Health inspection·December 17, 2025

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few facility and had a history of manipulative behavior. Nursing staff (CNA, LVN and RN) were required to provide safety, offer alternative time for care, back away, seek assistance if needed, notify the nurse of behaviors, provide medications as ordered, assess reports of behaviors and notify the MD if interventions are not effective if he becomes combative or aggressive. Staff were also required to be direct and firm when approaching him about behavior, clarify from him what he actually was saying or doing, document behavior in clinical record, inform staff on redirect methods for his behaviors when providing care, monitor for mental status changes, and psych services as needed. There were no notes related to R#1 and R#2's allegations. Review of R#1's progress notes between 12/06/25 and 12/09/25 reflected there were no notes related to R#1's and R#2's allegations. Review of R#1's POC response history for December 2025 showed staff documented there were no behaviors observed on 12/06/25, 12/07/25 and 12/09/25. There were also no documented entries on 12/08/25. Review of R#1's assessments from 12/06/25 through 12/10/25 reflected there were none related to R#1's and R#2's allegations. R#2Review of R#2's admission record, dated 12/12/25, showed she was admitted to the facility on [DATE]. She had medical diagnoses including cerebral palsy (a permanent group of neurological disorders affecting movement, posture, and coordination), bipolar disorder, schizophrenia, and generalized muscle weakness. Review of R#2's comprehensive MDS, dated [DATE], showed she had a 15/15 BIMS, which indicated she was cognitively intact. She also took antipsychotic, antianxiety, and antidepressant high risk medications. She required substantial/maximal assistance with dressing, toileting, bed mobility and dressing and was dependent on staff assistance for personal hygiene and transfers. Review of R#2's care plan report, initiated 09/19/25, showed she had manipulative behaviors and exhibited impulsive behaviors and was at risk of further episodes. Staff (CNA, LVN, RN and SW) were required to discuss behaviors with R#2, discuss what more reasonable behaviors would be, distract her with activities, notify MD/NP of behaviors, identify causes of impulsive behaviors, medications as ordered, monitor labs and report abnormalities to MD, psych services as needed, and routine medication as ordered. Review of R#2's progress notes reflected:A behavior note created by LPN H on 12/06/25 at 11:05 p.m., Resident also called non emergent police this evening regarding concerns. Policeman arrived and somewhat deescalated situation. Administrator aware. Will continue to monitor.Review of R#2's progress notes between 12/06/25 and 12/09/25 reflected there were no other notes related to R#2's allegations.Review of R#2's POC response history for December 2025 showed staff documented there were no behaviors observed on 12/06/25 and 12/09/25. Staff documented she cursed at others, expressed frustration/anger at others, screamed at others, and threatened others on 12/07/25. There were also no documented entries on 12/08/25.Review of R#2's assessments from 12/06/25 through 12/10/25 reflected there were none related to R#2's allegations.Review of the facility's incident log between 12/01/25 and 12/11/25 reflected there were no incidents related to R#1's and R#2's allegations.An observation of R#1's room on 12/11/25 at 10:09 a.m. showed R#1's room was locked. The surveyor attempted to knock on R#1's door and introduce themself. There was no response. During an interview with the ADM on 12/11/25 at 10:11 a.m., the ADM stated R#1 was not at the facility. He stated R#1 was wheelchair bound and provided his own care. He stated he was not at the facility on 12/06/25. He stated he expected staff to notify him of any alleged threats as soon as possible. He stated R#1 was not on 1:1 behavior monitoring and did not have any interventions in place from 12/06/25 through 12/10/25 because the OMB told him that it would be ineffective because R#1 often went out on pass. During an interview with the DON on 12/11/25 at 10:37 a.m., the DON stated R#1 required transfer and lower body dressing assistance, took care of his catheter and colostomy bag, demonstrated to her how he changed his colostomy bag, did not receive formal or follow-up training on colostomy care, and could independently (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 2 of 32 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 12/17/2025 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few shower. She stated she expected staff to immediately notify her of alleged threats. She stated she was unsure of the process for this similar circumstance, but she believed staff would follow ADM's direction if there were any alleged threats reported. She stated R#1 was not placed on 1:1 behavior monitoring and did not have any other interventions implemented from 12/06/25 through 12/10/25 because the OMB told her it would be ineffective because R#1 often went out on pass. During a telephone interview with R#1 on 12/11/25 at 12:17 p.m., R#1 stated he was paralyzed from the chest and down his body and required assistance from getting in and out of bed and wound care and foley catheter care. He stated he was trying to get into his wheelchair so he could go out on pass with a friend and get something to eat because he did not receive any snacks or meals on 12/06/25 . He stated he pressed his call light and no one came for 2-3 hours. He stated he called the HR and told her on 12/06/25 that he was tired of the ADM picking on him, bullying him and harassing him . He stated he also called the VPO and spoke with him and the CNO on 12/06/25 and told them that he was not being cared for, not helped out of bed, and felt bullied and picked on by the ADM. He stated the VPO offered to put him in a hotel on 12/06/25 and he refused because he could not care for himself and needed care and services. He stated no one would help him get into his wheelchair until CNA A, CNA D, and CNA E saw his call light for assistance and responded 2-3 hours after he pressed his call light to get up. He stated he was upset and told CNA A, CNA D, and CNA E to get him into his wheelchair. He stated CNA A, CNA D, and CNA E were trying to transfer him into his wheelchair in his room on 12/06/25 around 7:00 p.m.-7:30 p.m. He stated CNA A left his room, returned, and told him, CNA D and CNA E that they could not help him get in his wheelchair because RN B told them not to help him in his wheelchair and that the ADM was on his way to the facility. He stated he did not know why RN B told CNA A, CNA D, and CNA E not to help him into his wheelchair. He stated he put himself in his wheelchair, signed himself out on pass, went outside because he was upset, and returned inside the facility on 12/06/25. He stated he observed the ADM at the facility on 12/06/25. He stated he complained to SW, DOR, DON, ADON and HR on 12/08/25 about the lack of care that he received on 12/06/25 and 12/07/25. He stated they helped him file a grievance on 12/08/25. He stated the staff on duty on 12/06/25 told them (SW, DOR, DON, ADON and HR) that they did not check on him and did not care for him because they thought he was out on pass on 12/06/25. During an interview with the VPO on 12/11/25 at 1:34 p.m., the VPO stated he did not know if there were any grievances filed regarding R#1's care. He stated R#1 called him on 12/06/25 and told him that he was upset and tired of the ADM bullying him and getting rid of people who he got close to. He stated he looped the CNO into the phone conversation. He stated R#1 was not placed on 1:1 or had any other interventions implemented from 12/06/25 through 12/10/25. He stated he was unsure if the NP and MD gave any special instruction or if psych or behavior services were offered to R#1. During an interview with the CNO on 12/11/25 at 2:23 p.m., the CNO stated she did not know R#1's care or services or if he exhibited any behaviors. She stated R#1 called the VPO on 12/06/25. She stated the VPO included her in the phone conversation with R#1. She stated R#1 expressed he was irritated and tired of staff picking on him. She stated the VPO told her that R#1 was referring to the ADM. She stated R#1 wanted to speak with the VPO and the VPO told him that he would speak with R#1 on 12/09/25. She stated R#1 was not placed on 1:1 because it irritated him and staff were scared of him. She stated R#1 remained at the facility from 12/06/25 through 12/10/25. During an interview with CNA A on 12/11/25 at 4:13 p.m., CNA A stated her and CNA D were walking back to the memory care unit, observed R#1's call light and walked into his room to answer it on 12/06/25. She stated CNA E was already in R#1's room and were arguing back and forth with R#1. She stated that she and CNA D intervened. She stated her and CNA D believed R#1 was upset because he told them that he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 3 of 32 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 12/17/2025 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few had been waiting 2-3 hours for staff to answer his call light and put him in his wheelchair because he did not receive any snacks or meals. She stated she stepped out of R#1's room because she was receiving a call and then notified RN B that R#1 did not get any meals or snacks and was upset because he waited for 2-3 hours after pressing his call light for assistance with getting up. She stated RN B questioned why her and CNA D answered R#1's call light. She stated RN B told her that she told the staff not to get R#1 out of his bed, the ADM was on his way to the facility, and to tell CNA D and CNA E to get out of R#1's room and not help him out of bed. She stated she did not understand why her; CNA D and CNA E could not get R#1 out of bed and RN B did not give her a reason. She stated CNA D also questioned how they could not transfer R#1 because he requested to get out of bed. She stated RN B told her to not worry about it and that the ADM was on his way. She stated the ADM arrived and was at the facility on 12/06/25. She stated the police came to the facility the evening of 12/06/25 due to R#2 calling the nonemergency line and said, This nigger was going to choke me with his dick (genitals). She stated the police came to the facility and spoke with R#1 and R#2. She stated R#1 was not taken out of the facility. She stated the police officer told R#1 and R#2 to go to their rooms and stay away from each other. She stated she did not have to perform any 1:1 with R#1 on 12/06/25. She stated she did not work at the facility after 12/06/25. During an interview with the MD on 12/11/25 at 5:22 p.m., the MD stated R#1 lied in bed, checked himself out of the facility, was mobile with his wheelchair, required some ADL assistance, received wound care and medications, and was placed on hospice care during his admission for pain management and overall ADL decline. He stated R#1 had behaviors and the staff notified him and the NP and documented the behaviors since his admission. During an interview with R#2 on 12/11/25 at 6:15 p.m., R#2 stated she called the police nonemergency phone line to report that R#1 said he would choke her with his big, black dick (genitals). She stated the police arrived, told her to go back to her room, and was no help at all. She stated R#1 was not asked to go back to his room and she observed the ADM speak with him after the police left on 12/06/25. She stated staff did not do anything to ensure no further incidents occurred between her and R#1. She stated she was in fear of another incident occurring with R#1 after 12/06/25. She stated staff did not offer a room move and no interventions were put in place to ensure her and R#1 stayed away from each other. She stated her and R#1 continued to reside on the same hallway.During a telephone interview with R#1 on 12/11/25 at 6:32 p.m., R#1 stated R#2 called the police and alleged that he told her that he would choke her with his big, black dick. He stated he spoke with the police, had a video recording of the interaction, and was told to go back to his room and stay away from R#2. He stated he did not speak with the ADM after the police left on 12/06/25. He stated staff did not do anything to ensure no further incidents occurred between him and R#2. He stated staff did not offer a room move and no interventions were put in place to ensure him and R#2 stayed away from each other. He stated him and R#2 continued to reside on the same hallway.During an interview with LVN G on 12/12/25 at 9:18 a.m., LVN G stated she was familiar with R#1 and worked with him during the night shift. She stated R#1 had a stage 4 wound on is back, was paralyzed from the chest down, had a motorized wheelchair, required two-person transfer assistance, and one of his legs was amputated. She stated R#1 was always very respectful to her, always thanked her, never mistreated her, and never said anything threatening to her. She stated R#1 did not exhibit any behaviors on 12/08/25 and 12/09/25. She stated she did not have to conduct 1:1 with R#1. LVN G stated R#2 often yelled and said derogatory remarks. During an interview with the PO on 12/12/25 at 11:17 a.m., the PO stated he did not believe the police were called on 12/06/25. During an interview with the HR on 12/12/25 at 4:02 p.m., the HR stated R#1 called her at home on [DATE] and expressed he was very upset and said, I'm tired of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 4 of 32 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 12/17/2025 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few this nigga picking on me, harassing me, and bullying me. He's not allowing the CNAs to get me up. She stated she tried to calm R#1 down and said she would come to the facility and get the CNAs to help him up. She stated she observed the CN was in the room when she arrived at the facility and entered R#1's room. She stated R#1 was wheelchair bound, had a colostomy bag, urine bag and an amputated leg and could only do movement with his hands. She stated she did not call the police on 12/06/25. She stated she notified the ADM at the facility on 12/06/25 and told him to stay out of R#1's way because he was upset with him because he was tired of being bullied and harassed by the ADM. She stated the ADM did not call the police on 12/06/25. She stated she did not know why the police was not called on 12/06/25. She stated R#1 also called the VPO. During an interview with LPN H on 12/12/25 at 5:28 p.m., LPN H stated R#1 was an amputee, had one leg missing, would not get up on his own, could not walk and almost needed total care. She stated R#1 did not make any threats to her or anyone when she worked with him on 12/06/25 and 12/07/25. She stated R#1 had an aggressive personality and attitudes and could at time be verbally abusive, but she believed he could not carry out any threat. During an interview with CNA I on 12/12/25 at 5:53 p.m., CNA I stated R#1 was paralyzed, had a colostomy bag, required assistance with getting into his wheelchair, and never made a threat to shoot or cause bodily harm to anyone at the facility on 12/08/25 and 12/09/25. She stated R#1 made no threats to her and CNA J on 12/08/25. She stated she did not have to conduct 1:1 monitoring for R#1 on 12/08/25 and 12/09/25. During an interview with the DM on 12/13/25 at 9:57 a.m., the DM stated R#1 expressed to her that he felt staff were being petty, did not tell her who the staff were, and he told her that he cannot tell her who because she would confront them on 12/06/25. She stated she would immediately notify the ADM, ADM, and VPO of any allegations of ANE. She stated R#1's statement to her would be a resident abuse allegation. She stated the ADM was responsible for investigating and reporting allegations of ANE. She stated grievances were reviewed daily and ADM notified staff when he would report allegations to HHSC. She stated it was important to report and investigate ANE and said, It was important because resident alleging abuse and need to finish investigation. Resident could be at risk of retaliation if ANE allegations not reported and investigated.During an interview with R#1 on 12/13/25 at 10:14 a.m., R#1 