Health inspection·June 26, 2025

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few [receiving SNF] has accepted resident and will be transporting him to their facility. - A social services progress note dated 05/25/25, Resident will be transferred to [facility] today due to his need for a secured memory care unit. He will be transported there around 02:00 PM today. [Resident #1's family member] is aware of this plan and that she can later transfer him to another facility later on if she wishes to. - A nursing progress note dated 05/25/25, d/c'd to another facility. Record review of Resident #1's Discharge summary dated [DATE] reflected:- discharge date : [DATE].- Expected return? No. - Released to other facility.Reason for discharge: needs a secure memory care unit.- Final summary: Resident is transferring to [facility] a secured memory care unit.Review of Resident #1's discharge planning review record dated 05/25/25 reflected: Who initiated discharge? Facility. If facility, if this was a facility initiated discharge, was advance notice given (either 30 days or as soon as practicable on the reason of the discharge) to the resident, resident representative, and a copy to the Ombudsman; Did the notice include all the required components (reason, effective date, location, appeal rights, Ombudsman, ID, MI info as needed) and was it presented in a manner that could be understood; and if changes were made to the notice, were recipients of the notice updated? Signatures of facility staff included SW and ADON A dated 05/25/25.In an interview on 06/25/25 at 10:10 AM with Resident #1's family, she stated ADON A approached her after she arrived to the facility at approximately 10:00 AM on 05/25/25 and told her they needed to leave and should have never been admitted due to the condition of Resident #1 and his elopement risk. Resident #1's family stated this was sudden and it was a result of an elopement Resident #1 had earlier that morning. She stated she was not allowed ample time to decide where she wanted to take Resident #1. She stated she was not provided with options and the facility picked a facility without consulting with her and discharged him the same day. She stated she did not receive advance written notice, and she was not provided with information on appealing the decision or any information related to the ombudsman. She stated it was so sudden that it resulted in worsening confusion to Resident #1 on arrival at the new facility. In an interview on 06/25/25 at 11:16 AM with LVN C she stated that on 05/25/25 after Resident #1's family arrived at the facility at approximately 10:00 AM, [Resident #1's] family member approached her (LVN C) angry and demanding Resident #1's medication. LVN C stated, she was yelling and talking loud saying they had just been kicked out. In an interview on 06/25/25 at 11:48 AM with CNA D she stated she was involved with Resident #1's care on 05/25/25 and was caring for the resident after an elopement incident when she heard ADON A and Resident #1's family talking about sending him out. She stated Resident #1's family was visibly upset and was heard shouting. She stated she heard ADON A directing Resident #1's family to another facility. In an interview on 06/25/25 at 12:06 PM with ADON A he stated that after an elopement incident that occurred the morning of 05/25/25 the ADM advised SW to discharge Resident #1 to another facility. ADON A stated they knew Resident #1 had been an elopement risk for a while and they had been trying to get Resident #1 moved to another facility the week prior but had no takers. ADON A stated once SW received approval from another facility he was discharged that same day within a few hours of the elopement incident. ADON A stated Resident #1's family was upset about the discharge and she wanted Resident #1 to go to a different facility than where they had arranged for him to go but stated they could not make that happen in that moment. ADON A stated Resident #1's family was not provided options because this was the only facility that would accept him at the time, and he stated neither Resident #1 or his family were provided advance written discharge notice. In an interview on 06/25/25 at 04:00 PM with the area LTC Ombudsman, she stated she did not receive any notification of the residents' discharge and stated facilities do not have a right to discharge a resident on the same day a decision is made by the facility without providing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 2 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 - Minimal harm or potential for actual harm Residents Affected - Few advance notice. She stated if there was a facility initiated discharge the facility was required to provide a 30-day written notice to the resident, their family/representative, and the ombudsman. She stated if a resident was an elopement risk they need to be placed on 1:1 supervision until they can safely move him with proper notice. She stated a negative outcome of a fast discharge with no advance notice would be the resident can end up homeless, they can end up in a position where they become distressed or there can be a mental health barrier. If the family cannot find a place it can cause a hardship. Just sending him somewhere without giving the family time to prepare was a hardship. They need to let the ombudsman know as soon as they decide they will discharge a resident so that they can help. She stated it was her expectation that she received notification as soon as a decision was made in order to begin helping the resident and ensure his rights were not violated. In an interview on 06/26/25 at 11:38 AM with the SW, he stated he was told by the ADM the morning of 05/25/25 to send a referral to send Resident #1 out of the facility that day due to being an elopement risk. The SW stated he recalled ADON A and Resident #1's family had been arguing on her arrival because she was upset with the discharge. The SW stated he