Inspection·November 20, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few requesting return call. No adverse psychosocial or physical effects noted as a result of this incident. Social Services will continue to monitor and provide support as needed. - 11/03/25 at 9:30 PM, LVN A wrote: Resident tries to leave the facility when she was let out by staff to sit outside for a bit as per resident's request. Resident was brought back to the facility without any concern noted or voice. [sic] This writer asked resident where she was going, resident states ‘ I [sic] was going to get something from the store' This [sic] writer called RP. no [sic] response. Resident is sitting at the nursing station at this time. Will continue to monitor. - 11/04/25 at 6:06 AM, LVN B wrote: Resident monitored this shift q 15min continues slept most of the shift no any concerns voiced wctm [sic] - 11/04/25 at 12:52 PM, the SW wrote: SW met with resident to follow up regarding the wandering incident noted on 11/3/25. Resident was observed to be doing well, pleasant, and cooperative during the visit. No adverse psychosocial issues or changes in behavior were noted or reported at this time. Resident denied feelings of anxiety or distress. SW will continue to monitor and provide support as needed.- 11/05/25 at 2:59 PM, the SW wrote: SW completed a second follow-up visit with resident to provide ongoing support and assess for any arising needs related to the prior wandering incident. Resident remained calm, oriented, and engaged appropriately during the interaction. No new behavioral concerns or psychosocial issues were identified. Resident reported feeling comfortable and well-adjusted in the current environment. SW offered continued emotional support and reminded resident to seek staff assistance if feeling restless or disoriented. SW will continue routine monitoring and support. Record review of a Provider Investigation Report, dated 11/04/25, reflected the following: Description of the Allegation: Resident #1 was found walking with her walker on the sidewalk away from the Facility. She was brought back by Facility staff. No adverse incident or injuries noted on the resident. States: ‘she [sic] was walking towards the hospital and the store. Resident alert and oriented at that time. [sic].Provider Response: Resident is alert/oriented with bouts of confusion. Is able to relate the incident on how she walked with a walker on the sidewalk. She usually stays at the front of the entrance door and does not attempt to walk away. At that time, she decided to walk through the sidewalk attempting to go to the hospital and the store which was close by. She said she would never cross the street, so she decided to walk back.Investigation Summary: Alert/ oriented [sic] resident with a diagnosis of unspecified dementia, walked through the sidewalk with her walker away from the Facility premises without notifying anyone. Resident was last seen 15 minutes before she was reported seen by the sidewalk close to the [local pharmacy]. Resident is able to relate the circumstances that led her to reach where she was. She is independently ambulatory with a walker and she knows what she wants and where to go. She wanted to go to the store to get something. Asked [sic] what she wanted from the store, and she said she needed some stuff. Investigation Findings: Confirmed. Provider Action Taken Post-Investigation: Resident was assessed for any injuries. none noted. Resident was instructed not to leave the Facility [sic] unless someone is with her. Resident was supervised closely by the staff for any further attempt to leave. Staff was educated on Elopement [sic] risk and making sure residents are supervised closely. MD and family were notified. Left a message to [Resident #1's RP]. Awaiting call back. Referral to Psych initiated. Resident on the caseload for Psych Services. Record review of a witness statement, dated 11/04/25, and signed by the ADON reflected the following: [The previous admission Director] called the facility to report that [Resident #1] was observed walking on the sidewalk toward [a road nearby the facility]. The Director of Rehab and I, the ADON, went to meet the resident and the [previous admission Director] in front of [local pharmacy]. The resident stated that she was going to the hospital and the store. We safely returned to the facility with the resident without incident. The Director of Nursing (D.O.N.) was made aware. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676080 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 676080 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Town Hall Estates Arlington, Inc. 824 W Mayfield Rd Arlington, TX 76015 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 nurse on duty attempted to notify the family; no one answered, and a voicemail message was left. Observation and interview on 11/20/25 at 11:55 AM with Resident #1 revealed she was sitting in the dining room at one of the tables. Resident #1 was dressed and had her walker to the side of her. Resident #1 appeared to be upset because she was fidgeting and had a scowl on her face. Resident #1 said she was doing okay on the outside but not on the inside. Resident #1 said she remembered leaving the facility a few weeks ago because she had tried to find her son, then she said she had actually tried to find her house. Resident #1 seemed confused and kept going in and out of the two stories of why she left the facility. Resident #1 ultimately said she was upset and did not want to be at the facility. Interview on 11/20/25 at 12:06 PM, Resident #1's RP stated she was told Resident #1 usually sat in the front area of the facility and while the staff were not looking, she wandered off and went to the local pharmacy down the street on 11/03/25. Resident #1's RP said Resident #1 told her she had tried to buy some make up but she did not have enough money so she went back to the facility to get some more. Resident #1's RP said Resident #1 was no longer allowed to sit outside in the front area anymore, but she had never tried to leave the facility before this incident. Resident #1's RP said she feared something like this would happen to Resident #1 but the staff assured her that Resident #1 was always watched by them while she was outside in the front area. Resident #1's RP said her main concern was that Resident #1 had mental illness and what she thought was not reality and she could have been hurt leaving the facility. Resident #1's RP said thankfully Resident #1 was not injured from the 11/03/25 incident. Interview on 11/20/25 at 12:26 PM, RA B stated Resident #1 wanted freedom to come and go from the facility as she wished. RA B said Resident #1 periodically sat outside in the front of the building. RA B said since the elopement on 11/03/25, Resident #1 was not allowed in the front by herself, staff have to be with her at all times now. RA B said Resident #1 never talked about leaving the facility or attempted to leave the facility through the exit doors prior to the elopement on 11/03/25. RA B said there was always a receptionist at the front who kept an eye on Resident #1 while she sat outside in the front area. RA B said she was in-serviced and knew the facility's policy and procedures for elopements and wandering residents. RA B said she knew to look for the residents both inside and outside the facility if they were noted to be missing. RA B said she knew to call the Administrator and DON to report the missing resident immediately. RA B said she knew to report to the nurse when a resident wandered around or was exit seeking. RA B said she knew to redirect a resident if they were wandering or exit seeking and to keep a close eye on them to make sure they did not leave. Interview on 11/20/25 at 12:36 PM, LVN C stated she was in-serviced and knew the facility's policy and procedures for elopements and wandering residents. LVN C said she knew to look for the residents both inside and outside the facility if they were noted missing. LVN C said she knew to call the Administrator and DON to report the missing resident immediately. LVN C said she knew to redirect a resident if they were wandering or exit seeking and to keep a close eye on them to make sure they did not leave and possibly place on 1:1 monitoring too. LVN C said while she did not care for Resident #1, she knew she was an elopement risk. Interview on 11/20/25 at 12:52 PM, LVN D stated she cared for Resident #1 and knew she was an elopement risk. LVN D said she had to monitor Resident #1 after the elopement incident on 11/03/25. LVN D said Resident #1 never talked about wanting to leave the facility or attempted to exit seek that she was aware of. LVN D said Resident #1 was not allowed to go outside by herself in the front, she had to have a staff member with her at all times. LVN D said she was in-serviced and knew the facility's policy and procedures for elopements and wandering residents. LVN D said she knew to look for the residents both inside and outside the facility if they were noted missing. LVN D said she knew to call the Administrator and DON to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676080 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 676080 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Town Hall Estates Arlington, Inc. 824 W Mayfield Rd Arlington, TX 76015 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 report the missing resident immediately. LVN D said she knew to redirect a resident if they were wandering or exit seeking and to keep a close eye on them to make sure they did not leave and possibly place on 1:1 monitoring too. Interview on 11/20/25 at 12:56 PM, CNA E stated Resident #1 was an elopement risk. CNA E said she was in-serviced and knew the facility's policy and procedures for elopements and wandering residents. CNA E said she knew to look for the residents both inside and outside the facility if