stated the facility did not investigate his allegation of the ADM bullying him. He stated he was not offered psych services, behavior services, 1:1, or move to another room. He stated after he expressed the ADM was bullying him to the staff, from 12/06/25 through 12/10/25, he felt scared for his life. During an interview with the SW on 12/13/25 at 10:23 a.m., the SW stated R#1 told her that he felt the ADM was picking on him on 12/09/25 or 12/10/25. She stated she filed a grievance on 12/09/25 or 12/10/25. She stated there was no one who reviewed and followed up on the grievance while she was out on 12/11/25 and 12/12/25. She stated R#1 did not express any threats to her or anyone at the facility. She stated R#2 and R#1 went back and forth often. She stated she would speak with R#1 and R#2 whenever they argued. She stated R#2 expressed to her that she wanted to transfer to another facility about one week ago. She stated she was working on getting R#2 transferred to another facility. She stated it was resident abuse if a resident expressed a staff member was bullying or picking on them. She stated she would file a grievance for a resident if ANE was alleged. She stated she would review the grievance and assign it. She stated the ADM was the abuse and neglect coordinator and investigated ANE. She stated any staff member could report ANE to the SSA. She stated she was unsure when to report ANE to HHSC. She stated she was not educated on ANE reporting and investigation. During an interview with the ADON on 12/13/25 at 11:23 a.m., the ADON stated R#1 was not able to provide his own wound care. She stated she did not believe R#1 could harm anyone because of his paralysis, weakness, and amputee. She stated she did not receive any threats from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 5 of 32 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 12/17/2025 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few residents and staff. She stated there were no reports of threats made by R#1 towards staff. She stated she did not receive any allegations of abuse. She stated she could not recall a resident informing her that they felt they were being bullied or picked on by a staff member. She stated R#1 never expressed that he was being bullied, threatened, or picked on to her. She stated she expected the staff to take the grievance; we reviewed the grievance and give it to the abuse coordinator. She stated ADM was the abuse and neglect coordinator. She stated she knew to immediately notify the ADM. She stated the ADM reports and all staff as a team investigates ANE. She stated resident to resident incidents are still reported and investigated by the ADM and staff intervened and ensured residents were separated and away from each other. She stated she did not know who oversaw and ensured ADM reported and investigated ANE. She stated she knew it was important to report and investigate ANE and said, Because you want to make sure the residents are safe and everyone have the right to report and feel comfortable in their room and to ensure their safety and comfort. Residents could be at risk of feeling unsafe, unheard, needs not being met, and was being followed up on. During an interview and record review with the CN on 12/13/25 at 12:00 p.m., the CN stated R#1 was unable to harm anyone because of his health condition. He stated RN B and the ADM told him to get R#1's medications because he was leaving on 12/06/25. He stated he went into R#1's room to give him pain medication on an unknown date that he believed was 12/06/25 or 12/07/25. He stated R#1 was upset on 12/06/25. He stated R#1 did not make any remarks or threats of wanting to shoot or harm anyone. He stated R#1 did not tell him that the ADM was bullying him. He stated R#1 went outside and then came back inside the facility on 12/06/25. He stated he was expected to immediately notify the ADM, who was the abuse and neglect coordinator. He stated the ADM reported and investigated abuse and neglect. He stated he knew it was important to report and investigate ANE and said, You don't want to accuse someone falsely of anything. You want to make sure your ducks are in a row before HHSC comes out to the facility. Resident could be at risk of harm. During an interview with the DON on 12/13/25 at 12:56 p.m., the DON stated no residents expressed they were being picked on by staff. She stated R#1 did not express being bullied or picked on by the ADM. She stated R#1 told her on 12/08/25 that he asked staff to get him up and staff took a long time to get him up on 12/06/25. She stated R#1 did not file a grievance on 12/08/25. She stated could not recall if she had to provide any counseling to staff after the alleged incident. She stated R#1's care plan was not updated for any new interventions. She stated ADM was the abuse and neglect coordinator. She stated ADM investigated and reported ANE. She stated she expected staff to notify immediately the ADM of any allegations of ANE. She stated she knew it was important to report and investigate ANE and said, To make sure the resident doesn't get harmed. Resident could be at risk of potential harm.During an interview with CNA A on 12/13/25 at 1:23 p.m., CNA A stated R#1 expressed on 12/06/25 that he was tired of the ADM messing with him and he wanted the ADM to leave him alone. She stated she informed the charge nurse and the abuse and neglect coordinator, which is the ADM, immediately of any ANE allegations. She stated the DON and ADM investigate and report ANE. She stated it was important to report and investigate ANE allegations and said, Because it's our job and to make sure the residents are good. Residents could continue to get bullied, abused, or neglected and have a bad turnout and bad situation if not reported. During an interview with the ADM on 12/13/25 at 1:40 p.m., the ADM stated he could not recall if the HR notified him of anything related to R#1 feeling he was bullying, harassing and picking on him. He stated this was the first time he was hearing that R#1 felt he was bullying, harassing and picking on him. He stated he had not investigated the alleged incident. He stated R#2 called the police to report R#1 allegedly said he would choke her with his penis (genitals) and said, I guess it was something that we should've (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 6 of 32 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 12/17/2025 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few reported. He stated the police notified him on 12/06/25. He stated R#2 told him on 12/08/25 that she was frustrated and refused to talk. He stated R#1 told him on 12/8/25 that the incident did not occur. He stated staff monitored R#1 within eyesight and staff documented in electronic health records every 15 minutes until his discharge on [DATE]. He stated there were no subsequent incidents. He stated he was trying to discharge R#1 as an intervention. He stated he was the abuse and neglect coordinator. He stated he would investigate the alleged incident of suspicions or allegations of ANE. He stated he would expect staff to immediately report ANE to him, separate resident from AP, suspend alleged staff member, and ensure safety. He stated the CNO and VPO oversee to ensure he reported and investigated incident at least twice a week. He stated it was important to report and investigate ANE allegations and said, Because we are dealing with a vulnerable population and it was required to report and investigate by the state and federal government. Resident could be at risk of any form of ANE.During an interview with HR on 12/13/25 at 2:04 p.m., HR stated the ADM was the abuse and neglect coordinator and reported and investigated ANE allegations. She stated it was important to report and investigate ANE allegations and said, It's very important, because we should not let abuse happen and to protect the resident. Resident could be at risk of feeling like nothing is being done in the facility and something could continue to happen if not reported and investigated.During an interview with LPN H on 12/13/25 at 2:34 p.m., LPN H stated the nurse report to the ADM and the ADM handles ANE allegations. She stated it was important to report and investigate ANE allegations and said, To ensure resident was viable or not and to ensure if anything happened or had potential to happen. Resident could be at risk of ANE from the staff member.During staff interviews from 12/14/25 at 12:28 p.m. through 12/14/25 at 1:05 p.m., MA K, CNA L, CNA M, CNA N, CNA O and CNA P stated R#1 never made any threats to harm or hurt anyone from 12/06/25 through 12/10/25 and was not an endangerment to the facility because he was in a wheelchair and a paraplegic. They also stated they knew to report ANE allegations to the ADM, who was the abuse and neglect coordinator. They also stated the ADM reported to SSA and investigated ANE allegations. They knew the importance of reporting and investigating ANE allegations to ensure residents were safe and to prevent further ANE.During an interview with the DOR on 12/14/25 at 1:29 p.m., the DOR stated R#1 was a paraplegic and wheelchair bound, could not get up from his wheelchair, had full range of motion of his arms, was kind to residents, and was not an endangerment to the facility. She stated she received abuse and neglect allegations or suspicions and notified the ADM and filed grievances to the SW. She stated the ADM reported and investigated abuse and neglect. She stated it was important to report and investigate ANE and said, Because it is wrong and no resident should be subjected of any form of harm. Resident could be further harmed, could be seriously injured, and could lead to death and serious consequences. She stated no residents expressed being bullied or picked on. She stated R#1 was direct. She stated she did not engage with R#1 a lot. She stated R#1 was kind to residents. She stated R#1 was not an endangerment to the facility. She stated HR, SW, and her were present in the room, R#1 was requesting to get up, she requested a CNA J get him up, CNA J did not do it, and he filed a grievance that he felt he was being ignored sometime last week. During an interview with RN B on 12/15/25 at 2:26 p.m., RN B stated she was working from 12/06/25 through 12/08/25 and was on duty with the CN and 2-3 other CNAs. She stated the CNAs did not inform her of any alleged statements or threats made by R#1 on 12/06/25. She stated R#1 did not make any alleged statements or threats towards her on 12/06/25. She stated the ADM was at the facility on 12/06/25. She stated she was instructed by the ADM to inform the CNAs to not get R#1 up and did not know why.During an interview with the VPO on 12/15/25 at 2:59 p.m., the VPO stated he did not report R#1's allegation of the ADM harassing, bullying and picking on him to the SSA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 7 of 32 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 12/17/2025 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete because he spoke with R#1 on 12/06/25. He explained it was a broad statement made by R#1 and it was not regarding bullying, intimidating and being picking on by the ADM. He stated he did not file a grievance because he talked about it with R#1. He stated he was not informed by the ADM and other staff about ADM bullying and picking on him. He stated he would have a conversation with the ADM and speak with the resident, place the ADM on suspension, conduct safe surveys, and interview staff. He stated he expected the ADM to report to the SSA and investigate any allegations of abuse and neglect. He stated he was responsible for stepping in and investigating and reporting the ANE allegations related to the ADM. He stated he knew it was important to report and investigate ANE and said, Resident safety. Resident could be at risk for harm. During an interview with the CNO on 12/15/25 at 3:08 p.m., the CNO stated she expected staff to report ANE allegations immediately, suspend the alleged employee pending outcome, report to the SSA, collect all information, and said, Always report first and then investigate any allegation. She stated the ADM, who was the abuse and neglect coordinator, was responsible for reporting and investigating ANE allegations. She stated the DON oversaw and ensured if an ANE allegation was made against the ADM. She stated R#1 told her and the VPO that he was tired of the ADM picking on him and watching him all the time on 12/06/25. She stated any resident who alleged someone was picking on them could be self-reported to the SSA. She stated she knew it was important to report and investigate ANE and said, To ensure the safety and protect the residents and to ensure residents are protected from abuse and neglect. Residents could be at risk of continued abuse and neglect. During an interview with CNA D on 12/15/25 at 6:31 p.m., CNA D stated she was working with CNA A on 12/06/25. She stated her and CNA A walked towards the secure memory care unit, saw R#1's call light, and CNA E waved them down. She stated while her, CNA A, and CNA E were in R#1's room, R#1 said, When y'all get me up, y'all stay out the way. She stated CNA A's cellphone rang and she exited the room. She stated CNA A returned to the room and said, Oh someone was on the floor, someone come help me. She stated that she and CNA E exited the room. She stated RN B told her, CNA A and CNA E not to get R#1 up until the ADM came to the facility. She stated she questioned RN B why they could not get R#1 out of bed and RN B stated not to worry about it. She stated R#2 told her that R#1 kept calling her a bitch every time she passed by him. She stated police came out in response to R#2 alleging R#1 was going to choke her with his dick (genitals). She stated police left the facility and did not take anyone to jail on 12/0 Event ID: Facility ID: 675564 If continuation sheet Page 8 of 32 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 12/17/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to permit each resident to remain in the facility and not discharge the resident when the resident exercises his or her right to appeal a discharge notice for 1 of 6 residents (R#1). 1. The facility failed to discharge R#1 to a safe environment on [DATE]. R#1 had nowhere to go from [DATE] through [DATE] and was hospitalized on [DATE]. 