The Williamson County and Cities Health District (WCCHD) had its first confirmed cluster of COVID-19 in a nursing facility. Control orders were sent to 43 facilities on March 16, 2020, by the Williamson County and Cities Health District Health Authority. Updated control orders were delivered on April 23 to 65 facilities, to include assisted living, nursing homes, skilled nursing, and long-term care facilities. The investigation is ongoing, WCCHD is working closely with the facility to mitigate the spread among residents and staff. To date, this is the first cluster at a nursing home with 46 confirmed cases of staff and residents.