Health inspection·February 26, 2026

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few time. Resident had 3 shirts on, pants, socks and shoes. Resident was in pleasant mood making conversation with nurse. V/S 134/78, 88p, 18r, 97.7T, 98% O2. Called and spoke with NP [XX] no new orders given, RP was called no answer left voicemail to call facility. Resident had eloped from locked unit and walked down the highway and was seen by a police officer. Record review of Resident #1's skin assessment dated [DATE] reflected no abnormality. Record review of Resident #1's elopement assessment dated [DATE] reflected Resident #1 was at risk for elopement. Record review of Resident #1's 1:1 monitoring reflected Resident #1 was placed on 1:1 monitoring on 02/23/2026 at about 2:45 am and continued to be on 1:1 monitoring during the investigation on 02/26/2026. Review of LVN A's undated written statement showed CNA B heard the secure unit alarm approximately 30 minutes before PD arrived, did not notify her and did not look outside to ensure someone went outside. She also said she noticed Resident #1 was missing after PD spoke with her and a head count. During an interview on 02/26/2026 at 10:00 am, CNA D stated she worked the 10:00 pm to 6:00 am shift on the night of Resident #1's elopement and she was doing a 1:1 monitoring with another Resident when Resident #1 eloped from the facility. CNA D stated she found out about the elopement after Resident #1 was brought back to the facility. CNA D stated Resident #1 was put on a 1:1 monitoring immediately after the incident. CNA D stated she was in-serviced on elopement on 02/23/2026 right after the elopement incident and there was also an elopement drill conducted by the ADON. CNA D stated, they were told whenever the door alarms sounded, they should go and look outside and check the surroundings for a Resident. CNA D stated, if a Resident was not seen outside, notify the charge nurse to do a head count of all Residents. CNA D stated, after the head count of Residents, if someone was missing, notify the DON, do a count of everyone in the facility, and if not seen, notify the police. During an interview on 02/26/2026 at 11:23 am MA C stated she worked the 6:00 am to 6:00 pm shift and was not present when Resident #1 eloped from the facility. MA C stated she was in-serviced on elopement when she got back to work on 02/25/2026. MA C stated she was told to listen for the door alarm, and when it sounded to look for which door the sound was coming from. MA C stated she was supposed to go and look outside, checking the surroundings for residents and notify the charge nurse that the alarm went off and whether a resident was seen outside or not. MA C stated the charge nurse would do a head count of the residents and if a resident was missing, they would initiate elopement protocol. MA C stated if the resident was not found in the facility, the administrator or DON would be notified, and the search would extend outside, and the police would be notified. MA C stated Resident #1 had been on 1:1 monitoring since the incident. MA C stated the Maintenance Director added something on the door alarm on the secured unit to make it sound louder. MA C stated Resident #1 did not try to get out of the facility, and most days he was calm but was always talking about trying to go to the store. During an interview and observation on 02/26/2026 at 11:40 am Resident #1 was sitting in the hall on the secured unit and was on a 1:1 monitoring by the Assistant Manager for laundry. Resident #1 stated he went out the other night because he was trying to go home. Resident #1 stated he wanted to go to his family. During an interview on 02/26/2026 at 11:49 am the Assistant Manager for laundry stated she was assigned to do 1:1 monitoring with Resident #1 because he eloped from the facility the other night. The Assistant Manager for Laundry stated they could be within 10 feet of Resident #1 and he had to be visualized at all times. The Assistant Manager for laundry stated they had been in-serviced on elopement. The Assistant Manager for laundry stated she was told whenever the door alarm went off, they are to go and check the surroundings to see if a resident went out. If a resident was out, bring them back in the facility and notify the Administrator and the DON. If a resident was not found outside, notify the charge nurse to do a head count of residents. Continue the search within the facility and outside (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 2 of 6 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 02/26/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few the facility's premises. Notify the police if the resident was not found within the facility's premises. During an interview on 02/26/2026 at 11:53 am CNA E stated she was employed to the facility through a staffing agency. CNA E stated she was informed Resident #1 had eloped from the facility, and he had been placed on 1:1 monitoring. CNA E stated she was in-serviced on elopement on 02/25/2026 when she first got to the facility. CNA E stated she was told, when you hear the alarm, go out and check your perimeters, and if you do not see anyone outside, you do a head count of your residents. CNA E stated if someone is missing, you notify the Administrator and DON. If a resident is not missing, you will still notify the charge nurse immediately that the alarm went off. The elopement protocol will be activated. During an interview on 02/26/2026 