Health inspection·July 17, 2025

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete minutes found the Corporate Nurse and explained what occurred on the secure unit with CNA G. Another DON from a sister facility immediately went to the unit and walked with CNA G to the front office. CNA G wrote a statement, and she was immediately terminated upon further investigation. Interview on 07/17/2025 at 12:20 PM, CNA H stated CNA G did speak in a loud tone when speaking to Resident #14 in the dining room approximately 12:15 PM on 07/17/2025. She stated CNA G stated, you need to sit in your chair. She stated Resident #14 did not respond to CNA G. CNA H stated Resident #14 did not become upset after CNA H spoke to her in a loud tone. Interview on 07/17/2025 at 12:25 PM, CNA G stated she did speak in a loud tone when she stated sit in your chair when she spoke to Resident #14. CNA G stated, I did use a loud tone and was expected to use a softer tone when speaking to a resident. She stated, I can understand this was not the correct tone of voice to use when speaking to residents. CNA G stated she was in-service on abuse and neglect. She did not remember the date. Interview on 07/17/2025 at 2:05 PM, the Corporate Nurse stated CNA G was immediately terminated. She stated anyone using a loud tone when speaking to a resident was not tolerated in the facility. She stated there was a potential a resident may become more anxious and effect a resident's dignity if a staff used a loud tone when speaking to a resident. The Corporate Nurse stated to prevent this from happening again she felt terminating CNA G was in the best interest of the residents in the facility. She stated they wanted to ensure extra precautions were taken to prevent potential neglect or abuse. She stated the physician, ombudsman, family and HHSC were immediately contacted about the incident with Resident #14. The Corporate Nurse stated safety checks and skin assessments were completed on all residents on the secure unit and there were no concerns. She stated an investigation into the incident had begun and the full investigation would be completed within 5 days and submitted to HHSC. The Corporate Nurse stated the facility would not tolerate any rude tone being used when speaking to any of the residents. Interview on 07/17/2025 at 2:30 PM, the DON from the sister facility stated Resident #14 did not have any psychosocial negative outcomes from CNA G speaking to her in a rude tone. She stated Resident #14 was calm and did not display any anxious behavior such as worried expression, wringing her hands or pacing. She stated CNA G was immediately removed from the secure unit and terminated. She stated she instructed nurses to complete skin assessments and safety checks on all residents on the secure unit. The DON stated the skin assessments and safety checks were being completed as a precaution. She stated when staff used a rude tone with a resident this affected a resident's dignity. Interview on 07/17/2025 at 2:45 PM, . Resident #14 stated she did not like for anyone to speak to her very loud. Resident #14 stated no one had spoken to her in a loud tone or yelled at her. She stated no one was rude or mean to her. Resident #14 stated she wanted to see her family. She kept talking about her family. Resident #14 was calm and smiling. She stated, talk to someone else about all of this because I am fine here. Resident #14 stated she felt safe and was not afraid to live in the facility. She stated she did not want to talk anymore and stated come back next week for another visit. Record review of the facility's, undated Resident Rights policy reflected All residents have the right to be treated with dignity and respect, regardless of age, disability, race, ethnicity, religion, sexual orientation, gender identity, or socioeconomic status. Staff will interact with residents in a manner that promotes their self-esteem and self-worth, using preferred names and titles honoring their personal preferences. Record review of the facility's Identifying Types of Abuse Policy, dated June 2023, reflected verbal abuse includes but not limited to the use of oral, written, or gestured language. This definition includes communication that expresses disparaging and derogatory terms to residents within their hearing/seeing distance. Examples: name calling, swearing, threatening harm , trying to frighten the resident, racial slurs, etc . Event ID: Facility ID: 675564 If continuation sheet Page 2 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for two of eight residents (Resident# 12 and Resident #16) reviewed for ADL care. The facility failed to ensure Resident #12, and Resident # 16's nails were cleaned, and did not have rough edges. This failure could place residents at risk of not receiving services or care, diminished quality of life, and decreased self-esteem. Findings include: 1. Record review of Resident #12's face sheet, dated 07/17/2025, reflected an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #17 had diagnoses which included Type 2 diabetes mellitus without complications (a disorder where the body either does not produce enough insulin or cannot properly use the insulin it produces, leading to high blood sugar levels), lack of coordination (the inability to smoothly and efficiently combine movements of different body parts. It can manifest as clumsiness, unsteadiness, or difficulty with tasks such as buttoning a shirt), and anxiety disorder (conditions characterized by excessive fear, worry, and apprehension that can interfere with daily activities). Record review of Resident #12's Annual MDS, dated [DATE], reflected the resident had a BIMS score of 15, which indicated his cognition was intact. Resident #12 required partial/moderate assistance (helper does less than half the effort) with personal hygiene, and showers. He required supervision/or touching assistance (helper provides verbal cues and/or touching as resident completes activity) with the following: dressing, toileting, and oral hygiene. Record review of Resident #12's Comprehensive Care Plan, with completion date of 06/30/2025, reflected Resident # 12 required one staff assistance with bathing, dressing, grooming and hygiene. Observation and interview on 07/15/2025 at 11:01 AM, revealed Resident #12 was in his room sitting in his wheelchair. He had a blackish/ brownish substance underneath the middle and ring fingernails on his right hand. Resident #12's middle fingernail on his right hand was uneven around the edges. Resident #12 stated he requested for his nails to be cleaned and filed a few days ago. He did not recall the date or who he asked to clean his nails. Resident #12 stated the person explained he would receive nail care on Sunday (07/20/2025). He stated he did not recall the ladies name when he requested his nails to be cleaned and filed. 