has never seen the discharge policy and does not know what it says regarding discharges. He stated a potential negative outcome related to the discharge was it could be inconvenient for the family to visit him since it was a facility in another city, he stated he believe the ombudsman should have been notified in this situation. The SW stated he believed it was the ADM's responsibility to send out the discharge notifications to the ombudsman. The SW stated things they could have implemented prior to discharging the resident would be moving Resident #1's room closer to the nurses station or sit him near the nurses station for closer observation, make sure he was involved in activities to distract him and provide supervision. The SW stated he believed Resident #1 required more care and supervision but did not believe this discharge was handled appropriately. B)Review of Resident #2's admission Record, dated 06/26/25, reflected he was a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #2 was also his own RP. Resident #2 had medical diagnoses including acute respiratory failure with hypoxia (a life-threatening condition where the lungs cannot adequately oxygenate the blood, resulting in low blood oxygen levels), depressive disorders, insomnia, chronic obstructive pulmonary disease (a progressive lung disease that makes it hard to breathe), stiffness on joint, muscle wasting and atrophy, generalized muscle weakness, dysphagia (difficulty swallowing), unsteadiness on feet, other abnormalities of gait and mobility, lack of coordination, and anxiety disorder. Review of Resident #2's Significant Change MDS, dated [DATE], reflected he had a 13/15 BIMS, which indicated he was cognitively intact. Review of Resident #2's Care Plan, initiated 04/01/25, reflected there were no notes related to Resident #2's discharge goals and plans. Review of Resident #2's Progress Notes, from 05/27/25 through 06/26/25, reflected:-A note by the SW created on 06/24/25 at 10:39 a.m., [SW] and admissions went to talk with [Resident #2] about him no longer being on hospice and him not meeting medical necessity to be here long-term . [Resident #2] said he 'figured that.' He is going to talk with family about who he can stay with until he gets 'back on his feet and strong enough to get his own place.' [Resident #2] aware that he needs to have a discharge plan by the end of the week, as he is going to be private pay and occurring a bill. -A note by LVN A created on 06/24/25 at 11:28 a.m., New orders from hospice: discontinue from hospice services related to no longer meeting criteria and discontinue all medications. Copy of orders sent to NP. New orders from NP: Keep all medications that are not included in hospice comfort kit and discontinue hydrocodone PRN and scheduled. [Resident #2] informed and orders given to ADON with update on NP new orders.-A note by the SW created on 06/24/25 at 12:42 p.m., [Resident #2] and family wanted his referral sent to another facility to be considered for long term care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 3 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 - Minimal harm or potential for actual harm Residents Affected - Few there. The facility called the social worker and denied [Resident #2] admission due to not finding medical necessity for long-term care. -A note by the SW created on 06/24/25 at 5:02 p.m., [Resident #2's] family will pick him up tomorrow after 12:00 p.m. and take him home.-A note by the SW created on 06/25/25 at 9:26 a.m., [Resident #2's] referral sent to home health for therapy services after discharge.-A note by the SW created on 06/25/25 at 6:37 p.m., [Resident #2's] family will not be taking the resident home today. There were no other notes related to Resident #2's discharge. Review of Resident #2's Discharge summary, dated [DATE] at 5:02 p.m., reflected his discharge date /time was 06/25/25 at 12:00 p.m., he was not expected to return, he was released to home, there was no one indicated for person notified and date and time of notification, and his reason for discharge was he did not meet medical necessity for long term care for Medicaid to pay for the facility. Resident #2's final discharge summary reflected, Resident admitted on skilled services and transitioned to hospice services. Resident recently graduated hospice and does not meet medical necessity for long term care with Medicaid. He is discharging with his family . Resident referred to Home Health for services upon discharge. Review of Resident #2's Discharge Planning Review, dated 06/24/25 at 5:08 p.m., reflected Resident #2 initiated the discharge, his reason for discharge was he did not meet medical necessity for Medicaid long term care and could not afford private pay, his initial discharge goals were to return to the community, and he was his own RP. The resident signature and date reflected Resident #2's electronically typed printed name and 06/25/25. The staff signature and date reflected the SW's electronically typed printed name and 06/25/25. During an interview on 06/26/25 at 2:36 p.m., Resident #2 stated on 06/25/25, the SW told him that he had until 5:00 p.m. to be gone from the facility because he completed hospice services and needed to discharge so he did not accrue any substantial fines that he could not pay at the facility. Resident #2 stated he was not given a written discharge notice at least 30 days or as soon as practicable before he was required to discharge from the facility. Resident #2 explained that he did not receive a written notice including a reason for his discharge, effective discharge date , location to which he would discharge, a statement and information of his appeal rights, and the facility Ombudsman's contact information to review, consent, and sign. In an interview on 06/26/25 at 04:18 PM with the ADM she stated it was her expectation that the LTC Ombudsman was notified of discharges. She stated it occurred on a monthly basis and a report was sent