by the facility on 06/12/25 to 06/27/25. -On 06/10/25, Resident #77's physician ordered Oxycodone HCL(IR) 10mg, with taper orders to start 06/11/25 and end 07/08/25. -On 06/24/25 the pharmacy dispensed Oxycontin ER 10mg (instead of Oxycodone HCL(IR) 10mg). Oxycontin was used by the facility 06/28/25 to 07/26/25. Record review of Resident #77's narcotic sign sheets revealed: - Oxycontin ER 10mg, with the taper orders (4 tablets every 12 hours for 7 days, 3 tablets every 12 hours for 7 days, 2 tablets every 12 hours for 7 days, 1 tablet every 12 hours for 7 days) was signed out 06/12/25 to 06/27/25. The hospital physician was listed as the prescriber on the pharmacy label and not Resident #77's facility Physician. -Oxycontin ER 10mg, received on 06/24/25, had instructions on the label for the above taper orders, doses were signed out on Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675233 If continuation sheet Page 7 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 06/28/25 to 07/26/25. The hospital physician was listed as the prescriber on the pharmacy label and not Resident #77's facility Physician. - Oxycodone IR 10mg every 12 hours, received on 07/04/25, and doses were signed out on 07/04/25 and signed out on various dates through to 07/23/25. The signed dates were inconsistent with the instructions on the pharmacy label and not given every 12 hours. Record review of Resident #77's June and July 2025 MARs printed on 07/23/25 indicated nursing staff documented administration of Oxycodone HCL 10mg taper orders starting 06/11/25 to 07/08/25 then continued documenting twice daily until 07/26/25 except for 07/10/25, 07/11/25, 7/15/25, 07/21/25 when only one dose daily was administered. Resident #77 had no order listed on the MARs for Oxycontin ER 10mg taper orders. Record review of Resident #77's July 2025 MAR printed on 07/25/25 indicated nursing staff documented the administration of Oxycodone HCL 10mg 1 tablets every 12 hours for 7 days: -07/01/25 at 8:00 PM, 07/02/25 8:00 AM dose was held and not given, 8:00PM dose was given. Resident #77 received the medication twice daily on 07/03/25, 07/04/25, 07/05/25,07/06/25, 07/07/25 and 07/08/25 at 8:00AM. Resident #77 had no order listed on the MARs for Oxycontin ER 10mg one tablet twice daily for 7 days. Further review revealed Hydrocodone-Acetaminophen oral tablet 10-325mg one tablet every 6 hours as needed for pain was documented as administered one to 4 times per day for 19 days between 7/5/25 and 7/25/25. Resident #77's pain levels were documented 4 to 8 out of 10 (10 being the worst pain imaginable). Further review of Resident #77's July 2025 MAR revealed Oxycodone HCL oral tablet 5mg every 6 hours as needed for pain was documented as administered one to 3 times per day, for 17 days between 07/01/25 and 07/24/25. Pain levels were documented 4 to 9 out of a score of 10. Observation and interview on 07/23/25 at 6:55 AM, Resident #77 stated he was hit by a truck and was in the hospital for surgery to his leg. He had metal pins and a metal halo around his left leg. He stated he received Oxycodone twice a day and was due for the scheduled 9:00AM dose. He stated he could also have Hydrocodone-Acetaminophen oral tablet 10-325mg every 6 hours if he needed. He stated sometimes it may take 2.5 hours before he received pain meds after he asked for them. Then he later stated on the average it took one hour. He stated his pain was in his leg and his back and that his pain level was 8 out of 10. Observed RN-A administer Oxycodone IR 10mg and Hydrocodone-Acetaminophen 10-325mg one tablet at 8:00 AM prior to Resident #77 leaving for dialysis. In an interview on 07/25/25 at 9:30am, the DON stated the Oxycodone HCL was the same as the Oxycodone ER (Oxycontin). The DON stated she expected that the last person to administer the Oxycodone on 07/08/25 to Resident #77 should have removed it from the med cart, so there was no confusion. The DON confirmed the initials and stated MA-B administered the last dose on 07/08/25. The DON stated Resident #77 should not have been receiving Oxycodone ER 10mg after 07/08/25 without a physician's order. The DON stated the Oxycodone IR 10mg should have been started after 07/08/25. The DON stated continued administration of Oxycodone ER after 07/08/25 was a medication error that should not have happened and that it was probably due to a system failure. The DON stated the area of resident pain medication needed attention too, but her focus had been on behaviors since there were many residents with issues. The DON stated she expected nursing staff to match physician orders with the medication being administered and to follow the 5 rights of medication administration to prevent med errors. Record review of Resident #77's narcotic sheet for Oxycontin ER 10mg revealed a tablet was signed out on 