Inspection·August 11, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that the air conditioner had been out since 5:00 am. He said Resident #2 had said his room was hot and wanted the air conditioner turned on. He said as far as he knows none of the resident have gotten sick. He said MAIN was aware and that the DON also was aware. He said that the residents were complaining that it was hot in the facility. He said it was hot. An interview with the MAIN on 08/09/2025 at 4:56pm revealed that he got the call that the air conditioner was out at 2:17pm. He said that the air conditioner company was on their way. He said he was going to get four more emergency air conditioners. He said he did not have a log of the temperature. An interview with the DON at 08/09/2025 at 5:26pm revealed that the facility has a plan in place, and they were going to move residents. She said the staff moved the resident to the common area in the main building. She said that staff were positioned all around them so they could not leave the facility. She said that the MAIN should be there soon with the other air conditioners.An interview with the On-Call Doctor on 08/09/2025 at 7:58pm revealed that with the temperatures 93 degrees it could cause the residents dehydration if the staff were not monitoring the residents' fluids. She said the most that could happen that would be concerning was the residents getting dehydrated. Record review of the Weather Channel App on 08/09/2025 revealed the local temperature in [NAME] Heights was 97 degrees Fahrenheit. Record Review of the Extreme or Dangerous Temperature Levels Policy dated 11/2021 revealed Federal and Texas state standards for nursing centers require heating systems to be capable of maintain a minimum temperature of 71 F degrees and cooling systems to maintain a maximum temperature of not greater than 81 degrees F. Record Review of form 671 Long Term Care Facility Application for Medicare and Medicaid dated 8/9/2025 revealed a census of 24 residents in memory care area.This was determined to be an Immediate Jeopardy (IJ) on 08/09/2025 at 8:45pm. The DON was notified. The DON was given the IJ template on 08/09/2025 at 8:47pm.The facility's plan of removal was accepted on 8/11/2025 at 08:11am and reflected the following:Date Plan Implemented: 8/9/2025.Issue/Concern: AC unit required repair. Date occurred: 8/9/2025.Date of ADHOC: 8/9/2025 AdHoc Attendees: Administrator, Director of Nursing, and Medical Director Risk: All Residents who reside in the affected area (Memory Care Unit) may be affected. 1.On 8/9/2025 the Maintenance Director checked the HVAC system and found it in need of repair and contacted Oncor to make all necessary repairs. The Maintenance Director is responsible for maintaining the HVAC system.Date initiated: 8/9/2025Date completed: 8/9/20252.On 8/9 2025 the Maintenance Director received an estimate from Oncor for repair of HVAC system within one business day. The Administrator signed the proposal authorizing immediate repair. The Maintenance Director is responsible for maintaining the HVAC system.Date initiated: 8/9/2025.Date completed: 8/9/20253.The Maintenance Director established a direct line of communication with Oncor and requested status updates every two hours.Date initiated: 8/9/2025.Date completed: 8/9/20254.The Maintenance Director/Director of Nursing/Charge Nurses/ Nursing staff began taking the air temperature of resident rooms/resident care areas upon notice of the air conditioner not working properly and every 30 minutes for 2 hours. The Director of Nursing/Charge Nurses/Nursing Staff initiated plan to move residents from the affected area to other units. The Maintenance Director/Director of Nursing/Charge Nurses/ Nursing staff will continue to take air temperatures twice daily for the next 48 hours to ensure that the AC unit is functioning properly post being repaired on 8/9/2025 @ 1731. The Maintenance Director/Director of Nursing/Charge Nurses/ Nursing staff will document air temperatures on monitoring audit tool. The Maintenance Director ensured all wall thermostats were functioning properly on 8/10/2025 and will check wall thermometers twice daily for 2 days, then randomly weekly and ongoing and document compliance using a monitoring audit tool. Any issues will be addressed immediately.Date Initiated: 8/9/2025.Date Completed: 8/9/2025 and ongoing5.The Director of Nursing/Charge Nurses immediately began assessing/evaluating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675909 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675909 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harker Heights Nursing & Rehabilitation 415 Indian Oaks Dr Harker Heights, TX 76548 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some residents in the affected areas for s/s of hyperthermia, signs and symptoms of dehydration, safe, clean, comfortable, homelike environment.Date initiated: 8/9/2025.Date Completed: 8/9/2025 and ongoing6.The Administrator and Director of Nursing was educated on 8/9/2025 on what to do when the AC unit is not functioning properly by the vice president of operations and director of clinical operations. The Director of Nursing/Director of Clinical Education/Designee educated nursing staff on all shifts regarding what to do if the AC unit is not functioning properly, s/s of hyperthermia and how to recognize signs in the older adults.Date Initiated: 8/9/2025.Date Completed: 8/10/2025 and ongoing7.The Director of Nursing/Charge Nurses/designee began providing cold/cool