out. She stated she believed the SW was the one who would know if those discharges were sent out. She stated it was important for the ombudsman and residents to get the notice because it's part of their policy for them to receive notification. She stated she does not know what the potential negative outcome would be for failing to provide notice to the LTC Ombudsman because she was zero help. She stated in a facility-initiated discharge, they were required to provide 30 days, but the resident has the right to leave sooner if they decide. She stated the appropriate 30-day notice form will include information on the residents right to appeal and the ombudsman contact information, disabilities, and other resources.Review of the facility Transfer or Discharge, Facility-Initiated policy dated October 2022 reflected: Once admitted to the facility, residents have the right to remain in the facility. Facility-initiated transfers and discharges, when necessary, must meet specific criteria and require resident/representative notification and orientation, and documentation as specified in this policy. - Facility initiated transfer or discharge means a transfer or discharge which the resident objects to or did not originate through residents verbal or written request, and/or is not in alignment with the residents stated goals for care and preferences.- In some cases residents are admitted for short term skilled rehabilitation under Medicare, but, following completion of the rehabilitation program, they communicate that they are not ready to leave the facility. In these (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 4 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete situations, if the facility proceeds with a discharge, it is considered a facility-initiated discharge. Notice of transfer or dischargeUnder the following circumstances the notice is given as soon as practicable but before the transfer or discharge: - The resident's health improves sufficiently to allow a more immediate transfer or discharge;- An immediate transfer or discharge is required by the residents' urgent medical needs; or - A resident has not resided in the facility for 30 days. Notice of transfer is provided to the resident and representative as soon as practicable before the transfer and to the LTC Ombudsman when practicable (e.g., in a monthly list of residents that include all notice content requirements). Notices are provided in a form or manner that the resident can understand, taking into account the residents educational level, language, communication barriers, and physical or mental impairments. Nursing notes will include documentation of appropriate orientation and preparation of the resident prior to transfer or discharge. Appealing Transfer or DischargeResidents have the right to appeal a facility-initiated transfer or discharge through state agency that handles appeals. Event ID: Facility ID: 676438 If continuation sheet Page 5 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure each resident received adequate supervision for 1 of 10 residents (Resident #1) reviewed for accidents and supervision.The facility failed to ensure Resident #1 did not exit the facility without staff's knowledge and ambulate approximately 100 yards down their driveway to a busy street with a speed limit of 65 MPH on 05/25/25. The facility failed to ensure staff were knowledgeable on how to properly secure the doors using the door security box located at 2 of 2 nurses' stations (both the skilled nursing and long-term care sides of the facility). Staff were identified by ADON B pressing the door release button with a key emblem instead of the round door secure button resulting in the doors not being secured. An Immediate Jeopardy (IJ) was identified on 06/25/25. The IJ Template was provided to the facility on [DATE] at 05:10 PM. While the IJ was removed on 06/26/25, the facility remained out of compliance at a scope of isolated and a severity with 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. This failure could place residents at risk of harm and/or injury due to elopement. Findings included:Review of Resident #1's face sheet dated 06/25/25 reflected a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included Parkinson's disease (neurodegenerative disease primarily of the central nervous system, affecting both motor and non-motor systems) with Dyskinesia (uncontrolled, involuntary movements), Alzheimer's disease (a type of dementia that affects memory, thinking, and behavior), mood disorder due to known physiological condition with depressive features, and neurocognitive disorder with Lewy bodies (aka Lewy body dementia, is a type of dementia caused by protein deposits in the brain cells affecting thinking, memory, movement, sleep, and behavior). The face sheet reflected Resident #1 was discharged [DATE] at 2:09 PM after a 13-day length of stay. Review of Resident #1's discharge MDS assessment return not anticipated dated 05/25/25 reflected section A discharge status which was marked as Resident #1 being discharged to a long-term care facility with a discharge date of 05/25/25. Section C cognitive patterns reflected a BIMS score of 04 indicating severe cognitive impairment. Review of Resident #1's baseline care plan dated 05/12/25 reflected safety risks- is the resident an elopement risk? was not marked yes or no. Review of Resident #1's care plan last revised 05/25/25 reflected a focus initiated on 05/25/25 the resident is an elopement risk/wanderer related to disoriented to place. History of attempts to leave facility unattended, impaired safety awareness. Resident wanders aimlessly, significantly intrudes on privacy or activities. The care plan reflected there was no focus or interventions prior to 05/25/25 the date of the elopement. Review of Resident #1's progress notes reflected the following notes related to wandering/exit seeking behavior: - Nursing note dated 05/14/25 resident on follow up day 3/3 of new