at 12:01 pm CNA F stated she worked the 6:00 am to 2:00 pm shift and was not at work during Resident #1's elopement. CNA F stated Resident #1 had been on 1:1 monitoring since the incident. CNA F stated Resident #1 has always been talking about leaving but had never attempted to leave. CNA F stated she was in-serviced on elopement on 02/24/2026 when she got to work. CNA F stated she was in-serviced on checking the door and the surroundings when the door alarms. CNA F stated she would go check and see if someone is outside, get a count of residents in the building and notify the DON and Administrator and get directions from them. During an interview and observation on 02/26/2026 at about 12:12 pm the Maintenance Director stated after Resident #1's elopement incident on 02/23/2026 he added door stoppers (alerts you to any unauthorized exits and entries through an emergency exit doors and rear doors. Highly visible white STOP/Alarm Will Sound text with graphics against bold red background) to 2 of the doors on the secured unit which made the alarms sound louder on those doors. The Maintenance Director stated the doors had to be pushed very hard before they opened and the alarm would sound once the door was opened. The Maintenance Director stated, once the door is closed, the alarm would stop. Observation revealed all the alarm on the secured unit worked. Observation also revealed a door stopper was added to the door in the lobby of the secured unit from which Resident #1 eloped and at the door at the very end of the secure unit. It was also revealed that the alarm from the lobby of the secured unit could be heard from the door at the very end of the secured unit. The Maintenance Director stated the Administrator in-serviced the staff on elopement and the ADON conducted an elopement drill. During an interview on 02/26/2026 at 12:34 pm the ADON stated she was made aware by the Administrator of Resident #1's elopement on the morning of 02/23/2026 at about 3:00 am. The ADON stated by the time she got to the facility, the Police had already brought Resident #1 to the facility, he was on 1:1 monitoring, LVN A had done a head to toe assessment and there was no apparent injury noted. The ADON stated CNA B was an agency staff assigned on the secured unit but she [CNA B] was not at the facility when she [ADON] got to the facility, and she was told by the Administrator and LVN A that CNA B had refused to give a statement to the Administrator and the police. The ADON stated that was the first time she had seen CNA B at the facility. The ADON stated the Agency staff were usually trained by the agency on dementia care which focused on elopement. The ADON stated she was told CNA B heard the door alarm went off, she assumed that the other resident on the couch was the one that set the alarm off and she did not look outside or notify LVN A. The ADON stated CNA B should have gone out to check if a resident went outside and notified LVN A that the alarm on the unit went off. The ADON stated, if CNA B had told LVN A that the alarm went off, they would have done a head count and initiated the elopement protocol. The ADON stated if a resident was missing, the staff would start searching the rooms, the closets, notify the Administrator and the DON, and continue the search outside the facility. The ADON stated Resident #1 was at risk of injury when he eloped because of the major state highway he was found on. The ADON stated elopement in-service was initiated by the Administrator on 02/23/2026 and she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 3 of 6 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 02/26/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few later conducted an elopement drill the same night. The ADON stated another elopement drill was conducted on 02/25/2026. The ADON stated all staff were being trained on elopement before the start of their shifts. During an interview on 02/26/2026 at about 2:04 pm, the DON stated he got a call at about 4:00 am on 02/23/2026 notifying him of Resident #1's elopement. The DON stated by the time he got to the facility, Resident #1 was already brought back to the facility. The DON stated CNA B was an agency staff who was assigned to the secured unit and heard an alarm sounding at the door in the lobby area/sitting area on the secured unit, made an assumption that the resident that was on the couch was the one that set off the alarm on the door. The DON stated CNA B did not tell LVN A about the door alarm going off. The DON stated CNA B should have immediately told LVN A. They should have done an elopement search, looked in the facility, looked in the perimeter of the facility, and if the resident was not found, called the police. The DON stated Resident #1 was immediately put on 1:1 monitoring, assessed to make sure there was no injury, and they contacted Psychiatrist for evaluation. The DON stated they assessed all the residents in the facility for elopement risk, in-serviced the staff on elopement and how to respond to the alarm, did 2 elopement drills, and had an Ad hoc meeting to discuss the elopement. The DON stated Agency staff were trained by the Agency on elopement.During an interview on 02/26/2026 at 2:22 pm, the Administrator stated he was notified by LVN A immediately when she found out Resident #1 had eloped. The Administrator stated LVN A told him the police had come asking if they were missing a resident. The Administrator stated he went to the secured unit and