07/08/25 at 8:00 AM. Record review of Resident #77's July MAR indicated Oxycodone HCL 10mg tablet was documented as administered by MA-B on 07/08/25 at 8:00 AM. On 07/26/25 at 9:20AM an attempt was made to contact MA-B via telephone. A voice message was left. No return call was received. In an interview on 07/26/25 at 12:35 PM, LVN-C stated she would check physician's orders in PCC and verify the medication card matched with the narcotic sheet. LVN-C stated she believed there may have been a change in order for Resident #77's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675233 If continuation sheet Page 8 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some oxycodone but was unsure of the date. LVN-C stated Oxycodone ER meant extended release, and IR meant immediate release and the danger of mixing them up could be overdose, or in some cases may not be effective or cause constipation. In an interview on 07/26/25 at 12:47 PM, RN-A stated she would confirm orders, check for the right resident, right medication, right dose and right time prior to administering medications. She stated administering the wrong dose of Oxycodone could place the resident at risk for lethargy, decreased vitals or decreased breathing. She stated since she was the charge nurse for the unit where Resident #77 resided, she was ultimately responsible to remove the Oxycodone ER 10mg (Oxycontin) when the order changed. She stated even prior to surgery Resident #77 was taking Hydrocodone/Acetaminophen for generalized pain and getting more Oxycodone could affect his mood as he had bouts where the meds did not really help him, and she would reposition the resident and if still in pain she would notify the MD. She stated receiving IR and ER together may affect his pain levels, the medication may work one day and not the next day. She stated she was in charge, and it should have not happened, and it was her responsibility to check medications. In a telephone interview on 07/26/25 at 1:20PM, RN-D stated she was familiar with Resident #77. RN-D confirmed initials on the Oxycontin ER 10mg sign out sheet. She stated she was aware the Oxycontin was a 7-day taper. She stated when she administered medication she would check the order, the last time it was received, ask the resident about his pain level and follow the 5 rights of medication administration, which included the right name, time and dosage. She stated Resident #77 was precise with his pain levels. She stated the risks of using multiple opioids depended on the resident's tolerance level and Resident #77 was taking opioids daily and had a high tolerance. She stated even before the Oxycodone he was taking Norco every 6 hours. She stated it didn't affect him much because he would tell her he was still in pain; she would call the doctor. She stated the difference between Oxycodone IR and ER was the IR was used for acute pain and ER for chronic pain. In an interview on 07/26/25 at 1:40 PM, MA-E stated her steps when she administers medications included to check the MAR and confirm the order on the blister packet: the dose and the route. MA-E stated oxycodone ER lasts longer than the IR. MA-E stated if the last tablet was given, the blister pack and narcotic sheet would be given to the DON. MA-E stated if it was the last dose of oxycodone to be given it would have been at night and she would not be able to give the blister pack to the DON and it should have been taken care of the next day. MA-E stated she did not communicate that to the next med aide MA-E stated she went on vacation. MA-E stated the Oxycodone IR was supposed to continue after the taper order. MA-E confirmed her initials on 7/8/25 at 8:00PM on the narcotic sheet for Oxycontin ER 10mg tablets. In an interview on 07/26/25 at 2:15PM, the Administrator stated the nurses would be responsible for calling the physician to get an order to discontinue a medication. The Administrator stated for anything clinical the ADON and DON would be responsible for reviewing the resident's pain management profile. The Administrator stated he did not know what happened with Resident #77's orders for oxycodone because he was not clinical and did not know how medication errors would impact residents. In a telephone interview on 07/26/25 at 2:30 PM, Resident #77's Physician-F stated there was a med error, there were two issues, and it was his fault when requesting the oxycodone. Physician-F stated he was responsible as there were two prescriptions, one for oxycodone IR and one for ER. He stated one of them was there to taper the drug down and he may have sent another order by mistake. Physician-F stated Resident #77 was back on Oxycodone ER twice daily and Hydrocodone/Acetaminophen for breakthrough pain. Physician-F stated the error with the Oxycodone would not have an adverse effect on Resident #77 since