admit. He seems to be adjusting to being at facility. Does continue to wonder around. Alert to self but pleasantly confused. - Nursing advanced skill evaluation dated 05/15/25 resident wanders at night. - Nursing note dated 05/15/25 resident observed making multiple attempts to exit the facility through the secure doors. When redirected resident expressed confusion stating, I don't know what I am doing here. This nurse provided reorientation and education regarding his current medical condition and reason for admission. Resident has a feeding tube, medications and nutritional feeding were administered via tube as ordered. Despite tube feeding, resident was observed attempting to consume food from other residents' tray and requesting coffee. Staff have been providing frequent redirections and reassurance. Resident was brought to nursing station for closer observation; however, he is unable to remain seated for prolong period and frequently attempts to stand and ambulate unsafely. This nurse has made several multiple (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 6 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 interventions to promote safety including verbal redirections. - Nursing note dated 05/15/25 Resident found in room packing his clothes and personal belongings which were laid out on his bed. When asked what he is doing he states that he is going home, and his family member is coming to pick him up. Resident educated and redirected but resident remains insistent on leaving. This nurse attempted to contact family member , resident in his room alert and verbal still expressing desires to go home.- A nursing note dated 05/17/25, Resident up in his wheelchair at this time wheeling around everywhere trying to get into other residents' rooms and trying to eat and drink everyone's food and drinks. Resident has to be reminded that he cannot eat or drink anything at this time as he is strictly to not have anything by mouth and that he has a feeding tube that hives him the foods and fluids he needs. Resident stares at nurse and just wheels off. He is very confused, but it is a pleasant confused. Resident attempting to go towards the doors and staff again has to redirect him that he cannot go out of the building as he can fall and get hurt. Resident again just stared at nurse. He is currently wheeling around the nurses station. - A nursing note dated 05/18/25, Resident is up in his wheelchair at this time rolling around and will not stay in pod 1 as it has been asked of him to do that many of times so staff can keep a better eye on him- An advanced nursing skilled evaluation note dated 05/19/25, Resident is confused. Resident is awake at night. Resident wanders at night. - A nursing progress note dated 05/19/25, Resident is up in his wheelchair at this time rolling around and will not stay in pod 1 as it has been asked of him to do that many of times so staff can keep a better eye on him and he continues to go towards the doors and into other residents rooms. He is very pleasantly confused. An advanced skilled nursing evaluation note dated 05/20/25, safety concerns- resident has been trying to exit the doors. - An advanced skilled nursing evaluation note dated 05/21/25, resident wanders at night. - A nursing progress note dated 05/22/25, Resident has been up in his wheelchair rolling around and will not stay on pod 1 as it has been asked of him to do that many of times so staff can keep a better eye on him, and he continues to go towards the doors and into other residents' rooms. He is very pleasantly confused. An advanced skilled nursing evaluation note dated 05/23/25, Resident is confused. Resident is awake at night. Resident wanders at night. - A nursing progress note dated 05/25/25, a family member of one of our patients alerted us to Resident #1 being in the road on [main road off property] we immediately went and got the resident and brought him back in the facility. We brought him back in the facility and placed him on 1 on 1 family member is currently here now and I informed her of his elopement and also that we are trying to find placement for him at a memory care facility. We cannot meet his needs since we are not a lock down facility or have wonder guards to prevent resident from getting out the facility and getting hurt [receiving SNF] has accepted resident and will be transporting him to their facility. - An elopement evaluation progress note dated 05/25/25, Elopement evaluation: History of elopement while at home: Yes. Wandering behavior, a pattern or goal-directed: No. Wanders aimlessly or non-goal-directed: Yes. Wandering behavior likely to affect the safety or well-being of self / others: Yes. Wandering behavior likely to affect the privacy of others: Yes. Recently admitted or re-admitted (within past 30 days) and has not accepted the situation: Yes. Elopement Score: 8.0 Actioned clinical suggestions: [no actions indicated]. - A social services progress note dated 05/25/25, Resident will be transferred to [facility] today due to his need for a secured memory care unit. He will be transported there around 02:00 PM today. [Resident #1's family member ] is aware of this plan and that she can later transfer him to another facility later on if she wishes to. - A nursing progress note dated 05/25/25, d/c'd to another facility. Record review of Resident #1's Discharge summary dated [DATE] reflected:- discharge date : [DATE].- Expected return? No. - Released to other facility.- Reason for discharge: needs a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 7 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 secure memory care unit.