2. Record review of Resident # 16's face sheet, dated 07/17/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Resident #16 had diagnoses which included paraplegia, unspecified (partial or complete paralysis of both legs and often the lower trunk, with the specific cause or extent of the impairment not being clearly defined), lack of coordination (the inability to smoothly and efficiently combine movements of different body parts. It can manifest as clumsiness, unsteadiness, or difficulty with tasks such as buttoning a shirt), and contracture of left hand (a condition where the tissue under the skin of the palm thickens and tightens, causing one or more fingers to bend towards the palm and making it difficult to straighten them). Record review of Resident #16's Quarterly MDS Assessment, dated 06/09/2025, reflected Resident #16 had a BIMS score of 11, which indicated her cognitive status was moderately impaired. Resident #16 required set up assistance with personal hygiene, oral hygiene, and upper body dressing. She required partial/moderate assistance with showers (helper does less than half the effort). Record review of Resident #16's Comprehensive Care Plan, with completion date of 06/30/2025, reflected Resident #16 had an ADL self-care performance deficit related to disease process and impaired balance. Intervention: Bathing/Showering- check nail length and trim and clean on bath day and as necessary. Report any changes to the nurse. Observation and interview on 07/15/2025 at 11:15 AM, revealed Resident #16 was in her room sitting in Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 3 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few her wheelchair. She had a blackish/ brownish substance underneath the middle ring and fore fingernails on her right hand. Resident #16's ring and middle fingernail on her right hand were uneven around the edges. She stated on Saturday (07/12/2025) she asked a nurse if she would clean her nails. Resident #16 did not recall the nurse's name, and the nurse stated her nails would be cleaned and trimmed on Sunday (07/13/2025). She stated no one cleaned her nails on Sunday (07/13/2025). In an interview on 07/15/2025 at 2:00 PM, LVN F stated the nurses were responsible for residents with diagnosis of diabetes with nail care such as trimming, cleaning, filing. He stated the CNAs were responsible for all other residents' nail care. LVN F stated if a resident had brownish/blackish substance underneath their nails and if a resident swallowed the substance there was a possibility a resident may become ill, such as stomach problems nausea and vomiting. LVN F stated if a resident refused any type of care, the nurse would document the refusal in the nurse's notes. He stated Resident #12 and Resident #16 did not refuse nail care. He stated no one reported to him Resident #16 or Resident #12 refused nail care. LVN F stated he had worked with Resident #12 and Resident #16 for several weeks. He stated he was in- serviced on nail care, however, he did not recall the date. In an interview on 06/19/2025 at 9:20 AM, CNA G stated the CNAs were responsible for cleaning, trimming, and filing all residents' nails except for the residents with a diagnosis of diabetes. She stated the nurses were responsible for all the residents' nails with a diagnosis of diabetes. CNA G stated the residents' nails were usually cleaned on Sundays, their shower days and as needed. She stated if there was a blackish substance on the residents' fingertips or underneath their nails and the resident swallowed the blackish substance there was a possibility a resident may become ill, such as vomiting and diarrhea. She stated a resident may cause a skin tear if their fingernails were not smooth. CNA G stated she was in-serviced on cleaning, filing, and trimming residents' nails but she did not recall the date. She stated she had given care to Resident # 12 and Resident #16, and they did not refuse nail care. CNA G stated she did not know the last time these residents' nails were trimmed or cleaned. She stated if any resident refused care it was reported to the nurse and the nurse would document the refusal in the nurses note. In an interview on 06/19/25 at 10:30 AM, CNA C stated the nurses and the CNAs were responsible for nail care. She stated the nurses were responsible to trim and clean all resident's nails with a diagnosis of diabetes. She stated it was the CNAs' responsibility to clean and trim all other residents' nails during showers or as needed. She stated if there was a blackish substance underneath the resident's nails, there was a possibility the substance had bacteria. CNA C stated if a resident swallowed the bacteria there was a possibility a resident may become ill with stomach problems such as vomiting. CNA C stated she was in-serviced on nail care; however, she did not recall the date. She stated she had given care to Resident #12 and Resident #16. She stated she was not aware of Resident #12 or Resident #16 refusing nail care. In an interview on 07/17/25 at 09:36 AM, the Corporate Nurse stated if a resident ingested the blackish substance on their fingers or underneath their fingernails, there was a possibility the substance may be some type of bacteria, however it would be difficult to determine if the blackish/ brownish substance was bacteria. She stated it was a possibility a resident may become ill with stomach issues such as vomiting and nausea if they ingested the blackish/ brownish substance. She stated the CNAs were responsible for all residents' nails such as cleaning, trimming, and filing except for the residents with diabetes (a disease that occurs when your blood sugar, is too high). She stated for any resident with a diagnosis of diabetes the nurse was responsible for these residents' fingernails. The Corporate Nurse stated the nurse supervisor was responsible for monitoring CNAs giving ADL care which included nail care and the DON was responsible for monitoring the nurse supervisors. Record review of the facility's Policy on Activities (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 4 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete of Daily Living, dated 03/2018, reflected Residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out ADLs. Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal and oral hygiene. Interventions to improve or minimize a resident's functional abilities will be in accordance with the resident's assessed needs, preferences, stated goals and recognized standards of practice. The resident's response to interventions will be monitored, evaluated, and revised as appropriate. Event ID: Facility ID: 675564 If continuation sheet Page 5 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review, the facility failed, to provide an ongoing activities program to support residents in their choice of activities, both facility sponsored group and individual activities, and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for two of five residents ( Resident # 15 and Resident #25) reviewed for activities. The facility failed to provide Resident #15 and Resident #25 in room activities on the dates of 07/01/2025 thru 7/17/2025. This failure could place residents at risk for boredom, depression, and diminished quality of life. Based on interview, observation and record review, the facility failed, to provide an ongoing activities program to support residents in their choice of activities, both facility sponsored group and individual activities, and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for two of five