they were noted missing. CNA E said she knew to call the Administrator and DON to report the missing resident immediately. CNA E said she knew to report to the nurse when a resident began to wander around or was exit seeking. CNA E said she knew to redirect a resident if they were wandering or exit seeking and to keep a close eye on them to make sure they did not leave. Interview on 11/20/25 at 1:09 PM, the DOR stated she walked to the front of the building and the ADON said Resident #1 was down the street by the crosswalk. The DOR said she had a wheelchair available so she grabbed it and a gait belt and walked down the street with the ADON to Resident #1. The DOR said Resident #1 was able to walk back using her own walker until about three quarters of the way when she accepted being wheeled back by staff. The DOR said when Resident #1 was brought back into the facility, the nursing department evaluated her and then took her to eat dinner in the dining room. The DOR said she could not see any injuries to Resident #1. Interview on 11/20/25 at 1:11 PM, the ADON stated the previous Admissions Director called to tell her Resident #1 was on the sidewalk down the street from the facility around 4:30/5:00 PM on 11/03/25. The ADON said she ran from her office and told a few other people what happened, including the DOR, who grabbed a wheelchair and went with her. The ADON said they found Resident #1 down the street and she was uninjured. Interview on 11/20/25 at 1:34 PM, CNA F stated she did not care for Resident #1 but knew she was an elopement risk. CNA F said she was in-serviced and knew the facility's policy and procedures for elopements and wandering residents. CNA F said she knew to look for the residents both inside and outside the facility if they were noted to be missing. CNA F said she knew to call the Administrator and DON to report the missing resident immediately. CNA F said she knew to report to the nurse when a resident began to wander around or was exit seeking. CNA F said she knew to redirect a resident if they were wandering or exit seeking and to keep a close eye on them to make sure they did not leave. Interview on 11/20/25 at 2:08 PM, the previous Admissions Director stated he left the facility for the day and was driving down the street on 11/03/25 when he saw Resident #1 walking down the sidewalk away from the building. The previous Admissions Director said he pulled into the local pharmacy's parking lot and got out of his vehicle to talk to Resident #1 and asked her to wait with him. The previous Admissions Director said he called the ADON to let her know about Resident #1's location and after a few minutes both the ADON and the DOR met with them. The previous Admissions Director said the ADON and the DOR brought a wheelchair with them and took Resident #1 back to the building. The previous Admissions Director said he did not see any injuries on Resident #1. The previous Admissions Director said he asked Resident #1 why she left the facility and he was told two different stories: one was that she wanted to go buy a house by the hospital and the other was about wanting to go to the hospital for a procedure. Interview on 11/20/25 at 1:42 PM, the Receptionist stated she was at the facility the morning of 11/03/25 when Resident #1 eloped. The Receptionist said she left around 12:30 PM and asked Resident #1 to come inside since no one was going to be able to watch. The Receptionist said typically, Resident #1 sat in the front of the building outside and she could see her from where she sat inside. The Receptionist said before 11/03/25 Resident #1 had never tried to leave the building. The Receptionist said since 11/03/25, Resident #1 was no longer allowed to sit outside the building and had to have a staff member with her if that was what she wanted to do. Follow-up interview on 11/20/25 at 1:53 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676080 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 676080 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Town Hall Estates Arlington, Inc. 824 W Mayfield Rd Arlington, TX 76015 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 PM, the ADON stated since Resident #1 had never eloped before 11/03/25, she was not considered an elopement risk. The ADON said Resident #1 would make a comment saying she was waiting for her family member to pick her up but she would never act or say she wanted to leave. The ADON said it was normal for Resident #1 to sit in the front of the building outside because she enjoyed the sunshine. The ADON said the Receptionist would keep an eye on Resident #1 while she was outside to make sure she was safe. The ADON said Resident #1 was confused at times. The ADON said Resident #1 was no longer allowed to be outside without a staff member present with her after the elopement on 11/03/25. The ADON said, after the incident, staff were in-serviced regarding the facility's policy and procedures for elopements