it was not working very well with his pain. When asked how addictive was Oxycodone, Physician-F stated Resident #77 did have pain and needed the medication, they must continue to monitor and taper when needed. In a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675233 If continuation sheet Page 9 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete telephone interview on 07/27/25 at 11:20AM, Physician-F stated the Oxycodone IR 10mg was supposed to be tapered then eventually Resident #77 would stay on Oxycodone ER 10mg. Physician-F stated if Oxycodone HCL was the prescription, the pharmacy will usually fill it as Oxycodone IR. Physician-F stated he expected the nurses/med aides to check the orders before giving a medication to ensure the ordered medication was the same on the medication blister pack. He stated the Oxycodone ER helped with his pain but not the Oxycodone IR. Physician-F stated switching prescribing systems in a few days, will catch any mistakes. Record review of the facility policy and procedure for Administering oral medications, revised October 2010, revealed in part: The purpose of this procedure is to provide guidelines for the safe administration of oral medications. Preparation 1. Verify that there is a physician's medication order for the procedure.Steps in the Procedure.9.6. Check the label on the medication to confirm the medication name and dose with the MAR. Record review of the facility policy and procedure for Controlled Substances, revised November 2022, revealed in part: The facility complies with all laws, regulations, and other requirements related to handling, storage, disposal and documentation of controlled medications (listed as Schedule II-V of the Comprehensive Drug Abuse Prevention and Control Act of 1976).13. Controlled substances remaining in the facility after the order has been discontinued or the resident has been discharged are securely locked in an area with restricted access until destroyed. Event ID: Facility ID: 675233 If continuation sheet Page 10 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to, in accordance with State and Federal laws, store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys for one of four medication carts reviewed for storage of medications. RN-M failed to ensure the 200 Hall nurse medication cart was locked when unattended. This deficient practice could place residents at risk for loss of biologicals and place residents at risk of access to hazards.Findings included:In an observation and interview on 07/23/25 at 5:15 AM, revealed the 200 Hall Nurse Medication Cart was in the hallway positioned just outside the entrance to a resident's open room. The medication cart was unattended and unlocked, the lock was visibly not engaged. The medication cart contained a variety of medications labeled with Resident names and over-the-counter medications. The controlled substances were locked within the medication cart. RN-M was observed walking from one end of the hall towards the medication cart. RN-M stated she was called away to get something and forgot to lock the cart. RN-M stated the medication cart should be locked when unattended otherwise a confused resident could open the cart and take the medications. RN-M stated it was facility protocol to lock the cart before walking away and leaving the area.In an interview on 07/26/25 at 9:15 AM, the DON stated the nurse or medication aide assigned to the medication cart was responsible to make sure the cart is secure and not accessible to anyone who was not authorized access. The DON stated she would conduct a 1:1 in-service for medication storage. Event ID: Facility ID: 675233 If continuation sheet Page 11 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one of 5 residents (Resident #112). -CNA-K failed to properly clean Resident #112 during incontinent care.-CNA-K failed to perform hand hygiene between glove changes.-CNA-K and LVN-L failed to put on a gown prior to incontinent care for Resident #112 who was in Enhanced Barrier Precaution (EBP). These failures could place residents at risk of urinary tract infections (UTI), discomfort, skin breakdown and decreased quality of life. Findings included: Record review of Resident #112's face sheet dated 07/25/25 revealed a [AGE] year-old admitted to the facility on [DATE]. His diagnoses included sepsis (a blood infection), anemia (reduced number of red blood cells), dementia, and contractures of the lower left leg. Record review of Resident #112's admission assessment effective date 07/16/25 indicated Resident #112 had no difficulty making himself understood and had no difficulty understanding others. Resident #112 had a urinary catheter and the resident or family reported recurrent urinary tract infections. Resident #112 required limited assistance of one person for bed mobility. Record