residents ( Resident # 15 and Resident #25) reviewed for activities. The facility failed to provide Resident #15 and Resident #25 in room activities on the dates of 07/01/2025 thru 7/17/2025. This failure could place residents at risk for boredom, depression, and diminished quality of life. Findings included:Review of Resident #15's Face Sheet, dated 07/17/2025, reflected an [AGE] year-old female admitted on [DATE] with a diagnosis of Parkinson's disease without dyskinesia, without mention of fluctuations (motor symptoms like tremors, rigidity and slowness of movement. Dyskinesia- disease symptoms where involuntary movements are absent, and there are no significant variations in symptom throughout the day), muscle wasting and atrophy, not elsewhere classified, unspecified site (muscles that lose their nerve supply and waste away), and unspecified asthma (a respiratory condition marked by spasms in the lungs, causing difficulty in breathing).Review of Resident #15's admission MDS Assessment, dated 09/21/2024, reflected Resident #15 had a BIMS score of 15 which indicated her cognition was intact. Resident #15's activity preference was the following:1. Reading books or newspaper.2. Listening to music.3. Being around animals.4. Keeping up with the news.5. Do favorite activities.6. Go outside to get fresh air when the weather is good.7. Do things in groups of people.8. Participating in religious services or practices. Review of Resident #15's Quarterly MDS Assessment, dated 06/10/2025, reflected Resident #15 had a BIMS score of 15 which indicated Resident #15's cognition was intact. Review of Resident #15's Comprehensive Care Plan, dated 06/30/2025, reflected Resident #15 required in rom activity related to resident not participating in activities. Intervention: Activity Director will assess the resident's interest and create the activity plan. Review of Resident #15's Activity Initial Assessment, dated 09/16/2024, reflected Resident #15 preferred activities in her room. Review of Resident #15's Activity In room Participation Record, dated July 2025, reflected Resident #15 did not receive any in room activities from 07/01/2025 thru 07/17/2025. Observation and interview on 07/16/2025 at 2:20 PM, revealed Resident # 15 was in her room watching television. She stated she was tired of watching television every day. Resident #15 stated she did want activities in her room and wanted activity director to visit her and assist her with doing activities. Resident #15 stated she was receiving activities from the Activity Director at one time; however, she had not been getting activities in her room from the Activity Director over the past several weeks. Resident #15 stated she did get bored sometimes. She stated she did not want to attend group activities. Review of Resident #25's Face Sheet, dated 07/17/2025, reflected a 68- year-old male was admitted on [DATE] and readmitted on [DATE] with a diagnoses of unspecified dementia, unspecified severity, with other behavioral disturbance (a condition where a person exhibits symptoms of dementia, but the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 6 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few specific type of dementia was not identified, and the severity had not been specified. Dementia- a loss of thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities with behaviors such as agitation - characterized by restlessness, and anxiety - feelings of fear worry, unease , and apprehension), cognitive communication deficit ( difficulties in communication that arise from impairments in cognitive functions like attention, memory reasoning, and problem-solving), and lack of coordination ( the inability to smoothly and efficiently control movements). Review of Resident #25's Annual MDS, dated [DATE], reflected Resident #25 had a BIMS score of 7 which indicated his cognition was moderately impaired. Resident #25's activity preference was participating in religious services or practices. Review of Resident #25's Quarterly MDS, dated [DATE], reflected Resident #25 had a BIMS score of 8 which indicated his cognition was moderately impaired. Review of Resident #25's Comprehensive Care Plan Assessment, with a completion date of 06/30/2025, reflected Resident #25 was at risk for pain, impaired physical mobility, and inflammation in affected joints. Intervention: Encourage socialization and involvement in activities. Resident #15 required in room activity. Intervention: Activity Director will assess the resident's interest and create activity plan. Review of Resident #25's Activity In room Participation Record, dated July 2025, reflected Resident #15 did not receive any in room activities from 07/01/2025 thru 07/17/2025. Review of The Activity Director's Personnel record on 07/17/2025, reflected she was a certified Activity Director. Observation and interview on 07/17/2025 at 9:10 AM, Resident #25 was sitting in his room lying in bed. He was staring at the wall in front of him. There was not any stimulation on in his room. Resident #25 stated he sometimes gets bored and wished someone come in and talk to him. He stated he did not remember when anyone came in and talked to him or offered him activity. Resident #25 stated he did not want to attend group activities. He stated he did not enjoy being around a group. Resident #25 stated he was tired and come back tomorrow and talk to him. Interview on 07/16/2025 at 8:30 AM, the Activity Director stated Resident #15, and Resident #25 did not receive in room activities from 07/01/2025 thru 07/17/2025. The Activity Director stated she was expected to ensure all residents received activities based on their preferences and their physical abilities. She stated if a was not coming out of their room, the residents were to be provided in room activities. The Activity Director stated she provided in room activities at least twice a week. She stated there was not an excuse why Resident #15 and Resident #25 did not receive in room visits. The Activity Director stated if a resident was not receiving activities on a consistent basis there was a potential a resident may become bored, depressed, or have a decline in their quality of life. Interview on 07/17/2025 at 8:45 AM, The Corporate Nurse stated she expected in room activities be provided to the residents needing these type of activities. She stated if the if a resident was not receiving in room activities there was a possibility a resident may become depressed, bored, and isolated. She stated the Activity Director was responsible for all activities in the facility. The Corporate Nurse stated the Administrator quit on 07/01/2025 and the facility was in the process of hiring a new administrator. She stated the Administrator would be responsible for monitoring the Activity Director and she was going to assign someone (she did not know who at the time of the interview) to monitor activity programs until an administrator was hired. Review of the Facility Activity Programs Policy, dated 06/2018, reflected Activity programs are designed to meet the interests of and support the physical, mental and psychosocial well-being of each resident.Policy Interpretation and Implementation1. The activities program is