2. The facility failed to allow R#1 to remain in the facility when he exercised his right to appeal the discharge notice staff served him on [DATE]. An IJ was identified on [DATE]. The IJ template was provided to the facility on [DATE] at 5:17 p.m. While the IJ was removed on [DATE] at 5:30 p.m., the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy because of the facility's need to evaluate the effectiveness of their corrective systems.This failure could place residents at risk of worsening medical conditions, injury, hospitalization or death. Review of R#1's admission record, dated [DATE], revealed he was initially admitted to the facility on [DATE]. He had medical diagnoses that included vertebra osteomyelitis (a serious infection and inflammation of the spinal bones), a stage 4 pressure ulcer in his sacral region (a severe, full-thickness wound extending to muscle, bone, or supporting structures, involving tissue loss with potential for dead tissue, deep tunneling, and serious infection risk), neuromuscular bladder dysfunction (nerve damage disrupts signals between the brain and bladder, causing it to not fill or empty properly), paraplegia (paralysis affecting the lower half of the body, including the legs and sometimes the trunk), protein-calorie malnutrition (a serious nutritional disorder from not getting enough protein and/or energy), left lower limb cellulitis (a common bacterial skin infection affecting the skin and tissue of your left leg), and sepsis (life-threatening medical emergency where the body's extreme response to an infection damages its own tissues). He was discharged on [DATE] at 3:02 p.m. to other. Review of R#1's annual MDS, dated [DATE], revealed he had a 15/15 BIMS score, which indicated he was cognitively intact. He required partial/moderate assistance with upper body dressing and bed mobility, substantial/maximal assistance with toileting and showering and dependent on staff for lower body dressing and transfers. He also had one stage 3 pressure ulcer and one stage 4 pressure ulcer. He also had verbal behaviors that occurred 4-6 days but less than daily that did not impact him and others .Review of R#1's care plan report, initiated on [DATE], revealed he had a stage 3 pressure ulcer on his left heel, stage 4 pressure ulcer to his sacral region, right leg amputation and had a suprapubic catheter. He was also at risk for ADL decline and staff were required to provide extensive assistance for bed mobility and upper/lower body dressing, and total assistance with transfers. He also had episodes of exhibiting verbal/physical aggression towards staff and residents who reside in the facility and had a history of manipulative behavior. Nursing staff (CNA, LVN and RN) were required to provide safety, offer alternative time for care, back away, seek assistance if needed, notify the nurse of behaviors, provide medications as ordered, assess reports of behaviors and notify the MD if interventions are not effective if he becomes combative or aggressive. Staff were also required to be direct and firm when approaching him about behavior, clarify from him what he actually was saying or doing, document behavior in clinical record, inform staff on redirect methods for his behaviors when providing care, monitor for mental status changes, and psych services as needed. Review of R#1's order summary report, dated [DATE], showed he required hospice care every shift, a catheter change every shift if it was dislodged, his foley catheter bag drained empty every shift, pain assessed every shift, and left heel pressure ulcer cleaned every night shift. Review of R#1's discharge planning (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 9 of 32 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 12/17/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few review initiated by the CNO on [DATE] showed it was incomplete . Review of the OMB's email correspondence showed the OMB emailed the ADM on [DATE] and asked if he could let R#1 give him a call to discuss his discharge and attached a copy of the discharge and provider letter. There was no email response to the OMB's request. Review of R#1's notice of immediate discharge, dated [DATE], showed staff served a formal written notice of his immediate transfer and discharge from the facility on [DATE]. The was no address included that R#1 would discharge to. The reasons for this action reflected, On [DATE], you made a direct and credible threat to shoot the ADM, as reported by staff member. You have stated to staff that you have previously served time in prison and ‘would go back,' increasing concern for the seriousness of the threat.You routinely leave the community for extended periods and have access to financial resources, creating a credible risk that you could obtain a weapon and return to the facility. Texas Penal Code - Terroristic Threat (threat of violence causing fear and disrupting a licensed healthcare facility) The right to appeal section reflected, You have the right to appeal this discharge to HHSC. If you wish to appeal, you must contact HHSC immediately upon receipt of this notice. You may request a Fair Hearing by calling the HHSC Appeals Division or sending a written request to HHSC Appeals Division. During the appeal process, you have the right to remain in the facility until a final decision is made, except in cases of immediate jeopardy, which applies in this situation. Review of R#1's criminal trespass notice, dated [DATE], showed the VPO was the owner or had the authority to provide an official notice advising R#1 that his future entry onto the facility property was expressly forbidden and would be subject to arrest for criminal trespassing if he entered or remained on or in the facility property or failed to depart from the facility property. PO signed the notice. Review of the facility's discharge report between [DATE] and [DATE] showed R#1 was discharged to other on [DATE]. Review of the facility's in-service on [DATE] showed the DON taught staff to call the police and notify her, the ADON and ADM in the event R#1 arrived on the facility's premises. Review of the OMB's email correspondence showed the OMB emailed the VPO on [DATE] and informed him that R#1 requested to appeal his discharge and wanted to return to the facility until his discharge appeal hearing is completed. The VPO emailed the OMB on [DATE] and informed him that R#1 could not return to the facility during the appeal process and explained the facility community determined R#1 posed an ongoing threat to the health and safety of residents and staff based on repeated verbal threats of violence made toward the ADM and others. Review of R#1's progress notes between [DATE] and [DATE] reflected there were no notes related to the alleged incidents. Review of R#1's progress note created by the MD on [DATE] at 9:59 a.m. reflected, As we discussed, [facility] is issuing an immediate discharge for [R#1] today at 11a r/t his verbal threat to shoot the administrator. He made this threat known to a facility employee. discussed last week regarding previous threat to the corporate leadership and somehow getting hold of their personal contacts and called with threats. Discussed initially with CNO, then I called the administrator back directly -- advised getting the police to the [facility], escort him out directly to an ER, and the ER need to have the psychiatry team evaluate him for admission due to risk of harming others. [sic] Review of R#1's progress note created by the DM on [DATE] at 1:35 p.m. reflected, Resident has had behavioral issues and refuses care as noted previously by nursing. He will be D/C r/t increased aggressive behavior and threatening staff members. Recommend to continue diet with med pass r/t poor po intakes and increased needs r/t altered skin status. Recommended to continue high protein supplements such as prostate 30 ml BID for wound healing and to meet needs. Resident remains on hospice care. Weight loss may be unavoidable as the condition continues to decline. Resident's comfort takes priority overweight goals. Weight loss and decreased intake anticipated in end of life process; deceased intake increases endorphins and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 10 of 32 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 12/17/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few dynorphins which enhances comfort and can provide individuals with euphoric experiences and prevention of discomfort. [sic]Review of R#1's progress note created by the DON on [DATE] at 1:45 p.m. reflected, Resident was served immediate discharge documents from the [VPO]. Resident was served in the presence of two Police Officers and one Police Detective. Resident declined to take the document stating, I don't need a mother fucking thing. The [VPO] offered to pay for a hotel stay for five days for resident and have Hospice continue care. Hospice did speak with resident and explain extended services that will/can be provided while staying at the hotel. Resident received all medications and wound care supplies given in a bag. The list of medications given were: Biktarvy, gabapentin, atorvastatin, hydromorphone, glipizide, metformin, and metoprolol, gauze, collagen with xeroform, calcium alginate, abdominal pads, and kerlix dressing. Resident requested his clothes out of his room and the charge nurse assigned to resident got a clean trash bag and put resident's clothes in a bag and put it where the resident requested. Resident stated he was going to return to the building and no one would stop him. The Police Officers did explain to resident he was also getting served with a no trespassing order and it was explained to resident that failure to comply would result in the resident getting arrested. The Detective offered to take the resident to the hospital and the resident declined. Resident requested to speak with social worker. Social worker provided outside resources for resident to look into for continuity of care.spoke with [VPO] and administrator again. [R#1] no making more active threats. as such it's ok to discharge to self-care BUT still will involve the police this morning to ensure safety measures. [R#1] should not be allowed to return to facility because he made threats to multiple staff/employees/team members of physical violence, and even police had to be involved. This is to ensure the safety ofthe facility and employees. [sic]Review of R#1's POC response history for [DATE] showed staff documented there were no behaviors observed on [DATE], [DATE] and [DATE]. There were also no documented entries on [DATE]. Review of the facility's incident log between [DATE] and [DATE] reflected there were no incidents related to the alleged incidents. An observations of R#1's room on [DATE] at 10:09 a.m. showed R#1's room was locked. The surveyor attempted to knock on R#1's door and introduce themself. There was no response. During an interview with the ADM on [DATE] at 10:11 a.m., the ADM stated R#1 was not at the facility. He stated he believed R#1 was at a friend's home as of [DATE]. He stated he did not have confirmation of R#1 being at a friend's home. He stated he attempted to call R#1 on an unknown date and R#1 did not respond and call him back . He stated R#1 was wheelchair bound and provided his own care. He stated CNA A told him on an unknown date that R#1 told her in his room that he was threatening to shoot the ADM on [DATE]. He stated he and staff did not know if R#1 had any firearms or weapons because R#1 refused an inventory check. He stated RN B and CNA C told him on unknown date that they received threats from R#1 on [DATE]. The ADM did not elaborate on the threats that RN B and CNA C received from R#1 on [DATE]. The ADM stated the HR, VPO, and CNO told him on [DATE] that R#1 made threats to them on [DATE]. He stated R#1 made a threat while on the phone with HR and while on the phone with the VPO and CNO on [DATE]. He did not elaborate on the threats that R#1 made to the HR, VPO, and CNO on [DATE]. He stated he did not know why the HR, VPO, and CNO did not inform him on [DATE] of the threats that R#1 made to them on [DATE]. He stated he was not at the facility on [DATE]. He stated he expected staff to notify him of any alleged threats as soon as possible. He stated the VPO notified the police on [DATE]. He stated the police did not arrive at the facility until [DATE] because the police believed it was not an emergency. He stated R#1 was not on 1:1 and did not have any interventions in place from [DATE] through [DATE] because the OMB told him that it would be ineffective because R#1 often went out on pass. He stated the facility was trying to find another facility to transfer R#1 to on unknown date and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 11 of 32 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 12/17/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few he was declined by several other facilities. He stated the police arrived at the facility on [DATE] to ensure the discharge process was properly completed. He stated R#1 received an immediate discharge notice on [DATE]. He stated the OMB was aware of R#1's immediate discharge and received a copy of the immediate discharge notice given to R#1 on [DATE]. He stated the police offered to take R#1 to the hospital and R#1 refused on [DATE]. He stated the IDT team ensured residents had a safe and proper discharge. He stated he knew it was important to ensure residents had a safe and proper discharge and said, So they could continue to get care and services and make sure they were safe. Residents would be at risk of being unsafe if they did not have a safe and proper discharge. He stated he believed R#1 had a safe and proper discharge because the VPO offered him a hotel and he declined and the police offered to take him to the hospital and he declined. During an interview with the DON on [DATE] at 10:37 a.m., the DON stated R#1 required transfer and lower body dressing assistance, took care of his catheter and colostomy bag, demonstrated to her how he changed his colostomy bag, did not receive formal or follow-up training on colostomy care, and could independently shower. The ADM told her on [DATE] that R#1 made threats to RN B on [DATE] and the police were called and arrived at the facility on [DATE]. She stated she could not recall the threats the ADM notified her that R#1 made to RN B on [DATE]. She stated the ADM also told her on [DATE] that the HR was present when R#1 made a threat to harm the ADM by gunshot on [DATE]. She stated the CN was also on duty on [DATE]. She stated RN B had staff check on other residents and R#1 called the police and stepped outside on [DATE]. She stated she did not know when the police arrived at the facility on [DATE]. She stated the OMB was notified on unknown date, but before [DATE], of R#1's alleged threat on [DATE]. She stated the VPO was also notified on [DATE] of R#1's alleged threat on [DATE]. She stated she expected staff to immediately notify her of alleged threats. She stated she was unsure of the process for this similar circumstance, but she believed staff would follow ADM's direction. She stated R#1 was not placed on 1:1 and did not have any other interventions implemented from [DATE] through [DATE] because the OMB told her it would be ineffective because R#1 often went out on pass. She stated R#1 was provided with an immediate discharge notice on [DATE] around 12:00 p.m. She stated R#1 was immediately discharged due to the alleged threat he made on [DATE]. She stated the OMB was notified of the immediate discharge on [DATE]. She stated the VPO offered a hotel room to R#1 and he declined it on [DATE]. She stated R#1 was provided with all his medications before he discharged from the facility and documented it in a progress note. She stated the police provided R#1 with a no trespass order on [DATE]. She stated she did not know where R#1 was currently. She stated she believed the ADM had R#1's contact information and it might be listed in his clinical records. She stated she did not make due diligence to contact R#1 after he was discharged on [DATE]. She stated she did not know if staff attempted to contact R#1 after his discharge on [DATE]. She stated no in-services were initiated after R#1's discharge other than the VPO did an in-service on reporting R#1 to the police if he was observed on the facility property on [DATE]. During an interview with the PO on [DATE] at 11:50 a.m., the PO stated R#1 was served with a no trespass order, R#1 tore it, refused to leave the facility, and would not leave the facility until they told R#1 that he would be arrested if he did not leave the facility. During a telephone interview with R#1 on [DATE] at 12:17 p.m., R#1 stated he was paralyzed from the chest and down his body and required assistance from getting in and out of bed and wound care and foley catheter care. He stated the facility staff and police wanted to speak with him on [DATE] and he stepped outside the facility building. He stated he did not know he was being kicked out of the facility. He explained the VPO, ADM, DON, and police officers informed him that he was being immediately discharged on [DATE] due to an alleged threat that staff reported he made on [DATE]. He stated they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 12 of 32 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 12/17/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few explained to him that staff reported he threatened that he was going to shoot the ADM on [DATE]. He stated he did not make any threats to shoot the ADM on [DATE] and the allegation was absurd. He stated the police did not arrive at the facility and did not search him for any weapons from [DATE] through [DATE]. He also stated he did not have any weapons. He stated he was trying to get into his wheelchair so he could go out on pass with a friend and get something to eat because he did not receive any snacks or meals on [DATE]. He stated he pressed his call light and no one came for 2-3 hours. He stated he called the HR and told her on [DATE] that he was tired of the ADM picking on him, bullying him and harassing him. He stated he also called the VPO and spoke with him and the CNO on [DATE] and told them that he was not being cared for, not helped out of bed, and felt bullied and picked on by the ADM. He stated the VPO offered to put him in a hotel on [DATE] and he refused because he could not care for himself and needed care and services. He stated no one would help him get into his wheelchair until CNA A, CNA D, and CNA E saw his call light for assistance and responded 2-3 hours after he pressed his call light to get up. He stated he was upset and told CNA A, CNA D, and CNA E to get him into his wheelchair. He stated CNA A, CNA D, and CNA E were trying to transfer him into his wheelchair in his room on [DATE] around 7:00 p.m.