review of Resident #112's undated care plan revealed the resident was at risk for decline in ADL functions, initiated on date 07/17/25. The goal was for the resident to be well dressed, groomed, clean, odor free and will not decline in ADL functioning over the next 90 days. Interventions included staff assistance for bed mobility, toileting and personal hygiene. The resident was at risk for skin breakdown and injury. The goal was for resident's skin to remain clean/dry, intact without evidence of breakdown over the next 90 days. Interventions included weekly assessment of skin and as needed and report any breakdown to MD/RP. The resident had a urinary catheter in place and was at risk for increased UTIs and skin breakdown. The goal was for the urinary catheter to remain patent and the resident to not develop incidents of UTIs and skin breakdown. Interventions included urinary catheter care as ordered. The resident had had wound to the tailbone and to the lower legs. The goal was for the resident's skin to remain clean/dry, healing with no further complications. Interventions included to perform treatment per MD order. Record review of Resident #112's July 2025 MAR/TAR revealed wound care to the sacrum was performed daily. Observation and interview of incontinent care on 07/22/25 at 3:29 PM revealed Resident #112 had a urinary catheter and a catheter anchor was in place for security. Resident #112 had a PICC line (peripherally inserted central catheter) to the inner upper right arm, the dressing was clean/dry/intact and dated 07/11. LVN-L was assisting CNA-K with the procedure. CNA-K and LVN-L washed their hands at the sink and put on clean gloves. CNA-K and LVN-L did not put on gowns. CNA-K and LVN-L opened Resident #112's brief, the resident had a large amount of soft-loose stool. CNA-K began by using cleansing wipes to remove all the stool around the groin and scrotum. CNA-K removed her used gloves, did not hand sanitize, put on clean gloves, then used clean wipes to cleanse the lower abdomen and penis. Resident #112 was rolled to his right side. CNA-K used clean wipes to clean all the stool from the rectum and buttocks. CNA-K removed her used gloves, did not hand sanitize, then put on clean gloves. The resident had a small wound to the sacrum. CNA-K applied barrier cream to the surrounding skin. CNA-K removed the used gloves, did not wash her hands and put on clean gloves then positioned the clean brief, secured the brief and covered the resident with bed sheets. CNA-K and LVN-L removed their gloves, washed theirs hands and gathered the garbage bags to remove from the room. LVN-L stated she forgot to put on a gown because she was so excited to do the nailcare just prior to incontinent care. LVN-L stated the resident was to be in EBP for the wounds, PICC line and indwelling urinary catheter and the reason was Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675233 If continuation sheet Page 12 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete so not to introduce any new infections to the resident. In an interview on 7/22/25 at 3:50PM, CNA-K stated EBP was for residents with open wounds and urinary catheters CNA-K stated she should have put on a gown as well as gloves prior to starting the procedure but she was nervous and forgot. CNA-K stated she should have started cleaning the lower abdomen, then the groin and penis area first but she did not because she wanted to get all the stool cleaned up first. She stated she was taught to clean from penis first it should have been cleaned first because she should not have gone from dirty area to clean, and the rationale was to help prevent infections and cross-contamination. CNA-K stated she should have removed dirty used gloves and hand sanitization or wash hands, but she was nervous and forgot. CNA-K stated the risk to the resident was cross-contamination and infection. In an interview on 7/25/25 at 3:15 PM, the DON stated a gown, and gloves were to be worn during incontinent care for a resident on EBP in order to help prevent MDRO infection (multidrug-resistant organisms) for residents who have a urinary catheter, chronic wounds and residents who have had tracheostomy(an external breathing tube) for greater than 30 days because the tracheostomy would need to be protected. The DON stated for incontinent care for the male resident, she expected to start with the cleanest part and remove the majority of soilage if incontinent of bowel. The DON stated dirty gloves should be removed and hand hygiene performed prior to putting on new gloves to prevent cross-contamination and to make sure bacteria is not introduced to the urethra or any wounds from the dirty gloves. The DON stated it was the responsibility of the infection preventionist and the DON for ensuring the staff were following infection control practices. Record