provided to support the well-being of residents and to encourage both independence and community interaction.2. Activities offered are based on the comprehensive resident-centered assessment and the preferences of each resident.3. The activities program is ongoing and includes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 7 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete facility-organized group activities, independent individual activities and assisted individual activities.4. Activities are considered any endeavor, other than routine ADLs, in which the resident participates, that is intended to enhance his or her sense of well-being and to promote or enhance physical, cognitive or emotional health.5. Our activity programs are designed to encourage maximum individual participation and are geared to the individual resident's needs.6. Activities are scheduled 7 (seven) days a week and residents are given an opportunity to contribute to the planning, preparation, conducting, cleanup and critique of the programs.7. Our activity programs consist of individual, small group and large group activities that are designed to meet the needs and interests of each resident. Activity programs include activities that promote:1. self-esteem.2. comfort.3. pleasure.4. education.5. creativity.6. success; and7. independence.8. All activities are documented in the resident's medical record.9. Activities participation for each resident is approved by the attending physician based on information in the resident's comprehensive assessment.10. Scheduled activities are posted on the resident bulletin board. Activity schedules are also provided individually to residents who cannot access the bulletin board (e.g., bed bound or visually impaired residents). Individualized and group activities are provided that:1. reflect the schedules, choices and rights of the residents.2. are offered at hours convenient to the residents, including evenings, holidays and weekends.3. reflect the cultural and religious interests, hobbies, life experiences and personal preferences of the residents.4. appeal to men and women, as well as those of various age groups residing in the facility; and5. incorporate family, visitor and resident ideas of desired appropriate activities.11. Residents are encouraged, but not required, to participate in scheduled activities.12. Adequate space and equipment are provided to ensure that needed services identified in the resident's plan of care are met. Event ID: Facility ID: 675564 If continuation sheet Page 8 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to properly store, prepare, distribute food under sanitary conditions in accordance with professional standards for food service safety for 1 of 1 kitchen.1. The facility failed to label and date all food items located in the walk-in refrigerator, freezers and in the dry food pantry area on 7/15/2025, and 7/16/2025. 2. The facility failed to clean and sanitize its food storage areas, to include the shelves and 1freezer in storage room. on 7/15/2025, and 7/16/2025.3. The facility failed to clean and sanitize its dining area on 7/15/2025, 7/16/2025, and 7/17/2025. These failures could place residents who receive meals from the kitchen and dine in the facility's dining room at risk for foodborne illnesses.Observation during the initial tour of the kitchen on 7/15/2025 beginning at 09:30 AM, the following was observed:Dry Food Pantry area: 18 cans of diced red peppers, not labeled and dated 6 cans of Thick it, not labeled and dated 2 gallons of Coleslaw Dressings, not labeled and dated 6 cans of chicken noodles, not labeled and dated 4 boxes of Cream of Wheat, not labeled and datedWalk in refrigerator: Ziploc bag of thawed meat, not labeled and dated 3 pitchers of unmarked liquids or drinks, not labeled and dated A plastic pitcher filled about 2/3 full of peaches, not labeled and dated 6 gallons of milk, not labeled and datedUpright Freezer: 4 frozen jugs of orange juice and 4 frozen jugs of cranberry juice, not labeled and dated. Observed the shelf in the [NAME] freezer to be unclean, the shelf noted with sticky brown residue and an unknown dead insect resembling a beetle. The pantry shelves were observed to be unclean. There were mice droppings noted on the bottom shelf of the pantry room.07/15/2025, 12: 30 PM, the dining area was observed with: 5 dirty windowsills with dead bugs and cobwebs Cobwebs on beams Ceiling fans with significant dust and cobwebs07/16/2025 at 9:11AM, kitchen policy and procedure were requested from facility staff. During a follow up tour of kitchen on 7/16/2025 beginning at 11:00 AM, the following was observed: Unlabeled and not dated items remained: 18 cans of diced red peppers, 6 cans of Thick it, 2 gallons of Coleslaw Dressings,6 cans of chicken noodles, and 4 boxes of Cream of WheatNew items noted to be unlabeled and dated: opened frozen omelets and steak friesThe unclean shelves remained with the mouse droppings.The dining area remained with unclean windowsills.In an interview on 07/16/2025 at 3:15 PM Dietary Supervisor, stated the facility's practice is to keep open food for three days and then dispose of it. She also stated that all food products were expected to be labeled and dated upon arrival. She confirmed that her expectation was for all staff to follow this procedure.When asked about cleaning procedures, she stated that she personally trained staff on the cleaning schedule, which included daily cleaning of shelves and sweeping/mopping the storage room. However, when the surveyor asked to review the cleaning schedule book for the week of July 13-19, 2025, it was observed to have no entries. The Dietary Supervisor acknowledged that although staff had cleaned, no one had recorded their work in the log.The surveyor escorted the Dietary Supervisor to the food storage room and pointed out the mouse droppings and visibly soiled shelves. The Dietary Supervisor acknowledged the issue and stated the area would be cleaned that day. She was also shown the unlabeled food items in dry storage, the refrigerator, and freezer, and stated that they would all be marked immediately. She further admitted that she had previously noted a blue bag of food that was not labeled or dated.When asked what potential harm could result from food items not being labeled and dated properly, the Dietary Supervisor stated that items could expire and become contaminated, which could cause residents to become ill. The surveyor escorted the Dietary Supervisor to the windowsills; she stated housekeeping was responsible for cleaning the windowsills in the dining area.In an interview 07/17/2025 at 9:25 AM, Housekeeping (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 9 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Supervisor stated that she was responsible for overseeing the cleaning of the dining room. She reported that housekeeping staff sweep and mop the floors, sanitize all tables, and wipe down countertops. She stated that windows were cleaned once a week, and that dusting, spraying, and wiping of surfaces are part of the routine duties.When asked about who provides training on the cleaning schedule, the Housekeeping Supervisor stated that she