spoke with CNA B and CNA B stated she heard an alarm, saw a resident on the couch close to the secure door and she thought it was the resident on the couch that set the alarm off. The Administrator stated CNA B stated she turned the alarm off and she did not tell anyone, not the charge LVN A. The Administrator stated, about 20-30 minutes after the door had alarmed, the police called to find out if the facility was missing a Resident. The Administrator stated, when the PD arrived at the facility, they attempted to interview CNA B and she refused and stated she did not like their (the Police and Administrator's) attitudes. CNA B stated she made a mistake and she walked out. The Administrator stated Resident #1 was found about 0.9 miles away from the facility.The Administrator stated Resident #1 was assessed by LVN A, immediately placed on 1:1 monitoring, MD was notified, the ADON was notified, elopement in-service was initiated, the Maintenance Director checked the alarms at the door and added a door stopper to increase the sound of the alarm, and the ADON reached out to the staffing agency and was told CNA B would be fired. The Administrator stated he had been in-servicing staff around the clock and ensuring all agency staff were trained on elopement before their shift. The Administrator stated, when CNA B heard the door alarm, CNA B should have looked outside never assumed that the resident on the couch was the one that set off the alarm. The Administrator stated CNA B should have told her charge nurse that she heard the door alarm sound. The Administrator stated CNA B was supposed to do an immediate head count to ensure everyone was present, they would have known someone was missing sooner and notify the police and I. The Administrator stated all staff, agency and fulltime would be in-serviced on elopement before the start of their shift.During an interview on 02/26/2026 at 4:05 pm CNA G stated she was employed through an agency and worked the 2:00 pm to 10:00 pm shift. CNA G stated she did not work on the secured unit. CNA G stated when she got to the facility on [DATE] she was in-serviced on a Resident on the secured unit was on a 1:1 monitoring. CNA G stated when the door alarm went off, she would go and see, make sure no residents left the building and let the nurse know especially on the secured unit. CNA G stated if a resident was not seen outside after checking, she would come back into the facility and make sure all residents were accounted for and let the charge nurse know.During an interview on 02/26/2026 at 4:48 pm LVN A stated she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 4 of 6 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 02/26/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few the Charge Nurse on duty on the night of 02/22/2026 to the morning of 02/23/2026 on the 6:00 pm to 6:00 am shift. LVN A stated she did a nursing round on the secured unit at about 1:00 am and CNA B was sitting in the nurse's office. LVN A stated she asked CNA B to sit close to the two (2) residents in the lobby area of the secured unit. LVN A stated Resident #1 was sitting in his wheelchair and another Resident was on the couch. LVN A stated when she checked back on the unit at about 2:00 am, Resident #1 was not sitting where she last saw him. LVN A stated when she stepped out of the secured unit, a Police officer was at the door, and he asked if they were missing a resident.LVN A stated the Police officer said there was a man in a yellow wheelchair and it sound like Resident #1. LVN A stated she ran back to the secured unit and asked CNA B if a resident went out and CNA B stated no one went out of the facility. LVN A stated she asked CNA B if the door sounded and CNA B stated yes. LVN A stated CNA B told her that when the door alarm sounded, she (CNA B) went and looked and saw a resident on the couch and assumed he was the one that sounded the door alarm. LVN A stated she told CNA B she (CNA B) should have alerted her (LVN A) that the door alarm went off, and she (LVN A) would have done a head count of the residents on the unit. LVN A stated she looked in Resident #1's room and Resident #1 was not in his room. LVN A stated she notified the Administrator and told the Police Officer that person found was a resident of the facility. LVN A stated the Police brought back Resident #1 to the facility, she assessed Resident #1 from head to toe and placed Resident #1 on 1:1 monitoring immediately. LVN A stated CNA B refused talking to the Administrator and the Police Officer, she grabbed her things and left the facility. LVN A stated the Administrator requested a statement from CNA B and CNA B said the Administrator would figure out and walked out. LVN A stated an in-service on elopement was initiated the same night by the Administrator and the ADON. LVN A stated when the morning shift got in the facility, they were in-serviced on elopement before they took over their shift.During an interview on 02/26/2026 at 5:11 pm CNA H stated she worked the 2:00 pm to 10:00 pm shift. CNA H stated she was in-serviced on elopement on 02/25/2026 and she did not work the last 2 days after the elopement incident. CNA H stated when the door alarm went off, she was supposed to go out and check to make sure no resident went outside the facility, come back in the facility, ensure the door was closed and the alarm was back on and, notify the charge nurse to do a head count of the residents to make sure everyone was inside.During