review of the facility policy and procedure for Infection Prevention and Control Program updated on 04/2025 read in part: .2. The elements of the infection prevention and control program consist of coordination/oversight, policies/procedures, surveillance, data analysis, antibiotic stewardship, outbreak management, prevention of infection. Record review of the facility policy and procedure for Perineal Care revised in February 2018, revealed in part: The purpose of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition.For a male resident:.b. Cleanse perineal area starting with urethra and working outward. C. if the resident has an indwelling catheter, gently cleanse the juncture of the tubing from the urethra down the catheter about 3 inches. Gently rinse and dry the area.f. continue to cleanse the perineal area including the penis, scrotum, and inner thighs.j. ask the resident to turn to his side.l. Cleanse the rectal area thoroughly, including the area under the scrotum, the anus, and the buttocks. 8. Discard disposable items into designated containers. 9. Remove gloves and discard into designated container. 10. Wash and dry your hands thoroughly. 11. Reposition the bed covers. Make the resident comfortable.14. Wash and dry your hands thoroughly. Event ID: Facility ID: 675233 If continuation sheet Page 13 of 14 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 675233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Golfcrest 6150 S Loop East Houston, TX 77087 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 0921 Level of Harm - Potential for minimal harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and interview, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 1 of 1 facility reviewed for environmental concerns.The facility failed to properly dispose of waste in the appropriate receptacles. Two red cylindrical 32-gallon containers with white letters on the outside of it reading Infectious Waste: Biohazard containing unknown waste were located outside of the facility. This deficient practice could place residents, staff, and the public at risk of being exposed to potentially hazardous waste.The findings included: Observation on 07/22/2025 at 1:51 PM revealed 1 red, cylindrical, 32-gallon container without a lid, and with white letters on the outside of it reading Infectious Waste: Biohazard was located outside of the facility near the generator. The container held red bags of unknown origin and water. The container appeared to have been outside exposed to the weather for some time as some of the red bags were deteriorated. Observation on 07/22/2025 at 1:53 PM revealed 1 red, cylindrical, 32-gallon container without a lid, and with white letters on the outside of it reading Infectious Waste: Biohazard located outside of the facility near a storage shed. The container had various items of trash along with red biohazard bags. During an Interview on 07/24/2025 10:30 AM with the ADON/IP, she reported when asked about the facility process regarding use of the red biohazard bags, they only used the bags for residents in isolation. They kept the biohazard box with the red bag liner in the resident's room if they were on isolation. Once the bag needed to be removed, they closed the box lid and removed the box from the room. The box was taken to the Medical Waste room. They had a contract service that picked up the boxes from the medical waste room. The boxes and bags were not taken outside the building by staff. She was not aware of any biohazard containers outside of the building and said there was no reason to take it outside when it was picked up by the service inside the building. They don't use red garbage bins for disposal, and she did not know why there were red biohazard containers outside the building.Observation on 7/24/25 at 10:33 AM of the Medical Waste room revealed an unlocked closet with Medical Waste noted on the door. The room contained biohazard boxes and red biohazard bags. There were approximately 30 folded, unused boxes, 3 boxes filled and closed, and 1 box, lined with a red bag was open for use.During an interview on 07/25/2025 11:37 AM with the Administrator about biohazard containers located outside the building, he reported he did not know what was inside of them or how long they had been there. They had been emptied and discarded. During an interview on 07/25/2025 11:40am with the Maintenance Director, he reported he did not know how long the containers were there, probably for years. He did not know what was in the containers and reported that they were not used for biohazard disposal. The bags were disintegrating from being outside and they were not able to tell what the contents had been. The red containers have been disposed of in the dumpster. Event ID: Facility ID: 675233 If continuation sheet Page 14 of 14