was responsible for training staff. She noted that she has not been in her position long and has not yet had time to complete a formal cleaning schedule. She explained that the department has been short-staffed, and she has been assisting in other areas of the facility.She stated that cleaning the ceiling fans was the responsibility of the maintenance department, as housekeeping staff do not have access to ladders. When informed that several dead bugs were observed in the windowsills, the Housekeeping Supervisor stated that they would address the issue that day. She also stated that the three housekeepers currently working have been employed at the facility longer than she has.When asked about potential harm, she stated that dust could trigger resident allergies, and bugs could crawl on residents and bite them, potentially causing illness.In an interview 07/17/2025 at 9:35 AM, Housekeeper E stated that she has been working at the facility for two months. She reported that she has been trained on the facility's cleaning policies. She explained that the expected cleaning process in the dining room included wiping the tables first, sweeping the floors, cleaning the windows and windowsills, and mopping last.She stated that the Housekeeping Supervisor new and was in the process of developing a new cleaning schedule for the staff. When asked about the potential harm of having unclean areas in the dining room, Housekeeper E stated that it could cause health issues for residents or make them sick.In an interview 07/17/2025 at 9:51 AM, Dietary Aide D stated that she has been employed at the facility for six years and has worked in the kitchen for the past four years. She reported that she has been trained on all kitchen policies. Dietary Aide D stated they label and date all items received in the kitchen. She stated opened products were dated with date opened. Dietary Aide D stated they clean the kitchen daily and mark off task in the cleaning book. She stated both dietary and housekeeping clean the dining area, but housekeeping cleans the windowsills.Record Review of facility's Food Storage Policy not dated revealed: Food will be stored in an area that is clean, dry and free from contaminants. Storage areas will be free from rodent and insect infestation; and will be treated for pests and vermin on a regular schedule. Food should be dated as it is placed on the shelves if required by state regulation. Date marking should be visible on all high-risk food to indicate the date by which a ready-to-eat TCS food should be consumed, sold or discarded.Record Review of facility's General Food Preparation and Handling Policy not dated revealed: The kitchen will be kept neat and orderly. a. The kitchen surfaces and equipment will be cleaned and sanitized as appropriate. Leftovers must be labeled, dated, covered, and stored in refrigerator.Record Review of facility's Cleaning and Sanitation of Dining and Food Service Areas revealed: Policy: The food and nutrition services staff will maintain the cleanliness and sanitation of the dining and food service areas through compliance with a written, comprehensive cleaning schedule. Event ID: Facility ID: 675564 If continuation sheet Page 10 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to dispose of garbage properly in 1 of 1 kitchen.On 07/15/2025 at 9:30 AM, 1 of 2 facility garbage containers were observed with no lids attached or on them and they had waste inside. This failure has the potential to affect residents in the facility, staff, and visitors by placing them at risk of infection for exposure to germs and diseases carried by pests and rodents. In an interview with Dietary Supervisor on 07/16/2025 at 3:15 PM, Dietary Supervisor stated that trash cans should always have lids and should remain closed when not in use. Dietary Supervisor stated not keeping the lids closed could lead to cross contamination, placing residents at risk of illness.In an interview 07/17/2025 at 9:51 AM with Dietary Aide D, she stated that she has been employed at the facility for six years and has worked in the kitchen for the past four years. She reported that she has been trained on all kitchen policies. Dietary Aide D stated that trash cans should be kept always closed with a lid. She explained that if a trash can is left open, it can allow germs to accumulate, potentially contaminating the food and causing residents to become ill.Record review of the Dietary Services Policies and Procedures for Waste Control and Disposal, stated that Trash cans must be covered at all times except during use. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 11 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0851 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. Based on interview and record review the facility failed to electronically submit to CMS complete and accurate direct care staffing information, including the category of work for each person on direct care, including, but not limited to, whether the individual was a registered, nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other type of medical personnel as specified by CMS for one of one facility reviewed for administration. The facility failed to submit PBJ (Payroll Based Journal) staffing information to CMS for October 1, 2024, to December 31, 2024. This failure could place residents at risk for personal needs not being identified and met, decreased quality of care, decline in health status, and decreased feelings of well-being within their living environment. Record review of the CMS PBJ report for CMS FY Quarter 1 2025 (October 1, 2024 - December 31, 2024) indicated the facility failed to submit data for the quarter. Interview on 07/17/2025 at 7:45 AM the Corporate Nurse stated that she was aware the Payroll Based Journal had not been submitted for the quarter of October 1, 2024 December 31, 2024, to CMS. She stated she was unsure as to why the data had not been reported and she would reach out to her corporate level staff and attempt to get an answer. She stated she was aware the Payroll Based Journal was required to be submitted. The Corporate Nurse stated the Administrator did quit on 07/01/2025 and she could not answer why he did not ensure the Payroll Based Journal was not submitted. Review of the facility's Reporting Direct Care Staffing Information (Payroll- Based Journal), dated 2001, reflected the following Reporting Direct Care Staffing Information (Payroll-Based Journal)Policy StatementDirect care staffing information is reported electronically to CMS through the Payroll-Based Journal system.Policy Interpretation and Implementation1. Complete and accurate direct care staffing information is reported electronically to CMS through the Payroll-Based Journal (PBJ) system in a uniform format specified by CMS.2. Direct care staff are those individuals who, through interpersonal contact with residents or resident care management, provide care and services to allow residents to attain or maintain their highest practicable physical, mental, and psychosocial well-being.3. Direct care staffing information includes staff hired directly by the facility, those hired through an agency, and contract employees.4. Direct care staff does not include individuals whose primary duty is maintaining the physical environment of the facility (for example, housekeeping).5. Providers who are employed by the facility (including physicians) are included in direct care staffing information; providers who bill Medicare directly are not included.6. For auditing purposes, reported staffing information is based on payroll records, invoices, tied back to a contract, or other verifiable information.7. Data is submitted only by designated personnel with training on the PBJ user interface. 