an interview on 02/26/2026 at 5:18 pm LVN I stated he was off the last two days after the elopement incident and got back to work on 02/25/2026 for the 6:00 am to 6:00 pm shift. LVN I stated he was in-serviced on 02/25/2026 on elopement. He stated when you hear the door alarm, look outside to make sure a resident did not go outside, do a head count of residents, and notify the authority. LVN I stated Resident # was on a 1:1 monitoring.During an interview on 02/26/2026 at 5:27 pm CNA J stated he was employed through a staffing agency and worked the 2:00 pm to 10:00 pm shift. CNA J stated he worked on 02/24/2026 and he was in-serviced on elopement at the beginning of his shift. CNA J stated Resident #1 had been on 1:1 monitoring due to elopement. CNA J stated if he heard the door alarm, he would check the perimeter outside, come back in, do a head count and alert the charge nurse, the administrator and the DON. CNA J stated even if every resident was accounted for, he would still have to alert the administrator.Attempt made to contact CNA B on 02/26/2026 at 09:48 am and there was no response.Record review of CNA's training records reflected CNA B was trained on Dementia Care Assessment One on an unknown date and passed.The facility immediately implemented the following actions to immediately address Resident #1's elopement incident:PD brought Resident #1 back to the facility on [DATE]Resident #1 was assessed head to toe on 02/23/2026 and had no apparent injuriesResident #1 was placed on 1:1 monitoring on 02/23/2026Resident #1 and all other residents in the facility were reassessed for elopement risk on 02/23/2026Staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675564 If continuation sheet Page 5 of 6 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 02/26/2026 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete were in-serviced on elopement as of 02/23/2026Staff participated in elopement drills twice since Resident #1's incident on 02/23/2026 and 02/25/2026Door stoppers were placed on 2 of the secure unit doors on 02/23/2026The staffing Agency was notified of agency staff actions on 02/23/2026Maintenance checked alarms and door magnetic locksThe MD was notified of the incident on 02/23/2026An Ad hoc was held on 02/23/2026 Record review of facility's in-service initiated 02/23/2026 at 04:00 am provided by the ADON reflected the following: Elopement process- when alarm goes off, check to see resident near or outside the door. Notify nurse and do a head count on your residents notify the DON and Administrator.Record review of facility's elopement drill reflected a drill was conducted on 02/23/2026 from 3:30 to 4:05 pm.Record review of facility's in-service initiated 02/23/2026 at 10:00 am provided by the ADON reflected the following: Monitoring/Reporting--No one is to be sitting behind the glass/nurse's station in the unit. One CNA will remain in the lobby at all times, alternating to provide care on the unit to monitor behaviors. Report behaviors to charge nurse. Record review of investigation document reflected an Ad hoc was held on 02/23/2026 regarding elopement, door alarm and Resident #1 eloping from the secure unit on 02/23/2026 at about 2:00 am. Agency CNA responded to the alarm and assumed another Resident #2 on the couch was the cause of the alarm.Record review of facility's in-service initiated 02/23/2026 provided by the Administrator reflected: ln-service on facility door alarms By: [XXX], AdministratorDate: 02/23/2026IMPORTANTAnytime you hear a door alarm especially in the Secured Unit, never ever assume it's a resident sitting by the door who sounded the alarm! If you hear a door alarm sound, make an immediate search of the perimeter inside and out. Inform your charge nurse and conduct a resident body count to see if any residents are missing.Again, especially on the facility secured unit, never ever assume a resident sitting by a security door is the cause of the alarm going off! Make an immediate search of the perimeter inside and outside and conduct an immediate body count! If a resident is missing contact the police and notify the administrator immediately! Record review of facility's elopement drill reflected a drill was conducted on 02/25/2026 from 5:15 am to 5:30 am. Record review of facility's document titled Preventative Maintenance and Life Safety checklist-daily reflected the alarms were checked on weekdays and were checked on 02/23/2026. There was an indication on the document which reflected: Resident got out of secure door. Checked, door lock is undamaged and alarm sounds. Added exit stoppers to 2 secured doors. Record review of facility's policy titled elopement/missing resident dated [DATE] reflected: A resident is considered to be missing when the resident cannot be located on the facility's interior or exterior grounds. When a resident is considered missing, the Charge Nurse will notify the DON/ Administrator immediately. The DON or designer will implement the Elopement protocol immediately.All personnel will report to the nursing station for search assignments. Information should beobtained and communicated with regard to the last time the resident was seen, a description of the resident's clothing, and the location where the resident was last seen. The noncompliance was identified as PNC. The IJ began on 02/23/2026 and ended on 02/25/2026. The facility had corrected the noncompliance before the survey began. Event ID: Facility ID: 675564 If continuation sheet Page 6 of 6