- Final summary: Resident is transferring to [facility] a secured memory care unit.Review of Resident #1's discharge planning review record dated 05/25/25 reflected: Who initiated discharge? reflected was marked Facility.If facility, if this was a facility initiated discharge, was advance notice given (either 30 days or as soon as practicable on the reason of the discharge) to the resident, resident representative, and a copy to the Ombudsman; Did the notice include all the required components (reason, effective date, location, appeal rights, Ombudsman, ID, MI info as needed) and was it presented in a manner that could be understood; and if changes were made to the notice, were recipients of the notice updated? Signatures of facility staff on the document included SW and ADON A dated 05/25/25.In an interview on 06/25/25 at 11:16 AM with LVN C she stated she was the charge nurse working with Resident #1 on the day of the elopement on 05/25/25. She stated she was alerted by another nurse and other residents family members who provided a description of seeing a resident out of the facility that matched Resident #1. LVN C stated she then went out of the facility with CNA D to retrieve Resident #1. LVN C stated once they were able to locate Resident #1, he was no longer on the property, and was found down the street that leads up to the facility sitting in his wheelchair next to the main road. LVN C stated they were not sure which door Resident #1 exited from, and that he would frequently need redirecting from trying to leave through doors in other halls leading to the side of the building. LVN C stated if they saw Resident #1 trying to elope, they would attempt to redirect him, but was not aware of any other interventions in place to prevent elopement prior to the incident on 05/25/25. LVN C stated Resident #1 was a known elopement risk based on his care notes which documented each time he wandered and displayed exit seeking behavior. In an interview on 06/25/25 at 11:48 AM with CNA D, she stated she worked with Resident #1 on 05/25/25. She stated that she was alerted by LVN C that Resident #1 had eloped and went out with her to retrieve the resident. She stated they found Resident #1 away from the facility next to a busy road in his wheelchair. CNA D stated they were unsure which door Resident #1 used to leave the facility, but no alarms were heard. CNA D stated police were around, and police asked them (LVN C and CNA D) if Resident #1 was part of their facility; police then released Resident #1 back to them with no further questions. In an interview on 06/25/25 at 12:06 PM with ADON A, he stated he was at the facility on 05/25/25 and was notified of Resident #1's elopement by LVN C after the incident occurred. ADON A stated after Resident #1 was brought back to the facility he was placed on 1:1 until he was discharged later that same day. He stated he was previously aware of Resident #1's elopement risk for a while and they had been trying to get him to a secured facility the week prior but had no takers. He stated after the incident occurred that was when the ADM advised the SW to get him out of this facility and to another facility with a secured unit that day. ADON A stated Resident #1 was not appropriate for this facility and was constantly exit seeking. ADON A stated they should never have accepted him and that due to elopement risk and dementia they were not able to keep him safe. ADON A stated they presently had other residents with a diagnosis of dementia and will keep them as long as they don't try to reach for the door. ADON A stated after the incident they discharged Resident #1 to another facility within a few hours. In an observation and interview 06/25/25 at 01:04 PM with LVN E in the 200 hall (skilled nursing side); the door to the exterior was observed easily pushed open and not secured with the electromagnetic lock. The door alarm was functional and did sound as soon as the door opened. LVN E was observed closing the door and then pushing it open to test the magnetic hold on the door which was not holding allowing the door to easily swing open. LVN E was observed shouting down the hall to other staff telling them to push the button on the lock pad located at the nurse's station. This exchange occurred multiple times as they were observed to have difficulty getting the door to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 8 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 secure. LVN E stated staff were to check that the doors to the exterior were secured each shift. She stated a potential negative outcome of an unsecured door for residents that wander would be residents could get out and the road is right there, they can be harmed from a car or even from someone living at the apartment complex across the street; people are weird nowadays and you never know. In an observation and interview on 06/25/25 at 01:47 PM, observations were made of the exterior doors to the long-term care side of the facility with ADON B. The doors on halls 600 and 700 were observed unsecured when checked. Both doors were observed easily swinging open; no alarm was seen on the door or was heard sounding when the door opened. ADON B stated she was not sure why the doors were unlocked. ADON B was observed going to the nurses' station and pushing the button on the lock pad to secure the doors. ADON B was then observed going back to check the 600 and 700 doors appeared to be secured after pushing the button. ADON B stated she would investigate what occurred to cause the doors to not be secured. In an interview on 06/25/25 at 02:20 PM with ADON B, she stated it was identified the door was not securing because staff were pushing the incorrect button at the nurses' station and did not know the correct way to ensure the doors were locked. She stated the button to release the doors was being pressed instead of the button to secure the doors. She stated by pressing the button to release the doors, it causes all the doors on the long-term care side to be easily opened. ADON B stated she had to complete an in-service with staff to ensure they knew how to secure the doors now that this was identified and presented surveyor with in-service completed. Review of in-service record dated 06/25/25 presented by ADON B reflected topic educate on proper