Health inspection·January 13, 2026

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few called from a bank down the road. Resident #1's FM stated Resident #1 stated that he was trying to get to the hospital to visit his wife. Resident #1's FM stated Resident #1's wife was also a resident at the same facility but was recently hospitalized and he missed her and wanted to see her which prompted him leaving to attempt to make it to the hospital. Resident #1's FM stated that Resident #1 became tired and stopped at the bank to call so he could get picked up. Resident #1's FM stated she was unable to at the time and contacted the facility and learned they were unaware Resident #1 left the facility. Resident #1's FM stated that although Resident #1 was independent, she was concerned he was able to leave without the facilities knowledge since he was under their supervision. Resident #1's FM stated Resident #1 was picked up soon after by the facility and had no injuries or negative outcomes from the event. During an interview on 01/13/26 at 11:36 a.m., Resident #1 stated he recalled leaving the facility on the weekend and stated he did not alert any staff. He stated he left because his wife, another resident, was recently hospitalized and he wanted to see her. He stated he made it a bit down the road when he became tired and went into a bank to call his family member to pick him up. He stated the family member then called the facility and they picked him up. He stated he didn't know why he didn't alert anyone or sign out before leaving. He stated he had never done something like this before but that he just missed his wife and wanted to see her. Resident #1 stated he did not believe he was in any harm as he was independently ambulatory and knew how to call for help if he needed it. He stated he was gone from the facility less than 30 minutes. Resident #1 stated when he returned to the facility they placed someone to supervise him 1:1 and he was also reeducated on the sign out policy and notifying staff if he wanted to go out. He stated his wife returned from the hospital so he no longer had a reason to want to leave again and would be sure to sign out and notify staff if he wanted to go somewhere in the future. During an interview on 01/13/26 at 02:07 p.m., the DON stated the incident on 01/10/26 with Resident #1 leaving the facility unsupervised she would not call it an elopement. She stated Resident #1 had a plan, and intent and knew what he was doing and had a purpose. She stated Resident #1 was very independent, he knew the code to get out of the facility as he would go outside at times to walk around with staff. She stated Resident #1 did not require assistance ambulating nor an assistive device such as walker/wheelchair. The DON stated Resident #1's muscle memory was very intact, and he knew to call help if he needed it. The DON stated she did not believe Resident #1 was in danger or risk and had safety awareness. She stated he had not displayed elopement behavior in the past, did not previously wear a wander guard and that he left because he missed his wife and wanted to see her at the hospital. The DON stated he was only gone approximately 15 minutes before they realized he was out, and they picked him up from the bank. She stated upon his return to the facility, Resident #1 was assessed and there were no injuries, he was reeducated on the proper way to sign out and to notify staff, and he was provided with a wander guard and placed on 1:1 as additional precaution until his wife returned. The DON stated the wander guard was discontinued today 01/13/26 per the provider as he was not considered a true elopement risk and his wife was back which has made him happy and calmed his anxiety. During an interview on 01/13/26 at 03:03 p.m., CNA B stated Resident #1 is independent and did everything on his own and was supervised as needed. She stated that all residents were under the care of the facility and should be supervised and staff should know where they were. She stated Resident #1 was independently ambulatory and was never exit seeking behavior before but that during this incident she stated Resident #1 was trying to see his wife at the hospital. CNA B stated she was at the facility on 01/10/26 when the incident occurred and it happened near meal services time. She stated they passed out meal trays and Resident #1 was not in his room, which was not unusual because he would get up and go get coffee from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676327 If continuation sheet Page 2 of 4 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 676327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/13/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Springs Healthcare and Rehabilitation 1500 Cottonwood Creek Trail Cedar Park, TX 78613 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 - Minimal harm or potential for actual harm Residents Affected - Few the dining room frequently. She stated a few minutes later she was alerted that Resident #1 had left the facility and was being brought back. CNA B stated Resident #1 did not have any injuries and after the incident he was reeducated on signing out. CNA B stated immediately after she was assigned specifically to provide 1:1 with Resident #1 for extra supervision. She stated she was also provided training by the facility on elopement prevention and redirection. During an interview on 01/13/26 at 03:34 p.m., NP A stated Resident #1 had not exhibited exit seeking behavior in the past and was not a concern for elopement. She stated she spoke to Resident #1 and he told her he left to try to see his wife at the hospital because he missed her. NP A stated Resident #1 was independently ambulatory, alert to person/ place/ and situations