beverages upon care encounters, every two - four hours and more often as needed.Date Initiated: 8/9/2025.Date Completed: 8/9/2025 and ongoing8.The Director of Nursing/Charge Nurses/Nurse Aides evaluated all residents in the affected area to ensure residents were comfortable and offered/assisted with removing bed linens for those who desired less bed linens as needed.Date Initiated: 8/9/2025.Date Completed: 8/9/20259.The Director of Nursing / Charge Nurses /Nurse Aides ensured residents were dressed in appropriate clothing to ensure their comfort.Date Initiated: 8/9/2025.Date Completed: 8/9/2025 and ongoing10.Portable AC units were promptly delivered on-site by maintenance director and placed in resident care area affected in efforts to ensure a safe and comfortable temperature. The Maintenance Director was responsible for delivering the Portable AC Units.Date Initiated: 8/9/2025.Date Completed: 8/9/202512.In an abundance of caution the Administrator purchased portable air conditioning/heating units to have as needed for back up. The Administrator and Maintenance Director is responsible for approving the purchasing and renting equipment and purchasing of equipment. The portable air conditioning units are not in use due to the AC Units are back in service as of 8/9/2025 @1731 and properly functioning as evidenced by monitoring of temperatures using a temperature log audit tool.Date Initiated: 8/9/2025.Date Completed: 8/9/202513.After the HVAC repair was made, the Director of Nursing or designee will monitor resident room temperatures twice per day at random times/shifts for two days to ensure acceptable temperature ranges.Date Initiated: 8/9/2025.Date Completed: 8/9/2025 and ongoingQAPI Monitoring: Director of Nurses/Assistant Director of Nurses will review the 24-hour report, progress notes, SBARS/COCs and risk management reports to identify safety risks / concerns related to direct care staff providing care and/or any care related issues or concerns documented. This will take place daily up to 7 days a week for the next 2 months. Findings will be documented on a monitoring tool and retained in the designated survey binder. The [NAME] President of Operations and Director of Clinical Operations will be responsible for training management team members prior to them training non-management team members. This plan and all education and auditing tools will be placed in binder and kept with the Administrator or Director of Nursing Services. This plan will remain in place for the next 2 months and findings will be reported to the QAPI committee during monthly meeting for the next 2 months. The QAPI committee will then determine compliance or identify a need for additional training or updates to policies. Monitoring included: During an interview with MAIN on 08/09/2025 at 6:48pm revealed that he had come to the facility after getting the call for the AC on memory care. He stated that he checked everything on the AC, and it was working correctly. He said he then called [company name] which was the electric company to come out. He said they came out and checked the main building. He said [company name] did not find an issue. He said he checked all his system again and called [company name] back out and found that the transformer to the memory care had blown. The electric company fixed the transformer and AC started working. Observation of Residents in Memory care on 08/10/2025 at 10:00 am and at 3:15pm revealed that residents were dressed appropriately. Observation of memory care temperatures on 08/10/2025 at 3:15pm revealed that temperatures were 77, 77, 76, 77, 80 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675909 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675909 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harker Heights Nursing & Rehabilitation 415 Indian Oaks Dr Harker Heights, TX 76548 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and 78 according to the MAIN temperature gun and thermostat. Observation of Residents in memory care on 08/11/2025 at 3:40pm revealed residents were dressed appropriately.Observation of Memory care temperatures on 08/11/2025 at 3:40pm revealed the temperatures in memory care 600 hall were 77, 76, 75, 76. 600 hall dining room was 78. 700 hall dining room temperatures were 75 and 700 hall were 76, 75, and 76 according to the thermostat and the MAIN temperature gun.During an interview with CNA A on 08/11/2025 at 2:48pm revealed she worked the two to ten shift she had been trained on resident rights. She said that the policy for temperatures was that the temperatures needed to be between 71 and 81 degrees. She said that if the temperature were not within the range it was supposed to be reported to the administrator. She said some signs of dehydration were dry/cracked lips, constantly wanting water and white stuff in the corners of their mouths. She said if a resident got dehydrated, they could pass out or end up in the hospital. She said if she noticed the air conditioner not working, she would report it to the administrator and the DON. She said she would also encourage residents to drink water and have fans on the residents. During an interview with CNA B on 08/11/2025 at 2:53pm revealed she had been trained on resident rights and homelike environment. She said that the policy for temperatures was if the AC was not working staff were to let the Administrator and DON know immediately. She said staff were also to check the residents for dehydration, she said some signs of dehydration was