-7:30 p.m. He stated CNA A left his room, returned, and told him, CNA D and CNA E that they could not help him get in his wheelchair because RN B told them not to help him in his wheelchair and that the ADM was on his way to the facility. He stated he did not know why RN B told CNA A, CNA D, and CNA E not to help him into his wheelchair. He stated he put himself in his wheelchair, signed himself out on pass, went outside because he was upset, and returned inside the facility on [DATE]. He stated he observed the ADM at the facility on [DATE]. He stated he complained to SW, DOR, DON, ADON and HR on [DATE] about the lack of care that he received on [DATE] and [DATE]. He stated they helped him file a grievance on [DATE]. He stated the staff on duty on [DATE] told them (SW, DOR, DON, ADON and HR) that they did not check on him and did not care for him because they thought he was out on pass on [DATE]. He stated the staff provided him with his medications and did not provide him with wound care supplies on [DATE]. He stated the police offered EMS transport to the hospital and he declined on [DATE]. He also stated the VPO offered a 5-day hotel stay and he declined on [DATE]. He stated no other alternative placement was offered on [DATE]. He stated the police told him that he would be arrested if he did not leave the facility premises on [DATE]. He stated he had nowhere to go, told his hospice he had nowhere to go, and slept in his truck in 37 degree Fahrenheit weather on [DATE]. He stated he did not receive any wound care, colostomy care, ADL care, meals and his wounds smelled. During an interview with the VPO on [DATE] at 1:34 p.m., the VPO stated R#1 relied on his electric wheelchair and was on Medicaid. He stated R#1 often signed in and out of the facility and would take his medication with him. He stated R#1 was at the facility for a little bit, had received very little care, and had the financial means to purchase a firearm. He stated he was not aware if R#1 was in possession of a firearm. He stated he did not know if there were any grievances filed regarding R#1's care. He stated R#1 called him on [DATE] and told him that he was upset and tired of the ADM bullying him and getting rid of people who he got close to. He stated he looped the CNO into the phone conversation. He stated R#1 said, My mind will run and only violence would resolve the issue. He stated he believed R#1 was referring to the ADM. He stated R#1 told him and the CNO that he would make impulsive decisions that he would regret. He stated the police did not arrive at the facility on [DATE]. He stated he did not know why the police did not arrive at the facility on [DATE]. He stated he started investigating the alleged incident on [DATE]. He stated he interviewed CNA A on [DATE] and [DATE]. He stated CNA A told him that she was getting R#1 up when he told her, Put me up in this wheelchair, I'm going shoot up this nursing facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 13 of 32 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 12/17/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few like I did to the other one, on [DATE]. He stated R#1 called the HR, who heard R#1 was upset and arrived at the facility to speak with him. He stated the HR told him on [DATE] that R#1 said, Clear the hallways and put the residents in the dining room. I'm going to shoot [ADM], on [DATE]. He stated R#1 did not threaten to shoot any residents. He stated R#1 was not placed on 1:1 or had any other interventions implemented from [DATE] through [DATE]. He stated he was unsure if the NP and MD gave any special instruction or if psych or behavior services were offered to R#1. He stated he tried to notify the OMB on [DATE], [DATE], and [DATE] about the immediate discharge request. He stated he spoke with the OMB on [DATE] and notified him of the immediate discharge request. He stated he spoke with the OMB again on [DATE] and the OMB told him that he spoke with unknown HHSC staff member and they cleared R#1 immediate discharge due to the threat R#1 made on [DATE] around 4:45pm-5:00pm. He stated he wanted to discharge R#1 on [DATE]. He stated he notified the police on [DATE] that R#1 threatened to shoot the ADM on [DATE], they did not come out to the facility, did not conduct a search and did not explain why they did not come out to the facility. He stated he did not discharge R#1 on [DATE] because he wanted to have something in plan on [DATE]. He stated the CNO called R#1's hospice on [DATE]. He explained he wanted to make sure hospice could visit R#1. He stated he also wanted to make sure R#1 had a place to discharge to. He stated he also had police present when he served the immediate discharge notice to R#1 on [DATE]. He stated R#1 threw the immediate discharge notice back at them and police intervened. He stated Hospice was also present on [DATE]. He stated R#1's friend also showed up to the facility on [DATE]. He stated the police offered EMS transportation to R#1, but he declined. He stated R#1 was provided with his clothes, medications, and an address for where his personal belongings would be sent to. He stated the OMB came to the facility later on in the afternoon of [DATE]. He stated R#1 did not check into the hotel he offered and R#1 declined on [DATE]. He stated he did not know R#1's whereabouts. He stated he knew it was important to ensure residents had a safe and proper discharge and said, The safety of the discharge and ensuring they have a place to go. Residents could be at risk of lack of care if they did not have a safe and proper discharge. He stated residents could stay at the facility during a pending discharge appeal. During an interview with the CNO on [DATE] at 2:23 p.m., the CNO stated she did not know R#1's care or services or if he exhibited any behaviors. She stated R#1 called the VPO on [DATE]. She stated the VPO included her in the phone conversation with R#1. She stated R#1 expressed he was irritated and tired of staff picking on him. She stated the VPO told her that R#1 was referring to the ADM. She stated R#1 said, I can take care of business, the only way things could get settled is through violence. I do things without thinking and then after it's done I regret it. She stated she offered to put R#1 in hotel on [DATE] and he declined. She stated R#1 wanted to speak with the VPO and the VPO told him that he would speak with R#1 on [DATE]. She stated she was informed by the VPO on [DATE] that the ADM reported R#1 made threats to shoot the ADM on [DATE]. She stated the VPO told her that R#1 told a CNA that he would shoot up the entire facility and to get the residents in the dining room so he could shoot the ADM. She stated she was unsure if R#1 made alleged threats to anyone else. She stated she did not know if R#1 had any weapons in his possession to cause harm. She stated R#1 was not placed on 1:1 because it irritated him and staff were scared of him. She stated R#1 remained at the facility from [DATE] through [DATE]. She stated the VPO called the police on [DATE] and she did not know if the police arrived at the facility. She stated the OMB told the VPO on unknown date that HHSC told him there was grounds to immediately discharge R#1. She stated the MD was notified on unknown date of R#1's immediate discharge and agreed with it. She stated R#1's hospice was also notified on unknown date. She stated the VPO served the immediate discharge notice to R#1 on [DATE]. She stated R#1 was provided (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 14 of 32 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 12/17/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few with his medications and wound care supplies. She stated the VPO made a hotel reservation for R#1 for five days. She stated she did not know if R#1 accepted or declined the hotel reservation. She stated R#1 left with a friend who was a nurse, but she had no confirmation as to whether or not his friend had a current nurse license. She stated she did not know if R#1's friend was providing care and services to R#1. She stated she did not know R#1's whereabouts. She stated she did not know if R#1 reached out to his hospice. She stated the facility was responsible for residents' safe and proper discharge. She stated she knew it was important to ensure residents had a safe and proper discharge and said, It's important for residents so that their care and services continued. Residents could be at risk of not having their care and services continued if they did not have a safe and proper discharge. During an interview with CNA A on [DATE] at 4:13 p.m., CNA A stated her and CNA D were walking back to the memory care unit, observed R#1's call light and walked into his room to answer it [DATE]. She stated CNA E was already in R#1's room and was arguing back and forth with R#1. She stated that she and CNA D intervened. She stated R#1 was upset and said, I just want y'all motherfuckers to get me up in my chair and out the way. She stated CNA E sarcastically said, Oh don't shoot me. She stated as she and CNA D helped CNA E put R#1 into his wheelchair, R#1 said, Yeah because the previous nursing homes I've been in trouble for shooting them up. She stated she, CNA D and CNA E were not in fear and believed R#1 was upset because he told them that he had been waiting 2-3 hours for staff to answer his call light and put him in his wheelchair because he did not receive any snacks or meals. She stated she stepped out of R#1's room because she was receiving a call and then notified RN B that R#1 did not get any meals or snacks and was upset because he waited for 2-3 hours after pressing his call light for assistance with getting up. She stated RN B questioned why she and CNA D answered R#1's call light. She stated RN B told her that she told the staff not to get R#1 out of his bed, the ADM was on his way to the facility, and to tell CNA D and CNA E to get out of R#1's room and not help him out of bed. She stated she did not understand why she, CNA D and CNA E could not get R#1 out of bed and RN B did not give her a reason. She stated CNA D also questioned how they could not transfer R#1 because he requested to get out of bed. She stated RN B told her to not worry about it and that the ADM was on his way. She stated the ADM arrived and was at the facility on [DATE]. She stated the police came to the facility on [DATE] due to a nonemergency call that was unrelated to the conversation. During an interview with the MD on [DATE] at 5:22 p.m., the MD stated R#1 lied in bed, checked himself out of the facility, was mobile with his wheelchair, required some ADL assistance, received wound care and medications, and was placed on hospice care during his admission for pain management and overall ADL decline. He stated R#1 had behaviors and the staff notified him and the NP and documented the behaviors since his admission. He stated the CNO notified him on [DATE] that R#1 made threats to the VPO. He stated he could not recall what threats R#1 made to the VPO on [DATE]. He stated the CNO also notified him on [DATE] at 9:36 a.m. that R#1 threatened to shoot the ADM on an unknown date. He stated he expected the staff to notify the police and escort R#1 to the ER for psychiatric evaluation. He stated he notified the ADM on [DATE] to notify the police and have EMS escort R#1 to the ER if it was an active, direct, credible threat. He stated R#1 was not persistently making threats during his admission at the facility. He stated R#1 had a safe discharge because he was on hospice services, which was a critical piece of his care, and was informed that R#1 was offered a hotel stay despite denying the offer. He stated residents had the right to refuse care and services. He stated he could not recall who transported R#1 after his discharge. He stated he would be concerned if R#1 was not on hospice services and did not receive wound care and medications after discharge. During a telephone interview with R#1 on [DATE] at 6:32 p.m., R#1 stated a friend picked him (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 15 of 32 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 12/17/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete up, did not sign any paperwork and did not indicate he was going to take care of him on [DATE]. He stated he also did not sign any paperwork. He stated he told his hospice on [DATE] that he had nowhere to go when he was immediately discharged from the facility. During an interview with the CNO on [DATE] at 6:38 p.m., the CNO stated the OMB, hospice, and police were present when R#1 was discharged from the facility on [DATE]. During an interview and record review with CNA A on [DATE] at 9:17 a.m., CNA A stated the ADM called and told her on unknown date that he would type up her statement from [DATE]. She stated she refused and told the ADM that she could come to the facility and handwrite her own statement. She stated the ADM told her, That's okay, that's okay, I'll take care of it, and ended the call. She confirmed that she did not type the following statement the ADM provided the surveyor and believed it was falsified by the ADM, While assisting [R#1], I was asked to get him in his motherfucking wheelchair, he then directed all staff and residents to clear the way. He then stated that we must not know who he is because he will shoot up the place and he has shot up another nursing home. This caused me to call my father to help us out in case of emergency. She stated she never called her father on [DATE]. During an interview with LVN G on [DATE] at 9:18 a.m., LVN G stated she was familiar with R#1 and worked with him during the night shift. She stated R#1 was always very respectful to her, always thanked her, never mistreated her, and never said anything threatening to her. She stated R#1 did not exhibit any behaviors on [DATE] and [DATE]. She stated R#1 did not make any comments about shooting up the facility, shooting the ADM, and having a firearm. She stated she be[TRUNCATE Event ID: Facility ID: 675564 If continuation sheet Page 16 of 32 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 12/17/2025 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 0628 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide notice as soon as practicable before discharge and include the location to which the resident is discharged for 1 of 6 residents (R#1). 