way to lock door. Key on button is to unlock door, round button is to lock door. Review of the facility Wandering and Elopement policy last revised March 2019 reflected: The facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment for residents. - If identified as a risk of wandering, elopement, or other safety issues the resident care plan will include strategies and interventions to maintain the resident's safety. The Administrator was notified on 06/25/25 at 05:10 PM that an IJ had been identified and an IJ template was provided.The following POR was approved on 06/26/25 at 12:30 PM and reflected the following:Plan of RemovalImmediate Threat [Immediate Jeopardy] On 06/25/2025 an abbreviated survey was initiated at facility. On 06/25/2025 the surveyor provided anImmediate Threat (IT) [Immediate Jeopardy (IJ)] Template notification that the Regulatory Services has determined that thecondition at the facility constitutes an immediate threat to resident health and safety.The notification of Immediate Threat [Immediate Jeopardy] states as follows: F689 - The facility must ensure each resident receivesadequate supervision and assistance devices to prevent accidents.The facility failed to ensure Resident #1 did not exit the facility without staff's knowledge and ambulateapproximately 100 yards down their driveway to a busy street with a speed limit of 65 MPH on 05/25/25.Action: Resident was put on 1:1 service immediately with nursing staff member by facility DON and Admin until asafe placement at a secured facility could be located and resident transferred. All residents' elopement assessmentswere verified that they were up-to-date and that the elopement binders for at risk residents, at both nurse's stationsand the front reception desk, were up to date by Interdisciplinary Team (IDT) team. All exterior facility doors were audited by maintenance for functionality and changed door codes.Completion: 6/25/25On 06/25/2025 the Administrator notified the Medical Director of Immediate Jeopardy. On 06/25/2025,all exit doors throughout the facility were assessed for proper functioning.Action: Facility nursing staff have been re-educated on procedures to unlock and lock exit doors byADON. ADONs were in-serviced by Administrator. Admin was educated by Maintenance upon onorientation of start of position. (Maintenance was educated by prior company.) Any staff who are notworking will be re-educated prior to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 9 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 working their next shift. New staff will be educated on orientation.Any agency nursing staff will have to read and acknowledge the in-service on the staffing portal beforeshift acceptance. Comprehension will be verified by Admin/designee where staff will have to correctlyverbalize back how to properly lock and unlock the door. This will be recorded on the facility in-service log.Start Date: 6/25/25Completion Date: 6/25/25Responsible: AdministratorAction: Facility has placed directions to lock and unlock exit doors in nurse's binder at each nurse'sstationStart Date: 06/25/25Completion Date: 06/25/25Responsible: AdministratorAction: Door locks were tested and reactivated on all exit doors by maintenance on facility monitoringtool.Start Date: 06/25/25Completion Date: 06/25/25Responsible: MaintenanceAction: Facility Nursing Staff continue to check exit doors 3 times per shift to ensure the doors are secureusing facility monitoring tool and will be monitored by ADONs for completion.Start Date: 06/25/25Completion Date: 6/25/25Responsible: AdministratorAction: Maintenance checks facility doors once weekly to ensure exit doors have no maintenance issuespreventing them from securing with facility monitoring tool.Start Date: 06/25/25Completion Date: 06/25/2025Responsible: Maintenance SupervisorAction: The QA Committee will review door alarm logs weekly for 4 weeks, then monthly.Administrator/designee will conduct unannounced door security audits 2 x week for 30 days.Start Date: 06/25/25Completion date: 06/25/25Responsible person: Administrator/designeeThe POR was monitored on 06/26/25 in the following ways: Review of the documentation for door checks on Pods 2 of 2 (both skilled nursing and long term care side) reflected Doors codes have been changed for resident safety. Do not give the code to residents that should not have it. Do not give it to family members verbally in front of residents. Listen for the alarm. Alarm for front door is reset by a button at Pod 1. You are responsible for checking the doors at least 3 times per shift to make sure front door is secured as well as the doors to your pod. You must do these rounds. No exceptions. These can be done by a nurse or a CNA but must be signed off by whoever completes it. Each of the documents on Pod 1 and Pod 2 (skilled nursing and LTC side) were identified Door check log Pod 1 and Door check log Pod 2. It included a statement, you are responsible for checking all external exit doors on your Pod 3 times per shift as well as the front door 3 times per shift. It can be done by a CNA or nurse. Day shift and night shift. Record reflected it was logged with a date, time, and signature by staff multiple times a day beginning 05/25/25 and daily through 06/26/25.Review of an in-service sheet dated 06/25/25 presented by ADM/ IDT reflected to lock doors hit circle button, to unlock doors hit the key. Directions also in binder at both nurses' stations- competency: must verbally repeat back to educator. This included various staff from different positions including laundry, dietary, nursing, housekeeping, and admin staff such as MDS, marketing, activity director etc. Included both pods. 83 staff observed have either signed off physically or were marked as completed over the phone.Review completed with document dated 06/25/25 for door audits by maintenance all exit door locks were tested and reactivated with comments no issues with locks on doors signed by