extremely thirsty, dry mouth and chapped lips. She said if a resident gets dehydrated the resident could get ill and pass out. She said to prevent dehydration she would offer the resident water throughout the day. She said that the temperatures should be between 71-81 degrees Fahrenheit. During an interview with LVN H on 08/11/2025 at 3:03pm revealed she had been trained on resident rights and homelike environment. She said the policy for temperatures was if the AC was higher than 81 or lower than 71 it needed to be reported to the DON, MAIN and ADM immediately. She said some signs of dehydration was fatigue, dry mouth, light headedness, and decreased urination. She said if a resident became dehydrated the resident could become dizzy, confused, and have a fall. She said if the AC were not functioning correctly, she would provide the resident with fluids and keep them cool. She also said if it became intolerable then she would move the residents. During an interview with CNA C on 08/11/2025 at 3:07pm revealed she had been trained on resident rights and homelike environment. She said the policy for temperatures was if the AC was not working to report it to the ADM and the DON. She said the temperatures should be between 71- 81 degrees Fahrenheit. She said if the AC was not working staff were to watch the residents for signs of dehydration. She said some signs of dehydration were dry mouth and thirsty. She said if a resident got dehydrated, they could get sick or irritated. She also said if the AC was not working staff were to give the residents water. During an interview with CNA D on 08/11/2025 at 3:12pm revealed she had been trained on resident rights and homelike environment. She said the policy for temperatures was the temperature should be 71-81 degrees Fahrenheit, if not at those temperatures staff should immediately report to the admin. She also said if not at the correct temperature staff were to relocate the residents. She said signs of dehydration were dry mouth, waxy skin, and dry lips. She said if a resident did get dehydrated, they could become sick. She said staff should be ensuring the resident was getting enough fluids. During an interview with LVN I on 08/11/2025 at 3:21pm revealed she had been trained on resident rights and homelike environment. She said the policy for temperatures was if the AC was out staff were to report it to the DON and ADM. She said the temperatures should be between 71 degrees and 81 degrees Fahrenheit. She said staff were supposed to make sure the residents did not become dehydrated. She said that staff were to give residents adequate liquid and help residents with drinking. She said signs of dehydration were dry mouth and clammy skin. She said if a resident became dehydrated, they could have a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675909 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675909 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harker Heights Nursing & Rehabilitation 415 Indian Oaks Dr Harker Heights, TX 76548 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete poor health outcome. During an interview with LVN J on 08/11/2025 at 3:29pm revealed she had been trained on resident rights and homelike environment. She said the policy for temperatures was to call MAIN, ADM, and DON if the AC was not working. She said staff were to also watch the residents to ensure the heat was not affecting them. She said signs of dehydration were lethargic, sweating, dry mucus, and dry mouth. She said if a resident became dehydrated, they could get hyperthermia (elevated body temperature). She said if the AC was not working staff were to move the residents to a cool area and provide fluids to them. She also said staff were to monitor the resident's intake and output. She said the temperatures were to be between 71 degrees and 81 degrees Fahrenheit. Record review of the POR Documents revealed that the MAIN Director checked the system, called [company name] for repairs and did status checks every two hours on 08/09/2025. Record review of the Hardware Store Receipt revealed that the portable AC were purchased at 4:18pm on 08/09/2025 from the hardware store. Record review of the receipt from the Hardware Store dated 08/09/2025 revealed the facility purchased 4 portable AC units from the hardware store. Record review of the Temperature Log dated 08/09/2025, 08/10/2025 and 08/11/2025 revealed temperatures have remained within regulation since being fixed. Record review of resident medical records revealed 36/36 Residents in memory care were assessed on 8/9/2025 with no signs or symptoms noted. Record review of In-Services dated 08/09/2025 revealed the DON and Administrator were educated on 08/09/2025 on what to do when the AC unit is not functioning properly by the VP of Operations. Record review of In-services dated 08/09/2025 revealed all staff on all shifts had been educated on what to do when the AC is not functioning correctly, and how to spot and prevent dehydration. Record review of the Temperature monitoring log revealed that the DON had monitored the temperatures and no issues were noted. Record review of the QAPI revealed that QAPI meeting was held on 08/09/2025. The DON was informed the Immediate Jeopardy was removed on 08/11/2025 at 8:45pm. The facility remained out of compliance at a severity level of isolated and a scope of no actual harm with the potential for more than minimal harm due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 675909 If continuation sheet Page 5 of 5