8. Technical specifications for uploading data directly from a payroll or time and attendance system will be accessed through: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-S Direct care staffing information is submitted on the schedule specified by CMS, but no less frequently than quarterly. Event ID: Facility ID: 675564 If continuation sheet Page 12 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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, including hand hygiene, designed to provide a safe, sanitary, and comfortable environment, and to help prevent the development and transmission of communicable diseases and infections for 7 (Resident #5, Resident #8, Resident #22, Resident #27, Resident #15, Resident #39, and Resident #42 of 11 residents reviewed for infection control practices, in that: The facility failed to:1. Ensure CNA B and Medication Aide A practiced proper hand hygiene while serving and assisting residents #22, #27, and #42 during the lunch meal on [DATE].2. Ensure CNA C changed dirty gloves when handling clean items while providing peri care to Resident #8.3. Ensure Medication Aide A sanitized blood pressure monitors in between Resident #15 and Resident #39 while obtaining blood pressures. 4. Ensure LVN F washed his hands before and after the wound care on Resident #5 and changed dirty gloves when handling clean items while providing wound care. These failures could place residents at risk for healthcare associated cross-contamination and infections. An observation of the lunch meal on [DATE] between 12:08PM and 12:50PM revealed CNA B, and Medication Aide A assisted in the dining room.CNA B, and Medication Aide A were observed passing out trays to 12 residents at 6 tables.CNA B was observed sitting down to provide feeding assistance to Resident #42 immediately after passing lunch trays, without performing hand hygiene (washing or sanitizing hands). Medication Aide A was also observed sitting down to assist Resident #27 with feeding immediately after passing lunch trays, without performing hand hygiene. CNA B was observed later leaving Resident #42 after providing feeding assistance without performing hand hygiene. CNA B then proceeded to Resident #22 to help with her meal, again without washing or sanitizing his hands. Review of Resident #8's face sheet dated [DATE] reflected a [AGE] year-old female who was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including morbid (severe) obesity due to excess calories, depression, muscle weakness, abnormalities of gait, type 2 diabetes, anxiety disorder and infection following a procedure.Review of Resident #8's quarterly MDS assessment, dated [DATE] reflected a BIMS score of 12, indicating she had moderately impaired cognition.Review of Resident #8's care plan dated [DATE] had not indicated peri care.During an observation on [DATE] at 11:45am CNA C was providing peri care for Resident #8. CNA C put on gloves after washing his hands. After that he opened the brief and cleaned Resident #8's front and back with wet wipes dispensed directly from the wipe's packet. In that process he handled the whole wipe packet with the soiled gloves. He had not changed his gloves in the entire process and touched clean items that included a new brief and Resident #8's clothes and blanket. After the completion of peri care he placed the contaminated wipe packet containing wet wipes in a drawer containing Resident #8's personal belongings.During an interview on [DATE] at 11:55am CNA C stated he received training on peri care when he started working at the facility about 5 months ago. When the investigator walked through the peri care that he had done on Resident #8, CNA C stated he understood he should not have contaminated the wet wipe packet by handling it with soiled gloves, due to the danger of spreading germs. He said, by storing the contaminated packet in the drawer he had contaminated the items inside the drawer as well. He stated he also forgot to change the gloves before picking up the clean items after the completion of the cleaning.Review of Resident #5's face sheet dated [DATE] reflected a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including traumatic brain injury without loss of consciousness, injury to L5 level of lumbar spinal cord (5th segment of the lower part of the spinal cord) , severe protein-calorie malnutrition, pressure ulcer of sacral (pelvis) region, stage 4, spinal stenosis of lumbosacral region (narrowing of the spaces within the spine of the lower Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 13 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 - Some back region ).Review of Resident #5's initial MDS assessment, dated [DATE] reflected a BIMS score of 0 indicated he had severe impairment with cognition.Review of Resident #5's care plan, dated [DATE], reflected Resident #5 had pressure ulcer at the sacrum (pelvis) area r/t Immobility. The relevant intervention was administering treatments as ordered and monitor for effectiveness.Record review of Resident #5's Physician's order revealed : Sacrum: Cleanse with Wash Cloth, Pat dry, Pack with Silver alginate, Cover with Dry dressing, Change QD/PRN one time a day. Start Date-[DATE].During an observation on [DATE] at 3:00pm LVN F was performing wound care on Resident #5. He put on gown and mask and then went to resident for wound care. LVN F started wound care with putting on gloves, without washing or sanitizing his hands. He opened the brief and cleaned the wound on Resident #5's sacral area. LVN F then applied medication and closed the brief. After the competition of the wound care he adjusted the bed, tidied up bed and sheets, pulled up the blanket for Resident #5. LVN F did not change his gloves in the entire process. Once the process was completed, without sanitizing or washing his hands he left the room and continued work on the computer at the nursing station.During an interview on [DATE] at 3:55pm LVN F stated he worked at the facility for a few years and got experience as an LVN for years. When walked through the wound care that he had done on Resident #5, LVN F stated, as an experienced LVN he was not supposed to forget the fundamentals of wound care. He stated he should have washed his hands thoroughly before and after the wound care. He stated he was supposed to change his gloves when handling clean items during the procedure. LVN F stated he knew all these however forgotten to practice them at that time. LVN F stated proper infection control practices were important while doing nursing care to contain infectious diseases from spreading. He stated he attended infection control and hand hygiene in-services at the facility