MTA.Record review of QAPI ad hoc dated 06/25/25 reflected: The locks for the facility door must always be engaged. To engage the locks follow these steps: - To unlock door push the button with the key emblem- To lock press the circle button - Residents with high elopement risks should not be outside of the facility without proper supervision and you can find the resident with high elopement risks in the elopement binders at both nurses station. If a resident is leaving the facility they need to sign out at the front desk.Document included attendance and signature by ADM, ADON A, medical director via phone, BOM, SW, MDS LVN, treatment nurse, admissions, human resources, and activity director. Record review of blank logs created for maintenance/designee for weekly audits of the door. check all exterior doors for any maintenance issues that would prevent them from securing. Created for ongoing audits. An observation and record (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 10 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 review on 06/26/25 at 02:41 PM at nurses stations observed binders that contained instructions on locking the doors. Binder reflected How to lock/unlock doors- to unlock the doors press the button with the key emblem, to engage the locks press the circle button. A bright yellow document was also placed near the lock pads that reflected:Door locks- Doors should remain locked. If visitors buzz for entrance a staff member must walk to the front, open the entrance and verify they log into visitor log. - Locking access from the nurses station must be engaged. At any time if the button is pressed with key picture on it, it unlocks multiple doors. The round reset button must be pushed to relock the doors. - In other words, if you press the key button to unlock then you must hit the reset button to relock the doors. - Keeping the doors locked is not optional. In an interview and observation on 06/26/25 at 02:41 PM with LVN F she stated she arrived at 05:30 AM for her shift and was updated by the night shift nurse on the procedure to secure the door. LVN F stated she had already also received in-service via text 06/25/25 and had to verbalize understanding over how to secure the doors and elopements. She stated interventions other than redirection for residents who are exit seeking would include make sure exterior doors are closed and secured and check rooms to ensure you know where residents are at all times. She stated if residents are exit seeking they should also be moved closer to the nurses station for observation or placed on 1:1 care. She stated residents located in the elopement binders will get extra attention to ensure they are in their rooms or monitored while out of their rooms. LVN F stated a potential negative outcome in failing to supervise residents or failing to secure the doors would be this facility is near a highway and something bad could happen to them. LVN F was able to identify the abuse coordinator and also confirmed training on abuse and neglect. LVN F was observed locating the binder that contained information on securing the doors, as well as pressing the correct button to secure the doors . In an interview and observation on 06/26/25 at 02:50 PM with CNA G she stated she was an agency staff member but worked at the facility often. She stated she received in-service 06/25/25 and additional training 06/26/25. She stated the training covered ensuring the doors were secured, how to secure them, and elopements. She stated the training was provided to her by ADON B. CNA G stated she would be able to identify if the door is secured by the green light above the door near the magnetic strip. She stated if the light was green that would mean it was secured and that the door will also make noise if it was unsecured. CNA G stated anytime she was at the nurses station she has made it a habit to press the button to ensure the doors were secured. CNA G stated if a resident attempted to elope she would redirect them, provide them education, and would notify the charge nurse right away. CNA G stated she would find information on securing the doors in the binder located at the nurses station. She confirmed training on abuse and neglect and was able to identify the abuse coordinator as the ADM. CNA G was observed correctly demonstrating which button secured the doors. CNA G stated if she needed to identify who was an elopement risk she would look at the elopement binder located at the nurses station. In an interview on 06/26/25 at 03:02 PM with RN H he stated he was an RN charge nurse. He stated he received training on 06/25/25 via a text message on securing the doors/ elopements and was asked to let them know he understood the material. He stated on 06/26/25 he also observed the doors and was shown how to properly secure them. RN H stated if he witnessed exit seeking behavior he would redirect the resident that was exit seeking, keep them within view and safe distance from doors. RN H stated if anyone needed to identify someone who was an elopement risk they can do so by reviewing the elopement risk binder kept at the nurses station. RN H was able to successfully explain to surveyor the proper way to secure the door via the lock pad at the nurses station. In an interview on 06/26/25 at 03:08 PM with MA I, she stated she was both a medication aide and CNA. She stated she was in-serviced 06/26/25 by the ADONs on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 11 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 elopement and securing the doors (how to properly ensure they are secured). MA I stated if a resident shows exit seeking behavior she has been taught to give them distractions and redirect, provide them with activities, or give them food/snacks. MA I stated if a resident was able to get out she would notify the ADM immediately and ensure she was at the residents side at all times to ensure safety while they were redirected back. MA I confirmed she