1. The facility failed to notify R#1 of his discharge before [DATE].2. The facility failed to include the address where R#1 would be discharged to on the discharge notice he was served on [DATE]. R#1 had nowhere to go from [DATE] through [DATE] and was hospitalized on [DATE]. An IJ was identified on [DATE]. The IJ template was provided to the facility on [DATE] at 5:41 p.m. While the IJ was removed on [DATE] at 5:30 p.m., the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy because of the facility's need to evaluate the effectiveness of their corrective systems.This failure could place residents at risk of worsening medical conditions, injury, hospitalization or death. Review of R#1's admission record, dated [DATE], showed he was initially admitted to the facility on [DATE]. He had medical diagnoses that included vertebra osteomyelitis (a serious infection and inflammation of the spinal bones), a stage 4 pressure ulcer in his sacral region (a severe, full-thickness wound extending to muscle, bone, or supporting structures, involving tissue loss with potential for dead tissue, deep tunneling, and serious infection risk), neuromuscular bladder dysfunction (nerve damage disrupts signals between the brain and bladder, causing it to not fill or empty properly), paraplegia (paralysis affecting the lower half of the body, including the legs and sometimes the trunk), protein-calorie malnutrition (a serious nutritional disorder from not getting enough protein and/or energy), left lower limb cellulitis (a common bacterial skin infection affecting the skin and tissue of your left leg), and sepsis (life-threatening medical emergency where the body's extreme response to an infection damages its own tissues). He was discharged on [DATE] at 3:02 p.m. to other.Review of R#1's annual MDS, dated [DATE], showed he had a 15/15 BIMS, which indicated he was cognitively intact. He required partial/moderate assistance with upper body dressing and bed mobility, substantial/maximal assistance with toileting and showering and dependent on staff for lower body dressing and transfers. He also had one stage 3 pressure ulcer and one stage 4 pressure ulcer. He also had verbal behaviors that occurred 4-6 days but less than daily that not impact him and othersReview of R#1's care plan report, initiated on [DATE], showed he had a stage 3 pressure ulcer on his left heel, stage 4 pressure ulcer to his sacral, right leg amputation and had a suprapubic catheter. He was also at risk for ADL decline and staff were required to provide extensive assistance for bed mobility and upper/lower body dressing, and total assistance with transfers. He also had episodes of exhibiting verbal/physical aggression towards staff and residents who reside in the facility and had a history of manipulative behavior. Nursing staff (CNA, LVN and RN) were required to provide safety, offer alternative time for care, back away, seek assistance if needed, notify the nurse of behaviors, provide medications as ordered, assess reports of behaviors and notify the MD if interventions are not effective if he becomes combative or aggressive. Staff were also required to be direct and firm when approaching him about behavior, clarify from him what he actually was saying or doing, document behavior in clinical record, inform staff on redirect methods for his behaviors when providing care, monitor for mental status changes, and psych services as needed. Review of R#1's order summary report, dated [DATE], showed he required hospice care every shift, a catheter change every shift if it was dislodged, his foley catheter bag drained empty every shift, pain assessed every shift, and left heel pressure ulcer cleaned every night shift. Review of R#1's discharge planning review initiated by the CNO on [DATE] showed it was incomplete. Review of the OMB's email (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 17 of 32 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 12/17/2025 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 0628 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few correspondence showed the OMB emailed the ADM on [DATE] and asked if he could let R#1 give him a call to discuss his discharge and attached a copy of the inappropriate discharge and provider letter. There was no email response to the OMB's request. Review of R#1's notice of immediate discharge, dated [DATE], showed staff served a formal written notice of his immediate transfer and discharge from the facility on [DATE]. There was no address included that R#1 would discharge to. The reasons for this action reflected, On [DATE], you made a direct and credible threat to shoot the ADM, as reported by staff member. You have stated to staff that you have previously served time in prison and ‘would go back,' increasing concern for the seriousness of the threat.You routinely leave the community for extended periods and have access to financial resources, creating a credible risk that you could obtain a weapon and return to the facility. Texas Penal Code - Terroristic Threat (threat of violence causing fear and disrupting a licensed healthcare facility)The right to appeal section reflected, You have the right to appeal this discharge to HHSC. If you wish to appeal, you must contact HHSC immediately upon receipt of this notice. You may request a Fair Hearing by calling the HHSC Appeals Division or sending a written request to HHSC Appeals Division. During the appeal process, you have the right to remain in the facility until a final decision is made, except in cases of immediate jeopardy, which applies in this situation. Review of R#1's criminal trespass notice, dated [DATE], showed the VPO was the owner or had the authority to provide an official notice advising R#1 that his future entry onto the facility property was expressly forbidden and would be subject to arrest for criminal trespassing if he entered or remained on or in the facility property or failed to depart from the facility property. PO signed the notice. Review of the facility's discharge report between [DATE] and [DATE] showed R#1 was discharged to other on [DATE]. Review of the facility's in-service on [DATE] showed the DON taught staff to call the police and notify her, the ADON and ADM in the event R#1 arrived on the facility premises. Review of the OMB's email correspondence showed the OMB emailed the VPO on [DATE] and informed him that R#1 requested to appeal his discharge and wanted to return to the facility until his discharge appeal hearing is completed. The VPO emailed the OMB on [DATE] and informed him that R#1 could not return to the facility during the appeal process and explained the facility community determined R#1 posed an ongoing threat to the health and safety of residents and staff based on repeated verbal threats of violence made toward the ADM and others. Review of R#1's progress notes between [DATE] and [DATE] reflected there were no notes related to the alleged incidents. Review of R#1's progress note created by the MD on [DATE] at 9:59 a.m. reflected, As we discussed, [facility] is issuing an immediate discharge for [R#1] today at 11a r/t his verbal threat to shoot the administrator. He made this threat known to a facility employee. discussed last week regarding previous threat to the corporate leadership and somehow getting hold of their personal contacts and called with threats. Discussed initially with CNO, then I called the administrator back directly -- advised getting the police to the [facility], escort him out directly to an ER, and the ER need to have the psychiatry team evaluate him for admission due to risk of harming others.Review of R#1's progress note created by the DM on [DATE] at 1:35 p.m. reflected, Resident has had behavioral issues and refuses care as noted previously by nursing. He will be D/C r/t increased aggressive behavior and threatening staff members. Recommend to continue diet with med pass r/t poor po intakes and increased needs r/t altered skin status. Recommended to continue high protein supplements such as prostat 30 ml BID for wound healing and to meet needs. Resident remains on hospice care. Weight loss may be unavoidable as the condition continues to decline. Resident's comfort takes priority overweight goals. Weight loss and decreased intake anticipated in end of life process; deceased intake increases endorphins and dynorphins which enhances comfort and can provide individuals with euphoric (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 18 of 32 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 12/17/2025 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 0628 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few experiences and prevention of discomfort. Review of R#1's progress note created by the DON on [DATE] at 1:45 p.m. reflected, Resident was served immediate discharge documents from the [VPO]. Resident was served in the presence of two Police Officers and one Police Detective. Resident declined to take the document stating, I don't need a mother fucking thing. The [VPO] offered to pay for a hotel stay for five days for resident and have Hospice continue care. Hospice did speak with resident and explain extended services that will/can be provided while staying at the hotel. Resident received all medications and wound care supplies given in a bag. The list of medications given were: Biktarvy, gabapentin, atorvastatin, hydromorphone, glipizide, metformin, and metoprolol, gauze, collagen with xeroform, calcium alginate, abdominal pads, and kerlix dressing. Resident requested his clothes out of his room and the charge nurse assigned to resident got a clean trash bag and put resident's clothes in a bag and put it where the resident requested. Resident stated he was going to return to the building and no one would stop him. The Police Officers did explain to resident he was also getting served with a no trespassing order and it was explained to resident that failure to comply would result in the resident getting arrested. The Detective offered to take the resident to the hospital and the resident declined. Resident requested to speak with social worker. Social worker provided outside resources for resident to look into for continuity of care.spoke with [VPO] and administrator again. [R#1] no making more active threats. as such it's ok to discharge to self-care BUT still will involve the police this morning to ensure safety measures. [R#1] should not be allowed to return to facility because he made threats to multiple staff/employees/team members of physical violence, and even police had to be involved. This is to ensure the safety ofthe facility and employees.Review of R#1's POC response history for [DATE] showed their staff documented there were no behaviors observed on [DATE], [DATE] and [DATE]. There were also no documented entries on [DATE]. Review of the facility's incident log between [DATE] and [DATE] reflected there were no incidents related to the alleged incidents.An observation of R#1's room on [DATE] at 10:09 a.m. showed R#1's room was locked. The surveyor attempted to knock on R#1's door and introduce themself. There was no response. During an interview with the ADM on [DATE] at 10:11 a.m., the ADM stated R#1 was not at the facility. He stated he believed R#1 was at a friend's home as of [DATE]. He stated he did not have confirmation of R#1 being at a friend's home. He stated he attempted to call R#1 on an unknown date and R#1 did not respond and call him back. He stated R#1 was wheelchair bound and provided his own care. He stated CNA A told him on an unknown date that R#1 told her in his room that he was threatening to shoot the ADM on [DATE]. He stated he and staff did not know if R#1 had any firearms or weapons because R#1 refused an inventory check. He stated RN B and CNA C told him on unknown date that they received threats from R#1 on [DATE]. The ADM did not elaborate on the threats that RN B and CNA C received from R#1 on [DATE]. The ADM stated the HR, VPO, and CNO told him on [DATE] that R#1 made threats to them on [DATE]. He stated R#1 made a threat while on the phone with HR and while on the phone with the VPO and CNO on [DATE]. He did not elaborate on the threats that R#1 made to the HR, VPO, and CNO on [DATE]. He stated he did not know why the HR, VPO, and CNO did not inform him on [DATE] of the threats that R#1 made to them on [DATE]. He stated he was not at the facility on [DATE]. He stated he expected staff to notify him of any alleged threats as soon as possible. He stated the VPO notified the police on [DATE]. He stated the police did not arrive at the facility until [DATE] because the police believed it was not an emergency. He stated R#1 was not on 1:1 and did not have any interventions in place from [DATE] through [DATE] because the OMB told him that it would be ineffective because R#1 often went out on pass. He stated the facility was trying to find another facility to transfer R#1 to on unknown date and he was declined by several other facilities. He stated the police arrived at the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 19 of 32 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 12/17/2025 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 0628 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few facility on [DATE] to ensure the discharge process was properly completed. He stated R#1 received an immediate discharge notice on [DATE]. He stated the OMB was aware of R#1's immediate discharge and received a copy of the immediate discharge notice given to R#1 on [DATE]. He stated the police offered to take R#1 to the hospital and R#1 refused on [DATE]. He stated the IDT team ensured residents had a safe and proper discharge. He stated he knew it was important to ensure residents had a safe and proper discharge and said, So they could continue to get care and services and make sure they were safe. Residents would be at risk of being unsafe if they did not have a safe and proper discharge. He stated he believed R#1 had a safe and proper discharge because the VPO offered him a hotel and he declined and the police offered to take him to the hospital and he declined. During an interview with the DON on [DATE] at 10:37 a.m., the DON stated R#1 required transfer and lower body dressing assistance, took care of his catheter and colostomy bag, demonstrated to her how he changed his colostomy bag, did not receive formal or follow-up training on colostomy care, and could independently shower. the ADM told her on [DATE] that R#1 made threats to RN B on [DATE] and the police were called and arrived at the facility on [DATE]. She stated she could not recall the threats the ADM notified her that R#1 made to RN B on [DATE]. She stated the ADM also told her on [DATE] that the HR was present when R#1 made a threat to harm the ADM by gunshot on [DATE]. She stated the CN was also on duty on [DATE]. She stated RN B had staff check on other residents and R#1 called the police and stepped outside on [DATE]. She stated she did not know when the police arrived at the facility on [DATE]. She stated the OMB was notified on unknown date, but before [DATE], of R#1's alleged threat on [DATE]. She stated the VPO was also notified on [DATE] of R#1's alleged threat on [DATE]. She stated she expected staff to immediately notify her of alleged threats. She stated she was unsure of the process for this similar circumstance, but she believed staff would follow ADM's direction. She stated R#1 was not placed on 1:1 and did not have any other interventions implemented from [DATE] through [DATE] because the OMB told her it would be ineffective because R#1 often went out on pass. She stated R#1 was provided with an immediate discharge notice on [DATE] around 12:00 p.m. She stated R#1 was immediately discharged due to the alleged threat he made on [DATE]. She stated the OMB was notified of the immediate discharge on [DATE]. She stated the VPO offered a hotel room to R#1 and he declined it on [DATE]. She stated R#1 was provided with all his medications before he discharged from the facility and documented it in a progress note. She stated the police provided R#1 with a no trespass order on [DATE]. She stated she did not know where R#1 was currently. She stated she believed the ADM had R#1's contact information and it might be listed in his clinical records. She stated she did not make due diligence to contact R#1 after he was discharged on [DATE]. She stated she did not know if staff attempted to contact R#1 after his discharge on [DATE]. She stated no in-services were initiated after R#1's discharge other than the VPO did an in-service on reporting R#1 to the police if he was observed on the facility property on [DATE]. During an interview with the PO on [DATE] at 11:50 a.m., the PO stated R#1 was served with a no trespass order, R#1 tore it, refused to leave the facility, and would not leave the facility until they told R#1 that he would be arrested if he did not leave the facility. During a telephone interview with R#1 on [DATE] at 12:17 p.m., R#1 stated he was paralyzed from the chest and down his body and required assistance from getting in and out of bed and wound care and foley catheter care. He stated the facility staff and police wanted to speak with him on [DATE] and he stepped outside the facility building. He stated he did not know he was being kicked out of the facility. He explained the VPO, ADM, DON, and police officers informed him that he was being immediately discharged on [DATE] due to an alleged threat that staff reported he made on [DATE]. He stated he was provided with an immediate discharge notice on [DATE]. He stated his discharge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 20 of 32 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 12/17/2025 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 0628 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few notice did not include the address where he would be discharged to. He stated they explained to him that staff reported he threatened that he was going to shoot the ADM on [DATE]. He stated he did not make any threats to shoot the ADM on [DATE] and the allegation was absurd. He stated the police did not arrive at the facility and did not search him for any weapons from [DATE] through [DATE]. He also stated he did not have any weapons. He stated he was trying to get into his wheelchair so he could go out on pass with a friend and get something to eat because he did not receive any snacks or meals on [DATE]. He stated he pressed his call light and no one came for 2-3 hours. He stated he called the HR and told her on [DATE] that he was tired of the ADM picking on him, bullying him and harassing him. He stated he also called the VPO and spoke with him and the CNO on [DATE] and told them that he was not being cared for, not helped out of bed, and felt bullied and picked on by the ADM. He stated the VPO offered to put him in a hotel on [DATE] and he refused because he could not care for himself and needed care and services. He stated no one would help him get into his wheelchair until CNA A, CNA D, and CNA E saw his call light for assistance and responded 2-3 hours after he pressed his call light to get up. He stated he was upset and told CNA A, CNA D, and CNA E to get him into his wheelchair. He stated CNA A, CNA D, and CNA E were trying to transfer him into his wheelchair in his room on [DATE] around 7:00 p.m.