and able to comprehend where he was. She stated Resident #1 did not have negative behaviors and only some anxiety. She stated Resident #1 was all about his wife and wanted to be wherever she was. NP A stated Resident #1 had not had a wander guard prior because it was not necessary and was only used after the incident as a precaution until his wife returned. She stated it was discontinued today 01/13/26 since Resident #1 was not a true elopement risk. NP A stated after the incident on 01/10/26 Resident #1 was also under close supervision (1:1) and provided Ativan for his anxiety over not having his wife. She stated Resident #1 was very redirectable and provided education upon his return. She stated there were no injuries or negative outcomes for Resident #1 from the incident. During an interview on 01/13/26 at 05:15 p.m., the SW stated she would define elopement as a resident that unsafely left the facility without supervision. She stated she was very familiar with Resident #1 and he was alert and oriented x3 and a very good advocate for himself. She stated she spoke to Resident #1 upon his return and he told her he was only trying to visit his wife at the hospital. SW stated Resident #1 was able to call for assistance and called his family member from a bank down the road. She stated after Resident #1 called his family member, they in turn called the facility who went to retrieve him. SW stated she continued to offer emotional support after the event and Resident #1 was reeducated on the procedure of checking in and out as well as staff on elopement precautions. During an interview on 01/13/26 at 05:34 p.m., the ADM stated she would define elopement as someone who was unaware of their safety and going outside aimlessly without intent to include those with confusion. She stated this was not a description that fit Resident #1 as he was alert and oriented, independent, and had safety awareness. The ADM stated Resident #1 told her he was trying to see his wife at the hospital which was why he left. She stated he is not mentally incompetent, he knows what he is doing and what is going on. The ADM stated, based on their investigation, Resident #1 was only gone from the facility for 15-30 minutes. She stated Resident #1 knew the code to exit the facility because he frequently went on walks around the building. She stated Resident #1 did not have injuries upon his return and he was reeducated on the expectation of signing out and ensuring staff were aware before he left. She stated this was also not reported as an elopement because Resident #1 was able to go on walks unsupervised. During an interview and record review on 01/13/26 at 05:36 p.m., a policy was requested from the ADM, she stated while there was no official policy she provided an email from the senior vice president of clinical operations dated 05/11/23 at 08:49 a.m. that detailed the expectations and record review of the email reflected the following: It's summertime and the ending of PHE and our residents want to go out and family/close friends want to take them out of the building for visits, appointments, etc Please put the attached log in place starting today as we have Mother's Day this weekend. We need to know when our residents are leaving, who they are leaving with, as safety is our concern and not every resident should be leaving especially by themselves if there is any question as to their safety. We are also at times experiencing weather events and if there is a significant weather event, we need to know what residents are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676327 If continuation sheet Page 3 of 4 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 676327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/13/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Springs Healthcare and Rehabilitation 1500 Cottonwood Creek Trail Cedar Park, TX 78613 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete in the building at the time of the event and who is out on pass and again their safety during these weather events. Please in-service all staff on all shifts and days of week as well as department heads as to the expectation of completing and maintaining the log. Everyone is responsible in ensuring before the resident goes out the door that the log was completed. Please send a (facility communication system) message also out to the residents and families to let them know. See the below message. (facility communication system) Message:Subject: Resident Sign Out and Sign Back In Log, Its summertime and more of you want to visit your love one and also want to possibly take them out to spend time with them outside of our facility. Whether for a short time such as for lunch or a family party, reunion, Mother's Day, or take them to an appointment, etc. We need your help in signing out the resident on our Resident Sign Out and Sign Back In Log. The log is located at the Nurse's station as a nurse needs to initial it and make sure no medication needs to be administered or provided to your love one before they leave the building. If you have questions, please ask to speak to the Administrator. Thank You Please let myself and (other staff named) know once the log has been put in place and the (facility communication system) message has been sent out. Safety is our concern for our residents when they are in your community and knowing when they are not in the building. Record review of the blank undated Resident sign out and sign back in log reflected the following information required when leaving- Date, time leaving, AM/PM, resident name, resident signature, print name of person leaving with, staff initials, date/time returned, and staff initials. Event ID: Facility ID: 676327 If continuation sheet Page 4 of 4