however could not remember exact dates.Review of Resident #15's face sheet dated [DATE] reflected an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including muscle wasting, Lack of coordination, muscle weakness, abnormalities of gait and mobility, Parkinson's disease and atrial fibrillation (irregular heartbeats).Review of Resident #15's quarterly MDS assessment, dated [DATE] reflected a BIMS score of 15, indicating her cognition was intact.Review of Resident #15's care plan, dated [DATE], reflected Resident #15 had renal insufficiency and relevant intervention was monitoring (increased pulse, increased respirations and increased BP.Record review of Resident #15's Physician's order revealed: Coreg Oral Tablet 12.5 MG (Carvedilol): Give 1 tablet by mouth two times a day for Hold if SBP <110 or HR <70. Start Date: [DATE].Review of Resident #39's face sheet dated [DATE] reflected a [AGE] year-old female who was admitted to the facility initially on [DATE] and readmitted on [DATE] with diagnoses including hypertension, major depressive disorder, pain, atherosclerosis of aorta(main blood vessel leaving the heart has hardened due to build up of fat), Hyperlipidemia(too much fat (lipids) in blood), peripheral vascular disease (poor blood flow to the arms and legs) and generalized anxiety disorder.[VT1]Review of Resident #39's quarterly MDS assessment, dated [DATE] reflected a BIMS score of 15, indicating her cognition was intact.Review of Resident #39's care plan, dated [DATE], reflected Resident #39 had hypertension & Hyperlipidemia. The relevant intervention was obtaining blood pressure readings per MD order/per facility protocol.Record review of Resident #39's Physician's order revealed: Metoprolol Succinate ER [VT3] Tablet Extended Release 24 Hour 50 MG: Give 1 tablet by mouth one time a day related to essential (primary) hypertensionhold for SBP under 110 or HR under 70 and notify Nurse. Start Date-[DATE] During an observation on [DATE] at 10:35am Med Aide A failed to sanitize the wrist blood pressure monitor before using it on Resident #39, in between Resident #15 and Resident #39. Med Aide A took the blood pressure of Resident #15 with a blood pressure monitor without sanitizing it. After administering the medications to Resident #15 she moved on to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 14 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 - Some Resident #39 and used the same blood pressure monitor on her without sanitizing it. Med Aide A did not sanitize the monitor after the use on Resident #15 until the investigator pointed it out. The Assistant Director of Nursing brought some wipes to Med Aide A as there were no wet wipes readily available on the cart.During an interview on [DATE] at 11:15 a.m., Med Aide A stated sanitizing blood pressure cuffs in between the residents was important and, she did not sanitize it because there were no wipes available at the facility. The investigator notified this to the Assistant Director of Nurses and immediately Assistant Director of Nurses brought a few packets of wet wipes to Med Aide A. Med Aide A stated she was under the impression that the wipes were not available at the facility. She stated she was aware of the impact on residents if she did not follow the infection control protocol as it was necessary to minimize spreading diseases from one resident to another. Med Aide A stated she received trainings on infection control occasionally however no in-services received specifically on sanitizing medical equipment. During an interview on [DATE] at 2:20pm the Director of Nurses stated she was the Infection Preventionist at the facility as well. She said CNA C should not have handled the wet wipe packet with soiled gloves. She stated CNA C was supposed to throw away the contaminated wet wipe packet instead of saving for future use, when he realized that the packet was contaminated. The Director of Nurses stated she already completed a one-to-one in- service with CNA C and would be doing an in-service for all the staff members for peri care. The Director of Nurses stated, the deficient practice of LVN F during wound care was a concern as it was violating infection control practices, that opens the avenue for the germs to spread in the facility. She stated Resident #5's pressure ulcer also could get infected if the infection control protocol had not been followed appropriately. The Director of Nurses stated, as per facility's infection control protocol, all the medical equipment in use including blood pressure cuffs should be sanitized immediately after the use on residents. This was one of the ways minimizing contagious diseases and staff were trained for this. The Director of Nurses stated she could not remember exactly when the staff received in- services on infection control as she started working at the facility only few months ago and was in the process of fixing the issues one by one.An interview with CNA B on [DATE] at 1:23 PM revealed he was trained on proper hand hygiene. He stated that he has been working at the facility since [DATE]. He reported that he was currently PRN but was transitioning to a full-time position. When asked if he performed hand hygiene before assisting residents with meals, CNA B stated that he does wash his hands beforehand. He was asked what steps he takes before feeding a resident directly, and he responded that he was supposed to wash his hands or use hand sanitizer. When asked how he ensured proper hand hygiene when delivering meals to multiple residents, he stated that he sanitized his hands in between.The surveyor informed CNA B of the observations made of him failing to use proper hand hygiene before and between assisting residents. CNA B acknowledged the concern and admitted he should have known better, stating that his wife was a registered nurse. He admitted that he did not wash his hands prior to assisting Resident #42 and Resident #22 with their meals. He also stated there were not enough hand sanitizing stations in the facility and that the area was particularly busy that day. CNA B acknowledged that failure to use proper hand hygiene could potentially cause harm to residents by exposing them to germs and increasing the risk of illness.An interview conducted on [DATE] at 1:33 p.m., Medication Aide A stated that she has been working at the facility for one year and five months. When asked if she had received training on hand hygiene and assisting residents during dining, she confirmed that she had been trained on proper handwashing procedures. She stated that after serving every third resident, staff are expected to wash their hands and not use the same gloves or utensils repeatedly.Medication Aide A further stated that she typically washes her hands in the med room or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 15 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 - Some the restroom, as there is no handwashing station in the dining area. When asked what steps should be taken before directly feeding a resident, she replied that staff were supposed to perform hand hygiene.The surveyor informed Medication Aide A of observations where she failed to wash or sanitize her hands-once while passing