-7:30 p.m. He stated CNA A left his room, returned, and told him, CNA D and CNA E that they could not help him get in his wheelchair because RN B told them not to help him in his wheelchair and that the ADM was on his way to the facility. He stated he did not know why RN B told CNA A, CNA D, and CNA E not to help him into his wheelchair. He stated he put himself in his wheelchair, signed himself out on pass, went outside because he was upset, and returned inside the facility on [DATE]. He stated he observed the ADM at the facility on [DATE]. He stated he complained to SW, DOR, DON, ADON and HR on [DATE] about the lack of care that he received on [DATE] and [DATE]. He stated they helped him file a grievance on [DATE]. He stated the staff on duty on [DATE] told them (SW, DOR, DON, ADON and HR) that they did not check on him and did not care for him because they thought he was out on pass on [DATE]. He stated the staff provided him with his medications and did not provide him with wound care supplies on [DATE]. He stated the police offered EMS transport to the hospital and he declined on [DATE]. He also stated the VPO offered a 5-day hotel stay and he declined on [DATE]. He stated no other alternative placement was offered on [DATE]. He stated the police told him that he would be arrested if he did not leave the facility premises on [DATE]. He stated he had nowhere to go, told his hospice he had nowhere to go, and slept in his truck in 37 degree Fahrenheit weather on [DATE]. He stated he did not receive any wound care, colostomy care, ADL care, meals and his wounds smelled. During an interview with the VPO on [DATE] at 1:34 p.m., the VPO stated R#1 relied on his electric wheelchair and was on Medicaid. He stated R#1 often signed in and out of the facility and would take his medication with him. He stated R#1 was at the facility for a little bit, had received very little care, and had the financial means to purchase a firearm. He stated he was not aware if R#1 was in possession of a firearm. He stated he did not know if there were any grievances filed regarding R#1's care. He stated R#1 called him on [DATE] and told him that he was upset and tired of the ADM bullying him and getting rid of people who he got close to. He stated he looped the CNO into the phone conversation. He stated R#1 said, My mind will run and only violence would resolve the issue. He stated he believed R#1 was referring to the ADM. He stated R#1 told him and the CNO that he would make impulsive decisions that he would regret. He stated the police did not arrive at the facility on [DATE]. He stated he did not know why the police did not arrive at the facility on [DATE]. He stated he started investigating the alleged incident on [DATE]. He stated he interviewed CNA A on [DATE] and [DATE]. He stated CNA A told him that she was getting R#1 up when he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 21 of 32 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 12/17/2025 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 0628 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few told her, Put me up in this wheelchair, I'm going shoot up this nursing facility like I did to the other one, on [DATE]. He stated R#1 called the HR, who heard R#1 was upset and arrived at the facility to speak with him. He stated the HR told him on [DATE] that R#1 said, Clear the hallways and put the residents in the dining room. I'm going to shoot [ADM], on [DATE]. He stated R#1 did not threaten to shoot any residents. He stated R#1 was not placed on 1:1 or had any other interventions implemented from [DATE] through [DATE]. He stated he was unsure if the NP and MD gave any special instruction or if psych or behavior services were offered to R#1. He stated he tried to notify the OMB on [DATE], [DATE], and [DATE] about the immediate discharge request. He stated he spoke with the OMB on [DATE] and notified him of the immediate discharge request. He stated he spoke with the OMB again on [DATE] and the OMB told him that he spoke with unknown HHSC staff member and they cleared R#1 immediate discharge due to the threat R#1 made on [DATE] around 4:45pm-5:00pm. He stated he wanted to discharge R#1 on [DATE]. He stated he notified the police on [DATE] that R#1 threatened to shoot the ADM on [DATE], they did not come out to the facility, did not conduct a search and did not explain why they did not come out to the facility. He stated he did not discharge R#1 on [DATE] because he wanted to have something in plan on [DATE]. He stated the CNO called R#1's hospice on [DATE]. He explained he wanted to make sure hospice could visit R#1. He stated he also wanted to make sure R#1 had a place to discharge to. He stated he also had police present when he served the immediate discharge notice to R#1 on [DATE]. He stated R#1 threw the immediate discharge notice back at them and police intervened. He stated Hospice was also present on [DATE]. He stated R#1's friend also showed up to the facility on [DATE]. He stated the police offered EMS transportation to R#1, but he declined. He stated R#1 was provided with his clothes, medications, and an address for where his personal belongings would be sent to. He stated the OMB came to the facility later on in the afternoon of [DATE]. He stated R#1 did not check into the hotel he offered and R#1 declined on [DATE]. He stated he did not know R#1's whereabouts. He stated he knew it was important to ensure residents had a safe and proper discharge and said, The safety of the discharge and ensuring they have a place to go. Residents could be at risk of lack of care if they did not have a safe and proper discharge. He stated residents could stay at the facility during a pending discharge appeal. During an interview with the CNO on [DATE] at 2:23 p.m., the CNO stated she did not know R#1's care or services or if he exhibited any behaviors. She stated R#1 called the VPO on [DATE]. She stated the VPO included her in the phone conversation with R#1. She stated R#1 expressed he was irritated and tired of staff picking on him. She stated the VPO told her that R#1 was referring to the ADM. She stated R#1 said, I can take care of business, the only way things could get settled is through violence. I do things without thinking and then after it's done, I regret it. She stated she offered to put R#1 in hotel on [DATE] and he declined. She stated R#1 wanted to speak with the VPO and the VPO told him that he would speak with R#1 on [DATE]. She stated she was informed by the VPO on [DATE] that the ADM reported R#1 made threats to shoot the ADM on [DATE]. She stated the VPO told her that R#1 told a CNA that he would shoot up the entire facility and to get the residents in the dining room so he could shoot the ADM. She stated she was unsure if R#1 made alleged threats to anyone else. She stated she did not know if R#1 had any weapons in his possession to cause harm. She stated R#1 was not placed on 1:1 because it irritated him and staff were scared of him. She stated R#1 remained at the facility from [DATE] through [DATE]. She stated the VPO called the police on [DATE] and she did not know if the police arrived at the facility. She stated the OMB told the VPO on unknown date that HHSC told him there was grounds to immediately discharge R#1. She stated the MD was notified on unknown date of R#1's immediate discharge and agreed with it. She stated R#1's hospice was also notified on unknown date. She stated the VPO (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 22 of 32 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 12/17/2025 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 0628 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few served the immediate discharge notice to R#1 on [DATE]. She stated R#1 was provided with his medications and wound care supplies. She stated the VPO made a hotel reservation for R#1 for five days. She stated she did not know if R#1 accepted or declined the hotel reservation. She stated R#1 left with a friend who was a nurse, but she had no confirmation as to whether or not his friend had a current nurse license. She stated she did not know if R#1's friend was providing care and services to R#1. She stated she did not know R#1's whereabouts. She stated she did not know if R#1 reached out to his hospice. She stated the facility was responsible for residents' safe and proper discharge. She stated she knew it was important to ensure residents had a safe and proper discharge and said, It's important for residents so that their care and services continued. Residents could be at risk of not having their care and services continued if they did not have a safe and proper discharge. During an interview with CNA A on [DATE] at 4:13 p.m., CNA A stated her and CNA D were walking back to the memory care unit, observed R#1's call light and walked into his room to answer it [DATE]. She stated CNA E was already in R#1's room and were arguing back and forth with R#1. She stated that she and CNA D intervened. She stated R#1 was upset and said, I just want y'all motherfuckers to get me up in my chair and out the way. She stated CNA E sarcastically said, Oh don't shoot me. She stated as her and CNA D helped CNA E put R#1 into his wheelchair, R#1 said, Yeah because the previous nursing homes I've been in trouble for shooting them up. She stated her, CNA D and CNA E were not in fear and believed R#1 was upset because he told them that he had been waiting 2-3 hours for staff to answer his call light and put him in his wheelchair because he did not receive any snacks or meals. She stated she stepped out of R#1's room because she was receiving a call and then notified RN B that R#1 did not get any meals or snacks and was upset because he waited for 2-3 hours after pressing his call light for assistance with getting up. She stated RN B questioned why her and CNA D answered R#1's call light. She stated RN B told her that she told the staff not to get R#1 out of his bed, the ADM was on his way to the facility, and to tell CNA D and CNA E to get out of R#1's room and not help him out of bed. She stated she did not understand why her; CNA D and CNA E could not get R#1 out of bed and RN B did not give her a reason. She stated CNA D also questioned how they could not transfer R#1 because he requested to get out of bed. She stated RN B told her to not worry about it and that the ADM was on his way. She stated the ADM arrived and was at the facility on [DATE]. She stated the police came to the facility on [DATE] due to a nonemergency call that was unrelated to the conversation. During an interview with the MD on [DATE] at 5:22 p.m., the MD stated R#1 lied in bed, checked himself out of the facility, was mobile with his wheelchair, required some ADL assistance, received wound care and medications, and was placed on hospice care during his admission for pain management and overall, ADL decline. He stated R#1 had behaviors and the staff notified him and the NP and documented the behaviors since his admission. He stated the CNO notified him on [DATE] that R#1 made threats to the VPO. He stated he could not recall what threats R#1 made to the VPO on [DATE]. He stated the CNO also notified him on [DATE] at 9:36 a.m. that R#1 threatened to shoot the ADM on an unknown date. He stated he expected the staff to notify the police and escort R#1 to the ER for psychiatric evaluation. He stated he notified the ADM on [DATE] to notify the police and have EMS escort R#1 to the ER if it was an active, direct, credible threat. He stated R#1 was not persistently making threats during his admission at the facility. He stated R#1 had a safe discharge because he was on hospice services, which was a critical piece of his care, and was informed that R#1 was offered a hotel stay despite denying the offer. He stated residents had the right to refuse care and services. He stated he could not recall who transported R#1 after his discharge. He stated he would be concerned if R#1 was not on hospice services and did not receive wound care and medications after discharge. During a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 23 of 32 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 12/17/2025 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 0628 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete telephone interview with R#1 on [DATE] at 6:32 p.m., R#1 stated a friend picked him up, did not sign any paperwork and did not indicate he was going to take care of him on [DATE]. He stated he also did not sign any paperwork. He stated he told his hospice on [DATE] that he had nowhere to go when he was immediately discharged from the facility. During an interview with the CNO on [DATE] at 6:38 p.m., the CNO stated the OMB, hospice, and police were present when R#1 was discharged from the facility on [DATE]. During an interview and record review with CNA A on [DATE] at 9:17 a.m., CNA A stated the ADM called and told her on unknown date that he would type up her statement from [DATE]. She stated she refused and told the ADM that she could come to the facility and handwrite her own statement. She stated the ADM told her, That's okay, that's okay, I'll take care of it, and ended the call. She confirmed that she did not type the following statement the ADM provided the surveyor and believed it was falsified by the ADM, While assisting [R#1], I was asked to get him in his motherfucking wheelchair, he then directed all staff and residents to clear the way. He then stated that we must not know who he is because he will shoot up the place and he has shot up another nursing home. This caused me to call my father to help us out in case of emergency. She stated she never called her father on [DATE]. During an interview with LVN G on [DATE] at 9:18 a.m., LVN G stated she was familiar with R#1 and worked with him during the night shift. She stated R#1 was always very respectful to her, always thanked her, never mistreated her, and never said anything threatening to her. She stated R#1 did not exhibit any behaviors on [DATE] and [DATE]. She stated R#1 did not make any comments about shooting up t Event ID: Facility ID: 675564 If continuation sheet Page 24 of 32 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 12/17/2025 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident for 1 of 6 residents (R#1). 