was also trained on abuse and neglect, and was able to identify the ADM as the abuse coordinator. MA I was able to successfully explain to surveyor the proper way to secure the door via the lock pad at the nurses station.In an interview on 06/26/25 at 03:16 PM with HK J he stated he received training 06/25/25 by MTA on ensuring that doors are secured at all times and not opened. HK J stated if he observed any door that was unsecured he would immediately report it to the ADM or MTA. HK J stated he has also received training on abuse and neglect and provided examples. He stated the abuse coordinator was the ADM. In an interview on 06/26/25 at 03:20 PM with MA K she stated she received training that covered elopements and the doors being secured. MA K stated she gets very involved in the care of the residents so when she received the text message with the inservice information she called and asked what happened, wanted to ensure she obtained all the information needed to prevent it from occurring again. MA K stated she was a seasoned employee and would often train others or let others know who was an elopement risk. She stated there was also an elopement binder at the nurses station if you wanted to see that information. MA K stated she was trained to always check the doors to the exterior to ensure they were secured. If a resident was exit seeking to monitor them, provide redirection, check on them more frequently, and provide activities or keep them entertained. MA K stated she was also observed by ADONs checking the door and working the keypad to demonstrate understanding. MA K was able to successfully explain to surveyor the proper way to secure the door via the lock pad at the nurses station.In an interview on 06/26/25 at 03:28 PM with CNA L, she stated she received training on elopements and door security on 06/26/25 by ADON A. She stated she would make sure the light above the door was green to ensure it was locked. She stated the doors need to be checked to ensure they are secured. CNA L was able to describe how to properly secure the door and how to redirect a resident who was an elopement risk. She stated if a resident was exit seeking, she would report it to the charge nurse immediately after redirecting and ensuring the resident was safe. In an interview on 06/26/25 at 03:32 PM with ADON A, he stated he remained at the facility late 06/25/25 in order to receive training presented by the ADM on door security. He stated after training was completed on department heads they then went back and provided training to their direct staff. He stated it was his expectation that the side doors are not to be used at all unless of an emergency. He stated he expected that staff were to check them frequently and ensure they were secured through observation of the green light above the door. ADON A stated if residents begin to show exit seeking behavior he would expect that an updated elopement assessment was completed, to document the behavior in the nursing progress notes and monitor it for 3 days and ensure they are moved to a more appropriate facility if they need to. ADON A stated it was his expectation that staff redirect residents, provide activities, or try snacks to distract them. He stated both new and agency staff will be oriented and in-service on the expectations on ensuring the doors are secured, how to secure them, and elopement procedures. In an interview on 06/26/25 at 02:41 PM with the FD , she stated she received training both 06/25/25 and 06/26/26 on elopements (what to do) and securing the doors (how to properly secure them). She stated the training was presented to her by the ADM. She stated she also had a book at the front desk that indicated which residents were an elopement risks and would have to refer to it to ensure none of them were able to get out. She stated she would also ensure that all residents were properly signed out if going on pass to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 12 of 13 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 ensure all residents were accounted for. FD was able to explain how to correctly secure the door and explained the importance of ensuring all visitors and residents entering and exiting from the front were logging in and documented. In an interview and observation on 06/26/25 at 03:49 PM with MTA, observations were made of all exterior doors to ensure they were secured, had a functional electromagnetic lock, and alarm. The doors that were previously unsecured were e confirmed secured. The MTA stated staff should ensure the doors remained secured through regular checks. He stated he also was to complete a weekly audit of the doors magnets to ensure they were functional and hold. The MTA stated only during a fire when the fire alarm is pulled should all the doors release. The MTA stated he had knowledge on the proper way to secure the doors and provided that information to the ADM and department heads so that they could train all staff and ensure they were pressing the correct button to secure the door. In an interview on 06/26/25 at 04:18 PM with the ADM, she stated she can confirm that all staff had received training on elopements and the proper way to secure a door/ ensuring they are secured. She stated they had staff confirm they understood the material through verbal confirmation. She stated education was provided to everyone across different areas to include nursing, housekeeping, dietary, etc. The ADM stated agency staff had a form on the portal that would provide them with education on these topics prior to working, and that her new hire staff will also have it as part of their orientation in the new hire packet. The Administrator was informed the immediacy was removed on 06/26/25 at 05:20 PM. The facility remained out of compliance at a scope of isolated at a severity level of no actual harm that was not immediate due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 676438 If continuation sheet Page 13 of 13