meal trays and another time when feeding Resident #27. Medication Aide A responded that she did not know why she had not washed her hands in the dining room on that day. She explained that it was a rushed situation, as she was assisting with both meals and medications, and that she had a lot on her mind at the time. She stated a resident can become ill from not performing proper handwashing.In an interview with Director of Nursing, [DATE], 1:30PM, Director of Nursing stated that she has held her position at the facility since February 2025. She reported that she was responsible for conducting hand hygiene training for the staff and confirmed that training sessions were most recently completed in May and [DATE]. She added that she was now involving the Assistant Director of Nursing to assist with ongoing training.The Director of Nursing stated that she has high expectations for staff regarding hand hygiene practices. She emphasized that staff were expected to wash their hands before assisting residents with meals and to sanitize their hands between serving each tray. She further stated that staff should wash their hands before feeding residents and again between assisting different residents. The Director of Nursing reported that necessary supplies for hand hygiene were available and accessible, and that staff were also expected to assist residents with cleaning their hands before meals.She stated that poor hand hygiene could lead to the spread of infections, colds, and other illnesses, which may cause residents to become sick.Record review of facility's policy Handwashing / Hand hygiene revised in [DATE] reflected: Policy StatementThis facility considers hand hygiene the primary means to prevent the spread of healthcare-associated infections. Indications for Hand Hygiene1. Hand hygiene is indicated:2. immediately before touching a resident.3. before performing an aseptic task (for example, placing an indwelling device or handling an invasive medical device).4. after contact with blood, body fluids, or contaminated surfaces.5. after touching a resident.6. after touching the resident's environment.7. before moving from work on a soiled body site to a clean body site on the same resident; and8. immediately after glove removal.1. Use an alcohol-based hand rub containing at least 60% alcohol for most clinical situations.2. Wash hands with soap and water:9. when hands are visibly soiled; and10. after contact with a resident with infectious diarrhea including, but not limited to infections caused by norovirus, salmonella, shigella and C. difficile.3. Single-use disposable gloves should be used:1. before aseptic procedures.2. when anticipating contact with blood or body fluids; and3. when in contact with a resident, or the equipment or environment of a resident, who is on contact precautions.4. The use of gloves does not replace hand washing/hand hygiene. Record review of facility policy Wound care revised in [DATE] reflected: The purpose of this procedure is to provide guidelines for the care of wounds to promote healing. Steps in the Procedure1. Use disposable cloth (paper towel is adequate) to establish clean field on resident's overbed table. Placeall items to be used during procedure on the clean field. Arrange the supplies so they can be easilyreached.2. Wash and dry your hands thoroughly.4. Put on exam glove. Loosen tape and remove dressing.5. Pull glove over dressing and discard into appropriate receptacle. Wash and dry your hands thoroughly.10. Wear sterile gloves when physically touching the wound or holding a moist surface over the wound.Remove disposable gloves and discard into designated container. Wash and dry your hands thoroughly.21. Wipe reusable supplies with alcohol as indicated (i.e., outsides of containers that were touched by unclean hands, scissor blades, etc.). Return reusable supplies to resident's drawer in treatment cart.23.Wash and dry your hands thoroughly.Review of facility's policy Cleaning and Disinfecting Non-Critical Resident-Care Items revised in [DATE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 16 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete reflected:PurposeThe purpose of this procedure is to provide guidelines for disinfection of non-critical resident-care items. a. non-critical items are those that come in contact with intact skin but not mucous membranes.(1) Non-critical resident-care items include bedpans, blood pressure cuffs, crutches and computers.(2) Most non-critical reusable items can be decontaminated where they are used (as opposed to being transported to a central processing location).b. Reusable items are cleaned and disinfected or sterilized between residents (e.g., stethoscopes, durable medical equipment) . Event ID: Facility ID: 675564 If continuation sheet Page 17 of 18 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 675564 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Care at Giddings 1181 N Williamson Giddings, TX 78942 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review, the facility failed to maintain an effective pest control program so that the facility was free of pests for one of one kitchen reviewed for effective pest control.The facility had presence of mouse droppings on a shelf in the food storage room.This failure could place residents at risk for spread of infection, cross-contamination, and decreased quality of life.Observation on 07/15/2025 at 9:22 AM, in the facility's kitchen food storage room revealed several mouse droppings on the bottom shelf.In an interview with Dietary Supervisor on 07/16/2025 at 3:15 PM, she stated it looked like mouse droppings to her as well on the shelf. Dietary Supervisor stated the maintenance department was responsible for pest control. She stated the shelf would be cleaned that day.In an interview with the Maintenance Supervisor on 7/17/2025 at 9:44 AM, he stated that he began working at the facility on June 2, 2025. He reported that he has not personally seen any pests in the facility; however, some staff members have informed him that they have seen mice. The Maintenance Supervisor stated that pest control visited the facility twice last month and performed extermination services. He indicated he could provide the surveyor with copies of the pest control visit documentation. He also stated that the facility was surrounded by wooded areas and that he has contacted the city to request assistance with pest concerns related to the woods located behind the facility.Record Review of the facility's food storage policy, undated, stated:Procedure: 1. Storage areas will be free from rodent and insect infestation; and will be treated for pests and vermin on a regular schedule. Record Review of the facility's pest control service inspection report dated 07/14/2025 revealed, the facility was last treated for rodents. The facility's inspection report dated 06/27/2025 revealed, the facility was treated for roaches, spiders, and ants.Record Review of the facility's pest control policy, not dated revealed, Policy statement: Our facility shall maintain an effective pest control program.Policy Interpretation and Implementation: 1. This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 18 of 18