1. The facility failed to ensure a thorough investigation was completed in regard to the validity of witness statements alleged against R#1 on [DATE]. R#1 was discharged from the facility on [DATE] had nowhere to go from [DATE] through [DATE] and was hospitalized on [DATE].2. The facility failed to take immediate action to ensure the safety of all residents when there is a credible threat to the health and safety of residents alleged against R#1 on [DATE]. An IJ was identified on [DATE]. The IJ template was provided to the facility on [DATE] at 5:41 p.m. While the IJ was removed on [DATE] at 5:30 p.m., the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy because of the facility's need to evaluate the effectiveness of their corrective systems.This failure could place residents at risk of improper discharge, worsening medical conditions, injury, hospitalization or death. Review of R#1's admission record, dated [DATE], showed he was initially admitted to the facility on [DATE]. He had medical diagnoses that included vertebra osteomyelitis (a serious infection and inflammation of the spinal bones), a stage 4 pressure ulcer in his sacral region (a severe, full-thickness wound extending to muscle, bone, or supporting structures, involving tissue loss with potential for dead tissue, deep tunneling, and serious infection risk), neuromuscular bladder dysfunction (nerve damage disrupts signals between the brain and bladder, causing it to not fill or empty properly), paraplegia (paralysis affecting the lower half of the body, including the legs and sometimes the trunk), protein-calorie malnutrition (a serious nutritional disorder from not getting enough protein and/or energy), left lower limb cellulitis (a common bacterial skin infection affecting the skin and tissue of your left leg), and sepsis (life-threatening medical emergency where the body's extreme response to an infection damages its own tissues). He was discharged on [DATE] at 3:02 p.m. to other.Review of R#1's annual MDS, dated [DATE], showed he had a 15/15 BIMS, which indicated he was cognitively intact. He required partial/moderate assistance with upper body dressing and bed mobility, substantial/maximal assistance with toileting and showering and dependent on staff for lower body dressing and transfers. He also had one stage 3 pressure ulcer and one stage 4 pressure ulcer. He also had verbal behaviors that occurred 4-6 days but less than daily that did not impact him and othersReview of R#1's care plan report, initiated on [DATE], showed he had a stage 3 pressure ulcer on his left heel, stage 4 pressure ulcer to his sacral, right leg amputation and had a suprapubic catheter. He was also at risk for ADL decline and staff were required to provide extensive assistance for bed mobility and upper/lower body dressing, and total assistance with transfers. He also had episodes of exhibiting verbal/physical aggression towards staff and residents who reside in the facility and had a history of manipulative behavior. Nursing staff (CNA, LVN and RN) were required to provide safety, offer alternative time for care, back away, seek assistance if needed, notify the nurse of behaviors, provide medications as ordered, assess reports of behaviors and notify the MD if interventions are not effective if he becomes combative or aggressive. Staff were also required to be direct and firm when approaching him about behavior, clarify from him what he actually was saying or doing, document behavior in clinical record, inform staff on redirect methods for his behaviors when providing care, monitor for mental status changes, and psych services as needed. Review of R#1's order summary report, dated [DATE], showed he required hospice care every shift, a catheter change every shift if it was dislodged, his Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 25 of 32 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 12/17/2025 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few foley catheter bag drained empty every shift, pain assessed every shift, and left heel pressure ulcer cleaned every night shift. Review of R#1's discharge planning review initiated by the CNO on [DATE] showed it was incomplete. Review of the OMB's email correspondence showed the OMB emailed the ADM on [DATE] and asked if he could let R#1 give him a call to discuss his discharge and attached a copy of the inappropriate discharge and provider letter. There was no email response to the OMB's request. Review of R#1's notice of immediate discharge, dated [DATE], showed staff served a formal written notice of his immediate transfer and discharge from the facility on [DATE]. The was no address included that R#1 would discharge to. The reasons for this action reflected, On [DATE], you made a direct and credible threat to shoot the ADM, as reported by staff member. You have stated to staff that you have previously served time in prison and ‘would go back,' increasing concern for the seriousness of the threat.You routinely leave the community for extended periods and have access to financial resources, creating a credible risk that you could obtain a weapon and return to the facility. Texas Penal Code - Terroristic Threat (threat of violence causing fear and disrupting a licensed healthcare facility)These behaviors meet the criteria., which stated that a facility may transfer or discharge a resident when:The transfer or discharge is necessary for the resident's welfare and the facility cannot meet the resident's needs orThe safety of the individuals in the facility is endangered due to clinical or behavioral status of the resident.Efforts made to address the situation:The facility consulted with your attending physician regarding your condition and care needs.Alternative placement options were considered; however, your continued presence creates an immediate threat to the safety and well-being of other residents and staff. The right to appeal section reflected, You have the right to appeal this discharge to HHSC. If you wish to appeal, you must contact HHSC immediately upon receipt of this notice. You may request a Fair Hearing by calling the HHSC Appeals Division or sending a written request to HHSC Appeals Division. During the appeal process, you have the right to remain in the facility until a final decision is made, except in cases of immediate jeopardy, which applies in this situation. Review of R#1's criminal trespass notice, dated [DATE], showed the VPO was the owner or had the authority to provide an official notice advising R#1 that his future entry onto the facility property was expressly forbidden and would be subject to arrest for criminal trespassing if he entered or remained on or in the facility property or failed to depart from the facility property. PO signed the notice. Review of the facility's discharge report between [DATE] and [DATE] showed R#1 was discharged to other on [DATE]. Review of the facility's in-service on [DATE] showed the DON taught staff to call the police and notify her, the ADON and ADM in the event R#1 arrived on the facility premises. Review of the OMB's email correspondence showed the OMB emailed the VPO on [DATE] and informed him that R#1 requested to appeal his discharge and wanted to return to the facility until his discharge appeal hearing is completed. The VPO emailed the OMB on [DATE] and informed him that R#1 could not return to the facility during the appeal process and explained the facility community determined R#1 posed an ongoing threat to the health and safety of residents and staff based on repeated verbal threats of violence made toward the ADM and others. Review of R#1's progress notes between [DATE] and [DATE] reflected there were no notes related to the alleged incidents. Review of R#1's progress note created by the MD on [DATE] at 9:59 a.m. reflected, As we discussed, [facility] is issuing an immediate discharge for [R#1] today at 11a r/t his verbal threat to shoot the administrator. He made this threat known to a facility employee. discussed last week regarding previous threat to the corporate leadership and somehow getting hold of their personal contacts and called with threats. Discussed initially with CNO, then I called the administrator back directly -- advised getting the police to the [facility], escort him out directly to an ER, and the ER need to have the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 26 of 32 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 12/17/2025 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few psychiatry team evaluate him for admission due to risk of harming others.Review of R#1's progress note created by the DM on [DATE] at 1:35 p.m. reflected, Resident has had behavioral issues and refuses care as noted previously by nursing. He will be D/C r/t increased aggressive behavior and threatening staff members. Recommend to continue diet with med pass r/t poor po intakes and increased needs r/t altered skin status. Recommended to continue high protein supplements such as prostat 30 ml BID for wound healing and to meet needs. Resident remains on hospice care. Weight loss may be unavoidable as the condition continues to decline. Resident's comfort takes priority overweight goals. Weight loss and decreased intake anticipated in end of life process; deceased intake increases endorphins and dynorphins which enhances comfort and can provide individuals with euphoric experiences and prevention of discomfort. Review of R#1's progress note created by the DON on [DATE] at 1:45 p.m. reflected, Resident was served immediate discharge documents from the [VPO]. Resident was served in the presence of two Police Officers and one Police Detective. Resident declined to take the document stating, I don't need a mother fucking thing. The [VPO] offered to pay for a hotel stay for five days for resident and have Hospice continue care. Hospice did speak with resident and explain extended services that will/can be provided while staying at the hotel. Resident received all medications and wound care supplies given in a bag. The list of medications given were: Biktarvy, gabapentin, atorvastatin, hydromorphone, glipizide, metformin, and metoprolol, gauze, collagen with xeroform, calcium alginate, abdominal pads, and kerlix dressing. Resident requested his clothes out of his room and the charge nurse assigned to resident got a clean trash bag and put resident's clothes in a bag and put it where the resident requested. Resident stated he was going to return to the building and no one would stop him. The Police Officers did explain to resident he was also getting served with a no trespassing order and it was explained to resident that failure to comply would result in the resident getting arrested. The Detective offered to take the resident to the hospital and the resident declined. Resident requested to speak with social worker. Social worker provided outside resources for resident to look into for continuity of care.spoke with [VPO] and administrator again. [R#1] no making more active threats. as such it's ok to discharge to self-care BUT still will involve the police this morning to ensure safety measures. [R#1] should not be allowed to return to facility because he made threats to multiple staff/employees/team members of physical violence, and even police had to be involved. This is to ensure the safety ofthe facility and employees.Review of R#1's POC response history for [DATE] showed there staff documented there were no behaviors observed on [DATE], [DATE] and [DATE]. There were also no documented entries on [DATE]. Review of the facility's incident log between [DATE] and [DATE] reflected there were no incidents related to the alleged incidents.An observation of R#1's room on [DATE] at 10:09 a.m. showed R#1's room was locked. The surveyor attempted to knock on R#1's door and introduce themself. There was no response. During an interview with the ADM on [DATE] at 10:11 a.m., the ADM stated R#1 was not at the facility. He stated he believed R#1 was at a friend's home as of [DATE]. He stated he did not have confirmation of R#1 being at a friend's home. He stated he attempted to call R#1 on an unknown date and R#1 did not respond and call him back. He stated R#1 was wheelchair bound and provided his own care. He stated CNA A told him on an unknown date that R#1 told her in his room that he was threatening to shoot the ADM on [DATE]. He stated he and staff did not know if R#1 had any firearms or weapons because R#1 refused an inventory check. He stated RN B and CNA C told him on unknown date that they received threats from R#1 on [DATE]. The ADM did not elaborate on the threats that RN B and CNA C received from R#1 on [DATE]. The ADM stated the HR, VPO, and CNO told him on [DATE] that R#1 made threats to them on [DATE]. He stated R#1 made a threat while on the phone with HR and while on the phone with the VPO and CNO on [DATE]. He did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 27 of 32 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 12/17/2025 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few not elaborate on the threats that R#1 made to the HR, VPO, and CNO on [DATE]. He stated he did not know why the HR, VPO, and CNO did not inform him on [DATE] of the threats that R#1 made to them on [DATE]. He stated he was not at the facility on [DATE]. He stated he expected staff to notify him of any alleged threats as soon as possible. He stated the VPO notified the police on [DATE]. He stated the police did not arrive at the facility until [DATE] because the police believed it was not an emergency. He stated R#1 was not on 1:1 and did not have any interventions in place from [DATE] through [DATE] because the OMB told him that it would be ineffective because R#1 often went out on pass. He stated the facility was trying to find another facility to transfer R#1 to on unknown date and he was declined by several other facilities. He stated the police arrived at the facility on [DATE] to ensure the discharge process was properly completed. He stated R#1 received an immediate discharge notice on [DATE]. He stated the OMB was aware of R#1's immediate discharge and received a copy of the immediate discharge notice given to R#1 on [DATE]. He stated the police offered to take R#1 to the hospital and R#1 refused on [DATE]. He stated the IDT team ensured residents had a safe and proper discharge. He stated he knew it was important to ensure residents had a safe and proper discharge and said, So they could continue to get care and services and make sure they were safe. Residents would be at risk of being unsafe if they did not have a safe and proper discharge. He stated he believed R#1 had a safe and proper discharge because the VPO offered him a hotel and he declined and the police offered to take him to the hospital and he declined. During an interview with the DON on [DATE] at 10:37 a.m., the DON stated R#1 required transfer and lower body dressing assistance, took care of his catheter and colostomy bag, demonstrated to her how he changed his colostomy bag, did not receive formal or follow-up training on colostomy care, and could independently shower. the ADM told her on [DATE] that R#1 made threats to RN B on [DATE] and the police were called and arrived at the facility on [DATE]. She stated she could not recall the threats the ADM notified her that R#1 made to RN B on [DATE]. She stated the ADM also told her on [DATE] that the HR was present when R#1 made a threat to harm the ADM by gunshot on [DATE]. She stated the CN was also on duty on [DATE]. She stated RN B had staff check on other residents and R#1 called the police and stepped outside on [DATE]. She stated she did not know when the police arrived at the facility on [DATE]. She stated the OMB was notified on unknown date, but before [DATE], of R#1's alleged threat on [DATE]. She stated the VPO was also notified on [DATE] of R#1's alleged threat on [DATE]. She stated she expected staff to immediately notify her of alleged threats. She stated she was unsure of the process for this similar circumstance, but she believed staff would follow ADM's direction. She stated R#1 was not placed on 1:1 and did not have any other interventions implemented from [DATE] through [DATE] because the OMB told her it would be ineffective because R#1 often went out on pass. She stated R#1 was provided with an immediate discharge notice on [DATE] around 12:00 p.m. She stated R#1 was immediately discharged due to the alleged threat he made on [DATE]. She stated the OMB was notified of the immediate discharge on [DATE]. She stated the VPO offered a hotel room to R#1 and he declined it on [DATE]. She stated R#1 was provided with all his medications before he discharged from the facility and documented it in a progress