and wandering residents. The ADON said staff knew to look for the residents both inside and outside the facility if they were noted to be missing. The ADON said staff knew to call the Administrator and DON to report the missing resident immediately. The ADON said staff knew to redirect a resident if they were wandering or exit seeking and to keep a close eye on them to make sure they did not leave and possibly put them on 1:1 monitoring too. The ADON said staff had been informed that Resident #1 was an elopement risk now and to redirect her if she attempted to go outside without staff. Interview on 11/20/25 at 2:25 PM, LVN A stated she did not know Resident #1 was an elopement risk because the 11/03/25 elopement was her first time eloping. LVN A said she saw Resident #1 sit in front of the building often because she liked the sun. LVN A said Resident #1 never talked about wanting to leave or attempted to leave the facility. LVN A said Resident #1 was no longer allowed to go outside the facility without staff with her after she eloped on 11/03/25. LVN A said she was in-serviced and knew the facility's policy and procedures for elopements and wandering residents. LVN A said she knew to look for the residents both inside and outside the facility if they were noted to be missing. LVN A said she knew to call the Administrator and DON to report the missing resident immediately. LVN A said she knew to redirect a resident if they were wandering or exit seeking and to keep a close eye on them to make sure they did not leave and possibly put them on 1:1 monitoring too. Interview on 11/20/25 at 2:37 PM, the DON stated Resident #1 usually sat in the front of the building by herself. The DON said on 11/03/25 the ADON got a call from the previous Admissions Director who said Resident #1 was on the sidewalk down the street from the facility. The DON said she saw the DOR and ADON brought Resident #1 back to the building and she was not injured. The DON said the Receptionist was supposed to be watching her but she had left for the day. The DON said Resident #1 normally did not leave the area she sat at in the front of the building, but sometimes the resident was alert and sometimes she was not. The DON said afterwards, she asked Resident #1 why she left and she told her she just went walking. The DON said staff were in-serviced regarding the facility's policy on elopements and Resident #1 was monitored every 15 minutes for the next three days to make sure she was in the building and safe. The DON said Resident #1 could no longer go outside to the front area without staff with her at all times. The DON said staff redirect Resident #1 away from the front doors when they see her going near them. The DON said the purpose of making sure residents do not elope was to prevent injury or accidents. The DON said if a resident eloped from the facility they could go missing or have injuries from an accident. The DON said all staff were responsible for making sure residents did not elope from the facility. The DON said all staff had been trained and understood the expectation to keep all residents within eyesight and to check their whereabouts often. The DON said Resident #1 was the only resident in the facility who had been identified as an elopement risk and no other residents had eloped prior to or after the incident on 11/03/25. Record review of the facility's policy titled Elopement In-service reflected: Purpose: To educate staff on the prevention, identification, and appropriate response to resident elopement to ensure resident safety and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676080 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 676080 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Town Hall Estates Arlington, Inc. 824 W Mayfield Rd Arlington, TX 76015 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 compliance with facility policies. Definition of Elopement: Elopement occurs when a resident leaves the facility or a safe area without authorization and without necessary supervision, potentially placing themselves at risk for harm. Key Points: Conduct elopement risk assessments upon admission and as needed. Monitor exit doors and alarms for proper function. Observe residents who exhibit wandering, restlessness, or confusion. The facility implemented the following corrective actions following the incident: Record review of Resident #1's 15 Minute Monitoring Sheets, dated 11/03/25 to 11/05/25, reflected the resident was monitored every 15 minutes by staff to ensure she was safe and in the building. Record review of the Incident/Accident report from the last three months reflected Resident #1 was the only resident to elope from the facility. Record review of an in-service, dated 11/03/25 and 11/04/25, reflected staff were provided with in-service training regarding the facility's policy and procedures regarding elopements. Event ID: Facility ID: 676080 If continuation sheet Page 6 of 6