note. She stated the police provided R#1 with a no trespass order on [DATE]. She stated she did not know where R#1 was currently. She stated she believed the ADM had R#1's contact information and it might be listed in his clinical records. She stated she did not make due diligence to contact R#1 after he was discharged on [DATE]. She stated she did not know if staff attempted to contact R#1 after his discharge on [DATE]. She stated no in-services were initiated after R#1's discharge other than the VPO did an in-service on reporting R#1 to the police if he was observed on the facility property on [DATE]. During an interview with the PO on [DATE] at 11:50 a.m., the PO stated R#1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 28 of 32 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 12/17/2025 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few was served with a no trespass order, R#1 tore it, refused to leave the facility, and would not leave the facility until they told R#1 that he would be arrested if he did not leave the facility. During a telephone interview with R#1 on [DATE] at 12:17 p.m., R#1 stated he was paralyzed from the chest and down his body and required assistance from getting in and out of bed and wound care and foley catheter care. He stated the facility staff and police wanted to speak with him on [DATE] and he stepped outside the facility building. He stated he did not know he was being kicked out of the facility. He explained the VPO, ADM, DON, and police officers informed him that he was being immediately discharged on [DATE] due to an alleged threat that staff reported he made on [DATE]. He stated he was provided with an immediate discharge notice on [DATE]. He stated his discharge notice did not include the address where he would be discharged to. He stated they explained to him that staff reported he threatened that he was going to shoot the ADM on [DATE]. He stated he did not make any threats to shoot the ADM on [DATE] and the allegation was absurd. He stated the police did not arrive at the facility and did not search him for any weapons from [DATE] through [DATE]. He also stated he did not have any weapons. He stated he was trying to get into his wheelchair so he could go out on pass with a friend and get something to eat because he did not receive any snacks or meals on [DATE]. He stated he pressed his call light and no one came for 2-3 hours. He stated he called the HR and told her on [DATE] that he was tired of the ADM picking on him, bullying him and harassing him. He stated he also called the VPO and spoke with him and the CNO on [DATE] and told them that he was not being cared for, not helped out of bed, and felt bullied and picked on by the ADM. He stated the VPO offered to put him in a hotel on [DATE] and he refused because he could not care for himself and needed care and services. He stated no one would help him get into his wheelchair until CNA A, CNA D, and CNA E saw his call light for assistance and responded 2-3 hours after he pressed his call light to get up. He stated he was upset and told CNA A, CNA D, and CNA E to get him into his wheelchair. He stated CNA A, CNA D, and CNA E were trying to transfer him into his wheelchair in his room on [DATE] around 7:00 p.m.-7:30 p.m. He stated CNA A left his room, returned, and told him, CNA D and CNA E that they could not help him get in his wheelchair because RN B told them not to help him in his wheelchair and that the ADM was on his way to the facility. He stated he did not know why RN B told CNA A, CNA D, and CNA E not to help him into his wheelchair. He stated he put himself in his wheelchair, signed himself out on pass, went outside because he was upset, and returned inside the facility on [DATE]. He stated he observed the ADM at the facility on [DATE]. He stated he complained to SW, DOR, DON, ADON and HR on [DATE] about the lack of care that he received on [DATE] and [DATE]. He stated they helped him file a grievance on [DATE]. He stated the staff on duty on [DATE] told them (SW, DOR, DON, ADON and HR) that they did not check on him and did not care for him because they thought he was out on pass on [DATE]. He stated the staff provided him with his medications and did not provide him with wound care supplies on [DATE]. He stated the police offered EMS transport to the hospital and he declined on [DATE]. He also stated the VPO offered a 5-day hotel stay and he declined on [DATE]. He stated no other alternative placement was offered on [DATE]. He stated the police told him that he would be arrested if he did not leave the facility premises on [DATE]. He stated he had nowhere to go, told his hospice he had nowhere to go, and slept in his truck in 37 degree Fahrenheit weather on [DATE]. He stated he did not receive any wound care, colostomy care, ADL care, meals and his wounds smelled. During an interview with the VPO on [DATE] at 1:34 p.m., the VPO stated R#1 relied on his electric wheelchair and was on Medicaid. He stated R#1 often signed in and out of the facility and would take his medication with him. He stated R#1 was at the facility for a little bit, had received very little care, and had the financial means to purchase a firearm. He stated he was not aware if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 29 of 32 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 12/17/2025 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few R#1 was in possession of a firearm. He stated he did not know if there were any grievances filed regarding R#1's care. He stated R#1 called him on [DATE] and told him that he was upset and tired of the ADM bullying him and getting rid of people who he got close to. He stated he looped the CNO into the phone conversation. He stated R#1 said, My mind will run and only violence would resolve the issue. He stated he believed R#1 was referring to the ADM. He stated R#1 told him and the CNO that he would make impulsive decisions that he would regret. He stated the police did not arrive at the facility on [DATE]. He stated he did not know why the police did not arrive at the facility on [DATE]. He stated he started investigating the alleged incident on [DATE]. He stated he interviewed CNA A on [DATE] and [DATE]. He stated CNA A told him that she was getting R#1 up when he told her, Put me up in this wheelchair, I'm going shoot up this nursing facility like I did to the other one, on [DATE]. He stated R#1 called the HR, who heard R#1 was upset and arrived at the facility to speak with him. He stated the HR told him on [DATE] that R#1 said, Clear the hallways and put the residents in the dining room. I'm going to shoot [ADM], on [DATE]. He stated R#1 did not threaten to shoot any residents. He stated R#1 was not placed on 1:1 or had any other interventions implemented from [DATE] through [DATE]. He stated he was unsure if the NP and MD gave any special instruction or if psych or behavior services were offered to R#1. He stated he tried to notify the OMB on [DATE], [DATE], and [DATE] about the immediate discharge request. He stated he spoke with the OMB on [DATE] and notified him of the immediate discharge request. He stated he spoke with the OMB again on [DATE] and the OMB told him that he spoke with unknown HHSC staff member and they cleared R#1 immediate discharge due to the threat R#1 made on [DATE] around 4:45pm-5:00pm. He stated he wanted to discharge R#1 on [DATE]. He stated he notified the police on [DATE] that R#1 threatened to shoot the ADM on [DATE], they did not come out to the facility, did not conduct a search and did not explain why they did not come out to the facility. He stated he did not discharge R#1 on [DATE] because he wanted to have something in plan on [DATE]. He stated the CNO called R#1's hospice on [DATE]. He explained he wanted to make sure hospice could visit R#1. He stated he also wanted to make sure R#1 had a place to discharge to. He stated he also had police present when he served the immediate discharge notice to R#1 on [DATE]. He stated R#1 threw the immediate discharge notice back at them and police intervened. He stated Hospice was also present on [DATE]. He stated R#1's friend also showed up to the facility on [DATE]. He stated the police offered EMS transportation to R#1, but he declined. He stated R#1 was provided with his clothes, medications, and an address for where his personal belongings would be sent to. He stated the OMB came to the facility later on in the afternoon of [DATE]. He stated R#1 did not check into the hotel he offered and R#1 declined on [DATE]. He stated he did not know R#1's whereabouts. He stated he knew it was important to ensure residents had a safe and proper discharge and said, The safety of the discharge and ensuring they have a place to go. Residents could be at risk of lack of care if they did not have a safe and proper discharge. He stated residents could stay at the facility during a pending discharge appeal. During an interview with the CNO on [DATE] at 2:23 p.m., the CNO stated she did not know R#1's care or services or if he exhibited any behaviors. She stated R#1 called the VPO on [DATE]. She stated the VPO included her in the phone conversation with R#1. She stated R#1 expressed he was irritated and tired of staff picking on him. She stated the VPO told her that R#1 was referring to the ADM. She stated R#1 said, I can take care of business, the only way things could get settled is through violence. I do things without thinking and then after it's done, I regret it. She stated she offered to put R#1 in hotel on [DATE] and he declined. She stated R#1 wanted to speak with the VPO and the VPO told him that he would speak with R#1 on [DATE]. She stated she was informed by the VPO on [DATE] that the ADM reported R#1 made threats to shoot the ADM on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 30 of 32 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 12/17/2025 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few [DATE]. She stated the VPO told her that R#1 told a CNA that he would shoot up the entire facility and to get the residents in the dining room so he could shoot the ADM. She stated she was unsure if R#1 made alleged threats to anyone else. She stated she did not know if R#1 had any weapons in his possession to cause harm. She stated R#1 was not placed on 1:1 because it irritated him and staff were scared of him. She stated R#1 remained at the facility from [DATE] through [DATE]. She stated the VPO called the police on [DATE] and she did not know if the police arrived at the facility. She stated the OMB told the VPO on unknown date that HHSC told him there was grounds to immediately discharge R#1. She stated the MD was notified on unknown date of R#1's immediate discharge and agreed with it. She stated R#1's hospice was also notified on unknown date. She stated the VPO served the immediate discharge notice to R#1 on [DATE]. She stated R#1 was provided with his medications and wound care supplies. She stated the VPO made a hotel reservation for R#1 for five days. She stated she did not know if R#1 accepted or declined the hotel reservation. She stated R#1 left with a friend who was a nurse, but she had no confirmation as to whether or not his friend had a current nurse license. She stated she did not know if R#1's friend was providing care and services to R#1. She stated she did not know R#1's whereabouts. She stated she did not know if R#1 reached out to his hospice. She stated the facility was responsible for residents' safe and proper discharge. She stated she knew it was important to ensure residents had a safe and proper discharge and said, It's important for residents so that their care and services continued. Residents could be at risk of not having their care and services continued if they did not have a safe and proper discharge. During an interview with CNA A on [DATE] at 4:13 p.m., CNA A stated her and CNA D were walking back to the memory care unit, observed R#1's call light and walked into his room to answer it [DATE]. She stated CNA E was already in R#1's room and were arguing back and forth with R#1. She stated that she and CNA D intervened. She stated R#1 was upset and said, I just want y'all motherfuckers to get me up in my chair and out the way. She stated CNA E sarcastically said, Oh don't shoot me. She stated as her and CNA D helped CNA E put R#1 into his wheelchair, R#1 said, Yeah because the previous nursing homes I've been in trouble for shooting them up. She stated her, CNA D and CNA E were not in fear and believed R#1 was upset because he told them that he had been waiting 2-3 hours for staff to answer his call light and put him in his wheelchair because he did not receive any snacks or meals. She stated she stepped out of R#1's room because she was receiving a call and then notified RN B that R#1 did not get any meals or snacks and was upset because he waited for 2-3 hours after pressing his call light for assistance with getting up. She stated RN B questioned why her and CNA D answered R#1's call light. She stated RN B told her that she told the staff not to get R#1 out of his bed, the ADM was on his way to the facility, and to tell CNA D and CNA E to get out of R#1's room and not help him out of bed. She stated she did not understand why her; CNA D and CNA E could not get R#1 out of bed and RN B did not give her a reason. She stated CNA D also questioned how they could not transfer R#1 because he requested to get out of bed. She stated RN B told her to not worry about it and that the ADM was on his way. She stated the ADM arrived and was at the facility on [DATE]. She stated the police came to the facility on [DATE] due to a nonemergency call that was unrelated to the conversation. During an interview with the MD on [DATE] at 5:22 p.m., the MD stated R#1 lied in bed, checked himself out of the facility, was mobile with his wheelchair, required some ADL assistance, received wound care and medications, and was placed on hospice care during his admission for pain management and overall, ADL decline. He stated R#1 had behaviors and the staff notified him and the NP and documented the behaviors since his admission. He stated the CNO notified him on [DATE] that R#1 made threats to the VPO. He stated he could not recall what threats R#1 made to the VPO on [DATE]. He stated the CNO also notified (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 31 of 32 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 12/17/2025 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete him on [DATE] at 9:36 a.m. that R#1 threatened to shoot the ADM on an unknown date. He stated he expected the staff to notify the police and escort R#1 to the ER for psychiatric evaluation. He stated he notified the ADM on [DATE] to notify the police and have EMS escort R#1 to the ER if it was an active, direct, credible threat. He stated R#1 was not persistently making threats during his admission at the facility. He stated R#1 had a safe discharge because he was on hospice services, which was a critical piece of his care, and was informed that R#1 was offered a hotel stay despite denying the offer. He stated residents had the right to refuse care and services. He stated he could not recall who transported R#1 after his discharge. He stated he would be concerned if R#1 was not on hospice services and did not receive wound care and medications after discharge. During a telephone interview with R#1 on [DATE] at 6:32 p.m., R#1 stated a friend picked him up, did not sign any paperwork and did not indicate he was going to take care of him on [DATE]. He stated he also did not sign any paperwork. He stated he told his hospice on [DATE] that he had nowhere to go when he was immediately discharged from the facility. During an interview with the CNO on [DATE] at 6:38 p.m., the CNO stated the OMB, hospice, and police were present when R#1 was discharged from the facility on [DATE]. During an interview and record review with CNA A on [DATE] at 9:17 a.m., CNA A stated the ADM called and told her on unknown date that he would type up her statement from [DATE]. She stated she refused and told the ADM that she could come to the facility and handwrite her own statement. She stated the ADM told her, That's okay, that's okay, I'll take care of it, and ended the call. Event ID: Facility ID: 675564 If continuation sheet Page 32 of 32